Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes.

BACKGROUND: Pressure ulcers (PUs) represent a major problem for hospitalized patients, health professionals and society. AIM: To evaluate the impact of in-hospital PUs as a reservoir of multidrug-resistant organisms (MDROs), risk factor for bacteraemia and predictor of poor prognosis. METHODS: A prospective cohort study of patients with stage II or greater PUs hospitalized in a tertiary acute care university teaching hospital for more than 48 h was performed to evaluate colonization/infection by potential and/or multi-resistant hospital pathogens from April to December 2005 and from August 2009 to April 2010. FINDINGS: A total of 145 patients with stage II or greater PUs were included. Of these, 76.5% (111/145) had PUs colonized and/or infected with either S. aureus (20.7%), Gram-negative bacilli (32.5%), or both (46.8%) and most were MDROs (64.8%). Bacteraemia was detected in 50.5% (56/111) of the patients. The ulcers were considered to be the probable source of bacteraemia in 53.6% (30/56) of the episodes. Prior administration of antibiotics (P = 0.04) and infected wound (P < 0.001) were the variables independently associated with bloodstream infection as well as associated with a higher 30-day mortality rate; risk factors for the latter included hospitalization in ICU (P = 0.03) and mechanical ventilation use (P = 0.05). CONCLUSIONS: Our results suggest that besides being a major reservoir of MDROs, patients with PUs constitute a high-risk population for bacteraemia with a poor outcome. Broad-spectrum antibiotics and infected wound were independent factors predisposing patients to both bacteraemia and death.

Vancomycin use in a Brazilian University Hospital: comparison with Hospital infection control practices advisory committee guidelines

Emergence of vancomycin-resistant bacteria is of concer. In an effort to reduce this danger, guidelines to ensure proper prescribing of vancomycin have been proposed to the Hospital Infections Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control. To evaluate use of vancomycin at Uberlândia University Hospital in Brazil, each patient who received the drug during a 10 month period had nasal and recal cultures done within 48 hours of initiation of therapy, then at weekly intervals until discharge. Their hospital records were reviewed to obtain demographic and clinical data, and each was scored as to whether or not HICPAC guidelines were followed. Thirty-one patients were enrolled in the study; 15 of whom had been approved for vancomycin by the hospital infectious diseases (ID) specialist, and 16 who had the drug given without approval. During the study, 4 strains of VRE (Vancomycin Resitant Enterococci) and 8 strains of MRSA (Methicillin Resistant S.aureus) emerged. The use of vancomycin did not follow HICPAC guidelines in 21/31 patients (68 percent), in that the drug was prescribed empirically without prior documenation of need. This occurred 13 of 16 (81 percent) times when no approval by an ID specialist was provided, and 8 of 15 times (53 percent) after approval by a ID specialist. In 6 of 8 patients (75 percent), empirical use of vancomycin was approved by an ID specialist in patients with severe illnesses, each of whom subsequently died. his could be considered appropriate use, although outside the guidelines. Only 3 of 13 patients (23 percent) were severely ill when vancomycin was used without ID approval. Most of the vancomycin use which did not follow HICPAC guidelines occurred on the medicine service in patients moderately ill with pneumonia or bacteremia, and associated with invasive procedures. We conclude that there is a special need to improve education regarding the appropriate use of vancomycin and to increase review of its use by an ID specialist, particularly on medicine services of our hospital.

[Clinical evaluation of gastric emptying with 50% glucose in patients undergoing truncal vagotomy with partial antrectomy and gastroduodenostomy at the level of the lesser curvature]. / Avaliação clínica do esvaziamento gástrico com glicose a 50% em pacientes submetidos à vagotomia troncular com antrectomia parcial e gastroduodenostomia ao nível da curvatura menor.

The results after an oral glucose provocation test before and after surgery of 32 patients with duodenal chloridropeptic ulcer, who underwent a total vagotomy, partial antrectomy and gastroduodenal anastomosis at level of the lesser curvature ("VAGDPC") are presented. It is concluded that with this surgical procedure, when submitted to the oral glucose provocation test, nobody presented the dumping syndrome with clinical expression.

[Standardization of a form for analysis of antibiotic use and/or occurrence of hospital infection]. / Padronização de uma ficha para análise do uso de antibióticos e/ou ocorrência de infecção hospitalar.

In this study, a new report form was used in order to obtain information about the employment of antibiotics and/or the occurrence of infections at the Clinical Hospital of Federal University of Uberlândia. The authors show the results and analyze the variables related to the complete or incomplete accomplishment in using this form of report as a reliable data acquisition system, as well as suggest improvements to the methodology of collecting data when antibiotics and hospital infections are concerned.