International Nosocomial Infection Control Consortium report, datasummary of 50 countries for 2010-2015 : Device-associated module

Q3Artículo original1495-1504Background: We report the results of International Nosocomial Infection Control Consortium (INICC) sur-veillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America,Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.Methods:During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregateof 3,506,562 days.Results:Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAIrates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associatedpneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples,frequencies of resistance ofPseudomonasisolates to amikacin (29.87% vs 10%) and to imipenem (44.3%vs 26.1%), and ofKlebsiella pneumoniaeisolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27%vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.Conclusions:Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported inCDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the re-duction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC’s main goal tocontinue facilitating education, training, and basic and cost-effective tools and resources, such as stan-dardized forms and an online platform, to tackle this problem effectively and systematically

Programas no formales para la atención integral a la niñez en Costa Rica: aciertos y limitaciones / Costa Rican comprehensive non formal program on child care: accomplishments and limitations

Los programas no formales de atención integral para los infantes menores de siete años, surgen principalmente debido a dos factores, la inserción de la mujer en el campo laboral y la necesidad de los Estados de velar por la calidad de vida de esta población. De esta manera, en Costa Rica se crean los Centros de Nutrición y Atención Integral y los Hogares Comunitarios, programas no formales de atención a la niñez en los cuales se basó la investigación que sustenta el presente artículo. Esta tiene como objetivo general "Analizar el servicio que ofrecen los programas estatales no formales Hogares Comunitarios del Consejo de Atención Integral, Centros Infantiles de Nutrición y Atención Integral del Ministerio de Salud". Para ello se utilizó una metodología descriptiva, que brinda un detalle de los aciertos y limitaciones de los programas anteriormente señalados. Se pudo comprobar el esfuerzo que realizan los encargados de los programas por brindar una atención de calidad a la población infantil costarricense; sin embargo, se encuentran limitados por distintos factores lo cual hace evidente la necesidad de que sean reestructurados y que reciban mayor apoyo por parte del Estado para su fortalecimiento.   Informal education programs that are oriented to children under seven years arise because of two main reasons:  women becoming part of the workforce and governments pursuing a better quality of life for this population. In this way, the country establishes the “Centros de Nutrición y Atención Integral” and “Hogares Comunitarios”, informal child education programs, which served as the basis of this research. The main objective of this research is to “analize the service that Hogares Comunitarios of the “Consejo de Atención Integral” and “Centros Infantiles de Nutrición y Atención Integral” affiliated to the Ministry of Health offer as examples of non formal governmental education programs.  A descriptive methodology was chosen, as it allows the description of the strengths and weaknesses of such programs.  This research concluded that although these programs make great efforts to provide quality attention to children in Costa Rica; they are limited by several factors.  This calls for an immediate re-structuring and greater support from the State

Programas no formales para la atención integral a la niñez en Costa Rica: aciertos y limitaciones / Costa Rican comprehensive non formal program on child care: accomplishments and limitations

Los programas no formales de atención integral para los infantes menores de siete años, surgen principalmente debido a dos factores, la inserción de la mujer en el campo laboral y la necesidad de los Estados de velar por la calidad de vida de esta población. De esta manera, en Costa Rica se crean los Centros de Nutrición y Atención Integral y los Hogares Comunitarios, programas no formales de atención a la niñez en los cuales se basó la investigación que sustenta el presente artículo. Esta tiene como objetivo general "Analizar el servicio que ofrecen los programas estatales no formales Hogares Comunitarios del Consejo de Atención Integral, Centros Infantiles de Nutrición y Atención Integral del Ministerio de Salud". Para ello se utilizó una metodología descriptiva, que brinda un detalle de los aciertos y limitaciones de los programas anteriormente señalados. Se pudo comprobar el esfuerzo que realizan los encargados de los programas por brindar una atención de calidad a la población infantil costarricense; sin embargo, se encuentran limitados por distintos factores lo cual hace evidente la necesidad de que sean reestructurados y que reciban mayor apoyo por parte del Estado para su fortalecimiento. Informal education programs that are oriented to children under seven years arise because of two main reasons:  women becoming part of the workforce and governments pursuing a better quality of life for this population. In this way, the country establishes the “Centros de Nutrición y Atención Integral” and “Hogares Comunitarios”, informal child education programs, which served as the basis of this research. The main objective of this research is to “analize the service that Hogares Comunitarios of the “Consejo de Atención Integral” and “Centros Infantiles de Nutrición y Atención Integral” affiliated to the Ministry of Health offer as examples of non formal governmental education programs.  A descriptive methodology was chosen, as it allows the description of the strengths and weaknesses of such programs.  This research concluded that although these programs make great efforts to provide quality attention to children in Costa Rica; they are limited by several factors.  This calls for an immediate re-structuring and greater support from the State

Programas no formales para la atención integral a la niñez en Costa Rica: aciertos y limitaciones

Los programas no formales de atención integral para los infantes menores de siete años, surgen principalmente debido a dos factores, la inserción de la mujer en el campo laboral y la necesidad de los Estados de velar por la calidad de vida de esta población. De esta manera, en Costa Rica se crean los Centros de Nutrición y Atención Integral y los Hogares Comunitarios, programas no formales de atención a la niñez en los cuales se basó la investigación que sustenta el presente artículo. Esta tiene como objetivo general Analizar el servicio que ofrecen los programas estatales no formales Hogares Comunitarios del Consejo de Atención Integral, Centros Infantiles de Nutrición y Atención Integral del Ministerio de Salud. Para ello se utilizó una metodología descriptiva, que brinda un detalle de los aciertos y limitaciones de los programas anteriormente señalados. Se pudo comprobar el esfuerzo que realizan los encargados de los programas por brindar una atención de calidad a la población infantil costarricense; sin embargo, se encuentran limitados por distintos factores lo cual hace evidente la necesidad de que sean reestructurados y que reciban mayor apoyo por parte del Estado para su fortalecimiento

Virulent Brucella nosferati infecting Desmodus rotundus has emerging potential due to the broad foraging range of its bat host for humans and wild and domestic animals

Desmodus rotundus, vampire bats, transmit dangerous infections, and brucellosis is a hazardous zoonotic disease, two adversities that coexist in the subtropical and tropical areas of the American continent. Here, we report a 47.89% Brucella infection prevalence in a colony of vampire bats inhabiting the tropical rainforest of Costa Rica. The bacterium induced placentitis and fetal death in bats. Wide-range phenotypic and genotypic characterization placed the Brucella organisms as a new pathogenic species named Brucella nosferati sp. nov., isolated from bat tissues, including the salivary glands, suggesting feeding behavior might favor transmission to their prey. Overall analyses placed B. nosferati as the etiological agent of a reported canine brucellosis case, demonstrating its potential for infecting other hosts. To assess the putative prey hosts, we analyzed the intestinal contents of 14 infected and 23 non-infected bats by proteomics. A total of 54,508 peptides sorted into 7,203 unique peptides corresponding to 1,521 proteins were identified. Twenty-three wildlife and domestic taxa, including humans, were foraged by B. nosferati-infected D. rotundus, suggesting contact of this bacterium with a broad range of hosts. Our approach is appropriate for detecting, in a single study, the prey preferences of vampire bats in a diverse area, demonstrating its suitability for control strategies where vampire bats thrive.Desmodus rotundus, los murciélagos vampiro, transmiten infecciones peligrosas, y la brucelosis es una peligrosa enfermedad zoonótica, dos adversidades que coexisten en las zonas subtropicales y tropicales del continente americano. Aquí se informa de una prevalencia de infección por Brucella del 47,89% en una colonia de murciélagos vampiro que habitan la selva tropical de Costa Rica. La bacteria indujo placentitis y muerte fetal en los murciélagos. Una amplia caracterización fenotípica y genotípica situó a los organismos de Brucella como una nueva especie patógena denominada Brucella nosferati sp. nov., aislada de tejidos de murciélagos, incluidas las glándulas salivales, lo que sugiere que el comportamiento alimentario podría favorecer la transmisión a sus presas. Los análisis globales situaron a B. nosferati como agente etiológico de un caso de brucelosis canina notificado, lo que demuestra su potencial para infectar a otros hospedadores. Para evaluar los posibles huéspedes presa, analizamos mediante proteómica el contenido intestinal de 14 murciélagos infectados y 23 no infectados. Se identificó un total de 54.508 péptidos clasificados en 7.203 péptidos únicos correspondientes a 1.521 proteínas. D. rotundus infectado con B. nosferati se alimentó de veintitrés taxones de fauna silvestre y doméstica, incluidos los humanos, lo que sugiere el contacto de esta bacteria con una amplia gama de hospedadores. Nuestro enfoque es apropiado para detectar, en un solo estudio, las preferencias de presa de los murciélagos vampiro en una zona diversa, lo que demuestra su idoneidad para las estrategias de control donde prosperan los murciélagos vampiro. IMPORTANCIA: El descubrimiento de que una elevada proporción de murciélagos vampiro en una zona tropical está infectada con Brucella nosferati patógena y que los murciélagos se alimentan de seres humanos y muchos animales salvajes y domésticos es relevante desde la perspectiva de la prevención de enfermedades emergentes. En efecto, los murciélagos que albergan B. nosferati en sus glándulas salivales pueden transmitir esta bacteria patógena a otros huéspedes. Este potencial no es trivial ya que, además de la patogenicidad demostrada, esta bacteria posee todo el arsenal virulento necesario de los organismos Brucella peligrosos, incluidos los que son zoonóticos para el ser humano. Nuestro trabajo ha sentado las bases para futuras acciones de vigilancia en los programas de control de la brucelosis en los que prosperan estos murciélagos infectados. Además, nuestra estrategia para identificar el área de alimentación de los murciélagos puede adaptarse para explorar los hábitos alimentarios de diversos animales, incluidos los artrópodos vectores de enfermedades infecciosas, y por tanto ser de interés para un público más amplio, además de los expertos en Brucella y murciélagos.Universidad Nacional, Costa RicaEscuela de Medicina Veterinari

Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings

Purpose: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. Methods: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. Results: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01–1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01–1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06–1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08–1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75–4.49; p < 0.0001. The periods 2014–2016 and 2017–2019 had significantly higher risks than the period 2020–2022. Suprapubic catheters showed similar risks as indwelling catheters. Conclusion: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.Revisión por pare

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. Methods: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). Results: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. Conclusions: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.Revisión por pare

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings

Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available. Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%). PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied. Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher. Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically