Gláucia Helena Martinho

Estudo comparativo do diagnóstico da infecção do sítio cirúrgico durante e após a internação

OBJETIVO: A infeccao do sitio cirurgico constitui um grave problema dentre as infeccoes hospitalares por sua incidencia, morbidade e mortalidade. Devido ao curto periodo de internacao, a maioria dessas infeccoes se manifesta apos a alta hospitalar, sendo subnotificada quando nao ha o seguimento do paciente cirurgico. Programas de vigilância especificos do paciente apos a alta sao considerados fundamentais para controlar as infeccoes. O objetivo do estudo foi determinar a incidencia de infeccao do sitio cirurgico e comparar sua frequencia durante a internacao e apos a alta. METODOS: Realizou-se um estudo epidemiologico, tipo coorte, em um hospital universitario, com acompanhamento durante o periodo de internacao e no seguimento pos-alta hospitalar, de 504 pacientes que se submeteram a cirurgia do aparelho digestivo no primeiro semestre de 2000. RESULTADOS: Das 504 cirurgias realizadas no periodo do estudo, 398 (79,0%) dos pacientes retornaram ao ambulatorio de egressos. Do total de infeccoes do sitio cirurgico diagnosticadas, a maioria (62,9%) foi notificada no ambulatorio de egressos, sendo 88,0% superficiais, e 67,0% notificadas ate o setimo dia apos a alta. CONCLUSOES: Comprovou-se a importância do seguimento pos-alta para a obtencao de dados fidedignos sobre as infeccoes do sitio cirurgico devido a manifestacao tardia na maioria dos casos, levando a subnotificacao quando o seguimento do paciente e realizado somente durante a internacao.

Nosocomial infections and bacterial resistance in patients from a Teaching Hospital Intensive Care Unit

The Intensive Care Units represent an important and indispensable part of the modern medicine, for offering services to critically sick patients, using specialized human resources and advanced technology. In this study it was aimed to determine the incidence of the nosocomial infection, its possible relationship with the occurrence of the colonization by resistant microorganisms, the main agents of that colonization, and the mortality rate in that unit. It was a prospective and descriptive study, from August 2005 to July 2006. The data were collected from medical records and consultation to the microbiologic database. The global infection rate was 23,8%, the colonization for resistant microorganisms contributed to the development of infection (RR=6,8 [4,8-9,6], p <0,05), the resistant pathogens more prevalent were Pseudomonas aeruginosa and Acinetobacter baumannii. The mortality rate was 10,8%, and of these, 23 patients (37,1%) died after the diagnosis of nosocomial infection. Those results reinforce the need of efforts addressed to the control of the infection and of the bacterial resistance, subsidizing reflections in front of the adoption of measures such as the use of individual protection equipments, the invasive procedures, the handwashing, and the permanent education of the multiprofissional assistance team.

Neutropenic patients and their infectious complications at a University Hospital

Objective The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. Methods A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. Results One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-risk had a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5) vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. Conclusion Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.

Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation

In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

Assessing the Influence of Different Comorbidities Indexes on the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in a Developing Country.

Although the application of Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) has enabled better prediction of transplant-related mortality (TRM) in allogeneic hematopoietic stem cell transplants (AHSCT), data from developing countries are scarce. This study prospectively evaluated the HCT-CI and the Adult Comorbidity Evaluation (ACE-27), in its original and in a modified version, as predictors of post-transplant complications in adults undergoing a first related or unrelated AHSCT in Brazil. Both bone marrow (BM) and peripheral blood stem cells (PBSC) as graft sources were included. We analyzed the cumulative incidence of granulocyte and platelet recovery, sinusoidal obstructive syndrome, acute and chronic graft-versus-host disease, relapse and transplant-related mortality, and rates of event-free survival and overall survival. Ninety-nine patients were assessed. Median age was 38 years (18–65 years); HCT-CI ≥ 3 accounted for only 8% of cases; hematologic malignancies comprised 75.8% of the indications for AHSCT. There was no association between the HCT-CI or the original or modified ACE-27 with TRM or any other studied outcomes after AHSCT. These results show that, in the population studied, none of the comorbidity indexes seem to be associated with AHSCT outcomes. A significantly low frequency of high-risk (HCT-CI ≥ 3) in this Brazilian population might justify these results.

Nosocomial infections and resistance microbian in Intensive Care Unit of a University Hospital - an epidemiological study

In the last decades it has been observed an increase in frequency on nosocomial infections by resistant microorganisms, especially in Intensive Care Units (ICU). This study aimed to determine main sites of nosocomial infections and prevalence of multidrug resistant microorganisms. An epidemiological and descriptive study was developed in an adult ICU of a University Hospital of Belo Horizonte, Minas Gerais, from January to December, 2004. Among the most prevalent nosocomial infections were pneumonia, urinary tract infections, and bloodstream infections. Among the resistant microorganisms prevailed Pseudomonas aeruginosa, Acinetobacter baumanii, MRSA, Klebsiella, Enterobacteriaceas and Serratia. As this study is still going on, we expect to determine temporal trends for resistant microorganisms related to nosocomial infections main sites.

Assessing the impact of ABO incompatibility on major allogeneic hematopoietic stem cell transplant outcomes: a prospective, single-center, cohort study

Background ABO blood group incompatibility between donor and recipient is associated with a number of immunohematological complications, but is not considered a major contraindication to allogeneic hematopoietic stem cell transplantation. However, available evidence from the literature seems to be conflicting as to the impact of incompatibility on overall survival, event-free survival, transplant-related mortality, graft-versus-host disease, and time to neutrophil and platelet engraftment. Methods This single-center, prospective, cohort study included patients with hematological malignancies who underwent a first allogeneic hematopoietic stem cell transplantation between 2008 and 2014. Patients receiving umbilical cord blood as the stem cell source were excluded from this analysis. The impact of ABO incompatibility was evaluated in respect to overall survival, event-free survival, transplant-related mortality, acute graft-versus-host disease and engraftment. Results A total of 130 patients were included of whom 78 (60%) were males. The median age at transplant was 36 (range: 2–65) years, 44 (33%) presented ABO incompatibility, 75 (58%) had acute leukemia, 111 (85%) had a related donor, 100 (77%) received peripheral blood hematopoietic stem cells as graft source and 99 (76%) underwent a myeloablative conditioning regimen. There was no statistically significant association between ABO incompatibility and overall survival, event-free survival, transplant-related mortality, grade II–IV acute graft-versus-host disease, neutrophil or platelet engraftment in multivariate analysis. Conclusion These results show that ABO incompatibility does not seem to influence these parameters in patients undergoing allogeneic hematopoietic stem cell transplantation.