Prevalência de infecção em unidades de terapia intensiva de um hospital escola terciário

OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69%) received antimicrobials on the day of study, 72 (57%) for treatment, and 15 (12%) for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%), non- intensive care unit nosocomial infection in 24 (33.3%), and intensive care unit-acquired infection in 22 patients (30.6%). Eleven patients (15.3%) had no defined type. The most frequently reported infections were respiratory (58.5%). The most frequently isolated bacteria were Enterobacteriaceae (33.8%), Pseudomonas aeruginosa (26.4%), and Staphylococcus aureus (16.9%; [100% resistant to methicillin]). Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age >; 60 years (p = 0.007), use of a nasogastric tube (p = 0.017), and postoperative status (p = 0.017). At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088). CONCLUSION: The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age ³60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.OBJETIVO: Determinar a prevalência de infecções em pacientes de Terapia Intensiva, os agentes infecciosos mais comuns e seus padrões de resistência. Identificar os fatores relacionados a infecção adquirida na Unidade de Terapia Intensiva e as taxas de mortalidade. DESENHO: Estudo de prevalência de um dia. LOCAL:Um total de 19 Unidades de Terapia Intensiva do Hospital das Clínicas da FMUSP (HC-FMUSP) participaram do estudo. PACIENTES: Todos os pacientes com idade superior a 16 anos internados em leitos de terapia intensiva por mais de 24 horas foram incluídos. As 19 Unidades de Terapia Intensiva forneceram 126 casos. VARIÁVEIS:Taxas de infecção, uso de antibióticos, padrões de resistência microbiológica, fatores relacionados à infecção adquirida na Unidade de Terapia Intensiva, taxas de mortalidade. RESULTADOS: Um total de 126 pacientes foi estudado. Oitenta e sete (69%) receberam antibióticos no dia do estudo, sendo 72 (57%) para tratamento e 15 (12%) para profilaxia. Baseado no tipo, observou-se que a infecção adquirida na comunidade ocorreu em 15 pacientes (20,8%), infecção hospitalar fora da Unidade de Terapia Intensiva em 24 (33,3%), e infecção adquirida na Unidade de Terapia Intensiva em 22 pacientes (30,6%). Para 11 pacientes (15,3%) não se definiu o tipo de infecção. Quanto ao sítio de infecção, as respiratórias foram as infecções mais comuns (58,5%). Os agentes mais freqüentemente isolados foram: Enterobacteriaceae (33,8%), Pseudomonas aeruginosa (26,4%) e Staphylococcus aureus (16,9%; 100% meticilina-resistentes). Análise multivariada identificou 3 fatores associados à infecção adquirida na Unidade de Terapia Intensiva: idade maior ou igual a 60 anos (p=0,007), uso de sonda nasogástrica (p=0,017) e pós-operatório (p=0,017). Ao final de quatro semanas, a taxa de mortalidade foi de 28,8%. Entre os infectados, a mortalidade foi de 34,7%. Não houve diferença entre as taxas de mortalidade para pacientes infectados e não-infectados (p=0,088). CONCLUSÃO: A taxa de infecção é alta entre os pacientes de terapia intensiva, especialmente as infecções respiratórias. As bactérias predominantes foram: Enterobacteriaceae. Pseudomonas aeruginosa e Staphylococcus aureus (agentes resistentes). Fatores como uso de sonda nasogástrica, pós-operatório e idade maior ou igual a 60 anos mostraram associação com infecção. Este estudo documenta a impressão clínica de que a prevalência de infecção adquirida na Unidade de Terapia Intensiva é alta e sugere que medidas preventivas são importantes para reduzir a ocorrência de infecção em pacientes críticos

Infection as an independent risk factor for mortality in the surgical intensive care unit

OBJECTIVES: Medical and surgical intensive care unit patients represent two different populations and require different treatment approaches. The aim of this study was to investigate the parameters associated with mortality in medical and surgical intensive care units. METHODS: This was a prospective cohort study of adult patients admitted to a medical and surgical intensive care unit teaching hospital over an 11-month period. Factors associated with mortality were explored using logistic regression analysis. RESULTS: In total, 827 admissions were observed, and 525 patients >;18 years old and with a length of stay >;24 h were analyzed. Of these patients, 227 were in the medical and 298 were in the surgical intensive care unit. The surgical patients were older (

Effectiveness, safety and tolerability of gatifloxacin, a new 8-methoxyfluoroquinolone, in the treatment of outpatients with community-acquired pneumonia: a Brazilian study

OBJECTIVES: Evaluation of the effectiveness, safety and tolerability of gatifloxacin in the treatment of outpatients with community-acquired pneumonia (CAP). STUDY DESIGN: A prospective, multicenter, non-comparative clinical study carried out in Brazil. Voluntary, unpaid physician participation contributed to an unbiased study design. PATIENTS: Adult outpatients with clinical diagnosis of CAP. REGIMEN: Gatifloxacin, 400 mg PO once daily for 7 to 14 days. STUDY PROCEDURES: Initial clinical assessment, at the first day of gatifloxacin therapy; final evaluation after 7 to 14 days of treatment. RESULTS: According to the physicians' assessments 97.3% of patients were cured or improved after gatifloxacin treatment. The incidence of adverse events was low and the most commonly reported events were nausea and dyspepsia. CONCLUSIONS: Gatifloxacin, 400 mg PO once daily for 7 to 14 days, is effective and safe in the treatment of patients with CAP

Effectiveness, safety and tolerability of gatifloxacin, a new 8-methoxyfluoroquinolone, in the treatment of outpatients with community-acquired pneumonia: a Brazilian study

OBJECTIVES: Evaluation of the effectiveness, safety and tolerability of gatifloxacin in the treatment of outpatients with community-acquired pneumonia (CAP). STUDY DESIGN: A prospective, multicenter, non-comparative clinical study carried out in Brazil. Voluntary, unpaid physician participation contributed to an unbiased study design. PATIENTS: Adult outpatients with clinical diagnosis of CAP. REGIMEN: Gatifloxacin, 400 mg PO once daily for 7 to 14 days. STUDY PROCEDURES: Initial clinical assessment, at the first day of gatifloxacin therapy; final evaluation after 7 to 14 days of treatment. RESULTS: According to the physicians' assessments 97.3% of patients were cured or improved after gatifloxacin treatment. The incidence of adverse events was low and the most commonly reported events were nausea and dyspepsia. CONCLUSIONS: Gatifloxacin, 400 mg PO once daily for 7 to 14 days, is effective and safe in the treatment of patients with CAP

Ventilação mecânica na doença pulmonar obstrutiva crônica Mechanical ventilation in chronic obstructive pulmonary disease

JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de numerosos estudos clínicos que acrescentaram informações importantes para o manejo de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Ventilação Mecânica na Agudização da DPOC foi um dos temas propostos. O objetivo deste estudo foi descrever os pontos mais importantes relacionados à ventilação mecânica durante a agudização da doença pulmonar obstrutiva crônica (DPOC) e sugerir as principais abordagens terapêuticas. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: ventilação mecânica na DPOC: COPD and mechanical ventilation. RESULTADOS: São apresentadas recomendações quanto aos modos ventilatórios e aos parâmetros a serem aplicados quando do ajuste do ventilador, além da monitoração recomendada. Apresentam-se ainda, técnicas alternativas que possam ser utilizadas. CONCLUSÕES: Estratégias protetoras de ventilação mecânica são recomendadas durante a ventilação mecânica de um paciente DPOC agudizado.<br>BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Mechanical ventilation in COPD exacerbation has been one of the updated topics. Describe the most important topics on the mechanical ventilation during the COPD exacerbation and suggest the main therapeutic approaches. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the keywords "mechanical ventilation" and "COPD". RESULTS: We present recommendations on the ventilatory modes and settings to be adopted when ventilating a patient during an asthma attack, as well as the recommended monitoring. Alternative ventilation techniques are also presented. CONCLUSIONS: Protective ventilatory strategies are recommended when ventilating a patient during a