No abstract

Several factors are implicated in the increased vulnerability of multiple trauma victims to infection, especially in intensive care-units (ICU). This cohort study was designed to report the incidence, the topography, the etiology and to identify the risk factors for infection in trauma patients admitted in an ICU. From January 2000 to December 2001, 416 trauma patients were admitted to the ICU for more than 24 hours, the mean length of stay was 9.3 days (range 2-65) and 188 (45%) patients developed a total of 290 NI. The most prevailing infections were pneumonia (49%), bloodstream (19%) and urinary tract infections (12%). The variables studied were: the demographic data, diagnosis on admission, site and mechanism of injury, type and number of surgeries, use of invasive devices, days under mechanical ventilation (MV) and site and number of NI. These variables were analyzed with a univariable and multivariable regression analysis. The NI was associated with injury in more than 1 anatomic segment (OR=1.6; CI 95% 1.06-2.40); mechanical ventilation for more than 3 days (OR=12; CI 95% 6.87-24.02); more than 1 surgery (OR=3.13;CI 95% 1.75-5.65) and more than 2 invasive devices (OR=4.7; CI 95% 2.99-7.37). Deaths over the first 5 days had high association (RR=3.18) with NI. Three significant variables were identified in the logistic regression, which are: more than 3 days under MV, number of invasive devices and number of surgeries. Key-Words: Trauma, nosocomial infection, intensive care.The growing complexity of intensive care during recent decades has been accompanied by increased risk of nosocomial infection (NI) [1][2][3][4][5][6][7][8][9]. Patients with multiple traumas have increased survival, and several factors increased risk of NI too [10][11][12]. The interaction between victims of trauma and intensive care unit (ICU) is considered additive for morbidity, mortality, hospital days, and economic burden for both patient and hospital [13][14][15][16][17][18][19][20][21][22]. The objective of this study was to identify risk factors for NI in ICU. Materials and MethodsHospital do Trabalhador is a trauma referral center in Curitiba (Parana-Brazil).The UCI is a 10-bed unit with singlepatient rooms. Retrospective data was analysed (historical cohort study) from January 2000 tO December 2001. All 416 trauma patients who stayed for more than 24 hours at the ICU were included. Demographic data (age and gender), diagnosis on admission, sites and mechanism of injuries (blunt or penetrating injury), type and number of surgeries, use of invasive devices, days under mechanical ventilation, site and number of NI were recorded. Centers for Disease Control and Prevention's (CDC) [23,24] definitions of nosocomial infection (NI) were utilized. The data was analyzed using Mann-Whitney U Test. Categorical data was assessed using Chi-Square and Mantel-Haenszel Test and Comparison of 2 Proportions. Odds Ratio (OR) with 95% confidence interval was employed to measure the magnitude of association between the studied variables and NI. Logi...

Background: Viral meningoencephalitis is highly heterogeneous, varying by geographic location. The aim of this study was to characterize the etiology and reporting the clinical findings and outcome of viral encephalitis in children in southern Brazil. Methods: A cross-Sectional study was conducted at Hospital Pequeno Príncipe, Curitiba, Brazil, between January 2013 and December 2017. It included patients younger than 18 years, who fulfilled the criteria: altered mental status as a major criteria and 2 or more minor criteria (1) fever, (2) seizures, (3) focal neurologic findings, (4) central system fluid white cell count of ≥5 cells/mm3, (5) abnormal brain imaging, and/or (6) electroencephalogram abnormalities. Results: Viral meningoencephalitis was diagnosed in 270 children, with median age of 2 years (interquartile range: 0–4), The etiology of viral meningoencephalitis was confirmed in 47% of patients. Enterovirus (18%) was the major cause of encephalitis in Southern Brazilian children, and a high prevalence of Epstein-Barr virus (6%) was demonstrated. Most patients presented with fever (81%), followed by vomiting (50%), focal neurologic findings (46%), seizures (31%) and headache (30%). Few abnormalities were detected on electroencephalograms and brain magnetic resonance images. On discharge from hospital, symptoms resolved completely in 87% of children. Sequelae were mainly observed in patients with focal neurologic symptoms (P<0.001), presence of seizures (P<0.001) and electroencephalogram abnormalities (P=0.024). Conclusions: Enterovirus was the major cause of encephalitis. Etiologic agent of encephalitis seems to be influenced by the local virologic pattern. A poor outcome was identified in patients with seizures, focal neurologic findings and electroencephalogram abnormalities.

Background Although most enterovirus (EV) infections can be asymptomatic, these viral agents can cause serious conditions associated with central nervous system, respiratory disease and uncommon manifestations of hand, foot and mouth disease (HFMD). EV-coinfections have been rarely reported with development of complications and severe clinical outcome. An atypical case of a child presenting HFMD and severe acute respiratory syndrome, co-infected with EV-D68 and CVA6, is reported herein. Case presentation A 3-year-old boy was admitted in the emergency department unit showing fever, abdominal pain and tachycardia. Twenty-four hours after hospitalization the child developed severe clinical symptoms associated with HFMD and was discharged after recovery. Two days later, the child was readmitted with fever, cough and respiratory distress. RT-PCR and Sanger sequencing confirmed positivity for EV-D68 and CVA6 in oro and nasopharynges swabs and vesicles fluid, respectively. Phylogenetic analysis based on VP1 gene sequences suggested that CVA6 was closely related with HFMD viruses circulating in Turkey, while EV-D68 was genetically related to a Chinese strain. Conclusions To the best of our knowledge, this case is the first report of a double infection caused by CVA6 and EV-D68, which shed light on the pathogenesis of enterovirus infections. Further studies must be conducted to ascertain the role and clinical significance of EV co-infections, as well as a potential synergistic pathway between these viruses.

Background The Global Influenza Hospital Surveillance Network (GIHSN) was established in 2012 to conduct coordinated worldwide influenza surveillance. Here we describe underlying comorbidities, symptoms, and outcomes in hospitalized patients with influenza. Methods Between November/2018 and October/2019, GIHSN included 19 sites in 18 countries using a standardized surveillance protocol. Influenza infection was laboratory-confirmed with RT-PCR. A multivariate logistic regression model was utilized to analyze the extent to which various risk factors predict severe outcomes. Results Of 16,022 enrolled patients, 21,9% had laboratory-confirmed influenza; 49.2% of influenza cases were A/H1N1pdm09. Fever and cough were the most common symptoms, though they decreased with age (p &lt; 0.001). Shortness of breath was uncommon among those &lt;50 years but increased with age (p &lt; 0.001). Middle and older age and history of underlying diabetes or COPD were associated with increased odds of death and ICU admission, male sex and influenza vaccination were associated with lower odds. ICU admissions and mortality occurred across the age spectrum. Conclusions Both virus and host factors contributed to influenza burden. We identified age differences in comorbidities, presenting symptoms, and adverse clinical outcomes among those hospitalized with influenza, and benefit from influenza vaccination in protecting against adverse clinical outcomes. The GIHSN provides an ongoing platform for global understanding of hospitalized influenza illness.