Resistance-associated mutation prevalence according to subtypes B and non-B of HIV type 1 in antiretroviral-experienced patients in Minas Gerais, Brazil.

The emergence of resistance-associated mutations to the antiretroviral agents and the genetic variability of HIV-1 impose challenges to therapeutic success. We report the results of genotype testing assays performed between 2002 and 2006 in 240 antiretroviral-experienced patients followed up in an HIV reference center in Brazil. Drug resistance mutations and viral subtypes were assessed through the algorithms from the Brazilian Genotyping Network (RENAGENO-Brazil) and from Stanford University. Mutation 184VI was the most prevalent (70%) and the thymidine analogue mutations that appeared most frequently were 215FY, 41L, 67N, and 210W, in this order. Among nonnucleoside reverse transcriptase inhibitor mutations, 103NS (32.5%) stood out. HIV subtype B was identified in 184 patients (76.7%). A significant increasing trend in the prevalence of non-B subtypes was observed during the study period (p=0.004). The main differences in prevalence of mutations among HIV-1 subtypes were related to viral protease, with 20MRI, 36I, and 89IMT more prevalent among non-B subtypes, and 84V, 10FR, 63P, 71LTV, and 77I more common in subtype B (p<0.05). Most mutations to etravirine had a prevalence lower than 10%, but at least one mutation to this drug was observed in 45% of the patients. In only 11 patients (4.6%) three mutations to etravirine were verified. Regional surveillance of the resistance profile and HIV-1 subtypes is crucial in the context of public health, to prevent the transmission of resistant strains and to guide the introduction of new drugs in a specific population.

Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy.

We assessed the independent contributions of the surgical approach and other variables of the National Nosocomial Infections Surveillance System (NNIS) surgical patient component to the surgical site infection risk after cholecystectomy. Laparoscopic cholecystectomy was associated with a lower overall risk of surgical site infection and a lower risk of incisional infection but not a reduced risk of organ-space infection, compared with open cholecystectomy. The contribution of most of the variables of the NNIS surgical patient component to the risk of surgical site infection depended on the depth of the infection.

Factors influencing the risk of surgical site infection following diagnostic exploration of the abdominal cavity.

OBJECTIVES: We assessed the contribution of the surgical approach and the NNIS system's surgical component variables to surgical site infection (SSI) risk after diagnostic exploration of the abdominal cavity. METHODS: Retrospective cohort study with prospective data collection (1993-2006) in five private, non-universitary, secondary or tertiary healthcare facilities. Outcome variable was SSI development within 30 days after surgery. Explanatory variables were age, gender, surgical approach (laparoscopic/open), elective/emergency/trauma procedure, hospital, surgeon, year, additional procedures, wound class, operation duration and ASA-PS score. RESULTS: Consecutive in-patients (6761) were included. Mean age was 38.1 (+/-14.1) years and 87.3% were female; 68% procedures were laparoscopic. Postdischarge follow-up was obtained for 57.7% patients. Patients operated on laparoscopically had reduced adjusted overall risk of SSI (OR=0.40, 95% CI=0.28-0.56), incisional infection (OR=0.43, 95% CI=0.29-0.62) and organ/space infection (OR=0.19, 95% CI=0.07-0.49). Older age, longer procedures, emergency or trauma procedures, medium- or high-risk surgeons and year

C-reactive protein-guided approach may shorten length of antimicrobial treatment of culture-proven late-onset sepsis: an intervention study.

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged <28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was <12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.

A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units.

BACKGROUND: We report on nosocomial infections (NIs), causative organisms, and antimicrobial susceptibility patterns in neonates who were admitted to neonatal intensive care units (NICUs), and assess the performance of birth weight (BW) as a variable for risk-stratified NI rate reporting. METHODS: A prospective, 10-year follow-up, open cohort study that involved six Brazilian NICUs was conducted. The NI incidence rates were calculated using different denominators. RESULTS: Six thousand two hundred forty-three newborns and 450 NICU-months of data were available for analysis. This included 3603 NIs that occurred in 2286 newborns over 121,008 patient-days. The most frequent NIs were primary bloodstream infection (pBSI; 45.9%), conjunctivitis (12.1%), skin infections (9.6%), and pneumonia (6.8%). Only the pBSI (but not pneumonia or central venous catheter-related pBSI) rate distribution differed significantly with varying BW. Gram-negative rods (mainly Klebsiella sp. and Escherichia coli) were responsible for 51.6% episodes of pBSI. Gram-positive organisms (mainly coagulase-positive staphylococci) accounted for 37.4%. Candida sp. was the fourth isolated organism. A high resistance to third-generation cephalosporins was recorded in K pneumoniae and E coli isolates. CONCLUSIONS: This report highlights the burden of NI, and identifies the major focus for future NI control and prevention programs. Except for pBSI, BW had a poor performance as a variable for risk-stratified NI rate reporting.

C-reactive protein-guided approach may shorten length of antimicrobial treatment of culture-proven late-onset sepsis: an intervention study

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged <28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was <12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.