OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, extra length of stay, and attributable mortality in intensive care units (ICUs) in three Brazilian hospitals that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in five ICUs in three city hospitals in Brazil by applying the definitions of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS). RESULTS: Between April 2003 and February 2006, 1 031 patients hospitalized in five ICUs for an aggregate 10 293 days acquired 307 DAIs, a rate of 29.8% or 29.8 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 20.9 per 1 000 ventilator-days; the rate for central venous catheter-associated bloodstream infections (CVC-BSI) was 9.1 per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 9.6 per 1 000 catheter-days. Ninety-five percent of all Staphylococcus aureus DAIs were caused by methicillin-resistant strains. Infections caused by Enterobacteriaceae were resistant to ceftriaxone in 96.7% of cases, resistant to ceftazidime in 79.3% of cases, and resistant to piperacillin-tazobactam in 85.7% of cases. Pseudomonas aeruginosa DAIs were resistant to ciprofloxacin in 71.3% of cases, resistant to ceftazidime in 75.5% of cases, and resistant to imipenem in 27.7% of cases. Patients with DAIs in the ICUs of the hospitals included in this study presented extra mortality rates of 15.3% (RR 1.79, P = 0.0149) for VAP, 27.8% (RR 2.44, P = 0.0004) for CVC-BSI, and 10.7% (RR 1.56, P = 0.2875) for CAUTI. CONCLUSION: The DAI rates were high in the ICUs of the Brazilian hospitals included in this study. Patient safety can be improved through the implementation of an active infection control program comprising surveillance of DAIs and infection prevention guidelines. These actions should become a priority in every country.

OBJETIVOS: Determinar las tasas de infección asociadas a aparatos (IAA), los perfiles microbiológicos, la resistencia bacteriana, la estancia hospitalaria adicional y la mortalidad atribuible en las unidades de cuidados intensivos (UCI) de tres hospitales brasileños miembros de la Comunidad Científica Internacional de Control de Infecciones Nosocomiales (INICC). MÉTODOS: Se realizó una vigilancia prospectiva de cohorte de las IAA en cinco UCI de tres hospitales urbanos de Brasil, según las definiciones del Sistema Nacional de Vigilancia de Infecciones Nosocomiales de los Centros para el Control y la Prevención de Enfermedades (CDC-NNIS) de los Estados Unidos de América. RESULTADOS: Entre abril de 2003 y febrero de 2006 se hospitalizaron 1 031 pacientes en las cinco UCI estudiadas, con un total de 10 293 días en los que se adquirieron 307 IAA, para una tasa de 29,8% (29,8 IAA por 1 000 días-UCI). Las tasas fueron: de 20,9 casos por 1 000 días-ventilador en neumonía asociada a respiradores (NAR); de 9,1 por 1 000 días-catéter en infecciones circulatorias asociadas con cateterismo venoso central (IC-CVC); y de 9,6 por 1 000 días-catéter en infecciones urinarias asociadas con el uso de catéteres (IUAC). De las IAA causadas por Staphylococcus aureus, 95% se debieron a cepas resistentes a la meticilina. De las infecciones causadas por Enterobacteriaceae, 96,7% fueron resistentes a la ceftriaxona, 79,3% a la ceftazidima y 85,7% a la combinación piperacilina-tazobactam. De las IAA causadas por Pseudomonas aeruginosa, 71,3% resultaron resistentes a la ciprofloxacina, 75,5% a la ceftazidima y 27,7% al imipenem. Los pacientes con IAA en las UCI estudiadas presentaron tasas de mortalidad adicional de 15,3% (riesgo relativo [RR] = 1,79; P = 0,0149) por NAR, 27,8% (RR = 2,44; P = 0,0004) por IC-CVC y 10,7% (RR = 1,56; P = 0,2875) por IUAC. CONCLUSIONES: Las tasas de IAA en las UCI de los hospitales brasileños estudiados fueron elevadas. Se puede mejorar la seguridad de los pacientes mediante la implementación de un programa de control activo de las infecciones, que contemple la vigilancia de las IAA y directivas para la prevención de las infecciones. Estas acciones deben ser una prioridad en todos los países.

INTRODUÇÃO: O número de casos notificados de tétano acidental no Estado de São Paulo sofreu redução. O declínio do número de casos de qualquer doença sempre traz transformações no seu perfil epidemiológico, que devem sempre ser analisadas para aprimorar as medidas preventivas. Assim, foi analisado o perfil clínico e epidemiológico dos casos de tétano internados em hospital universitário de Campinas de 1989 a 1996. MATERIAL E MÉTODO: Estudo descritivo e retrospectivo (série de casos). Todos os pacientes com diagnóstico de tétano de janeiro de 1989 a março de 1996, internados no hospital universitário, foram analisados. RESULTADOS: Catorze (28%) eram da zona rural e 36 (72%) da zona urbana. A idade média foi de 47,6 anos e a mediana de 49,5. Dos pacientes da zona rural, 42,8% tinham até 30 anos e 21,42% tinham mais de 50 anos, sendo a média 36,21 e a mediana 34,5; dos pacientes da zona urbana, 13,9% tinham até 30 anos e 58,3% mais de 50 anos, sendo a média de 52,2 e a mediana de 54,5. A letalidade foi de 20%, mais elevada nos pacientes curarizados (60%). CONCLUSÃO: Na região estudada existem dois padrões epidemiológicos: o rural, com maior número de jovens, refletindo uma vacinação inadequada, e o urbano, semelhante ao dos países desenvolvidos, com predomínio das faixas etárias mais altas.

INTRODUCTION: Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY: A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS: In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION: A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS: There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.

INTRODUÇÃO: O número de casos notificados de tétano acidental no Estado de São Paulo sofreu redução. O declínio do número de casos de qualquer doença sempre traz transformações no seu perfil epidemiológico, que devem sempre ser analisadas para aprimorar as medidas preventivas. Assim, foi analisado o perfil clínico e epidemiológico dos casos de tétano internados em hospital universitário de Campinas de 1989 a 1996. MATERIAL E MÉTODO: Estudo descritivo e retrospectivo (série de casos). Todos os pacientes com diagnóstico de tétano de janeiro de 1989 a março de 1996, internados no hospital universitário, foram analisados. RESULTADOS: Catorze (28%) eram da zona rural e 36 (72%) da zona urbana. A idade média foi de 47,6 anos e a mediana de 49,5. Dos pacientes da zona rural, 42,8% tinham até 30 anos e 21,42% tinham mais de 50 anos, sendo a média 36,21 e a mediana 34,5; dos pacientes da zona urbana, 13,9% tinham até 30 anos e 58,3% mais de 50 anos, sendo a média de 52,2 e a mediana de 54,5. A letalidade foi de 20%, mais elevada nos pacientes curarizados (60%). CONCLUSÃO: Na região estudada existem dois padrões epidemiológicos: o rural, com maior número de jovens, refletindo uma vacinação inadequada, e o urbano, semelhante ao dos países desenvolvidos, com predomínio das faixas etárias mais altas.

INTRODUCTION: Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY: A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS: In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION: A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS: There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.