Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study

Background: Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE ( vancomycin- resistant enterococci). the aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.Methods: A prospective survey was conducted on all patients receiving vancomycin between 1(st) March 2002 and 30(th) September 2002 in a university- school hospital. Appropriateness of vancomycin use was assessed, according to the criteria established by the Centers for Disease Control and Prevention ( CDC), at two time points: first, at the beginning of therapy, and second, continuing after 72 hours.Results: A total of 557 patients received vancomycin. Three hundred seventy- four ( 67.1%) were under 60 years old, 374 ( 67.1%) had prolonged stays (> two weeks) in hospital, and 455 ( 81.7%) were in the intensive care unit ( ICU). Two hundred sixty- three patients ( 47.2%) had some invasive device. in 324 ( 58.2%) patients the duration of vancomycin treatment was up to two weeks. Vancomycin was inappropriately used in 65.7% during the first 24 hours and in 67% at the 72 hours point according to CDC criteria [ 4]. the inappropriateness of vancomycin use during the first 24 hours was related to: patients aged less than 60 ( OR 1.7; CI 95% 1.1 - 2.5), non- ICU patients ( OR 1.5; CI 95% 1.0 - 2.4) and patients without neutropenia ( OR 7.5; CI 95% 2.4 - 22.7). At 72 hours, the inappropriateness of vancomycin use was related to: patients aged less than 60 ( OR 1.5; CI 95% 1.0 - 2.3), non- ICU patients ( OR 1.7; CI 95% 1.1 - 2.7) and patients without neutropenia ( OR 8.0; CI 95% 2.6 - 24.3).Conclusion: Vancomycin was abused. Patients aged less than 60, non- ICU patients and those who did not present neutropenia were the principal groups at risk of inappropriate use.Universidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilWeb of Scienc

A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection

Background: Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. We observed decreased carbapenem susceptibility among K. pneumoniae isolated from patients at a tertiary private hospital that showed a phenotype compatible with carbapenemase production although this group of enzymes was not detected in any sample. the aim of this study was to describe the epidemiology and clinical outcomes associated with carbapenem-resistant K. pneumoniae and to determine the antimicrobial resistance mechanisms.Methods: Risk factors associated with carbapenem-resistant K. pneumoniae infections were investigated by a matched case-control study from January 2006 through August 2008. A cohort study was also performed to evaluate the association between carbapenem resistance and in-hospital mortality. Bacterial identification and antimicrobial susceptibility were determined by Vitek 2 and Etest. Carbapenemase activity was detected using spectrophotometric assays. Production of beta-lactamases and alterations in genes encoding K. pneumoniae outer membrane proteins, OmpK35 and OmpK36, were analyzed by PCR and DNA sequencing, as well as SDS-Page. Genetic relatedness of carbapenem resistant isolates was evaluated by Pulsed Field Gel Electrophoresis.Results: Sixty patients were included (20 cases and 40 controls) in the study. Mortality was higher for patients with carbapenem-resistant K. pneumoniae infections compared with those with carbapenem-susceptible K. pneumoniae (50.0% vs 25.7%). the length of central venous catheter use was independently associated with carbapenem resistance in the multivariable analysis. All strains, except one, carried bla(CTX-M-2), an extended-spectrum betalactamase gene. in addition, a single isolate also possessed bla(GES-1). Genes encoding plasmid-mediated AmpC beta-lactamases or carbapenemases (KPC, metallo-betalactamases or OXA-carbapenemases) were not detected.Conclusions: the K. pneumoniae multidrug-resistant organisms were associated with significant mortality. the mechanisms associated with decreased K. pneumoniae carbapenem susceptibility were likely due to the presence of cephalosporinases coupled with porin alterations, which resulted from the presence of the insertion sequences in the outer membrane encoding genes.Instituto Israelita de Ensino e Pesquisa Israelita Albert EinsteinHosp Israelita Albert Einstein, Infect Control Unit, BR-05652000 São Paulo, BrazilHosp Israelita Albert Einstein, Microbiol Lab, BR-05651901 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, Div Infect Dis, BR-04024002 São Paulo, BrazilHosp Israelita Albert Einstein, Intens Care Unit, BR-05651901 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP EPM, Div Infect Dis, BR-04024002 São Paulo, BrazilInstituto Israelita de Ensino e Pesquisa Israelita Albert Einstein: 449.08Web of Scienc

EXPLORAÇÃO SEXUAL INFANTO-JUVENIL NO TURISMO: DIAGNÓSTICO DA REGIÃO CAMINHO DOS CÂNIONS – SANTA CATARINA - BRASIL

A exploração sexual de crianças e adolescentes no país tem tido uma repercussão relevante no contexto turístico, com o crescimento de destinos receptivos do chamado “turismo sexual”, notadamente nas regiões Norte e Nordeste. Muitas organizações do movimento da infância e juventude têm atuado a favor do enfrentamento à causa, em especial, o Ministério do Turismo do Brasil. Com base neste cenário, o Programa Turismo Sustentável & Infância foi lançado pelo Governo Federal no ano de 2004, abarcando um conjunto de projetos e ações para lidar com a exploração infanto-juvenil, por meio de campanhas e seminários de sensibilização, que buscam trabalhar a mudança cultural deste tipo de turismo. O objetivo deste trabalho foi o diagnosticar casos de aliciamento de crianças e adolescentes com a finalidade de praticar sexo na Região Turística Caminho dos Cânions, no extremo Sul Catarinense, bem como sensibilizar profissionais alvo de aliciamento, nesta pesquisa, os caminhoneiros. A metodologia empregada foi a pesquisa exploratória, utilizando-se a técnica da entrevista semi-estruturada para coleta de dados qualitativos, cujos entrevistados foram os motoristas de caminhões que pernoitam nos postos de combustíveis localizados nos municípios às margens da Rodovia Federal BR 101 Sul. Os resultados mostraram que, segundo a vivência do público alvo nas estradas, a maior incidência de casos de exploração sexual de crianças e adolescentes ocorrem nas regiões Centro-Oeste e Nordeste do país. Além disso, a maioria dos informantes alegou conhecer e, aprovar a campanha nacional do Ministério do Turismo – Programa Turismo Sustentável & Infância

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

Background: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.Methods: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (<= 16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).Results: in our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (<= 16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. the most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). the crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). the most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.Conclusions: in our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.Pfizer, Inc.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Inst Oncol Pediat IOP GRAAC, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilHosp 9 Julho, São Paulo, BrazilSanta Casa Porto Alegre, Porto Alegre, RS, BrazilHosp Conceicao, Porto Alegre, RS, BrazilHosp Base, Brasilia, DF, BrazilHosp Walter Cantidio, Fortaleza, Ceara, BrazilHosp Diadema, São Paulo, BrazilHosp Espanhol, Salvador, BA, BrazilHosp Coracao, Natal, RN, BrazilHosp UNIMED, Natal, RN, BrazilHosp Clin Goiania, Goiania, Go, BrazilHosp Rim & Hipertensao, São Paulo, BrazilUniv Fed Triangulo Mineiro, Uberaba, MG, BrazilVirginia Commonwealth Univ, Richmond, VA USAUniversidade Federal de São Paulo UNIFESP, São Paulo, BrazilFAPESP: 2006/57700-0Web of Scienc

High success and low mortality rates with non-invasive ventilation in influenza A H1N1 patients in a tertiary hospital

<p>Abstract</p> <p>Background</p> <p>In 2009, an outbreak of respiratory illness caused by influenza A H1N1 virus occurred worldwide. Some patients required Intensive Care Unit (ICU) admission. The use of non-invasive ventilation (NIV) in these patients is controversial, as the aerosol dispersion may contaminate the environment and health-care co-workers.</p> <p>Methods</p> <p>Describe the respiratory profile, the mortality rate, and the benefit of using NIV in patients with confirmed diagnosis of influenza AH1N1 who were admitted in the ICU during the year 2009.</p> <p>Results</p> <p>A total of 1, 401 cases of influenza A H1N1 were confirmed in our hospital by real-time RT-PCR in 2009, and 20 patients were admitted to the ICU. The patients' ages ranged from 18 to 74 years (median of 42). Acute Respiratory Failure (ARF) was present in 70% of patients. The median Acute Physiology and Chronic Health Evaluation II score was 7 (range 7 to 25). Of the 14 patients who developed ARF, 85.7% needed NIV and 14% needed invasive MV at admission. Our success rate (41.6%) with NIV was higher than that described by others. The hospital mortality rate was 2.1%. When influenza A H1N1 arrived in Brazil, the disease was already on endemic alert in other countries. The population was already aware of the symptoms and the health-care system of the treatment. This allowed patients to be properly and promptly treated for influenza A H1N1, while health-care workers took protective measures to avoid contamination.</p> <p>Conclusion</p> <p>In our study we found a high success and low mortality rates with non-invasive ventilation in patients with influenza A H1N1.</p

Catheter Related Bloodstream Infection (CR-BSI) in ICU Patients: Making the Decision to Remove or Not to Remove the Central Venous Catheter

Background Approximately 150 million central venous catheters (CVC) are used each year in the United States. Catheter-related bloodstream infections (CR-BSI) are one of the most important complications of the central venous catheters (CVCs). Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. Methods We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU) from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (\u3e15 CFU) culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1) differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2) simultaneous quantitative blood culture with 5:1 ratio (CVC versus peripheral). Results 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method) were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208) in ICU patients. Conclusion In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure (vol 9, e114548, 2014)

Hosp Univ Austral, Div Infect Dis Prevent & Infect Control Serv, Buenos Aires, DF, ArgentinaHosp Univ Austral, Microbiol Lab, Buenos Aires, DF, ArgentinaMonash Hlth, Monash Infect Dis, Clayton, Vic, AustraliaWollongong Hosp, Wollongong, NSW, AustraliaUniversidade Federal de São Paulo, Div Infect Dis, Lab Especial Microbiol Clin, São Paulo, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilVirginia Commonwealth Univ, Med Ctr, Richmond, VA USAHosp Rim & Hipertensao, São Paulo, BrazilHosp Santa Casa Porto Alegre, Porto Alegre, RS, BrazilHosp Conceicao, Porto Alegre, RS, BrazilHosp Walter Cantidio, Fortaleza, Ceara, BrazilHosp Diadema, São Paulo, BrazilHosp Espanhol, Salvador, BA, BrazilHosp Clin Goiania, Goiania, Go, BrazilMt Sinai Hosp, Toronto, ON M5G 1X5, CanadaUniv Alberta, Div Infect Dis, Edmonton, AB, CanadaCairo Univ Kasr Ainy, Dar Al Fouad Hosp, Fac Med, Dept Clin Pathol, Cairo, EgyptHygeia Gen Hosp, Athens, GreeceUniv Tubingen Hosp, Internal Med, Div Infect Dis, Tubingen, GermanyTokyo Metropolitan Tama Med Ctr, Dept Infect Prevent, Tokyo, JapanAmphia Hosp Breda, Lab Microbiol & Infect Control, Breda, NetherlandsThammasat Univ Hosp, Div Infect Dis, Pathum Thani, ThailandSt John Hosp & Med Ctr, Infect Prevent & Control Dept, Grosse Pointe Woods, MI USAUniv Hosp Bern, Dept Infect Dis, CH-3010 Bern, SwitzerlandUniv Bern, Bern, SwitzerlandBarnes Jewish Hosp, St Louis, MO 63110 USAUniversidade Federal de São Paulo, Div Infect Dis, Lab Especial Microbiol Clin, São Paulo, BrazilWeb of Scienc

Combination of searches for heavy spin-1 resonances using 139 fb−1 of proton-proton collision data at s = 13 TeV with the ATLAS detector

A combination of searches for new heavy spin-1 resonances decaying into different pairings of W, Z, or Higgs bosons, as well as directly into leptons or quarks, is presented. The data sample used corresponds to 139 fb−1 of proton-proton collisions at = 13 TeV collected during 2015–2018 with the ATLAS detector at the CERN Large Hadron Collider. Analyses selecting quark pairs (qq, bb, , and tb) or third-generation leptons (τν and ττ) are included in this kind of combination for the first time. A simplified model predicting a spin-1 heavy vector-boson triplet is used. Cross-section limits are set at the 95% confidence level and are compared with predictions for the benchmark model. These limits are also expressed in terms of constraints on couplings of the heavy vector-boson triplet to quarks, leptons, and the Higgs boson. The complementarity of the various analyses increases the sensitivity to new physics, and the resulting constraints are stronger than those from any individual analysis considered. The data exclude a heavy vector-boson triplet with mass below 5.8 TeV in a weakly coupled scenario, below 4.4 TeV in a strongly coupled scenario, and up to 1.5 TeV in the case of production via vector-boson fusion

Combination of searches for heavy spin-1 resonances using 139 fb−1 of proton-proton collision data at √s = 13 TeV with the ATLAS detector

A combination of searches for new heavy spin-1 resonances decaying into diferent pairings of W, Z, or Higgs bosons, as well as directly into leptons or quarks, is presented. The data sample used corresponds to 139 fb−1 of proton-proton collisions at √s = 13 TeV collected during 2015–2018 with the ATLAS detector at the CERN Large Hadron Collider. Analyses selecting quark pairs (qq, bb, tt¯, and tb) or third-generation leptons (τν and τ τ ) are included in this kind of combination for the frst time. A simplifed model predicting a spin-1 heavy vector-boson triplet is used. Cross-section limits are set at the 95% confdence level and are compared with predictions for the benchmark model. These limits are also expressed in terms of constraints on couplings of the heavy vector-boson triplet to quarks, leptons, and the Higgs boson. The complementarity of the various analyses increases the sensitivity to new physics, and the resulting constraints are stronger than those from any individual analysis considered. The data exclude a heavy vector-boson triplet with mass below 5.8 TeV in a weakly coupled scenario, below 4.4 TeV in a strongly coupled scenario, and up to 1.5 TeV in the case of production via vector-boson fusion