Enfermagem em UTI: cuidados essenciais na assistência direta ao paciente / ICU nursing: essential care in direct patient care

Objetivo: O objetivo deste estudo foi identificar e descrever os cuidados essenciais que os enfermeiros devem ter ao atuar em uma Unidade de Terapia Intensiva (UTI). Métodos: Realizou-se uma revisão bibliográfica da literatura, com uma abordagem qualitativa, descritiva e exploratória. As buscas foram realizadas PubMed, SciELO, LILACS e BIREME. Resultados: Os cuidados de enfermagem desempenham um papel crucial na recuperação e bem-estar dos pacientes em estado crítico na UTI. As intervenções dos enfermeiros devem ser embasadas em conhecimento científico, empatia e habilidades técnicas avançadas. Discute-se a importância da monitorização rigorosa, controle de infecções, prevenção de complicações da imobilidade, abordagem holística ao paciente e comunicação efetiva na UTI. Conclusão: Conclui-se que os enfermeiros devem basear suas intervenções em conhecimento científico, empatia e habilidades técnicas avançadas, destacando-se a importância da monitorização, controle de infecções, prevenção de complicações da imobilidade, abordagem holística ao paciente e comunicação efetiva na UTI.(AU)

Objectives: The objective of this study was to identify and describe the essential care that nurses must take when working in an Intensive Care Unit (ICU). Methods: A bibliographical review of the literature was carried out, with a qualitative, descriptive and exploratory approach. The searches were carried out in PubMed, SciELO, LILACS and BIREME. Results: Nursing care plays a crucial role in the recovery and well-being of critically ill patients in the ICU. Nurses' interventions must be based on scientifi c knowledge, empathy and advanced technical skills. The importance of rigorous monitoring, infection control, prevention of immobility complications, a holistic approach to the patient and effective communication in the ICU are discussed. Conclusion: It is concluded that nurses must base their interventions on scientifi c knowledge, empathy and advanced technical skills, highlighting the importance of monitoring, infection control, prevention of immobility complications, a holistic approach to the patient and effective communication in the ICU.(AU)

Objetivos: El objetivo de este estudio fue identifi car y describir los cuidados esenciales que deben tener las enfermeras cuando trabajan en una Unidad de Cuidados Intensivos (UCI). Métodos: Se realizó una revisión bibliográfi ca de la literatura, con un enfoque cualitativo, descriptivo y exploratorio. Las búsquedas se realizaron en PubMed, SciELO, LILACS y BIREME. Resultados: Los cuidados de enfermería juegan un papel crucial en la recuperación y el bienestar de los pacientes críticos en la UCI. Las intervenciones de las enfermeras deben basarse en el conocimiento científi co, la empatía y las habilidades técnicas avanzadas. Se discute la importancia de un seguimiento riguroso, el control de infecciones, la prevención de complicaciones de la inmovilidad, un enfoque holístico del paciente y una comunicación efi caz en la UCI. Conclusión: Se concluye que los enfermeros deben basar sus intervenciones en el conocimiento científi co, la empatía y las habilidades técnicas avanzadas, resaltando la importancia del seguimiento, control de infecciones, prevención de complicaciones de la inmovilidad, abordaje holístico del paciente y comunicación efectiva en la UCI.(AU)

Resistencia antimicrobiana de Enterobacterias causante de infección del tracto urinario en pacientes ambulatorios / Antimicrobial resistance of Enterobacteriaceae causing urinary tract infection in ambulatory patients / Resistência antimicrobiana de Enterobacteriaceae causadora de infecção do trato urinário em pacientes ambulatoriais

Las infecciones del tracto urinario son consideradas un problema de salud a nivel hospitalario y comunitario por el aumento de bacterias resistentes a los antibióticos. Objetivo: Analizar el patrón de susceptibilidad y resistencia antimicrobiana de Enterobacterias causante de infección del tracto urinario. Métodos: Se aplicó una investigación descriptiva de diseño documental. La población fue de 672 registros de urocultivos positivos, recopilados de la base de datos del Laboratorio San Pablo en el periodo 2021-2022. Para su tabulación y análisis los datos obtenidos fueron procesados en el Software SPSS versión 25.0. Resultados: Las ITU se presentan con mayor frecuencia en el género femenino 86,5%. El grupo etario con más afección es la edad adulta 50,4%. El agente etiológico con mayor incidencia fue Escherichia coli 75,74%, Citrobacter Freundii 8,93%, Klebsiella spp 6,10%. La producción de BLEE como mecanismo de resistencia predominaron en las cepas de E.coli y Klebsiella spp. Se encontró un mayor porcentaje de resistencia para Ampicilina y SXT. Los antibióticos con mejor sensibilidad destacaron nitrofurantoína, fosfomicina. Conclusión: La especie con mayor aislamiento, implicada en la etiología de infecciones urinarias sigue siendo E.coli con una sensibilidad alta para nitrofurantoína y fosfomicina.

Urinary tract infections are considered a health problem at hospital and community level due to the increase of antibiotic resistant bacteria. Objective: To analyze the pattern of susceptibility and antimicrobial resistance of Enterobacteriaceae causing urinary tract infection. Methods: A descriptive research of documentary design was applied. The population was 672 records of positive urine cultures, collected from the San Pablo Laboratory database in the period 2021-2022. For tabulation and analysis, the data obtained were processed in SPSS software version 25.0. Results: UTIs occur more frequently in females 86.5%. The age group with the highest incidence was adulthood 50.4%. The etiological agent with the highest incidence was Escherichia coli 75.74%, Citrobacter Freundii 8.93%, Klebsiella spp 6.10%. The production of BLEE as a mechanism of resistance predominated in the strains of E.coli and Klebsiella spp. A higher percentage of resistance was found for Ampicillin and SXT. The antibiotics with the best sensitivity were nitrofurantoin and fosfomycin. Conclusion: The species with the highest isolation, implicated in the etiology of urinary tract infections, continues to be E.coli with a high sensitivity to nitrofurantoin and fosfomycin.

As infecções do trato urinário são consideradas um problema de saúde a nível hospitalar e comunitário devido ao aumento de bactérias resistentes aos antibióticos. Objetivo: Analisar o padrão de suscetibilidade e resistência antimicrobiana das Enterobacteriaceae causadoras de infecções do trato urinário. Métodos: Foi aplicada uma metodologia de investigação documental descritiva. A população foi de 672 registros de culturas de urina positivas, coletados do banco de dados do Laboratório San Pablo no período de 2021-2022. Para tabulação e análise, os dados obtidos foram processados no software SPSS versão 25.0 Resultados: As ITUs ocorreram com maior frequência no sexo feminino 86,5%. A faixa etária com maior incidência foi a adulta 50,4%. O agente etiológico com maior incidência foi a Escherichia coli 75,74%, Citrobacter Freundii 8,93%, Klebsiella spp 6,10%. A produção de BLEE como mecanismo de resistência predominou em E. coli e Klebsiella spp. Foi encontrada uma maior percentagem de resistência para a ampicilina e o SXT. Os antibióticos com melhor sensibilidade foram a nitrofurantoína e a fosfomicina. Conclusão: A espécie com maior isolamento, implicada na etiologia das infecções do trato urinário, continua a ser a E. coli com uma elevada sensibilidade à nitrofurantoína e à fosfomicina.

Accuracy of Quick Sequential Organ Failure Assessment (qSOFA) scoring as in-hospital mortality predictor in adult patients with sepsis secondary to urinary tract infection admitted in a local tertiary hospital in Davao City: A cross-sectional study

Background@#The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third International Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in identifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection.@*Methodology@#A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013 to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale (GCS).@*Results@#Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%) survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76.@*Conclusion@#Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy for in-hospital mortality.

Magnitude and factors associated with catheter associated urinary tract infection, and antimicrobial susceptibility profile at Hawassa, Sidama Regional State, Ethiopia: A prospective cross-sectional study

Introduction: The use of urinary catheter benefit patients who are unable to urinate for various medical rea-sons. Despite its use, a urinary catheter during its application may introduce bacteria to the urinary tract and result in Urinary tract infection (UTI). Even though the burden of catheter-associated UTI is expected to be high in resource-limited countries, there is limited data. The aim of this study was to determine the magnitude of culture-confirmed catheter-associated urinary tract infection (CAUTI), associated factors, and antimicrobial sus-acceptability profiles of bacteria. Methods: This prospective cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital (HUCSH), Sidama region, from May-August 2022. One hundred forty-nine catheterized patients at HUCSH were included. Socio-demographic, clinical, and laboratory data were collected using structured questionnaire. Urine specimens were cultured on blood and MacConkey agar. Culture-confirmed catheter-associated urinary tract infection was established if >1 X 105colonies of bacteria per milliliters of urine was detected. The disc diffusion method was used for antimicrobial susceptibility testing. For data analysis, SPSS version 26 was used. Factors associated with culture confirmed CAUTI were assessed using binary logistic regression. Results: The magnitude of culture confirmed CAUTI was 30.2% (n=45; 95% CI=22.8−37.6). The most common bacterial isolates were Escherichia coli (n=12; 26.7%), followed by Klebsiella species (n=10; 22.2%), and Staphylococcus aureus (n=6; 13.3%). Duration of catheterization (AOR=9.6, 95% CI=3.8−24.2) and comorbidities (AOR=4.1, 95% CI=1.7−9.8) were significantly associated with culture-confirmed CAUTI. Most Gram-neg-active bacteria were resistant to commonly prescribed antimicrobial agents. Conclusions:The magnitude of culture-confirmed CAUTI at HUCSH was high.E.coli was the leading bacteria and most of them were resistant to various types of antimicrobial agents. Duration of catheterization and comorbidities were significantly associated with culture-confirmed CAUTI

Central line-associated bloodstream infections in patients with COVID-19 / Infecciones de la circulación sanguínea relacionadas con catéter venoso central en pacientes con COVID-19 / Infecção primária de corrente sanguínea relacionada a cateter venoso central em pacientes com COVID-19

Objective: to investigate the association between central line-associated bloodstream infections and clinical and care variables of intensive care unit patients with COVID-19 hospitalized at a reference public health institution. Method: a case-control study. Results: the study sample consisted of 70 patients diagnosed with central line-associated bloodstream infections (case group) and 70 non-infected patients (control group). Most patients were male, with mean age of 57.93±13.93 years old and provided with a double lumen catheter. Median time of central line-associated bloodstream infections onset was 11 (8-18) days. Longer time on mechanical ventilation ( P =0.014; OR: 1.79; 95% CI: 0.91-3.51) and prone position ( P =0.017; OR: 2.41; 95% CI: 1.22-4.81) were associated with central line-associated bloodstream infections onset. Conclusion: longer time on invasive mechanical ventilation and prone position contributed to central line-associated bloodstream infections onset in COVID-19 patients.

Objetivo: investigar la asociación entre infecciones de la circulación sanguínea relacionadas con catéter venoso central y variables clínicas y asistenciales de pacientes con COVID-19 ingresados en la unidad de cuidados intensivos de una institución pública de salud de referencia. Método: un estudio caso-control. Resultados: la muestra del estudio estuvo compuesta por 70 pacientes con diagnóstico de infección de la circulación sanguínea relacionada con catéter venoso central (grupo caso) y 70 pacientes no infectados (grupo control). La mayoría de los pacientes eran del sexo masculino, con edad media de 57,93±13,93 años y provistos de catéter de doble luz. El tiempo medio de aparición de las infecciones del torrente sanguíneo asociadas a catéter venoso central fue de 11 (8-18) días. Un mayor tiempo en ventilación mecánica ( P =0,014; RP: 1,79; IC 95%: 0,91-3,51) y en posición de decúbito prono ( P =0,017; RP: 2,41; IC del 95 %: 1,22-4,81) se asociaron con la aparición de infecciones de la circulación sanguínea relacionadas con catéter venoso central. Conclusión: un tiempo más prolongado con ventilación mecánica invasiva y posición de decúbito prono contribuyeron a la aparición de infecciones de la circulación sanguínea relacionadas con catéter venoso central en pacientes con COVID-19.

Objetivo: investigar a associação entre infecção primária de corrente sanguínea relacionada a cateter venoso central e variáveis clínicas e assistenciais de pacientes com COVID-19 internados na unidade de terapia intensiva de uma instituição pública de saúde de referência. Método: estudo caso-controle. Resultados: o estudo foi composto por 70 pacientes com diagnóstico de infecção primária de corrente sanguínea relacionada a cateter venoso central (grupo caso) e 70 pacientes sem infecção (grupo controle). Pacientes predominantemente do sexo masculino, média de idade de 57,93±13,93 anos e portadores de cateter de duplo lúmen. A mediana de tempo de ocorrência das infecções primárias de corrente sanguínea relacionadas a cateter venoso central foi de 11 (8-18) dias. Maior tempo em ventilação mecânica ( P =0,014; RP: 1,79; IC 95%: 0,91-3,51) e posição prona ( P =0,017; RP: 2,41; IC 95%: 1,22-4,81) foram associados à ocorrência de infecções primárias de corrente sanguínea relacionadas a cateter venoso central. Conclusão: maior tempo em ventilação mecânica invasiva e posição prona contribuíram para a ocorrência de infecções primárias de corrente sanguínea relacionadas a cateter venoso central em pacientes com COVID-19.

COVID-19 e o ciclo gravídico-puerperal: uma revisão narrativa / COVID-19 and the pregnancy cycle: a narrative review

Até este momento da pandemia de COVID-19, embora as gestantes não tenham maior risco de se infectar do que a população geral, elas têm maiores riscos de desenvolver formas graves e demandar cuidados de UTI e ventilação invasiva, so- bretudo aquelas que apresentam comorbidades. No Brasil, a mortalidade materna por COVID-19 está entre as mais elevadas do mundo. A transmissão vertical do SARS-CoV-2 parece ser um evento raro, e até o momento não se observou aumento da ocorrência de abortos e malformações. Entretanto, a COVID-19 está associada a elevadas taxas de prematuridade, baixo peso ao nascer e admissão em UTI neona- tal. Em adaptação a esse novo cenário, são indicados cuidados especiais durante o ciclo gravídico-puerperal, sendo útil destacar: o espaço crescente da telemedicina no pré-natal; a não obrigatoriedade da realização de cesariana em caso de gestan- te infectada no momento do parto e a liberação da amamentação pelas puérperas com COVID-19.

The Association of Asymptomatic Urinary Tract Infection (UTI) with Diabetes Mellitus (DM) in Pregnant Women

Background: Urinary tract infection (UTI) is a common infection of diabetic pregnant women because of excess urine glucose excretion and lowered immunity. UTI during pregnancy is directly proportionate to maternal and neonatal complications. Diabetes mellitus (DM) and urological health problems are closely related during pregnancy. DM patients are prone to UTI, bladder issues and sexual dysfunction. The intent of the study was to find out the association of asymptomatic urinary tract infection (UTI) with diabetes mellitus (DM) in pregnant women. Material & Methods: A prospective cross-sectional study was carried out in the Department of Public Health of Varendra University in Bangladesh for the duration of 4 months in the summer session from May 2018 to August 2018. All the pregnant mothers (N=119) with diabetes mellitus in Chapai Nawabganj during the study period constituted the study population. Ethical clearance was taken from the hospital. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Results: Among the study population (N=119), the mean age of the respondents was 25.14 ± 4.82 years, and most of the respondents were in the age group of below 25 years. It was observed that around one-third of the respondents (36,30.3%) monthly income was up to 15,000 taka. Regarding the duration of gestation, it was observed that the mean duration of gestation was 19.06 ± 5.62 weeks. Around one-fourth of the respondents (33,27.7%) had good but unhygienic sanitation and the majority of them (78,65.5%) had good and hygienic sanitation conditions. It was recognized that the majority of the respondents (82,68.9%) had 6-8 times of micturition per day. Sixty-two respondents who had DM did not know about UTI and the relationship between the pattern of DM and urinary tract infection was not found statistically significant (p>0.05). Conclusion: In the case of pregnancy, in women with DM, UTI is the most commonly noticed maternal infection. The findings provided by the analysis might help in the management of asymptomatic urinary tract infections during pregnancy.

Panorama da qualidade biológica da água destinada ao tratamento dialítico em pacientes sob cuidados críticos em Unidades de Terapia Intensiva / Overview of the biological quality of water intended for dialysis treatment in patients under critical care in Intensive Care Units

A incidência da lesão renal aguda caracteriza-se como evento frequente em pacientes críticos internados em Unidades de Terapia Intensiva e está associada ao aumento de mortalidade, causando grande impacto à Saúde Pública. As intercorrências clínicas são minimizadas com intervenções dialíticas, acarretando a exposição do paciente a volumes expressivos de água tratada durante a terapia renal em leito. As análises microbiológicas e de determinação de endotoxinas bacterianas em amostras de água tratada e em soluções de dialisato foram executadas em dois hospitais públicos do município de São Paulo, seguindo metodologias analíticas preconizadas em compêndios oficiais. A avaliação demonstrou que a porcentagem de resultados satisfatórios no período de 2010 a 2022 variou entre 35,2 a 100% e de 40 a 100% para as unidades hospitalares I e II para a água tratada, respectivamente; e, 100% para as soluções de dialisato para a unidade hospitalar I. A eficácia de ações delineadas pelas equipes técnicas das unidades hospitalares, na adequação da água destinada à terapia dialítica, aponta para a importância em estimular outras instituições hospitalares na padronização e implantação de melhoria contínua de seus sistemas de tratamento de água para uso em procedimento dialítico, prevenindo riscos adicionais aos pacientes expostos à terapia renal.

The incidence of acute kidney is high among critically ill patients admitted to Intensive Care Units and is associated with increased mortality, having a major impact on public health. Clinical complications are minimized with dialysis interventions, which expose patients to significant volumes of treated water during in-bed renal therapy. Microbiological analyzes and determination of bacterial endotoxins were performed on treated water samples and dialysate solutions in two public hospitals in São Paulo city, using analytical methodologies recommended in official compendia. The evaluation showed that the percentage of satisfactory results for treated water ranged from 35.2% to 100% in Hospital Unit I and from 40% to 100% in Hospital Unit II between 2010 and 2022. For dialysate solutions in Hospital Unit I, the percentage of satisfactory results was 100% during the same period. The effectiveness of actions implemented by the technical hospital teams, in adapting water for dialysis therapy, points to the importance of encouraging other hospital institutions to standardize and implement a program of continuous improvement for their water treatment systems used in dialysis procedures. This will help to prevent additional risks to patients exposed to renal therapy.

Panorama da qualidade biológica da água destinada ao tratamento dialítico em pacientes sob cuidados críticos em Unidades de Terapia Intensiva / Overview of the biological quality of water intended for dialysis treatment in patients under critical care in Intensive Care Units

A incidência da lesão renal aguda caracteriza-se como evento frequente em pacientes críticos internados em Unidades de Terapia Intensiva e está associada ao aumento de mortalidade, causando grande impacto à Saúde Pública. As intercorrências clínicas são minimizadas com intervenções dialíticas, acarretando a exposição do paciente a volumes expressivos de água tratada durante a terapia renal em leito. As análises microbiológicas e de determinação de endotoxinas bacterianas em amostras de água tratada e em soluções de dialisato foram executadas em dois hospitais públicos do município de São Paulo, seguindo metodologias analíticas preconizadas em compêndios oficiais. A avaliação demonstrou que a porcentagem de resultados satisfatórios no período de 2010 a 2022 variou entre 35,2 a 100% e de 40 a 100% para as unidades hospitalares I e II para a água tratada, respectivamente; e, 100% para as soluções de dialisato para a unidade hospitalar I. A eficácia de ações delineadas pelas equipes técnicas das unidades hospitalares, na adequação da água destinada à terapia dialítica, aponta para a importância em estimular outras instituições hospitalares na padronização e implantação de melhoria contínua de seus sistemas de tratamento de água para uso em procedimento dialítico, prevenindo riscos adicionais aos pacientes expostos à terapia renal. (AU)

The incidence of acute kidney is high among critically ill patients admitted to Intensive Care Units and is associated with increased mortality, having a major impact on public health. Clinical complications are minimized with dialysis interventions, which expose patients to significant volumes of treated water during in-bed renal therapy. Microbiological analyzes and determination of bacterial endotoxins were performed on treated water samples and dialysate solutions in two public hospitals in São Paulo city, using analytical methodologies recommended in official compendia. The evaluation showed that the percentage of satisfactory results for treated water ranged from 35.2% to 100% in Hospital Unit I and from 40% to 100% in Hospital Unit II between 2010 and 2022. For dialysate solutions in Hospital Unit I, the percentage of satisfactory results was 100% during the same period. The effectiveness of actions implemented by the technical hospital teams, in adapting water for dialysis therapy, points to the importance of encouraging other hospital institutions to standardize and implement a program of continuous improvement for their water treatment systems used in dialysis procedures. This will help to prevent additional risks to patients exposed to renal therapy. (AU)

"É um bombardeio de sentimentos": experiências maternas no contexto do nascimento prematuro / "It's an explosion of feelings": maternal experiences in the context of preterm birth / "Es un bombardeo de sentimientos": experiencias maternas en el contexto del parto prematuro

O presente estudo investigou a experiência da maternidade de mães de bebês nascidos extremamente prematuros durante suas hospitalizações na UTI Neo. Em particular, buscou-se conhecer os sentimentos maternos relacionados a esse contexto. Participaram 18 mães cujos bebês tinham entre 25 e 28 semanas gestacionais e pesavam entre 625g e 1000g. As mães foram entrevistas 15 dias após o parto e as respostas foram examinadas por meio de análise de conteúdo qualitativa. Foram desenvolvidos três eixos, derivados das entrevistas: sentimentos sobre a UTI Neo; sentimentos sobre as manifestações do bebê; e sentimentos sobre a maternidade. Os achados revelaram uma complexidade de sentimentos maternos no contexto da UTI Neo. Porém, destacaram-se nas verbalizações maternas o investimento narcísico das mães nos seus bebês, que as levavam a se comunicar com eles a partir de pequenos gestos e expressões sensoriais, o que oportunizava, simultaneamente, a construção de um lugar simbólico para o bebê. (AU)

The present study investigated the motherhood experience of mothers of extremely preterm infants during their hospitalizations in the NICU. In particular, we sought to investigate the maternal feelings related to this context. Participants included 18 mothers whose babies were between 25 and 28 gestational weeks and weighed between 625g and 1000g. Mothers were interviewed 15 days after delivery and the responses were examined using qualitative content analysis. Three axes were developed, derived from the interviews: feelings about the NICU; feelings about the baby's manifestations; and feelings about motherhood. The findings revealed the complexity of maternal feelings in the context of the NICU. However, the mothers' narcissistic investment in their babies, which led them to communicate with them using small gestures and sensory expressions, stood out in the maternal verbalizations, which simultaneously made it possible to build a symbolic place for the infant. (AU)

El presente estudio investigó la experiencia de maternidad de madres de bebés nacidos extremadamente prematuros durante sus hospitalizaciones en la UCI Neonatal. En particular, se buscó conocer los sentimientos maternos relacionados con este contexto. Participaron 18 madres cuyos bebés tenían entre 25 y 28 semanas de gestación y pesaban entre 625 g y 1000 g. Las madres fueron entrevistadas 15 días después del parto y las respuestas se examinaron mediante análisis de contenido cualitativo. Se desarrollaron tres ejes, derivados de las entrevistas: sentimientos sobre la UCI Neonatal; sentimientos sobre las manifestaciones del bebé; y sentimientos sobre la maternidad. Los hallazgos revelaron una complejidad de los sentimientos maternos en el contexto de la UCI Neonatal. Sin embargo, la inversión narcisista de las madres en sus bebés se evidenció en sus verbalizaciones, que las llevaba a comunicarse con ellos a través de pequeños gestos y expresiones sensoriales que, simultáneamente, permitían la construcción de un lugar simbólico para el bebé. (AU)

Pacientes quemados graves en la unidad de cuidados intensivos / Severe burn patients in the Intensive Care Unit / Queimaduras graves na Unidade de Terapia Intensiva

Resumen: Objetivo: se presenta una breve descripción de la experiencia de un centro de tercer nivel de atención de pacientes quemados graves en la unidad de cuidados intensivos (UCI) en la Ciudad de México. Material y métodos: análisis retrospectivo de 101 pacientes adultos que ingresaron a la UCI entre los años 2019-2022. Se describen características demográficas, principales diagnósticos, causas de complicaciones y tasa de mortalidad. Se subdividen en grupo de sobrevivientes y no sobrevivientes, y en grupo de adultos mayores de 65 años y menores de 65 años. Resultados: se describen 101 pacientes mayores de 18 años, 20 mujeres (19.1%), 81 hombres (80.1%). Promedio de edad de 40.1 ± 12.4 años. Promedio días de estancia de 13.3 ± 12.4 días/paciente. El principal diagnóstico de ingreso fue por quemaduras por fuego en 66 pacientes (65.3%). Mortalidad global de 19.8%, y en mayores de 65 años de 28.5%. La principal causa de muerte fue el choque séptico. Las principales causas de infección fueron Acinetobacter baumannii, Pseudomonas aeruginosa y diferentes especies de Candida. Conclusiones: las lesiones secundarias por quemaduras graves ocasionan una alta morbimortalidad, principalmente en adultos mayores, siendo la principal causa de muerte el choque séptico por bacterias multirresistentes.

Abstract: Objective: a brief description of the experience of a tertiary care center for severely burned patients in the intensive care unit in Mexico City is presented. Material and methods: retrospective analysis of 101 adult patients admitted to the intensive care unit between the years 2019-2022. Demographic characteristics, main diagnoses, causes of complications and mortality rate are described. They are subdivided into the group of survivors and non-survivors, and adults over 65 years of age and under 65 years of age. Results: 101 patients older than 18 years are described, 20 women (19.1%), 81 men (80.1%). Average age of 40.1 ± 12.4 years. Average days of stay of 13.3 ± 12.4 days/patient. The main admission diagnosis was fire burns in 66 patients (65.3%). Overall mortality of 19.8%, and in those over 65 years of age 28.5%. The main cause of death was septic shock. The main causes of infection were Acinetobacter baumannii, Pseudomonas aeruginosa and different species of Candida. Conclusions: secondary injuries due to severe burns cause high morbidity and mortality, mainly in older adults, with septic shock due to multiresistant bacteria being the main cause of death.

Resumo: Objetivo: apresenta-se uma breve descrição da experiência de um centro de atenção terciária para pacientes queimados em estado grave na unidade de terapia intensiva da Cidade do México. Material e métodos: análise retrospectiva de 101 pacientes adultos, internados na Unidade de Terapia Intensiva entre os anos de 2019-2022. São descritas características demográficas, principais diagnósticos, causas de complicações e taxa de mortalidade. Eles são subdivididos em grupos de sobreviventes e não sobreviventes e adultos com mais de 65 anos e menos de 65 anos. Resultados: são descritos 101 pacientes maiores de 18 anos, 20 mulheres (19.1%), 81 homens (80.1%). Idade média de 40.1 ± 12.4 anos. Média de dias de internação de 13.3 ± 12.4 dias/paciente. O principal diagnóstico de admissão foi queimaduras por fogo em 66 pacientes (65.3%). Mortalidade geral de 19.8%, e em pessoas com mais de 65 anos de 28.5%. A principal causa de morte foi choque séptico. As principais causas de infecção foram Acinetobacter baumannii, Pseudomonas aeuroginosa e diferentes espécies de Candida. Conclusões: lesões secundárias a queimaduras graves causam alta morbimortalidade, principalmente em idosos, sendo o choque séptico por bactérias multirresistentes a principal causa de morte.

UTI among patients attending IPD and its relation with preterm labor in Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur

Background: Urinary tract infections (UTIs) now have become a severe public health problem because of the morbidity and treatment cost. UTI can be occur in all age groups, but women are more prone to develop UTI in comparison to men, due to several factors like short urethra, absence of prostatic secretions, pregnancy and easy infection in the urinary tract with fecal flora.Material & Methods:This study was a retrospective cross-sectional study which was conducted at the department of Obstetrics and Gynaecology, Bangabandhu Sheikh Muzib medical college hospital, Faridpur, Bangladesh. The study was conducted during the period of January 2021- January 2022. The total sample size for this study was 197.Results:Most of the respondents 87(44.2%) were aged between 25-29 years and followed by 16(8.1%) were aged 20-24 years, 81(41.1%) were 30-34 years and 13(6.6%) were aged >34 years. According to gravida, 4th gravida were 65(33.0%), 3rd gravida 37(18.8%), 2nd gravida 62(31.5%) and 1st gravida were 33(16.8%). The most common isolated organism was E. coli which was found in 135(68.5%) cases and followed by S. Aureus in 21(10.7%), Coagulase negative staph in 20(10.2%), Klebsiella in 9(4.6%) and GBS in 12(6.1%) cases. Majority of the patients 192(97%) had no complications onwards and only 5(3%) case was found with pyelonephritis.Conclusion: UTI in pregnancy has a major influence on pregnancy outcome. The unsolicited miseries of the pregnant mothers and their progenies might easily be legitimate by early diagnosis and treatment of UTI during pregnancy.

Clinical approach and diagnosing bladder stone in a 74-year-old man patient: a case report

This article reports a 74-year-old man came to the emergency department with complaint blood in urine, urinary tract symptom such as nocturia, frequency urgency, and cloudy urine.Physical examination showed suprapubic area was hard on palpation. The abdominal X-ray of the patient showed an opaque stone in the bladder. An ultrasound scan showed a multiple bladder stone with the longest stone 1.59 cm in size. Bilateral kidney cyst and the prostate was enlarged with volume �3.85 cc, IPP 2.29 cm. Entirestoneeliminationand eradicationrelatedBPH and urinary tract infections (UTIs) arethe principalgoalof theremedy. The patient was treated with Lithotripsy, antibiotics, alpha-blockers, antihypertension medications and showed clinical remission.

Causative Organisms of Urinary Tract Infection and Antibiotic Susceptibility Among Patients Attending in Tertiary Care Hospitals of Bangladesh

Background: Urinary tract infections (UTIs) are considered to be the chronic public health problem due to morbidity and financial cost as urological diseases causes the highest health care cost. UTI is known as one of the most common diseases today. UTI can occur in both men and women, but studies found that the incidence of UTI is more common in women especially among the sexually active women. Material & Methods:This study was a retrospective cross-sectional study which was conducted at the department of Medicine in Tairunnessa Memorial Medical College and Hospital, Gazipur, obstetrics and gynecology in Bikrampur Bhuiya Medical College and Hospital, Munshiganj and Medicine in City Medical College and Hospital, Gazipur. The study was conducted during the period of February 2018- January 2022. The total sample size for this study was 131.Results:Most of the respondents 56(42.7%) were aged from 26-35 years. Majority of them 117(89%) were female whereas only 14(11%) were male. Burning sensation of micturition was found in 115 patients where 46(40%) had burning for 0-3 days, 63(54.8%) for 4-7 days and 6(5.2%) for >7 days. In most cases causative organism was E. Coli in this study. According to sensitivity patterns of E. Coli Amoxiclav was used in 77(59%) cases and followed by Amikacin in 94(72%), Azithromycin in 120(92%), Cefixime in 130(99.2%), Ceftriaxone in 83(63.3%), Cefuroxime in 37(28.2%), Imipenem in 62(47%), Ciprofloxacine 64(49%), and Gentamicin in 38(29%) cases. In assessing the antibiotic resistance pattern of E. coli Ampicillin was used in 55(42%) cases and followed by Amoxycillin in 98(75%), Colchicine in 13(10%), Linezolid in 35(26.2%), Amoxiclav in 54(41.2%), Colistin in 16(12.2%), Imipenem in 69(53%) and Novobiocin in 62(47%) cases.Conclusions:Antibiotics are considered to be the only treatment for UTI. But antibiotic resistance is highly prevalent in bacterial isolates around the world, especially in developing countries.

Obesidad como factor pronóstico en el paciente crítico / Obesity as a prognostic factor in the critical ill patients / Obesidade como fator prognóstico no paciente crítico

Resumen: Introducción: La obesidad es una enfermedad con impacto negativo en la sobrevida; se hace referencia al término «paradoja de la obesidad¼ utilizado como un efecto protector en la mortalidad. Objetivo: Determinar si la obesidad es un factor de protección en el paciente crítico. Material y métodos: Se realizó un estudio de cohorte. Se obtuvo información de expedientes de Unidad de Cuidados Intensivos (UCI) del Hospital Regional Monterrey del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE) Monterrey durante 2018. Se hizo análisis bivariado para asociación χ2 y U de Mann-Whitney para correlación fórmula de Pearson y análisis de supervivencia con curva de Kaplan-Meier. Resultados: Se analizaron 151 expedientes de pacientes, 73 obesos y 78 no obesos, se observó que la obesidad es un factor protector para mortalidad (p = 0.044, OR 0.431 (IC 0.187-0.992). El IMC no se correlaciona con el Acute physiology and chronic health evaluation (APACHE) II (p = 0.066); sin embargo, con un impacto en la curva de supervivencia (p = 0.42). Conclusiones: Se detecta la obesidad como factor protector; sin embargo, su asociación con enfermedades crónicas degenerativas, estancia prolongada en UCI y sus complicaciones no dejan de tener impacto negativo en la supervivencia fuera de la unidad.

Abstract: Introduction: Obesity is a disease with a negative impact on survival; the prognosis of these patients is has controversial results. The term «obesity paradox¼ refers as a protective effect on mortality. Objective: To determine whether obesity is a protective factor in the critically ill patient. Material y methods: A cohort study was conducted. Data was obtained from ICU records of the ISSSTE Monterrey Regional Hospital during 2018, bivariate analysis was performed for χ2 and Mann Whitney's U association, for Pearson's formula correlation and survival analysis with Kaplan-Meier curve. Results: 151 records of 73 obese and 78 non-obese patients were analyzed, it was observed that obesity is a protective factor for mortality (p = 0.044, OR 0.431(IC 0.187-0.992), BMI does not correlate with APACHE II (p = 0.066), however, an impact on the survival curve was observed (p = 0.42). Conclusions: According to the results obtained, it matches with the term «obesity paradox¼, however, its association with chronic degenerative diseases, prolonged stay in the ICU and its complications do not cease to have a negative impact on survival outside the unit.

Resumo: Introdução: A obesidade é uma doença com impacto negativo na sobrevida; O termo «paradoxo da obesidade¼ refere-se a um efeito protetor sobre a mortalidade. Objetivo: Determinar se a obesidade é um fator protetor em pacientes críticos. Material e métodos: Foi realizado um estudo de coorte. As informações foram obtidas dos registros da UTI do ISSSTE Monterrey Regional Hospital durante o ano de 2018, foi realizada análise bivariada para associação χ2 eU Mann-Whitney, para correlação da fórmula de Pearson e análise de sobrevida com curva de Kaplan-Meier. Resultados: Foram analisados 151 prontuários de 73 pacientes obesos e 78 não obesos, observou-se que a obesidade é fator protetor para mortalidade (p = 0.044, OR 0.431(IC 0.187-0.992), IMC não se correlaciona com APACHE II (p = 0.066), porém, com impacto na curva de sobrevida (p = 0.42). Conclusões: A obesidade é encontrada como fator de proteção, porém, sua associação com doenças crônico-degenerativas, permanência prolongada na UTI e suas complicações não deixam de ter impacto negativo na sobrevida fora da unidade.

Perfil de reinternação em UTI: a tomada de decisão em organizações complexas / Readmission profile in ICU: decision-making in complex organizations

Resumo Introdução A tomada de decisão, num ambiente complexo como de uma UTI pode sofrer diversas interferências e ocasionar a alta precoce de um paciente para um setor de menor complexidade. Objetivo Objetiva-se analisar o perfil de pacientes que foram readmitidos, em menos de 24 horas, na UTI de um hospital privado. Método Esta análise foi realizada por meio do método de correspondências múltiplas, utilizando-se um corte longitudinal, e os dados foram extraídos do sistema Epimed. Resultados Os resultados apontam que o perfil de readmissão se caracterizou pelos pacientes do sexo feminino, com idades entre 0 e 30 anos. A origem desses pacientes é do tipo clínica com diagnóstico predominantemente cardiológico e hematológico. Esse achado pode auxiliar na prevenção da reinternação, visto que os dados interferem no indicador de qualidade do setor, podendo, assim, definir estratégias e meios para minimizar a reinternação. Conclusão Conclui-se, a partir do perfil de pacientes que foram readmitidos na UTI em menos de 24, que há necessidade de cuidado especial para pacientes jovens, do sexo feminino e com diagnóstico cardiológico e hematológico. Esses resultados servem de apoio à tomada de decisão da alta dos pacientes.

Abstract Background Decision making in a complex ICU environment can suffer from various interferences and lead to the early discharge of patients to lower complexity wards. Objective The objective is to analyze the profile of patients readmitted, in less than 24 hours, to an ICU, in a private hospital. Method This analysis was performed using the multiple correspondence method, using a longitudinal section. The data were extracted from the Epimed system. Results The results indicate that female patients, aged 0 to 30 years, characterized the readmission profile. The origin of these patients is of clinical type, with predominantly cardiac and hematological diagnoses. This finding may help to prevent readmission, since the data affects the sector quality indicator, thereby helping to define strategies to minimize readmission. Conclusion From the profile of patients who were readmitted to the ICU in less than 24 hours, it is concluded that there is a need for special care for young female patients with cardiovascular and hematological diagnosis. These results support decision making for discharge of patients.

Manejo dos pacientes sépticos admitidos no Hospital Universitário Santa Terezinha / Management of septic patients admitted to Santa Terezinha teaching hospital

Introdução: A sepse é uma disfunção orgânica potencialmente fatal, que se origina de uma resposta desregulada do hospedeiro a uma infecção. Objetivo: Analisar o manejo dos pacientes sépticos admitidos na emergência de um hospital universitário da região do Meio Oeste de Santa Catarina. Métodos: Estudo documental, retrospectivo, descritivo e com caráter quantitativo, realizado no setor de prontuários do Hospital Universitário Santa Terezinha, sendo os dados coletados nos 67 prontuários dos pacientes atendidos entre fevereiro e junho de 2018. Resultados: Predominância de mulheres; idade de 67,0 ± 19,4 anos; foco infeccioso prevalente na admissão: pulmonar; predomínio de infecção por Gram-negativos; ressuscitação volêmica preponderantemente com cristaloide; prevalência de antibioticoterapia de amplo espectro; 29,9% foram admitidos na UTI, sendo que o tempo médio de espera para admissão nesse setor foi de 41,65 horas; comparando-se os desfechos desses pacientes em conjunto com o tempo de espera até a internação na UTI, notou-se que os óbitos demoraram um tempo, em dias, quase quatro vezes maior para conseguirem leito de cuidado intensivo; os pacientes da UTI contabilizaram um tempo de internação duas vezes maior do que os que não estiveram nesse setor; a média geral de óbito foi de 32,8%. Conclusão: A despeito da instituição precoce de medidas terapêuticas preconizadas na literatura internacional, a mortalidade por sepse nesta instituição apresenta-se ainda elevada. Maior facilidade de acesso à UTI parece ser primordial neste contexto, visto que se percebeu tendência a um aumento de mortalidade nos casos em que houve demora na transferência do paciente para a UTI.

Introduction: Sepsis is a potentially fatal organ dysfunction resulting from a dysregulated host response to infection. Objective: To evaluate the management of septic patients admitted to the Emergency Department of a teaching hospital in the Midwest region of Santa Catarina, Brazil. Methods: We conducted a documentary, retrospective, descriptive, and quantitative study in the Medical Records Department of the Santa Terezinha Teaching Hospital. Data were collected from 67 medical records of patients treated between February and June 2018. Results: Most patients were women, with a mean age of 67.0±19.4 years. The primary infectious focus on admission was the lungs, with a prevalence of Gram-negative infections. Fluid resuscitation was mostly achieved with crystalloids, and there was a prevalence of broad-spectrum antibiotic therapy. Of 67 patients, 29.9% were admitted to the Intensive Care Unit (ICU), with a mean waiting time of 41.65 hours. When analyzing patient outcome in relation to the waiting time until ICU admission, those who died waited approximately four times longer (in days) to get an ICU bed. ICU patients had a length of stay twice as long compared to patients admitted to other departments. Overall mean death rate was 32.8%. Conclusions: Despite the early introduction of therapeutic interventions recommended in the international literature, the rate of sepsis mortality was still high. Easier access to ICU admission seems to be essential in this setting, given that mortality rates tended to be higher when there was a delay in patient transfer to the ICU.

Evaluation of Pathogens Causing Urinary Tract Infection and Their Sensitivity Pattern

Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.

Microbiology and Drug Resistance Pattern in Clinically Significant Isolates of urine from Medical Wards of a Tertiary Care Hospital in North India.

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in clinical practice both in community and hospital settings in all age groups. It is the second most frequently occurring infection in general population after upper respiratory tract infection .Urinary tract infections (UTIs) are the leading cause of Gram negative sepsis in hospitalized patients and are the origin for about half of all hospital acquired infections caused by urinary catheters and are associated with considerable cost in terms of morbidity and economic and research expenditure. Material And Methods: This prospective cross sectional study was carried out in the Department of Microbiology of Government Medical College, Srinagar. A total of 800 patients were taken up for the study. The sample falling under the set inclusion criteria were selected from the urine specimen received in the laboratory for urine culture and sensitivity from Hospitalized patients (IPD). Culture and sensitivity reports and patient data obtained from hospital records was analyzed for this study. Out of 800 samples taken up for the study 208 (26%) were culture positive and 592Results: (74%) were negative. 208 positive samples 125(60.10%) were females and 83(39.90%) were males. female predominance was observed with 71% whereas 29% males were affected by UTI. UTI was predominantly in females of age group (21-40 yrs). most common organism isolated on culture was Escherichia coli(43.26%) both in short stay patients (<48hrs hospital stay) /OPD 22.59% as well as in IPD (>48hrs hospital stay) 20.67%.E.coli was isolated from patients of both uncomplicated and complicated UTI. The second most common organism isolated in our study was Enterococcus faecalis(22.59%), the rate of isolation was much higher 18.75% in inpatients (>48hrs hospital stay) and only 3.84% in OPD/short stay patients (<48hrs hospital stay). In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. Pseudomonas spp was 1 isolate in OPD (0.48%) and 6 (2.88%) in IPD, Acinetobacter 3 (1.44%), Proteus 1 (0.48%) found only in hospitalized patients (stay >48hrs). E.coli showed following sensitivity pattern 96.7% to nitrofurantoin, 93.3% to imipenem, 90.0% to amikacin, 75.6% to gentamycin, 73.3% to cefoperazone-salbactam and meropenem both, 68.9% to pipercillin tazobactam.The sensitivity to TMP-SMX was 45.6%, and to ceftriaxone and cefipime was only 22.2% and 21.1% respectively. The organism also showed resistance to drugs like levofloxacin 82.2% and ciprofloxacin 76.7%.Enterococcus faecalis isolated in our study was sensitive to Vancomycin 95.74% followed by Linezolid (93.6%), Nitrofurantoin (78.7%), HL-Amikacin (74.5%),HL- Gentamycin (70.2%). Enterococcus faecalis showed resistance to drugs commonly used to treat UTI i.e. 91.5% resistant to Ciprofloxacin and 89.4% resistant to Levofloxacin. Gram negative bacteria were most predominantConclusion: microorganisms resulting in more than 50% infections causing urinary tract infection. In our study we have seen that Gram positive cocci especially Enterococcus result in UTI in a significant proportion of patients. In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. The implementation of antibiotic stewardship programs is crucial to minimize resistance. Appropriate antibiotics need to be prescribed based on the antibiotic susceptibility testing which will be narrow spectrum, effective and less expensive with least side effects.

Prevalence of Bacterial Urinary Tract Infection among patients With Type 2 Diabetes Mellitus on Sodium-Glucose Cotransporter-2 Inhibitors:A prospective real-world setting study / Journal of the ASEAN Federation of Endocrine Societies

Background@#Genitourinary tract infections, mycotic as well as bacterial, as defined by clinical symptoms, are one of the common adverse effects associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients in clinical trials. However, Indian data in terms of the prevalence of culture-proven bacterial type of urinary tract infection (UTI), and the causative organism is limited.@*Objective@#This study aimed to determine the prevalence and causative agents of bacterial UTI among patients with T2DM on SGLT2i.@*Methodology@#This was a prospective longitudinal study involving all patients with T2DM who were prescribed with SGLT2i, uncontrolled on other oral anti-diabetic medications, from June 2019 to February 2020. Prevalence of bacterial UTI was evaluated at baseline and 12 weeks after initiation of SGLT2i.@*Results@#A total of 80 patients were started on SGLT2i. One female patient on canagliflozin had significant asymptomatic bacteriuria and the causative agent was Acinetobacter baumannii. One male patient on dapagliflozin had symptomatic UTI with negative urine culture study. Four patients developed genital mycotic infection.@*Conclusion@#In this real-world study, SGLT2i as a class, was well tolerated with favorable safety profile, and risk of developing significant bacteriuria and/or symptomatic UTI was minimal.