Disponibilidade de recursos e equipamentos complementares para uso na prevenção de infecções relacionadas à assistência à saúde

Background and Objectives: Recently, complementary resources and equipment have emerged to improve prevention of healthcare-associated infections (HAIs). Our aim is to verify availability and use of different resources/equipment by infection controllers. Methods: We conducted a survey with infection controllers from the State of Rio de Janeiro, Brazil, by invitation using a social media group, in August 2022. Nine different resources and equipment were evaluated. Categorical and continuous variables were evaluated by the chi-square test and Mann–Whitney U test, respectively. A p value of less than 0.05 was considered statistically significant. Results: One hundred and eight persons answered the questionnaire. The mean age was 42.8 years (SD +/- 8.5 years) and 53 (49.1%) reported most of their workload in public hospitals, 45 (41.7%) in private hospitals and 10 (9.2%) reported the same workload in public and private hospitals. Sixty-there percent reported teaching activities in their institutions. There was no correlation between the existence of teaching activities and hospital profile (p=0.42). The most common resource available was molecular biology (PCR) for microbiological samples research for 73 (67.6%) participants. The second resource most available was applications (Apps) for HAIs prevention and control for 33 (30.6%), 19 (17.6%) reported no availability of resource/equipment technology. Conclusion: Molecular biology (PCR) for microbiological samples research was the most common resource available for infection controllers of an important state of Brazil.Antecedentes y objetivos: Recientemente han surgido recursos y equipos complementarios para mejorar la prevención de las infecciones asociadas a la atención de la salud. El objetivo es verificar la disponibilidad y el uso de diferentes recursos/equipos por los controladores de infecciones. Métodos: Realizamos una encuesta entre los controladores de infecciones del estado de Rio de Janeiro, Brasil, por invitación en redes sociales, en agosto de 2022. Se evaluó la disponibilidad y uso de nueve recursos y equipos diferentes. Las variables categóricas y continuas se evaluaron mediante las pruebas de chi-cuadrado y Mann-Whitney, respectivamente. Se consideró estadísticamente significativo un valor de p < 0.05. Resultados: Ciento ocho personas respondieron al cuestionario. La edad media fue de 42,8 años (DE +/- 8,5 años) y 53 (49,1%) reportaron mayor carga de trabajo en hospitales públicos, 45 (41,7%) en privados y 10 (9,2%) reportaron la misma carga en hospitales públicos y privados. De los 108, el 63% reportó actividades docentes en sus instituciones. No hubo correlación entre la existencia de actividades docentes y el tipo de hospital (p=0,42). El recurso más disponible fue el uso de la biología molecular (reacción en cadena de la polimerasa) por 73 (67,6%) participantes. El segundo más común fue el uso de aplicaciones de prevención y control de infecciones por 33 (30,6%) participantes. Diecinueve participantes (17,6%) señalaron la ausencia de todos los recursos/equipos. Conclusiones: El uso de la biología molecular para investigar muestras microbiológicas fue el recurso/equipo más disponible para los controladores de infecciones de un importante estado brasileño.Justificativas e Objetivos: Recentemente, recursos e equipamentos complementares têm surgido para melhorar a prevenção de infecções relacionadas à assistência à saúde. O objetivo deste artigo é verificar a disponibilidade e o uso de diferentes recursos e equipamentos pelos controladores de infecção. Métodos: Realizamos uma pesquisa do tipo survey com controladores de infecção do estado do Rio de Janeiro, por meio de convite pela mídia social, em agosto de 2022. Nove diferentes recursos e equipamentos foram avaliados quanto à disponibilidade e ao uso. Variáveis categóricas e contínuas foram avaliadas pelo teste qui-quadrado e Mann-Whitney, respectivamente. Um valor de p menor que 0,05 foi considerado estatisticamente significativo. Resultados: Cento e oito pessoas responderam ao questionário. A média de idade foi de 42,8 anos (DP +/- 8,5 anos), e 53(49,1%) relataram maior carga de trabalho em hospitais públicos, 45 (41,7%) em hospitais privados e 10(9,2%) carga horária similar nos dois tipos de hospitais. Dos 108, 63% relataram a existência de atividades de ensino nas instituições. Não houve correlação entre existência de atividades de ensino e tipo de hospital (p=0,42). O recurso mais disponível foi o uso de biologia molecular (reação em cadeia de polimerase) por 73 (67,6%) participantes. A segunda ferramenta mais encontrada foi o uso de aplicativos para prevenção e controle de infecção para 33 (30,6%) desses participantes. Dezenove deles (17,6%) relataram ausência de todos os recursos/equipamentos. Conclusão: O uso de biologia molecular para pesquisa de amostras biológicas foi o recurso mais disponível para controladores de infecção de um importante estado brasileiro.

Dinâmica da circulação de bactérias multirresistentes em unidades de terapia intensiva pediátrica do Rio de Janeiro

A circulação de bactérias multirresistentes entre unidades de terapia intensiva pediátricas é uma realidade, sendo necessário conhecer o perfil dos microrganismos mais prevalentes para estabelecer medidas de controle eficazes. O objetivo deste artigo é descrever o perfil das bactérias multirresistentes(BMR) importadas em uma unidade de terapia intensiva pediátrica do Rio de Janeiro, de acordo com a região geográfica dos hospitais. Métodos: Foi realizada coleta de swab nasal e retal em todos os pacientes que permaneceram mais que 12 horas em outras unidades, admitidos nas 4 unidades de terapiaintensiva pediátrica do Prontobaby. Resultados: Entre agosto de 2009 e dezembro de 2011, detectamos 60 BMR sendo 19 causadoras de infecção e 41 colonizações. Bactérias Gram negativas representaram 68,4% dasinfecções e 60,8% das colonizações. A maior parte dos hospitais (21/33- 63,6%) estava localizada na cidade do Rio de Janeiro e aqueles localizados na zona norte e oeste concentraram 25 das 60 (41,6%) BMR. Klebsiella pneumoniae ESBL foi a bactéria mais comumente isolada em infecções enquanto Escherichia coli E SBL foi a mais frequente em colonizações por Gram negativos. Conclusão: Concluímos que as BMR gram negativas importadas foram mais prevalentes tanto em infecções quanto em colonizações. As regiões norte e oeste dacidade apresentaram a maior parte dos casos de BMR

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

CITATION: Araujo da Silva AR, Marques A, Di Biase C, et al Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review Archives of Disease in Childhood 2020;105:563-568.Introduction Antimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates. Methods We searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded. Results The initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates. Conclusion ASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies

Trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination in Rio de Janeiro, Brazil / Tendências do número de admissões pediátricas da COVID-19 durante as primeiras 24 semanas de vacinação da COVID-19 no Rio de Janeiro, Brasil

Objective: To describe trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination.   Design: A retrospective study was conducted in children (0-18 years), admitted in two pediatric hospitals of Rio de Janeiro city, between January 17 and July 3, 2021 with confirmed COVID-19 by reverse transcription polymerase chain reaction or serological tests. Trends of COVID-19 pediatric admissions number during the first 24 weeks of COVID-19 vaccination in Rio de Janeiro, Brazil and the pre-vaccine period were measured by linear regression. Participants: Children admitted in pediatric hospitals in Rio de Janeiro, city, Brazil Results: The number of total admitted patients (with all diseases) were 5340 during the pre-vaccine period, being 94 (1.8%) of them with confirmed COVID-19, and 4182 children admitted during the vaccine period, with 86 confirmed COVID-19 patients (2.1 %) (p=0.29). Media of cases admitted per/week were 2.02 in pre-vaccine period and 3.6 during the first 24 weeks of COVID vaccination (p=0.009). One death was reported in the pre-vaccine period and four in the vaccine period (p=0.14). Trends of increase in the number of admitted cases were verified both in the pre-vaccine period as in the vaccine period, being more expressive in the last one. Conclusion: There was trend of increase in number of children admitted with confirmed COVID-19 during the first 24 weeks of COVID-vaccination in Rio de Janeiro, city. Considering that few people were fully vaccinated, reducing of number of admitted children with confirmed COVID-19 was not verified

Controle de infecções relacionadas à assistência à saúde por bactérias Gram-negativas resistentes à carbapenêmicos em unidade de tratamento intensivo neonatal do Rio de Janeiro.

Justificativa e objetivos. Bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) são um problema de saúde pública global, pela possibilidade de causar infecções intratáveis em neonatos. O objetivo foi descrever o controle das taxas de BGN-CR causando infecções relacionadas à assistência à saúde (IRAS) em unidade de tratamento intensivo neonatal (UTINEO). O consumo de antimicrobianos/carbapenêmicos também foi avaliado. Métodos. Estudo prospectivo descritivo das IRAS em uma UTINEO, durante 1 ano. O consumo de antimicrobianos/antibióticos foi medido em dias de terapia/1000pacientes-dia (DOT/1000PD) Resultados e conclusões: Entre setembro de 2017 e setembro de 2018, admitimos 308 pacientes, a maioria com peso>1500g (303/308-98,4%), totalizando 2223 pacientes-dia. Oito IRAS foram registradas, correspondendo a uma taxa de 2,6% (ou densidade de incidência de 3,6/1000PD). Em cinco das oito infecções (62,5%), um agente infeccioso foi isolado, sendo três bactérias Gram-negativas (todas Klebsiella pneumoniae, 2 com perfil de produção de beta-lactamase de espectro estendido) e duas infecções por Candida sp. Não houve infecção por BGN-CR. O consumo total de antimicrobianos em DOT/1000PD foi de 1638 e o de carbapenêmicos 49,3; o que representou 3% do total, com tendência de queda durante o ano. Em setembro de 2017, implementamos um programa de gestão de antimicrobianos (PGA), em adição às medidas de controle de infecção realizadas desde 2005. Os elementos-chave do PGA foram: auditoria de antibióticos e feedback, restrição de antimicrobianos-alvo e maior rapidez na liberação de resultados de culturas. Verificamos adequado controle de BGN-CR, não sendo encontrada infecção por este agente, tendência de queda no consumo de antimicrobianos e carbapenêmicos

Antimicrobial consumption in pediatric intensive care units during the first year of COVID-19 pandemic / Consumo antimicrobiano em unidades de cuidados intensivos pediátricos durante o primeiro ano da pandemia de COVID-19

Introduction: The absence of standardized treatment for critical children admitted in pediatric intensive care units (PICUs) with COVID could lead to an increase in antimicrobial consumption, as indirect effect. Aim: To describe trends of antimicrobial consumption in two PICUs before and during the COVID pandemic year.Methods: We did a retrospective study in children admitted in two PICUs of Rio de Janeiro city, between March 2019 and March 2021. The first year represented the pre-pandemic period and the last one the pandemic period. Trends of antimicrobial consumption were measured by days of therapy (DOT/1000 patient-days) and analyzed by linear regression for antibiotics, antivirals and antifungals Results: Number of patients-days in the PICU 1 was 3495 in the pre-pandemic period and 3600 in the pandemic period. The overall DOT/1000 PD of antibiotics, antivirals and antifungal was 15,308.1, 942.8 and 1,691.1, respectively in the pre-pandemic period and 13,481.5, 1,335.4 and 1,243.7, respectively in pandemic period. It was verified trend of reduction of antibiotic and antifungals and increase in antivirals consumption. Number of patients-days in the PICU 2 was 5029 in the pre-pandemic period and 4557 in the pandemic period and the overall DOT/1000 PD of antibiotics, antivirals and antifungal was 16,668.5, 1,385 and 1,966.7, respectively in the pre-pandemic period and 10,896.5, 830.7 and 677.3 in pandemic period. It was verified trend of reduction of antibiotic, antivirals and antifungals consumption. Conclusion: Trends of antimicrobial consumption reduction were verified for antibiotics and antifungals in two PICUs and reduction for antiviral in one of them

Respirometry and Ruminant Nutrition

The gaseous exchange between an organism and the environment is measured by respirometry or indirect calorimetry. Once the oxygen consumption (O2) and the production of carbon dioxide (CO2) and methane (CH4) are known, the energy losses by gas and heat can be calculated. Energy metabolism and methane production have been studied in the Calorimetry and Metabolism Laboratory of the Federal University of Minas Gerais, located in Belo Horizonte, Minas Gerais, Brazil. Animals used are mainly Zebu cattle and their crossbreeds that represent most beef and dairy cattle breed grazed on tropical pastures. System calibration and routine work are addressed in this text. The results obtained on respirometric chambers are expressed in net energy (NE), which can be net energy for maintenance (NEm), lactation (NEL), weight gain (NEg), and pregnancy (NEp). NE is, in fact, what is used by the animal for maintenance and each productive function. The values of k (conversion efficiency of ME into NE) for maintenance (km), milk (kL), weight gain or growth (kg), and pregnancy (kp) are determined. Thanks to the peculiarity of the respirometric technique, the same animal can be evaluated several times, in different physiological states and planes of nutrition

The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review.

BACKGROUND: Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown. AIM: To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. METHODS: Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. RESULTS: Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. CONCLUSIONS: There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units

Classification of schizophrenic traits in transcriptions of audio spectra from patient literature: artificial intelligence models enhanced by geometric properties

Schizophrenia is a severe mental illness that affects approximately 1% of the global population and presents significant challenges for patients, families, and healthcare professionals. Characterized by symptoms such as delusions, hallucinations, disorganized speech or behavior, and cognitive impairment, this condition has an early onset and chronic trajectory, making it a debilitating challenge. Schizophrenia also imposes a substantial burden on society, exacerbated by the stigma associated with mental disorders. Technological advancements, such as computerized semantic, linguistic, and acoustic analyses, are revolutionizing the understanding and assessment of communication alterations, a significant aspect in various severe mental illnesses. Early and accurate diagnosis is crucial for improving prognosis and implementing appropriate treatments. In this context, the advancement of Artificial Intelligence (AI) has provided new perspectives for the treatment of schizophrenia, with machine learning techniques and natural language processing allowing a more detailed analysis of clinical, neurological, and behavioral data sets. The present article aims to present a proposal for computational models for the identification of schizophrenic traits in texts.  The database used in this article was created with 139 excerpts of patients' speeches reported in the book “Memories of My Nervous Disease” by German judge Daniel Paul Schreber, classifying them into three categories: 1 - schizophrenic, 2 - with schizophrenic traits and 3 - without any relation to the disorder. Of these speeches, 104 were used for training the models and the others 35 for validation.Three classification models were implemented using features based on geometric properties of graphs (number of vertices, number of cycles, girth, vertex of maximum degree, maximum clique size) and text entropy. Promising results were observed in the classification, with the Decision Tree-based model [1] achieving 100% accuracy, the KNN- k-Nearest Neighbor model observed with 62.8% accuracy, and the 'centrality-based' model with 59% precision. The high precision rates, observed when geometric properties are incorporated into Artificial Intelligence Models, suggest that the models can be improved to the point of capturing the language deviation traits that are indicative of schizophrenic disorders. In summary, this study paves the way for significant advances in the use of geometric properties in the field of psychiatry, offering a new data-based approach to the understanding and therapy of schizophrenia