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Ebenezer K.,Christian Medical College and Hospital | James E.J.G.,Christian Medical College and Hospital | Michael J.S.,Hospital Infection Control Committee | Kang G.,Hospital Infection Control Committee | Verghese V.P.,Christian Medical College and Hospital
Indian Pediatrics | Year: 2011

We report an outbreak of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in 6 infants with acute lower respiratory tract infection. Non-bronchoscopic bronchoalveolar lavage isolated A. baumannii in all these infants. Environmental microbiological survey of the Pediatric intensive care unit and pediatric wards identified oxygen humidifying chambers as the source of Acinetobacter. Practices of cleaning and changing of the humidifiers were reviewed and the outbreak was controlled with new recommendations. © 2011 Indian Academy of Pediatrics.


Kara A.,Dr Behcet Uz Childrens Hospital | Devrim T.,Dr Behcet Uz Childrens Hospital | Bayram N.,Dr Behcet Uz Childrens Hospital | Katipoglu N.,Dr Behcet Uz Childrens Hospital | And 5 more authors.
Brazilian Journal of Infectious Diseases | Year: 2015

Background: Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. Aim: In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. Method: A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycin-resistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). Conclusion: In conclusion, our study found that 1.55% of vancomycin-resistant enterococci-colonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycin-resistant enterococci bloodstream infections. © 2014 Elsevier Editora Ltda.


da Silva A.R.A.,Hospital Infection Control Committee | de Souza C.V.,Hospital Infection Control Committee | Guimaraes M.E.V.,Hospital Infection Control Committee | Sargentelli G.,Hospital Infection Control Committee | And 2 more authors.
Infection Control and Hospital Epidemiology | Year: 2012

We describe the incidence rates of home healthcare-associated infections (HHAIs) in a pediatric home healthcare service (PHHCS). The overall incidence density of HHAIs was 11.1 infections per 1,000 patient-days. Average incidence density of ventilator-associated pneumonia (VAP) was 6.8 per 1,000 ventilator-days. Strategies for control of VAP should be prioritized in PHHCSs. © 2012 by The Society for Healthcare Epidemiology of America. All rights reserved.


Araujo Da Silva A.R.,Hospital Infection Control Committee | De Souza C.V.,Hospital Infection Control Committee | Viana M.E.,Hospital Infection Control Committee | Sargentelli G.,Hospital Infection Control Committee | And 2 more authors.
American Journal of Infection Control | Year: 2012

The number of children in home health care services is increasing, and there is a need for infection control regulation in this environment. We describe the main causes of infection and hospitalization in children assisted by a pediatric home health care service in Rio de Janeiro, Brazil. © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


Magedanz L.,Hospital Infection Control Service | Silliprandi E.M.,Hospital Infection Control Service | Dos Santos R.P.,Hospital Infection Control Service | Dos Santos R.P.,Hospital Of Clinicas Of Porto Alegre | Dos Santos R.P.,Hospital Infection Control Committee
International Journal of Clinical Pharmacy | Year: 2012

Background Antimicrobial stewardship programs (ASP) have been implemented to promote rational use of antimicrobial drugs. Multidisciplinary teams are needed to form effective committees. Objective Assess the impact of ASP, with and without the presence of a pharmacist, in a cardiology hospital in Brazil. Methods The program started with an infectious disease (ID) physician, and after 22 months, a pharmacist started to work in the ASP team. We present data related to: stage 1-before the program implementation; stage 2-with the ID physician; and stage 3 with the inclusion of a pharmacist. Analysis was made by segmented regression of time series. Results After the start of ASP there was a significant reduction of consumption of all antimicrobials. The pharmacist contributed to the significant reduction in consumption of fluoroquinolones, clindamycin and ampicillin/sulbactam and in increase in total cephalosporins use in stage 3. Adherence rate to the ASP team recommendations was 64.1%. There was a significant reduction of 69% in hospital antibiotics costs. Conclusion A non-expensive ASP in a limited resource country resulted in reductions in antimicrobial consumption and costs. The multidisciplinary team contributed to maximize the impact of interventions. © 2011 CARS.


dos Santos R.P.,Hospital Infection Control Committee | dos Santos R.P.,Hospital Of Clinicas Of Porto Alegre | Jacoby T.,Hospital Infection Control Committee | Machado D.P.,Hospital Of Clinicas Of Porto Alegre | And 8 more authors.
Infection Control and Hospital Epidemiology | Year: 2011

Objective. To evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic hand rub, and the density rate of invasive practices. design. Before-and-after trial. setting. A tertiary care university hospital in southern Brazil. methods. Ertapenem was first added to the hospital formulary in June 2006, and it was excluded in February 2009. We evaluated Pseudomonas aeruginosa resistance rates through 3 study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months). results. After introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days (level change from 0.04 to -1.08; P <.01), and an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days (level change from -0.14 to 0.91; P <.01), by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods. However, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (P =.04). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection. conclusions. Use of alcohol-based hand gel, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. Measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone. © 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.


Rubio F.G.,Parasitary and Dermatology Diseases | Rangel R.M.C.,Hospital Infection Control Committee | Nogueira M.C.L.,Parasitary and Dermatology Diseases | Nogueira M.C.L.,Microbiology Laboratory | And 2 more authors.
Brazilian Journal of Infectious Diseases | Year: 2013

The objective of this study was to investigate bacterial resistance trends, infection sites and the relationship between resistance and admittance to the intensive care unit (ICU). A total of 53,316 bacteria identified between 1999 and 2008 were evaluated. Multidrug resistance was characterized when gram-negative bacilli (GNB) presented resistance to two or more classes of antibiotics. Gram-positive cocci (CPC) were assessed for resistance to penicillin, oxacillin and vancomycin. GNB were the most common (66.1%) isolate. There was a 3.7-fold overall increase in multidrug resistant GNB over the study period; Acinetobacter baumanii and Staphylococcus aureus were the most prevalent. Highest increases were recorded for Klebsiella pneumoniae (14.6-fold) and enterococci (73-fold). The resistance rates for GNB and GPC were 36% and 51.7%, respectively. Most multidrug resistant GNB and GPC were recovered from ICU patients (p-value < 0.001). Vancomycin-resistant enterococci were isolated during this decade with an increase of 18.7% by 2008. These data confirm the worldwide trend in multidrug bacterial resistance. © 2013 Elsevier Editora Ltda.


Yapicioglu H.,Cukurova University | Ozcan K.,Cukurova University | Mutlu B.,Cukurova University | Satar M.,Cukurova University | And 2 more authors.
Journal of Tropical Pediatrics | Year: 2011

In this study, we have prospectively recorded healthcare-associated infections (HAIs) in NICU and found incidence density as 18 infections per 1000 patient days. Of the infections, 51.3% was bacteriemia (BSI), and 45.1% was ventilator-associated pneumonia (VAP). Gram-negative microorganisms were predominant in VAP and Staphylococcus epidermidis was the leading microorganism (53.0% of BSIs) in BSIs. Multivariate logistic regression analysis showed the importance of hood O2 use in days (RR: 1.3) and total parenteral nutrition use in days (RR: 1.09) for BSIs. Umbilical arterial catheterization in days (RR: 1.94), ventilator use in days (RR: 1.05), chest tube (RR: 12.55), orogastric feeding (RR: 3.32) and total parenteral nutrition in days (RR: 1.05) were found to be significantly associated with VAP. In conclusion, incidence density in our unit is high and Gram-negative rods are predominant similar to developing countries. These results strongly suggest improving measures of prevention and control of HAIs in the unit. © The Author [2010]. Published by Oxford University Press. All rights reserved.


Jacoby T.S.,Federal University of Rio Grande do Sul | Kuchenbecker R.S.,Hospital Infection Control Committee | dos Santos R.P.,Hospital Infection Control Committee | Magedanz L.,Federal University of Rio Grande do Sul | And 3 more authors.
Journal of Hospital Infection | Year: 2010

We performed a 30-month ecological study to determine the impact of hospital-wide antibiotic consumption, invasive procedure use and hospital-acquired infections (HAIs) on antibiotic resistance in an intensive care unit (ICU). Microbiological isolates from ICU patients with established diagnosis of hospital infection were monitored throughout the study. Overall hospital consumption per 100 patient-days of piperacillin-tazobactam, fluoroquinolones and cephalosporins increased from 1.9 to 2.3 defined daily doses (DDD) (P<0.01), from 4.7 to 10.3 DDD (P<0.01) and from 12.1 to 16.4 DDD (P<0.01), respectively. Bacterial multiresistance in ICU was identified in 31.3% (N=466) of isolates, with increasing resistance demonstrated for meropenem-resistant Klebsiella spp. (P=0.01) and meropenem-resistant Acinetobacter spp. (P=0.02). There was a positive correlation between multiresistance rate and DDD of cephalosporins (P<0.01) and fluoroquinolones (P=0.03). The rate of ceftazidime-resistant Klebsiella spp. correlated with DDD of fluoroquinolones and cephalosporins; the rate of ceftazidime-resistant Pseudomonas spp. correlated with consumption of cephalosporins, and rate of meticillin-resistant Staphylococcus aureus (MRSA) correlated with fluoroquinolone use. During the studied period, 36.9% (P<0.001) and 34.5% (P<0.01) of the changing multiresistance rate in ICU was associated with use of invasive procedures and overall HAI rate, respectively. Multiresistance rates in ICU are influenced by the variation in overall HAI rate, hospital-wide invasive procedures and antibiotic consumption outside the ICU. © 2009 The Hospital Infection Society.


PubMed | Pontifical Catholic University of Goiás, Federal University of Paraiba, Federal University of Rio Grande do Sul, Pequeno Principe Hospital and 8 more.
Type: Journal Article | Journal: American journal of infection control | Year: 2016

Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals.This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology.The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals.This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

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