As infecções relacionadas à assistência à saúde (IRAS) são um grande problema de saúde pública e evidências têm demonstrado que a adoção de medidas de prevenção de IRAS (bundles) reduz a sua ...incidência, mas em populações de alto risco para infecções, como os transplantados, a eficiência dessas medidas tem sido pouco mensurada.
Avaliar o impacto da implementação de bundles de prevenção de IRAS na sua ocorrência entre pacientes transplantados de fígado (TxF). Metodologia: estudo do tipo quase-experimental com 1.479 pacientes submetidos à TxF no período de 2002-14. Os pacientes foram divididos em dois grupos: pré (jan/02 a abr/07; n = 519) e pós implementação dos bundles (mai/07 a dez/14; n = 960). O desfecho primário: incidência de casos de IRAS e taxas de densidade de incidência (TDI) de cada IRAS separadamente: infecções de corrente sanguínea (ICS, associadas ou não à cateter - CVC), infecções do trato urinário (ITU), associadas ou não à dispositivo, pneumonias associadas à ventilação (PAV) ou não (BCP) e infeções de sítio cirúrgico (ISC). Preditores de IRAS foram avaliados por regressão logística e a capacidade discriminatória do modelo foi avaliada por AUC-ROC.
Após a implantação dos bundles a incidência de casos de IRAS reduziu de 38,3% para 17,2% (P < 0,001), e a TDI reduziu de 21,7 para 10,6/1000 paciente-dia (P < 0,001). Houve redução significativa nas TDI de ICS-CVC (2,76 vs. 1,30) e de PAV (12,3 vs. 1,85, P < 0,001), e na incidência de ISC (15,4 vs. 8,43, P < 0,001). Houve também redução nas TDI de ICS não associadas à CVC (1,81 vs. 0,51, P<0,001) e de BCP (2,85 vs. 1,54, P = 0,009). Não houve reduções significativas nas ITU. De forma independente, observou-se associação entre IRAS e as seguintes variáveis: MELD = 21-29 (OR = 1,50; P = 0,02) e MELD > 29 (OR = 2,61; P < 0,001), tendo-se como referência MELD < 21; hemodiálise (OR=1,69; P=0,001); nutrição parenteral (OR = 2,07; P = 0,001); traqueostomia (OR = 6,78; P < 0,001); reabordagem cirúrgica abdominal (OR = 2,89; P < 0,001); e implementação dos bundles (OR = 0,26; P < 0,001). O modelo apresentou poder discriminatório moderado: AUC-ROC = 0,78, IC95% = 0,75-0,80, P < 0,001.
A implementação dos bundles de prevenção de IRAS em pacientes TxF reduziu de forma significativa a incidência de casos de IRAS, bem como das TDI de ICS, de pneumonias e de ISC. A adoção dessas medidas reduziu em 74% o risco do desenvolvimento de IRAS, demonstrando-se eficiente, mesmo em um população de alto risco para infecções.
Background
Urinary tract infections are frequent complications early after kidney transplantation, and the use of antimicrobial coated catheters in settings other than transplantation has shown ...promising results for infection prevention. The purpose of this study was to compare the efficacy of Nitrofurazone‐coated silicone urinary catheters with non‐impregnated silicone urinary catheters in reducing bacteriuria and urinary tract infections in kidney transplant recipients.
Methods
This single‐center study, randomized controlled trial at the Hospital do Rim, a tertiary referral center in kidney transplantation, located in São Paulo, Brazil. Subjects involved living donor kidney transplant recipients, and were randomized 1:1 ratio with a computer‐generated system to a Nitrofurazone‐coated silicone urinary catheter and non‐impregnated silicone urinary catheter from March 2013 to December 2014. Patients with asymptomatic bacteriuria or urinary tract infection at baseline, deceased kidney transplant donors, patients with known hypersensitivity to nitrofurantoin, pregnancy, and those refusing to sign the informed consent form were excluded from the study.
Results
Two hundred fourteen subjects were randomized and one hundred seventy‐six completed the study. There were no differences in the rates of asymptomatic bacteriuria (12.5% in the Nitrofurazone group and 11.4% in the control group, P = 0.99) and urinary tract infection (8% and 6.8%, P = 0.99) and the incidence of side effects was more frequent in the Nitrofurazone‐impregnated silicone urinary catheter group (46.6% and 26.1%, P = 0.007).
Conclusion
The study suggests that there is no beneficial effect of the employment of Nitrofurazone‐coated urinary catheter. Trial registration number: ISRCTN57888785.
•Health care-associated infections are an important public health and patient safety issue.•A bundle is a specific tool with clear parameters to guide the multidisciplinary team in the intensive care ...unit.•Central line-associated blood stream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia rates declined 58.6%, 56.7%, and 82.6%, respectively, after bundle implementation.
A retrospective cohort study was conducted to evaluate the bundle of techniques developed by the multidisciplinary team to minimize infections in an adult intensive care unit over a 22-year span. Two periods were analyzed: 1996-2006 and 2007-2017. Bloodstream infections, urinary tract infections, and ventilator-associated pneumonia declined 58.6%, 56.7%, and 82.6%, respectively (P < .05) from 2007 to 2017 compared with these same infections during 1996-2006.
Secular trends of candidemia in a tertiary care hospital Sampaio Camargo, Thiago Zinsly, MD; Marra, Alexandre Rodrigues, MD, PhD; Silva, Claudia Vallone, RN ...
American journal of infection control,
09/2010, Letnik:
38, Številka:
7
Journal Article
Recenzirano
Background Candidemias account for 8% to 15% of hospital-acquired bloodstream infections. They have been associated with previous exposure to antimicrobials and are considered high-morbidity ...infections with high treatment costs. This study characterizes candidemias in a tertiary care hospital and assesses their incidence rates, clinical and microbiological features, and use of antifungals. Methods We assessed hospital-acquired candidemias in the period from January 1997 to July 2007 in a high-complexity private hospital. Results There were 151 cases of candidemia in 147 patients. The incidence rate was 0.74 episodes/1000 admissions. The mean age of the patients was 60 years (standard deviation ± 24.9), and the mean length of hospital stay before the blood culture identified candidemia was 40.9 days (standard deviation ± 86.3). The in-hospital mortality rate was 44.2%. C albicans was isolated in 44% (n = 67) of the cases, and no difference in mortality rates was found between species ( Candida albicans vs C non-albicans , P = .6). The average use of antifungals in the period was 104.0 defined daily dose/1000 patient-days. Conclusion We found a high mortality rate associated to candidemia events and an increasingly important role of Candida non- albicans . New approaches to health care-related infection control and to defining prophylactic and preemptive therapies should change this scenario in the future.
Background
Management of infections due to carbapenemase‐resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT‐SOT‐CPE score has ...been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking.
Methods
Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7‐year period. Primary endpoint was all‐cause 30‐day mortality from infection onset. A comparison between INCREMENT‐SOT‐CPE and other selected scores was performed. A two‐level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut‐point were calculated. Multivariable Cox regression analysis of risk factors for all‐cause 30‐day mortality was carried out.
Results
Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range IQR: 46–62) and 157 were males (62.8%). All‐cause 30‐day mortality was 35.6%. A sequential organ failure assessment (SOFA) score ≥ 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT‐SOT‐CPE ≥ 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT‐SOT‐CPE score ≥ 11 and SOFA score ≥ 11 were independently associated with all‐cause 30‐day mortality, while a tigecycline‐based targeted regimen was found to be protective.
Conclusions
Both INCREMENT‐SOT‐CPE ≥ 11 and SOFA ≥ 11 were identified as strong predictors of all‐cause 30‐day mortality in a large cohort of CRE carriers developing infection after LT.
We evaluated the prognostic role of the INCREMENT‐SOT‐CPE score, specifically developed from SOT recipients, and other main scores to stratify mortality risk. Our results suggest that both INCREMENT‐SOT‐CPE ≥ 11 and SOFA ≥ 11 are strong predictors of all‐cause 30‐day mortality in a cohort of CRE carriers developing infection after liver transplant.
Liver transplant seems to be an effective option to prolong survival in
patients with end-stage liver disease, although it still can be
followed by serious complications. Invasive fungal infections ...(ifi) are
related to high rates of morbidity and mortality. The epidemiology of
fungal infections in Brazilian liver transplant recipients is unknown.
The aim of this observational and retrospective study was to determine
the incidence and epidemiology of fungal infections in all patients who
underwent liver transplantation at Albert Einstein Israeli Hospital
between 2002-2007. A total of 596 liver transplants were performed in
540 patients. Overall, 77 fungal infections occurred in 68 (13%)
patients. Among the 77 fungal infections, there were 40 IFI that
occurred in 37 patients (7%). Candida and Aspergillus species were
the most common etiologic agents. Candida species accounted for 82% of
all fungal infections and for 67% of all IFI, while Aspergillus species
accounted for 9% of all fungal infections and for 17% of all IFI.
Non-albicans Candida species were the predominant Candida isolates.
Invasive aspergillosis tended to occur earlier in the post-transplant
period. These findings can contribute to improve antifungal prophylaxis
and therapy practices in Brazilian centres.
Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.
We identified the predominant ...pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).
In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.
In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Background
There is a paucity of information about Brazilian COVID‐19 in‐hospital mortality probability of death combining risk factors.
Objective
We aimed to correlate COVID‐19 Brazilian in‐hospital ...patients' mortality to demographic aspects, biomarkers, tomographic, echocardiographic findings, and clinical events.
Methods
A prospective study, single tertiary center in Brazil, consecutive patients hospitalized with COVID‐19. We analyzed the data from 111 patients from March to August 2020, performed a complete transthoracic echocardiogram, chest thoracic tomographic (CT) studies, collected biomarkers and correlated to in‐hospital mortality.
Results
Mean age of the patients: 67 ± 17 years old, 65 (58.5%) men, 29 (26%) presented with systemic arterial hypertension, 18 (16%) with diabetes, 11 (9.9%) with chronic obstructive pulmonary disease. There was need for intubation and mechanical ventilation of 48 (43%) patients, death occurred in 21/111 (18.9%) patients. Multiple logistic regression models correlated variables with mortality: age (OR: 1.07; 95% CI 1.02–1.12; p: 0.012; age >74 YO AUC ROC curve: 0.725), intubation need (OR: 23.35; 95% CI 4.39–124.36; p < 0.001), D dimer (OR: 1.39; 95% CI 1.02–1.89; p: 0.036; value >1928.5 ug/L AUC ROC curve: 0.731), C‐reactive protein (OR: 1.18; 95% CI 1.05–1.32; p < 0.005; value >29.35 mg/dl AUC ROC curve: 0.836). A risk score was created to predict intrahospital probability of death, by the equation: 3.6 (age >75 YO) + 66 (intubation need) + 28 (C‐reactive protein >29) + 2.2 (D dimer >1900).
Conclusions
A novel and original risk score were developed to predict the probability of death in Covid 19 in‐hospital patients concerning combined risk factors.
In‐hospital COVID 19 mortality.
Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. ...Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient's symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.
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