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OBJETIVO: Avaliar as infecções relacionadas à assistência à saúde, em unidade de terapia intensiva neonatal, causadas pelo Staphylococcus coagulase negativa, verificando o perfil de sensibilidade antimicrobiana e possíveis esquemas antibióticos eficazes. MÉTODOS: Estudo descritivo retrospectivo de uma série de casos de infecções relacionadas à assistência à saúde tardias de origem hospitalar atribuída ao Staphylococcus coagulase negativa, avaliando o perfil de sensibilidade antimicrobiana. Foram estudados os recém-nascidos internados entre 1º de janeiro de 2010 a 30 de junho de 2012 em uma unidade de terapia intensiva neonatal da cidade do Rio de Janeiro, sendo todos os pacientes oriundos de outras unidades. RESULTADOS: Foram admitidos 765 pacientes, totalizando 3.051 pacientes-dia e uma densidade de incidência de infecção geral de 18,9 por 1.000 pacientes-dia. A taxa de utilização de cateteres venosos centrais foi de 71,6% e a positividade das culturas de todos os sítios para todas as infecções relacionadas à assistência à saúde foi de 68,4%. O Staphylococcus coagulase negativa foi implicado em 11 (19,2%) das 57 infecções relacionadas à assistência à saúde e Klebsiela pneumoniae produtor de betalactamase de espectro estendido e Candida sp em 5 ocasiões cada. Das 11 infecções, 10 (90,9%) foram atribuídas a infecções primárias de corrente sanguínea. A sensibilidade dos isolados de Staphylococcus coagulase negativa em relação à vancomicina, clindamicina, ciprofloxacin, oxacilina e gentamicina foi de 100%, 81,8%, 72,7%, 27,2%, 22,2%, respectivamente. Não houve óbito atribuído diretamente à infecção por Staphylococcus coagulase negativa. CONCLUSÃO: O Staphylococcus coagulase negativa foi o principal agente encontrado nas infecções relacionadas à assistência à saúde tardias de origem hospitalar, sendo baixas as taxas de infecções relacionadas a cateter venoso central. Em hospitais semelhantes ao aqui estudado, com elevado perfil de resistência à oxacilina, a vancomicina pode ser utilizada como terapêutica inicial, sendo também a clindamicina uma alternativa viável.

A sífilis congênita (SC) ocorre em virtude da disseminação hematogênica da bactéria Treponema pallidum, da gestante infectada não tratada ou inadequadamente tratada para o seu concepto por via transplacentária em qualquer fase gestacional ou por meio do contato com o canal de parto, se presença de lesões genitais maternas. O presente estudo tem como objetivo analisar o perfil epidemiológico da SC no estado do Rio de Janeiro no período de 2010 a 2022. Trata-se de um estudo ecológico retrospectivo que utilizou dados públicos do Sistema de Informações de Agravos de Notificação (SINAN), do Sistema de Informações sobre Nascidos Vivos (SINASC) e do IBGE. Foram analisados os casos confirmados de sífilis congênita, no período de 2010 a 2022, de acordo com o ano de notificação, com a microrregião IBGE de notificação, com a escolaridade materna, com a faixa etária materna, com o tratamento dos parceiros e segundo a classificação final de aborto/natimorto por sífilis. Calculou-se a prevalência de sífilis congênita a cada 100 habitantes das microrregiões do IBGE. Além disso, foram calculadas a incidência de sífilis na gravidez na adolescência e a taxa de letalidade da SC. Durante o período analisado houve 45.875 casos confirmados de sífilis congênita no estado do Rio de Janeiro. A microrregião do IBGE com maior prevalência foi o Rio de Janeiro (0,33 casos/ 100 habitantes). Ademais, foi possível observar que 27% dos casos são de mães que possuem como nível de escolaridade o ensino fundamental incompleto e apenas 0,45% das mulheres possuíam nível superior completo. A análise do tratamento dos parceiros de mulheres com diagnóstico confirmado mostrou que somente 10% realizaram o tratamento para sífilis. Além disso, notou-se que a incidência de SC dentre as gravidezes na adolescência no estado foi de 2,62 casos/ 100 gravidezes de jovens de 10 a 19 anos e dentre os casos de SC confirmados, 25,52% eram mães nesta faixa etária. Por fim, percebeu-se que a taxa de letalidade da SC foi de 1,768 para cada 100 casos confirmados. Notou-se uma forte relação entre os casos de SC e a baixa escolaridade materna e com gravidez na adolescência, enfatizando possíveis correlações entre situações de vulnerabilidade social. A baixa taxa de tratamento de parceiros é alarmante para a saúde pública assim como a taxa de letalidade. A prevenção e o rastreio de SC é essencial, feita pela Estratégia da Saúde da Família, a fim de garantir o diagnóstico e o tratamento precoces. Palavras-chave: Sífilis congênita, Infecções Sexualmente transmissíveis, Treponema pallidum. Conflitos de interesse: Não houve conflitos de interesse. Ética e financiamentos: Declarações de interesse: Nenhum.

The objective of this study was to identify the prevalence and self-recognition for indicators of inflammation suggestive of periodontal disease in military personnel of both genders. The military personnel was recruited to conduct a dental census for the entire population of the Admiral Wandenkolk Training Center of the Brazilian Navy, totaling 409 volunteers. Two groups were formed for further analysis: Group 1- containing exclusively women and Group 2- containing exclusively men. A total of 409 clinical examinations were performed and the questionnaires were analyzed. The results showed that, regarding the military participants, 40.1% were female and 59.9% were male; 87% used dental floss, of which 56% used it daily; 77% brushed three times a day or more; 74.3% reported that they visited the dentist regularly, and the proportion of women who regularly visited the dentist significantly exceeded the proportion of men who did (C.I. 95%; p

Background: Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant gram-negative bacteria (CRB). Our aim was to describe the use of CAZ-AVI in children admitted to pediatric intensive care units (PICUs), with suspected or proven CRB infections. Methods: A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included. Results: CAZ-AVI was used in 37 patients. The median age was 28 months (range 1–215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1–138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1–22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%. Conclusion: Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.

Background and Objectives: Recently, complementary resources and equipment have emerged to improve prevention of healthcare-associated infections (HAIs). Our aim is to verify availability and use of different resources/equipment by infection controllers. Methods: We conducted a survey with infection controllers from the State of Rio de Janeiro, Brazil, by invitation using a social media group, in August 2022. Nine different resources and equipment were evaluated. Categorical and continuous variables were evaluated by the chi-square test and Mann–Whitney U test, respectively. A p value of less than 0.05 was considered statistically significant. Results: One hundred and eight persons answered the questionnaire. The mean age was 42.8 years (SD +/- 8.5 years) and 53 (49.1%) reported most of their workload in public hospitals, 45 (41.7%) in private hospitals and 10 (9.2%) reported the same workload in public and private hospitals. Sixty-there percent reported teaching activities in their institutions. There was no correlation between the existence of teaching activities and hospital profile (p=0.42). The most common resource available was molecular biology (PCR) for microbiological samples research for 73 (67.6%) participants. The second resource most available was applications (Apps) for HAIs prevention and control for 33 (30.6%), 19 (17.6%) reported no availability of resource/equipment technology. Conclusion: Molecular biology (PCR) for microbiological samples research was the most common resource available for infection controllers of an important state of Brazil.

Introduction: Pediatric emergency care is essential for adequate medical treatment of pediatric cancer-associated complications and for increasing the chances of cure. Objective: This study aimed to describe pediatric cancer-associated emergencies and outcomes, and to analyze the factors associated with hospitalization. Method: A retrospective observational cohort study was conducted including patients aged ≤19 years who attended the pediatric emergency of a general cancer hospital from April 17 to October 17, 2019. The variables analyzed were demographics, socioeconomic status, disease and treatment factors, reasons for seeking emergency care, and associated outcomes. Results: This study included 309 patients who required 994 emergency consultations, with a total of 766 reasons for seeking care. The median age was 4.86 years; 50.8% were female and 51.5% were white. The patients had solid tumors (49.8%), central nervous system tumors (27.5%), and hematological neoplasms (15.5%). Most of the patients were home discharged (72.2%) or to support houses (6.7%). Fever was the most frequent symptom (30.8%) and the most common reason for admission. 19.2% of the patients were admitted to the ward and 2.0% to the pediatric intensive care unit (2.0%). Only two of the 309 patients (0.6%) seeking care in the pediatric emergency died in the emergency room, and these patients were in end-of-life care. Conclusion: The availability of a pediatric emergency room with skilled professionals in supportive care of pediatric patients with cancer was essential for the management of disease and treatment-related complications.

Objective: To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. Methods: Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. Results: This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. Conclusion: The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.

Objective: To evaluate COVID-19 vaccination status in admitted children in 2020–2021 and during the OMICRON variant circulation (2022), a period when children older than 12 years of age had received two doses of COVID-19 vaccines. Design: An observational retrospective study. Patients with confirmed COVID-19 were compared in two different periods: 2020–2021 when adolescents aged 12–18 years had not received the complete COVID-19 vaccine, and 2022 when children older than 12 years had received the complete Pfizer-BioNTech vaccine scheme. Setting: Two pediatric hospitals in Rio de Janeiro city. Patients: Children aged < 18 years with confirmed COVID-19. Intervention: None. Main outcome: Vaccination status for COVID-19 on admission. Results: In total, 300 patients were admitted with confirmed COVID-19 (240 in 2020–2021 and 60 in 2022). The distribution of patients according to the age-groups was: 0–2 years (33.3% in 2020–2021 and 53.4% in 2022), 2–5 years (21.7% in 2020–2021 and 10% in 2022), 5–11 years (29.2% in 2020–2021 and 28.3% in 2022), and 12–18 years (15.8% in 2020–2021 and 8.3% in 2022) (p = 0.076). The median length of stay was six days in 2020–2021 and six days in 2022 (p = 0.423). We verified six deaths in the first analysis period and one death in the second one (p = 0.894). Of the 60 children admitted in 2022, 58 (96.7%) did not receive the complete COVID-19 vaccine scheme available. Conclusions: We verified in a “real-world condition” the ability of the Pfizer-BioNTech vaccine to prevent hospitalization in children over 12 years of age.

Justificativa e objetivos. Bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) são um problema de saúde pública global, pela possibilidade de causar infecções intratáveis em neonatos. O objetivo foi descrever o controle das taxas de BGN-CR causando infecções relacionadas à assistência à saúde (IRAS) em unidade de tratamento intensivo neonatal (UTINEO). O consumo de antimicrobianos/carbapenêmicos também foi avaliado. Métodos. Estudo prospectivo descritivo das IRAS em uma UTINEO, durante 1 ano. O consumo de antimicrobianos/antibióticos foi medido em dias de terapia/1000pacientes-dia (DOT/1000PD) Resultados e conclusões: Entre setembro de 2017 e setembro de 2018, admitimos 308 pacientes, a maioria com peso>1500g (303/308-98,4%), totalizando 2223 pacientes-dia. Oito IRAS foram registradas, correspondendo a uma taxa de 2,6% (ou densidade de incidência de 3,6/1000PD). Em cinco das oito infecções (62,5%), um agente infeccioso foi isolado, sendo três bactérias Gram-negativas (todas Klebsiella pneumoniae, 2 com perfil de produção de beta-lactamase de espectro estendido) e duas infecções por Candida sp. Não houve infecção por BGN-CR. O consumo total de antimicrobianos em DOT/1000PD foi de 1638 e o de carbapenêmicos 49,3; o que representou 3% do total, com tendência de queda durante o ano. Em setembro de 2017, implementamos um programa de gestão de antimicrobianos (PGA), em adição às medidas de controle de infecção realizadas desde 2005. Os elementos-chave do PGA foram: auditoria de antibióticos e feedback, restrição de antimicrobianos-alvo e maior rapidez na liberação de resultados de culturas. Verificamos adequado controle de BGN-CR, não sendo encontrada infecção por este agente, tendência de queda no consumo de antimicrobianos e carbapenêmicos.

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections (HAI) in neonates admitted in neonatal intensive care units (NICUs). Methods: We did a systematic review using PRISMA methodology to identify the main etiological agents in Brazilian NICUs. Eligible studies published without period restriction were identified in PUBMED, SCIELO, LILACS and DOAJ. Studies were included if they were conducted in neonates hospitalized at NICU. Studies done in outpatient care, neonates outside NICU, emergency department, primary care, long-term care facilities or a combination of these were excluded. Results: We identified 6384 articles in the initial search and four papers met the inclusion criteria. In all studies included, rates of device-associated infections were described, including VAP rates. The VAP incidence density, in exclusively Brazilian NICU, ranged from 3.2 to 9.2 per 1000 ventilator-days. Pneumonia was described as the main HAI in NICU in one article, as the second type of HAI in two other articles and as the fourth type of HAI in the last one. The main pathogens causing all HAI types were described in three of four articles, but, none of the articles reported which pathogens were related or associated to VAP. Conclusion: Etiological agents causing VAP in Brazilian NICUs are, until the present time, not known. Keywords: Systematic reviews, Ventilator-associated pneumonia, Newborn, Etiological agents

ABSTRACT OBJECTIVE: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). METHODS: Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. RESULTS: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. CONCLUSIONS: Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.

Background: Infection with Gram-negative bacteria is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of 7- and 30-day mortality in pediatric patients in an intensive care unit with cancer and/or hematologic diseases and Gram-negative bacteria infection. Methods: Data were collected relating to all episodes of Gram-negative bacteria infection that occurred in a pediatric intensive care unit between January 2009 and December 2012, and these cases were divided into two groups: those who were deceased seven and 30 days after the date of a positive culture and those who survived the same time frames. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, infection by multidrug resistant-Gram-negative bacteria, colonization by multidrug resistant-Gram-negative bacteria, neutropenia in the preceding seven days, neutropenia duration ≥3 days, healthcare-associated infection, length of stay before intensive care unit admission, length of intensive care unit stay >3 days, appropriate empirical antimicrobial treatment, definitive inadequate antimicrobial treatment, time to initiate adequate antibiotic therapy, appropriate antibiotic duration ≤3 days, and shock. In addition, use of antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy in the previous 30 days was noted. Results: Multivariate logistic regression analysis resulted in significant relationship between shock and both 7-day mortality (odds ratio 12.397; 95% confidence interval 1.291–119.016; p = 0.029) and 30-day mortality (odds ratio 6.174; 95% confidence interval 1.760–21.664; p = 0.004), between antibiotic duration ≤3 days and 7-day mortality (odds ratio 21.328; 95% confidence interval 2.834-160.536; p = 0.003), and between colonization by multidrug resistant-Gram-negative bacteria and 30-day mortality (odds ratio 12.002; 95% confidence interval 1.578–91.286; p = 0.016). Conclusions: Shock was a predictor of 7- and 30-day mortality, and colonization by multidrug resistant-Gram-negative bacteria was an important risk factor for 30-day mortality. Keywords: Cancer, Pediatric intensive care unit, Infection with Gram-negative bacteria, Mortality

A circulação de bactérias multirresistentes entre unidades de terapia intensiva pediátricas é uma realidade, sendo necessário conhecer o perfil dos microrganismos mais prevalentes para estabelecer medidas de controle eficazes. O objetivo deste artigo é descrever o perfil das bactérias multirresistentes(BMR) importadas em uma unidade de terapia intensiva pediátrica do Rio de Janeiro, de acordo com a região geográfica dos hospitais. Métodos: Foi realizada coleta de swab nasal e retal em todos os pacientes que permaneceram mais que 12 horas em outras unidades, admitidos nas 4 unidades de terapiaintensiva pediátrica do Prontobaby. Resultados: Entre agosto de 2009 e dezembro de 2011, detectamos 60 BMR sendo 19 causadoras de infecção e 41 colonizações. Bactérias Gram negativas representaram 68,4% dasinfecções e 60,8% das colonizações. A maior parte dos hospitais (21/33- 63,6%) estava localizada na cidade do Rio de Janeiro e aqueles localizados na zona norte e oeste concentraram 25 das 60 (41,6%) BMR. Klebsiella pneumoniae ESBL foi a bactéria mais comumente isolada em infecções enquanto Escherichia coli E SBL foi a mais frequente em colonizações por Gram negativos. Conclusão: Concluímos que as BMR gram negativas importadas foram mais prevalentes tanto em infecções quanto em colonizações. As regiões norte e oeste dacidade apresentaram a maior parte dos casos de BMR.

Com o objetivo de medir a prevalência de anticorpos IgG contra o parvovírus B19 em gestantes com até 24 semanas de idade gestacional e detectar a ocorrência de casos de hidropisia fetal não-imune atribuídos a esse vírus, coletamos 249 amostras de soro em uma maternidade de referência na cidade do Rio de Janeiro, entre junho de 2003 e março de 2005. As gestantes foram acompanhadas até o termo da gestação, sendo detectados 17 casos de hidropisia fetal. Quatro casos foram atribuídos ao parvovírus B19 e dois destes ocorreram em gestantes residentes na zona oeste da cidade, em fevereiro de 2005. Resultados positivos para anticorpos IgG antiparvovírus B19 foram encontrados em 172 (71,6%) gestantes (IC 95% 65,5-77,7%), sendo esta prevalência de anticorpos comparável à encontrada em outras cidades brasileiras. A única variável associada com aquisição prévia de anticorpos IgG foi número de gestações anteriores maior que um(p= 0,02, IC 95% 0,36-0,94).With the aim of measuring the prevalence of anti-parvovirus B19 IgG antibodies during pregnancy up to 24 weeks of gestation and detecting cases of nonimmune hydrops fetalis, 249 sera from pregnant women attending a reference hospital in Rio de Janeiro city, from June 2003 to November 2004 were collected. They were followed-up until the end of pregnancy, with 17 cases of fetal hydrops detected. Four cases were caused by parvovirus B19 and two of them occurred in pregnant women living in the western zone of the city, during February 2005. Anti-parvovirus B19 IgG antibodies were found in 172 (71.6%) pregnant women (CI 95% 65.5%-77.7%); this antibody prevalence is similar to results found for others Brazilian cities. The only variable associated with previous acquisition of IgG antibodies to parvovirus B19 was number of pregnancies greater than one (p= 0.02, CI 95% 0.36-0.94).

OBJETIVO: descrever a etiologia, evolução e prevalência de hidropisia fetal em coorte de gestantes em 10 anos de acompanhamento (1992 a 2002), em uma maternidade terciária. MÉTODOS: estudo retrospectivo foi realizado em pacientes referidas para a maternidade do Instituto Fernandes Figueira com o diagnóstico de hidropisia fetal, detectado pelo exame de ultra-sonografia, durante o período compreendido entre 1992 e 2002. Os casos foram selecionados quanto à etiologia (imune ou não-imune), sendo comparados quanto à evolução, procedimentos invasivos realizados e sobrevivência. A análise das variáveis foi realizada por meio do programa Epi-Info 6.0, sendo considerado valor de significância estatística um valor de pPURPOSE: to describe etiology, evolution and prevalence of hydrops fetalis in a cohort of pregnant women during a period of ten years (1992 to 2002) in a tertiary maternity. METHODS: a retrospective study was carried out in patients referred to the maternity of the Fernandes Figueira Institute, with diagnosis of hydrops fetalis, detected by ultrasonography, during the period from 1992 to 2002. The cases were selected according to etiology (immune or nonimmune) and evolution, performed invasive procedures and survival were compared between both groups. Analysis of variables was performed by Epi-Info 6.0 and a p value less than 0.05 was considered to be statistical significant. RESULTS: in ten years of follow-up, 80 patients with an initial diagnosis of hydrops were attended. The frequency of hydrops in this population was 1 in 157 live births. Rh immunization (immune group) was detected in 13 cases (16.2%), and for 67 cases (83.8%) nonimmune causes (nonimmune group) were considered. Major causes of nonimmune hydrops fetalis were idiopathic (40.2%), genetic (20.8%), infectious diseases (20.7%), and cardiopathy (7.4%). A difference was found in relation to maternal age in the immune group (mean = 32.8 years) when compared with the nonimmune group (mean = 28.7 years) (p=0.03), but gestational age at delivery was similar in both groups (mean = 33.6 weeks in the immune group and 33.1 weeks in the nonimmune group) (p=0.66). Amniocentesis and blood transfusion in utero were carried out more frequently in the immune group (p

ABSTRACT Introduction Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections (HAI) in neonates admitted in neonatal intensive care units (NICUs). Methods We did a systematic review using PRISMA methodology to identify the main etiological agents in Brazilian NICUs. Eligible studies published without period restriction were identified in PUBMED, SCIELO, LILACS and DOAJ. Studies were included if they were conducted in neonates hospitalized at NICU. Studies done in outpatient care, neonates outside NICU, emergency department, primary care, long-term care facilities or a combination of these were excluded. Results We identified 6384 articles in the initial search and four papers met the inclusion criteria. In all studies included, rates of device-associated infections were described, including VAP rates. The VAP incidence density, in exclusively Brazilian NICU, ranged from 3.2 to 9.2 per 1000 ventilator-days. Pneumonia was described as the main HAI in NICU in one article, as the second type of HAI in two other articles and as the fourth type of HAI in the last one. The main pathogens causing all HAI types were described in three of four articles, but, none of the articles reported which pathogens were related or associated to VAP. Conclusion Etiological agents causing VAP in Brazilian NICUs are, until the present time, not known.

Descrevem-se os resultados de treinamentos de estudantes de graduação e profissionais da saúde em prevenção de infecções relacionadas à assistência à saúde com uso de simuladores. O treinamento foi realizado em cinco módulos: higienização de mãos, prevenção de infecções de corrente sanguínea, prevenção de pneumonia associada a dispositivos respiratórios, prevenção de infecção urinária e biossegurança. Os treinamentos simulados foram aplicados a pequenos grupos de alunos de diferentes períodos da graduação e diversos cursos. Entre maio de 2012 e abril de 2013, 61 estudantes fizeram pelo menos um módulo do curso. O desempenho dos estudantes foi medido por um pré-teste e pós-teste aplicado antes e após cada módulo. O aproveitamento positivo nos módulos de I a V foi de 34,2%, 34%, 40,4%, 28,2% e 42,2%, respectivamente. Não houve diferença estatística significativa, em relação ao aproveitamento positivo, nos cinco módulos, quando analisados os estudantes dos diferentes cursos. Concluiu-se que treinamentos simulados em prevenção de infecções relacionadas à assistência à saúde foram efetivos para aumentar o conhecimento de alunos de graduação em saúde de diferentes cursos e períodos.

RESUMO Introdução Programas de gestão de antimicrobianos (PGA) são ferramentas importantes para minimizar o problema global da resistência antimicrobiana. As bases destes programas devem começar idealmente na graduação médica. Objetivo Identificar a apresentação dos conceitos dos PGA no currículo de uma escola médica. Material e métodos Estudo transversal realizado com docentes da Universidade Federal Fluminense (UFF). O critério de inclusão utilizado foi ministrar conteúdos relativos a PGA para o curso de Medicina. Foram mensurados apresentação de componentes-chave dos PGA, carga horária destinada, metodologias de ensino e avaliações empregadas. Resultados Estudo realizado entre dezembro de 2017 e janeiro de 2018, sendo incluídos 6 dos 329 (1,8%) docentes que ministravam aulas para o curso de Medicina. A carga horária destinada à apresentação dos PGA totalizou 83 horas, com mediana de 3 h/docente, o que correspondeu a 1,1% da carga horária total do curso inteiro. Cinco dos seis professores (83,3%) apresentaram pelo menos um dos componentes-chave dos PGA. A frequência de apresentação dos componentes-chave dos PGA foi de: especificidade do tratamento (5/6 - 83,3%), duração do tratamento (4/6 - 66,7%), otimização do tempo de administração (4/6 - 66,7%), possibilidade de troca de via de administração (3/6 - 50%) e monitorização de níveis séricos (2/6 - 33,3%). Quatro dos seis docentes (66,7%) utilizaram combinações de metodologia de ensino, as quais foram reportadas nas seguintes frequências: aulas tradicionais (5/6 - 83,3%), estudos de casos clínicos (4/6 - 66,7%) e aprendizado baseado em problemas (4/6 - 66,7%). Cinquenta por cento dos docentes utilizaram combinações de avaliações para assimilação do conteúdo, e as mais utilizadas foram: respostas dissertativas curtas (3/6), casos clínicos (2/6), perguntas de múltipla escolha (2/6), resumos clínicos (1/6), seminários (1/6) e respostas dissertativas longas (1/6). Conclusões Verificamos que os componentes-chave relativos aos PGA foram apresentados em uma escola médica do Rio de Janeiro, sendo a combinação de diferentes metodologias de ensino a principal estratégia para transmissão dos conceitos. Metade dos docentes utilizou combinação de avaliações para mensurar o conteúdo apresentado. Há necessidade de ajustes para que aspectos importantes, como troca de via de administração e monitorização de níveis séricos, sejam mais debatidos na graduação.

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.