Paulo Pinto Gontijo Filho

Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study

INTRODUCTION Report the incidence of nosocomial infections, causative microorganisms, risk factors associated with and antimicrobial susceptibility pattern in the NICU of the Uberlândia University Hospital. METHODS Data were collected through the National Healthcare Safety Network surveillance from January 2006 to December 2009. The patients were followed five times/week from their birth to their discharge or death. RESULTS The study included 1,443 patients, 209 of these developed NIs, totaling 293 NI episodes, principally bloodstream infections (203; 69.3%) and conjunctivitis (52; 17.7%). Device-associated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonias per 1000 ventilator-days. The mortality rate in neonates with NI was 11.9%. Mechanical ventilation, total parenteral nutrition, orogastric tube, previous antibiotic therapy, use of CVC and birth weight of 751-1,000g appeared to be associated with a significantly higher risk of NI (p < 0.05). In multiple logistic regression analysis for NI, mechanical ventilation and the use of CVC were independent risk factors (p < 0.05). Coagulase- negative Staphylococcus (CoNS) (36.5%) and Staphylococcus aureus (23.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and S. aureus were 81.8% and 25.3%, respectively. CONCLUSIONS Frequent surveillance was very important to evaluate the association of these well-known risk factors with NIs and causative organisms, assisting in drawing the attention of health care professionals to this potent cause of morbidity.

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. METHODS We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. RESULTS Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. CONCLUSIONS Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant.

Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit.

AIM We assessed late onset sepsis (LOS) rates of neonates in a neonatal intensive care unit (NICU) before and after implementing an evidence-based bundle to prevent these infections in a country with poor resources. METHODS We evaluate trends of LOS between October 2010 and August 2012 in a large tertiary hospital in Brazil. We designed a protocol based of CDC guidelines for insertion of maintenance of central venous catheter targeted to reduction of bloodstream infections. During this period two major events occurred: a great increase of LOS rates in January months and relocation of the unit to a provisory place. Additionally we evaluated the risk factors and etiology of these infections. RESULTS A total of 112 (20.3%) cases defined as LOS were found. The overall incidence rate of LOS in the study was 16.1/1000 patient/days and 23.0/1000 CVC-days. Our monthly rates data of LOS/1000 patient-day reveal fluctuations over the studied period, with incidence rates of these infections in staff vacation period (January 2011 and 2012) significantly higher (59.6/1000 patients-days) than compared with the other months rates (16.6/1000 patients-days) (IRR=3.59; p<0.001). As opposite, the incidence rates of LOS during relocation period was lower (10.3/1000 patients-days) when compared with baseline period 26.7/1000 patients-days (IRR=2.59; p=0.007). After the intervention period, these rates decreased in the post intervention period, when compared with preintervention 14.7/1000 patients-days and 23.4/1000 patients-days, respectively (IRR=1.59; p=0.04). CONCLUSION Through simple infection control measures, LOS can be successfully controlled especially in NICUs of limited resources countries such as ours.

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.

Analysis of the clonal diversity of Staphylococcus aureus methicillin-resistant strains isolated at João Pessoa, state of Paraíba, Brazil

To investigate the clonal diversity of Staphylococcus aureus strains isolated at João Pessoa, State of Paraíba, Brazil, digested genomic DNA were studied by pulsed-field gel electrophoresis (PFGE) in nine methicillin-resistant strains (MRSA) and three methicillin-sensitive strains (MSSA), selected among 67 isolates based on their antimicrobial susceptibility and epidemiology. The isolates were obtained between April and November 1992 from the Hospital of the Federal University of Paraíba, located in João Pessoa. Two MRAS isolates from the Oswaldo Cruz Hospital, São Paulo, Brazil, including an epidemic strain previously detected from different hospitals at the country were used as control. Five different patterns, were demonstrated by MRSA isolated in João Pessoa and these patterns were described in several epidemiologically unrelated hospitals in São Paulo. Our results suggest the interstate dissemination of a MRSA clone in João Pessoa which is similar to that described in other cities of Brazil.

Early-onset neonatal sepsis by Group B Streptococcus in a Brazilian public hospital

Despite the known efficacy of the intrapartum antibiotic prophylaxis (IAP),1 no Group B Streptococcus (GBS) prophylaxis program are in place in Brazil,2 and rates of early-onset sepsis (EOS) may be underestimated. We conducted a retrospective analysis on the incidence EOS, IAP use and outcomes of infants born in a Brazilian University Hospital (Hospital de Clínicas de Uberlândia, HC-U). An early-onset GBS sepsis episode was defined based on positive blood cultures in the first 72 h of postnatal life. Blood cultures for all newborn infants with suspected sepsis were performed by an automated system (Vitek 2 system BioMerieux, France). Maternal/infant demographic and clinical data were obtained from the medical records. The study was approved by the University Hospital Ethics Committee (protocol 394/09). From January 2008 to December 2011, there were 8818 live births. Among them, we identified eight infants with confirmed early-onset GBS sepsis. The overall incidence rate was 0.90 cases per 1000 live births. Infants’ characteristics and clinical outcomes are shown in Table 1. All neonates were born vaginally. The average hospital length of stay was eight days (range: 1–36 days). The case-fatality rate was 50% (4/8), occurring in the first four days of life. Out of four

AVALIAÇÃO DA ATIVIDADE ESTERILIZANTE DO PARAFORMALDEÍDO

Sporocidal activity of paraformaldehyde tahlests was assessed by means of the Association of Official Analytical Chemists technic which is required in Brazil to register this class of sanitizing substances by the Health Ministery. According to this methodology paraformaldehyde showed sterilizing activity at the 3% (3,0 g/cm3) concentration in 3 hour exposure period at 50 °C in the presence of relative humidity.