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Otero ML, Menezes RC, Ferreira IBB, Issa FL, Agareno G, Carmo TA, Arriaga MB, Fukutani KF, Pamplona Neto L, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections. Infect Drug Resist 2020; 13:2811-2817. [PMID: 32848430 PMCID: PMC7430765 DOI: 10.2147/idr.s264276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. Methods Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. Results A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23–39.27, OR: 2.48, 95% CI 1.17–5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. Conclusion Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.
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Affiliation(s)
- Matheus L Otero
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Rodrigo C Menezes
- Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
| | | | - Francine L Issa
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Gabriel Agareno
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Thomas Azevedo Carmo
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - María B Arriaga
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Kiyoshi F Fukutani
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | | | - Sydney Agareno
- Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M Filgueiras Filho
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil.,Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Kevan M Akrami
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.,Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
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de Carvalho AJL, Ferreira HM, Borges EF, Borges Junior LH, de Paula ALT, Hattori WT, de Oliveira Azevedo EVMG. Analyses of the effectiveness of a Brazilian pediatric home care service: a preliminary study. BMC Health Serv Res 2019; 19:324. [PMID: 31117997 PMCID: PMC6532231 DOI: 10.1186/s12913-019-4148-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Technological advances in health care currently provide better care conditions and have increased survival rates of premature infants, along with increasing the life expectancy of chronically ill children. In this context, the home care service has emerged as an effective tool for the treatment of this group of children. Thus, this preliminary study aimed at evaluating the effectiveness of the Home Care Service (HCS) with regard to pediatric care. METHODS A cross-sectional study was performed through a medical record analysis of a tertiary hospital in Minas Gerais/Brazil. Two groups were compared: 36 patients from the HCS (home group) and 13 patients hospitalized with an indication for home care (hospital group). To analyze the effectiveness of HCS, we evaluated the number of readmissions, infection rate, number of procedures, and optimization of beds. RESULTS The hospital group presented 6.04 times more infections and was submitted to 6.43 times more procedures. The home group presented lower readmission rates; with 41.66% of children studied not being readmitted and 76.19% of those who needed readmissions did so after more than 30 days from hospital discharge. HCS optimized hospital beds and allowed, over five (5) years, the hospitalization of around 102 patients in the hospital studied. CONCLUSION In this preliminary study, HCS reduced the number of procedures and infections compared to hospitalized patients. Moreover, HCS presented lower readmission rates and optimized hospital beds, which could be considered an indication of effectiveness.
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Affiliation(s)
- Antônio José Lana de Carvalho
- Graduate Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
| | - Hyster Martins Ferreira
- Graduate Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
| | - Eliza Fernanda Borges
- Graduate Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
| | - Laerte Honorato Borges Junior
- Home Care Service, Hospital of Clinics of Uberlândia, Federal University of Uberlândia, 1720 - Pará Ave, Umuarama, Uberlândia, 38405-320 Brazil
| | - Ana Laura Teodoro de Paula
- Institutional Program for Voluntary Scientific Initiation, Medical School, Federal University of Uberlândia, 1720 - Pará Ave., Bloco 2U, Umuarama, Uberlândia, 38402-022 Brazil
| | - Wallisen Tadashi Hattori
- Department of Public Health, Faculty of Medicine, Federal University of Uberlândia, 1720 - Pará Ave., Umuarama, Uberlândia, 38405-320 Brazil
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Souza ES, Belei RA, Carrilho CMDDM, Matsuo T, Yamada-Ogatta SF, Andrade G, Perugini MRE, Pieri FM, Dessunti EM, Kerbauy G. Mortality and risks related to healthcare-associated infection. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015002940013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Healthcare-associated infections are a major cause of morbidity-mortality among hospitalized patients. The aim of this epidemiological study was to determine mortality and risks related to death in adult patients with healthcare-associated infections admitted to a teaching hospital in one year. Patient data were collected from infection medical reports. The mortality rate associated with infections was 38.4%, and it was classified as a contributing factor to deaths in 87.1% of death cases. The correlation between healthcare-associated infection and death was statistically significant among clinical patients (41.3%) presenting comorbidities related to the diagnosis (55.8%), cardiovascular infection (62.2%), pneumonia (48.9%), developing sepsis (69.0%), as well as patients who had been colonized (45.2%) and infected (44.7%) by multidrug resistance microorganisms.
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