Health care associated infections (HAIs) are currently among the major challenges to the care of hematopoietic stem cell transplantation (HSCT) patients. The objective of the present study was to evaluate the impact of 2% chlorhexidine (CHG) bathing on the incidence of colonization and infection with vancomycin-resistant Enterococcus (VRE), multidrug-resistant (MDR) gram-negative pathogens, and to evaluate their CHG minimum inhibitory concentration (MIC) after the intervention.A quasi-experimental study with duration of 9 years was conducted. VRE colonization and infection, HAI rates, and MDR gram-negative infection were evaluated by interrupted time series analysis. The antibacterial susceptibility profile and mechanism of resistance to CHG were analyzed in both periods by the agar dilution method in the presence or absence of the efflux pump inhibitor carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) and presence of efflux pumps (qacA/E, qacA, qacE, cepA, AdeA, AdeB, and AdeC) by polymerase chain reaction (PCR).The VRE colonization and infection rates were significantly reduced in the postintervention period (P = 0.001). However, gram-negative MDR rates in the unit increased in the last years of the study. The CHG MICs for VRE increased during the period of exposure to the antiseptic. A higher MIC at baseline period was observed in MDR gram-negative strains. The emergence of a monoclonal Pseudomonas aeruginosa clone was observed in the second period.Concluding, CHG bathing was efficient regarding VRE colonization and infection, whereas no similar results were found with MDR gram-negative bacteria.
We described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem
cell transplantation (HSCT) outpatients and evaluated risk factors for
hospitalization and death. Records of outpatients presenting with positive blood
cultures over a 5-year period (January 2005 to December 2008) were reviewed.
Variables with p< 0.1 in bivariate analysis were used in a regression
logistic model. A total of 266 agents were identified, being 175 (66.7%)
gram-negative, 80 (30.3%) gram-positive bacteria and 9 (3.4%) fungi. The most
common underlying disease was acute leukemia 40 (27.4%), followed by lymphoma
non-Hodgkin 26 (18%) and 87 patients (59.6%) were submitted to allogeneic
hematopoietic stem cell transplant (HSCT). BSI episodes were more frequent
during the first 100 days after transplantation (183 or 77.8%), and ninety-one
(38.7%) episodes of BSI occurred up to the first 30 days. Hospitalization
occurred in 26% of the episodes and death in 10% of cases. Only autologous HSCT
was protector for hospitalization. Although, central venous catheter (CVC)
withdrawal and the Multinational Association of Supportive Care in Cancer
(MASCC) score up to 21 points were protector factors for death in the bivariate
analysis, only MASCC remained as protector.
OBJECTIVE To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model. DESIGN Before-after trial with a 44-week baseline period and 24-week intervention period. SETTING Medical intensive care unit of a tertiary care teaching hospital. PARTICIPANTS All patients admitted to the unit. METHODS We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted. RESULTS The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0-2.1). CONCLUSIONS The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention. Infect Control Hosp Epidemiol 2016;1-8.
Background:Among the anastomoses of the gastrointestinal tract, those of the esophagus
are of special interest due to several anatomical or even general
peculiarities. Aim:Evaluate retrospectively the results comparing mechanical vs. manual suture
at cervical esophagogastric anastomosis in megaesophagus treatment. Methods:Were included 92 patients diagnosed with advanced megaesophagus with clinical
conditions to undergo the surgery. All underwent esophageal mucosectomy,
performing anastomosis of the esophagus stump with the gastric tube at the
cervical level. In order to make this anastomosis, the patients were divided
into two groups: group A (n=53) with circular mechanical suture, lateral
end; group B (n=39) with manual suture in two sides, lateral end. In the
postoperative period, an early evaluation was performed, analyzing local and
systemic complications and late (average 5.6 y) analyzing deglutition. Results:Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in
group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of
esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group
B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%)
in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6
(15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the
patients presented the criteria 4 and 5 from SAEED, expressing effective
swallowing mechanisms without showing significant differences among the
groups. Conclusion:Cervical esophagogastric anastomosis by means of mechanical suture is more
proper than the manual with lower incidence of local complications and, in
the long-term evaluation, regular deglutition was acquired in both suture
techniques in equal quality.
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