Estudio descriptivo y comparativo de los cambios clínico-epidemiológicos de las Candidemias Nosocomiales en un hospital universitario, análisis de los factores pronóstico asociados a mayor mortalidad y la influencia del tratamiento precoz y adecuado junto con la retirada precoz del catéter en su evolución.Estudio transversal y observacional de pacientes adultos que desarrollaron CN durante su ingreso en el Hospital (enero-2002 a mayo- 2005). Se revisaron las historias clínicas de pacientes con hemocultivos positivos para Candida sp.El análisis comparativo se realizó con un grupo histórico (1993-8).Los resultados se derivan del estudio estadístico clínico-epidemiológico, patrones de cambio, factores pronóstico asociados a mortalidad y protectores de mortalidad.Conclusiones: La mortalidad (50%) no ha variado en los últimos años. C.no albicans predomina sobre C. albicans.Los principales factores pronóstico asociados a mayor mortalidad son: La situación de gravedad crítica inicial, el tratamiento antifúngico tardío y la no retirada precoz del catéter vascular. / Observational study of a group of adult patients with Nosocomial Candidemia (NC) admitted at a university hospital (january 2002 to may 2005). We analised epidemiological, clinical, microbiological and laboratory data and changes respesct to other historical group (1993-1998).Conclusions: Acute severity od illness at onset is associated to mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are asociated to cur

Thesis (M. Sc. Med.)--University of Sydney, 2007. / Title from title screen (viewed 15 October 2008). Submitted in fulfilment of the requirements for the degree of Master of Science in Medicine to the Discipline of Medicine, Faculty of Medicine. Includes bibliographical references. Also available in print form.

Submitted by LUCIA HELENA DE ALMEIDA TESTA null (luciatesta2011@gmail.com) on 2016-03-07T22:13:50Z No. of bitstreams: 1 Infecção viral respiratória comunitária e hospitalar em pacientes submetidos a transplante de células tronco hematopoiéticas.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-09T14:00:14Z (GMT) No. of bitstreams: 1 testa_lha_me_bot.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) / Made available in DSpace on 2016-03-09T14:00:14Z (GMT). No. of bitstreams: 1 testa_lha_me_bot.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) Previous issue date: 2016-02-03 / As infecções por vírus respiratórios (VR) são causas importantes de mortalidade em pacientes submetidos a Transplante de Células-Tronco Hematopoiéticas (TCTH) especialmente no período anterior à pega do enxerto. Estas infecções também podem ser adquiridas dentro dos hospitais, possivelmente transmitida por contato com profissionais de saúde ou cuidadores infectados, ou com objetos ou superfícies contaminadas. Portanto, é importante caracterizar o tipo de transmissão para que medidas rigorosas de controle possam ser implantadas. Objetivos: Analisar os casos de infecção por vírus respiratórios (VR) nos pacientes submetidos a TCTH entre agosto de 2010 a dezembro de 2013 e caracterizar os tipos de transmissão durante esse período. Método: O presente estudo foi realizado no Hospital Amaral Carvalho de Jahu nas unidades de internação e ambulatório de TCTH e na unidade de hematologia, incluindo pacientes com diagnóstico comprovado de VR por imunofluorescência ou PCR multiplex em amostras de lavado nasal. A transmissão foi definida como hospitalar na ausência de sintomas respiratórios à admissão e diagnóstico de VR comprovado laboratorialmente após cinco dias da internação ou até cinco dias após a alta hospitalar. Resultados: Durante este período 187 pacientes tiveram 214 episódios de infecção por VR. Cento e oitenta e três (85,5%) foram considerados infecção comunitária e 31 (14,5%) episódios foram considerados infecção hospitalar, sendo que 17 (7,9 %) episódios ocorreram na unidade de TCTH e 21 (9,8 %) episódios na unidade de hematologia (p=NS). A permanência hospitalar por mais de 23 dias se associou a transmissão hospitalar (p=<0,001) e o ano de 2013 mostrou uma queda significante desse tipo de transmissão (p=0,04). O VSR foi o VR com maior frequência de progressão para pneumonia. Conclusão: Concluímos que a higienização das mãos, coleta de lavado nasal (LN) antes das internações para o transplante de células tronco hematopoiéticas (TCTH), isolamento de contato para os pacientes com vírus respiratório positivo, busca ativa de sintomas e a educação continuada para os pacientes, familiares e profissionais da saúde devem ser contínua para o controle das infecções por VR nas unidades de TCTH. A maioria dessas medidas são de baixo custo e altamente efetivas. Cuidadores, contactuantes domiciliares e profissionais de saúde devem aderir às medidas de controle para garantir a segurança dos pacientes. / Introduction: Community-acquired respiratory viruses (RV) are the most frequent etiologic agents causing acute respiratory infections (ARI) in humans. These agents have a wide antigenic range, universal distribution, affect people in all age groups, and may cause various clinical syndromes involving both the upper and lower respiratory tract. These respiratory infections are major causes of mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), especially in the period prior to engraftment. These infections may also be acquired in hospitals, possibly transmitted by contact with infected health professionals or patient caregivers, or with contaminated objects or surfaces. Since 2008, a continued education program was started at the HSCT Program of Amaral Carvalho Foundation aiming to improve the control of RV transmission. Patients, caregivers, donors, family members and employees are invited to participate in the activities. Objectives: To review the cases of RV infections in patients undergoing HSCT from August 2010 to December 2013, characterize the type of transmission, if community- or hospital-acquired during this period, and determine the morbidity and mortality of RV infections. Methods: The study was conducted at the HSCT Service of Amaral Carvalho Hospital, analyzing the charts of HSCT recipients with RV infection diagnosed by immunofluorescent assay or multiplex PCR. Medical data and images from patients admitted to the HSCT and hematology wards, as well as from patients assisted at the outpatient clinic were retrospectively reviewed. Hospital transmission was defined when the interval between hospital admission and the first symptoms was more than five days, or when the interval between patient discharge and the first symptoms was up to five days. Results: During this period, 187 patients had 214 episodes of VRI. Thirty-one episodes (14.5%) were considered hospital-acquired. Rates of hospital transmission were similar between HSCT unit (7,9%) and the hematology ward (9,8%). Hospital stay for more than 23 days was associated with hospital transmission (p=0.001) and a significant decrease in this type of transmission was observed in 2013 (p=0.04). VSR was the RV with the highest frequency of progression to pneumonia (42%). Conclusion: We conclude that hand hygiene, nasal lavage collection (LN) before hospitalizations for hematopoietic stem cell transplantation (HSCT), contact isolation for patients with positive respiratory virus, active pursuit of symptoms and continuing education for patients, family and healthcare professionals should be continuous for the control of infections in HSCT VR units. Most of these policies have low cost and are highly effective. Caregivers, household contacts and health professionals must comply with the control policies to ensure the safety of patients.

Orientador: Clarisse Martins Machado / Resumo: As infecções por vírus respiratórios (VR) são causas importantes de mortalidade em pacientes submetidos a Transplante de Células-Tronco Hematopoiéticas (TCTH) especialmente no período anterior à pega do enxerto. Estas infecções também podem ser adquiridas dentro dos hospitais, possivelmente transmitida por contato com profissionais de saúde ou cuidadores infectados, ou com objetos ou superfícies contaminadas. Portanto, é importante caracterizar o tipo de transmissão para que medidas rigorosas de controle possam ser implantadas. Objetivos: Analisar os casos de infecção por vírus respiratórios (VR) nos pacientes submetidos a TCTH entre agosto de 2010 a dezembro de 2013 e caracterizar os tipos de transmissão durante esse período. Método: O presente estudo foi realizado no Hospital Amaral Carvalho de Jahu nas unidades de internação e ambulatório de TCTH e na unidade de hematologia, incluindo pacientes com diagnóstico comprovado de VR por imunofluorescência ou PCR multiplex em amostras de lavado nasal. A transmissão foi definida como hospitalar na ausência de sintomas respiratórios à admissão e diagnóstico de VR comprovado laboratorialmente após cinco dias da internação ou até cinco dias após a alta hospitalar. Resultados: Durante este período 187 pacientes tiveram 214 episódios de infecção por VR. Cento e oitenta e três (85,5%) foram considerados infecção comunitária e 31 (14,5%) episódios foram considerados infecção hospitalar, sendo que 17 (7,9 %) episódios oc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Community-acquired respiratory viruses (RV) are the most frequent etiologic agents causing acute respiratory infections (ARI) in humans. These agents have a wide antigenic range, universal distribution, affect people in all age groups, and may cause various clinical syndromes involving both the upper and lower respiratory tract. These respiratory infections are major causes of mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), especially in the period prior to engraftment. These infections may also be acquired in hospitals, possibly transmitted by contact with infected health professionals or patient caregivers, or with contaminated objects or surfaces. Since 2008, a continued education program was started at the HSCT Program of Amaral Carvalho Foundation aiming to improve the control of RV transmission. Patients, caregivers, donors, family members and employees are invited to participate in the activities. Objectives: To review the cases of RV infections in patients undergoing HSCT from August 2010 to December 2013, characterize the type of transmission, if community- or hospital-acquired during this period, and determine the morbidity and mortality of RV infections. Methods: The study was conducted at the HSCT Service of Amaral Carvalho Hospital, analyzing the charts of HSCT recipients with RV infection diagnosed by immunofluorescent assay or multiplex PCR. Medical data and images from patients admitted to the HSC... (Complete abstract click electronic access below) / Mestre

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Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 187-204). Also available in print.

Corynebacterium striatum (CS) is an underappreciated human pathogen that has been associated with serious infections in both immunocompetent and immunocompromised hosts. CS infections tend to be more frequent in males and major infection sites have included blood stream, lung, and central nervous system. Most are nosocomially acquired and there is a significant association with medical devices ranging from intravascular catheters to central nervous system drainage devices. Empiric therapy with vancomycin is advisable as susceptibility to other agents is variable. Treatment may also include removal of foreign material such as an intravascular catheter. The present review describes the wide spectrum of infections associated with CS and we add a unique case of CS pancreatic abscess where treatment included linezolid.

published_or_final_version / Mechanical Engineering / Doctoral / Doctor of Philosophy

This dissertation examines factors associated with healthcare-associated infections (HAIs) in four acute care hospitals located in New York City. Specifically, this investigation focuses on the role that the physical environment plays with regard to patient-to-patient transmission. The initial analyses describe the scope of the problem by reporting the incidence of HAIs and antimicrobial resistance over a seven-year period in the study institutions. In total, 19,052 HAIs were identified among 761,426 discharges. HAI rates fell over time within all hospitals and for all organisms and infection types included in the study, and the odds of acquiring an HAI decreased significantly over time for all organisms. Resistance levels were stable for Enterococcus spp., Staphylococcus aureus, Acinetobacter baumannii, and Streptococcus pneumoniae. Multidrug resistance increased for Pseudomonas aeruginosa and decreased for Klebsiella pneumoniae, though imipenem resistance among K. pneumoniae climbed sharply in 2011. A systematic literature review is presented to summarize what is known and unknown about how patients’ exposure to infected or colonized concurrent roommates and prior bed occupants affects their risk of developing HAIs. Eighteen articles meeting the inclusion criteria were identified. More than half reported at least one statistically significant positive association between the infection/colonization status of a roommate or previous room occupant and the development of HAIs. Only a single article identified a statistically significant negative association. The remainder found no associations that reached statistical significance, though this may be due to the fact that they were insufficiently powered. The dissertation concludes with a matched case-control study designed to quantify the association between having a prior bed occupant or roommate with a positive blood, respiratory, urine, or wound culture and subsequent infection with the same organism. In a multivariable analysis controlling for patient characteristics and mutually controlling for each exposure, the odds of being exposed to a prior bed occupant with the same organism were 5.83 (95% Confidence Interval [3.62, 9.39]) times greater for cases versus controls and the odds of being exposed to a roommate with the same organism were 4.82 [3.67, 6.34] times greater.

<p><strong>Introduction</strong> Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections.</p><p><strong>Aim</strong> In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s.</p><p><strong>Methods </strong>The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample.</p><p><strong>Results</strong> The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected.</p><p><strong>Conclusion</strong> To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.</p>