6 research outputs found
Invasive Trichosporon infection in solid organ transplant patients: a report of two cases identified using IGS1 ribosomal DNA sequencing and a review of the literature
No full textInternational audienc
4775Diagnostic value of Positron emission tomography (PET/CT) in native and prosthetic infective endocarditis
No full textSurgical Site Infections In Women And Their Association With Clinical Conditions
No full textIntroduction: Surgical site infections (SSIs) can affect body tissues, cavities, or organs manipulated in surgery and constitute 14% to 16% of all infections. This study aimed to determine the incidence of SSIs in women following their discharge from a gynecology outpatient clinic, to survey different types of SSIs among women, and to verify the association of SSIs with comorbidities and clinical conditions. Methods: Data were collected via analytical observation with a cross-sectional design, and the study was conducted in 1,026 women who underwent gynecological surgery in a teaching hospital in the municipality of Teresina, in the northeast Brazilian State of Piauí, from June 2011 to March 2013. Results: The incidence of SSIs after discharge was 5.8% among the women in the outpatient clinic. The most prevalent surgery among the patients was hysterectomy, while the most prevalent type of SSI was superficial incisional. Comorbidities in women with SSIs included cancer, diabetes mellitus, and hypertension. Conclusions: Surveillance of SSIs during the post-discharge period is critical for infection prevention and control. It is worth refl ecting on the planning of surgical procedures for patients who have risk factors for the development of SSIs.474457461Assistência Segura: Uma Refl exão Teórica Aplicada à Prática (2013) Vigilância e Monitoramento em Serviços de Saúde (GVIMS), , Gerência Geral de Tecnologia em Serviços de Saúde (GGTES). Série Segurança do Paciente e Qualidade em Serviços de Saúde. Brasília (DF)Martins, M.A., França, E., Matos, J.C., Goulart, E.M.A., Post-discharge surveillance of children and adolescents treated for surgical site infections at a university hospital in Belo Horizonte, Minas Gerais State, Brazil (2008) Cad Saude Publica, 24, pp. 1033-1041Ferreira, F.A.P.B., Marin, M.L.G., Strabelli, T.M.V., Carmona, J.C., Ways the anesthesiologist can contribute to the prophylaxis of infection in the surgical patient (2009) Rev Bras Anestesiol, 59, pp. 756-766Garcia, R.B., Delagado, M.L., Kuba, E.B., Cabello, R.R., Chessin, A., Rendón, J.C., Infección del sitio quirúrgico. Experiencia de dos años en el servicio de ginecología y obstetricia del Hospital General de México (2006) Ginecol Obstet Mex, 74, pp. 260-264Gomes, A.E.B., Cavalcante, R.S., Pavan, E.C.P., Freitas, E.S., Fortaleza, C.B., Predictive factors of post-discharge surgical site infections among patients from a teaching hospital (2014) Rev Soc Bras Med Trop, 47, p. 238Assis, D.B., Madalosso, G., Ferreira, A.S., Yassuda, Y.Y., Polachini, Z.M., Surveillance System for Hospital Infections in the State of São Paulo in 2011 (2012) BEPA, 9, pp. 15-23Amorim, M.M.R., Santos, L.C., Guimaraes, V., Risk Factors for Infection after Total Abdominal Hysterectomy (2000) Rev Bras Ginecol Obstet, 22, pp. 443-448Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection (1999) Infec Control and Hosp Epidemiol, 20, pp. 247-278Anderson, D.J., Kaye, S.K., Classen, D., Arias, K.M., Podgorny, K., Burstin, H., Strategies to prevent surgical site infections in acute care hospitals (2008) Infect Control and Hosp Epidemiol, 29, pp. 51-61Lichtenfels, E., Frankini, A.D., Paludo, J., D'azevedo, P.A., Prevalence of bacterial resistance in surgical wound infections in peripheral arterial surgery (2008) J Vasc Bras, 7, pp. 239-247Torres, L.M., (2011) Readmissão por infecção do sítio cirúrgico em um hospital público de Belo Horizonte-MG. 2011, , Dissertação (Mestrado em Enfermagem)-Escola de Enfermagem-Universidade de São Paulo, São PauloSasaki, V.D.M., Romanzini, A.E., Jesus, A.P.M., Carvalho, E., Gomes, J.J., Damiano, V.B., Surgical site infection surveillance in post-hospital discharge after cardiac reconstructive surgery (2011) Texto contexto-enferm, 20, pp. 328-332Oliveira, A.C., Ciosak, S.I., Lorenzo, D., Post-discharge surveillance and ITS impact ON surgical site infection incidence (2007) Rev Esc Enferm USP, 41, pp. 653-659. , São PauloErcole, F.F., Chianca, T.C.M., Duarte Ds Carlos, E.F., Carneiro, M., Surgical site infection in patients submitted to orthopedic surgery: The NNIS risk index and risk prediction (2011) Rev Latino-Am Enfermagem, 19, pp. 269-276Breigeiron, R., (2005) Fatores de risco para infecção de sítio cirúrgico em pacientes submetidos à cirurgia por perfuração esofágica, , Porto Alegre: PUCRS. Dissertação (Mestrado)-Pontifícia Universidade Católica do Rio Grande do Sul. Faculdade de MedicinaFelippe, A.B., (2005) Fatores associados à infecção do sítio cirúrgico após cirurgia para o tratamento do câncer de mama em mulheres usuárias do sistema de drenagem, , [Masters Dissertation]. [Rio de Janeiro]: Universidade Federal do Rio de JaneiroParker, W.H., Broder, M.S., Chang, E., Feskanich, D., Farquhar, C., Liu, Z., Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study (2009) Obstet Gynecol, 113, pp. 1027-1037Sória, H.L.Z., Fagundes, D.J., Sória-Vieira, S., Cavalli, N., Santos, R.C., Hysterectomy and benign gynecological diseases: What has been performed in Medical Residency in Brazil? (2007) Rev Bras Ginecol Obstet, 29, pp. 67-73Batista, T.F., Rodrigues, M.C.S., Surveillance of surgical site infection after hospital discharge in a teaching hospital of the Federal District, Brazil: A retrospective descriptive study in the period 2005 (2012) Epidemiol Serv Saude, 21, pp. 253-264Lake, A.M.G., McPencow, A.M., Dick-Biascoechea, M.A., Martin, D.K., Erekson, E.A., Surgical site infection after hysterectomy (2013) Am J Obstet Gynecol, 209, pp. 490-499Costa, A.A.R., Amorim, M.M.R., Cursino, T., Vaginal hysterectomy versus abdominal hysterectomy in patients without uterine prolapse: A randomized clinical trial (2003) Rev Bras Ginecol Obstet, 25, pp. 169-176Geller, E.J., Vaginal hysterectomy: The original minimally invasive surgery (2014) Minerva Ginecol, 66, pp. 23-33Custovic, A., Zulcic-Nakic, V., Asceric, M., Hadzic, S., Surveillance of intrahospital infections at the clinic for gynaecology and obstetrics (2009) Bosn J Basic Med Sci, 9, pp. 66-70Moraes, C.M., Galvão, C.M., Surgical site infection: Analysis of scientific production in nursing (2006) Rev SOBECC, 11, pp. 22-31Silva, E.C.B.F., Samico, T.M., Cardoso, R.R., Rabelo, M.A., Bezerra, N.A.M., Melo, F.L., Colonization by Staphylococcus aureus among the nursing staff of a teaching hospital in Pernambuco (2012) Rev Esc Enferm USP, 46, pp. 132-137Aguiar, A.P.L., Prado, P.R., Opitz, S.P., Vasconcelos, S.P., Faro, M.C., Factors associated with surgical site infections in a hospital in the western brazilian amazon (2012) Rev SOBECC, 17, pp. 60-70Ledur, P., Almeida, L., Pellanda, L.C., Schaan, D.B., Predictors of infection in post-coronary artery bypass graft surgery (2011) Rev Bras Cir Cardiovasc, 26, pp. 190-196Chen, S., Anderson, M.V., Cheng, W.K., Wongworawat, M.D., Diabetes associated whith increased surgical site infection in spinal arthrodesis (2009) Orthop Relat Res Clin, 467, pp. 1670-1673Gutiérrez, M.G.R., Gabrielloni, M.C., Barbi, T., Areias, V.L., Surgical site infections: Surveillance measures in the early discharge after breast cancer surgery (2004) Rev Bras Cancer, 50, pp. 17-2
HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort
No full textThe HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001), a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008) and stroke (25% vs. 17% p = 0.05) but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004), death in-hospital (4% vs. 18%; p = 0.001) or after 1 year follow-up (6% vs. 20%; p = 0.01) than IE due to other pathogens (n = 5514). On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01) and younger age (OR 0.62; CI 0.49-0.90; p<0.01). The overall outcome of HE was excellent with the in-hospital mortality (4%) significantly better than for non-HE (18%; p<0.001). Prosthetic valve endocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences. © 2013 Chambers et al
Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the international collaboration of Endocarditis-Prospective Cohort Study
No full textBackground. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis–Prospective Cohort Study.
Methods. Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use.
Results. EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non–S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39–1.15]; P = .15).
Conclusions. In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE
Особенности развития и течения синдрома диссеминированного внутрисосудистого свертывания при хирургических вмешательствах у детей с онкологическими заболеваниями
No full textCoagulopathy always accompanies blood loss, and its transformation into disseminated intravascular coagulation syndrome (DIC) is associated with increased morbidity and mortality.Objective: to characterize the features of the development and course of DIC during bleeding, as well as identify the main predictors of its formation during surgical interventions in children with oncological diseases.Material and Methods. A retrospective study of children under 18 years of age with oncological pathology who received surgical treatment for the period from 2017 to 2019 years. Children who received blood transfusion and hemostatic therapy with intraoperative bleeding were selected. The resulting cohort (n=207) was divided into two groups using the modified ISTH assessment system: children with DIC (n=59), without DIC (n=148). Demographic, clinical, and laboratory factors were compared between groups. The final model of multivariate logistic regression included signs that were before the development of DIC on the second day after the operation and were selected as a result of univariate analysis (P<0.05), had less than 10% missing data and were clinically plausible. The prediction accuracy of the multivariate model was checked by analyzing the area under the ROC curve.Results. DIC was found to develop often in children with cancer during surgical operations in the retroperitoneal space (OR=2.09 [1.07; 4.05]; P=0.03) and liver (OR=3.86 [1.72; 8.67]; P=0.001). Multiple organ failure (MOF) was more severe and was represented by pulmonary, hepatic and renal failure in the group with identified DIC. The development of MOF was accompanied by a decrease in tissue perfusion and an increase in D-dimer. The probability of detecting acute thrombosis after surgery was 4.5 times higher in the group of patients with DIC than in the group without DIC (OR=4.5 [1.4; 14.3]; P=0.01). 90-daily survival was 84.41±6.49% [71.69%; 97.13%] in the group of patients with DIC, and 96.22±3.12 [90.1%; 100%] in the group without DIC. Multivariate analysis showed that age less than 8 years, platelet count less than 150X109/l, hypocalcemia less than 1 mmol/l and the period of intraoperative critical hypotension for more than 25 minutes are predictors of the development of DIC after surgery. ROC analysis showed excellent quality of the obtained predictive model (AUC=0,94 [0,9; 0,97]).Conclusion. In children with oncological diseases, in the presence of bleeding, coagulopathy in the postoperative period is transformed into a DIC-syndrome, proceeding clinically with the development of organ failure. Age less than 8 years, platelet count less than 150X109/l, hypocalcemia less than 1 mmol/L and a period of intraoperative critical hypotension of more than 25 minutes are predictors of the development of DIC. The extreme expression of the «organ» type DIC is the progression of thrombotic syndrome to life threatening complications, which reduces the 90-day survival by 12%.Кровопотере всегда сопутствует коагулопатия, а ее трансформация в синдром диссеминированного внутрисосудистого свертывания (ДВС-синдром) связана с повышенным уровнем заболеваемости и смертности.Цель исследования. Охарактеризовать особенности развития и течения ДВС-синдрома при кровотечениях, а также выявить основные предикторы его формирования при оперативных вмешательствах у детей с онкологическими заболеваниями.Материалы и методы. Ретроспективное исследование у детей в возрасте до 18 лет с онкологическими заболеваниями, получавших хирургическое лечение в период с 2017 по 2019 годы. Отобрали детей, получавших гемотрансфузии и гемостатическую терапию при интраоперационном кровотечение. Полученную когорту (n=207) разделили на две группы с использованием модифицированной системы оценки ISTH: дети с ДВС-синдромом (n=59), без ДВС-синдрома (n=148). Провели сравнение демографических, клинических и лабораторных факторов между группами. В окончательную модель многофакторной логистической регрессии включили признаки, которые были до развития ДВС-син-дрома на 2-е сутки после операции и были отобраны в результате однофакторного анализа (p<0,05), имели менее 10% пропущенных данных и были клинически правдоподобными. Точность прогнозирования многофакторной модели проверили по анализу площади под кривой ROC.Результаты. Установили, что ДВС-синдром у детей с онкологическими заболеваниями часто развивается при операциях в области забрюшинного пространства (OR=2,09 [1,07; 4,05]; p=0,03) и печени (OR=3,86 [1,72; 8,67]; p=0,001). Полиорганная недостаточность (ПОН) была более тяжелой и была представлена легочной, печеночной и почечной недостаточностью в группе с выявленным ДВС-синдро-мом. Развитие ПОН сопровождалось снижением показателей тканевой перфузии и ростом D-димера. Вероятность выявления острого тромбоза после операции была в 4,5 раза выше в группе пациентов с ДВС-синдромом, чем в группе без ДВС-синдрома (OR=4,5 [1,4; 14,3]; p=0,01). 90-дневная выживаемость составила в группе пациентов с ДВС-синдромом — 84,41±6,49% [71,69%; 97,13%], а в группе без ДВС-синдрома — 96,22±3,12% [90,1%; 100%]. Многофакторный анализ показал, что возраст менее 8 лет, количество тромбоцитов менее 150Х109/л, гипокальциемия менее 1 ммоль/л и период интраоперационной критической гипотонии более 25 минут являются предикторами развития ДВС-синдрома после операции. ROC-анализ показал превосходное качество полученной прогностической модели (AUC=0,94 [0,9; 0,97]).Заключение. У детей с онкологическими заболеваниями, при наличии кровотечения, коагуло-патия в послеоперационном периоде трансформируется в ДВС-синдром, протекающий клинически с развитием органной недостаточности. Возраст менее 8 лет, количество тромбоцитов менее 150Х109/л, гипокальциемия менее 1 ммоль/л и период интраоперационной критической гипотонии более 25 минут являются предикторами развития ДВС-синдрома. Крайним выражением ДВС-синдрома «органного типа» является прогрессирование тромботического синдрома до реализации осложнений, угрожающих жизни, что и уменьшает 90-дневную выживаемость на 12%
