ABSTRACT
Carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species are worrisome nosocomial pathogens. After introduction of a preventive program involving clinical surveillance culture to reduce the spread of those pathogens, we observed an 80% decrease in the percentage of cultures that yielded carbapenem-resistant Acinetobacter isolates. The percentage of cultures that yielded carbapenem-resistant P. aeruginosa remained relatively stable during the intervention.
Subject(s)
Acinetobacter/isolation & purification , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Drug Resistance, Bacterial , Hospitals, Teaching , Pseudomonas aeruginosa/isolation & purification , Acinetobacter/classification , Acinetobacter/drug effects , Acinetobacter Infections/epidemiology , Acinetobacter Infections/microbiology , Brazil/epidemiology , Culture Media , Female , Humans , Male , Population Surveillance , Pseudomonas Infections/epidemiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Respiratory System/microbiology , Urine/microbiologyABSTRACT
Vancomycin-resistant enterococci (VRE) are important pathogens causing nosocomial infections, and there is reason for concern about their resistance and great ability to spread in hospital environments, especially intensive-care units (ICU). To determine the prevalence of rectal colonization by VRE, and the risk factors associated with their presence, rectal surveillance swabs were taken from patients under treatment in two intensive-care units (one medical and another both medical and surgical) at São Paulo Hospital, over a two-year period. Thirty-three percent of the 147 patients evaluated had VRE. The only significant variable in the logistic regression was the length of stay in the ICU.
Subject(s)
Cross Infection/epidemiology , Enterococcus/drug effects , Rectum/microbiology , Vancomycin Resistance , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Cross Infection/microbiology , Feces/microbiology , Female , Humans , Intensive Care Units , Logistic Models , Male , Middle Aged , Prevalence , Risk FactorsABSTRACT
OBJETIVO: O enterococo resistente à vancomicina é atualmente um dos principais microorganismos implicados em infecções nosocomiais. Assim, realizou-se estudo com o objetivo de avaliar sua epidemiologia em um hospital terciário de ensino. MÉTODOS: Trata-se de um estudo epidemiológico retrospectivo, realizado de 2000 a 2002, que analisou amostras de culturas clínicas positivas para enterococo resistente à vancomicina (VRE) em um hospital universitário com 660 leitos. Procurou-se definir sua incidência e os principais sítios e unidades de isolamento. Foi verificada a significância entre as variáveis nos três anos de estudo, sendo considerado como significante p<0,05. RESULTADOS: Houve aumento progressivo na resistência à vancomicina nas culturas clínicas positivas para Enterococcus spp. nos três anos de estudo. Em 2000, 9,5 por cento das amostras eram resistentes à vancomicina, com aumento para 14,7 por cento em 2001 e 15,8 por cento em 2002. As unidades com maior número de isolados foram respectivamente: pronto-socorro (19,5 por cento) e UTI geral (15 por cento); os sítios mais isolados foram: urina (36 por cento) e sangue (20 por cento). CONCLUSÕES: Com o aumento progressivo na incidência de resistência à vancomicina e da taxa de VRE, concluiu-se ser necessárias medidas de controle mais efetivas para deter a disseminação do VRE.
Subject(s)
Epidemiologic Measurements , Vancomycin Resistance , Strepto-EnterococcusABSTRACT
Vancomycin-resistant enterococci (VRE) are important pathogens causing nosocomial infections, and there is reason for concern about their resistance and great ability to spread in hospital environments, especially intensive-care units (ICU). To determine the prevalence of rectal colonization by VRE, and the risk factors associated with their presence, rectal surveillance swabs were taken from patients under treatment in two intensive-care units (one medical and another both medical and surgical) at São Paulo Hospital, over a two-year period. Thirty-three percent of the 147 patients evaluated had VRE. The only significant variable in the logistic regression was the length of stay in the ICU.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cross Infection/epidemiology , Enterococcus/drug effects , Rectum/microbiology , Vancomycin Resistance , Brazil/epidemiology , Cross Infection/microbiology , Feces/microbiology , Intensive Care Units , Logistic Models , Prevalence , Risk FactorsABSTRACT
OBJECTIVE: Vancomycin-resistant Enterococcus (VRE) is today one of the principal microorganisms implicated in nosocomial infections. Thus, a study was carried out with the objective of evaluating its epidemiology at a tertiary-level teaching hospital. METHODS: This was a three-year retrospective epidemiological study conducted from 2000 to 2002. Samples of VRE-positive clinical cultures at a 660-bed university hospital were analyzed. The incidence of VRE and the main anatomical sites and hospital units from which it was isolated were defined. Differences between the variables over the three years of the study were verified, and these were considered significant when p<0.05. RESULTS: There was a progressive increase in the vancomycin resistance in the clinical cultures that were positive for Enterococcus spp., over the three years of the study. In 2000, 9.5% of the samples were vancomycin-resistant, and this increased to 14.7% in 2001 and 15.8% in 2002. The hospital units with the largest numbers of isolates were, respectively, the emergency ward (19.5%) and the general intensive care unit (15%). The anatomical sites with the highest amounts of isolates included: urine (36%) and blood (20%). CONCLUSIONS: With the progressive increase in the incidence of vancomycin resistance and the VRE rate, it is concluded that more effective control measures are needed for deterring the dissemination of VRE.
Subject(s)
Cross Infection/microbiology , Enterococcus/drug effects , Hospitals, University , Vancomycin Resistance , Brazil/epidemiology , Cross Infection/epidemiology , Enterococcus/isolation & purification , Hospital Bed Capacity, 500 and over , Hospitals, University/statistics & numerical data , Humans , Incidence , Retrospective StudiesABSTRACT
Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital São Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.
Subject(s)
Cross Infection/prevention & control , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria , Gram-Negative Bacterial Infections/prevention & control , Infection Control/methods , Intensive Care Units , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Hospitals, Teaching , HumansABSTRACT
Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital São Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.
Subject(s)
Humans , Cross Infection , Drug Resistance, Multiple , Gram-Negative Bacteria , Gram-Negative Bacterial Infections , Infection Control , Intensive Care Units , Cross Infection , Gram-Negative Bacterial Infections , Hospitals, TeachingABSTRACT
Os pacientes graves que requerem cuidados intensivos prolongados estão mais expostos a riscos de adquirirem infecções. Muitas destas são causadas por microorganismos multirresistentes, determinando aumento do período de hospitalização, da mortalidade e dos custos assistenciais. OBJETIVO: Avaliar o custo direto das infecções hospitalares por Pseudomonas aeruginosa e Acinetobacter baumannii multirresistentes em unidade de terapia intensiva (UTI). MATERIAL E MÉTODOS: Foi realizado um estudo tipo caso-controle na UTI geral de adultos da Disciplina de Anestesiologia, Dor e Terapia Intensiva Cirúrgica do Hospital São Paulo no período de 01 de março de 1997 a 31 de agosto de 1998. Foram considerados pacientes casos os 46 pacientes com infecção hospitalar por A. baumannn elou P. aeruginosa sensível apenas a polimixina B. Quarenta e seis pacientes controles foram selecionados na mesma unidade de internação que não apresentaram infecção hospitalar. 0 sucesso de pareamento foi de 96,57 por cento para os critérios: idade, sexo, data de internação, similar diagnóstico na admissão e número de comorbidades. Foram considerados para análise os custos diretos referentes ao atendimento aos pacientes (diária hospitalar, antimicrobianos, interconsultas, cirurgias, exames laboratoriais, entre outros). Os valores foram estimados em dólar americano, com base na cotação média de dezembro 2001: US$ 1.00 = R$ 2,36. RESULTADOS: Foram avaliados 1033 pacientes internados na UTI neste período, equivalentes a 6794 pacientes-dia. Foi utilizado os critérios para o diagnóstico de infecção hospitalar do Nacional Nosocomial Infectíon Surveillance System (NNISS). A média das infecções hospitalares por 1000 pacientes-dia foi de 52,53 e a média das infecções hospitalares por Pseudomonas aeruginosa e Acinetobacterbaumannii multirresistentes foi de 9,95 por 1000 pacientesdia. A pneumonia e a infecção de trato urinário foram as infecções mais freqüentes. A média de permanência na UTI foi 45 dias para os casos e 6,8 dias para os controles (p<0,001), com um custo médio de...(au)
