Carla Morales Guerra

Nosocomial Bloodstream Infections in Brazilian Hospitals: Analysis of 2,563 Cases from a Prospective Nationwide Surveillance Study

ABSTRACT Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. Data from a nationwide, concurrent surveillance study, Brazilian SCOPE (Surveillance and Control of Pathogens of Epidemiological Importance), were used to examine the epidemiology and microbiology of nBSIs at 16 Brazilian hospitals. In our study 2,563 patients with nBSIs were included from 12 June 2007 to 31 March 2010. Ninety-five percent of BSIs were monomicrobial. Gram-negative organisms caused 58.5% of these BSIs, Gram-positive organisms caused 35.4%, and fungi caused 6.1%. The most common pathogens (monomicrobial) were Staphylococcus aureus (14.0%), coagulase-negative staphylococci (CoNS) (12.6%), Klebsiella spp. (12.0%), and Acinetobacter spp. (11.4%). The crude mortality was 40.0%. Forty-nine percent of nBSIs occurred in the intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 622 patients (24.3%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (70.3%). Methicillin resistance was detected in 157 S. aureus isolates (43.7%). Of the Klebsiella sp. isolates, 54.9% were resistant to third-generation cephalosporins. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 55.9% and 36.8%, respectively, were resistant to imipenem. In our multicenter study, we found high crude mortality and a high proportion of nBSIs due to antibiotic-resistant organisms.

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

Background Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. Methods 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). Results 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. Conclusions 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.

How to educate health care professionals in developing countries? A Brazilian experience

E-learning is an important tool to bring health care professionals updated information, especially in a large, developing country like Brazil, where teaching resources are limited. It allows the exchange of experiences between professionals, promotes simultaneous knowledge acquisition by a large number of participants, and reaches some remote areas.

Perceptions and attitudes of the professional staff concerning infection surveillance and control programs in Brazilian hospitals

BACKGROUND Several countries have conducted studies to assess the status of their infection control programs (ICP) with the objective of improving quality of infection control practices. METHODS To assess the perceptions and attitudes of the health care workers (HCW) concerning ICP in Brazilian hospitals, we conducted a cross-sectional survey using a self-administered online questionnaire during a Web-based course (WBC) on infection control (IC) and antimicrobial resistance (AR). RESULTS Of 6256 Brazilian HCW registered for the WBC, 1998 were members of infection control committees (ICC) and answered the survey. Eight hundred six (40.4%) respondents said that an ICP was established for more than 10 years in their institutions. Most professionals reported that their hospitals perform microbiologic surveillance targeted at epidemiologically important multidrug-resistant organisms, but the majority underestimated the prevalence of AR. CONCLUSION Our survey highlights important information about the perceptions and attitudes of ICC members that may be used to tailor key interventions for implementing effective ICP. It suggests, additionally, that, to achieve countrywide standardized IC mechanisms in a developing country, authorities should consider the social, cultural, and economical disparities between regions and identify specific regional needs to make available the resources required to minimize such disparities.

Health Care-Related Infections in Solid Organ Transplants

The health care-related infections are well-known in a critical care setting, but reports of those infections in solid organ transplanted patients are scarce. We developed a study of retrospective cohort in a tertiary teaching hospital for 14 months. Eighty-one patients underwent solid organ transplants. The global incidence of health care-related infection was 42.0%. Fifteen percent of the cases were occurrences of surgical site infections, 14.0% pneumonias, 9.0% primary blood stream infections, 4.0% urinary tract infections and 2.0% skin infection. The most prevalent etiologic agents were K. pneumoniae (8.6%), P. aeruginosa (7.4%); A. baumannii (5.0%) and S. aureus (2.5%). Mortality was 18.0%, none of then related to health care infections. The high rate of those infections, mainly surgical site infections, suggests a demand for stricter measures to prevent and control health care-related infections.

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure (vol 9, e114548, 2014)

Hosp Univ Austral, Div Infect Dis Prevent & Infect Control Serv, Buenos Aires, DF, Argentina

Incidence and outcomes of infections in cardiac allograft recipients: A Brazilian perspective

To the Editor: Heart transplantation (HT) is an acceptable therapy for end-stage heart disease. Over the past 25 years, more than 80,000 procedures were performed worldwide with overall 5-year survival estimated at 70.0%. In Brazil, HT has been performed since 1984. The longterm results are comparable with those of European and US centers, despite regional and socioeconomic differences and the high proportion of patients with Chagas heart disease (ChD) included in the statistics. Despite many advances in transplantation medicine over this period, infectious complications (IC) influence long-term survival, and their prevention and treatment remain important medical challenges. Several factors appear to influence their incidence, including the degree of immune suppression, coinfection with immunomodulating pathogens, and the intensity of epidemiologic exposure. However, studies focusing on this issue cover only populations from Europe or North America. We assessed the incidence rates and risk factors for IC in 126 HT recipients older than 18 years, submitted to the procedure in a Brazilian hospital from 1986 and 2007, and who survived at least 48 hours. ICs were defined as severe sepsis or septic shock and infections of the central nervous system, surgical site, urinary tract, respiratory tract, myocardium, primary bloodstream and any cytomegalovirus infections or Trypanossoma cruzi reactivation. Of all patients, 78.6% were male, with mean age of 41.5 (SD 6 15); 34.9% had ChD. The cumulative incidence of infections was 1.4 episode/patient over 206 months of follow-up (SD 6 156). The main agents identified were Staphylococcus aureus, Trypanossoma cruzi, and gram-negative microorganisms. The allograft was the primarysite of infection in 10.0% of the cases, mainly by protozoa (Table 1). The risk factors identified were urgent mediastinum re-exploration (Reop) (odds ratio [OR], 11.45 [95% confidence interval (CI): 1.86-70.32]); ischemic cardiomyopathy [CAD], OR, 6.12 [95% CI: 1.0535.58]); and pretransplantation hemoglobin level<12.0 g/L (anemia) (OR, 4.35 [95% CI: 1.05-18.10]) (P < .05).