Rafael Souza da Silva

Nosocomial Infection in an Intensive Care Unit in a Brazilian University Hospital

This prospective study aimed to determine the nosocomial infection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fishers test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.

Infecção hospitalar em unidade de tratamento intensivo de um hospital universitário brasileiro

This prospective study aimed to determine the nosocomial infection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fishers test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.

Bacterial Resistance and Mortality in an Intensive Care Unit

Objetivou-se identificar fatores de risco para o desenvolvimento de infeccoes, relacionadas ao cuidar em saude, por microrganismos resistentes e a mortalidade dos pacientes em um centro de terapia intensiva. Trata-se de estudo epidemiologico prospectivo, realizado entre 2005 e 2008, envolvendo 2.300 pacientes. Utilizou-se estatistica descritiva, analise de regressao logistica bivariada e multivariada. Na analise bivariada, a infeccao por microrganismo resistente esteve significativamente associada a pacientes com infeccao comunitaria (p=0,03; OR=1,79) e colonizacao por microrganismo resistente (p<0,01; OR=14,22). Na analise multivariada, severidade clinica C (p=0,03; OR=0,25) e colonizacao por microrganismo resistente (p<0,01; OR=21,73) foram significativas. Para obitos, observou-se, como fator de risco: tipo de paciente, severidade clinica e uso de ventilacao mecânica. A constatacao da relacao entre microrganismo resistente e obitos evidencia a necessidade de monitorizacao da adesao as medidas de controle de infeccao, no sentido de melhorar a qualidade da assistencia e, sobretudo, a sobrevida de pacientes criticos.The goal was to identify risk factors for healthcare-associated infections by resistant microorganisms and patient mortality in an Intensive Care Unit. A prospective and descriptive epidemiological research was conducted from 2005 till 2008, involving 2300 patients. Descriptive statistics, bivariate and multivariate logistic regression analysis were used. In bivariate analysis, infection caused by resistant microorganism was significantly associated to patients with community-acquired infection (p=0.03; OR=1.79) and colonization by resistant microorganism (p<0.01; OR=14.22). In multivariate analysis, clinical severity (p=0.03; OR=0.25) and colonization by resistant microorganism (p<0.01; OR=21.73) were significant. Mortality was associated to the following risk factors: type of patient, average severity index, besides mechanical ventilation. The relation between resistant microorganisms and death shows the need to monitor adherence to infection control measures so as to improve care quality and mainly survival of critical patients.

Resistência bacteriana e mortalidade em um centro de terapia intensiva

Objetivou-se identificar fatores de risco para o desenvolvimento de infeccoes, relacionadas ao cuidar em saude, por microrganismos resistentes e a mortalidade dos pacientes em um centro de terapia intensiva. Trata-se de estudo epidemiologico prospectivo, realizado entre 2005 e 2008, envolvendo 2.300 pacientes. Utilizou-se estatistica descritiva, analise de regressao logistica bivariada e multivariada. Na analise bivariada, a infeccao por microrganismo resistente esteve significativamente associada a pacientes com infeccao comunitaria (p=0,03; OR=1,79) e colonizacao por microrganismo resistente (p<0,01; OR=14,22). Na analise multivariada, severidade clinica C (p=0,03; OR=0,25) e colonizacao por microrganismo resistente (p<0,01; OR=21,73) foram significativas. Para obitos, observou-se, como fator de risco: tipo de paciente, severidade clinica e uso de ventilacao mecânica. A constatacao da relacao entre microrganismo resistente e obitos evidencia a necessidade de monitorizacao da adesao as medidas de controle de infeccao, no sentido de melhorar a qualidade da assistencia e, sobretudo, a sobrevida de pacientes criticos.The goal was to identify risk factors for healthcare-associated infections by resistant microorganisms and patient mortality in an Intensive Care Unit. A prospective and descriptive epidemiological research was conducted from 2005 till 2008, involving 2300 patients. Descriptive statistics, bivariate and multivariate logistic regression analysis were used. In bivariate analysis, infection caused by resistant microorganism was significantly associated to patients with community-acquired infection (p=0.03; OR=1.79) and colonization by resistant microorganism (p<0.01; OR=14.22). In multivariate analysis, clinical severity (p=0.03; OR=0.25) and colonization by resistant microorganism (p<0.01; OR=21.73) were significant. Mortality was associated to the following risk factors: type of patient, average severity index, besides mechanical ventilation. The relation between resistant microorganisms and death shows the need to monitor adherence to infection control measures so as to improve care quality and mainly survival of critical patients.

Epidemiology and nosocomial infection control in a pediatric unit

This research aimed at determining the pediatric patients profile at a SchoolHospital, according to the variables sex, age, patients lenght-of stay, colonizing/infecting microorganisms, nosocomial infections (NI) and patiens outcomes. This was a prospective and descriptive epidemiological study developed in 2006 to which a database was developed in the SPSS program so as to type datas and analysed them afterwards. It was identified 668 patients, from whom, 53,7% were male, global avarage age was 5,1 years old and lenght-of-stay avarage was 10,1 days. It was colonized by resistant microorganisms 4,2% of the patients and 7,5% developed NI, being sepsis them most recurrent and Staphylococcus epidermides and Cândida albicans the most evident microorganisms. There were 98,5% of discharge and 1,5% of deaths. This study reinforces the needing for continuous/active NI surveillance programes and the identification of (re) emergence of resistant bacterias so as to direct NI prevention and controle measures by those microorganisms. Descriptors: nosocomial infections; pediatrics; resistance; drug; children.

Infección hospitalaria en unidad de tratamiento intensivo de un hospital universitario brasileño

This prospective study aimed to determine the nosocomial infection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fishers test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.

Resistencia bacteriana y mortalidad en un Centro de Terapia Intensiva

Objetivou-se identificar fatores de risco para o desenvolvimento de infeccoes, relacionadas ao cuidar em saude, por microrganismos resistentes e a mortalidade dos pacientes em um centro de terapia intensiva. Trata-se de estudo epidemiologico prospectivo, realizado entre 2005 e 2008, envolvendo 2.300 pacientes. Utilizou-se estatistica descritiva, analise de regressao logistica bivariada e multivariada. Na analise bivariada, a infeccao por microrganismo resistente esteve significativamente associada a pacientes com infeccao comunitaria (p=0,03; OR=1,79) e colonizacao por microrganismo resistente (p<0,01; OR=14,22). Na analise multivariada, severidade clinica C (p=0,03; OR=0,25) e colonizacao por microrganismo resistente (p<0,01; OR=21,73) foram significativas. Para obitos, observou-se, como fator de risco: tipo de paciente, severidade clinica e uso de ventilacao mecânica. A constatacao da relacao entre microrganismo resistente e obitos evidencia a necessidade de monitorizacao da adesao as medidas de controle de infeccao, no sentido de melhorar a qualidade da assistencia e, sobretudo, a sobrevida de pacientes criticos.The goal was to identify risk factors for healthcare-associated infections by resistant microorganisms and patient mortality in an Intensive Care Unit. A prospective and descriptive epidemiological research was conducted from 2005 till 2008, involving 2300 patients. Descriptive statistics, bivariate and multivariate logistic regression analysis were used. In bivariate analysis, infection caused by resistant microorganism was significantly associated to patients with community-acquired infection (p=0.03; OR=1.79) and colonization by resistant microorganism (p<0.01; OR=14.22). In multivariate analysis, clinical severity (p=0.03; OR=0.25) and colonization by resistant microorganism (p<0.01; OR=21.73) were significant. Mortality was associated to the following risk factors: type of patient, average severity index, besides mechanical ventilation. The relation between resistant microorganisms and death shows the need to monitor adherence to infection control measures so as to improve care quality and mainly survival of critical patients.