Navegando por Palavras-chave "infecção"

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    Aplicação da técnica de pcr em tempo real na identificação microbiana e detecção de genes de resistência a antimicrobianos em episódios de bacteremia de pacientes pediátricos com câncer
    (Universidade Federal de São Paulo (UNIFESP), 2014-04-11) Carlesse, Fabianne Altruda de Moraes Costa [UNIFESP]; Pignatari, Antonio Carlos Campos Pignatari [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Bloodstream infections (BSI) are major cause of infection-related mortality in patients with cancer. Phenotipic methods are utilized to detect and to identify pathogens in blood stream cultures but with slow time for positivity and final results. Molecular techniques have been utilized for a quick ethiologic diagnosis of blood stream infections allowing the institution of an early adequate therapy improving patients survival rates. Aim: To evaluate if the Real Time PCR method used to identify the main pathogens causing blood stream infections and some important antimicrobial resistance genes causing bloodstream infections could improve the early diagnosis and adequate therapy in oncology pediatric patients. Methods: During March 2010 to March 2012 we conducted a retrospective study at the Oncology Pediatric Institute (IOP-GRAACC-Brazil). The blood stream samples were incubated in the automated Bactec® system and the microbal identification and susceptibility tests were done in the automated Phoenix® system. We included 81 blood positive blood stream samples that were submitted to molecular analysis. Polimicrobial infections were excluded, 69 BSI were analysed in 64 patients. Samples from the blood stream bottles were submitted to molecular tests by Real Time PCR with specific Gram probes, 17 specific gender sequences and antimicrobial resistance genes blaSHV, blaTEM, blaCTX, blaKPC, blaIMP, blaSPM, blaVIM, vanA, vanB e mecA.The adequacy of the antimicrobial therapy was evaluated at the time of the Gram stain result from the positive blood bottle (time 1) and in the available final phenotypic result for the assistant physician (time 2). Results: Gram positive bacteria were identified in 61% of the samples, Gram negative bacteria in 32% and fungi in 7%. There was agreement in 82,6% for the initial Gram stain and 78,2% in the final species identification between the phenotipic and molecular methods. The mecA gene was detected in 81,4% of Staphylococcus spp, and was 91,6% concordant with the phenotypic method. Detection of vanA gene was 100% concordant. For Gram negative bacteria the concordance was 71,4% for Enterobacteriacea and 50% for Pseudomonas aeruginosa. Therapy was inadequate particularly in patients who died (5/6). The molecular tests was concordant in 50% of theses cases. Conclusion: Real Time PCR could be useful in the early identification of pathogens and antimicrobial resistance genes in bloodstream infections of pediatric oncologic patients and could contribute to improve the antimicrobial therapy.
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    Avaliação de um pacote de medidas para prevenção de pneumonia associada à ventilação mecânica em unidades de terapia intensiva de um hospital universitário
    (Universidade Federal de São Paulo (UNIFESP), 2014-08-31) Pereira, Elaine Cristina [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Ventilator-associated pneumonia (VAP) is the leading cause of infection in intensive care units (ICU) is associated with high mortality rates, longer hospital stay and higher costs. Among patients using mechanical ventilation around 10-20% develop this infection. There are simple steps that when applied together appear to be favorable in reducing rates of this infection. Objective: To evaluate the impact of a protocol for prevention of VAP incidence of this infection, mortality, duration of mechanical ventilation and length of hospital stay in two ICUs. Method: Patients admitted to the ICU of Pneumology and ICU of Cardiovascular Surgery (UPOCC) of a university hospital underwent a daily protocol for prevention of VAP between January 1 to December 31, 2011 In this protocol we evaluated the suitability of elevation bedside between 30th - 45th, cuff pressure above 20 cmH2O, exchange ventilatory circuit every seven days, no condensate in the ventilatory circuit, peptic ulcer prophylaxis, prophylaxis for deep venous thrombosis and awaken daily sedation. The information collected in 2011 were compared to information collected retrospectively in 2010 when there was no application of the Protocol. For statistical analysis statistical tests such as Pearson chi-square, Student's t test, considering a significance level of 5% and a confidence interval of 95% were used. Was also used Stata 12 program to calculate the density of incidence of pneumonia, with a confidence interval of 95%. Results: In the Pulmonary ICU decreased the duration of mechanical ventilation ranged from an average of 12 days in 2010 to 9.5 days in 2011 (p = 0.024). Although this unit was a reduction in the number of reintubations which in 2010 had a mean value of 15.1 episodes in 2011 and the value was 14.9 (p = 0.001). ICU of Pneumology there was a reduction in the incidence density, which ranged from 15.4%, with a total of 19 cases in 2010 to 9.3%, with a total of 10 cases in 2011 (p = 0.193) . In UPOCC was no reduction in length of hospital stay showed that on average 45 days in 2010 and 40 days in 2011 (p = 0.014). In UPOCC was no increase in incidence density which increased from 13.6% with a total of 16 cases in 2010 to 14.5% with a total of 10 cases in 2011 (p = 0.896). The adequacy in relation to the indicators obtained a value greater than 80% in at least five of the seven indicators, with XIX better performance presented by UPOCC. The ICU of Pneumology had a worse performance than the realization of awakening diary already UPOCC was less adequate in relation to the measurement of cuff pressure. Microorganisms found in two ICUs were similar between the pre-intervention period and intervention in both ICUs. Conclusion: Although we found no statistically significant difference in ICU Pulmonology showed a lower value in the incidence density of VAP in the year in which the protocol was applied. The period of application of the Protocol statistically significant difference in ICU of pulmonology in relation to shorter mechanical ventilation, and reducing episodes of reintubation was observed. The UPOCC showed a reduction in hospital stay. We observe a good fit to the protocol in two ICUs studied. Studies with a longer period of time are needed to confirm the usefulness of prevention protocols in reducing VAP.
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    Estudo comparativo do uso de drenos de secção e pontos de tensão progressiva na prevenção de seromas e infecções de ferida operatória após correção cirúrgica de hérnias incisionais volumosasEnsaio clínico randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2014-02-26) Westphalen, Andre Pereira [UNIFESP]; Lopes Filho, Gaspar de Jesus Lopes Filho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To carry out a comparative study between the use of tubular drains in closed suction system and the use of progressive tension sutures in patients with large incisional hernias, undergoing hernia repair with onlay positioned mesh, in order to evaluate the post operative seromas and wound infection as endpoints. Methods: From May to December 2012, forty two patients with incisional hernias (5 -15 cm length) underwent surgical repair with onlay placement of mesh as described by Chevrel, at Western Parana University Hospital. After mesh placement, patients were electronically randomized in two groups. In group I, closed suction subcutaneous drains were used in the patients. In group II, progressive tension stitches were used, as described by Pollock. Patients were clinically evaluated regarding seromas and wound infection during the first 30 days after surgery. Ultrasound of abdominal wall was used in the following periods: 4 -6 postoperative days (early period), 14 – 15 postoperative days (intermediary period) and 29 – 30 postoperative days (late period) to evaluate seroma formation. Results: Both groups were similar in regard to gender, age, body mass index, smoking, cardiologic risk factors, serum albumin levels, hernia size, subcutaneous thickness, hernia defect area, surgical time and seroma incidence in the early, intermediary or late periods. The highest incidence of seromas detected by ultrasound was in the intermediary period (52.4%), although 33.4% were clinically detectable. There was no statistical difference among incidences of seroma in non period between the studied groups. Wound infection rate in nine patients was 21.4%. There was no statistical difference in wound infection between the studied groups. The results of univariate tests have shown that the presence of infection on the 30th postoperative day was not associated to the use of drain or progressive tension sutures. Conclusion: There was no significant difference in incidence of seromas, either detected clinically or by ultrasound, as well as in wound infection incidence between the groups using closed suction subcutaneous drains or progressive tension sutures, in patients undergoing large incisional hernia repair using onlay technique.
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    Incidência de antigenemia positiva para citomegalovírus em pacientes com doenças reumáticas autoimunes: um estudo retrospectivo de três anos em ambiente hospitalar
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Santos, Rebeka Paulo [UNIFESP]; Pinheiro, Marcelo de Medeiros Pinheiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Determinar a incidência de antigenemia positiva para CMV e descrever o perfil clínico e laboratorial de pacientes com doenças reumáticas autoimunes (DRAI) internados em um hospital terciário da cidade de São Paulo/SP, bem como os locais de acometimento da infecção viral e identificar os principais fatores de risco para o óbito. Pacientes e Métodos: Foram incluídos nesse estudo retrospectivo todos os pacientes internados em um hospital terciário da cidade de São Paulo/SP, de 01 de janeiro de 2011 a 31 de dezembro de 2014, com diagnóstico de DRAI e antigenemia positiva para o CMV. Foram documentados dados clínicos e laboratoriais, incluindo a evolução, comorbidades, terapêutica instituída e desfechos de cada paciente. A infecção pelo CMV foi definida pela antigenemia (Ag) positiva para, pelo menos, uma célula. Resultados: Um total de 443 pacientes com DRAI foram internados no período do estudo. A Ag para CMV foi solicitada em 70 deles, sendo positiva em 24 (34,3%), com incidência de Ag positiva para CMV de 4,97% (IC 95% 3,1%-7,4%). O lúpus eritematoso sistêmico (LES) (59%), sobretudo o de início recente (53,8% com menos de 12 meses de doença), seguido pelas vasculites ANCA associadas (18,2%) e artrite reumatoide (9%) foram as doenças que mais se associaram com a presença de Ag positiva para o CMV. No momento da infecção, os pacientes com LES apresentavam atividade de doença de moderada a grave, com elevada frequência do anticorpo anti-dsDNA positivo (69,2%) e consumo de complemento (61,5%), além de estarem em uso de elevadas doses de glicocorticoesteroides e outros imunossupressores. Os principais sítios de envolvimento pelo CMV foram pulmão (45,5%), sistema hematopoiético (citopenias) (40,9%) e trato gastrointestinal (27,3%). Quinze (68,2%) pacientes foram tratados com ganciclovir e, de modo interessante, aqueles tratados apresentaram tendência a maior número de núcleos positivos na Ag do que aqueles não tratados durante a evolução [16 (1-500) vs. 1 (1-4) p=0,05]. A mortalidade foi de 45,5%, mas sem diferença estatística quanto à idade, média dos números de núcleos positivos, sítio de acometimento viral, tempo de sintomas até a solicitação da primeira antigenemia, realização de pulsoterapia nos últimos seis meses e uso de ganciclovir entre pacientes que sobreviveram ou foram a óbito. Houve tendência a maior dose de corticosteroide oral (107±55,4 vs. 71,7±46,3; p=0,069) e a menor número absoluto de linfócitos no sangue periférico dos pacientes que foram a óbito (309±368,2/?l vs. 821±692,9/?l; p=0,059). Na análise univariada, o maior tempo de internação se associou a menor chance de morte [OR 0,957 (0,915-0,999); p=0,048)]. Conclusão: Nossos dados mostraram elevada incidência de Ag para o CMV em pacientes com DRAI em ambiente hospitalar, particularmente naqueles com LES e associação com maior gravidade da doença e maior mortalidade. Assim, a possibilidade de CMV deve ser incluída no diagnóstico diferencial de causas de infecção em pacientes com DRAI.
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    Medidas gerais no tratamento das doenças falciformes
    (Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2007-09-01) Braga, Josefina Aparecida Pellegrini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This article presents the most important measures in the care of patients with sickle cell disease, which is characterized by a high morbimortality rate. Effective preventive measures including newborn screening, education of patients and caregivers, nutrition support, protective vaccinations and prophylaxis using penicillin to prevent pneumococcal, contribute to a decrease in the morbimortality as well as to improve the quality of life of these patients.