Irna Carla do Rosário de Souza Carneiro

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.

Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

BACKGROUND Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Epidemiological, clinical and evolutionary aspects of tuberculosis among elderly patients of a university hospital in Belém, Pará

As alteracoes fisiologicas, principalmente as imunologicas, tornam o idoso mais vulneravel a infeccoes, como a tuberculose, doenca que nesse grupo apresenta especificidade tanto em sua apresentacao clinica quanto no seu manejo terapeutico. O objetivo consistiu em avaliar os aspectos epidemiologicos, clinicos e evolutivos da tuberculose em idosos em um Hospital Universitario de Belem – Para. Trata-se de um estudo do tipo coorte retrospectivo, realizado no Hospital Universitario Joao de Barros Barreto, onde foram analisados 82 prontuarios de casos de tuberculose em idosos diagnosticados no periodo de 2009 a 2013, e como forma complementar de obtencao de informacoes foi consultado o banco de dados do Sistema Nacional de Agravos de Notificacao da Secretaria de Estado de Saude Publica. Para a analise estatistica utilizou-se o programa eletronico Statistical Package for the Social Sciences(SPSS) versao 22.0, e aplicou-se oTeste G, admitindo-se nivel α=0,05 (5%) e valor de P≤0,05. O estudo foiaprovado peloComite de Etica e Pesquisa do Nucleo de Medicina Tropical sob Parecer no 1.081.347.A maioria dos idosos era do sexo masculino (n=53; 64,6%), com faixa etaria de 60-69 anos, tanto entre os homens (n=34; 64,2%) quanto entre as mulheres (n=13; 44,8%), sendo essa diferenca estatisticamente significativa (p=0,009), casos novos de tuberculose (n=78; 95,1%), apresentando forma clinica pulmonar (n=62; 75,6%), agravos associados (n=57; 69,5%) e tempo de internacao superior a 21 dias (n=38; 46,3%). A febre (n=55; 67,1%), dispneia (n=53; 64,6%), emagrecimento (n=50; 61,0%), tosse produtiva (n=49; 59,8%) e dor toracica (n=42; 51,2%) foram os principais sinais e sintomas evidenciados. Em relacao ao tratamento, houve elevado percentual de reacoes adversas (n=41; 50%), destacando-se as manifestacoes gastrointestinais (n=29; 70,7%). A maioria dos idosos evoluiu com cura (n=49; 59,8%), contudo ressalta-se que o obito por tuberculose foi consideravel no grupo estudado (n=13; 15,9%), ocorrendo principalmente no periodo de internacao ate 7 dias. Quanto as variaveis de exposicao e o desfecho por cura e obito por tuberculose, houve diferenca estatisticamente significativa na relacao das variaveis faixa de idade (p=0,017), tempo de internacao (p=0,000) e reacao adversa (p=0,018). Conclui-se que a apresentacao clinica e manejo terapeutico da tuberculose no idoso e diferenciado, por isso, faz-se necessario o fortalecimento de estrategias que propiciem a identificacao precoce dos idosos suspeitos de tuberculose na comunidade, o que deve ocorrer principalmente atraves da Atencao Basica.

Parapneumonic pleural effusion: reality and strategies in an Amazon university hospital

OBJECTIVE to define the profile and analyze the postoperative evolution of children with parapneumonic pleural effusion (PPE), and to evaluate strategies used in the presence of diagnostic and therapeutic limitations, emphasizing the open thoracic drainage (OTD) . METHODS we conducted a cross-sectional, prospective, analytical study in which we followed children admitted in an Amazon university hospital with surgically addressed PPE, from October 2010 to October 2011. RESULTS we studied 46 patients, most children under three years of age (74%), with no gender predominance. A significant portion of the sample (28%) had inappropriate body mass index. We found short stature in five patients (11%), which tended, in general, to a worst postoperative outcome when compared with children of normal height (p=0.039). The average duration of symptoms till admission was 16.9 days. Empyema was a common diagnosis in the first surgery (47.8%), and its bearers had longer duration of chest tube drainage (p=0.015). Most children (80.4%) were operated only once. The mean length of hospital stay was 25.9 days. Thoracic drainage (water-sealed) was the most common procedure (85%), with conversion to OTD in 24% of the sample, thoracotomy being rare (4%). There were no deaths. CONCLUSION the studied individuals often had advanced disease and nutritional disorders, affecting outcome. OTD remains a valid option for specific situations, and further studies are needed for confirmation.

Healthcare-associated infections among HIV-positive and HIV/AIDS-negative patients: a casuistic from the Amazonian Region

OBJETIVO: Investigar y comparar la incidencia de infecciones asociadas a los cuidados de la salud (IACS), involucrando a pacientes VIH y no VIH/SIDA. METODO: Estudio analitico, de observacion y prospectivo en la Enfermeria de Enfermedades Infecciosas del Hospital Universitario Joao de Barros Barreto en Belem, Estado de Para, Brasil. Pacientes: Internos, portadores de VIH y no VIH/SIDA, de febrero a diciembre de 2007, con monitoreo diario desde el ingreso hasta el alta hospitalaria. RESULTADOS: Durante el periodo de estudio, se relataron 20.276 pacientes/dia. De 1.130 pacientes con alta, 40 contrajeron IACS, y las IACS fueron mas frecuentes en los VIH-positivos (57,5%), con 29 (60,4%) episodios de IACS (p ≤ 0,05). Un total de 11 (55%) VIH-positivos presento conteo de celulas TCD4 < 100 celulas/mm3, y 15 (65,22%) VIH-positivos murieron de complicaciones asociadas con las IACS (p = 0,009). La infeccion mas frecuente fue la del trato urinario, asociada al uso de cateter urinario, 1.000 cateteres-dia en pacientes no VIH, con 12,11 episodios (p = 0,13). No obstante, los VIH-positivos presentaron neumonia mas frecuentemente, con 1,6 episodios en 1.000 pacientes-dia (p = 0,04). CONCLUSION: Las IACS presentan mas probabilidad de suceder en VIH-positivos, probablemente debido a sus condiciones de inmunidad, y ese riesgo, que esta asociado a procedimientos invasivos, justifica la necesidad de medidas preventivas

Caracterização fenotípica e genotípica de Serratia marcescens provenientes de Unidade Neonatal de Referência em Belém, Pará, Brasil

Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belém. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMérieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belem. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMerieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.

Phenotypic and genotypic characterization of Serratia marcescens from a Neonatal Unit in Belém, Pará State, Brazil

Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belém. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMérieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belem. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMerieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.

La caracterización fenotípica y genotípica de Serratia marcescens proveniente de la Unidad de Neonatología de Referencia de Belém (Pará, Brasil)

Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belém. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMérieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.Serratia marcescens has been reported as an important agent of health care-related infections and has been highlighted for presenting a high level of intrinsic resistance to antimicrobials used in neonatology, besides persisting in hospital environments for long periods. In this work, S. marcescens was recovered from colonies in the gastrointestinal tract or late sepsis in newborn infants hospitalized in a Neonatal Unit in Belem. The identification of S. marcescens and the sensitivity test was carried out using a Vitek (BioMerieux) automated system; susceptibility to ertapenem was assessed using e-test strips (Oxoid). Genotyping was executed by ERIC-PCR using the primers ERIC1 (5’-TGAATCCCCAGGAGCTTACAT-3’) and ERIC2 (5’-AAGTAAGTGACTGGGGTGAGCG-3’). Twenty-two strains of S. marcescens were recovered: 15 from hemocultures and seven from surveillance (rectal swab culture). All presented resistance to ampicillin, ampicillinsulbactam, gentamicin and cephalothin. There were no indications of resistance to ciprofloxacin, imipenem, meropenem or ertapenem. The susceptibility profiles varied for other antibiotics. Eleven amplification patterns by ERIC-PCR were obtained, and two were shared by 14 isolates. It was possible to observe a characteristic polymorphic pattern in the strains from gastrointestinal colonization, except for two cases, which presented genotypic patterns related to cases of sepsis. The data obtained in this work confirm the high level of resistance of S. marcescens against antimicrobials; however, all isolates displayed sensitivity to ciprofloxacin and carbapenemics. Antibiogram and ERIC-PCR typing suggest a dispersion of clones associated with colonization or sepsis among the wards of the Neonatal Unit in the surveyed hospital.