Fernando Gatti de Menezes

Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: Risk factors and mortality

OBJECTIVES The aim of this study was to evaluate the risk factors and attributable mortality associated with imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in a medical-surgical intensive care unit (ICU). METHODS A retrospective case-control study was carried out at a 16-bed medical-surgical ICU in a 780-bed, university-affiliated hospital. All patients admitted from January 1, 2003, to December 31, 2004, who had nosocomial infection caused by IRPA, were included in the study. RESULTS Imipenem-resistant P. aeruginosa was recovered from 63 patients during the study period. One hundred eighty-two controls were matched with cases by period of admission, age, and time at risk. Urinary tract (34.9%) and respiratory tract (22.2%) were the main sources of IRPA isolation. In multivariate analysis, a previous stay in the ICU (odds ratio, 3.54; 95% confidence interval [CI], 1.29-9.73; P = .03) was the only independent risk factor for IRPA infection. The in-hospital mortality rate among case patients was 49% (31 of 63) compared with 33% (61 of 182) for control patients (odds ratio, 1.92; 95% CI, 1.07-3.44; P = .02). Thus, we had an attributable mortality of 16% (95% CI, 9.74%-22.3%; P = .03). CONCLUSIONS Our study suggests that IRPA infections are strongly related to previous ICU stay, and that IRPA infections significantly increase mortality in those critical patients.

Persistence of Zika Virus in Breast Milk after Infection in Late Stage of Pregnancy

We detected Zika virus in breast milk of a woman in Brazil infected with the virus during the 36th week of pregnancy. Virus was detected 33 days after onset of signs and symptoms and 9 days after delivery. No abnormalities were found during fetal assessment or after birth of the infant.

Risk Factors for Surgical Site Infection in Kidney Transplant Recipients

We analyzed the epidemiologic characteristics and risk factors for surgical site infection (SSI) in kidney transplant recipients. From among 1,939 kidney transplant recipients, 120 with corresponding control subjects were evaluated in this study (1:1 ratio). Reoperation, chronic glomerulonephritis, acute graft rejection, delayed graft function, diabetes, and high body mass index were identified in the analysis as risk factors for SSI.

What is the impact of surgical site infection on graft function in kidney transplant recipients

F.G. Menezes, S.B. Wey, C.A. Peres, J.O. Medina‐Pestana, L.F.A. Camargo. What is the impact of surgical site infection on graft function in kidney transplant recipients?
Transpl Infect Dis 2010: 12: 392–396. All rights reserved

Risk factors for mortality in ventilator-associated tracheobronchitis: a case-control study

RESUMO Objetivo Descrever as caracteristicas microbiologicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada a ventilacao mecânica em um estudo caso-controle de pacientes de terapia intensiva. Metodos Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva medico-cirurgica de 40 leitos, em um hospital privado e de nivel terciario em Sao Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissao de Controle de Infeccao Hospitalar. O Grupo Controle foi [...]

Subclinical Propionibacterium acnes infection estimation in the intervertebral disc (SPInE-ID): protocol for a prospective cohort

Introduction Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. Methods and analysis An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume. Ethics and dissemination This study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs. Trials registration number NCT0315876; Pre-results.

Multiple interventions in a postanesthesia care unit: Impact on hand hygiene compliance

Hand hygiene (HH) is an important patient safety measure in the postanesthesia care unit (PACU) to prevent health care–associated infections (HCAIs),1,2 but studies about PACU’s HH compliance are rare.1 In our hospital, the PACU’s HH compliance was much lower than in other units, even though the World Health Organization (WHO) Multimodal HH Improvement Strategy3 has been applied since 2008. We conducted a prospective, interventional quasiexperimental study in 2 PACUs totaling 25 beds of the surgical center of a private, tertiary, 600-bed hospital in São Paulo, Brazil, which was performing 3,000 surgeries per month. This study was approved by the ethics and research committee and carried out in 3 phases: preintervention (PI) (July 2013), intervention (PII) (July 2014), and postintervention (PIII) (September 2014). We aimed to evaluate if multiple interventions in the workplace focusing on the PACU’s team and activities could increase HH compliance. HH compliance was measured using the WHO direct observation method at 5 moments (1: before touching a patient; 2: before a clean-aseptic procedure; 3: after contact with body fluids; 4: after touching a patient; and 5: after touching patient surroundings)4 by a trained and validated infection preventionist nurse (IPN) in the morning and afternoon shifts. We used a minimum of 200 opportunities of HH,4 which were considered compliant if the technique was correct. To assess the interventions’ impact on HH compliance, the χ2 test was used, and the statistical significance was 2-sided with a significance level set at 0.05. The actions and results of the 3 phases are subsequently presented. In PI, 27 health care workers (HCWs), including 14 nurse technicians, 3 nurses, and 10 physicians, answered the WHO questionnaires about HH and HCAI knowledge and perception. The number of correct answers by the HCWs for the questions about HH and HCAI knowledge are as follows: (1) the main route of crosstransmission of microorganisms between patients in a health care facility (21 HCWs; 77.8%); (2) the minimal time needed for alcoholbased handrub (ABHR) is 20 seconds (20 HCWs; 74.1%) and (3) ABHR is more effective against germs than handwashing with soap (11 HCWs; 40.7%). The answers for the questions about HH perceptions can be seen in Table 1. HH practices were observed for 1 week, and overall compliance was 40.2% (99/246) (Table 2). In PII, IPN conducted 4 focus group sessions with HCWs to identify and discuss HH barriers, and forgetfulness and high work demands were the main reasons for low HH compliance. One week later, a 7-minute educational video showing 5 moments in the PACU was presented in loco to all HCWs, and immediate HH feedback was given during direct observation for 1 week. There was a significant HH compliance increase from PI (40.2%) to PII (74.3%) (P < .001). Better HH compliance was achieved by nurse technicians (86.6%) and nurses (82.7%), and at moments 2 (93.3%), 3 (100.0%), and 4 (81.0%). There were 52 episodes of feedback in 202 opportunities (25.7%) (Table 2). In PIII, we achieved an overall HH compliance of 49.3% (101/ 205). From PI to PIII, there was an increase of 22.6% in HH compliance (P = .06). Nurses achieved higher HH compliance with an increase of 70.8% (43.9% to 75%), nurse technicians’ HH compliance was 54.5% with an increase of 6% (51.4% to 54.5%), and physicians had an increase of 75.5% (10.2% to 17.9%) and the least use of ABHR (40%) compared with nurses (94.4%) and nurse technicians (100%). Moments 3 (66.7%), 4 (56.3%), and 1 (54.1%) had better HH compliance (Table 2). We have not confirmed our hypothesis that multiple interventions aimed at PACU activities and teams could improve HH compliance. According to Pittet et al,1 PACU HH compliance is a highly complex and challenging issue considering its patient flow and high number of procedures and contacts between HCWs and patients, which leads to a high risk of cross-contamination. They have also found lower HH compliance in the PACU at patient admission (19.6%) and after patient admission (12.5%), and a lower use of ABHR of 79.0%,1 compared with our data. Table 1 HCW perception answers about HH in the postanesthesia care unit (N = 27), 2013