International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Aspectos clínicos da intoxicação experimental pelas favas de Stryphnodendron fissuratum (Leg. Mimosoideae) em caprinos Clinical aspects of the experimental poisoning by the pods of Stryphnodendron fissuratum (Leg. Mimosoideae) in goats

Com o objetivo de caracterizar o quadro clínico da intoxicação por Stryphnodendron fissuratum Mart. (Leg. Mimosoideae) em caprinos, administraram-se as favas dessa planta a oito caprinos, por via oral forçada em doses únicas e a outros dois caprinos, em doses fracionadas. A menor dose que causou sinais clínicos e morte foi a de 10g/kg. Doses de 20g/kg e 40g/kg causaram sinais acentuados e doses únicas de 5g/kg não provocaram sinais. Doses fracionadas de 5g/kg durante quatro dias, totalizando 20g/kg provocaram sinais acentuados e morte. Em ambos os grupos, os primeiros sinais de intoxicação foram observados a partir do primeiro dia de experimento e a evolução variou de 4-25 dias. A doença caracterizou-se principalmente por alterações digestórias e nervosas que consistiram em anorexia, desidratação, hipomotilidade e atonia ruminal, timpanismo, gemidos constantes, dor à percussão abdominal, fezes com muco, ranger de dentes, apatia, ataxia, dismetria, tremores de cabeça, tremores musculares, fraqueza com o andar cambaleante e trôpego, acentuada depressão e decúbito esternal ou lateral prolongado e morte. Alguns animais apresentaram acentuada queda de pêlos na região dorsal; apenas um caprino apresentou fezes líquidas, marrom-escuras e fétidas. Outros sinais incluíram perda de fluido ruminal durante a ruminação, sialorréia, exsudato nasal seroso e lacrimejamento. As provas de função hepática e renal revelaram alterações discretas. As concentrações séricas de aspartato aminotransferase encontraram-se levemente aumentadas e as de creatinofosfocinase muito aumentadas.<br>In order to confirm the susceptibility of goats to the poisoning by Stryphnodendron fissuratum Mart. (Leg. Mimosoideae) and to characterize the clinical disease, the pods of the plant were given orally to each of eight young goats and in fractioned doses to other two. The lowest lethal dose was 10g/kg. The same dose was the lowest that induced disease. Doses of 20g/kg and 40g/kg caused pronounced clinical signs and doses of 5g/kg did not caused signs. Fractioned doses of 5g/kg during four days also caused pronounced signs. In each groups the first signs of poisoning were observed from the first day of experiments and the changes ranged from 4-25 days. The disease was characterized mainly by digestive and nervous disorders. Clinical signs were partial to complete anorexia, dehydration, decrease in ruminal activity up to atonia, tympanism, constant vocalizations, grinding of the teeth pain up on abdominal palpation, apathy, ataxia, depression, dysmetria, head and muscle tremors, weakness, difficulty in rising, sternal or lateral recumbency and death. Some goats presented extense hair loss in the skin of the dorsum; one goat presented liquid and black fetid feces. Other signs included loss of ruminal fluid during rumination, drooling, serous nasal and ocular discharges. Liver and kidney function tests had resulted in slight changes. AST serum levels were slightly increased and creatine phosphokinase levels were highly increased. These changes can associated to the effects of triterpenic saponins contained in the S. fissuratum pods