Background Surgical site infections (SSIs) can account for 25% of all nosocomial infections and contribute significantly to the economic burden resulting from infectious complications. To control this problem, an active surveillance program with the feedback of SSI rates to surgeons can reduce subsequent rates by up to 40%, since 19% to 65% of these infections are diagnosed after patient discharge. However, there is no standard method for conducting surveillance outside the hospital and the best methodology is still unknown. For many hospitals, SSI surveillance has three main objectives: to feedback surgeons with their SSI rates; to evaluate SSI rates over time, identifying outbreaks; and to compare data among different institutions. This study aims to answer the crucial question: is surveillance after patient discharge worthwhile? Methods Prospective surveillance according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC) at Hospital Lifecenter, Hospital Madre Teresa and Hospital Universitário Ciências Médicas, tertiary care centers, which serve the metropolitan area of Belo Horizonte, Brazil. The data were collected between Jan/2017 and Dec/2019. Results In almost three years of study, the infection rate data were calculated with and without surveillance. The monthly analysis by clinic showed that the inclusion of post-discharge patients in the computed rates increases its value, but not significantly. Of 22.009 patients analyzed, in Lifecenter Hospital, 229(1%) had SSI. This percentage refers to the infection rate with the post-discharge survey, while the rate of surgical infection without vigilance corresponds to 202(0,9%) (Table 1). The surveillance for Madre Teresa, those numbers were: 29.770, 382(1,3%) and 351(1,2%), respectively (Table 2). In Hospital Universitário Ciências Médicas: 20.286, 447 (2,2%) and 215(1,1%) (Table 3). Table 1 - Surgical site infection: data with and without post-discharge surveillance. Hospital Lifecenter (Jan/ 2017 to Jul/2019): month-by-month analysis. Table 2 - Surgical site infection: data with and without post-discharge surveillance. Hospital Madre Teresa (Jan/ 2017 to Dec/2019): month-by-month analysis. Table 3 - Surgical site infection: data with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/ 2017 to Dec/2019): month-by-month analysis. Conclusion SSI post-discharge surveillance is indicated only for specific procedures. However, once the endemic curve with the infection rate did not change with the inclusion of post-discharge SSI, the study strongly suggests that surveillance after the discharge of the surgical patient is not necessary. Graph 1 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Lifecenter (Jan/2017 to Jul/2019): endemic curve. Graph 2 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Madre Teresa (Jan/2017 to Jul/2019): endemic curve. Graph 3 - Surgical site infection: rate with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/2017 to Jul/2019): endemic curve. Disclosures All Authors: No reported disclosures
Background Vancomycin-Resistant Enterococcus (VRE) is considered one of the main pathogens of hospital-acquired infections (HAI), responsible for high morbidity and mortality rates. HAI caused by this bacteria, especially in intensive care units (ICU), are concerning for the health system, given that the microorganism is multi resistant to most antimicrobials available, especially vancomycin. Therefore, the present study is built from and analyzes the data of VRE, collected by the Infection Prevetion and Control Service of hospitals in Brazil, to clarify: the incidence rate, the gross lethality of these infections and what are the profiles of infected patients. Methods Collection and analysis of epidemiological data, according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC), in 10 hospitals in Brazil, between Jan/2017 - Dec/2019. Results In three years, 118 VRE infections were diagnosed in the hospitals analyzed: 51 from ICU (43%), 24 from Vascular Acess (20%), 18 from General Clinic (15%), 10 from General Surgery (8%) and 15 from Others (13%). Patients ages ranged from 0 to 93 years, with a mean of 62 years (standard deviation of 20 years) and a median of 66 years. Time between admission and diagnosis of infection was 1 to 1001 days, with a mean of 68 days (standard deviation of 25 days) and a median of 59 days. The gross lethality for VRE infections was 47/118 (40%). The infection sites were: Bloodstream Infections – BSI = 34 (29%); Urinary Tract Infections – UTI = 28 (24%); Surgical Site Infections – SSI = 27 (23%); Skin and Soft Tissue Infections – SST = 14 (12%); Bone and Joint Infections – BJ = 5 (4%); Cardiovascular System Infections – CVS = 5 (4%); Lower Respiratory System Infections, other than pneumonia – LRI = 2 (2%); Pneumonia – PNEU = 2 (2%) and Gastrointestinal System Infections – GI = 1 (1%). Percentage of VRE infections by hospital units Percentage of VRE infections by infection sites Infection sites of VRE infections by hospital Conclusion VRE infection is a highly lethal event that usually occurs after two months of hospitalization. The main site of infection is the BSI, with a higher incidence in patients over 62 years or the ones in ICU. Early and accurate investigations of multiresistant microorganisms in a hospital setting are necessary to reduce patient morbidity and mortality. Disclosures All Authors: No reported disclosures
(UTI) são susceptíveis a infecções, principalmente bacterianas, que, quando complicadas, desencadeiam quadros de sepse. Essa condição de grande inflamação sistêmica gera consequências como a Injúria Renal Aguda (IRA). A fisiopatologia da IRA ainda não foi completamente elucidada, mas sabe-se que os danos ao paciente são graves e a mortalidade é alta. Objetivo: revisar aspectos da injúria renal aguda e abordar a conduta mais adequada para pacientes na UTI. Métodos: revisão sistemática da literatura, utilizando bancos de dados eletrônicos (SCIELO, PUBMED, LILACS, UPTODATE) e a busca manual de artigos. Resultados e discussão: é importante que métodos diagnósticos para confirmação da infecção e para a triagem de lesões renais sejam realizados precocemente, na suspeita de sepse. Após a confirmação do quadro, o tratamento adequado deve ser executado para minimizar as sequelas e reduzir a mortalidade dos pacientes.
Congenital adrenal hyperplasia (CAH) is a chronic condition, mainly related to lack of the enzyme 21 hydroxylase (21-OH), that belongs to a group of cytochrome P450 enzymes. Individuals with the disorder are exposed to elevated levels of intrauterine androgens as a result of endogenous cortisol deficiency. In the classic form of disease, there is a division between simple virilizaing (VS) and Losing Salt (PS). Prenatal exposure to androgens, especially in individuals with 46 XX karyotype, can influence the mental health of those affected, determining the development of a higher incidence of gender dysphoria (GD), in addition to direct neurodevelopmental, psychiatric and psychosocial disorders. This integrative literature review deals with the main points that associate CAH to DG and other disorders, comparing the existing bibliography for a reflective analysis of the subject. There are few studies available on this topic, and more comparative research is needed for a assertive conclusion.
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