Utilização de cateter central de inserção periférica e ocorrência da infecção da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal

Objective: To analyze the prevalence of hospital primary bloodstream infections in a neonatal intensive care unit (NICU). Methods: A retrospective study involving analyses of records of patients admitted to the NICU from January to December 2010 was conducted. The incidence density of catheter-associated bloodstream infections per 1000 catheter-days was calculated. Results: Among 192 newborns, 16 (8.3%) who used peripherally inserted central catheters had bloodstream infections. The infection density confirmed by blood culture reached 5.9, while the density based on clinical criteria accounted for 3.5 per 1000 patients with central vascular catheter-days, with the following distribution by weight range: 10.31 (750-999 g), 2.76 (1000-1499 g), 5.65 (1500-2499 g), and 6.79 (>2500 g) per 1000 patients with vascular catheter-days. The average time between catheter insertion and the development of infection was 11 days. The most common insertion site was the jugular vein (37.5%). Mortality rates associated with nosocomial bloodstream infections reached 31%. Conclusions: The use of peripherally inserted central catheter is a practice not without risk considering that this is an invasive device and can predispose the occurrence of nosocomial infection.Objetivo: Analisar a prevalência de infecção hospitalar primária da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal. Métodos: Estudo retrospectivo, com análise de prontuários de uma Unidade de Terapia Intensiva Neonatal, no período de janeiro a dezembro de 2010. Foi calculada a densidade de incidência de infecção de corrente sanguínea associada ao cateter por 1000 cateteres-dia. Resultados: Dos 192 recém-nascidos, 16 (8,3%) apresentaram infecção da corrente sanguínea e todos estes utilizaram o cateter central de inserção periférica. A densidade de infecção confirmada por hemocultura foi de 5,9 e a baseada em critérios clínicos foi de 3,5 por 1000 pacientes com cateter vascular central-dia. A distribuição por faixa de peso foi de: 30,9 (750-999g); 11 (1000-1499g); 8,5 (1500-2499g) e 6,8 (> 2500g) por 1000 pacientes com cateter vascular dia. A média do tempo de uso do cateter foi de 11 dias. O sítio de inserção mais comum foi o acesso jugular (37,5%) e a mortalidade associada à infecção da corrente sanguínea foi de 31%. Conclusões: A utilização do cateter central de inserção periférica é uma prática não isenta de riscos, considerando que este é um dispositivo invasivo e pode predispor à ocorrência de infecção

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Background: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions: HAI increased during COVID-19. The microorganisms’ susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use

NOSOCOMIAL INFECTIONS IN RENAL-TRANSPLANT PATIENTS

A matched-pair case-control study was performed on 72 renal transplant patients with nosocomial urinary tract and postoperative wound infections to assess the length of their hospitalizations. Patients with nosocomial infections required longer hospitalization than the respective controls. There were statistically significant differences (p less-than-or-equal-to 0.05) between: patients who acquired only postoperative wound infection, compared with noninfected renal transplant patients (34 vs. 17 days); patients with urinary tract and postoperative wound infections, compared with noninfected controls (38 vs. 20 days); and between the entire case group and controls (30 vs. 19 days). Patients who acquired concomitant infections had longer hospitalizations than those with only nosocomial urinary tract infection (38 and 25 days, p less-than-or-equal-to 0.05). The results stress the need for effective preventive measures against nosocomial infections, considering the reduction of morbidity and costs of extended hospitalizations of renal transplant patients.ESCOLA PAULISTA MED SCH,DISCIPLINA DOENCAS INFECCIOSAS & PARASITARIAS,BR-04023 SAO PAULO,BRAZILESCOLA PAULISTA MED SCH,DISCIPLINA DOENCAS INFECCIOSAS & PARASITARIAS,BR-04023 SAO PAULO,BRAZILWeb of Scienc

Risk Factors for Nosocomial Urinary Tract and Postoperative Wound Infections in Renal Transplant Patients: A Matched-Pair Case-Control Study

A matched-pair case-control study was done on 4 groups of renal transplant patients who acquired nosocomial infections: 1) urinary tract infection, 2) postoperative wound infection, 3) urinary tract plus postoperative wound infection and 4) the entire group of patients. For urinary tract infection patients a prolonged period of hemodialysis before hospitalization was considered a risk factor. Renal transplantation with an HLA-1 (identical) donor graft was a characteristic related to the control group. High levels of plasma creatinine and prolonged vesical catheterization were risk factors for acquiring postoperative wound infection. The latter was also considered to be a risk factor for both infections, as well as the inadequate use of antibiotic prophylaxis and the number of antibiotics used. For the entire group of patients surgical wall hematoma was a risk factor. In this group the independent risk factors analyzed by multivariate logistic regression were renal transplantation with a cadaver donor graft, prolonged vesical catheterization and prolonged use of antibiotics. Careful management of the cadaver donor allograft, decreasing the chances of contamination, decreasing the interval of urinary catheter maintenance and use of antibiotics in the postoperative period are measures that can contribute to lessen the incidence of these nosocomial infections in renal transplant recipients.ESCOLA PAULISTA MED SCH,DISCIPLINA NEFROL,BR-04023 SAO PAULO,BRAZILESCOLA PAULISTA MED SCH,DISCIPLINA NEFROL,BR-04023 SAO PAULO,BRAZILWeb of Scienc