Infecção em cuidados de saúde: perspectiva actual

After a short review on the history of nosocomial infection and its current concept, the relevance assumed nowadays by healthcare-associated infections is enhanced. Worrying nosocomial infection rates are registered in developed Western Countries, with serious socio-economics repercussions, as a consequence of the increase in morbidity and mortality rates. Programmes for the prevention of nosocomial infection and their strict compliance can reduce its rate. The scope of nosocomial infection is greater nowadays, as it covers all healthcare-associated infections independently of the location where the healthcare is rendered, including health centres and nursing homes. The more common nosocomial infections and their etiologic agents, as well as the conditions which can favour their occurrence are pointed out. The increase of antimicrobial resistance and the need of guidelines for a correct use of antibiotics are also enhanced. The fundamental role of the Health Services for Infection Control is noted.. Finally, the Portuguese situation and the national surveys on nosocomial infection prevalence, carried out by the Directorate-General of Health, are also analyzed.Após uma breve resenha sobre a história da infecção nosocomial e sobre seu conceito actual, é chamada atenção para a relevância que a infecção associada à prestação de cuidados de saúde actualmente assume, mostrando-se a sua prevalência em países ocidentais, de elevado nível de desenvolvimento, onde a infecção nosocomial mostra valores preocupantes, com graves consequências sociais e económicas, pelo aumento da morbilidade e da mortalidade que condiciona, e naturalmente maior sofrimento humano. A instituição de normas de prevenção adequadas e o seu cumprimento estrito podem reduzir a taxa de infecção nosocomial, cujo âmbito é hoje mais vasto, pois abrange toda a infecção que resulte da prestação de cuidados de saúde, qualquer que seja o local em que sejam praticados. Referem-se o tipo de infecções mais comuns, bem como os factores que podem propiciar a sua ocorrência. De igual modo se realça a crescente eclosão das resistências microbianas e as normas que devem ser seguidas na prescrição de antibióticos. É chamada a atenção para a importância das funções que competem às Comissões de Controlo da Infecção, pilar fulcral nessa luta. A situação vivida em Portugal e a análise dos vários inquéritos realizados pela Direcção Geral da Saúde são também focadas.&nbsp

Editorial

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Bacterial meningitis in an urban area: etiologic study and prognostic factors

Objectives: The study of clinical features, diagnostic methods and prognostic factors of bacterial meningitis, in an urban area. Patients and Methods: All patients admitted between June 2001 and July 2004 in the emergency departments of a few hospitals, with the diagnosis of bacterial meningitis were included. CSFand blood cultures were performed in every case. Phenotypic characterization of strains of 5treptococcus pneumoniae and Neisseria meningitidis identified by culture were performed. In order to detect the three most common agents it was done a PCRassay in culture negative CSFsamples. Results: Bacterial meningitis was diagnosed in 201 patients. Etiologic definition was based on culture in 142 patients (70.6%), done by CSFPCRassay in 33 (16.4%) other patients and exclusively by latex agglutination test results in two cases. Thus, an etiologic diagnosis was established in 177 (88%) cases. Antigenic characterization showed a slight prevalence of N. meningitidis phenotype C:2b:P1; the 5. pneumoniae serotype characterization showed that 43.8% of identified serotypes are not included in any of the available vaccines. Eighteen patients died (8.9%). The statistic analysis found that factors associated with an adverse outcome were age older than 50 years (aR 7.07; IC 95% 1.1-27.4), the presence of comorbidities (aR 3.3; IC 95% 1.1-9.6) and the occurrence of systemic complications (aR 5.8; IC 95% 2.1-16.0). Conclusions: This epidemiologic pattern is similar to that found in other countries after the introduction of Haemophilus influenzae b conjugated vaccine. The association of culture and noncultural methods of diagnosis had a better performance in defining the etiology. Comparing to other series, in-patients mortality rate was lower (8.9%) than usually referred to, being considered unfavourable prognostic factors the age more than 50 years, the presence of comorbidities and of systemic complications

Hepatite vírica : Epidemiologia e diagnóstico

Dissertação de Doutoramento em Medicina apresentada à Faculdade de Medicina da Universidade do Port

Analysis of a Local HIV-1 Epidemic in Portugal Highlights Established Transmission of non-B and -G Subtypes

The existing data supports Portugal as the Western Europe country with highest HIV-1 subtype diversity. However, detailed phylogenetic studies of Portuguese HIV-1 epidemics are still scarce. Thus, our main goal was to analyze the phylodynamics of a local HIV-1 infection in the Portuguese region of Minho. Molecular epidemiological analysis was applied to data from 289 HIV-1 infected individuals followed in the reference Hospital of the province of Minho, Portugal, in which isolated viruses had been sequenced between 2000 and 2012. Viruses of the G (29.1%) and B (27.0%) subtypes were the most frequent, followed by recombinant forms (17.6%), C (14.5%), F1 (7.3%) and A1 (4.2%) subtypes. Multinomial logistic regression revealed that the odds of being infected with A1 and F1 subtype increased over the years when compared with B, G, C or recombinant viruses. As expected, polyphyletic patterns suggesting multiple and old introductions of subtypes B and G were found. However, transmission clusters of non-B and -G viruses among native individuals were also found with the dates of the most recent common ancestor estimated to the early 2000s. Our study supports that the HIV-1 subtype diversity in the Portuguese region of Minho is high and has been increasing in a manner that is apparently driven by factors other than immigration and international travel. Infections with A1 and F1 viruses in the region of Minho are becoming established and were mainly found in sexually transmitted clusters, reinforcing the need for more efficacious control measures targeting this infection route

Emergência da patologia infecciosa

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