BackgroundThe Centers for Disease Control and Prevention (CDC) proposed standard definitions for acquired resistance in bacterias. Resistant bacteria were categorized as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). This study describes the incidence of Gram-negative MDR, XDR and PDR in 12 private and adult intensive care units (ICU’s) from Belo Horizonte, Minas Gerais, the sixth most populated city in Brazil, with approximately 3 million inhabitants.MethodsData were collected between January/2013 to December/2017 from 12 ICU’s. The hospitals used prospective healthcare-associated infections (HAI) surveillance protocols, in accordance to the CDC. Antimicrobial resistance from six Gram-negatives, causing nosocomial infections, were evaluated: Acinetobacter sp., Klebsiella sp., Proteus sp., Enterobacter sp., Escherichia coli, and Pseudomonas sp.. We computed the three categories of drug-resistance (MDR+XDR+PDR) to define benchmarks for the resistance rate of each Gram-negative evaluated. Benchmarks were defined as the superior limits of 95% confidence interval for the resistance rate.ResultsAfter a 5 year surveillance, 6,242 HAI strains were tested: no pandrug-resistant bacteria (PDR) was found. Acinetobacter sp. was the most resistant Gram-negative: 206 strains from 1,858 were XDR (11%), and 1,638 were MDR (88%). Pseudomonas sp.: 41/1,159 = 3.53% XDR; 180/1,159 = 15.53% MDR. Klebsiella sp.: 2/1,566 = 0,1% XDR; 813/1,566 = 52% MDR. Proteus sp.: 0/507 = 0% XDR; 163/507 = 32% MDR. Enterobacter sp.: 0/471 = 0% XDR; 148/471 = 31% MDR. Escherichia coli: 0/681 = 0% XDR; 157/681 = 23% MDR. Benchmarks for the global resistance rate of each Gram-negative (MDR+XDR+PDR): Acinetobacter sp. = 92%; Klebsiella sp. = 62%; Proteus sp. = 40%; Enterobacter sp. = 48%; Escherichia coli = 33%; Pseudomonas sp. = 30%.ConclusionThis study has calculated the incidence of Gram-negative MDR, XDR and PDR, and found a higher incidence of MDR Acinetobacter sp., with an 88% multiresistance rate. Henceforth, developing countries healthcare institutions must be aware of an increased risk of infection by Acinetobacter sp.. Benchmarks have been defined, and can be used as indicators for healthcare assessment. Disclosures All authors: No reported disclosures.
Objective: To determine whether the SEIR model, associated to mobility changes parameters, can determine the likelihood of establishing control over an epidemic in a city, state or country. Study design and setting: The critical step in the prediction of COVID-19 by a SEIR model are the values of the basic reproduction number (R0) and the infectious period, in days. R0 and the infectious periods were calculated by mathematical constrained optimization, and used to determine the numerically minimum SEIR model errors in a country, based on COVID-19 data until April 11th. The Community Mobility Reports from Google Maps (<https://www.google.com/covid19/mobility>) provided mobility changes on April 5th compared to the baseline (Jan 3th to Feb 6th). The data was used to measure the non-pharmacological intervention adherence. The impact of each mobility component was calculated by logistic regression models. COVID-19 control was defined by SEIR model R0<1.0 in a country. Results: The ECDC has registered 1,653,204 COVID-19 worldwide on April 11th. Sixteen countries presented 78% of all cases. Of the six Google Maps mobility parameters, the “Stay at home” parameter was the strongest one to control COVID-19 in a country: an increase of 50% in mobility trends for places of residence has a 99% chance of outbreak control. Conclusions: Residential mobility restriction presented itself as the most effective measure. The SEIR model associated with mobility parameters proved to be a useful tool in determining the chance of COVID-19 outbreak control.
Introdução: O câncer de pele é o mais incidente no Brasil e no mundo. O principal fator de risco é a exposição à radiação ultravioleta (UV), que causa dano ao DNA celular e reduz moléculas supressoras. O tipo não melanoma se divide em carcinomas basocelular (CBC) e espinocelular (CEC), sendo o primeiro mais comum e menos agressivo. O CBC ocorre em áreas expostas ao sol e é mais frequente em homens brancos, > 40 anos. Apresenta-se como placas eritematosas ou nódulos de crescimento lento e de bordas mal demarcadas. O CEC resulta da radiação solar acumulada, podendo surgir a partir de lesões não invasivas, como ceratoses actínicas. Sua maior gravidade deve-se à possibilidade de apresentar metástases. Já o melanoma é caracterizado pela assimetria da lesão e evolução progressiva. Mesmo que menos frequente, é a forma mais grave da doença, pois há alto potencial de metástases. Seu prognóstico pode ser bom, se detectado na fase inicial. Grande parte das neoplasias de pele são identificadas pelo paciente, devendo este ser encaminhado para avaliação de um dermatologista ou cirurgião, que poderão solicitar uma biópsia e definição terapêutica. A cirurgia com margens livres é o tratamento mais indicado. A radioterapia e a quimioterapia podem ser utilizadas. O câncer de pele pode ser prevenido, sendo importante que a população esteja engajada em adotar comportamentos de proteção e que os profissionais de saúde realizem uma avaliação integral do paciente. O objetivo do estudo é apresentar os panoramas do câncer de pele no Brasil. Metodologia: estudo de revisão integrativa da literatura nas bases de dados PubMed e SCIELO, com os descritores: “skin neoplasm" e “tumores da pele”. Foram selecionados 19 artigos publicados a partir de 2010. Discussão: Diante da visualização de lesões cutâneas de aspecto suspeito, a dermatoscopia é uma alternativa. O diagnóstico pode ser aventado de forma clínica pelos especialistas da área, mas a confirmação histológica e a avaliação do subtipo tumoral apenas é feita mediante a realização da biópsia. O tratamento é definido de acordo com o risco de recorrência do tumor em associação às preferências do paciente. A cirurgia micrográfica de Mohs baseia-se em uma avaliação circunferencial completa da margem profunda e periférica. Já quando o quadro trata-se de um CBC de baixo risco, é feita a excisão ampla do local da ferida. Em situações de tumor de alto grau pode-se lançar mão de estratégias, como curetagem e eletrodissecção, imiquimode, terapia fotodinâmica, 5-fluorouracil (5-FU) tópico e radioterapia. O tratamento do melanoma é baseado no estadiamento. A biópsia de linfonodo sentinela pode ser necessária, assim como a terapia adjuvante, com imunoterápicos ou radioterapia. Sabe-se que pacientes com pele clara, efélides (sardas) ou que apresentam queimadura após curto período de exposição solar, devem minimizar a exposição à radiação ultravioleta (UV), a fim de eliminar esse fator de risco. O uso de filtro solar e a redução da exposição ao sol devem ser popularizados. É imprescindível que sejam utilizados artifícios e estratégias para reduzir a incidência dessa doença no cenário brasileiro, a fim de poupar gastos públicos. Conclusão: O câncer de pele é um problema de saúde pública no Brasil e em todo o mundo. A incidência da doença vem aumentando ao longo dos anos e é importante que a população esteja ciente da necessidade de prevenção e diagnóstico precoce.
Background A Ventriculoperitoneal shunt is the main treatment for communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and an expressive cause of morbidity and mortality of the treatment. The objective of our study is to answer three questions: a)What is the risk of meningitis after ventricular shunt operations? b) What are the risk factors for meningitis? c) What are the main microorganisms causing meningitis? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing ventricular shunt operations between 2015/Jul and 2018/Jun from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Sample size = 926. 26 variables were evaluated by univariate and multivariate analysis (logistic regression). Results 71 patients were diagnosed with meningitis which represent a risk of 7.7% (C.I.95%= 6.1%; 9.6%). From the 26 variables, three were acknoleged as risk factors: age < two years old (OR = 3.20; p < 0.001), preoperative hospital length of stay > four days (OR = 2.02; p = 0.007) and more than one surgical procedure (OR = 3.23; p = 0.043). Patients two or more years old, who had surgery four days after hospital admission, had increased risk of meningitis from 4% to 6% (p = 0.140). If a patient < two years had surgery four days post hospital admission, the risk is increased from 9% to 18% (p = 0.026). 71 meningitis = > 45 (63%) the etiologic agent identified: Staphylococcus aureus (33%), Staphylococcus epidermidis (22%), Acinetobacter sp (7%), Enterococcus sp (7%), Pseudomonas sp (7%), and other (18%). Hospital length of stay in non-infected patients (days): mean = 21 (sd = 28), median = 9; hospital stay in infected patients: mean = 34 (sd = 37), median = 27 (p=0.025). Mortality rate in patients without infection was 10% while hospital death of infected patients was 13% (p=0.544). Conclusion Two intrinsic risk factors for meningitis post ventricular shunt, age under two years old and multiple surgeries, and one extrinsic risk factor, preoperative length of hospital stay, were identified. Incidence of meningitis post VP shunt decreases with urgent surgical treatment. Disclosures All Authors: No reported disclosures
Background: The ventriculoperitoneal shunt is the main procedure used for to treat communicating hydrocephalus. Surgical site infection associated with the shunt device is the most common complication and a cause of morbidity and mortality of related to the treatment. We sought to answer 3 questions: (1) What is the risk of meningitis after ventricular shunt operations? (2) What are the risk factors for meningitis? (3) What are the main microorganisms causing meningitis? Methods: We conducted a retrospective cohort study of patients undergoing ventricular shunt operations between July 2015 and June 2018 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the CDC NHSN. Our sample size was 926, and we evaluated 26 preoperative and operative variables by univariate and multivariate analysis. Our outcome variables of interest were meningitis and hospital death. Results: In total, 71 cases of meningitis were diagnosed (risk, 7.7%; 95% CI, 6.1%–9.6%). The mortality rate among patients without infection was 10%, whereas hospital mortality of infected patients was 13% (P = .544). The 3 main risk factors for meningitis after ventricular shunt were identified by logistic regression model: age <2 years (OR, 3.20; P < .001), preoperative hospital stay >4 days (OR, 2.02; P = .007) and >1 surgical procedure, in addition to ventricular shunt (OR, 3.23; P = .043). Almost 1 of 3 of all patients was <2 years old (290, 31%). Also, 430 patients had >4 preoperative days (46%). Patients aged ≥2 years who underwent surgery 4 days after hospital admission had an increased risk of meningitis, from 4% to 6% (P = .140). If a patient <2 years old underwent surgery 4 or more days after hospital admission, the risk of meningitis increased from 9% to 18% (P = .026; Fig. 1). We built a risk index using the number of main risk factors based on a logistic regression model (0, 1, 2 or 3; Fig. 2). Conclusions:We identified 2 intrinsic risk factors for meningitis after ventricular shunt, age <2 years and multiple surgical procedures, and 1 extrinsic risk factor, the preoperative length of hospital stay.Funding: NoneDisclosures: None
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