Paulo Henrique Orlandi Mourão

Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates

OBJECTIVE To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (LCBI) in a Brazilian neonatal unit for progressive care (NUPC). METHODS This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset LCBI, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset LCBI, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS 50 patients with late onset LCBI were matched with 100 patients without late onset LCBI. In the group of patients with late onset LCBI, a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS Surgical procedures and CVC usage were significant risk factors for LCBI. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

Populational genetic data for 15 STR markers in the Brazilian population of Minas Gerais

Fifteen short tandem repeats (STR) markers were analyzed (TPOX, D2S1338, D3S1358, FGA, D5S818, CSF1PO, D7S820, D8S1179, TH01, vWA, D13S317, D16S539, D18S51, D19S433, and D21S11) in unrelated individuals undergoing paternity studies from Minas Gerais state, Brazil. Allele frequencies and statistical parameters for the 15 loci were calculated.

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

BACKGROUND Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041). CONCLUSIONS Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.

Clinical and microbiological characteristics of OXA-23- and OXA-143-producing Acinetobacter baumannii in ICU patients at a teaching hospital, Brazil

BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAb) is an important cause of nosocomial infections especially in intensive care units. This study aimed to assess clinical aspects and the genetic background of CRAb among ICU patients at a Brazilian teaching hospital. METHODS 56 critically ill patients colonized or infected by CRAb, during ICU stay, were prospectively assessed. Based on imipenem MIC≥4μg/mL, 28 CRAB strains were screened for the presence of genes encoding metallo-β-lactamases and OXA-type β-lactamases. The blaOXA-type genes were characterized by PCR using primers targeting ISAba-1 or -3. Genetic diversity of blaOXA-positive strains was determined by ERIC-PCR analysis. RESULTS Patients mean age (±SD) was 61 (±15.1), and 58.9% were male. Eighty-percent of the patients presented risk factors for CRAb colonization, mainly invasive devices (87.5%) and previous antibiotic therapy (77.6%). Thirty-three patients died during hospital stay (59.0%). Resistance to carbapenems was associated with a high prevalence of blaOXA-23 (51.2%) and/or blaOXA-143 (18.6%) genes. ERIC-PCR genotyping identified 10 clusters among OXA-producing CRAb. Three CRAb strains exhibited additional resistance to polymyxin B (MIC≥4μg/mL), whereas 10 CRAb strains showed tigecycline MICs>2μg/mL. CONCLUSIONS In this study, clonally unrelated OXA-123- and OXA-143-producing A. baumannii strains in ICU patients were strongly correlated to colonization with infected patients being associated with a poor outcome.

Current approaches to visceral leishmaniasis treatment in solid organ transplant recipients

ABSTRACT Introduction: The increasing number of transplants performed worldwide and the growing global mobility with migration and travel to and from developing countries and tropical areas are bringing new challenges for the management of transplant infectious diseases, previously less commonly seen, such as Leishmaniasis. However, in this scenario there is a lack of information and the current knowledge is based on a few studies. The selection of the most appropriate treatment depends on various factors, such as patient profile, Leishmania species, disease extent, drug availability, concomitant infections and previous treatments. Therapeutic options may include different formulations of amphotericin B, pentavalent antimonials, miltefosine and paromomycin, among others. These drugs can be used alone or in combination. Areas covered: This review is a practical guide for Visceral Leishmaniasis (VL) specific treatment in solid organ transplant recipients (SOT), including therapeutic options and assessment of therapy response. Expert commentary: The main challenges for treatment of leishmaniasis in SOT recipients are related to the duration of therapy, curative criteria and secondary prophylaxis. Immunosuppression dose reduction is often recommended, but such decisions must be made on an individual basis. At present, Liposomal Amphotericin B is the best choice for treatment and prophylaxis.

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients

To describe the profile of reported healthcare‐associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center.

The perception of the healthcare workers about the Hospital Infection Control Committee - an exploratory study

Introduction:The actions of the Infection Hospital Control Comitte (HICC) according to federal regulations 2616/98, are based essentially on the surveillance epidemiologic that makes possible the definition of guidelines’s prevention and control infection. However a high unrest for the health care workers refer the fact that during the health care they haven’t understood that the infection control is an ineherent aspect in their practice because of the risk in manipulation of organic matter, secretions and excretions, in addition to contact with microorganisms disseminated by differents route of transmission.Objective: to identify the perception of the healthcare workers team about the performance of Infection Hospital Control Committee (HICC). Methods: This is a descriptive study, completed in a hospital university of Belo Horizonte. A questionnaire was applied to 86 professionals (nurses, physicians and physiotherapists). Results: It was found that 88% of the professionals had knowledge of the meaning of the acronym HICC, 64% of them could identify a case of hospital infection, however just 48,8% had knowledge about the identification criterion of the resistant microorganisms. The lack of knowledge and commitment were the main cause for the low or not adhesion of control measures for hospital infection. In relation to the professional’s perception of the HICC, the majority considers it actively participative. Conclusion: this study has important contributions for the reflections of the practices of the healthcare workers team, as well as, for the HICCs think about yours strategic of the training and involvement with the hospital community.