Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco; Kiffer, Carlos Roberto Veiga; Barth, Afonso Luís; Carneiro, Irna Carla do Rosário Souza; Giamberardino, Heloisa Ilhe Garcia; Rodrigues, Jorge Luíz Nobre; Filho, Lauro Santos; Mello, Maria Júlia Gonçalves de; Pereira, Milca Severino; Filho, Paulo Gontijo; Rocha, Michael S.; Medeiros, Eduardo Alexandrino Sérvolo de; Pignatari, Antônio Carlos Campos

doi:10.1016/j.ajic.2015.08.004

Cited by 27 publications

(45 citation statements)

References 20 publications

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“…aeruginosa is a global problem as a consequence of the ability of this microorganism to develop resistance to almost all antibiotics that are available for treatment, either by mutations present in chromosomal gene, or by horizontal gene transfer [ 1 , 2 ]. In Brazil, this problem is aggravated because of either the very high density of the antimicrobials use, especially β-lactams (including carbapenems) and fluoroquinolones [ 3 , 4 ] and the lack of affirmative action’s for prevention of these infections [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Molecular Epidemiology of Multidrug-Resistant P. aeruginosa Carrying aac(6')-Ib-cr, qnrS1 and blaSPM Genes in Brazil

et al. 2016

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We described a comprehensive analysis of the molecular epidemiology of multidrug-resistant (MDR) P. aeruginosa. Molecular analysis included typing by Pulsed Field Gel Electrophoresis, identification of genes of interest through PCR-based assays and sequencing of target genes. Case-control study was conducted to better understand the prognostic of patients and the impact of inappropriate therapy in patients with bacteremia, as well as the risk factors of MDR infections. We observed a high rate of MDR isolates (40.7%), and 51.0% of them was independently associated with inappropriate antibiotic therapy. Bacteremia was detected in 66.9% of patients, and prolonged hospital stay was expressive in those resistant to fluoroquinolone. Plasmid-mediated quinolone resistance genes (PMQR), qnrS1 and aac(6’)Ib-cr, were detected in two different nosocomial isolates (5.3%), and the aac(6’)-Ib7 variant was detected at a high frequency (87.5%) in those negative to PMQR. The presence of mutations in gyrA and parC genes was observed in 100% and 85% of selected isolates, respectively. Isolates harboring PMQR genes or mutations in gyrA and parC were not closely related, except in those containing SPM (São Paulo metallo-β-lactamase) clone. In addition, there is no study published in Brazil to date reporting the presence of Pseudomonas aeruginosa isolates harboring both qnrS1 and aac(6’)Ib-cr genes, with alarming frequency of patients with inappropriate therapy.

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Section: Introductionmentioning

confidence: 99%

Clinical and Molecular Epidemiology of Multidrug-Resistant P. aeruginosa Carrying aac(6')-Ib-cr, qnrS1 and blaSPM Genes in Brazil

et al. 2016

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“…Even though results for VSH are still poor, governmental policies may have favourably impacted our findings 9. …”

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confidence: 87%

Use of parenteral antimicrobials in very small hospitals in inner Brazil: patterns, determinants, and opportunities for interventions in developing countries

Giacomini

Fortaleza

2017

Journal of Hospital Infection

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Much of healthcare in developing countries takes place in small hospitals. Little is known about the use of antimicrobials in those settings. We studied the 60-day use of parenteral antimicrobials in 48 hospitals with up to 50 beds in inner Brazil. The overall use was 242.0 defined daily doses per 100 admissions, and broad-spectrum agents accounted for 26.8%. The existence of local guidelines, educational measures and restrictive policies for antimicrobial prescriptions, as well as infection control and microbiology resources, were significantly associated with lesser use. Those findings point to possible interventions aimed at preventing antimicrobial over-use in developing countries.

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“…Although Brazil has made considerable progress regarding healthcare prevention programs in the last two decades, structure fragilities remain (7) . Government systems of epidemiological surveillance have been introduced, but they still need to be improved (8) .…”

Section: Characteristics Of Healthcare-associated Infectionsmentioning

confidence: 99%

The concept of vulnerability applied to Healthcare-associated Infections

et al. 2019

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Objective: To discuss the potentialities of using the concept of vulnerability to support measures for preventing and controlling healthcare-associated infections (HAIs). Methods: This theoretical study was conducted in steps: 1) presentation of markers that frame the concept of vulnerability; 2) presentation of the characteristics of the health events to which the concept of vulnerability is intended to be applied; 3) identification of research gaps that could be potentially filled by using the concept of vulnerability; 4) identification of the potentialities of using the concept of vulnerability to deal with HAIs. Results: Proposal of a framework for analyzing HAIs from a vulnerability perspective, including the individual and collective dimensions. Conclusion: Using the concept of vulnerability to study and deal with HAIs favors a new approach to an old problem, unlike the dominant studies that highlight the individual aspects of the practices in healthcare services.

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Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

Abstract: This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Cited by 27 publications

References 20 publications

Clinical and Molecular Epidemiology of Multidrug-Resistant P. aeruginosa Carrying aac(6')-Ib-cr, qnrS1 and blaSPM Genes in Brazil

Clinical and Molecular Epidemiology of Multidrug-Resistant P. aeruginosa Carrying aac(6')-Ib-cr, qnrS1 and blaSPM Genes in Brazil

Use of parenteral antimicrobials in very small hospitals in inner Brazil: patterns, determinants, and opportunities for interventions in developing countries

The concept of vulnerability applied to Healthcare-associated Infections

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