Bakgrund:Kvarliggande kateter [KAD] är en behandling för akut eller kronisk urinretention och används vid sjukdomar eller vissa operationer. Samtidigt ökar KAD risk för urinvägsinfektion, vilket minskar patientsäkerheten, förlänger återhämtningstid och ökar behandlingskostnad. Förebyggande åtgärder för att minska kateterassocierad urinvägsinfektion [UVI] blir därför allt viktigare. Flera länder i Europa, Nord- och Sydamerika har gjort flertalet studier och hittat effektiva evidensbaserade förebyggande åtgärder mot kateterassocierad UVI. Utifrån säker och evidensbaserad vård skulle evidensbaserade förebyggande åtgärder tas reda på och användas för att minska kateterassocierad UVI.  Syfte:Att beskriva förebyggande åtgärder inom omvårdnad mot kateterassocierad UVI. Metod:Litteraturöversiktutifrån Polit och Becks niostegsmodell användes i urval och datainsamling till att 12 artiklar gick igenom kvalitetsgranskningen och analyserades till resultatet med induktiv ansats.  Resultat:Förebyggande åtgärder sammanställdes i tre huvudkategorier. Första huvudkategorin följ riktlinjer med underkategorierna kateterisering endast utifrån läkarordination och lämpliga indikationer, aseptisk teknik med rätt utrustning, fixering av KAD och uppsamlingspåsen samt borttagning av KAD om inga behov föreligger. Andra huvudkategorin utför kontrollrutiner med underkategorierna utför kateteriserings checklista samt kontrollera, rapportera    och dokumentera kateter dagligen. Tredje huvudkategorin etablera ett systematiskt förbättringsarbete med underkategorierna utse en eller två ansvariga personer, erbjud föreläsning och träning om kateterisering samt arrangera workshop. Slutsatser:Kateterassocierad UVI kan förebyggas om sjuksköterska uppfyller sin kompetens med hjälp av workshop, utför kateterisering enligt riktlinjer, samt hanterar och kontrollerar urinkateter enligt kontrollrutiner såsom kateteriserings checklista. / Background:An indwelling catheter is used as a treatment for acute or chronic urinary retention and is commonly used for diseases or some surgeries. At the same time, indwelling catheters increases the risk of urinary tract infections, which reduces patient safety, prolongs patient’s recovery and increases treatment costs. Several countries in Europe, North- and South America have conducted several studies that found evidence-based, effective preventive measures against catheter associated urinary tract infections. Evidence-based preventative measures should be found out and be used to decrease catheter associated urinary tract infections. Aim: To describe preventive measures in nursing against catheter-associated urinary tract infections. Method:Literature overview with Polit and Beck's nine-way model is used in selection and data collection to ensure that the 12 articles selected to the quality review were analyzed for results with an inductive approach. Results:Prevention measures were compiled into three main categories. First main category follows guidelines with subcategories catheterization only based on medical ordinance and appropriate indications, aseptic technique with proper equipment, fixation of catheter and collection bag and removal of catheter if no needs exists. Second main category performs check routines with subcategories perform catheterization checklist as well as check, report and document catheters daily. Third main category establish a systematic improvement work with subcategories appoint one or two responsible persons, offer lecture and training on catheterization and arrange workshop. Conclusions:Catheter associated urinary tract infections can be prevented if the nurse fulfills her/his competency with help of workshop, performs catheterization according to guidelines, manages and controls the urinary catheter according to control routines such as catheterization checklist.

Made available in DSpace on 2015-12-06T23:47:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 / Objetivos: 0 estudo procurou determinar os fatores de risco associados a infeccao de sitio cirurgico e do trato urinario pos-transplante simultaneo de rim-pancreas. Foi tambem estudada a incidencia de infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes e os principais patogenos causadores destas infeccoes. Metodo: 0 estudo foi realizado no Hospital São Paulo, hospital terciario de ensino da Universidade Federal de São Paulo. 0 estudo utilizou uma coorte de pacientes que incluiu todos os pacientes que realizaram transplante simultaneo de rim-pancreas no periodo de 01 de dezembro de 2000 a 31 de dezembro de 2006 (119 receptores). Estes pacientes foram acompanhados atraves do prontuario, por um periodo de um mes pos-transplante, para desenvolvimento de infeccao de sitio cirurgico, e durante todo 0 periodo de internacao apos 0 transplante para 0 desenvolvimento de infeccao do trato urinario hospitalar. Os criterios usados para 0 diagnostico de infeccao hospitalar foram definidos pelo Centers for Disease Control and Prevention (CDC). E foram realizados dois estudos tipo caso-controle aninhado (do ingles Nested Case Control), onde foram avaliados os fatores de risco para infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes. A analise multivariada foi realizada pela tecnica de regressao logistica multipla, utilizando as variaveis com p≤ 0,05 na analise univariada. 0 metodo utilizado foi 0 Stepwise forward. Resultados: A mortalidade nos primeiros 30 dias apos 0 transplante foi 11,8%. A infeccao de sitio cirurgico ocorreu em 55 (46,2%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11 %). Ap6s a regressao logistica multivariada, as variaveis independentemente associadas a ISC foram: necrose tubular aguda (OR=4,4; IC95%= 1,77 - 10,99; p=0,001); fistula renal ou pancreatica pos-­transplante (OR=7,25; IC95%= 1,35 - 38,99; p=0,02) e rejeicao do enxerto (OR=4,28; IC95%= 1,59 - 11,48; p=0,004). A infeccao do trato urinario ocorreu em 29 (24,4%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae 13 (43,5%), Acinetobacter baumannii 7 (23,5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%).Apos a regressao logistica multivariada, as variaveis independentemente associadas a ITU foram: tempo de hipertensao arterial (OR=1, 1; IC95%= 1,00 - 1,02; p=0,01); uso de alcool pelo doador (OR=7,49; IC95%= 1,01 - 55,66; p=0,04) e uso de drogas vasoativas no doador (OR=0,08; IC95%= 0,01 - 0,84; p=0,03) e, como fator protetor: diurese residual pre-transplante (OR=0,16; IC95%= 0,04 - 0,59; p=0,006). Conclusao: Nosso estudo demonstrou que variaveis relacionadas ao procedimento cirurgico estao mais relacionadas ao desenvolvimento de infeccao de sitio cirurgico e que variaveis relacionadas ao receptor e doador estao mais relacionadas ao surgimento de infeccao do trato urinario em pacientes submetidos a transplante simultaneo rim­-pancreas. Nosso estudo e um dos primeiros a avaliar fatores de risco para essas duas importantes infeccoes nosocomiais nessa coorte de pacientes. / BV UNIFESP: Teses e dissertações

The introduction of antibiotics in healthcare is one of the most important medical achievements with regard to reducing human morbidity and mortality. However, bacterial pathogens have acquired antibiotic resistance at an increasing rate, and due to a high prevalence of resistance to some antibiotics they can no longer be used therapeutically. The antibiotic mecillinam, which inhibits the penicillin-binding protein PBP2, however, is an exception since mecillinam resistance (MecR) prevalence has remained low. This is particularly interesting since laboratory experiments have shown that bacteria can rapidly acquire MecR mutations by a multitude of different types of mutations. In this thesis, I examined mechanisms and dynamics of mecillinam resistance in clinical and laboratory isolates of Escherichia coli. Only one type of MecR mutations (cysB) was found in the clinical strains, even though laboratory experiments demonstrate that more than 100 genes can confer resistance Fitness assays showed that cysB mutants have higher fitness than most other MecR mutants, which is likely to contribute to their dominance in clinical settings. To determine if the mecillinam resistant strains could compensate for their fitness cost, six different MecR mutants (cysB, mrdA, spoT, ppa, aspS and ubiE) were evolved for 200-400 generations. All evolved mutants showed increased fitness, but the compensation was associated with loss of resistance in the majority of cases. This will also contribute to the rarity of clinical MecR isolates with chromosomal resistance mutations. How MecR is mediated by cysB mutations was previously unclear, but in this thesis I propose and test a model for the mechanism of resistance. Thus, inactivation of CysB results in cellular depletion of cysteine that triggers an oxidative stress response. The response alters the intracellular levels of 450 proteins, and MecR is achieved by the increase of two of these, the LpoB and PBP1B proteins, which rescue the cells with a mecillinam-inhibited PBP2. Mecillinam is used for UTI treatments and to investigate mecillinam resistance in a more host-like milieu, MecR strains were grown in urine and resistance was examined. Interestingly, this study showed that neither laboratory, nor clinical cysB mutants are resistant in urine, most likely because the cysteine present in the urine phenotypically reverts the bacteria to susceptibility. These findings suggest that mecillinam can be used to treat also those clinical strains that are identified as MecR in standard laboratory tests, and that testing of mecillinam susceptibility in the laboratory ought to be performed in media that mimics urine to obtain clinically relevant results. In summary, the work described in this thesis has increased ourgeneral knowledge of mecillinam resistance and its evolution. Hopefully this knowledge can be put to good use in clinical settings to reduce the negative impact of antibiotic resistance.

INTRODUÇÃO: Infecção do trato urinário (ITU) é doença cujos sinais e sintomas são frequentemente inespecíficos, especialmente em lactentes. Portanto, o conhecimento de seus aspectos epidemiológicos, clínicos e laboratoriais são relevantes para a adequada abordagem clínica. OBJETIVOS PRINCIPAIS: Descrever: a prevalência de ITU como motivo de atendimento em pronto-socorro geral de Pediatria; a variabilidade da frequência de ITU e dos agentes etiológicos em diversas faixas etárias e sexo; o perfil de sensibilidade antimicrobiana de Escherichia coli; o quadro clínico, laboratorial e evolutivo de lactentes jovens. OBJETIVOS SECUNDÁRIOS: Cálculo de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo do corte de leucocitúria >= 10.000 leucócitos/mL para o diagnóstico de ITU em lactentes jovens. Comparar as diferenças de ITU por Escherichia coli e Staphylococcus saprophyticus em adolescentes do sexo feminino e discutir as melhores escolhas de terapia antimicrobiana empírica para uso na população estudada. MÉTODO: Estudo retrospectivo, descritivo, incluindo todos os casos de ITU (urocultura quantitativa com >= 50.000 UFC/mL por sondagem vesical ou >= 100.000 UFC/mL por jato médio) atendidos no Pronto-Socorro de Pediatria do Hospital Universitário da Universidade de São Paulo, de 01/01/2010 a 31/12/2012, idades entre zero a 15 anos incompletos. Resultados: Do total de 188.460 atendimentos realizados, 7994 colheram urocultura por suspeita de ITU; este diagnóstico foi confirmado em 1071 casos (prevalência: 0,57% do total de atendimentos e 13,4% das uroculturas incluídas). A proporção de casos entre sexo masculino e feminino foi: 1:0,3 em menores de três meses; 1:3,9 entre três meses a 12 anos e 1:12 entre 12 a 15 anos. Escherichia coli foi o principal agente responsável por 73,2% dos casos totais de ITU. Entretanto, outros agentes importantes foram Klebsiella pneumoniae (18,46%) e Enterococcus faecalis (7,7%) em lactentes jovens (menores de três meses de idade); Proteus mirabilis (30,8%) em meninos de três meses a 12 anos; Staphylococcus saprophyticus (25%) em adolescentes do sexo feminino entre 12 a 15 anos. A sensibilidade antimicrobiana de Escherichia coli foi observada acima de 80% para: amoxicilina/ácido clavulânico (87%), cefuroxima (98%), cefotaxima (98%), ceftriaxona (100%), cefepime (99%), amicacina (100%), gentamicina (97%), ciprofloxacina (98%), norfloxacina (94%), ácido nalidíxico (93%) e nitrofurantoína (97%). Em lactentes jovens, febre sem sinais localizatórios foi o sintoma mais frequente de ITU (77,8%). Exames subsidiários de hemograma e proteína C reativa foram de pouca utilidade clínica. O teste de nitrito positivo apresentou baixa sensibilidade: 30,8% (IC 95%: 19,9%-43,4%), porém elevada especificidade e valor preditivo positivo. Enquanto que o corte de leucocitúria > 10.000 leucócitos/mL para ITU revelou boa sensibilidade: 87,7% (IC 95%: 77,2%-94,5%), porém baixa especificidade e valor preditivo positivo. Nas adolescentes do sexo feminino entre 12 a 15 anos, houve menor positividade do teste do nitrito nas ITU por Staphylococcus saprophyticus do que nas ITU por Escherichia coli. Na população do presente estudo, a terapia empírica inicial recomendada seria: zero a três meses: tratamento parenteral com aminoglicosídeo ou cefalosporina de terceira geração; podendo associar ampicilina para cobertura de Enterococcus faecalis. Entre três meses a 15 anos: amoxicilina/ácido clavulânico ou cefuroxima ou ceftriaxona ou aminoglicosídeos. CONCLUSÕES: ITU é doença frequente em atendimentos de pronto-socorro. Os aspectos epidemiológicos, clínicos e laboratoriais são variáveis nas diversas faixas etárias e sexos; portanto, a abordagem deve ser individualizada em cada um destes segmentos / INTRODUCTION: Urinary tract infection (UTI) frequently presents with nonspecific signs and symptoms, particularly in infants. Therefore, the understanding of its epidemiological, clinical and laboratory aspects are relevant to its appropriate clinical approach. MAIN OBJECTIVES: To describe: the prevalence of UTI as a cause for attending the pediatric emergency department; the variability of the frequency of UTI and etiological agents in different age groups and sexes; the antimicrobial sensitivity profile of Escherichia coli; the clinical features, laboratory findings and treatment outcomes in young infants. SECONDARY OBJECTIVES: To evaluate sensitivity, specificity, positive predictive value and negative predictive value of pyuria >= 10,000 leukocytes/mL for screening UTI in young infants. To compare UTI due to Escherichia coli with UTI due to Staphylococcus saprophyticus in female adolescents and to discuss the best empirical antimicrobial treatment in the population studied. METHODS: Retrospective, descriptive study, including all cases of UTI (urine culture of >= 50,000 CFU/mL obtained by bladder catheterization or >= 100,000 CFU/mL obtained by midstream-voided method) attended at the pediatric emergency department of University Hospital of the University of São Paulo, from 01/01/2010 to 12/31/2012, ages from zero to 15 years old. Results: Of 188,460 visits in this period, 7994 collected urine culture on suspicion of UTI. This diagnosis was confirmed in 1071 cases (prevalence: 0.57% of total visits and 13.4% of urine cultures included). The proportion of cases between male and female was: 1: 0.3 in children younger than three months old; 1: 3.9 from three months to 12 years old and 1:12 from 12 to 15 years old. Escherichia coli was the main etiology responsible for 73.2% of total cases of UTI. However, other important agents were Klebsiella pneumoniae (18.46%) and Enterococcus faecalis (7.7%) in young infants (under three months of age); Proteus mirabilis (30.8%) in boys from three months to 12 years old; Staphylococcus saprophyticus (25%) in female adolescents aged 12-15 years. The antimicrobial sensitivity of Escherichia coli was still above 80% for amoxicillin / clavulanic acid (87%), cefuroxime (98%), cefotaxime (98%), ceftriaxone (100%), cefepime (99%), amikacin (100%), gentamicin (97%), ciprofloxacin (98%), norfloxacin (94%), nalidixic acid (93%) and nitrofurantoin (97%). In young infants, the absence of another source of fever was the most frequent UTI symptom (77.8%). Laboratory parameters including peripheral white blood cell count and C-reactive protein concentration were of limited clinical usefulness. The sensitivity of nitrite testing for bacteriuria was low: 30.8% (95% CI: 19.9%-43.4%), but had high specificity and positive predictive value. Pyuria> 10,000 leukocytes / mL for identifying UTI had high sensitivity: 87.7% (95% CI: 77.2%-94.5%), but low specificity and positive predictive value. In female adolescents aged 12 to 15 years old, there were few positive nitrite tests in UTI due to Staphylococcus saprophyticus compared with UTI due to Escherichia coli. In the population studied, the initial empirical therapy recommended would be: from zero to three months old: parenteral treatment with aminoglycoside or third generation cephalosporin; it could be associated with ampicillin to treat Enterococcus faecalis. Between three months to 15 years old: amoxicillin / clavulanic acid or cefuroxime or ceftriaxone or aminoglycosides. In cystitis: in addition to amoxicillin / clavulanic acid or cefuroxime; nitrofurantoin is also a good option for Staphylococcus saprophyticus UTI whereas nalidixic acid is also a nice choice for Proteus mirabilis UTI. CONCLUSIONS: UTI is a common disease in emergency department visits. The epidemiological, clinical and laboratory aspects are variable in the different age and sex groups; therefore, the approach must be individualized in each of these groups

Au cours des dernières décennies, les capteurs et les biocapteurs électrochimiques ont connu un développement considérable en raison de leur simplicité, fiabilité, rapidité et sélectivité. Ils ont constitué les alternatives les plus séduisantes pour les méthodes analytiques classiques dans des domaines aussi variés que l'agro-alimentaire, la médecine et la biologie clinique, ou le contrôle de la qualité de l'environnement. Dans ce travail de recherche, nous nous sommes intéressés, dans un premier volet, aux développements des immunocapteurs et capteurs électrochimiques à base des polymères à empreintes moléculaires (MIPs) pour le contrôle de la qualité des miels. La première partie de ce volet concerne le développement des immunocapteurs sur des structures dites Bio-MEMS basées sur des microélectrodes en or. L'élaboration de ces immunocapteurs a été dédiée à la détection des résidus d'antibiotiques à savoir la sulfapyridine (SPy) et la tétracycline (TC). Une nouvelle structure des nanoparticules magnétiques (MNPs) revêtues du copolymère poly (acide pyrrole-co-pyrrole-2-carboxylique) a été exploitée dans ces travaux pour leur réseau d'immobilisation tridimensionnel ainsi que pour leur stabilité pendant de longues périodes. La détection de la SPy et de la TC a été réalisée par différentes approches compétitives en utilisant des anticorps polyclonaux. Dans la deuxième partie de ce volet, nous avons fabriqué des capteurs à base des MIPs pour la détection de la sulfaguanidine, la doxycycline et le chloramphénicol dans le miel. Ces dispositifs ont été développés sur la surface des électrodes sérigraphiées en or en employant une matrice polymérique du polyacrylamide en présence des molécules empreintes. Les performances de ces capteurs et biocapteurs (limite de détection, sélectivité, reproductibilité, application dans les milieux réels) ont ensuite été évaluées. Dans un deuxième volet, nous nous sommes parvenus à appliquer un dispositif de la langue électronique voltammétrique (Langue-EV) pour des analyses agroalimentaires et biomédicales. Dans un premier temps, nous avons discriminé les miels issus de quatorze régions de la France et du Maroc par le dispositif de la Langue-EV. Nous nous sommes aussi parvenus à démontrer la fiabilité de ce dispositif à prédire les résultats des différents paramètres physico-chimiques d'après les réponses des méthodes analytiques utilisées. Dans un deuxième temps, nous sommes passés à l'application du dispositif de la Langue-EV en analyse biomédicale dans le but de discriminer les urines des patientes souffrants des infections urinaires avec celles des femmes saines / In recent decades, the use of electrochemical sensors and biosensors have grown considerably due to their simplicity, reliability, rapidity, and selectivity. They were the most attractive alternative tools for conventional analytical methods in various fields such as food control, medicine, and clinical biology or environmental control. In this research works, we focused, in the first part, on the development of immunosensors and electrochemical sensors based on molecularly imprinted polymers (MIPs) for the quality control of honey. In the second part, we managed to apply a voltammetric electronic tongue (VE-tongue) for food monitoring and biomedical analyzes. The first part of our research work concerns the development of immunosensors based on gold microelectrodes of the Bio-MEMS devices. The development of these immunosensors was dedicated to the detection of antibiotic residues namely sulfapyridine (SPy) and tetracycline (TC). A new structure of magnetic nanoparticles (MNPs) coated with the poly (pyrrole-co-pyrrole-2-carboxylic acid) copolymer has been exploited in this work for their three-dimensional immobilization network as well as for their stability for long periods. The detection of SPy and TC was performed by different competitive approaches using polyclonal antibodies. In this part, we have also synthesized the MIP sensors dedicated to the detection of sulfaguanidine, doxycycline, and chloramphenicol in honey. These devices have been developed on the surface of the screen-printed gold electrodes by employing a polyacrylamide matrix in the presence of the target molecules. The performances of these sensors and biosensors (limit of detection, selectivity, reproducibility, applications in real samples) were then evaluated. Regarding the second part of our research works, it involved the discrimination between honeys from fourteen regions from France and Morocco. We have succeeded in demonstrating the reliability of this device in predicting the results of the different physico-chemical parameters of honey samples according to the responses of the used analytical methods. In other steps, we proceeded to the application of the VE-tongue in biomedical analyzes to discriminate urine specimens of patients suffering from urinary tract infections and those of healthy subjects

Introduktion: Vårdrelaterade infektioner (VRI) har negativ inverkan på folkhälsan med påverkan på mortalitet, morbiditet och livskvalitet. Inom hälso- och sjukvården är VRI en stor utmaning. Den vanligaste VRI i Sverige är vårdrelaterade urinvägsinfektioner (VUVI). För att förebygga VRI är regelbundna mätningar och återkopplingar viktigt. Mätinstrument som idag används på lokal och nationell nivå för att mäta incidens av VRI är bl.a. Markörbaserad journalgranskning och Infektionsverktyget. Syfte: Validera Infektionsverktyget och jämföra incidens av VUVI från Infektionsverktyget mot manuell journalgranskning och Markörbaserad journalgranskning samt studera förekomsten av urinkateter i samband med VUVI. Metod: Under 2017 samlades data in från 143 slumpmässigt utvalda journaler i slutenvården på Södra Älvsborgs sjukhus. Diagnostiserad VUVI och samhällsförvärvad urinvägsinfektion (SUVI) i Infektionsverktyget validerades mot manuell journalgranskning. Incidensen av VUVI i Infektionsverktyget jämfördes även mot VUVI i markörbaserad journalgranskning. Resultat: Incidens av VUVI innan validering var 1.5 % medan den uppskattade incidensen efter manuell journalgranskning och validering var 3.6 %. Markörbaserad journalgranskning visade en incidens på 1.1 %. I 65.6 % av fallen med VUVI fanns en koppling till urinkateter. Den mest förekommande orsaken till inkorrekt registreringen av VUVI var att patienter med urinkateter bedömdes som SUVI. Slutsats: Den rapporterade incidensen av VUVI skiljer sig mellan de mätinstrument som används idag och incidensen är troligtvis högre än vad som idag rapporteras. För att få bra kvalitet på övervakningsdata krävs kunskap och granskning av hög kvalitet. Dock begränsas resultatet från denna studie av att studiepopulationen var relativt liten och därmed begränsar generaliserbarheten. / Introduction: Health care associated infections (HCAIs) have a negative impact on public health, with an impact on mortality, morbidity and quality of life. The most common HCAIs in Sweden are health care associated urinary tract infections (UTI). One important component in preventing HCAIs are regular measurements and feedback to these. Instruments that are currently used for measuring HCAIs at a local and national level in Sweden are marker-based journal review and the Anti-Infection Tool (AIT). Aim:  The aim of this study was to validate the AIT and compare the incidence of health care associated UTI measured with the AIT against both manual journal review and marker-based journal review. The aim was also to study the presence of urinary catheters in conjunction with a healthcare associated UTI. Methods: In 2017, data was collected from 143 records from a random sample of patients admitted to somatic wards at Södra Älvsborg's Hospital. From the AIT, diagnosed health care associated UTI and community-acquired UTI were studied and validated against manual journal review. Also, the incidence of health care associated UTI in the AIT was compared with that found in marker-based journal review. Results: Incidence of health care associated UTI before the validation was 1.5% while the estimated incidence after manual journal review and validation was 3.6%. Marker-based journal review showed an incidence of 1.1%. In 65.6 % of the cases with health care associated UTI, the patient was equipped with urinary catheter. The most common cause of incorrect registration of health care associated UTI was that patients with urinary catheters were assessed as community-acquired UTI.   Conclusion:  The reported incidence of health care associated UTI differs greatly between these instruments. The incidence is probably much higher than what is currently reported using these instruments. To obtain good quality of monitoring data, knowledge and journal reviews of high quality are required. However, the generalizability of the result of this study is limited, due to the relatively small study sample.

In today's hospital environment, good care has become synonymous with positive patient outcomes. Marring this landscape is the alarming rate of hospital acquired (nosocomial) infections. Urinary tract infection (UTI) is one of the most common hospital acquired infections. The major cause associated with these infections is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with urinary catheter-associated UTI can be minimized by prudent decisions concerning catheter usage and good catheter care. The principle route of dispersal of nosocomial infections is likely from patient-to-patient via transiently contaminated hands of hospital personnel. The purpose of this evidence-based project was to determine if hospital-acquired catheter-associated urinary tract infection rates among patients admitted to an acute care facility could be decreased through staff education and consistent application of nursing care using selected perineal infection control interventions. The setting was a 43-bed medical/surgical floor in a 321 bed not for profit Magnet hospital in Northeast Florida. Twenty-four registered nurses and 18 patient care technicians completed targeted in-service education on general nosocomial infections, perineal care, and hand hygiene. A catheter dwell time notification system was also implemented. Chart review data was obtained from 383 admissions (197 pre-intervention, 133 after the educational intervention, and 53 after the dwell time notification). There was a significant difference in catheter-associated urinary tract infection rates after the interventions (11.17 pre-intervention, 10.53 after the educational intervention and 0.392 after the dwell time notification). A longer length of time in practice an on this hospital unit was associated with lower infection rates.

No description available.

As ITU são as mais freqüentes infecções ocasionadas por ExPEC. Entre os fatores de virulência (FV) encontram-se nestas cepas adesinas, invasinas, toxinas, sideróforos, e evasinas, localizados em plasmídios ou ilhas de patogenecidade. O objetivo deste estudo foi caracterizar 45 cepas de E. coli isoladas de 33 cães e 7 gatos com ITU, quanto aos sorotipos, FV e grupos filogenéticos. Dos sorogrupos relacionados às ITU foram encontrados O6 (20%), O2 (16%), O25 (4%), O4 e O11 (4% cada um). Entre os genes pesquisados, foram encontrados fimH (100%), pap (47%), sfa (33%) e iha (4%); ibeA (29%); cnf1 (31%), hlyA (27%); fyuA (80%), iucD (22%); traT (51%); cvaC (20%) e malX (67%). Os isolados felinos foram agrupados em B2 (89%) e D (11%), enquanto os caninos em A (5,5%), B1 (19,5%), B2 (55,5%) e D (19,5%). Estes resultados sugerem que as ExPEC isoladas de cães e gatos apresentam potencial patogênico para ocasionar doenças mais graves que as ITU, assim como ocorre em humanos. Além disso, a similitude com as amostras humanas reforça a hipótese acerca de seu potencial zoonótico. / The ability of ExPEC to cause extraintestinal infections in humans, dogs, and cats is associated with the expression of a variety of virulence factors (VF). The aim of this study was to evaluate the frequency of VF related to ExPEC, serotypes, and phylogenetic groups in 45 strains isolated from 33 dogs and 7 cats with UTI. These strains presented serogroups related with extraintestinal infections, e.g. O6 (20%), O2 (16%), O25 (4%), O4 e O11 (each one) and the following genes: fimH (100%), pap (47%), sfa (33%) e iha (4%); ibeA (29%); cnf1 (31%), hlyA (27%); fyuA (80%), iucD (22%); traT (51%); cvaC (20%) e malX (67%), cvaC (20%), and malX (67%). All feline strains were concentrated in B2 (89%) and D (11%) phylogenetic groups, whereas the canine ones were distributed in the four groups, A (5,5%), B1 (19,5%), B2 (55,5%) and D (19,5%). These findings suggesting that ExPEC isolated from dog and cat contain virulence markers to cause diseases, more severe than UTI, likewise in humans. Besides, these the close similarity between human and animal ExPEC supports the hypotesis of zoonotic potencial of them.

Thesis (Ph. D.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).