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Cedeño K, Silva MDO, Mendes AV, de Castro AC, Barbosa MS, Barberino MG, Reis MGD, Martins IS, Reis JN. Assessing the burden of disease of gram-negative bloodstream infections in a Brazilian hospital: A retrospective cohort study from 2015 to 2019. IJID REGIONS 2024; 12:100401. [PMID: 39188887 PMCID: PMC11345680 DOI: 10.1016/j.ijregi.2024.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024]
Abstract
Objectives This study aimed to estimate the disease burden of BSIs caused by gram-negative bacteria (GNB-BSIs) in a Brazilian hospital from 2015 to 2019, measured in disability-adjusted life-years (DALYs). Methods A retrospective cohort study of adult patients with GNB-BSI was conducted from April 01, 2015 to March 31, 2019. This study was carried out in a 356-bed private hospital with a 68-bed medical intensive care unit located in Salvador, Brazil. Demographic and clinical data were collected through a review of medical records. DALYs were estimated using Monte Carlo Simulations, using life tables for Brazilians estimated for 2020 and the Global Burden of Diseases 2010 (GBD 2010). Results A total of 519 GNB-BSI episodes in 498 individuals were identified. The mean age was 59.92 ± 17.97 years, with 61.1% being male. The most common bacterial infections were Klebsiella pneumoniae and Escherichia coli (66.5%), whereas carbapenem-resistant gram-negative bacteria (CR-GNB) accounted for 32.7% of cases. The highest overall DALYs were observed in 2018 (752, 95% confidence interval [CI]: 520-1021 with Brazilian Life Tables and 782, 95% CI: 540-1062 with GBD 2010). Infections due to CR-GNB had the highest DALYs, particularly, in 2017, reaching 7050 (95% CI: 3200-12,150 with Brazilian Life Tables and 7350, 95% CI: 3350-12,700 with GBD 2010) DALYs per 1000 patient days and an estimated mortality rate of 40% per 1000 patient days. Conclusions The persistently high DALYs associated with CR-GNB raise alarming concerns, potentially leading to over 300 deaths per 1000 patient days in the coming years. These findings underscore the urgency of addressing GNB-BSI as a significant public health issue in Brazil. These results are expected to provide helpful information for public health policymakers to prioritize interventions for infections due to antibiotic-resistant bacteria.
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Affiliation(s)
- Kehvyn Cedeño
- Global Health Disparities Research Training Program, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marcio de Oliveira Silva
- Program of Biotechnology in Health and Investigative Medicine, Instituto Gonçalo Moniz/FIOCRUZ, Salvador, Brazil
- São Rafael Hospital, Salvador, Brazil
| | | | - Adriele Conceição de Castro
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Matheus Sales Barbosa
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Salvador, Brazil
| | | | - Mitermayer Galvão dos Reis
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratory of Pathology and Molecular Biology, Instituto Gonçalo Moniz/ FIOCRUZ, Salvador, Brazil
- Yale School of Public Health, Yale University, New Haven, USA
| | - Ianick Souto Martins
- Faculty of Medicine, Fluminense Federal University Downtown, Rio de Janeiro, Brazil
- Hospital of Cancer I, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Joice Neves Reis
- Program of Biotechnology in Health and Investigative Medicine, Instituto Gonçalo Moniz/FIOCRUZ, Salvador, Brazil
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Salvador, Brazil
- Laboratory of Pathology and Molecular Biology, Instituto Gonçalo Moniz/ FIOCRUZ, Salvador, Brazil
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Camargo CH, Yamada AY, de Souza AR, Sacchi CT, Reis AD, Santos MBN, de Assis DB, de Carvalho E, Takagi EH, Cunha MPV, Tiba-Casas MR. Genomic characterization of New Delhi metallo-beta-lactamase-producing species of Morganellaceae, Yersiniaceae, and Enterobacteriaceae (other than Klebsiella) from Brazil over 2013-2022. Microbiol Immunol 2024; 68:1-5. [PMID: 37859304 DOI: 10.1111/1348-0421.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
Over the last decade, New Delhi metallo-beta-lactamase (NDM) carbapenemase has silently spread in Brazil. In this study, we analyzed a large collection of Enterobacterales other than Klebsiella spp. received in our reference laboratory between 2013 and 2022. A total of 32 clinical isolates displaying different pulsed-field gel electrophoresis profiles, and represented by 11 species in the families Enterobacteriaceae (Citrobacter freundii, Citrobacter portucalensis, Enterobacter hormaechei, and Escherichia coli), Morganellaceae (Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, and Raoultella ornithinolytica), and Yersiniaceae (Serratia marcescens) had their whole genomes sequenced and further analyzed. Antimicrobial susceptibility was determined by disk diffusion, except for polymyxin B, assessed by broth microdilution. The blaNDM-1 allele was predominant (n = 29), but blaNDM-5 was identified in an E. coli specimen with a novel ST, and the blaNDM-7 allele was found in E. hormaechei ST45 and E. coli ST1049. Polymyxin was active against all but one Enterobacteriaceae isolate: an mcr-1-producing E. coli presenting minimal inhibitory concentration (4 mg/L). Isolates producing extended-spectrum β-lactamases were common: cefotaximase from Munich (CTX-M)-15 (n = 10), CTX-M-2 (n = 4), and CTX-M-8 (n = 3) were detected, and the mcr-1-producing E. coli was found to co-produce both CTX-M-8 and CTX-M-55 β-lactamases. The mcr-9 gene was found in 5/8 E. hormaechei isolates, distributed in four different sequence types, all of them presenting susceptibility to polymyxin. This study showed that NDM-producing Enterobacterales other than Klebsiella are already spread in Brazil, in diversified species, and cocarrying important resistance genes. Prompt detection and effective implementation of measures to prevent further spread are mandatory for mitigating the dissemination of NDM carbapenemase in hospital settings and preserving the already limited antimicrobial therapy options.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Camargo CH, Yamada AY, de Souza AR, Cunha MPV, Ferraro PSP, Sacchi CT, Dos Santos MB, Campos KR, Tiba-Casas MR, Freire MP, Barretti P. Genomic analysis and antimicrobial activity of β-lactam/β-lactamase inhibitors and other agents against KPC-producing Klebsiella pneumoniae clinical isolates from Brazilian hospitals. Sci Rep 2023; 13:14603. [PMID: 37670032 PMCID: PMC10480165 DOI: 10.1038/s41598-023-41903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) are highly disseminated worldwide, and isolates co-resistant to other antimicrobial agents pose a threat to effective antimicrobial therapy. Therefore, evaluation of novel antimicrobial drugs is needed to identify potential treatments with better outcomes. We evaluated the in vitro activity of novel antimicrobial drugs/combinations against 97 KPC-producing Klebsiella pneumoniae isolates recovered from different hospitals in Brazil during 2021-2022. Clonality, resistance and virulence genes were detected by whole-genome sequencing. The majority of the isolates (54.6%) were classified as extensively drug resistant or multidrug resistant (44.3%); one isolate showed a pandrug resistance phenotype. The most active antimicrobial agents were meropenem-vaborbactam, cefiderocol, and ceftazidime-avibactam, with sensitivities higher than 90%; resistance to ceftazidime-avibactam was associated with KPC-33 or KPC-44 variants. Colistin and polymyxin B were active against 58.6% of the isolates. The 97 isolates were distributed into 17 different sequence types, with a predominance of ST11 (37.4%). Although high in vitro susceptibility rates were detected for meropenem-vaborbactam and cefiderocol, only ceftazidime-avibactam is currently available in Brazil. Our findings showed limited susceptibility to antimicrobial drugs employed for infection treatment of carbapenem-resistant K. pneumoniae, underscoring the urgent need for stringent policies for antimicrobial stewardship to preserve the activity of such drugs.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil.
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil.
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Andreia Rodrigues de Souza
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Marcos Paulo Vieira Cunha
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Pedro Smith Pereira Ferraro
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Claudio Tavares Sacchi
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Marlon Benedito Dos Santos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Karoline Rodrigues Campos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Monique Ribeiro Tiba-Casas
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Maristela Pinheiro Freire
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Av. Prof. Montenegro, S/N, Botucatu, 18618-687, Brazil
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Camargo CH, Yamada AY, Souza ARD, Lima MDJDC, Cunha MPV, Ferraro PSP, Sacchi CT, Santos MBND, Campos KR, Tiba-Casas MR, Freire MP, Barretti P. Genomics and Antimicrobial Susceptibility of Clinical Pseudomonas aeruginosa Isolates from Hospitals in Brazil. Pathogens 2023; 12:918. [PMID: 37513765 PMCID: PMC10384983 DOI: 10.3390/pathogens12070918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Pseudomonas aeruginosa, an opportunistic pathogen causing infections in immunocompromised patients, usually shows pronounced antimicrobial resistance. In recent years, the frequency of carbapenemases in P. aeruginosa has decreased, which allows use of new beta-lactams/combinations in antimicrobial therapy. Therefore, the in vitro evaluation of these drugs in contemporary isolates is warranted. We evaluated the antimicrobial susceptibility and genomic aspects of 119 clinical P. aeruginosa isolates from 24 different hospitals in Brazil in 2021-2022. Identification was performed via MALDI-TOF-MS, and antimicrobial susceptibility was identified through broth microdilution, gradient tests, or disk diffusion. Whole-genome sequencing was carried out using NextSeq equipment. The most active drug was cefiderocol (100%), followed by ceftazidime-avibactam (94.1%), ceftolozane-tazobactam (92.4%), and imipenem-relebactam (81.5%). Imipenem susceptibility was detected in 59 isolates (49.6%), and the most active aminoglycoside was tobramycin, to which 99 (83.2%) isolates were susceptible. Seventy-one different sequence types (STs) were detected, including twelve new STs described herein. The acquired resistance genes blaCTX-M-2 and blaKPC-2 were identified in ten (8.4%) and two (1.7%) isolates, respectively. Several virulence genes (exoSTUY, toxA, aprA, lasA/B, plcH) were also identified. We found that new antimicrobials are effective against the diverse P. aeruginosa population that has been circulating in Brazilian hospitals in recent years.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, Sao Paulo 01246-902, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-902, SP, Brazil
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, Sao Paulo 01246-902, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-902, SP, Brazil
| | | | | | | | | | | | | | | | | | | | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu 18618-686, SP, Brazil
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Almeida Junior ERD, Braga IA, Filho PPG, Ribas RM. Multicentre surveillance of epidemiologically important pathogens causing nosocomial bloodstream infections and pneumonia trials in Brazilian adult intensive care units. J Med Microbiol 2023; 72. [PMID: 36753436 DOI: 10.1099/jmm.0.001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem.Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil.Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections.Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed.Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3 %, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3 %), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs.Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.
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Affiliation(s)
- Elias Rodrigues de Almeida Junior
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Iolanda Alves Braga
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Paulo Pinto Gontijo Filho
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Alvim ALS, Couto BRMG, Gazzinelli A. Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0229pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.
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Alvim ALS, Couto BRMG, Gazzinelli A. The quality of professional practices in infection control programs in Brazil: a cross-sectional study. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0229en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.
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Genomic Diversity of NDM-Producing Klebsiella Species from Brazil, 2013–2022. Antibiotics (Basel) 2022; 11:antibiotics11101395. [PMID: 36290053 PMCID: PMC9598336 DOI: 10.3390/antibiotics11101395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Since its first report in the country in 2013, NDM-producing Enterobacterales have been identified in all the Brazilian administrative regions. In this study, we characterized by antimicrobial susceptibility testing and by molecular typing a large collection of NDM-producing Klebsiella isolates from different hospitals in Brazil, mainly from the state of Sao Paulo, over the last decade. Methods: Bacterial isolates positive for blaNDM-genes were identified by MALDI-TOF MS and submitted to antimicrobial susceptibility testing by disk diffusion or broth microdilution (for polymyxin B). All isolates were submitted to pulsed-field gel electrophoresis, and isolates belonging to different clusters were submitted to whole genome sequencing by Illumina technology and downstream analysis. Mating out assays were performed by conjugation, plasmid sizes were determined by S1-PFGE, and plasmid content was investigated by hybrid assembly after MinIon long reads sequencing. Results: A total of 135 NDM-producing Klebsiella were identified, distributed into 107 different pulsotypes; polymyxin B was the only antimicrobial with high activity against 88.9% of the isolates. Fifty-four isolates presenting diversified pulsotypes were distributed in the species K. pneumoniae (70%), K. quasipneumoniae (20%), K. variicola (6%), K. michiganensis (a K. oxytoca Complex species, 2%), and K. aerogenes (2%); blaNDM-1 was the most frequent allele (43/54, 80%). There was a predominance of Clonal Group 258 (ST11 and ST340) encompassing 35% of K. pneumoniae isolates, but another thirty-one different sequence types (ST) were identified, including three described in this study (ST6244 and ST6245 for K. pneumoniae, and ST418 for K. michiganensis). The blaNDM-1 and blaNDM-7 were found to be located into IncF and IncX3 type transferable plasmids, respectively. Conclusions: Both clonal (mainly driven by CG258) and non-clonal expansion of NDM-producing Klebsiella have been occurring in Brazil in different species and clones, associated with different plasmids, since 2013.
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Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer. Cancers (Basel) 2022; 14:cancers14153835. [PMID: 35954498 PMCID: PMC9367341 DOI: 10.3390/cancers14153835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery. Abstract Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.
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Yamada AY, de Souza AR, Lima MDJDC, Reis AD, Campos KR, Bertani AMDJ, de Araujo LJT, Sacchi CT, Tiba-Casas MR, Camargo CH. Co-production of Classes A and B Carbapenemases BKC-1 and VIM-2 in a Clinical Pseudomonas Putida Group Isolate from Brazil. Curr Microbiol 2022; 79:250. [PMID: 35834136 DOI: 10.1007/s00284-022-02945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
Emergence of resistance to classical antimicrobial agents is a public health issue, especially in countries with high antimicrobial consumption rates. Carbapenems have been employed as first-choice option for empirical treatment complicated infections. However, in the last decades, frequency of carbapenemase-producing Gram-negative bacteria has rising, demanding the use of alternative antimicrobial agents. By sequencing the entire genomes with short and long reads technologies, we report the isolation and genomic characterization of a carbapenem-resistant Pseudomonas clinical isolate. The identification based on average nucleotide identity indicates a putative new species into the Pseudomonas putida Group, which carries both the blaBKC-1 and blaVIM-2 carbapenemase genes. The blaBKC-1 was found to be on a transferable IncQ plasmid backbone, whereas blaVIM-2 was found in a new integron, In2126 (intl1∆-blaVIM-2-aacA7-blaVIM-2∆-aacA27-3'CS), described in this study. Our findings indicate that co-occurrence of classes A and B carbapenemase enzymes underscores the evolving emergence of more complex antimicrobial resistance in opportunistic pathogens.
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Affiliation(s)
- Amanda Yaeko Yamada
- Bacteriology Division, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 9º floor, Sao Paulo, 01246-902, Brazil.,Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, 455, São Paulo, 01246-000, Brazil
| | - Andreia Rodrigues de Souza
- Bacteriology Division, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 9º floor, Sao Paulo, 01246-902, Brazil
| | | | - Alex Domingos Reis
- Strategic Laboratory, Rapid Response Center, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 10º floor, Sao Paulo, 01246-902, Brazil
| | - Karoline Rodrigues Campos
- Strategic Laboratory, Rapid Response Center, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 10º floor, Sao Paulo, 01246-902, Brazil
| | | | - Leonardo Jose Tadeu de Araujo
- Strategic Laboratory, Rapid Response Center, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 10º floor, Sao Paulo, 01246-902, Brazil
| | - Claudio Tavares Sacchi
- Strategic Laboratory, Rapid Response Center, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 10º floor, Sao Paulo, 01246-902, Brazil
| | - Monique Ribeiro Tiba-Casas
- Bacteriology Division, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 9º floor, Sao Paulo, 01246-902, Brazil
| | - Carlos Henrique Camargo
- Bacteriology Division, Instituto Adolfo Lutz, Doutor Arnaldo Avenue, 351, 9º floor, Sao Paulo, 01246-902, Brazil. .,Faculdade de Medicina, Universidade de São Paulo, Doutor Arnaldo Avenue, 455, São Paulo, 01246-000, Brazil.
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Camargo CH. Current status of NDM-producing Enterobacterales in Brazil: a narrative review. Braz J Microbiol 2022; 53:1339-1344. [PMID: 35690653 DOI: 10.1007/s42770-022-00779-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/03/2022] [Indexed: 01/05/2023] Open
Abstract
New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales was first detected in Brazil in 2014, in a Providencia rettgeri isolate recovered from surveillance swabs in the Southern region. Since then, an increasing number of NDM enzymes have been reported in different species. Nevertheless, comprehensive data on the current epidemiology of NDM-producing Enterobacterales in Brazil are lacking. Therefore, this study reviewed the available information on the status of NDM-producing bacteria in Brazil. The main finding was the diversity of bacteria producing NDM, including Klebsiella, Enterobacter, Morganella, Proteus, Escherichia, and Providencia. Limited data on clonality are available, but a few studies report different clonal backgrounds in NDM-producing K. pneumoniae, likely indicating local outbreaks. Over the years, a rise in the number of reported strains in different locations has been verified; however, different biases may have contributed to this finding. Therefore, a national surveillance study is warranted to identify the actual prevalence and incidence of NDM-producing Enterobacterales in Brazil and their role in patient management and outcome.
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Affiliation(s)
- Carlos Henrique Camargo
- Instituto Adolfo Lutz, Avenida Dr. Arnaldo, 9º Andar, 351, São Paulo, CEP 01246-902, Brazil.
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Caldara M, Belgiovine C, Secchi E, Rusconi R. Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices. Clin Microbiol Rev 2022; 35:e0022120. [PMID: 35044203 PMCID: PMC8768833 DOI: 10.1128/cmr.00221-20] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.
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Affiliation(s)
- Marina Caldara
- Interdepartmental Center on Safety, Technologies, and Agri-food Innovation (SITEIA.PARMA), University of Parma, Parma, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Secchi
- Institute of Environmental Engineering, ETH Zürich, Zürich, Switzerland
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano–Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele–Milan, Italy
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Camargo CH, Yamada AY, Nagamori FO, de Souza AR, Tiba-Casas MR, de Moraes França FA, Porto MHTN, de Lima Garzon ML, Higgins P, Madalosso G, de Assis DB. Clonal spread of ArmA- and OXA-23-coproducing Acinetobacter baumannii International Clone 2 in Brazil during the first wave of the COVID-19 pandemic. J Med Microbiol 2022; 71. [PMID: 35417321 DOI: 10.1099/jmm.0.001509] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Carbapenem-resistant Acinetobacter baumannii (CRAB) is the primary pathogen causing hospital-acquired infections. The spread of CRAB is mainly driven by the dissemination of resistant clones, and in Latin America, International Clones IC-1 (also known as clonal complex CC1), IC-4 (CC15) and IC-5 (CC79) are the most prevalent.Gap Statement. There are no documented outbreaks of CRAB International Clone 2 (IC-2) reported in Brazil.Aim. To describe a large outbreak of CRAB caused by the uncommon IC-2 in a Brazilian COVID-19 hospital.Methodology. From May 2020 to May 2021, 224 patients infected or colonized with CRAB were identified in a single hospital; 92 % of them were also infected with SARS-CoV-2. From these patients, 137 isolates were recovered and subjected to antimicrobial susceptibility testing, PCR analysis and molecular typing. Whole-genome sequencing and downstream analysis were carried out on a representative isolate (the first available isolate).Results. In 76 % of the patients, a single OXA-23-producing CRAB IC-2 was identified. All the isolates were susceptible to polymyxin B, but highly resistant (>95 %) to aminoglycosides, fluoroquinolones and beta-lactams. Genomic analysis revealed that the representative isolate also carried the 16S rRNA Methylase ArmA, which was detected for the first time in this species in Brazil.Conclusion. We report the rapid spread of an emerging CRAB clone responsible for causing a large outbreak in a hospital in Brazil, a country with predominance of other CRAB clones. Continuous and prospective surveillance is warranted to evaluate the impact of this clone in Brazilian hospital settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Paul Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Geraldine Madalosso
- Divisão de Infecção Hospitalar, Centro de Vigilância Epidemiológica, São Paulo, Brazil
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Detrimental Effect of Ozone on Pathogenic Bacteria. Microorganisms 2021; 10:microorganisms10010040. [PMID: 35056489 PMCID: PMC8779011 DOI: 10.3390/microorganisms10010040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Disinfection of medical devices designed for clinical use associated or not with the growing area of tissue engineering is an urgent need. However, traditional disinfection methods are not always suitable for some biomaterials, especially those sensitive to chemical, thermal, or radiation. Therefore, the objective of this study was to evaluate the minimal concentration of ozone gas (O3) necessary to control and kill a set of sensitive or multi-resistant Gram-positive and Gram-negative bacteria. The cell viability, membrane permeability, and the levels of reactive intracellular oxygen (ROS) species were also investigated; (2) Material and Methods: Four standard strains and a clinical MDR strain were exposed to low doses of ozone at different concentrations and times. Bacterial inactivation (cultivability, membrane damage) was investigated using colony counts, resazurin as a metabolic indicator, and propidium iodide (PI). A fluorescent probe (H2DCFDA) was used for the ROS analyses; (3) Results: No reduction in the count colony was detected after O3 exposure compared to the control group. However, the cell viability of E. coli (30%), P. aeruginosa (25%), and A. baumannii (15%) was reduced considerably. The bacterial membrane of all strains was not affected by O3 but presented a significant increase of ROS in E. coli (90 ± 14%), P. aeruginosa (62.5 ± 19%), and A. baumanni (52.6 ± 5%); (4) Conclusion: Low doses of ozone were able to interfere in the cell viability of most strains studied, and although it does not cause damage to the bacterial membrane, increased levels of reactive ROS are responsible for causing a detrimental effect in the lipids, proteins, and DNA metabolism.
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Reprocessing of loaned surgical instruments/implants in Australia and Brazil: A survey of those at the coalface. Infect Dis Health 2021; 27:23-30. [PMID: 34657820 DOI: 10.1016/j.idh.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country. METHODS Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible. RESULTS A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices. CONCLUSION There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff.
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Osme SF, Souza JM, Osme IT, Almeida APS, Arantes A, Mendes-Rodrigues C, Gontijo Filho PP, Ribas RM. Financial impact of healthcare-associated infections on intensive care units estimated for fifty Brazilian university hospitals affiliated to the unified health system. J Hosp Infect 2021; 117:96-102. [PMID: 34461175 DOI: 10.1016/j.jhin.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Studies show that healthcare-associated infections (HAIs) represent a crucial issue in healthcare and can lead to substantial economic impacts in intensive care units (ICUs). AIM To estimate direct costs associated with the most significant HAIs in 50 teaching hospitals in Brazil, affiliated to the unified health system (Sistema Único de Saúde: SUS). METHODS A Monte Carlo simulation model was designed to estimate the direct costs of HAIs; first, epidemiologic and economic parameters were established for each HAI based on a cohort of 949 critical patients (800 without HAI and 149 with); second, simulation based on three Brazilian prevalence scenarios of HAIs in ICU patients (29.1%, 51.2%, and 61.6%) was used; and third, the annual direct costs of HAIs in 50 university hospitals were simulated. FINDINGS Patients with HAIs had 16 additional days in the ICU, along with an extra direct cost of US$13.892, compared to those without HAIs. In one hypothetical scenario without HAI, the direct annual cost of hospital care for 26,649 inpatients in adult ICUs of 50 hospitals was US$112,924,421. There was an increase of approximately US$56 million in a scenario with 29.1%, and an increase of US$147 million in a scenario with 61.6%. The impact on the direct cost became significant starting at a 10% prevalence of HAIs, where US$2,824,817 is added for each 1% increase in prevalence. CONCLUSION This analysis provides robust and updated estimates showing that HAI places a significant financial burden on the Brazilian healthcare system and contributes to a longer stay for inpatients.
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Affiliation(s)
- S F Osme
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - J M Souza
- Institute of Geography, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - I T Osme
- York University, Gledon Campus, Toronto, Canada
| | - A P S Almeida
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - A Arantes
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - C Mendes-Rodrigues
- Institute of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - P P Gontijo Filho
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil.
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Seasonality and weather dependance of Acinetobacter baumannii complex bloodstream infections in different climates in Brazil. PLoS One 2021; 16:e0255593. [PMID: 34411123 PMCID: PMC8376013 DOI: 10.1371/journal.pone.0255593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
Recent studies report seasonality in healthcare-associated infections, especially those caused by Acinetobacter baumannii complex. We conducted an ecologic study aimed at analyzing the impact of seasons, weather parameters and climate control on the incidence and carbapenem-resistance in A. baumannii complex bloodstream infections (ABBSI) in hospitals from regions with different climates in Brazil. We studied monthly incidence rates (years 2006–2015) of ABBSI from hospitals in cities from different macro-regions in Brazil: Fortaleza (Ceará State, Northeast region), Goiânia (Goiás State, Middle-west) and Botucatu (São Paulo State, Southeast). Box-Jenkins models were fitted to assess seasonality, and the impact of weather parameters was analyzed in Poisson Regression models. Separate analyses were performed for carbapenem-resistant versus carbapenem-susceptible isolates, as well as for infections occurring in climate-controlled intensive care units (ICUs) versus non-climate-controlled wards. Seasonality was identified for ABSSI ICUs in the Hospitals from Botucatu and Goiânia. In the Botucatu hospital, where there was overall seasonality for both resistance groups, as well as for wards without climate control. In that hospital, the overall incidence was associated with higher temperature (incidence rate ratio for each Celsius degree, 1.05; 95% Confidence Interval, 1.01–1.09; P = 0.006). Weather parameters were not associated with ABBSI in the hospitals from Goiânia and Fortaleza. In conclusion, seasonality was found in the hospitals with higher ABBSI incidence and located in regions with greater thermal amplitude. Strict temperature control may be a tool for prevention of A. baumanii infections in healthcare settings.
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Dos Santos CA, Hernandes RT, Cunha MPV, Nagamori FO, Gonçalves CR, Sacchi CT, Tiba-Casas MR, Camargo CH. Two Novel Mutations Associated with Polymyxin-B Resistance in a Pandemic Lineage of Uropathogenic Escherichia coli of the Sequence Type 69. Chemotherapy 2021; 66:92-98. [PMID: 34325421 DOI: 10.1159/000517817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) are frequent pathogens worldwide, impacting on the morbidity and economic costs associated with antimicrobial treatment. OBJECTIVES We report two novel mutations associated with polymyxin-B resistance in an UPEC isolate collected in 2019. METHODS Isolate was submitted to antimicrobial susceptibility testing including broth microdilution for polymyxin B. Whole genome was sequenced and analyzed. RESULTS Polymyxin-B total inhibition occurred at 16 mg/L (resistant). UPEC isolate was assigned to the phylogroup D, serotype O117:H4, and Sequence Type 69. mcr genes were not detected, but two novel mutations in the pmrA/basS (A80S) and pmrB/basR (D149N) genes were identified. CONCLUSIONS The occurrence of non-mcr polymyxin resistance in E. coli from extraintestinal infections underscores the need of a continuous surveillance of this evolving pathogen.
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Affiliation(s)
| | - Rodrigo Tavanelli Hernandes
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, Brazil
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de Barcellos TAF, Bueno MS, Cunha MPV, Nagamori FO, de Carvalho E, Takagi EH, Moreno LZ, Moreno AM, Chimara E, Tiba-Casas MR, Camargo CH. Silent mutations in ribosomal protein genes are associated with high-risk clones of carbapenem-resistant Acinetobacter baumannii prevalent in Brazil. INFECTION GENETICS AND EVOLUTION 2020; 88:104686. [PMID: 33359045 DOI: 10.1016/j.meegid.2020.104686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze the relationship of ribosomal protein mutations and clonality of high-risk clones Acinetobacter baumannii. METHODS Seventy-nine carbapenem-resistant A. baumannii were subjected to whole-genome sequencing (Illumina NextSeq), and codifying sequences of ribosomal proteins were extracted and screened for mutations. MALDI-TOF MS analysis (Bruker Biotyper) and Spectra data from MALDI-TOF was employed to generate a dendrogram based on principal component analysis (PCA) data. Clones were identified by Multilocus sequencing typing (MLST) based on WGS. RESULTS Ribosomal RNA protein sequences extracted from the genomes identified mutations that were associated with clonal complexes, but most of them were silent. PCA did not cluster the isolates according to their clonality identified by MLST. CONCLUSIONS By comparing the nucleotide and amino acid sequences of diversified A. baumannii, and Bruker Biotyper profiles, we showed that silent mutations in ribosomal RNA nucleotides are associated with clonal complexes, but since most of the mutations were silent, MALDI-TOF MS raw data was not a useful tool for typing the high-risk clones of this species.
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Affiliation(s)
| | - Mariana Sardinha Bueno
- Instituto Adolfo Lutz, São Paulo, SP 01246-902, Brazil; Universidade de São Paulo, São Paulo, SP 01246-903, Brazil.
| | | | | | | | | | | | | | - Erica Chimara
- Instituto Adolfo Lutz, São Paulo, SP 01246-902, Brazil.
| | | | - Carlos Henrique Camargo
- Instituto Adolfo Lutz, São Paulo, SP 01246-902, Brazil; Universidade de São Paulo, São Paulo, SP 01246-903, Brazil.
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Camargo CH, Cunha MPV, de Barcellos TAF, Bueno MS, Bertani AMDJ, dos Santos CA, Nagamori FO, Takagi EH, Chimara E, de Carvalho E, Tiba-Casas MR. Genomic and phenotypic characterisation of antimicrobial resistance in carbapenem-resistant Acinetobacter baumannii hyperendemic clones CC1, CC15, CC79 and CC25. Int J Antimicrob Agents 2020; 56:106195. [DOI: 10.1016/j.ijantimicag.2020.106195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/29/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
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Spatial and sociodemographic factors associated with surgical site infection rates in hospitals in inner São Paulo State, Brazil. J Hosp Infect 2020; 108:181-184. [PMID: 33248977 DOI: 10.1016/j.jhin.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022]
Abstract
Low-to-middle-income countries often have high incidence of surgical site infection (SSI). To assess spatial and sociodemographic predictors of SSI rates, this study analysed and georeferenced governmental surveillance data from 385 hospitals located in inner São Paulo State, Brazil. In multi-variate models, SSI rates were positively associated with distance from the state capital [incidence rate ratio (IRR) for each 100 km 1.19, 95% confidence interval (CI) 1.07-1.32], and were lower for non-profit (IRR 0.95, 95% CI 0.37-0.85) and private (IRR 0.47, 95% CI 0.31-0.71) facilities compared with public hospitals. Georeferencing results reinforced the need to direct SSI-prevention policies to hospitals located in areas distant from the state capital.
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Izadi N, Eshrati B, Etemad K, Mehrabi Y, Hashemi-Nazari SS. Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance. New Microbes New Infect 2020; 38:100768. [PMID: 33093962 PMCID: PMC7568181 DOI: 10.1016/j.nmni.2020.100768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. Hospital-acquired infections are common in ICU wards, while UTIs and device-related infections are more prevalent in Iran. Device, catheter and ventilator-associated infections accounted for 38.72, 18.79%, and 16% of all HAIs, respectively.
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Affiliation(s)
- N Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Eshrati
- Department of Social Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - K Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Y Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S-S Hashemi-Nazari
- Prevention of Cardiovascular Disease Research Centre, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Evaluation of 3 year surveillance of device associated infections in a neonatal intensive care unit. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.680314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bento Talizin T, Dantas de Maio Carrilho CM, Magalhães Carvalho Grion C, Tibery Queiroz Cardoso L, Toshiyuki Tanita M, Boll KM, Moro Kauss IA, Festti J, Ribeiro Lopes C, Alves da Silva LM, Patruceli de Azevedo I, Paes K, Medeiros EA. Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance. PLoS One 2020; 15:e0237880. [PMID: 32813749 PMCID: PMC7437913 DOI: 10.1371/journal.pone.0237880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic. Patients and methods This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018. Results During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high. Conclusions In our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship.
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Affiliation(s)
- Thalita Bento Talizin
- Comissão de Epidemiologia Hospitalar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Medical School, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
- * E-mail:
| | | | | | | | - Marcos Toshiyuki Tanita
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Karine Maria Boll
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Ivanil Aparecida Moro Kauss
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Josiane Festti
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | | | | | | | - Késia Paes
- Medical School, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Eduardo Alexandrino Medeiros
- Comissão de Epidemiologia Hospitalar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Osme SF, Almeida APS, Lemes MF, Barbosa WO, Arantes A, Mendes-Rodrigues C, Gontijo Filho PP, Ribas RM. Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case-control study. J Hosp Infect 2020; 106:303-310. [PMID: 32693085 DOI: 10.1016/j.jhin.2020.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the economic burden of healthcare-associated infections (HAIs) in Brazil. AIM To analyse the costs of hospitalization by reimbursement from the Brazilian government, via the Brazilian Unified Health System (SUS) affiliation, and direct costs in the adult Intensive Care Unit (ICU). METHODS The matched-pairs case-control study (83 patients with HAIs and 83 without HAIs) was performed at a referral tertiary-care teaching hospital in Brazil in January 2018. In order to calculate the HAI costs from the perspective of the payer, the total cost for each hospitalization was obtained through the Hospital's Billing Sector. Direct costs were calculated annually for 949 critical patients during 2018. FINDINGS The reimbursement cost per hospitalization of patients with HAIs was 75% (US$2721) higher than patients without HAIs (US$1553). When a patient has an HAI, in addition to a longer length of stay (15 days), there was an extra increase (US$996) in the reimbursement cost per hospitalization. An HAI in the ICU was associated with a total direct cost eight times higher compared with patients who did not develop infections in this unit, US$11,776 × US$1329, respectively. The direct cost of hospitalization in the ICU without HAI was 56.5% less than the reimbursement (US$1329 × US$3052, respectively), whereas for the patient with an HAI, the direct cost was 111.5% above the reimbursement (US$11,776 × US$5569, respectively). CONCLUSION HAIs contribute to a longer stay and an eight-fold increase in direct costs. It is necessary to reinforce programmes that prevent HAIs in Brazilian hospitals.
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Affiliation(s)
- S F Osme
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - A P S Almeida
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - M F Lemes
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - W O Barbosa
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - A Arantes
- Federal University of Uberlandia, Clinical Hospital, Uberlandia, Brazil
| | - C Mendes-Rodrigues
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - P P Gontijo Filho
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil.
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Lara MO, Lucas TC, Kalapothakis E, Thomasini RL, Machado CJ. Molecular tracking of pathogens in central venous catheter. J Vasc Access 2020; 22:209-217. [PMID: 32588732 DOI: 10.1177/1129729820934354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central venous catheter-related bloodstream infection is an important adverse event in health care. Molecular methods are not yet substitutive of microbiological in the detection of the pathogens responsible for the infection, but they can help in the epidemiological characterization. AIM To detect bacteria by polymerase chain reaction, from material extracted from the tip of central catheters of patients suspected of infection at the intensive care unit. METHODS Catheters (n = 34) of patients suspected of central venous catheter-related infection were analyzed by polymerase chain reaction. The findings were compared with culture of catheter tip and blood cultures performed by the hospital. FINDINGS The prevalence of bacteria was Staphylococcus aureus (50%), Enterococcus faecalis (41.2%), Klebsiella pneumoniae (32.4), Pseudomonas aeruginosa (20.6%), Acinetobacter baumannii (38.2%), Escherichia coli (2.9%), and Enterobacter cloacae (0%). No blood culture showed bacterial growth, the culture of catheter tip revealed bacteria in 21 (61.8%) and the polymerase chain reaction had positivity in 31 (91.2%) of the catheters. The mean central venous catheter time was 11 days, and the jugular vein was the site of insertion. CONCLUSION The molecular method identified more bacteria than microbiological methods and revealed colonization of the catheters. The most commonly found bacteria are in the environment and in the microbiota of the skin, which suggests contamination by the hands of health professionals and points out the need for more efforts in preventive strategies.
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Affiliation(s)
- Maristela Oliveira Lara
- Nursing Department, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Thabata Coaglio Lucas
- Nursing Department, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Evanguedes Kalapothakis
- Laboratory of Biotechnology and Molecular Markers, General Biology Department, Institute of Basic Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ronaldo Luis Thomasini
- Faculty of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil
| | - Carla Jorge Machado
- Department of Social and Preventive Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Head and neck surgical antibiotic prophylaxis in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2020; 28:188-193. [PMID: 32332205 DOI: 10.1097/moo.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Antimicrobial resistance represents a global threat and causes almost 700 000 deaths per year. The rapid dissemination of resistant bacteria is occurring globally, turning this into the primary threat to public health in the 21st century and forcing organizations around the globe to take urgent action. RECENT FINDINGS About risks related to surgical site infection (SSI) in head and neck surgery, surgical limitations in resource-constrained settings, comorbidities and the risk of SSI, evidence about surgical prophylaxis from low and middle-income countries, SSI gap between the developed and developing worlds and how to reduce resistance. SUMMARY Antibiotic protocols can be adjusted to local and regional bacterial resistance profiles, taking into account the availability of antibiotics and cost limitations on each country in order to decrease the SSI risk.
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Bezerra TB, Valim MD, Bortolini J, Ribeiro RP, Marcon SR, Moura MEB. Adherence to hand hygiene in critical sectors: Can we go on like this? J Clin Nurs 2020; 29:2691-2698. [PMID: 32301162 DOI: 10.1111/jocn.15293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES The rates of healthcare-associated infections are high around the world. Hand hygiene is considered the most effective measure to reduce the transmission of pathogens in the hospital environment. Our objective was to evaluate adherence to hand hygiene in critical units of a tertiary-level hospital in Central-West Brazil. DESIGN Observational study employing cross-sectional data. Reporting rigour was demonstrated using the STROBE checklist. METHODS Observation of hand hygiene practices of 129 professionals from the health team, including nursing staff, physicians and physical therapists. Data collection was carried out using the World Health Organization form. RESULTS A total of 3,025 hand hygiene opportunities were observed, and the overall rate of adherence was only 46.25%. There was a greater frequency of hand hygiene after risk of exposure to bodily fluids and after contact with patients, 60.80% and 53.45%, respectively. Nurses obtained a higher rate of adherence to hand hygiene (59.80%). The neonatal ICU had a higher rate of adherence to hand hygiene when compared to other sectors. CONCLUSIONS The physical structure for hand hygiene in the institution was poor, and no professionals reached the minimum time required for execution of hand hygiene techniques. There were low rates of adherence to hand hygiene by professionals at all five times and in all categories and sectors observed, which may have been influenced by poor infrastructure present in the institution. RELEVANCE TO CLINICAL PRACTICE This study is of great relevance to patient safety, given the rates of healthcare-associated infections worldwide, with emphasis on underdeveloped countries. It is hoped that the results of this research can guide organisations to validly and systematically evaluate adherence to hand hygiene and achieve higher rates of adherence to hand hygiene and consequently reduce the number of infections in health environments.
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Affiliation(s)
| | | | - Juliano Bortolini
- Statistics Department, Federal University of Mato Grosso, Cuiabá, Brazil
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de Miranda Costa MM, Santana HT, Saturno Hernandez PJ, Carvalho AA, da Silva Gama ZA. Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals. J Hosp Infect 2020; 105:24-34. [PMID: 32151673 DOI: 10.1016/j.jhin.2020.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quality improvement (QI) methods are recommended to address healthcare-associated infections (HCAIs) in hospitals, but whereas internal initiatives have been widely studied, there is little evidence on the application and effect of a QI approach from an external system-wide perspective. AIM To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil. METHODS A QI cycle approach designed and assessed with a before-and-after quasi-experimental design was implemented by the Brazilian Health Regulatory Agency (ANVISA), targeting 1869 hospitals. Eleven evidence-based quality indicators related to HCAI prevention and a composite measure were assembled, shared, and assessed; the intervention to improve was then based on participatory multifaceted regulatory actions. Absolute and relative improvements were estimated after the intervention. FINDINGS In all, 563 hospitals (30.1% response) totalling 86,837 beds participated in the baseline assessment, and 681 hospitals (36.4% response) totalling 101,231 beds in the second. Ten of the 11 criteria improved (P < 0.05), as well as the composite indicator (P = 0.001) in all the regions of the country, particularly in the group of hospitals participating at baseline. 'Hand hygiene (HH) infrastructure' reached 100% (baseline: 97.9; P = 0.001), 'HH protocol' 96.9% (baseline: 92.9; P = 0.001), 'HH monitoring' 70% (baseline: 60.7; P < 0.001) and 'existence of antimicrobial prescription protocol' 80.7% (baseline: 73.2; P < 0.001), among others. The HCAI rates of the participating hospitals decreased after the intervention (P < 0.05). CONCLUSION The QI cycle approach was useful in guiding system-wide interventions for patient safety. External regulation was feasible and effective in promoting internal HCAI prevention nationwide.
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Affiliation(s)
- M M de Miranda Costa
- Brazilian Health Regulatory Agency, Brasília, Brazil; Graduate Program in Quality Management in Health Services, Federal University of Rio Grande do Norte, Natal, Brazil
| | - H T Santana
- Brazilian Health Regulatory Agency, Brasília, Brazil
| | | | - A A Carvalho
- Brazilian Health Regulatory Agency, Brasília, Brazil.
| | - Z A da Silva Gama
- Graduate Program in Quality Management in Health Services, Federal University of Rio Grande do Norte, Natal, Brazil; Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil.
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Santos PLC, Padoveze MC, Lacerda RA. Desempenho dos programas de prevenção e controle de infecções em pequenos hospitais. Rev Esc Enferm USP 2020; 54:e03617. [DOI: 10.1590/s1980-220x2019002103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Avaliar a conformidade de estrutura e processo dos programas de prevenção e controle de infecções relacionadas à assistência à saúde. Método Estudo prospectivo, transversal, realizado de 2015 a 2016, em pequenos hospitais de até 70 leitos de uma região do estado de São Paulo. Foram avaliados 4 indicadores previamente validados, expressos em índice de conformidade (porcentagem em relação aos itens avaliados). Resultados Dentre os 27 hospitais recrutados, 14 consentiram em participar. Os valores médios de conformidade para cada indicador foram: Estrutura dos programas 61,0%; Diretrizes operacionais 84,5%; Vigilância epidemiológica 57,9%; Atividades de prevenção 74,5%. Maior conformidade foi observada em hospitais privados (73,9%) e com presença de unidade de terapia intensiva (90,3%). Os hospitais possuíam enfermeiros designados para o programa (92,9%), mas somente 23,1% das instituições privadas atuavam com dedicação exclusiva de seis horas. Conclusão Apenas o indicador referente às Diretrizes Operacionais dos programas avaliados esteve acima de 90% de conformidade na mediana dos hospitais. A maior dispersão dos resultados de conformidade entre os hospitais estudados foi referente ao indicador de Vigilância Epidemiológica.
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Dias ICB, Lima EDFA, Fioresi M, Carrara D, Oliveira ISD, Primo CC. Construction of hypermedia for prevention of bloodstream infection. Rev Bras Enferm 2020; 73:e20190593. [DOI: 10.1590/0034-7167-2019-0593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To describe the process of construction and assessment of the content of a Virtual Learning Object on preventing bloodstream infections associated with infusion therapy. Method: Methodological study carried out in three stages: elaborating the technical, scientific content; assessing theoretical content; and constructing the Virtual Learning Object. Results: We produced the theoretical content of the Virtual Learning Object. Such content obtained an 85% agreement in assessment, which was adequate. The final product comprised 39 content screens, which integrate the main recommendations and contain images, hypertexts, videos, case studies, and quiz, through an exclusive platform. Final Considerations: This study made it possible to portray the method for constructing and assessing the content of a Virtual Learning Object, enabling am easy application to health professionals, aiming at guiding them to quality care.
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Good infection prevention practices in three Brazilian hospitals: Implications for patient safety policies. J Infect Public Health 2019; 12:619-624. [DOI: 10.1016/j.jiph.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
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Huerta-Gutiérrez R, Braga L, Camacho-Ortiz A, Díaz-Ponce H, García-Mollinedo L, Guzmán-Blanco M, Valderrama-Beltrán S, Landaeta-Nezer E, Moreno-Espinosa S, Morfín-Otero R, Rodríguez-Zulueta P, Rosado-Buzzo A, Rosso-Suárez F, Trindade-Clemente W, Wiltgen D. One-day point prevalence of healthcare-associated infections and antimicrobial use in four countries in Latin America. Int J Infect Dis 2019; 86:157-166. [PMID: 31229613 DOI: 10.1016/j.ijid.2019.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS Experience in the region shows that in some countries there is very good surveillance of Healthcare-associated infections (HAIs) in health services, but there is no national data consistently in all countries. Therefore, we set to estimate the total burden of HAIs and antimicrobial use in acute care hospitals in Brazil, Venezuela, Mexico, and Colombia using the one-day point prevalence methodology. METHODS The survey was conducted between June and July 2016. In each ward or unit, HAIs and antimicrobial use data were collected on a single day by a trained team of researchers. Also, for each patient, we collected data on risk factors for infections. RESULTS One out of ten individuals surveyed had at least one healthcare-associated infection (HAI). Pneumonia and surgical site infections were the most relevant among the surveyed countries. Most of the surveyed participants, regardless of their HAI status, received antibiotics except the individuals managed in Brazil. Carbapenems and third-generation Cephalosporins were among the most frequently used antibiotics. CONCLUSION Our results add to WHO's recent efforts to understand HAIs prevalence and antibiotic consumption in low and middle-income countries, of which we studied three that were not included in their last report.
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Affiliation(s)
| | - L Braga
- CCIH-HC/UFMG Filial Ebserh, Brazil
| | - A Camacho-Ortiz
- Infectious Deseases, Department Hospital Universitario Dr. José E. González, Monterrey, N.L., Mexico
| | | | | | - M Guzmán-Blanco
- Jefe del Departamento de Medicina del Centro Médico y Jefe de Servicio de Infectología del Hospital Vargas, Caracas, Venezuela
| | - S Valderrama-Beltrán
- Jefe de Unidad de Infectología, Hospital Universitario San Ignacio, Pontífica Universidad Javeriana, Colombia
| | - E Landaeta-Nezer
- Jefe de Servicio de Infectología del Hospital Universitario de Caracas, Caracas, Distrito Capital, Venezuela
| | - S Moreno-Espinosa
- Departamento de Infectología del Hospital Infantil de México, "Federico Gómez", Mexico
| | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Instituto de Patología Infecciosa, Universidad de Guadalajara, Mexico
| | - P Rodríguez-Zulueta
- Department of Infectious Diseases, Hospital General Dr. Manuel GEA González, Mexico City, Mexico
| | | | - Fernando Rosso-Suárez
- Departamento de Medicina Interna-Infectología, Fundación Clínica Valle del Lili, Cali, Colombia
| | - W Trindade-Clemente
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Denusa Wiltgen
- Universidade Federal de Ciências da Saúde de Porto AlegreRio Grande do Sul, Brazil
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Ansari S, Hassan M, Barry HD, Bhatti TA, Hussain SZM, Jabeen S, Fareed S. Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus 2019; 11:e4801. [PMID: 31396469 PMCID: PMC6679712 DOI: 10.7759/cureus.4801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Any infection occurring at the site of a surgical incision superficially or deep within the fascia, within 30 days of a surgical procedure is termed as a surgical site infection (SSI). Due to limited resources, non-adherence to infection control guidelines and substandard sterilization practices, the incidence is higher in developing countries. The aim of this study is to estimate the incidence of surgical site infections in general surgeries at a tertiary care hospital in Pakistan and identify the predisposing risk factors. Methods This was a retrospective analysis that included all surgical records from June 1, 2018, to December 31, 2018. After exclusion, 882 records were included. The incidence of SSI and predisposing risk factors were noted. Data were entered and analyzed using SPSS v. 22.0 (IBM Corp, Armonk, NY, US). Results The incidence of SSI was 8.84% (n=78). SSIs were more common in older participants (11.4% vs. 6.4%; p=0.009), in patients with more than 24 hour of preoperative hospital stay (11.2% vs. 64%; p=0.013), in procedures of longer duration (1.53 ± 0.35 vs 2.57 ± 0.17; p<0.0001), and in emergency surgeries (19.2% vs. 7.5%; p=0.0001). The combined incidence of SSIs in American Society of Anesthesiologists (ASA) index III and above was 37 (47.4%) and that in I and II was 41 (52.6%) (p<0.00001). Conclusion This study has revealed a very high incidence of surgical site infections. These infections are more common in elderly patients, patients undergoing emergency surgeries, those with longer preoperative hospital stay and longer surgical duration, and patients with a high ASA index.
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Affiliation(s)
- Shahbaz Ansari
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Habiba D Barry
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shah Jabeen
- Physiology, Liaquat College of Medicine and Dentistry, Karachi, PAK
| | - Sundus Fareed
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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Padoveze MC, Juskevicius LF, Santos TRD, Nichiata LI, Ciosak SI, Bertolozzi MR. The concept of vulnerability applied to Healthcare-associated Infections. Rev Bras Enferm 2019; 72:299-303. [PMID: 30916298 DOI: 10.1590/0034-7167-2017-0584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/29/2018] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
| | | | | | | | - Suely Itsuko Ciosak
- Universidade de São Paulo, Escola de Enfermagem. São Paulo, São Paulo, Brazil
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Tavares LCB, de Vasconcellos FM, de Sousa WV, Rocchetti TT, Mondelli AL, Ferreira AM, Montelli AC, Sadatsune T, Tiba-Casas MR, Camargo CH. Emergence and Persistence of High-Risk Clones Among MDR and XDR A. baumannii at a Brazilian Teaching Hospital. Front Microbiol 2019; 9:2898. [PMID: 30662431 PMCID: PMC6328482 DOI: 10.3389/fmicb.2018.02898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/12/2018] [Indexed: 01/04/2023] Open
Abstract
Dissemination of carbapenem-resistant Acinetobacter baumannii is currently one of the priority themes discussed around the world, including in Brazil, where this pathogen is considered endemic. A total of 107 carbapenem-resistant A. baumannii (CRAB) isolates were collected from patients with bacteraemia attended at a teaching hospital in Brazil from 2008 to 2014. From these samples, 104 (97.2%) carried blaOXA−23−like, all of them associated with ISAba1 The blaOXA−231 (1.9%) and blaOXA−72 (0.9%) genes were also detected in low frequencies. All isolates were susceptible to minocycline, and 38.3% of isolates presented intermediate susceptibility to tigecycline (MIC = 4 μg/ml). Molecular typing assessed by multi-locus sequence typing demonstrated that the strains were mainly associated with clonal complexes CC79 (47.4%), followed by CC1 (16.9%), and CC317 (18.6%), belonging to different pulsotypes and in different prevalences over the years. Changes in the clones' prevalence reinforce the need of identifying and controlling CRAB in hospital settings to preserve the already scarce therapeutic options available.
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Affiliation(s)
- Laís Calissi Brisolla Tavares
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Carlos Henrique Camargo
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
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Fortaleza CMCB, Silva MDO, Saad Rodrigues F, da Cunha AR. Impact of weather on the risk of surgical site infections in a tropical area. Am J Infect Control 2019; 47:92-94. [PMID: 30262260 DOI: 10.1016/j.ajic.2018.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/27/2023]
Abstract
We studied the impact of average daily temperature and relative humidity on the risk of surgical site infections in 36,429 surgeries performed in a hospital in inner Brazil. Adjusted Poisson regression models found an association between surgical site infections and temperature (rate ratio [RR], 1.013; 95% confidence interval [CI], 1.001-1.025). The effect was concentrated on clean wound procedures and was greater over the 75th (RR, 1.109; 95% CI, 1.015-1.212) and 90th (RR, 1.196; 95% CI, 1.055-1.355) percentiles of daily temperature.
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Affiliation(s)
| | - Marina de Oliveira Silva
- Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Fernanda Saad Rodrigues
- Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Antônio Ribeiro da Cunha
- Faculty of Agronomical Sciences, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
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Fraser C, Harron K, Dalton L, Gilbert R, Oddie SJ. Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales. PLoS One 2018; 13:e0204894. [PMID: 30383769 PMCID: PMC6211675 DOI: 10.1371/journal.pone.0204894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background There is uncertainty about the variation in infection prevention practices for central venous catheters (CVC) in neonatal units (NNUs) and how practices relate to national guidance. Aim To evaluate evidence supporting infection prevention practices for CVCs recommended in national guidelines and to compare with reported practices for peripherally inserted central catheters (PICC), a type of CVC widely used in NNUs. Design We searched national guidelines for neonates and children to identify infection prevention practices for CVCs and conducted an overview of studies to determine the quality of evidence underpinning recommendations. We surveyed 134 NNUs in England and Wales to ascertain reported practice. Results We found low quality evidence supporting CVC care bundles and use of 2% alcoholic chlorhexidine to decontaminate catheter ports and skin before insertion. Moderate quality evidence supported recommendations against routinely replacing CVCs and against chlorhexidine-impregnated dressings. 90% (44/49) of NICUs and 40% (34/85) of LNUs responded. 66% (48/73) of NNUs reported using CVC care bundles for insertion; 62% (45/73) used bundles for maintenance. 63% (32/51) of those using bundles reported monitoring adherence. 85% (61/72) of NNUs did not routinely replace PICCs and 89% (63/71) did not use chlorhexidine-impregnated dressings. Antiseptic use varied with alcoholic 2% chlorhexidine used for skin preparation in 33% (23/71) of NNUs and for catheter ports in 52% (37/71). Conclusions Lack of consistency across NNUs in antiseptic use and low rates of reported CVC care bundle use may reflect the low quality of evidence of the effectiveness and safety of these interventions in NNUs. Clinical trials are needed to quantify benefits and harms of infection prevention practices in NNUs.
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Affiliation(s)
- Caroline Fraser
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Laura Dalton
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sam J. Oddie
- Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom
- Centre for reviews and dissemination, University of York, York, United Kingdom
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Multi-centre point-prevalence survey of hospital-acquired infections in Ghana. J Hosp Infect 2018; 101:60-68. [PMID: 29730140 DOI: 10.1016/j.jhin.2018.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of data describing hospital-acquired infections (HAIs) in Africa. OBJECTIVE To describe the prevalence and distribution of HAIs in acute care hospitals in Ghana. METHODS Between September and December 2016, point-prevalence surveys were conducted in participating hospitals using protocols of the European Centre for Disease Prevention and Control. Medical records of eligible inpatients at or before 8am on the survey date were reviewed to identify HAIs present at the time of the survey. FINDINGS Ten hospitals were surveyed, representing 32.9% of all acute care beds in government hospitals. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values in hospitals ranged from 3.5% to 14.4%, with higher proportions of infections in secondary and tertiary care facilities. The most common HAIs were surgical site infections (32.6%), bloodstream infections (19.5%), urinary tract infections (18.5%) and respiratory tract infections (16.3%). Device-associated infections accounted for 7.1% of HAIs. For 12.5% of HAIs, a micro-organism was reported; the most commonly isolated micro-organism was Escherichia coli. Approximately 61% of all patients surveyed were on antibiotics; 89.5% of patients with an HAI received at least one antimicrobial agent on the survey date. The strongest independent predictors for HAI were the presence of an invasive device before onset of infection and duration of hospital stay. CONCLUSION A low HAI burden was found compared with findings from other low- and middle-income countries.
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Braga IA, Campos PA, Gontijo-Filho PP, Ribas RM. Multi-hospital point prevalence study of healthcare-associated infections in 28 adult intensive care units in Brazil. J Hosp Infect 2018. [PMID: 29522784 DOI: 10.1016/j.jhin.2018.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Healthcare-associated infection (HAI) represents a major problem for patient safety worldwide. AIM To provide an up-to-date picture of the extent, aetiology, risk factors and patterns of infections in intensive care units (ICUs) in 28 Brazilian hospitals of different sizes. METHODS A one-day point prevalence survey in 2016 enrolled the ICUs of hospitals from the 12 meso-regions in Minas Gerais state, south-east Brazil. Hospitals were classified as university or non-university hospitals. All patients with >48 h of admission to the study ICUs at the time of the survey were included. FINDINGS In total, 303 patients were studied; of these, 155 (51.2%) were infected and 123 (79.4%) had at least one ICU-acquired infection. The most common ICU-acquired infections were pneumonia (53.0%) and bloodstream infection (27.6%). One hundred and nineteen bacterial isolates were cultured; the most common were Acinetobacter baumannii (27.1%), Pseudomonas aeruginosa (27.1%) and Staphylococcus aureus (39.0%). According to type of infection, the most common pathogens were P. aeruginosa (30.4%) in pneumonia, coagulase-negative staphylococci (23.4%) and Enterobacteriaceae (23.4%) in bloodstream infections, and Enterobacteriaceae (47.6%) in urinary tract infections. CONCLUSION This study found that the overall prevalence of ICU-acquired infections in surveyed Brazilian hospitals was higher than that reported in most European countries and the USA. A greater proportion of infections were caused by non-fermenting Gram-negative bacteria. These observations, along with a high rate of antimicrobial use, illustrate the urgent need for HAIs to be a priority in the public health agenda of Brazil.
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Affiliation(s)
- I A Braga
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - P A Campos
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - P P Gontijo-Filho
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Brazil.
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Maroldi MAC, Felix AMDS, Dias AAL, Kawagoe JY, Padoveze MC, Ferreira SA, Zem-Mascarenhas SH, Timmons S, Figueiredo RM. Adherence to precautions for preventing the transmission of microorganisms in primary health care: a qualitative study. BMC Nurs 2017; 16:49. [PMID: 28919838 PMCID: PMC5594588 DOI: 10.1186/s12912-017-0245-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background Health care associated infections (HAIs) are a source of concern worldwide. No health service in any country can be considered HAI risk-free. However, there is scarcity of data on the risks to which both patients and health workers are subject in non-hospital settings. The aim of this study was to identify issues that determine the adherence of professionals to precautions for preventing transmission of microorganisms in primary health care. Method This was a qualitative study, using focus groups of primary health care staff, in two Brazilian municipalities. The data were analysed using content analysis. Results Four focus groups were conducted with 20 professionals (11 community health workers, 5 nursing assistants and 4 nurses), and the analysed content was organized into four thematic categories. These categories are: low risk perception, weaknesses in knowledge, insufficient in-service training and infrastructure limitations. Participants expressed their weaknesses in knowledge of standard and transmission based precautions, mainly for hand hygiene and tuberculosis. A lack of appropriate resources and standardization in sharps disposal management was also highlighted by the participants. Conclusion The study points out the need to provide in-service training for professionals on the transmission of microorganisms in primary health care to ensure adequate level of risk perception and knowledge. Further recommendations include investment to improve infrastructure to facilitate adherence to precautions and to minimize the risk of disease transmission for both patients and health care workers.
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Affiliation(s)
| | | | | | | | | | | | | | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning (CHILL), Nottingham University Business School, Nottingham, UK
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Silva DS, Dourado AAG, Cerqueira CRE, Romero FH, Amaral NA, Pearce PF, Pereira LP, Calcagno JI. Hand hygiene adherence according to World Health Organization Recommendations in a Neonatal Intensive Care Unit. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-93042017000300008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate the application of hand hygiene technique, according to the World Health Organization (WHO) recommendations, in the neonatal intensive care unit, at a Maternity in Salvador de Bahia, Brazil. Methods: cross-sectional study. Hand hygiene technique by professional category and alcohol solution consumption were systematically registered. For this task an adapted instrument created by the WHO was used and applied using factsheets. The sample was taken from medical physicians, physiotherapists, nurses and nursing technicians. Results: hand hygiene adherence regarding WHO recommendations was deficient in terms of technique and in terms of frequency (adequate technique ranged from 0% to 13.3% between professional categories). Hand hygiene was frequently ignored (27% between physicians and 51.8% between nursing technicians). The moment right after touching surfaces next to patients was the most ignored one. Alcohol gel solution monthly use was only 35% of the expected value for the unit. Conclusions: despite the international investigations and efforts for better results, the adherence and compliance to the hand hygiene guidelines is still deficient and continues to be a major problem.
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