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Search Results: 1 - 10 of 189429 matches for " Eduardo Alexandrino Servolo de; "
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Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units
Bicudo, Daniela;Batista, Ruth;Furtado, Guilherme Henrique;Sola, Angela;Medeiros, Eduardo Alexandrino Servolo de;
Brazilian Journal of Infectious Diseases , 2011, DOI: 10.1590/S1413-86702011000400005
Abstract: introduction: central venous catheters (cvc) are devices of great importance in health care. the advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (bsi). in spite of its importance, few national studies have addressed this issue. objective: the aim this study was to determine the incidence of bsi in patients with cvc, hospitalized in icu, as well as the variables associated with this complication. methods: multicentric cohort study carried out at icus of three hospitals at universidade federal de s?o paulo complex. results: a total of 118 cases of bsi in 11.546 catheters day were observed: 10.22 bsi per 1,000 catheters day. on average, bsi was associated to seven additional days of hospital stay in our study (p < 0.001), with a significant difference between types of catheters. concerning the place of insertion, there was no statistical difference in bsi rates. conclusion: we concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001). the median duration of catheter use was 14 days among patients with bsi and 9 days in patients without infection (p < 0.001). there was higher prevalence of gram-negative infections. the risk factors for bsi were utilization of multiple-lumen catheters, duration of catheterization and icu length of stay.
Risk factors for surgical-site infection after cardiac surgery
Fermina Mendon?a Borges,Renato Satovschi Grinbaum,Jacyr Pasternak,Eduardo Alexandrino Servolo de Medeiros
Einstein (S?o Paulo) , 2005,
Abstract: Objective: Surgical site infection is a serious complication inpatients undergoing heart surgery because in addition to highmorbitity rates, length of hospital stay and hospital costs areincreased. This study aims to identify pre-, peri- and postoperativerisk factors related to surgical-site infection after cardiac surgery.Methods: The study comprised 1053 patients undergoing cardiacsurgery, with sternotomy, performed consecutively, between June1 and October 31, 1999, by three cardiac surgery teams. Therecommendations of the Centers for Disease Control and Preventionwere followed for surgical site infection diagnosis and classification.Sixteen pre-, peri- and postoperative risk factors and the presenceof surgical site infection in the chest area were evaluated byunivariate analysis followed by logistic regression analysis. Apost-surgery surgical site surveillance was performed by meansof a questionnaire and either personal or telephone contact withthe patients. Results: The incidence of surgical site infection was4.18% (44 cases); in that, 2.85% (30) were superficial, 0.95% (10)deep and 0.38% (4) mediastinitis. Diagnosis of 56.80% was madefollowing hospital discharge. Staphylococcus was the mostfrequent microorganism in the surgical site infection (57%). Amongthe risk factors analyzed, the surgeries performed by the A(p=0.020) and B (p=0.020) medical teams remained independentrisk factors in the development of surgical site infections.Conclusions: In the population studied, the incidence was small,particularly of deep surgical site infection and mediastinitis; postdischargesurveillance made a major impact on diagnosis andincidence; and the major risk factors in the development of surgicalsite infection were the surgeries performed by the A and B medicalteams, most likely because of their intraoperative surgicaltechniques.
Treatment of adults with community-acquired respiratory tract infections: results of a multicentric clinical trial with gatifloxacin
Medeiros, Eduardo Alexandrino Servolo;
Brazilian Journal of Infectious Diseases , 2002, DOI: 10.1590/S1413-86702002000400001
Abstract: respiratory tract infections have an important clinical and economic impact and they are the most common indication for antibiotic use in outpatient practice. this prospective, multicenter non-controlled trial assessed the efficacy and safety of gatifloxacin in the treatment of community-acquired respiratory tract infections. patients were treated with a daily oral dose of gatifloxacin 400 mg for 7-14 days. the diagnosis of respiratory infection was made based on the clinical condition and/or radiologic findings. a total of 5,044 adult patients with community-acquired respiratory infections was treated with gatifloxacin in different centers in brazil between march 1, 2001, and october 31, 2001. among the 5,044 patients treated, 1,501 patients (29.76%) had community-acquired pneumonia, 756 (14.99%) had acute exacerbation of chronic bronchitis and 2,787 (55.25%) had acute sinusitis. of the total of patients treated, 3,607 (71.51%) were considered cured, 1,261 (25%) progressed with some clinical improvement, 28 (0.56%) presented a relapse, 56 (1.11%) failed to treatment and 92 (1.82%) were unable to be evaluated. adverse events were described in 634 (12.57%) patients. the most common adverse events were: nausea (2.24%); dyspepsia (1.86%); diarrhea (0.79%); change in taste (0.46%); insomnia and irritability (0.22%); dizziness (0.77%); headache (0.42%); allergic reaction (0.18%); central nervous system alterations - insomnia, agitation, anxiety - (0.46%). this study showed that the treatment of respiratory tract infections with gatifloxacin was safe and efficient and had a low incidence of adverse events.
Treatment of adults with community-acquired respiratory tract infections: results of a multicentric clinical trial with gatifloxacin
Medeiros Eduardo Alexandrino Servolo
Brazilian Journal of Infectious Diseases , 2002,
Abstract: Respiratory tract infections have an important clinical and economic impact and they are the most common indication for antibiotic use in outpatient practice. This prospective, multicenter non-controlled trial assessed the efficacy and safety of gatifloxacin in the treatment of community-acquired respiratory tract infections. Patients were treated with a daily oral dose of gatifloxacin 400 mg for 7-14 days. The diagnosis of respiratory infection was made based on the clinical condition and/or radiologic findings. A total of 5,044 adult patients with community-acquired respiratory infections was treated with gatifloxacin in different centers in Brazil between March 1, 2001, and October 31, 2001. Among the 5,044 patients treated, 1,501 patients (29.76%) had community-acquired pneumonia, 756 (14.99%) had acute exacerbation of chronic bronchitis and 2,787 (55.25%) had acute sinusitis. Of the total of patients treated, 3,607 (71.51%) were considered cured, 1,261 (25%) progressed with some clinical improvement, 28 (0.56%) presented a relapse, 56 (1.11%) failed to treatment and 92 (1.82%) were unable to be evaluated. Adverse events were described in 634 (12.57%) patients. The most common adverse events were: nausea (2.24%); dyspepsia (1.86%); diarrhea (0.79%); change in taste (0.46%); insomnia and irritability (0.22%); dizziness (0.77%); headache (0.42%); allergic reaction (0.18%); Central Nervous System alterations - insomnia, agitation, anxiety - (0.46%). This study showed that the treatment of respiratory tract infections with gatifloxacin was safe and efficient and had a low incidence of adverse events.
Prevalence and clinical outcomes of episodes of ventilator-associated pneumonia caused by SPM-1-producing and non-producing imipenem-resistant Pseudomonas aeruginosa
Furtado, Guilherme Henrique Campos;Gales, Ana Cristina;Perdiz, Luciana Baria;Santos, Anderson Fernandes;Medeiros, Eduardo Alexandrino Servolo de;
Revista da Sociedade Brasileira de Medicina Tropical , 2011, DOI: 10.1590/S0037-86822011000500015
Abstract: introduction: pseudomonas aeruginosa is a leading cause of ventilator-associated pneumonia (vap) and exhibits high rates of resistance to several antimicrobial drugs. the carbapenens are usually the drugs of choice against this microorganism. however, the carbapenem resistance has increased among these strains worldwide. the presence of metallo-β-lactamases (mbl) has been pointed out as a major mechanism of resistance among these strains. no previous study addressed outcomes of respiratory infections caused by these strains. methods: our group sought to analyze the epidemiology and clinical outcomes of patients with vap caused by imipenem-resistant p. aeruginosa. a total of 29 clinical isolates of carbapenem-resistant pseudomonas aeruginosa were screened for metallo-β-lactamase (mbl) genes. results: demographic and clinical variables were similar between the spm-1-producing and non-spm-1-producing group. five (17.2%) isolates were positive for blaspm-1. no other mbl gene was found. all patients were treated with polymyxin b. the infection-related mortality was 40% and 54.2% for spm-1-producing and -non-producing isolates, respectively. conclusions: there were no differences in epidemiological and clinical outcomes between the two groups.
Multivariate analysis of the factors associated with the risk of pneumonia in intensive care units
Carrilho, Cláudia Maria Dantas de Maio;Grion, Cintia Magalh?es Carvalho;Bonametti, Ana Maria;Medeiros, Eduardo Alexandrino Servolo;Matsuo, Tiemi;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000300008
Abstract: pneumonia is the most frequent hospital infection in patients admitted to intensive care units (icu) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. the objective of this study was to identify predisposing factors for pneumonia. a prospective cohort study was carried out between june 1996 and june 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult icu of the londrina state university's teaching hospital. of these, 83 (15.4%) developed pneumonia. all patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the icu. multivariate analysis identified four risk factors for pneumonia in the icu: tracheotomy (rr = 1.09; 95%ci = 1.04-1.17), nasogastric tube feeding (rr = 1.11; 95%ci = 1.05-1.18), h2-blocker use (rr = 1.09; 95%ci = 1.05-1.14) and decreased level of consciousness (rr = 2.67; 95%ci = 1.43-5.04). in 56.6% of patients, pneumonia occurred within the first four days following icu admission. the risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.
Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features
Carlos Alberto Pires Pereira, Alexandre R. Marra, Luis Fernando Aranha Camargo, Ant?nio Carlos Campos Pignatari, Teresa Sukiennik, Paulo Renato Petersen Behar, Eduardo Alexandrino Servolo Medeiros, Julival Ribeiro, Evelyne Gir?o, Luci Correa, Carla Guerra, Irna Carneiro, Carlos Brites, Marise Reis, Marta Antunes de Souza, Regina Tranchesi, Cristina U. Barata, Michael B. Edmond, Brazilian SCOPE Study Group
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068144
Abstract: Background Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. Methods We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). Results In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. Conclusions In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Uso de diagramas de controle na vigilancia epidemiológica das infec es hospitalares
Arantes Aglai,Carvalho Eduardo da Silva,Medeiros Eduardo Alexandrino Servolo,Farhat Calil Kairalla
Revista de Saúde Pública , 2003,
Abstract: OBJETIVO: Monitorizar a tendência de ocorrência e identificar surtos de infec es hospitalares utilizando diagramas de controles. MéTODOS: No período de janeiro de 1998 a dezembro de 2000, a ocorrência de infec es hospitalares foi avaliada em uma coorte de 460 pacientes, internados em uma Unidade de Terapia Intensiva Pediátrica de um hospital universitário, segundo os conceitos e critérios da metodologia do sistema "National Nosocomial Infection Surveillance", do "Centers for Disease Control" (EUA). Os gráficos foram construídos de acordo com a distribui o probabilística de Poisson. Quatro linhas horizontais foram plotadas. A linha central foi representada pela incidência média das infec es hospitalares no período estudado e as linhas de alerta superior e de controle superior foram calculadas a partir de dois e três desvios-padr o acima da incidência média das infec es hospitalares, respectivamente. Os surtos de infec o hospitalar foram identificados quando sua incidência mensal permaneceu acima da linha do limite de controle superior. RESULTADOS: A incidência média de infec es hospitalares por mil pacientes dia foi de 20. Um surto de infec o do trato urinário foi identificado em julho de 2000, cuja taxa de infec o foi de 63 por mil pacientes dia, ultrapassando a linha de controle superior, configurando um período epidêmico. CONCLUS ES: A utiliza o dos diagramas de controle do nível endêmico, tanto por avalia o global e sítio específica, possibilitou identificar e distinguir das varia es naturais nas taxas de ocorrência de infec es hospitalares aquelas de causas incomuns, como os surtos ou epidemias, dispensando o uso de cálculos e testes de hipóteses.
Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit
Moreira, Marina;Freitas, Marise R.;Martins, Sinaida T.;Castelo, Adauto;Medeiros, Eduardo Alexandrino Servolo;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000100015
Abstract: methicillin-resistant staphylococcus aureus (mrsa) is endemic in most brazilian hospitals, and there are few studies which show the efficacy of control measures in such situations. this study evaluated intensive care unit (icu) patients, in two years divided in control, intervention and post-intervention group. intervention measures: hands-on educational programs for healthcare workers; early identification of mrsa infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. the hospital infection rates in the control period were compared to the ones in the post-intervention period. hospital infection rates were found by means of the nniss methodology the incidence coefficients of mrsa hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and mrsa-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already mrsa-positive when admitted to the unit. in the intervention period, most of those mrsa infected patients (76.2%) were nasal carrier. mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. intervention measures for the prevention and control of mrsa infections in icus, have been efficient in the reduction of the bloodstream and mrsa-originated hospital infections incidence, and reduced the overall mortality rate significantly.
The organization of Hospital Infection Control Committees and their importance in Brazil
El Far, Fabiane;Marino, Cristiane G. J.;Medeiros, Eduardo Alexandrino Servolo;
Brazilian Journal of Infectious Diseases , 2001, DOI: 10.1590/S1413-86702001000600001
Abstract: the importance of hospital infection control committees (hicc) increases every year due to the emergence of multiresistant bacterial strains, hospital outbreaks, and other factors that cause hi. this demonstrates the fragility of the quality of hospital and medical care. having a well-organized hicc benefits hospitals by improving quality, lowering costs and, most important, reducing patient morbidity and mortality. this review records the history of the development of hiccs, their present organizational structure, and offers recommendations for the best methods of infection surveillance.
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