Nosocomialinfection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomialinfection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomialinfection and mortality and pediatrics/neonate/newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomialinfection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE) II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomialinfection can be reduced and health care quality improved in pediatric hospitals.
The growing complexity of intensive care during recent decades has been accompanied by increased risk of nosocomialinfection (NI) [1-9]. Patients with multiple traumas have increased survival, and several factors increased risk of NI too [10-12]. The interaction between victims of trauma and intensive care unit (ICU) is considered additive for morbidity, mortality, hospital days, and economic burden for both patient and hospital [13-22]. The objective of this study was to identify risk factors for NI in ICU.
Objective: To Identify through the literature review the strategies used by the epidemiological surveillance for prevention and control of nosocomial infections. Method: Literature review in Lilacs and Bdenf databases included in the last five years of full-text articles in portuguese, english or spanish, which were related with epidemiological surveillance, hospital infection and prevention/control. Results: The epidemiology is characterized by the observation of the risk factors that contribute to the apperance of the infections in order to provide information for intervention and control measures and make us think about the practice in health. Conclusion: Epidemiological surveillance is the facilitator of the health-disease process, because identifies the links of chain infection transmission to guide the implementation of control measures. Descriptors: Epidemilogic surveillance, Nosocomialinfection, Prevention and control.
Objective: Determine the rate and outcome of nosocomialinfection (NI) in pediatric intensive care unit patients in a developing country. Design: Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomialinfection and NNISS (National NosocomialInfection Surveillance System) methodology. Setting: São Paulo Hospital – Universidade Federal de São Paulo – Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. Participants: All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. Results: The NI incidence was 18.3% and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6%), followed by bloodstream infections (17.3%), and surgical site infection (17.3%). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8%), followed by Gram-positive bacterias (23.8%), and yeasts. Conclusion: Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population. Key Words: Nosocomial infections, pediatric ICU, pneumonia.
In Brazil, only in recent years there has been concern by the authorities on this topic, evidenced by taking important steps such as the enactment of laws and ordinances regulating the measures that must be implemented for the control and prevention of HI as well as investments in training professionals for the use of SP which is understood as strategies with the intent of reducing risks of complications related to nosocomialinfection in the daily work of health professionals. Thus, such measures include hand hygiene, use of gloves, apron, goggles, masks, proper disposal of needle stick, are fundamental to the control and prevention of HI. 6,13
Infection surveillance was consistently conducted according to the National NosocomialInfection Surveillance System (NNIS/CDC/Atlanta) definitions, which consider all neonatal infections, whether acquired during delivery or during hospitalization, as nosocomial, unless evidence indicates transplacental acquisition [11,12]. Bloodstream infections were considered as clinical sepsis when clinical and laboratory findings of infection were present, without positive cultures, and as confirmed when positive cultures were also present. Catheter related bloodstream infection was defined as the isolation of the same microbe from blood cultures that is shown to be significantly colonizing the catheter of a patient with clinical features of bloodstream infection in the absence of any other local infection caused by the same microbe that could have given rise to bloodstream infection . Nosocomial pneumonia required new sputum production, progressive new infiltrate not present on admission chest radiograph accompanied by respiratory failure and laboratory evidence of infection. Surgical site infections was diagnosed on the basis of one of the following: purulent drainage from incision site or from a drain; positive result from a culture of fluid obtained from a surgical site closed primarily; the surgeon’s or attending physician’s diagnosis of infection; or the surgical site requires reopening.
of harm to the patient and own professional.5 Asepsis of the chosen puncture location towards the venous return is another important point, because taking care of asepsis and antisepsis during the procedure, the risks for opening an access to sterile body tissues by an invasive procedure become is less dangerous for a possible nosocomialinfection.² In addition to the correct technique, the efficacy of antiseptic used is of great importance.
5. Pollock E., Ford-Jones E.L., Corey M., et al. Use of the pediatric risk of mortality score to predict nosocomialinfection in a pediatric intensive care unit. Crit Care Med 1991;19(2):160-5. 6. Singh-Naz N., Sprague B.M., Patel K.M., Pollack M.M. Risk factors for nosocomialinfection in critically ill children: a prospective cohort study. Crit Care Med 1996;24(5)875-8.
Results: A total of 1311 patients were analyzed, with a mean age of 83.2. Of the patients’ sample, 33.6% were autono- mous, 32.6% were partially dependent and 33.7% were total- ly dependent. Nosocomialinfection was observed in 10.6% of patients. There was a statistically significant association between the dependence level and the nosocomial infec- tions acquisition, as well as between the presence of noso- comial infection and mortality, and readmission after 30 days. The dependence level was also significantly associated with days of hospitalization, with mortality and with readmission. Discussion and Conclusion: This study revealed that noso- comial infection development was superior in patients with a greater dependence level as well as the mortality, which was also higher in this subgroup of patients. In this way, the loss of autonomy should be considered as a predisposing potential for acquisition of infection.
ABSTRACT - Our aim was to study the fauna of ants in the Hospital Universitário of the Universidade Federal do Triângulo Mineiro, municipality of Uberaba, Minas Gerais State, Brazil, as well as to identify the microorganisms the ants carry and their patterns of resistance to antibiotics. Sterile tubes (traps) containing honey were used to attract the ants. Traps were exposed for 3h, and those which attracted ants were considered the test group, while the ones that did not attract the insects constituted the control group. Only the ant species Tapinoma melanocephalum (Fabricius) was sampled. Sixty microorganisms were isolated from the sampled ants, including seven Gram-positive bacilli, 14 Gram-negative bacilli, 22 Gram- positive cocci and 17 filamentous fungi. Pseudomonas, Staphylococcus and Group D Streptococcus were the microorganisms with the highest resistance to the tested antibiotics. The ants should be considered an important vector of infections as they carry several pathogenic microorganisms, spreading them on the surface of sterile materials, equipments and uncontaminated food. It is impossible to define the exact role of ants in nosocomial infections at this moment; however, this issue must be better studied and special attention must be given by the commissions of NosocomialInfection Control.
presence of more than 10% immature neutrophils. The clinical condition of each patient with CDAD was classified daily as SIRS, sepsis, severe sepsis or septic shock using criteria previously published by the American Col- lege of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) . Sepsis was defined as SIRS associated with C. difficile-associated diarrhea. Sepsis associated with organ dysfunction, hypotension or systemic manifesta- tions of hypoperfusion constituted severe sepsis. Septic shock was defined as sepsis associated with hypotension unresponsive to intravenous fluid challenge or the need for a vasopressor agent. The presence of organ system fail- ure was assessed using the criteria described by Fagon . Nosocomialinfection was defined as an infection that occurred >48 hours after hospital admission, an infection that occurred <48 hours after admission to the hospital in patients that had been hospitalized in the 3 weeks prior to the admission, or an infection that occurred <48 hours after admission to the hospital in patients that had been transferred from another hospital or nursing home . Treatment for CDAD was defined as the receipt of metronidazole at a dosage of 250 mg 4 times per day or 500 mg 3 times per day for 10–14 days, or oral vancomycin 125 mg 4 times per day for the same duration.
A limitation of this study is that more complete clinical data were not available. As data on central line days were not available, the incidence rate of CLAB per 1,000 central line days could not be estimated and benchmarked against other prospective studies [30–47]. As data on process surveillance were not available, the reasons for the increased incidence of HAB could not be systematically assessed [32,41,48,49]. Another potential limitation is that blood cultures may not have been performed for all patients with a likelihood of nosocomialinfection, and this might lead to an underestimation in the incidence of HAB and HCAB among participating hospitals. In addition, data on hospitalization in other hospitals not participating in the study (for example, a district hospital or a private hospital in the province) were not available, which could have resulted in an underestimation of the incidence of HAB and HCAB in our study. It is also possible that some patients with HAB and HCAB in our study may have had contaminated cultures and were incorrectly counted. However, the high mortality in patients with HAB and HCAB suggested that true infection was more likely than culture contamination. Although our data showed that, in general, patients with HAB and HCAB stayed in the hospital longer than those without, the analysis did not take account of the high mortality associated with HAB and HCAB. The length of stay would be further extended if death of patients with HAB and HCAB could be reduced. Additional costs and extra length of stay attributable to HAB and HCAB will be further evaluated using health economic models [50,51].
24.1%, which is closer to the rate in the present study (33.8%). It is extremely difficult to establish the role that nosocomialinfection has on the death of a neonate who is admitted to a NICU. Infants are vulnerable to many complications from their initial condition, and several coexisting factors can contribute to undesirable outcomes.
Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are among the most important nosocomial pathogens in patients from neonatal intensive care units, mainly in bloodstream infections. The main objective of this study is to determine the occurrence of nosocomial infections by these microorganisms using two surveillance systems (Laboratorial Surveillance and National NosocomialInfection Surveillance System) and to determine the most important risk factors during a two-year period (2001-2002). Two outbreaks by both methicillin susceptible S. aureus (MSSA) (1.5%) and methicillin resistant CoNS (MRCoNS) (1.0%) were observed, from January to February/02 and August to September/02. Endemic incidence rates of 3.77% and 5.16% of S. aureus and CoNS, respectively were detected. Risk factors included age ≤7 days, hospitalization ≥7 days and utilization of polietilene central vascular catheter (CVC) through vein dissection (phlebotomy), but none of these independent factors were confirmed by the multivariate analysis. However, oxacillin resistant CoNS prevailed (66.0%) in the epidemic episodes. Molecular analysis by pulsed field gel electrophoresis showed the polyclonal nature of S. aureus isolates. In conclusion, two outbreaks were identified of mixed etiology by MSSA and MRCoNS associated to the lack of an adequate material (central venous catheter) for neonates, related invasive procedure. The outbreaks were controlled with the substitution of polietilene CVC for peripherally inserted central catheter.
Os critérios de elegibilidade finais, tanto de inclusão como de exclusão no estudo, foram cumpridos por 155 casos. No geral, a prevalência de infeções associadas aos cuidados de saúde (prevalência conjunta em estudos de alta qualidade, de 10,5 por 100 pacientes [95% CI 6,1-14,9]) foi maior do que nos EUA e na Europa. Mas a prevalência no hospital chinês (prevalência de pacientes infetados, 1,97 por 100 pacientes) é ainda menor do que o valor mí nimo de um estudo oficial em paí ses europeus. Assim, no geral, a taxa de prevalência de infeções associadas aos cuidados de saúde nos paí ses em desenvolvimento é superior à dos paí ses desenvolvidos. Uma vez que a diferença entre as taxas de prevalência anual, analisando os três casos, foi estatisticamente significativa no caso do hospital chinês, concluí mos que a taxa de prevalência diminuiu ao longo do tempo. A maior prevalência de infeções associadas aos cuidados de saúde apresenta-se em pacientes cujo tempo de internamento excede o valor médio, sendo assim melhor encurtar razoavelmente o dia de internamento para prevenir infeções associadas aos cuidados de saúde. As abordagens aplicadas pelo International NosocomialInfection Control Consortium (INICC) no controlo multidimensional das infeções têm um efeito de intervenção bem-sucedido.
This prospective study aimed to determine the nosocomialinfection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fisher’s test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.
Os resultados desta pesquisa sugerem que a cavida- de bucal de pacientes internados em UTI pode servir como importante reservatório para patógenos respira- tórios associados à pneumonia nosocomial. Estes da- dos propõem uma nova visão em que procedimentos especíicos para o controle destes patógenos na ca- vidade oral devem ser considerados na prevenção de pneumonia nosocomial, especialmente em pacientes de UTI.