We were not able to identify the common source for these cases of infection, but the adopted measures have proven to be effective at controlling the outbreak.

Background The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. Methods We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). Results A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008). Conclusions This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

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We describe an outbreak of nosocomial endophthalmitis due to a common source, which was determined to be trypan blue solution prepared in the hospital's pharmacy service. We assume that viable bacteria probably gained access to the trypan blue stock solution during cooling after autoclaving. The temporal cluster ofPseudomonas aeruginosaendophthalmitis was readily perceived on the basis of clinical and microbiological findings, and an exogenous source of contamination was unequivocally identified by means of DNA fingerprinting.

A real-time PCR assay was developed for detecting the presence of Acinetobacter baumannii on hospital equipment and compared to conventional bacterial culture using 100 hospital environmental samples. The real-time PCR detected contaminated surfaces in 4 h with high sensitivity (100%) compared to conventional culture. Thirty-eight percent of samples were positive by real-time PCR and negative by bacterial culture (false positives), possibly indicating the widespread presence of bacterial DNA that is not associated with viable bacteria. N osocomial infections caused by drug-resistant bacteria represent an important clinical challenge. Acinetobacter baumannii has become one of the most problematic causative agents of nosocomial infections due to its remarkable ability to survive on hospital surfaces and acquire antibiotic resistance, resulting in the global emergence of multidrug-resistant strains with resistance to multiple antibiotic classes (5). A. baumannii has been especially problematic in critically ill patients in the intensive care setting, as it is an important cause of ventilator-associated pneumonia and bacteremia. In this context, patients are exposed to A. baumannii via contact with contaminated hospital equipment or by contact with hospital personnel carrying the bacteria. A number of studies have demonstrated widespread contamination with A. baumannii on hospital environmental surfaces, most notably in intensive care units (ICUs) (1,4,8,9).Environmental surveillance protocols have been employed for the identification of hospital equipment colonized by A. baumannii so that appropriate decontamination procedures can be carried out (1,4,8,9). Since these surveillance methods employ conventional bacterial culture to determine the presence of A. baumannii, definitive species identification can require between 24 and 48 h. Nucleic acid-based tests, such as real-time PCR, have been employed for the identification of numerous bacterial pathogens (2); however, to our knowledge this technique has not been applied to identifying contaminated hospital equipment. The objective of the present study was to develop a real-time PCR for identifying hospital surfaces colonized by A. baumannii.A real-time PCR assay was developed using TaqMan chemistry for the amplification of nucleotides 774 to 859 of the outer membrane protein A gene (ompA; accession number AY485227). The ompA gene was chosen because it is present in all sequenced genomes of A. baumannii available in the public domain (as of March 2010), and the sequences chosen for the primers and probe correspond to regions highly conserved between published A. baumannii ompA sequences (100% sequence identity). The primers OmpA Forward (5=-TCTTGGTGGTCACTTGAAGC-3=) and Ompa Reverse (5=-ACTCTTGTGGTTGTGGAGCA-3=) and the probe (5=-AAGTTGCTCCAGTTGAACCAACTCCA-3=), 5= labeled with 6-carboxyfluorescein and the 3= labeled with 6-carboxytetramethylrhodamine, were used. A quantification standard, pGEM-ompA, was constructed by inserting the ompA gene from the ATCC 19606 strain...

La atención integrada y amigable a los adolescentes en salud es un aspecto de vital importancia para el logro de indicadores en salud y para la prevención de comportamientos de riesgo que dejan consecuencias severas.Objetivos: Identificar la percepción, experiencias y expectativas de jóvenes y funcionarios de salud sobre los servicios a jóvenes de la zona de ladera de Cali, Colombia. Desarrollar una estrategia conjunta entre jóvenes y funcionarios para el mejoramiento de los mismos servicios de salud a partir de los lineamientos de los Servicios Amigables para Jóvenes (SAJ).Métodos: Estudio de investigación-acción-participación con jóvenes y funcionarios de una ESE de Cali. La población de jóvenes se encontraba entre los 10 a 19 años. Inicialmente se aplicó un instrumento de evaluación al personal de salud y luego una encuesta sobre los SAJ. Se e realizaron entrevistas grupales y grupos de discusión para analizar los resultados. Se hizo abogacía y se formularon propuestas ante las autoridades locales y tomadores de decisiones sobre el manejo de los recursos.Resultados: La encuesta al personal de salud mostró que en la mayoría de las instituciones prestadoras de salud, no se cuenta con espacios y horarios definidos para la atención a los jóvenes, falta capacitación y número adecuado de funcionarios para la atención, ausencia de material de apoyo para educación en salud. La encuesta de jóvenes fue respondida por 100 jóvenes, el 76% fueron mujeres. El promedio de edad fue de 15.7 años con un rango entre los 12 y 26 años; con relación a la satisfacción en la atención brindada por el personal de salud, el porcentaje más alto lo obtuvo el personal médico y el más bajo el personal auxiliar de enfermería. El servicio más consultado es la consulta con médico general y los servicios más frecuentados en el último mes fueron vacunación (19.7%), odontología y urgencias (11.8% para cada uno).Conclusiones: Es necesario y de gran utilidad reorientar los servicios de salud que se ofrecen al joven de acuerdo a los principios y lineamientos de los SAJ, los cuales enfatizan en acciones de promoción de la demanda temprana y la prestación de servicios de atención integral y sin barreras, así como fortalecer conocimientos y habilidades específicas de los prestadores de servicios para que identifiquen y atiendan a jóvenes en forma idónea.

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