Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital
| Autor: | Maria Luiza Moretti, Mirtes Loeschner Leichsenring, Plínio Trabasso, Renata Fagnani, Sônia Regina Pérez Evangelista Dantas, Carlos Emílio Levy, Luis Gustavo de Oliveira Cardoso, Flávia Alves Ferreira Rossini |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine Adolescent lcsh:RC955-962 Epidemiology medicine.medical_treatment Attack rate Psychological intervention Infection control Hospitals University Young Adult Risk Factors Intensive care Internal medicine medicine Humans Resistência à vancomicina Child Epidemiologia Disease outbreaks Aged Retrospective Studies Aged 80 and over Mechanical ventilation Cross Infection Infection Control business.industry Controle de infecção Outbreak Vancomycin Resistance Middle Aged biochemical phenomena metabolism and nutrition Surtos Ciprofloxacin Metronidazole Infectious Diseases Vancomycin Female Parasitology Vancomycin resistance business Brazil Enterococcus Program Evaluation medicine.drug |
| Zdroj: | Revista da Sociedade Brasileira de Medicina Tropical, Volume: 45, Issue: 2, Pages: 184-188, Published: APR 2012 Revista da Sociedade Brasileira de Medicina Tropical, Vol 45, Iss 2, Pp 184-188 (2012) Revista da Sociedade Brasileira de Medicina Tropical v.45 n.2 2012 Revista da Sociedade Brasileira de Medicina Tropical Sociedade Brasileira de Medicina Tropical (SBMT) instacron:SBMT |
| Popis: | INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE. INTRODUÇÃO: Enterococos resistentes a vancomicina (ERV) podem colonizar e causar infecção em pacientes de alto risco, bem como contaminar o ambiente. Nosso objetivo foi descrever a investigação epidemiológica de um surto de ERV, as intervenções realizadas e o impacto no controle do surto. MÉTODOS: Estudo retrospectivo, descritivo, por revisão de prontuários de pacientes com cultura positiva para ERV em um hospital geral, público, universitário, admitidos entre fevereiro de 2008 e janeiro de 2009. As intervenções foram divididas em ações educacionais, revisão de processos de trabalho, medidas administrativas e de engenharia. RESULTADOS: Foram avaliados 150 pacientes, 139 (92,7%) colonizados e 11 (7,3%) infectados por ERV. Setenta e três por cento estavam internados em unidades de cuidados não intensivos (p=0,028). Infecção por ERV foi mais frequente em pacientes usando cateter venoso central (p=0,043), ventilação mecânica (p=0,013), cateter urinário (p=0,049) ou drenos cirúrgicos (p=0,049). Vancomicina, metronidazol, ciprofloxacina ou cefalosporina de terceira geração foram utilizados previamente por 47 (31,3%), 31 (20,7%), 24 (16%) e 24 (16%) pacientes, respectivamente. Óbito foi mais frequente em pacientes infectados por ERV (73%) em relação aos colonizados (17%) (p |
| Databáze: | OpenAIRE |
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