Betina Brixner

What are the risk factors and agents responsible for bacterial infections in ICUs

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult and neonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted in adult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU, 58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulase negative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantly presented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) and Enterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but with infections caused by Gram positive cocci, mainly CNS. Palavras-chave: Hospital Infections. Risk factors. Bacterial infections. Intensive care units. *Department of Biology and Pharmacy, UNISC. Santa Cruz do Sul, RS, Brazil. E-mail: janerenner@unisc.br DOI: 10.15343/0104-7809.201842016176 INTRODUCTION Healthcare-associated infections (HAI) are public health problems, with impact on length of hospital stay, morbidity and mortality, and spending on therapeutic and diagnostic procedures. The repercussions for the patients, their families and the community in general, go from being absent from their jobs and social lives, to the consequent psychological, economic and social commitment1. In addition, infections with antimicrobial-resistant microorganisms has been increasing the attention of hospital infection control services. The impact of this infectious complication is translated as prolonged hospitalization, new admissions, increased costs, sequelae and death. There is no accurate estimate of the worldwide impact of these infections2. Critically ill patients hospitalized in Intensive Care Units (ICUs) are more vulnerable to nosocomial infection compared to other units, because of their high complexity in care and their high risk of infection. These patients are frequently exposed to risk factors such as immunosuppressive drugs, complex surgeries, broad spectrum antimicrobials, interaction with the health team, among others3. This means that although the number of patients in ICUs is smaller in comparison to the number of patients in other sectors, the infection rate is significantly higher4. Invasive therapies or diagnostic interventions, such as mechanical ventilation, invasive pressure monitoring, urinary catheterization and central venous catheterization, as well as a more debilitated state of health and prolonged hospitalization time contribute to this profile5. In a multidisciplinary context in the ICU environment, the approach of hospitalized patients colonized or infected with multiresistant bacteria has received special attention from Hospital Infection Control Committees (HICCs) in recent years6. Given the importance of the role of the HICC in a hospital, through this study we sought to outline a bacterial profile responsible for HAIs in the ICU of this university hospital. Moreover, we sought to W ha t a re th e ri sk fa ct or s an d ag en ts re sp on si bl e fo r b ac te ri al in fe ct io ns in IC U s? O M un do d a Sa úd e, S ão P au lo 20 18 ;4 2( 1) :6 176 62 verify if the function of the HICC, together with the clinical staff and assisting laboratory, is having an effect on the control of the number of HAIs. Evaluation studies of HAI are indispensable in that they share important information in the fight against this health problem. This study aimed to analyze the main predisposing factors and the prevalence of microorganisms in bacterial infections of patients hospitalized in the Adult and Neonatal ICUs of a university hospital in Vale do Rio Pardo RS.

FREQUÊNCIA DE EXACERBAÇÃO EM PACIENTES PORTADORES DE DPOC SUBMETIDOS A UM PROGRAMA DE REABILITAÇÃO PULMONAR

O objetivo deste estudo foi avaliar a frequencia de exacerbacao em pacientes diagnosticados com Doenca Pulmonar Obstrutiva Cronica (DPOC) submetidos em Programa de Reabilitacao Pulmonar (PRP) em hospital de ensino no interior do Rio Grande do Sul. Estudo transversal com 32 pacientes. A coleta de dados ocorreu em outubro de 2015, atraves do sistema computadorizado do hospital e banco de dados do PRP. A amostra foi estratificada em grupos, conforme o tempo de permanencia no PRP: menos de dois meses (G1), de dois a 12 meses (G2) e mais de 12 meses (G3).Verificou-se que 59,4% eram do sexo masculino com idade media de 63,5 anos (± 6,9). No G1, 50% dos pacientes exacerbaram, no G2, 65% e no G3, 37,5%. Os resultados demonstraram que portadores de DPOC que frequentaram o PRP por tempo superior a 12 meses apresentaram menor frequencia e menor intensidade de exacerbacao da doenca. Descritores: Reabilitacao; Doenca Pulmonar Obstrutiva Cronica; Exacerbacao dos Sintomas.

Formas utilizadas para tentativa de suicídio e características sociodemográficas de pacientes atendidos no serviço de emergência de um hospital de ensino

Aims: To assess the methods used in suicide attempts and sociodemographic characteristics of suicidal patients treated at the emergency department of a teaching hospital. Methods: Cross-sectional retrospective study, with active search for electronic medical records of patients treated at the emergency department of a public teaching hospital in the countryside of Rio Grande do Sul, Brazil, from January to December 2015. All cases of suicide attempt were included, regardless of the suicide methods used. Successful suicide cases were not investigated. The statistical analyses included descriptive statistics, univariate analysis, and Pearson’s chi-square test. Results: A total of 233 patients treated at the emergency department were referred for psychiatric evaluation, and 122 of them had attempted suicide. The mean age of the suicidal patients was 36.8±14.3 years, (minimum of 14 years and maximum of 88 years) and 74 (60.6%) of them were female. The most common suicide attempt methods were ingestion of medications (72 cases, 59%) and of pesticide (14 cases, 11.5%). Of all patients, 119 (97.5%) lived in Santa Cruz do Sul, predominantly in the urban area (103 patients, 84.4%). Of the 50 (41.0%) referrals, 32 (64.0%) were sent to the Center for Psychosocial Care, 7 (14%) to the Center for Children’s and Adolescents’ Psychosocial Care, 6 (12%) were admitted to a mental health unit, and 5 (10%) were sent to Psychosocial Care Center for Alcohol and Drug Abuse. Sixty-six (54.1%) patients had no electronic medical records of their outcome after discharge and 6 (4.9%) were lost to follow-up. Conclusions : Most of the treated suicidal patients were young adult females. The most common method of suicide attempt was the ingestion of medications, followed by the ingestion of pesticides.

ACOMPANHAMENTO FARMACOTERAPÊUTICO DE PACIENTES ATENDIDOS EM PRONTO ATENDIMENTO EM UM HOSPITAL DE ENSINO

O objetivo deste estudo foi identificar e quantificar o numero de intervencoes farmaceuticas realizadas durante o acompanhamento farmacoterapeutico de pacientes internados em unidade de Pronto Atendimento de um Hospital de ensino, de Marco a Maio de 2015, atraves do registro em planilhas eletronicas realizadas pelos farmaceuticos residentes apos avaliacao de prescricoes medicas. Foram avaliadas 278 prescricoes de 190 pacientes, 59% eram do sexo feminino. A media de idade foi 62,9 (±17,8) anos. Foram realizadas 52 intervencoes farmaceuticas, das quais 80,8% foram aceitas. Atraves das atividades clinicas busca-se garantir seguranca, detectando erros antes que impactem na qualidade da terapia medicamentosa do paciente. A aceitabilidade das intervencoes farmaceuticas encontradas indica a necessidade e importância da atuacao do farmaceutico clinico no âmbito hospitalar atuando junto a equipe de saude no cuidado do paciente, tanto no ponto de vista economico, quanto clinico, garantindo o uso racional de medicamentos, seguranca e qualidade do tratamento. Descritores: Intervencao/Farmaceuticos; Hospitalar.