Diarréia nosocomial em unidade de terapia intensiva: incidência e fatores de risco Nosocomial diarrhea in the intensive care unit: incidence and risk factors

RACIONAL: Diarréia nosocomial parece ser comum em unidades de terapia intensiva, embora sua epidemiologia seja pouco documentada em nosso meio. OBJETIVO: Determinar a incidência e fatores de risco de diarréia entre pacientes adultos internados em unidade de terapia intensiva. MÉTODOS: Foram incluídos prospectivamente 457 pacientes no período entre outubro de 2005 e outubro de 2006. Dados demográficos, clínicos e bioquímicos, bem como aspecto e número de evacuações eram registrados diariamente até a saída do paciente do setor. RESULTADOS: Diarréia ocorreu em 135 (29,5%) pacientes, durando em média 5,4 dias. O tempo do seu início em relação à internação foi de 17,8 dias e casos similares de diarréia no mesmo período foram registrados em 113 (83,7%) pacientes. A mortalidade hospitalar foi maior nos pacientes com diarréia do que naqueles sem esta intercorrência. Na análise multivariada através de modelo de regressão logística, apenas o número de antibióticos (OR 1,65; IC 95% = 1,39-1,95) e o número de dias de antibioticoterapia (OR 1,16; IC 95% = 1,12-1,20) associaram-se estatisticamente com a ocorrência de diarréia. Cada dia de acréscimo a mais da antibioticoterapia aumentou em 16% o risco de diarréia (IC 12% a 20%), enquanto a adição de um antibiótico a mais ao esquema antimicrobiano aumentou as chances de ocorrência de diarréia em 65% (IC 39% a 95%). CONCLUSÃO: A incidência de diarréia nosocomial na unidade de terapia intensiva é elevada (29,5%). Os principais fatores de risco para sua ocorrência foram número de antibióticos prescritos e duração da antibioticoterapia. Além das precauções entéricas, a prescrição judiciosa e limitada de antimicrobianos, provavelmente reduzirá a ocorrência de diarréia neste setor.<br>BACKGROUND: Nosocomial diarrhea seems to be common at intensive care units, although its epidemiology be poorly documented in Brazil. AIM: To determine the incidence and risk factors of diarrhea among adult patients admitted to intensive care units. METHODS: Four hundred and fifty five patients were prospectively included during the period between October 2005 and October 2006. Demographic, clinical and biochemical data as well as aspect and number of bowel movements were recorded on a daily basis until discharge from the unit. RESULTS: Diarrhea occurred in 135 (29.5%) patients, lasting 5.4 days average. The time of its onset in according to admission was 17.8 days and similar cases of diarrhea during the same period were recorded in 113 (83.7%) patients. In a multivariate analysis through the logistics regression model, only the number of antibiotics (OR 1.65; I.C. 95% = 1.39-1.95) and the number of days of antibiotic therapy (OR 1.16; I.C. 95% = 1.12-1.20) were statistically associated with the diarrhea occurrence. Each day added of antibiotic therapy, raised in 16% the risk of diarrhea (I.C. 12% to 20%), while the addition of one more antibiotic to the scheme, increased the chances of occurring diarrhea in 65% (I.C. 39% to 95%). CONCLUSION: The incidence of nosocomial diarrhea in intensive care units is high (29.5%). The main risk factors for its occurrence were number of prescribed antibiotics and duration of the antibiotic therapy. Besides the enteric precautions, judicious and limited prescription of antimicrobians probably will reduce the occurrence of diarrhea at this unit

Centrality dependence of the pseudorapidity density distribution for charged particles in Pb\u2013Pb collisions at 1asNN = 2.76 TeV

We present the first wide-range measurement of the charged-particle pseudorapidity density distribution, for different centralities (the 0\u20135%, 5\u201310%, 10\u201320%, and 20\u201330% most central events) in Pb\u2013Pb collisions at 1asNN = 2.76 TeV at the LHC. The measurement is performed using the full coverage of the ALICE detectors, 125.0 < \u3b7 < 5.5, and employing a special analysis technique based on collisions arising from LHC \u2018satellite\u2019 bunches. We present the pseudorapidity density as a function of the number of participating nucleons as well as an extrapolation to the total number of produced charged particles (Nch = 17 165 \ub1 772 for the 0\u20135% most central collisions). From the measured dNch/d\u3b7 distribution we derive the rapidity density distribution, dNch/dy, under simple assumptions. The rapidity density distribution is found to be significantly wider than the predictions of the Landau model. We assess the validity of longitudinal scaling by comparing to lower energy results from RHIC. Finally the mechanisms of the underlying particle production are discussed based on a comparison with various theoretical models

Production of charged pions, kaons and protons at large transverse momenta in pp and Pb–Pb collisions at s

Transverse momentum spectra of pi(+/-), K-+/- and p((p) over bar) up to p(T) = 20 GeV/c at mid-rapidity in pp, peripheral (60-80%) and central (0-5%) Pb-Pb collisions at v root s(NN) = 2.76 TeV have been measured using the ALICE detector at the Large Hadron Collider. The proton-to-pion and the kaon-to-pionratios both show a distinct peak at p(T) approximate to 3 GeV/c in central Pb-Pb collisions. Below the peak, p(T) 10 GeV/c particle ratios in pp and Pb-Pb collisions are in agreement and the nuclear modification factors for pi(+/-), K-+/- and p((p) over bar) indicate that, within the systematic and statistical uncertainties, the suppression is the same. This suggests that the chemical composition of leading particles from jets in the medium is similar to that of vacuum jets

Production of charged pions, kaons and protons at large transverse momenta in pp and Pb–Pb collisions at sNN=2.76\sqrt{s_{NN}}=2.76 TeV

Transverse momentum spectra of pi(+/-), K-+/- and p((p) over bar) up to p(T) = 20 GeV/c at mid-rapidity in pp, peripheral (60-80%) and central (0-5%) Pb-Pb collisions at v root s(NN) = 2.76 TeV have been measured using the ALICE detector at the Large Hadron Collider. The proton-to-pion and the kaon-to-pionratios both show a distinct peak at p(T) approximate to 3 GeV/c in central Pb-Pb collisions. Below the peak, p(T) 10 GeV/c particle ratios in pp and Pb-Pb collisions are in agreement and the nuclear modification factors for pi(+/-), K-+/- and p((p) over bar) indicate that, within the systematic and statistical uncertainties, the suppression is the same. This suggests that the chemical composition of leading particles from jets in the medium is similar to that of vacuum jets

Production of charged pions, kaons and protons at large transverse momenta in pp and Pb–Pb collisions at sNN=2.76\sqrt{s_{NN}}=2.76 TeV

Transverse momentum spectra of pi(+/-), K-+/- and p((p) over bar) up to p(T) = 20 GeV/c at mid-rapidity in pp, peripheral (60-80%) and central (0-5%) Pb-Pb collisions at v root s(NN) = 2.76 TeV have been measured using the ALICE detector at the Large Hadron Collider. The proton-to-pion and the kaon-to-pionratios both show a distinct peak at p(T) approximate to 3 GeV/c in central Pb-Pb collisions. Below the peak, p(T) 10 GeV/c particle ratios in pp and Pb-Pb collisions are in agreement and the nuclear modification factors for pi(+/-), K-+/- and p((p) over bar) indicate that, within the systematic and statistical uncertainties, the suppression is the same. This suggests that the chemical composition of leading particles from jets in the medium is similar to that of vacuum jets

Centrality, rapidity and transverse momentum dependence of J/\u3c8 suppression in Pb-Pb collisions at 1asNN= 2.76TeV

The inclusive J/.nuclear modification factor (R-AA) in Pb-Pb collisions at root(NN)-N-S = 2.76TeVhas been measured by ALICE as a function of centrality in the e+ e-decay channel at mid-rapidity (| y| < 0.8) and as a function of centrality, transverse momentum and rapidity in the + -decay channel at forward-rapidity (2.5 < y < 4). The J/.yields measured in Pb-Pb are suppressed compared to those in ppcollisions scaled by the number of binary collisions. The RAAintegrated over a centrality range corresponding to 90% of the inelastic Pb-Pb cross section is 0.72 - 0.06(stat.) - 0.10(syst.) at mid-rapidity and 0.58 - 0.01(stat.) - 0.09(syst.) at forward-rapidity. At low transverse momentum, significantly larger values of RAAare measured at forward-rapidity compared to measurements at lower energy. These features suggest that a contribution to the J/.yield originates from charm quark (re) combination in the deconfined partonic medium