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- ItemSomente MetadadadosAvaliação Da Colonização Por Bactérias Multirresistentes Em Pacientes Submetidos A Hemodiálise Crônica Ambulatorial(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Manfredi, Silvia Regina [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introdution: Infection Is The Leading Cause Of Morbidity And The Second Leading Cause Of Mortality In Patients With Chronic Kidney Disease. Factors Such As Immunosuppression, Presence Of Comorbidities, Use Of Central Venous Catheters For Prolonged Periods, The Environment Shared By Different Individuals Simultaneously, Device Manipulation And Care Practices Contribute To The Risk Of The Occurrence Of Infectious Events. Multidrug Resistant Bacterial Colonization (Mdr) Is A Worldwide Public Health Problem Because It Increases The Risk Of Infection And Contributes Significantly To The Spread Of Antimicrobial Resistance In Health Care Settings. Among Chronic Renal Patients On Hemodialysis, The Risk For Acquisition And Dissemination Of These Bacteria Is Higher And The Surveillance Culture Is Recommended As A Component Of Infection Control Programs. Objective: The Objective Of This Study Was To Evaluate Colonization By Multiresistant Bacteria In Chronic Hemodialysis Outpatients Material And Methods: In This Study W
- ItemSomente MetadadadosClonal spread of carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit(W B Saunders Co Ltd, 2018) Maciel, W. G.; da Silva, K. E.; Croda, J.; Cayo, Rodrigo [UNIFESP]; Ramos, Ana Carolina [UNIFESP]; de Sales, R. O.; de Almeida de Souza, G. H.; Bampi, J. V. B.; Limiere, L. C.; Casagrande, J. C.; Gales, Ana Cristina [UNIFESP]; Simionatto, S.Acinetobacter baumannii has often been associated with colonization and/or infection in neonatal intensive care units (NICU). This study describes a clonal spread of carbapenem-resistant A. baumannii (CRAB) isolates in an NICU. In total, 21 CRAB isolates were collected from premature newborns. Only polymyxin B was active against such isolates. Nineteen CRAB isolates were clonally related (Cluster C, which belonged to worldwide-disseminated ST1). All newborns had peripheral access and had received beta-lactam therapy previously. The implementation of strict infection control measures was of fundamental importance to eradicate the clonal type in the study hospital. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
- ItemAcesso aberto (Open Access)Colonização nasofaríngea pelo Streptococcus pneumoniae em crianças portadoras de doença falciforme imunizadas com a vacina pneumocócica conjugada 7-valente(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Fonseca, Patricia Belintani Blum [UNIFESP]; Farhat, Calil Kairalla [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To assess the prevalence of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease using prophylactic penicillin and immunized with 7-valent pneumococcal conjugate vaccine; to identify risk factors for nasopharyngeal colonization; to assess the resistance profile to penicillin and other antimicrobials and to determine the most frequent serotypes in the nasopharyngeal isolates in children with sickle cell disease and in children from the control group. Methodology: Cross-sectional case-control study. A total of 424 swabs were collected from the nasopharynx in 216 children with sickle cell disease and 109 samples from the control group, both in the age range of 2 to 60 months, in the period between 11/06/2007 and 11/28/2008. Isolation and identification of pneumococcus followed standard procedures. Minimum inhibitory concentration (MIC) for penicillin and ceftriaxone were determined by the E-test method and interpreted according to CLSI 2008 criteria. Serotyping was performed by the Neufeld-Quellung reaction and by Imuno- blot. Results: Prevalence of nasopharyngeal colonization by pneumococcus in the 216 children with sickle cell disease was 17%, and 11% in the control group. The risk factors for increased colonization in children with sickle cell disease were the presence of more than five people in home (p=0.004), daycare/school attendance (p= 0.003) and low prophylaxis compliance (p=0,007). The prevalence of strains with penicillin resistance was 57.5% in patients with sickle cell disease and 25% in the control group, and in regard to ceftriaxone it was 15% and 16.7% respectively. There were no strains resistant to levofloxacin and vancomycin. The most frequently isolated serotype in both groups was NT (strains without polysaccharide capsule). Vaccine serotypes 6B, 14, 19F and 23F were isolated from five colonized children with sickle cell disease (13,5%), four of them with complete immunization for their age. Conclusions: Prevalence of nasopharyngeal colonization by pneumococcus was similar among the groups; although the penicillin prophylaxis decrease colonization, the high prevalence of strains resistant to penicillin among sickle cell disease patients may have been responsible for the similarity in the colonization rate. Prophylactic use of penicillin favored the increased prevalence of resistant strains. Since in the control group the most prevalent strain was also NT, it was not possible to verify the vaccine’s efficacy in decreasing the colonization by the vaccine serotypes.
- ItemSomente MetadadadosRisk factors for enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients(Wiley-Blackwell, 2010-12-01) Mikulska, Malgorzata; Del Bono, V.; Prinapori, R.; Boni, L.; Raiola, A. M.; Gualandi, F.; Van Lint, Maria Teresa; Dominietto, A.; Lamparelli, T.; Cappellano, Paola [UNIFESP]; Bacigalupo, Andrea; Viscoli, Claudio; San Martino Univ Hosp; Ist Toscano AOU Tumori Careggi; Universidade Federal de São Paulo (UNIFESP)P>Bacteremia is a well known cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients and enterococci are among the most frequently isolated pathogens. the aim of this study was to identify risk factors for enterococcal bacteremia during the first 30 days after allogeneic HSCT. A retrospective case-control study was performed; for each case, 3 controls were randomly selected among 306 patients transplanted during the study period (January 1, 2004 to December 31, 2007). Odds ratios (OR) with 95% confidence intervals (CI) were calculated for variables influencing the risk for bacteremia. Overall, 33 patients developed enterococcal bacteremia, within a median of 9 days after HSCT (range, 2-24). the cumulative incidence was 10.8%. Multivariate analysis identified the following variables as risk factors for enterococcal bacteremia: donor and transplant type (greater risk for mismatched related or cord blood) (OR=8.98, 95% CI, 1.65-48.99 and OR=7.52, 95% CI, 1.56-36.31, respectively, P=0.047); severe (grades 3-4) mucositis (OR=9.04, 95% CI, 1.97-41.52, P=0.018); pharyngeal enterococcal colonization (OR=4.48, 95% CI, 1.11-18.03, P=0.035); and previous empirical therapy with cephalosporins (OR=4.16, 95% CI, 0.93-18.66 for 1-7 days of therapy, and OR=7.31, 95% CI, 1.78-30.12 for 8-23 days, P=0.018). Higher Karnofsky score (>= 50) and previous empirical therapy with glycopeptides were associated with a decreased risk (OR=0.25, 95% CI, 0.06-0.97, P=0.045 and OR=0.11, 95% CI, 0.02-0.59, P=0.010, respectively). the crude mortality at 7 and 30 days was 12% (4/33) and 24% (8/33), respectively. Enterococcal bacteremia is frequent after allogeneic HSCT. the factors associated with this infection are type of transplant, pharyngeal colonization, severe mucositis, and use of cephalosporins. Good general conditions and the use of vancomycin were associated with lower risk of enterococcal bacteremia.
- ItemAcesso aberto (Open Access)Screening and treatment for Staphylococcus aureus in patients undergoing hemodialysis: a systematic review and meta-analysis(Biomed Central Ltd, 2014-12-18) Grothe, Cibele [UNIFESP]; Taminato, Monica [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: This study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.Methods: A systematic review and meta-analysis were performed. the literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. the descriptors were Staphylococcus aureus, MRSA, MSSA, treatment, decolonization, nasal carrier, colonization, chronic kidney disease, dialysis, and haemodialysis or hemodialysis. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of > 0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). the outcomes were skin infection at the central venous catheter insertion site and bacteremia.Results: in total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. the probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05-0.34; p < 0.001). the risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08-0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51-1.15; p = 0.20).Conclusions: Twenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.
- ItemSomente MetadadadosSecond-generation central venous catheter in the prevention of bloodstream infection: a systematic review(Soc Brasil Pediatria, 2016) Dorociaki Stocco, Janislei Gislei; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida [UNIFESP]; Meier, Marineli JoaquimObjective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL