Objective: to analyze mortality and hospitalizations due to non-drug intoxication (NMx) in Brazil from 2009 to 2018. Methods: records of hospitalizations for “treatment of intoxication or poisoning by exposure to substances for non-drug use” from the Hospital Information System (SIH) were analyzed in a time series case study. Results: there were 125,570 hospitalizations due to NMx intoxication. The average incidence of hospitalizations was 6.28/100 thousand inhabitants, being higher in males (8.0/100 thousand inhabitants) compared to females (4.6/100 thousand inhabitants). The incidence of hospitalizations and the overall mortality of NMx hospitalizations decreased from 9.4 to 4.5 per 100 thousand inhabitants and from 2.5 to 1.6 per million inhabitants, respectively. Conclusions: there was a reduction in the incidence of hospitalizations and mortality from NMx intoxications during the analyzed decade.

Objetivo: analizar la mortalidad y las hospitalizaciones por intoxicaciones no medicamentosas (NMx) en Brasil de 2009 a 2018. Métodos: se analizaron los registros de hospitalizaciones por “tratamiento de intoxicación o intoxicación por exposición a sustancias de uso no farmacológico” del Sistema de Información Hospitalaria (SIH) en un estudio de serie temporal de casos. Resultados: hubo 125.570 hospitalizaciones por intoxicación por NMx. La 5ortalidad media de hospitalizaciones fue de 6,28/100 mil habitantes, siendo mayor en el sexo masculino (8,0/100 mil habitantes) en comparación 5ortal 5ortalid (4,6/100 mil habitantes). La 5ortalidad de hospitalizaciones y la mortalidade global de las hospitalizaciones NMx disminuyeron de 9,4 a 4,5 por 100 mil habitantes y de 2,5 a 1,6 por millón de habitantes, respectivamente. Conclusiones: hubo una reducción en la 5ortalidad de hospitalizaciones y mortalidade por intoxicaciones por NMx durante la década analizada.

Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por “tratamento de intoxicação ou envenenamento por exposição a substâncias de uso nãomedicamentoso” no Sistema de Informações Hospitalares (SIH), por regressão de Prais Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade das intoxicações NMx durante a década analisada.

Resumo Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por “tratamento de intoxicação ou envenenamento por exposição a substâncias de uso não medicamentoso” no Sistema de Informações Hospitalares (SIH), por regressão de Prais-Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade por intoxicações NMx durante a década analisada.

Abstract Objective: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. Methods: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for “treatment of intoxication or poisoning due to exposure to non-drug substances” held on the Hospital Information System. Results: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. Conclusions: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Resumen Objetivo: determinar la tasa de hospitalizaciones por eventos agudos de intoxicación no medicamentosa (NMx) y analizar la mortalidad resultante en Brasil de 2009 a 2018. Métodos: estudio de serie temporal en el que se analizaron los registros de hospitalizaciones por “tratamiento de intoxicación o envenenamiento por exposición a sustancias de uso no farmacológico” del Sistema de Información Hospitalaria (SIH) por la regresión de Prais-Winsten. Resultados: hubo 125.570 hospitalizaciones por intoxicación NMx. La mortalidad promedio de hospitalizaciones fue de 6,3/100 mil hab., siendo más alta en el sexo masculino (8,0/100 mil hab.) en comparación con el femenino (4,6/100 mil hab.). La tasa de hospitalizaciones y la mortalidad global de las hospitalizaciones por NMx disminuyeron de 9,4 a 4,5 por 100 mil hab. y de 2,5 a 1,6 por 1 millón de hab., respectivamente. Conclusiones: hubo reducción en la tasa de hospitalizaciones y en la mortalidad por intoxicaciones NMx durante la década analizada.

Resumo Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por “tratamento de intoxicação ou envenenamento por exposição a substâncias de uso não medicamentoso” no Sistema de Informações Hospitalares (SIH), por regressão de Prais-Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade por intoxicações NMx durante a década analisada.

Resumen Objetivo: determinar la tasa de hospitalizaciones por eventos agudos de intoxicación no medicamentosa (NMx) y analizar la mortalidad resultante en Brasil de 2009 a 2018. Métodos: estudio de serie temporal en el que se analizaron los registros de hospitalizaciones por “tratamiento de intoxicación o envenenamiento por exposición a sustancias de uso no farmacológico” del Sistema de Información Hospitalaria (SIH) por la regresión de Prais-Winsten. Resultados: hubo 125.570 hospitalizaciones por intoxicación NMx. La mortalidad promedio de hospitalizaciones fue de 6,3/100 mil hab., siendo más alta en el sexo masculino (8,0/100 mil hab.) en comparación con el femenino (4,6/100 mil hab.). La tasa de hospitalizaciones y la mortalidad global de las hospitalizaciones por NMx disminuyeron de 9,4 a 4,5 por 100 mil hab. y de 2,5 a 1,6 por 1 millón de hab., respectivamente. Conclusiones: hubo reducción en la tasa de hospitalizaciones y en la mortalidad por intoxicaciones NMx durante la década analizada.

Abstract Objective: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. Methods: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for “treatment of intoxication or poisoning due to exposure to non-drug substances” held on the Hospital Information System. Results: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. Conclusions: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Resumo Contexto As infecções profundas de extremidades representam um desafio para o salvamento de membro dos pacientes. Objetivos Investigar se existe concordância entre as culturas de osso e tecido profundo em pacientes com lesões tróficas de extremidades. Métodos Foi realizado um estudo retrospectivo incluindo 54 pacientes com lesões tróficas profundas de extremidades internados, no Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brasil. Foram incluídos todos os pacientes que realizaram culturas de lesões tróficas profundas, com duas modalidades de coleta de exame: osso e fragmentos de tendão profundo. Analisaram-se a concordância, o número total de microrganismos e o número de microrganismos de acordo com a coloração de Gram em ambas as amostras. Resultados Entre os 54 doentes incluídos na amostra, a média de idade foi de 63,6 anos, 80% apresentavam DAOP, 70% eram diabéticos, e 72% hipertensos. Estudando as culturas dos 54 pacientes, 28 amostras (52%) foram completamente concordantes, sendo cultivados os mesmos microrganismos nos fragmentos de tendão profundo e de osso. Houve discordância parcial em 13 amostras (24%), e discordância total em 13 (24%). Observou-se que cresceu em média 1,62 microrganismo nos fragmentos de tendão profundo, e 1,72 nas amostras de osso. Analisando separadamente os microrganismos gram-positivos, a média de espécies cultivadas foi de 0,48 em tendão e de 0,44 em tecido ósseo. Por outro lado, para os microrganismos gram-negativos, a média de microrganismos cultivados foi de 1,14 e 1,27 nas amostras de tendão e de osso, respectivamente. Conclusões Cerca de metade dos pacientes portadores de lesões tróficas profundas de extremidades apresentaram concordância total entre as culturas de osso e de tendão.

Abstract Background Deep infections of the extremities are a challenge that threaten limb salvage. Objectives To investigate whether the results of bone and deep tissue cultures from patients with trophic limb ulcers coincide. Methods A retrospective study was conducted with data from 54 patients with deep trophic limb ulcers admitted to the Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brazil. The study analyzed all patients for whom cultures of material from foot wounds in patients with tissue loss had been performed using two specimen types: bone and fragments of deep tendon. The study analyzed concordance between the two sample types and total number of microorganisms and numbers of microorganisms by Gram staining in both samples. Results The mean age of the 54 patients in the sample was 63.6 years, 80% had PAOD, 70% were diabetic, and 72% were hypertensive. Analysis of the cultures showed that 28 (52%) pairs of samples from the 54 patients exhibited complete concordance, with the same microorganisms grown from fragments of deep tendon and bone. There was partial disagreement in 13 samples (24%) and total disagreement in 13 (24%). On average, 1.62 microorganisms were isolated from deep tendon fragments and 1.72 were isolated from bone samples. Analyzing Gram-positive microorganisms separately, the mean number of species grown was 0.48 for tendon cultures and 0.44 for bone cultures. In contrast, the mean number of Gram-negative microorganisms isolated was 1.14 for tendon samples and 1.27 for bone samples. Conclusions Around half of the patients with foot tissue loss had bone and tendon cultures that coincided exactly.

ABSTRACT Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all β-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5 mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for blaIMP, blaVIM, blaNDM, blaKPC and blaOXA-48 enzymes confirmed the presence of blaNDM gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.

ABSTRACT Bloodstream infections (BSIs) are among the most concerning bacterial infections. They are one of the leading causes of morbidity and mortality, and occur in 30-70% of critical care patients. The prompt identification of the causative microorganism can help choosing the appropriate antimicrobial therapy that will lead to better clinical outcomes. Blood culture is one of the most relevant tests for microbiological diagnosis of bacterial infections. The introduction of the MALDI-TOF microbiological diagnosis significantly decreased the time of identifying microorganisms. However, it depends on the growth on solid culture medium. In this study, 538 bottles of positive blood cultures were evaluated to test the accuracy of an in house modified protocol. The study sample consisted of 198 Gram-negative and 350 Gram-positive bacteria. In all, 460 (83.94%) species were identified based on the direct plate findings. The protocol allowed the identification of 185/198 (93.43%) of the Gram-negative bacteria, including aerobes, anaerobes, and non-fermenters, and 275/350 (78.85%) of the Gram-positive bacteria. The proposed method has the potential to provide accurate results in comparison to the traditional method with the potential to reduce the turnaround time for the results and optimize antimicrobial therapy in BSI.

Methicillin-resistant Staphylococcus aureus has emerged as a pathogen associated with community-acquired infections worldwide. We report the spectrum of community-acquired S. aureus infections and compare the patients infected with methicillin-susceptible or methicillin-resistant strains among patients aged <20 years. Overall, 90 cases of community acquired S. aureus were detected in an 11-year period. Clinical and microbiological data were registered. Fifty-nine (66%) patients were male and the median age was two years. The majority (87%) of the patients were hospitalized and chronic underlying illnesses were detected in 27 (30%) cases. Overall, 34 (37.8%) patients had skin/soft tissue infections and 56 (62.2%) patients had deep-seated infection. Four (5.1%) patients were transferred to the intensive care unit and two (2.6%) died. Complications were detected in 17 (18.9%) cases, such as pleural effusion (41.2%), osteomyelitis (23.5%), and sepsis (17.6%). Six (6.7%) methicillin-resistant strains were detected. Patients infected with methicillin-susceptible or methicillin-resistant strains had similar baseline characteristics and treatment outcomes. Approximately 93% of the cases received systemic antibiotics, out of which 59 (65.5%) used oxacillin or cefalotin. Both methicillin-susceptible and methicillin-resistant S. aureus strains resulted in morbidity and death among children in this setting where methicillin-resistant strains are infrequent.

Milk may represent an important source of infectious agents to hospitalized pediatric patients. To describe the bacterial microflora isolated from the hands, stools, pharynx of all workers at milk kitchens in pediatric hospitals in the city of Salvador, Brazil, as well as in the formulas prepared by them, we carried out this cross-sectional study with all 91 workers from the 20 milk kitchens of all the public and private hospitals in Salvador, Brazil. Hand and pharynx swabs and stool samples were collected from all workers, as well as samples of the milk and formulas delivered by the kitchens. All samples were cultured for the detection of pathogenic and non-pathogenic bacteria. Pathogenic bacteria were isolated from 20 (22.0%) and 8 (8.8%) cultures of the hands and pharynx of the workers, respectively. No pathogenic bacteria were isolated from stool samples. Pathogenic bacteria were isolated from 17 (18.7%) milk samples. The prevalence of pathogenic bacteria in hand swabs was significantly higher in workers from public (37.8%) than from private (6.5%) hospitals (prevalence ratio [PR]=5.8; p<0.01). Pathogenic bacteria were isolated from two (4.4%) workers from public hospitals and six (13.0%) workers from private hospitals (PR=0.38; p=0.27). Pathogenic bacteria were isolated from 11 (24.4%) milk samples from public hospitals and 6 (13.0%) from private hospitals (PR=1.9; p=0.16). A high prevalence of contamination was found, mainly on the hands of workers on units for manipulation of milk. Preventive efforts should be intensified and focus primarily on effective hand washing and continuous work supervision.

Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days) of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases), C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each). The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC), use of parenteral nutrition support (PNS), previous exposure to antibiotics, and chronic renal failure (CRF). No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity of the underlying diseases, than as a direct consequence of Candidemia.

Pneumonia is one of the leading causes of hospitalization and death among children in developing countries, and mortality due to pneumonia has been associated with S. pneumoniae infection. This investigation was designed to describe the antimicrobial susceptibility and serotype patterns of pneumococcal strains recovered from the blood of children with community-acquired pneumonia (CAP) and to assess the clinical findings of pneumococcal bacteremic patients with pneumonia. In a 26 month prospective study, blood cultures were obtained as often as possible from children (<16 years of age) diagnosed with CAP in two emergency rooms. Antimicrobial drug susceptibility tests and serotyping were performed when pneumococcus was identified. We studied 3,431 cases and cultured blood samples from 65.5% of those. Pneumococcus was recovered from 0.8% of the blood samples. The differences in age, somnolence, wheezing and hospitalization among children with and without pneumococcal bacteremia were statistically significant. Pneumococcal bacteremia was age-related (mean 1.63 ± 1.55; median 0.92) and associated with somnolence and hospitalization among children with CAP. One strain was recovered from pleural fluid. Penicillin resistance was detected in 21.0% (4/19) of the strains at an intermediate level, whereas 63.0% of the strains were resistant to trimethoprim-sulfamethoxazole. The most common serotypes were 14 and 6B, and these serotypes included the resistant strains. Eight of our 18 isolates from blood were of types included in the heptavalent conjugate pneumococcal vaccine, recently licensed in the USA.