Nas últimas décadas, a incidência de infecções hospitalares causadas por bactérias Gram-negativas multirresistentes vem crescendo de maneira vertiginosa em todo o mundo, de modo que a Organização Mundial de Saúde (OMS) recentemente reconheceu essas infecções como uma preocupação mundial devido ao seu impacto negativo sobre as taxas de mortalidade intra-hospitalar e dos custos da assistência à saúde, afetando tanto os países desenvolvidos quanto os em desenvolvimento. Atualmente considera-se que o uso racional de antimicrobianos, a higienização das mãos e o isolamento de contato são as principais medidas disponíveis para contenção desse avanço. Porém, elas são apenas parcialmente efetivas e de implementação trabalhosa e onerosa. Assim, considera-se necessário o desenvolvimento de formas mais simples e eficientes para lidar com esse problema. No presente estudo, nos propusemos a avaliar o impacto da administração de um produto simbiótico a pacientes colonizados e/ou infectados por bactérias Gram-negativas multirresistentes sobre a incidência subsequente de infecções hospitalares relacionadas ao trato respiratório e urinário. Trata-se de um ensaio clínico randomizado, duplamente cego, controlado com placebo, cuja intervenção consistiu na administração oral ou enteral diária de 1010 unidades de Lactobacillus bulgaricus e 1010 unidades de Lactobacillus rhamnosus associados a fruto-oligosacarídeos durante 7 dias, a pacientes internados em um hospital terciário, com colonização prévia por bactérias Gram-negativas multirresistentes, demonstrada por meio de cultura seletiva de swab retal. O desfecho primário do estudo foi a incidência de infecção hospitalar posterior à intervenção, que, na análise do tipo intenção de tratar foi 18/48 (37,50%) no grupo experimental e 12/53 (22,64%) no grupo controle (odds ratio ajustado=1,95, IC95%=0,69-5,50, p=0,21). Os desfechos secundários principais, também de acordo com a análise intenção de tratar, foram: o tempo de internação hospitalar; sendo a mediana de 17 dias no grupo controle e 31 dias no grupo experimental (p= 0,07), taxas de óbito; com valores de 3,77% no grupo placebo e 8,33% no grupo simbiótico (odds ratio ajustado = 1,34, IC95%= 0,454,00, p= 0,61) e ocorrência de eventos adversos; 7,55% no grupo que utilizou placebo e 6,25% no grupo sob intervenção (p= 1,00). Os dados obtidos pelo estudo nos levam à conclusão de que o simbiótico estudado demonstrou-se inefetivo na prevenção de infecções hospitalares do trato respiratório e urinário em pacientes colonizados e/ou infectados por bactérias Gram-negativas multirresistentes. / In recent decades the incidence of multidrug resistant Gram-negative nosocomial infections has been dramatically raising in the whole world. The World Health Organization (WHO) recently recognized nosocomial infections as a global concern due to its negative impact on patients, health care workers and health care institutions, affecting developed countries as well as developing ones. They negatively impact in-hospital mortality and healthcare related costs. Antibiotic stewardship, hand hygiene promotion and contact precautions are the main available measures to control such multidrug resistant Gram-negative organisms in hospitals. However, they are only partially effective as well as difficult to be implemented and expensive. Therefore, simpler and more effective actions are thought to be helpful and urgent. In the main study, we propose to analyze the impact of the administration of a symbiotic product on patients colonized and/or infected by Gram-negative multidrug resistant bacteria upon the subsequent incidence of respiratory and urinary tract nosocomial infections. A randomized, double- blinded, placebo controlled, clinical trial was proposed in order to provide oral or enteral daily administration of 1010 units of Lactobacillus bulgaricus and 1010 units of L. rhamnosus associated with fructo-oligosacharide (FOS) during 7 days, to previously colonized patients with multi-resistant Gram-negative bacteria, identified through selective culture of rectal swab, hospitalized in a tertiary-care hospital. The primary outcome was the incidence of nosocomial infections after the intervention, which in the intention to treat analysis was 18/48 (37,50%) in the experimental group versus 12/53 (22,64%) in the control group (adjusted odds ratio= 1,95, IC95%= 0,69-5,50, p=0,21). Secondary outcomes, according to intention to treat analysis, were hospital length of stay: median of 17 days in the control group and 31 days in the symbiotic group (p= 0,07), mortality rates: 3,77% in the placebo group versus 8,33% in the experimental group (adjusted odds ratio = 1,34, IC95%= 0,45 4,00, p= 0,61) and adverse effects: 7,55% in the control group and 6,25% in the intervention group (p= 1,00). The results of this study leads to the conclusion that the studied symbiotic proved to be ineffective to prevent nosocomial respiratory and urinary tract infections in patients colonized and/or infected by Gram-negative multi-resistant bacteria.

Neonatal septicaemia and nosocomial infection are major causes of morbidity in neonatal intensive care units (NICU) in both developed and developing countries. This study documents infective episodes at two resource disparate NICUs; the Grantley Stable Neonatal Unit (GSNU), Royal Brisbane and Women’s Hospital (RBWH), Australia 1997-2006 and Danang NICU, Vietnam. The specific aims are: 1. To compare the incidence of neonatal septicaemia at RBWH and Danang NICU. 2. To compare of the epidemiological characteristics of nosocomial infections in the two NICUs. 3. To study risk factors associated with nosocomial infection in the two NICUs (including staff numbers, infant numbers and nursing workload). 4. To review published guidelines on healthcare physical environments and staffing levels and to survey the GSNU & Danang NICU in relation to these. 5. To develop a prospective surveillance system to monitor infection episodes in Danang NICU 6. To recommend strategies for the control of neonatal sepsis in Danang NICU. The GSNU at the RBWH, Australia is a 71 bed neonatal care facility with an established infection surveillance system in a well resource environment. Danang NICU, Vietnam provides care to a high risk neonatal population with no established infection surveillance system in a developing country with more limited resources. This study found the GSNU had a low rate of neonatal septicaemia, during the ten year period from 1997 to 2006 with 253 babies (2.1%) diagnosed with septicaemia. In Danang NICU, in the year 2007 alone, there were 52 cases (2.9%) of septicaemia documented but the incidence of neonatal infection is likely to have underestimated due to (i) the failure to collect blood culture before commencing antibiotic treatment. (ii) Difficulties associated with data retrieval from maternal and neonatal records and (iii) lack of a systematic surveillance system with prospectively collected data. The organisms causing early onset and late onset septicaemia were substantially different in the two NICUs. Group B streptococcus (GBS) and Escherichia coli were the major organisms causing early onset sepsis (EOS) at the GSNU, accounting for 37.8% and 29.7% respectively, whilst coagulase-negative staphylococcus (CONS) was the commonest organism (25.7%) for late onset sepsis (LOS). In Danang NICU, Klebsiella spp was the major pathogen and was responsible for 75% of neonatal septicaemia in both early and late onset sepsis. The isolation of Klebsiella spp in a high proportion of infants at less than 48 hours may suggest nosocomial or maternal route of acquisition. The rate of GBS infections in Danang Hospital, Vietnam, is hard to estimate and interpret due to limited microbiologic data. The anti-serum used to classify the Streptococcal types is not readily available in Danang Hospital. In some cases, organisms that are isolated are suspected to be GBS however, this is not confirmed microbiologically. The study identifies a high prevalence of neonatal septicaemia in Danang NICU. It identifies a close relationship between rates of infection and poor nursing care practices and limited resources. The standard care system used at the GSNU as well as the international literature was studied in relation to infection control practices. This was then used to develop the following recommendations that specifically target a reduction in infection rates in Danang NICU: 1. Implement an infection surveillance system 2. Report regularly from the database and embed discussion of the data into unit management policy 3. Revise neonatal and pathology practice in relation to blood cultures 4. Use shorter duration of antibiotics course based on culture results 5. Modify care practices that expose infants to cross infection 6. Identify specific staff with particular responsibilities in maintenance of standards

Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens affecting the human race in our time. In spite of recent medical advances, our therapeutic choices for MRSA infections remain limited due to the propensity of this organism to develop resistance to antimicrobials. Therefore, there is a continuing need to develop newer methods of treating MRSA infections. This dissertation examines the effects of bacteriophages 88 and 92 on ten clinical isolates of MRSA from the central Florida area. . For the majority of the MRSA isolates, bacteriophages 88 and 92 were unable to induce lysis. However, bacteriophage 88 was found to lyse MRSA Sample 94. Reduced cytotoxicity and apoptosis due to MRSA Sample 94 was also observed. This protective effect was most notable in the 1:10-6 concentration of MRSA 94 and bacteriophage 88. In addition, this effect was observable with both immediate inoculation of the cell culture with the MRSA concurrent with the bacteriophage and with bacteriophage applied one hour after initial inoculation of the MRSA. This effect was likely due to the increased replication of the bacteriophage in the actively growing bacteria found in the 1:10-6 samples. The bacteria in the 1:10-6 concentration were likely more able to replicate in comparison to the higher bacterial concentrations because of less competition between the bacteria for the limited nutrients in the 1:10-6 concentration. The long-term goal of this study is the development of a bacteriophage-containing ointment for the control of MRSA nasal carriage. In addition, the concept of bacteriophage therapy may open a new horizon in controlling infections such as those caused by MRSA. Finally, as for future studies, it would be informative to be able compare these results with other MRSA isolates and bacteriophages samples to examine the effects across a wider sample of bacteria and bacteriophages. In addition, it would be interesting to examine the possibility of being able to modify the bacteriophage in order to allow lysis of the previously resistant bacterial strains.

Darbo tikslas- įvertinti hospitalinės infekcijos paplitimą bei valdymo galimybes rajonų ir apskričių ligoninėse. Uždaviniai: 1) įvertinti hospitalinių infekcijų struktūrą ir paplitimą Lietuvos rajonų ir apskričių ligoninėse, 2) nustatyti ir palyginti rizikos veiksnius ir objektus rajoninėse ir apskričių ligoninėse, 3) teikti pasiūlymus hospitalinių infekcijų valdymo tobulinimui. Tyrimo metodika. Tyrimo objektai –bendrosios chirurgijos, ortopedijos- traumatologijos, reanimacijos- intensyvios terapijos, akušerijos – ginekologijos skyriai. Hospitalinių infekcijų paplitimas įvertintas 4 rajonų ligoninėse ir 2 apskričių ligoninėse. Tyrimas buvo atliekamas naudojantis hospitalinių infekcijų registravimo protokolais, kurie buvo ligos istorijose. Už 2005 m. ištirta 2002 hospitalinių infekcijų atvejai. Duomenys apie hospitalinės infekcijos atvejus buvo gretinami su įrašais hospitalinių infekcijų žurnaluose ir pranešimais Visuomenės sveikatos centruose. Tyrimo duomenų matematinė ir statistinė analizė atlikta, naudojantis skaičiuoklės Microsoft EXCEL statistinėmis funkcijomis bei uždavinių analizės posistemės “Data Analysis”funkcijomis. Rezultatai: Tyrime dalyvavusių rajonų ligoninėse hospitalinių infekcijų paplitimas 3,1%; 3,2%; 2,8%; 3,3%, o apskričių – 4,0%; 4,6%. Rizikos veiksnių paplitimas : operacija 24%; intraveninė priemonė 22,9% ; pneumonija 16,8 %, kitos kvėpavimo takų infekcijos 13,9 %. Hospitalinių infekcijų atvejai registracijos žurnaluose ir VSC tirtose rajonų... [toliau žr. visą tekstą] / Aim: to assess the incidence of nosocomial infections and possibilities of their management in district and county hospitals. Objectives: 1) to assess the incidence and structure of nosocomial infections in district and county hospitals in Lithuania, 2) to determine and compare the risk factors of nosocomial infections in district and county hospitals, 3) to develop proposals for the improvement of nosocomial infection management. Methodology. The analysis was carried out in 4 district and 2 county hospitals, at the departments of general surgery, orthopedics and traumatology, reanimation and intensive therapy, obstetrics and gynaecology.. Nosocomial infection registration records presented in case histories served as a primary source of information. 2002 cases of nosocomial infections that occurred in 2005 were investigated. The data of the cases of nosocomial infections were compared with the records in nosocomial infection registers and reports in Public Health Centres. Statistical analysis of the research data was performed applying statistical functions of the Microsoft EXCEL spreadsheet and the functions of the task analysis subsystem Data Analysis. Results: The incidence of nosocomial infections was 3.1%, 3.2%, 2.8%, and 3.3% in the district hospitals, and 4.0%, 4.6% in the county hospitals. The major risk factors were surgery (24%), intravenous implement (22.9%), pneumonia (16.8%), and other respiratory infections (13.9%). The cases of nosocomial infections... [to full text]

Darbo tikslas – atlikti sergamumo hospitalinėmis infekcijomis, jų rizikos veiksnių, hospitalinių infekcijų sąlygoto mirštamumo bei ekonominį įvertinimą Lietuvos vaikų intensyviosios terapijos skyriuose. Tikslui pasiekti iškelti šie uždaviniai: 1) ištirti sergamumą hospitalinėmis infekcijomis, nustatyti dažniausią jų lokalizaciją bei sukėlėjus; 2) įvertinti hospitalinių infekcijų rizikos veiksnius; 3) nustatyti sergamumo bei rizikos įgyti hospitalines infekcijas pokyčius, įdiegus intervencijos programą; 4) įvertinti hospitalinių infekcijų ir ligos baigties sąsajas; 5) įvertinti hospitalinę infekciją įgijusių ir neįgijusių tiriamųjų gulėjimo trukmę bei gydymo išlaidas ir apskaičiuoti gulėjimo trukmės pailgėjimo dėl įgytos hospitalinės infekcijos sąlygotas išlaidas; 6) įvertinti intervencijos metodo ekonominę naudą, išvengus hospitalinės infekcijos. Perspektyvusis analitinis stebėjimo tyrimas vyko Lietuvos vaikų intensyviosios terapijos skyriuose 2003 - 2007 m. Į tyrimą įtraukti visi nuo 1 mėn. iki 18 m. amžiaus ligoniai, kurie gydėsi VITS > 48 val. Iš viso dalyvavo 1831 tiriamasis. Tyrimo duomenimis, sergamumas hospitalinėmis infekcijomis sudarė 15,0 atvejų 100-ui ligonių arba 24,5 atvejo 1000-čiui lovadienių. Sukurtas ir išbandytas unikalus ventiliacinės pneumonijos profilaktikos priemonių paketas. Išnagrinėtos hospitalinės infekcijos ir ligos baigties sąsajos bei ekonominiai šios problemos aspektai, remiantis šalyje patvirtintais vaikų reanimacijos paslaugų įkainiais... [toliau žr. visą tekstą] / The objectives of the study were as follows: 1) to investigate and to assess the incidence rates of nosocomial infections, their distribution by site and causative microorganisms; 2) to assess the risk factors of nosocomial infections; 3) to evaluate the changes of the risk of acquisition of nosocomial infections and the changes of the incidence of nosocomial infections after the implementation of the intervention programme; 5) to assess the association between nosocomial infection and outcomes; 6) to evaluate the increase of length of stay and the costs of patients with and without nosocomial infections, and to calculate the cost of single case of nosocomial infection and single patient with noscomial infection; 7) to make cost-benefit analysis of the intervention programme. The prospective surveillance study was carried out between March 2003 and December 2007. The paediatric intensive care unit patients aged between 1 month and 18 years and stayed in the units for more than 48 hours were eligible for inclusion in this study. The incidence of 15.0 cases per 100 patients and incidence density of 24.5 cases per 1000 patient-days was observed. Also the unique intervention programme was designed and implemented, which resulted in significant decrease of the incidence rates. No mortality attributable to nosocomial infections was found in the study. The minimal direct costs due to increase in length-of-stay was calculated in the study, as well as benefit of the intervention... [to full text]

Nosokomiale Infektionen bei Früh- und Neugeborenen stellen aufgrund ihrer hohen Inzidenz und Mortalität eine große Herausforderung für die moderne Versorgung dar. Außerdem sind sie Indikatoren für die Pflegequalität, wie auch Verletzungen und Gefäßschädigungen. In dieser retrospektiven Querschnittsstudie wurden die epidemiologische Situation nosokomialer Infektionen auf den neonatologischen Stationen der Universitätskinderklinik Leipzig für das Jahr 2006 beleuchtet, die Abhängigkeit der genannten Komplikationen von Plegepersonalqualifikation und –quantität untersucht, sowie die Stationsauslastung und Personalbesetzung mit deutschen Empfehlungen verglichen. Die Inzidenz systemischer Infektionen lag sowohl auf der neonatologischen Intensiv- als auch auf der Nachsorgestation unter dem deutschlandweiten Durchschnitt. Dagegen traten Lokalinfekte wie Windel-/ Mundsoor und Konjunktivitiden häufig auf. Das beobachtete Keimspektrum zeigte das aus der Literatur bekannte Bild, multiresistente Keime traten nicht auf. Bei der Untersuchung der Abhängigkeiten zeigte sich für die Intensivstation eine signifikante Häufung von Candidainfektionen bei geringerer Stationsauslastung und höherer Personalbesetzung, unabhängig von der Qualifikation des Personals. Auf der Nachsorgestation wurde eine vermehrte Zahl systemischer Infektionen bei höherem Anteil von Schwestern am Gesamtpersonal festgestellt. Beide Stationen waren gegenüber den Empfehlungen fast das ganze Jahr überbelegt und unterbesetzt. Gründe für die gefundenen Abhängigkeiten wurden vermutet in Informationsverlust und Trittbrettfahrerproblemen in größeren Kollektiven und verstärkter minimal-handling-Pflege und verstärkter Hygiene-Compliance in Stresssituationen. Die geringe Inzidenz systemischer Infektionen spricht für eine sichere Pflege und ist demnach sehr positiv zu bewerten, trotzdem sollten die Hintergründe für das Auftreten der Lokalinfekte, auch wenn sie meist einen milden Verlauf zeigten, überprüft werden. Eine Gesamtbeurteilung der Pflege ist anhand der gemachten Untersuchungen nicht möglich, da aufgrund der Retrospektive keinerlei Faktoren wie Belastungseinschätzung der Schwestern, Lerneinschätzung der Schüler oder Betreuungseinschätzung der Eltern einfließen konnten.

Medidas restritivas de controle de antimicrobianos têm sido propostas para controlar surtos epidêmicos de infecção por germes multirresistentes em hospitais, mas são escassas as publicações a respeito de sua eficácia. Em um estudo quaseexperimental com controles históricos, avaliou-se a efetividade de uma intervenção restritiva ao uso de antimicrobianos para controlar a emergência de germes multirresistentes em uma unidade de cuidados intensivos (UTI) de um hospital geral. Os Serviços de Controle de Infecção e Comissão de Medicamentos restringiu o uso de drogas antimicrobianas em pacientes hospitalizados na UTI a não mais que dois agentes simultaneamente, exceto em casos autorizados por aqueles serviços. A incidência de eventos clínicos e bacteriológicos foi comparada entre o ano que precedeu a intervenção e o ano que a seguiu. No total, 225 pacientes com idade igual ou maior de 15 anos , com infecção, internados na UTI por pelo menos 48 horas, foram estudados no ano precedente a intervenção e 263 no ano seguinte a ela. No ano seguinte à intervenção, um percentual menor de pacientes foi tratado simultaneamente com mais de dois antimicrobianos, mas não houve modificação no número total de antimicrobianos prescritos, na duração e no custo do tratamento. Mortalidade e tempo de internação foram similares nos dois períodos de observação. O número de culturas positivas aumentou depois da intervenção, tanto para germes Gram positivos, quanto para germes Gram negativos, principalmente devido ao aumento do número de isolados do trato respiratório. A maioria dos isolados foi Staphylococcus aureus dentre os Gram positivos e Acinetobacter sp dentre os germes Gram negativos. No ano seguinte à intervenção, a sensibilidade dos microorganismos Gram negativos para carbenicilina, ceftazidima e ceftriaxona aumentou, e para o imipenem diminuiu. A ausência de resposta dessa intervenção sobre desfechos clínicos pode ser em conseqüência da insuficiente aderência ou a sua relativa ineficácia. A melhora da sensibilidade microbiana de alguns germes, semaumento de custos ou a incidência de efeitos adversos, encoraja o uso de protocolos similares de restrição de drogas antimicrobianas para reduzir a taxa de resistência bacteriana na UTI. / Restrictive policies of the use of antimicrobial drugs have been proposed to prevent the occurrence of outbreaks of infection by multiresistant germs in hospitals, but assessments of their effectiveness have been scarcely reported. In a quasiexperimental study with historical controls, we evaluate the effectiveness of a policy of restriction in the use of antimicrobial drugs to control the emergence of multiresistant strains in an Intensive Care Unit of a general hospital. The Services of Infection Control and Intensive Care and of the Committee of Pharmacy restricted the use of antimicrobial drugs in patients hospitalized in the ICU a no more than two agents simultaneously, excepted in cases authorized by those Services. Clinical and bacteriological outcomes were compared in the year preceding the intervention with the year following the restriction. In the total, 225 patients with 15 years of age or more, with infection, hospitalized in the Intensive Care Unit for at least 48 hours, were studied in the year preceding the intervention and 263 in the year following it. In the year following the intervention fewer patients were treated simultaneously with more than two antimicrobial drugs, but the total number of drugs used, the duration of use and expenses with antimicrobial drugs did not change. Mortality rates and length of hospitalization in the Intensive Care Unit and in the Hospital were also similar in both periods of observation. The number of positive cultures increased after the intervention, both for Gram positive and Gram negative germs, mainly due to the increase of isolates from the respiratory tract. Most isolates were Staphylococcus aureus among Gram positive germs and Acinetobacter sp among Gram negative germs. In the year following the intervention the sensibility of Gram negative microorganisms to carbenecillin, ceftazidime and ceftriaxone increased and to imipenem decreased. The absence of efficacy of this intervention on clinical outcomes may be due to the insufficient adherence by the clinical staff it or to its inefficacy. The improvement in the antimicrobial sensitivity of some germs, without increasing in costs and in the incidence of adverse events, encourages the use of this or similar rules of restriction of antimicrobial drugs to reduce the resistance rates of bacterial strains in intensive care units.

Introdução: Devido ao uso indiscriminado de antibióticos, infecção por Clostridium difficile (ICD) tem aumentado significativamente em frequência e severidade ao longo dos anos, acarretando em maior morbidade e mortalidade além de maiores custos hospitalares. Objetivo: O objetivo deste estudo é avaliar os fatores de risco e fatores associados à pior prognóstico por colite Clostridium difficile em pacientes adultos internados. Desenho do estudo: Estudo de caso-controle retrospectivo Métodos: Em um Hospital terciário, durante o período de 1° de janeiro de 2010 a 31 de julho de 2012, foram comparados 75 pacientes com colite por Clostridium difficile documentada com 75 controles correspondentes com diarreia de origem nosocomial devido a outras etiologias. Foram identificados pacientes com ICD aqueles cuja pesquisa de toxinas A ou B, exame imunoenzimático VIDAS®, foi positiva ou aqueles com exames negativos ou indeterminados para estas toxinas com colonoscopia compatível com colite por Clostridium difficile. Todas variáveis clínicas e microbiológicas com P <0,10 na análise univariada, foram incluídos na análise de regressão logística múltipla afim de avaliar potenciais fatores de risco e fatores de pior prognóstico associados a colite por C. difficile entre pacientes com diarréia internados. Na análise multivariada, variáveis independentes permaneceram se P < 0,05. Resultados: Uso prévio de antibióticos (OR, 13.3; 95% CI, 1.40-126.90), presença de distensão abdominal (OR, 3.85; 95% CI, 1.35-10.98) e leucócitos fecais (OR, 8.79; 95% CI, 1.41-54.61) diante a apresentação de diarreia foram de preditores de infecção por Clostridium difficile. Por outro lado, presença de anorexia esteve negativamente associado com ICD (OR, 0.15; 95% CI, 0.03-0.66). Em relação a análise multivariada, alimentação por sonda naso-entérica (SNE) mostrou-se o único fator independente associado a pior prognóstico, este avaliado como: pacientes admitos em unidade de terapia intensiva (UTI), mortalidade hospitalar e falência de tratamento (OR, 3.75; 95% CI, 1.24-11.29). Conclusão: Uso de antibiótico foi fator de risco para colite por Clostridium difficile observado neste estudo. O uso de suporte nutricional por SNE foi o único fator associado a pior prognóstico. / Background: Due to the indiscriminate use of antibiotics, Clostridium difficile infections (CDI) is increasing in frequency and severity over the years, resulting in increased morbidity and mortality as well as higher hospital costs. Objective: The aim of this study was to evaluate factors associated with Clostridium difficile infection among adult patients with hospital-acquired diarrhea and factors associated with poor prognosis. Study design: Retrospective case-control study. Methods: In a terciary hospital, during the period of january 1° 2010 to 31 july 2012, were compared 75 patients with documented Clostridum difficile colitis with 75 matched controls with hospital-acquired diarrhea secondary to an etiology other than Clostridium difficile. Patients with colits were identified by a positive toxins A or B, an immunoenzymatic test VIDAS®, or by a negative or indeterminate test for these toxins with colonoscopy compatible with Clostridium difficile colitis. All clinical and microbiological variables with a P value <0.10 in the univariate analysis were included in the stepwise multiple logistic regression to identify potential factors associated with C. difficile etiology among patients with hospital-acquired diarrhea and factors associated with poor prognosis among those patients with documented C.difficile colitis. In the multivariate model, independent variables remained in the model if the P value was < 0.05. Results: Previous antibiotic treatment (OR, 13.3; 95% CI, 1.40-126.90), presence of abdominal distension (OR, 3.85; 95% CI, 1.35-10.98) and fecal leukocytes (OR, 8.79; 95% CI, 1.41-54.61) at the onset of diarrhea were predictors of CDI. On the other hand, presence of anorexia was negatively associated with C.difficile etiology (OR, 0.15; 95% CI, 0.03-0.66). Upon multivariate analysis, enteral tube feeding was the only factor independently associated with a composite endpoint which included in-hospital mortality, ICU admission and treatment failure (OR, 3.75; 95% CI, 1.24-11.29). Conclusion:.Previous antibiotic use was risk factor for clostridium difficile colits. In this study tube feeding was the only factor associated with poor prognosis.

Theoretical part of dissertation was written on the basis of studying professional literature. It provides overview of Scabies disease, its epidemiological incidence, transmission, clinical course, diagnostics and also of its treatment. Practical part was formed retrospectively by qualitative research and secondary data analysis. These data were collected from different publications from the State Health Institute in Prague and the Health Information and Statistics Institute in the Czech Republic. The main aim of this dissertation was analyzing the trend of scabies incidence in the Czech Republic within ten years period (2003 2012). Moreover the practical part of this dissertation contains information related to trends of scabies incidence in individual districts of the Czech Republic depending on age, sex, team, seasonal index, or epidemiological scabies incidence as occupational disease. Linear regression was used to assess the incidence trend. Subsequently correlations were ascertained by using method of correlation coefficient calculation. In the research it was found that registered scabies incidence seems to more likely be decreasing from the beginning of followed period (i.e. from the beginning of 2003). According to the seasonal index the most common incidence of this disease within followed period was in October. On the other hand the lowest scabies incidence was in June. The highest sickness rate was recorded in the district Ústí nad Labem with almost 50 cases per 100 000 inhabitants. Scabies as occupational disease belongs to the most common recorded transmissible and parasitic disease in the Czech Republic, mainly at nurses in the hospitals, attendants in retirement homes, in internal wards and in social care institutes. The highest incidence rate was notified in age categories from 5 to 9 years. There exists strong positive linear correlation between scabies incidence and age. Epidemiological scabies incidence in the Czech Republic had two main peaks during period 1965 2012, in 1970 and 1993.

Espécies do gênero Acinetobacter são patógenos oportunistas que têm sido associados a várias infecções relacionadas à assistência em saúde acometendo principalmente, pacientes hospitalizados em centros de tratamento intensivo. A. baumannii , Acinetobacter genoespécie 3 e Acinetobacter genoespécie 13TU constituem o complexo A. baumannii e são consideradas as espécies de maior importância clínica. O objetivo deste trabalho foi identificar em nível de espécie, avaliar o perfil de resistência e analisar a diversidade genética de 102 amostras de Acinetobacter spp. isoladas de hemoculturas de pacientes internados em quatro hospitais do estado do Rio de Janeiro. Após a utilização de duas técnicas moleculares, 87 (85,3%) amostras foram identificadas como A. baumannii, sete (6,9%) como A. genoespécie 3, duas (1,9%) A. genoespécie 13TU e seis (5,9%) não foram identificadas em nível de espécie. A maioria das amostras de A. baumannii apresentou caráter multirresistente mostrando percentuais de resistência acima de 70% para ceftazidima, cefotaxima e ciprofloxacina. A resistência aos carbapenêmicos variou de 59% a 91%. Foi encontrada uma grande variedade de antibiotipos entre as amostras de A. baumannii, sendo prevalente dois multirresistentes. Um deles, caracterizado pela sensibilidade apenas aos aminoglicosídeos, ocorreu em 20,7% das amostras e o outro observado em 14,9% das amostras , foi caracterizado pela resistência a todos os antimicrobianos testados. Através da PCR, foi observado que 77% das amostras de A. baumannii apresentaram produto de amplificação compatível com gene blaOXA-23-like e destas, 64 mostraram-se resistentes tanto a imipenem quanto a meropenem. Em contrapartida, todas as amostras de A. baumannii OXA-23 negativas mostraram-se sensíveis aos carbapenens. Em relação às amostras de A. genoespécie 3 e 13TU, foram observados baixos percentuais de resistência frente aos antimicrobianos testados e apenas uma amostra de Acinetobacter genoespécie 3 apresentou produto de amplificação compatível com gene blaOXA-23-like, sendo esta sensível aos carbapenens. Não foram detectados os genes blaOXA-40-like e blaOXA-58-like nas 102 amostras de Acinetobacter spp.. A análise do polimorfismo genético das amostras de A. baumannii por PFGE mostrou a presença de 35 clones distribuídos entre os hospitais. Um clone (designado A), presente em 32 amostras (36,9%), foi encontrado nos quatro hospitais, sendo prevalente em três. Em 93,8% das amostras do clone A foi detectado o gene blaOXA-23-like. A disseminação de um clone de A. baumannii multirresistente produtor de OXA-23 entre os hospitais estudados evidencia a importância de medidas de controle de infecções mais eficazes, visando minimizar a morbidade e a mortalidade causadas por este importante patógeno. Além disso, como outras espécies também podem estar associadas a infecções, destacamos a importância da identificação correta das amostras em nível de espécie, visando o conhecimento da patogenicidade, do perfil de resistência e dados epidemiológicos des outras espécies, principalmente as pertencentes ao complexo A. baumannii / Acinetobacter species are opportunistic pathogens that have been associated with wide variety infections related to health care affects mainly patients hospitalized in intensive care units. A. baumannii and its phenotypically related species (Acinetobacter genoespécie 3 and genoespécie 13TU), together forming the A.baumannii complex and are considered species of greatestclinical importance. The objective of this study was to identify at the species level, to know the resistance profile and analyze the genetic diversity of 102 samples of Acinetobacter spp. isolated from blood cultures of patients admitted to four hospitals in the state of Rio de Janeiro. After using two molecular techniques, 87 (85.3%) were identified as A. baumannii, seven (6.9%) as A. genoespécie 3, two (1.9%) A. genoespécie 13TU and six (5.9%) were not identified at the species level. The most specimens of A. baumannii presented multidrug resistance, showing resistance rates above 70% for ceftazidime, cefotaxime and ciprofloxacin. The carbapenem resistance ranged from 59% to 91%. There was a wide variety of antibiotype between samples of A. baumannii, with two prevalent multiresistant antibiotypes. One, characterized by sensitivity only to aminoglycosides occurred in 20.7% of the samples and the other (14.9% of the samples) characterized by resistance to all antimicrobials tested. By PCR, we observed that 77% of the samples of A. baumannii showed amplification product consistent with gene blaOXA-23-like and of these, 64 were resistant to both imipenem and meropenem. In contrast, all samples of A. baumannii OXA-23 negative were sensitive to carbapenems. In samples of A. genoespécie 3 and 13TU were observed low percentages of resistance against the tested antimicrobials and only a sample of Acinetobacter genoespécie 3 showed amplification product consistent with blaOXA-23-like, which was sensitive to carbapenens. The genes blaOXA-40-like and blaOXA-58-like were not detected in 102 samples of Acinetobacter spp.. Analysis of genetic polymorphism of the samples of A. baumannii by PFGE showed the presence of 35 clones distributed among the hospitals. A clone (designated A), present in 32 samples (36.9%) was found in four hospitals. In 93.8% of the samples inclued clone A were detected the gene blaOXA-23-like. The spread of a clone multidrug-resistant A. baumannii producing the OXA-23 enzyme in the four hospitals showed the importance of infections control measures more effective, in order to minimize morbidity and mortality caused by this important pathogen. Moreover, as other species may also can be associated with infections, we showed the importance of correct identification of the samples at the species level, for the knowledge of the pathogenicity.The resistance profile and epidemiological study of species of Acinetobacter other than A. baumannii, especially those belonging to the Complex A. baumannii