Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil.

Although restricting over-the-counter (OTC) antimicrobial drug sales is recommended globally, no data track its effect on antimicrobial resistance (AMR) in bacteria. We evaluated the effect of a national policy restricting OTC antimicrobial sales, put in place in November 2010, on AMR in a metropolitan region of São Paulo, Brazil. We reviewed associations between antimicrobial sales from private pharmacies and AMR in 404,558 Escherichia coli and 5,797 Streptococcus pneumoniae isolates using a dynamic regression model based on a Bayesian approach. After policy implementation, a substantial drop in AMR in both bacterial species followed decreased amoxicillin and trimethoprim/sulfamethoxazole sales. Conversely, increased ciprofloxacin sales were associated with increased ciprofloxacin resistance, and extended spectrum ß-lactamases-positive E. coli isolates and azithromycin sales increases after 2013 were associated with increased erythromycin resistance in S. pneumoniae isolates. These findings suggest that restricting OTC antimicrobial sales may influence patterns of AMR, but multifaceted approaches are needed to avoid unintended consequences.

Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in kidney transplant recipients.

INTRODUCTION: Solid organ transplant recipients are especially susceptible to healthcare-associated infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp-HAIs). The aim of the study was to evaluate risk factors and outcome of these infections in kidney transplant recipients. METHODS: This was a retrospective cohort of kidney transplant (KTx) recipients between January 2009 and December 2013. Cases were defined as patients who developed KPC-Kp-HAI, confirmed by PCR for bla( KPC) gene after KTx during the study period. We analysed variables related to recipient; induction immunosuppressant therapy; delayed graft function; use of invasive devices; SOFA score on the first day of infection; type of therapy; time from positive culture to appropriate antimicrobial therapy; bacteraemia; and concomitant infection. Outcome measures were the occurrence of KPC-Kp-HAI and 30-day mortality after KPC-Kp-HAI. RESULTS: A total of 1,101 were submitted to KTx in the period, 21 patients were classified as infected with KPC-Kp. Another ten patients had KPC-Kp-HAI in the period and were transplanted before 2009. Of those 31 patients, 48.4 % showed evidence of prior colonization and 38.7 % had bacteraemia. The most common site of infection was the surgical wound. Risk factors for KPC-Kp-HAI were multi-organ transplantation and the use of a ureteral stent. Eight of the infected patients experienced recurrence of the infection. The 30-day mortality rate was 41.9 %. Survival was significantly lower among the patients with KPC-Kp-HAI (72 vs. 89.1 %; P = 0.002). The only risk factor independently associated with 30-day mortality was an elevated SOFA score on the first day of infection. CONCLUSIONS: In KTx recipients, the occurrence of KPC-Kp-HAI was related to invasive devices and type of transplant; these infections had a high rate of recurrence and reduced survival after KTx.

Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation.

BACKGROUND: Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. METHODS: We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. RESULTS: A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum ß-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. CONCLUSION: Amikacin prophylaxis is a useful strategy for preventing SSIs.

Active surveillance of Hansen's Disease (leprosy): importance for case finding among extra-domiciliary contacts.

Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae.

Conhecimento de mães primíparas sobre desenvolvimento infantil: um estudo em Itajaí, SC / Primiparous mothers'knowledge about child development: a study in Itajaí, SC

Resumo: A presente pesquisa teve como objetivo avaliar os conhecimentos que mães primíparas têm ao longo de primeiro ano de vida de seu filho sobre o processo de desenvolvimento infantil. Participaram da pesquisa 109 mães primíparas, maiores de 18 anos, com filho ou filha de até um ano de vida e que viviam na cidade de Itajaí (SC). Para sua realização foi utilizado o KIDI (Knowledge of Infant Development Inventory) e para identificar o nível socioeconômico dos pais foi utilizada a Escala de Avaliação de Status Socioeconômico de Hollingshead. Através de análise estatística, foi verificado que fatores sócio-demográficos, tais como: escolaridade e ocupação da mãe estão correlacionados significativamente com seu conhecimento sobre cuidados parentais. Foi constatado que o maior conhecimento das mães é sobre cuidados parentais (crenças, estratégias e comportamentos dos pais). Conclui-se que o status socioeconômico é um fator importante na determinação do conhecimento da mãe sobre sua criança.

Conhecimento de mães primíparas sobre desenvolvimento infantil: um estudo em Itajaí, SC / Primiparous mothers' knowledge about child development: a study in Itajaí, SC

A presente pesquisa teve como objetivo avaliar conhecimentos que mães primíparas têm ao longo de primeiro ano de vida de seu filho sobre o processo de desenvolvimento infantil. Participaram da pesquisa 109 mães primíparas, maiores de 18 anos, com filho ou filha de até um ano de vida e que viviam na cidade de Itajaí (SC). Para sua realização foi utilizado o KIDI (Knowledge of Infant Development Inventory) e para identificar o nível socioeconômico dos pais foi utilizada a Escala de Avaliação de Status Socioeconômico de Hollingshead. Através de análise estatística, foi verificado que fatores sócio-demográficos, tais como: escolaridade e ocupação da mãe estão correlacionados significativamente com seu conhecimento sobre cuidados parentais. Foi constatado que o maior conhecimento das mães é sobre cuidados parentais (crenças, estratégias e comportamentos dos pais). Conclui-se que o status socioeconômico é um fator importante na determinação do conhecimento da mãe sobre sua criança.(AU)

The central focus of this study was to evaluate primiparous mothers' knowledge about parenting and child development throughout the first year of life of their children. Participants were 109 primiparous mothers, aged 18 years or older, living in Itajaí (Santa Catarina), with a child aged 1-12 months. The KIDI (Knowledge of Infant Development Inventory) was employed to evaluate mothers' conceptions of infant development and the Hollingshead Four Factor Index of Socioeconomic Status was used to evaluate the socioeconomic level of mothers' and their families'. Through statistical analysis it was verified that mothers' educational attainment and occupation correlated significantly with their knowledge on parenting and child development. The study revealed that mothers had more knowledge about parenting (beliefs, strategies and practices of the parents) when compared with other types of knowledge. The study concluded that the mothers' socioeconomic level is an important factor related to their knowledge about the child development.(AU)