Coronaviruses belong to a large family of viruses and, for 60 years, have been a known cause of respiratory infection in humans and animals. In December 2019, a novel coronavirus was identified as responsible for the flu syndrome and severe pulmonary complications, the COVID-19. Its origin, still uncertain, is probably related to a mutation in the coronavirus that infects bats, breaking the genetic barrier to adapt to a new species. The original site of transmission was a seafood and live animal market in the city of Wuhan, China. The first cases were linked to individuals who frequented this market. Later, the virus infected family members and, in geometrical progression, nearby provinces, expanding to several countries in all continents.

Os coronavírus pertencem a uma grande família viral e são conhecidos há 60 anos como causadores de infecções respiratórias em humanos e animais. Em dezembro de 2019, um novo coronavírus foi identificado como causador de síndrome gripal e graves complicações pulmonares, a COVID-19. A origem, ainda incerta, está provavelmente relacionada a uma mutação do coronavírus que infecta morcegos, quebrando a barreira genética para conseguir se adaptar a uma nova espécie. O local inicial de transmissão foi um mercado de frutos do mar e animais vivos na cidade de Wuhan, China. Os primeiros casos foram de indivíduos frequentadores desse mercado. Posteriormente o vírus foi transmitido para familiares e, em progressão geométrica, para províncias próximas, expandindo-se para diversos países de todos os continentes.

INTRODUCTION: Enterobacteriaceae strains are a leading cause of bloodstream infections (BSI). The aim of this study is to assess differences in clinical outcomes of patients with BSI caused by Enterobacteriaceae strains before and after introduction of an automated microbiologic system by the microbiology laboratory. METHODS: We conducted a retrospective cohort study aimed to evaluate the impact of the introduction of an automated microbiologic system (Phoenix(tm) automated microbiology system, Becton, Dickinson and Company (BD) - Diagnostic Systems, Sparks, MD, USA) on the outcomes of BSIs caused by Enterobacteriaceae strains. The study was undertaken at Hospital São Paulo, a 750-bed teaching hospital in São Paulo, Brazil. Patients with BSI caused by Enterobacteriaceae strains before the introduction of the automated system were compared with patients with BSI caused by the same pathogens after the introduction of the automated system with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. RESULTS: We evaluated 90 and 106 patients in the non-automated and automated testing periods, respectively. The most prevalent species in both periods were Klebsiella spp. and Proteus spp. Clinical cure/improvement occurred in 70% and 67.9% in non-automated and automated period, respectively (p=0.75). 14-day mortality rates were 22.2% and 30% (p=0.94) and 28-day mortality rates were 24.5% and 40.5% (p= 0.12). There were no significant differences between the two testing periods with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. CONCLUSIONS: Introduction of the BD Phoenix(tm) automated microbiology system did not impact the clinical outcomes of BSIs caused by Enterobacteriaceae strains in our setting.

The nosocomial transmission of tuberculosis is a serious occupational health problem. An effective prevention of this disease includes environmental measures to avoid its dissemination and to reduce the amount of droplet nuclei in the air. It is a descriptive study that aimed to describe the necessary structure for the implementation of an isolation room with negative air pressure for patients with tuberculosis. The units were projected with HVAC system with temperature control at 22 ± 2ºC, air recirculation system, HEPA filters, twenty two air changes per hour and negative air pressure. After repairs and the implementation of the environmental control the functioning of the respiratory isolation was monitored for 12 months. In the event of the negative air pressure becoming neutral the manometers in the room would display the filters saturation level and the need for their replacement. Soon after that the negative air pressure could be restarted. The isolation unit implementation required an investment of US$ 75,000.00 being the monthly repair cost US$ 550.00. The respiratory isolation unit requires specific management strategies so as to ensure the protection of healthcare workers and patients.

La transmisión intrahospitalaria de la tuberculosis es un problema de salud en el trabajo y las medidas efectivas de control incluyen controles ambientales destinados a prevenir la diseminación de la enfermedad y reducir la cantidad de partículas infecciosas en el aire. Este estudio se realizó con el objetivo de describir la estructura necesaria para implementar y operar una unidad de aislamiento para la tuberculosis con presión de aire negativa. La unidad fue diseñada con un sistema de climatización con control de temperatura de 22 ± 2 º C, recirculación del aire, filtros HEPA, veinte cambios de airepor horaypresión negativa. Después del proceso de reforma e implementación de los controles ambientales, el funcionamiento del aislamiento respiratorio fue monitoreado durante doce meses. Las ocasiones en que la presión negativa se convirtió en neutra fueron identificadas por manómetros en las habitaciones y en los filtros, señalando saturación y necesidad de sustitución. En seguida, la presión negativa fue restablecida. La inversión para instalar el aislamiento fue de U$S 75.000,00 y el costo de mantenimiento mensual es de U$S 550,00. La unidad requiere estrategias de gestión adecuadas para garantizar la protección de los profesionales de la salud y de los pacientes.

A transmissão intra-hospitalar da tuberculose consiste em um problema de saúde ocupacional, e as medidas de controle efetivas incluem os controles ambientais que visam prevenir a disseminação dessa doença e reduzir as partículas infecciosas aéreas.Trata-se de um estudo descritivo, realizado com o objetivo de descrever a estrutura necessária para implantar e operacionalizar uma unidade de isolamento para tuberculose com pressão negativa do ar. A unidade foi projetada com um sistema de climatização com controle de temperatura de 22 ± 2ºC, recirculação do ar, filtragem HEPA, 20 trocas de ar por hora e pressão negativa. Após a reforma da unidade e a implantação dos controles ambientais, o funcionamento do isolamento respiratório foi monitorizado por 12 meses. As ocasiões em que a pressão negativa se tornou neutra foram identificadas pelos manômetros nos quartos e nos filtros, indicando a saturação deles e sua substituição. Em seguida, a pressão negativa foi restabelecida. O investimento para a implantação do isolamento foi de 75 mil dólares e o custo mensal de manutenção, 550 dólares. A unidade requer gerenciamento apropriado para assegurar a proteção dos profissionais da saúde e demais pacientes.

INTRODUÇÃO: Pseudomonas aeruginosa é uma importante causa de pneumonia associada à ventilação mecânica (PAV) e exibe altas taxas de resistência a vários antimicrobianos. Os carbapenens são usualmente as drogas de escolha para esse microorganismo. Contudo, a resistência a carbapenens tem crescido entre essas amostras em todo o mundo. A presença de metalo- β-lactamase (MBL) tem sido apontado como um importante mecanismo de resistência nessas cepas. Nenhum estudo prévio avaliou desfechos clínicos de infecções respiratórias causadas por essas amostras MÉTODOS: Nosso grupo analisou a epidemiologia e evolução clínica de episódios de PAV causada por P. aeruginosa resistente a imipenem. Um total de vinte e nove isolados clínicos de Pseudomonas aeruginosa resistente a carbapenem foram avaliados quanto à presença de genes para metalo-β-lactamase (MBL). RESULTADOS: Variáveis clínicas e demográficas foram similares entre o grupo produtor de SPM-1 e o não-produtor. Cinco (17,2%) isolados foram positivos para blaSPM-1. Nenhum outro gene para MBL foi encontrado. Todos os pacientes foram tratados com polimixina B. A mortalidade relacionada à infecção foi de 40% e 50% respectivamente para os isolados produtores de SPM-1 e não-produtores de SPM-1. CONCLUSÕES: Nao houve diferença entre os dados epidemiológicos e a evolução clínica entre os dois grupos.

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.

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 São 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.

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.

O objetivo do estudo foi descrever os eventos adversos clínicos e laboratoriais secundários ao uso dos agentes anti-retrovirais em indivíduos submetidos à quimioprofilaxia. Foram avaliados 37 funcionários de um hospital universitário submetidos à quimioprofilaxia com quatro esquemas de medicação anti-retroviral após exposição ocupacional a fluidos de pacientes contaminados com infecção pelo vírus da imunodeficiência humana. Trinta e dois (86,5%) desenvolveram eventos adversos clínicos ou laboratoriais. A profilaxia teve que ser suspensa em dois profissionais (5,4%) em virtude das reações ocorridas. Os eventos adversos relacionados à quimioprofilaxia para infecção por HIV em funcionários de saúde, vítimas de acidente ocupacional foram freqüentes. Porém, raramente foi necessário retirar a medicação anti-retroviral.

The objective of the study was to describe adverse events detected clinically or in the laboratory that were secondary to the use of antiretroviral agents among individuals undergoing antiretroviral prophylaxis. Evaluations were performed on 37 teaching hospital employees who underwent prophylaxis using four regimens of antiretroviral medication following occupational exposition to contaminated fluids from patients with human immunodeficiency virus infection. Thirty-two (86.5%) developed adverse events detected clinically or in the laboratory. The prophylaxis administered to two professionals (5.4%) had to be suspended because of the reactions that occurred. Adverse events relating to prophylaxis for HIV infection in health care workers who were victims of occupational accidents were frequent. However, it was rarely necessary to withdraw the antiretroviral medication.