Made available in DSpace on 2015-07-22T20:49:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24 / Introdução: Apesar dos inúmeros avanços no entendimento da fisiopatologia das infecções da corrente sanguínea (ICS), a má evolução clínica e a manutenção da elevada mortalidade persistem nos pacientes com esta síndrome. O uso de terapêutica empírica de largo espectro, em virtude do desconhecimento da evolução e das características clínicas e microbiológicas dessas infecções em nossos hospitais agravam o surgimento da resistência microbiana e aumentam os custos relacionados sem, na maioria das vezes, diminuírem as taxas de morbidade e mortalidade dos pacientes acometidos pela doença. Objetivos: Observar a evolução clínica, os fatores predisponentes e a mortalidade atribuída em pacientes com hemoculturas positivas, durante 30 dias, em um hospital terciário, na cidade de Maceió. Metodologia: Foram incluídos no estudo 143 pacientes, admitidos no hospital sede da pesquisa, no período de outubro de 2005 a dezembro de 2006, que apresentaram pelo menos uma hemocultura positiva. Todas as variáveis foram aferidas sistematicamente no protocolo do estudo, até o trigésimo dia de evolução. Para se verificar a associação entre as variáveis qualitativas foi utilizado o teste de Qui-quadrado (SIEGEL). O nível de significância foi de 5%. O pacote estatístico utilizado foi o SPSS 15.0 for Windows. Resultados: Até o trigésimo dia de acompanhamento, 30,1% dos pacientes apresentaram apenas bacteremia e 69,9% evoluíram para sepse. Destes, 20,3% desenvolveram sepse grave e 10,5% evoluíram para choque séptico. A Taxa global de mortalidade no Hospital, durante o período da pesquisa foi de 3,7%, enquanto a mortalidade atribuída a esta patologia foi de 37,8%. Entre os pacientes que apresentaram quadro de bacteremia, sem repercussão clínica, sepse, sepse grave e choque séptico, estas taxas foram respectivamente 9,3%, 50%, 65,5% e 84,6% no trigésimo dia, após o diagnóstico. Os focos prevalentes nesta amostra foram secundários aos tratos: respiratório (32,2%), urinário (14%), e intra-abdominal (7,7%). 14% das ICS foram relacionadas ao cateter venosos central. Entre as especialidades que mais contribuíram para a casuística deste estudo estão a neurologia, cardiologia, clínica médica geral, oncologia, pediatria e neonatologia, correspondendo, respectivamente a 19,6%, 18,9%, 16,8%, 12,6%, 8,4% e 7,7%. A taxa de ocorrência de bacteremia/candidemia observada nas unidades de terapia intensiva (UTI) foi de 1,2%, contra 0,33% nas enfermarias. Nestas últimas, 55,12% evoluíram para sepse, enquanto na UTI este índice aumentou significativamente para 87,69% ( p<0,05). Entre as comorbidades, a diabetes melitus foi incidente em 26,6% dos casos, insuficiência renal crônica em 21,7%, neuropatia em 29,4% e a doença pulmonar obstrutiva crônica em 11,2%. Os principais agentes etiológicos isolados foram: Staphylococcus coagulase negativo (25,9%), Staphylococcus aureus (21%), Klebsiella pneumoniae (14%), Escherichia coli (9,1%) e Candida Spp. (8.4%). O principal microrganismo isolado nas hemoculturas dos pacientes que evoluíram para o óbito foi o S. aureus, presente em 24,1% dos casos. Observamos que 14% dos casos foram ICS de origem nosocomial. Conclusão: Os resultados apresentados condizem com os dados publicados na literatura, em relação à incidência, à evolução e a mortalidade atribuída aos distintos quadros das ICS e corroboram com a necessidade do estabelecimento das características desta doença, que poderão nortear as Instituições na adoção de medidas preventivas e terapêuticas eficazes. / Introduction: Despite the countless breakthroughs regarding the understanding of the pathophysiology of bloodstream infections (BSIs), poor response and persistently high mortality rates are the norm for these patients. In view of the poor knowledge as to the pathological outcome and clinical and microbiological features of these infections within our hospitals, the use of empirical broad-spectrum therapeutics contributes to the emergence of anti-microbial resistance and to higher related costs, without a concomitant reduction in morbidity and mortality rates for these patients. Objectives: Study the clinical outcome, the predisposing factors, and the mortality rate in patients with positive hemoculture during a 30-day period in a tertiary hospital in the city of Maceió. Methodology: A total of 143 patients referred to the hospital between October 2005 and December 2006 took part in the study. They all had at least one positive hemoculture result. All variables were systematically assessed for the study protocol during a 30-day interval. The Chi-square test (SIEGEL) was employed when verifying the association between the qualitative variables. Significance level was at 5%. The statistical analysis software used was the SPSS 15.0 for Windows. Results: At the end of 30 days, 30.1% of the patients had been diagnosed as having only bacteremia and 69.9% had developed sepsis. Out of this latter group, 20.3% went on to severe sepsis and 10.5% suffered from septic shock. Throughout the study, the overall mortality rate for the Hospital was 3.7%, whilst the like rate attributed to this malady was at 37.8%. Mortality rates for patients who had been diagnosed as having bacteremia with no clinical repercussions, with sepsis, severe septis, and septic shock, were, respectively, 9.3%, 50%, 65.5% and 84.6% thirty days after diagnosis. Secondary foci of infection were the most prevalent and were found in the respiratory (32.2%), urinary (14%), and intra-abdominal (7.7%) tracts. Fourteen percent of BSIs were related to the central venous catheter. The medical specialties accounting for most of the cases in this study were neurology, cardiology, general clinical practice, oncology, pediatrics, and neonatology. Their respective figures were 19.6%, 18.9%, 16.8%, 12.6%, 8.4%, and 7.7%. The bacteremia rate in intensive care units (ICUs) was 1.2%, as opposed to 0.33% in wards. Out of these latter cases, 55.12% of them turned into sepsis, while at the ICU this figure rose significantly to 87.69% ( p<0,05). Diabetes mellitus in 26.6% of the patients, chronic renal failure in 21.7%, neuropathy in 29.4%, and chronic obstructive pulmonary disease in 11.2% were the most prevalent comorbidities. Most commonly isolated etiological agents were: coagulase-negative staphylococcus (25.9%), Staphylococcus aureus (21%), Klebsiella pneumoniae (14%), Escherichia coli (9.1%), and Candida Spp. (8.4%). S. aureus was the isolated pathogen in 24.1% of fatal cases. Nosocomial BSIs accounted for 14% of the cases. Conclusion: With regard to prevalence, progression, and mortality attributed to distinct BSI cases, the results herein presented are in compliance with data published elsewhere. In addition, they lend support to the need for setting down the features that clearly define this disease, which in turn will lead to more effective treatment and greater preventive measures. / TEDE

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Nosocomial infections are a serious public health problem. In recent years, bloodstream infections (BSI) has increased significantly in hospitals, accounting for high morbidity and mortality rates. These, mostly are caused by bacteria, which are detected by performing blood cultures. Currently, due to the frequency and severity of BSI in the hospital environment, it is necessary to evaluate the epidemiological importance data, improving the control and prevention of these infections. Thus, this study aimed to analyze the microorganisms related to BSI from patients admitted to the University Hospital of Santa Maria (HUSM) in the one-year period (2012-2013). We analyzed the epidemiological profile and sensitivity of positive blood cultures of patients admitted at HUSM from April 2012 to March 2013. During the study period, 1080 samples were positive, 69.3% caused by gram-positive organisms (GP), 22.9% by Gram-negative (GN) and 7.9% by fungus. The most common organism was Staphylococcus epidermidis (24%), followed by Staphylococcus hominis (6.8%), Staphylococcus haemolyticus (6.8%) and Pseudmonas aeruginosa (6%). The isolates predominated in male patients (50.6%) and aged between 0-20 years, and the Pediatric/Neonatal Intensive Care Unit was the sector with the highest number of insulation, 24.3% (10.3%/14%). The evaluation of the sensitivity profile showed 100% sensitivity daptomycin, linezolid, tigecycline and vancomycin front of GP microorganisms, and a rate of 42.31% of Staphylococcus were characterized phenotypically as coagulase negative Staphylococcus resistant to methicillin (MRSCoN). Already, between the GN, all microorganisms in study showed 100% of resistance to ampicillin, and Pseudomonas aeruginosa 100% of resistance to cephalothin and cefoxitin, and 1.57% of these isolates showed ESBL mechanism resistance. Impact assessment studies of BSI have significant impact in reducing mortality, especially in patients with weakened immune system, since that provide an immediate start of effective empirical antimicrobial therapy, also decreasing hospital costs. Through this study it was observed that there was a predominance of GP bacteria, and approximately 50% of the isolates were caused by Staphylococcus spp. and 42.31% of strains were resistant to methicillin. This fact should be reconsidered when the empirical antibiotic therapy institution, especially in patients admitted to critical care units. ICS impact assessment studies have significant impact on mortality, especially in patients with weakened immune system, since provide immediate onset of effective empiric antibiotic therapy. These infections should be investigated along the Hospital Infection Control Commission for further steps to be taken, reducing the incidence of ICS, hospital costs and also mortality rates. / Infecções hospitalares constituem um sério problema de saúde pública. Nos últimos anos, as infecções de corrente sanguínea (ICS) vem aumentando significativamente nos hospitais, sendo responsáveis por elevadas taxas de morbi-mortalidade. Estas, majoritariamente são ocasionadas por bactérias, as quais são detectadas pela realização de hemoculturas. Atualmente, devido a frequência e a gravidade das ICS no ambiente hospitalar, torna-se necessário a avaliação de dados de importância epidemiológica, melhorando o controle e prevenção destas infecções. Dessa forma, este estudo teve como objetivo analisar os microrganismos relacionados à ICS, de pacientes admitidos no Hospital Universitário de Santa Maria (HUSM), no período de um ano (2012-2013). Foi realizada a avaliação do perfil epidemiológico e de sensibilidade das hemoculturas positivas dos pacientes admitidos no HUSM entre abril de 2012 a março de 2013. No período de estudo, 1080 amostras foram consideradas positivas, sendo 69,3% causadas por microrganismos gram-positivos (GP), 22,9% por gram-negativos (GN) e 7,9% fungos. O microrganismo mais frequente foi o Staphylococcus epidermidis (24%), seguido pelo Staphylococcus hominis (6,8%), Staphylococcus haemolyticus (6,8%) e Pseudmonas aeruginosa (6%). Os isolamentos predominaram em pacientes do sexo masculino (50,6%) e na faixa etária compreendida entre 0-20 anos, sendo a Pediatria/Unidade de terapia intensiva neonatal, o setor com maior número de isolamentos, 24,3% (10,3%/14%). A avaliação do perfil de sensibilidade evidenciou 100% de sensibilidade a daptomicina, linezolida, tigeciclina e vancomicina frente aos microrganismos GP, sendo que uma taxa de 42,31% dos isolados do gênero Staphylococcus foram caracterizados fenotipicamente como Staphylococcus coagulase negativa resistentes à meticilina (MRSCoN). Já, entre os GN, todos os microrganismos em estudo apresentaram 100% de resistência frente a ampicilina, e a Pseudomonas aeruginosa 100% de resistência a cefalotina e cefoxitina, e 1,57% destes isolados apresentaram mecanismo de resistência ESBL. Através deste estudo foi possível observar que houve o predomínio de bactérias GP, sendo que aproximadamente 50% dos isolamentos foram causados por Staphylococcus spp. e 42,31% destas cepas foram resistentes a meticilina. Esse fato deve ser reconsiderado quando da instituição da antibioticoterapia empírica, principalmente nos pacientes admitidos em unidades críticas. Estudos de avaliação da incidência de ICS apresentam impacto significativo na mortalidade, principalmente dos pacientes com sistema imune debilitado, uma vez que propiciam o início imediato da efetiva terapia antimicrobiana empírica. Estas infecções devem ser investigadas juntamente da Comissão de Controle de Infecção Hospitalar para que novas medidas sejam adotadas, reduzindo a incidência das ICS, os custos hospitalares e também as taxas de mortalidade.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Complete abstract click electronic access below) / Mestre