Introduction: Surveillance of nosocomial infections (NIs) is an essential part of quality patient care; however, there are few reports of National Healthcare Safety Network (NHSN) surveillance in neonatal intensive care units (NICUs) and none in developing countries. The purpose of this study was to report the incidence of NIs, causative organisms, and antimicrobial susceptibility patterns in a large cohort of neonates admitted to the NICU during a 16-year period. Methods: The patients were followed 5 times per week from birth to discharge or death, and epidemiological surveillance was conducted according to the NHSN. Results: From January 1997 to December 2012, 4,615 neonates, representing 62,412 patient-days, were admitted to the NICU. The deviceassociated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonia infections per 1,000 ventilator-days. A total of 1,182 microorganisms were isolated from sterile body site cultures in 902 neonates. Coagulase-negative staphylococci (CoNS) (34.3%) and Staphylococcus aureus (15.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and Staphylococcus aureus were 86.4% and 28.3%, respectively.
Conclusions:The most important NI remains bloodstream infection with staphylococci as the predominant pathogens, observed at much higher rates than those reported in the literature. Multiresistant microorganisms, especially oxacillin-resistant staphylococci and gram-negative bacilli resistant to cephalosporin were frequently found. Furthermore, by promoting strict hygiene measures and meticulous care of the infected infants, the process itself of evaluating the causative organisms was valuable.
Introduction. Carbapenem-resistant
Pseudomonas aeruginosa
is responsible for increased patient mortality.
Gap Statement. Five and 30 day in-hospital all-cause mortality in patients with
P. aeruginosa
infections were assessed, followed by evaluations concerning potential correlations between the type III secretion system (TTSS) genotype and the production of metallo-β-lactamase (MBL).
Methodology. This assessment comprised a retrospective cohort study including consecutive patients with carbapenem-resistant infections hospitalized in Brazil from January 2009 to June 2019. PCR analyses were performed to determine the presence of TTSS-encoding genes and MBL genes.
Results. The 30-day and 5-day mortality rates for 262 patients were 36.6 and 17.9 %, respectively. The unadjusted survival probabilities for up to 5 days were 70.55 % for patients presenting exoU-positive isolates and 86 % for those presenting exo-negative isolates. The use of urinary catheters, as well as the presence of comorbidity conditions, secondary bacteremia related to the respiratory tract, were independently associated with death at 5 and 30 days. The exoS gene was detected in 64.8 % of the isolates, the presence of the exoT and exoY genes varied and exoU genes occurred in 19.3 % of the isolates. The exoU genotype was significantly more frequent among multiresistant strains. MBL genes were not detected in 92 % of the isolates.
Conclusions. Inappropriate therapy is a crucial factor regarding the worse prognosis among patients with infections caused by multiresistant
P. aeruginosa
, especially those who died within 5 days of diagnosis, regardless of the genotype associated with TTSS virulence.
The intensive care unit (ICU) requires a specialized team with adequate human resources, including nursing. For an adequate measurement of the workload of nursing professionals of Brazilian ICUs, the Nursing Activities Score (NAS) has been used to promote better adequacy of work scales. Work overload can increase the incidence of adverse events, including healthcare-associated infections (HAI). Objective: To associate the nursing workload measured by the NAS with the rates of HAI in an Adult ICU of a university hospital, in addition to evaluating the impact of the separation of ICUs by unit, or type of specialization. Method: Data collection was performed at Brazil, in the Adult ICU: stratified by the Surgical, Neurological and Medical specialties; including the calculation of the means of NAS and the monthly rates of HAI of each ICU unit, from 2016 to April 2019. NAS data were collected from secondary spreadsheets, without identification of the patient, and the rates of HAIs were collected from information from the Hospital Infection Control Service. Results: The mean NAS was different for each unit, with Neurological unit with the highest mean. In relation to HAIs, neurological unit patients had a higher incidence of HAIs and patients with HAIs. Pneumonia associated with mechanical ventilation (VAP) was higher in Surgical and Neurological units. Bloodstream and urinary tract infection were higher in the Medical unit. There was a positive correlation for NAS and VAP in the Medical unit and with urinary tract infection in the Surgical unit. In the Neurological unit there was a negative correlation with the rate of HAI and rate of patients with HAI. Conclusion: The mean NAS observed by us was lower when compared to other ICUs and variations may be associated with the type of hospital and clinical profile of patients. It was possible to observe that each unit has its particularity regarding the incidence of HAIs and the association between NAS (nursing workload) and rates, reinforcing the need for stratification and association of indicators per unit.
Background and objectives: Bloodstream infection (BSI) by multidrug-resistant Pseudomonas aeruginosa is a severe infection. This study aimed to evaluate and identify the predictors of mortality in patients who had bloodstream infection by carbapenem-resistant P. aeruginosa. Methods: This is a retrospective cohort study, approved by Committee of Ethics in Research with Human Participants, which included 87 consecutive patients hospitalized in a referral hospital in Brazil. Clinical and demographic information about each patient were obtained from hospital records. The Student’s T-test was used to compare continuous variables and x2 or Fisher’s exact tests to compare categorical variables. To determine independent risk factors for 30-day mortality, a multiple logistic regression model was used. A survival curve was constructed using the Kaplan–Meier method. Results: Among the patients, 87.3% use antibiotics previously, 60.9% received inadequate empirical treatment, and the 30-day mortality rate was 57.5%. Inappropriate antibiotic empirical therapy was independently associated with a 30-days death and mortality rate. Conclusion: These findings can show some insights about the relationship between higher mortality and inappropriate empirical therapy for patients with BSI by P. aeruginosa. There is a need for better diagnostic tests and infection control programs should focus on de-escalation the antibiotic inappropriate therapy, mainly in BSI caused by carbapenem-resistant P. aeruginosa.
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