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A dengue, infecção caracterizada por ciclos epidêmicos que se repetem a cada 3 a 5 anos, figura como um dos problemas de maior destaque, tendo em vista sua progressiva expansão em número de casos e extensão geográfica. Em que pese sua vasta distribuição geográfica, é nas Américas e Sudeste Asiático que a doença incide de forma mais intensa. No contexto de surtos e epidemias, as infecções transmitidas pelos doadores podem representar um grande desafio devido à falta de dados, na literatura, de uma política clara para triagem dos doadores e dos possíveis desfechos indesejáveis. Casos de transmissão provável e confirmada têm sido relatados em receptores de diferentes órgãos. Embora o total de casos descritos seja pequeno, é importante considerar a possibilidade de subnotificação e o aumento substancial do risco desse evento, especialmente nos períodos em que a transmissão da dengue atinge níveis epidêmicos na população. Com base na escassa literatura, porém baseada em estratégias adotadas em outros países que já experimentaram epidemias de dengue com transmissão do vírus por meio de transplante de órgãos, a Comissão de Infecção em Transplante (COINT) da Associação Brasileira de Transplante (ABTO) sugere triagem de doadores e candidatos a transplante com o uso combinado de NS1/IgM no sangue e critérios para o aceite do doador e do candidato.

Contextualização: Desde maio de 2022, casos de monkeypox (varíola dos macacos ou mpox) foram relatados em vários países, com evidências de transmissão comunitária. No cenário atual, temos transmissão identificada em diferentes continentes, relacionada com disseminação local do vírus por contato íntimo inter-humano. Objetivo: O objetivo desse artigo é informar a comunidade transplantadora sobre as eventuais implicações da doença para a população de receptores de transplantes e seus doadores. Método: Nesse artigo apresenta-se as orientações para adequar a avaliação de doadores e de candidatos a transplantes de órgãos, tendo em vista os riscos potenciais decorrentes da emergência de mpox em nosso meio. É importante considerar que este documento reflete a opinião de especialistas diante das escassas evidências atualmente disponíveis. Resultados e Conclusões: As recomendações de manejo e avaliação do doador baseiam-se no risco potencial da transmissão do vírux MPXV. Estima-se que o risco de transmissão pelo transplante seja baixo, levando-se em conta a incerteza sobre a duração da viremia em pacientes com mpox e a presença de vírusviável em células e tecidos. Recomenda-se, no entanto, que os médicos responsáveis pelo paciente estejam alerta para as evidências de infecção e que acionem ou notifiquem as instituições caso haja indícios de transmissão pelo transplante.

Objectives: The study proposed to evaluate the quality of polymyxin B prescription in a Brazilian high-complexity public teaching and reference hospital. Methods: This study of drug use describes the medical prescription habits, with the retrospective collection carried out with critically ill patients using polymyxin B. The dose by weight for each patient's first prescription was calculated from the Infectious Diseases Society of America (IDSA) guideline to assess the loading dose adequacy. The glomerular filtration rate (GFR) was estimated to evaluate the adequacy of the dose prescribed at the onset of treatment, based on the Kidney Disease – Improving Global Outcomes (KDIGO). Results: 346 prescriptions were analyzed, representing 259 patients. Only 61 (17.6%) included a loading dose of polymyxin B. On the other hand, no adjusted doses were identified in 147 (73.1%) prescriptions for patients whose GFR range requires renal adjustment. A total of 438 cultures were analyzed, and 97 carbapenem-resistant GNB were selected for the study (22.2%). A loading dose was identified in only 13 (13.4%) of these prescriptions, and 80 (82.5%) prescriptions had no dose adjustment by renal function. The prevalent microorganism was Klebsiella pneumoniae (70 [16.0%]). Conclusion: The study identified high rates of non-compliance with the protocol for using polymyxin B concerning the loading dose and a high percentage of cases in compliance with the protocol regarding the nonindication of renal adjustment. The development of institutional clinical protocols and the performance of the ASP team are critical to rationalizing the use and avoiding unsatisfactory clinical and microbiological results.

Objective: The use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. Methods: This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). Results: From 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p = 0,005). Conclusion: It was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.

Até o momento, muito se tem discutido sobre a realização de transplantes em candidatos que apresentam resultado positivo em testes virais (por exemplo, teste de antígeno e molecular) ou exposição recente/quadro compatível com a Covid-19. Infelizmente, a literatura ainda não apresenta orientações conclusivas, e deve-se considerar o risco de complicações, de perda de enxerto e de óbito. Este documento discute esses pontos e fornece algumas premissas para fundamentar e auxiliar a decisão da equipe transplantadora.

A Covid-19 impactou fortemente os transplantes de órgãos sólidos (TOS). Os pacientes em lista de TOS e aqueles já transplantados pertencem à população prioritária para a vacinação contra a Covid-19, que tem por objetivo reduzir a morbimortalidade da Covid-19. Todas as vacinas hoje em dia utilizadas contra a Covid-19 podem ser administradas no cenário de TOS. O esquema vacinal (plataforma de fabricação, idade, número de doses, indicação de doses de reforço) varia conforme o país.vacinal (plataforma de fabricação, idade, número de doses, indicação de doses de reforço) varia conforme o país.

Introdução/objetivo: A COVID-19 é uma doença associada a quadros respiratórios agudos, que já causou a morte de mais de 4.800.000 pessoas em todo o mundo. A pressão sobre os sistemas de saúde, o aumento de internações em UTI e, consequentemente, do uso de antimicrobianos levaram a um aumento considerável nas taxas de Infecções Relacionadas à Assistência à Saúde (IRAS) e na ocorrência de microrganismos multirresistentes (MR). Este trabalho objetiva descrever o perfil de pacientes com COVID-19, internados na UTI de um hospital de referência, localizado em Belo Horizonte/MG, identificando fatores associados à ocorrência de IRAS e infecção por microrganismos MR, e o desfecho clínico desses pacientes. Métodos: Análise retrospectiva do banco de dados do Serviço de Controle de Infecção Hospitalar, contendo informações clínicas de pacientes adultos, com RT-PCR ou teste de antígeno positivos para COVID-19, internados na UTI, no período de março de 2020 a agosto de 2021. Resultados: Foram analisados 436 pacientes, sendo que a mediana de idade foi 68 anos. 352 (80,7%) pacientes necessitaram de ventilação mecânica (VM). A taxa global de letalidade por COVID-19 foi 57,8%, sendo que a letalidade até 7 dias foi 4,6%, e até 30 dias, 37,8%. 198 (45,4%) pacientes apresentaram IRAS, com letalidade de 70,7%. Infecção Primária da Corrente Sanguínea Laboratorial (IPCSL) foi a infecção mais frequente (97, 49,0%), seguida por Pneumonia Associada a Ventilação (PAV), com 59 casos, 29,8%. A mortalidade por IRAS foi 32,1%. A densidade de incidência (por 1.000 procedimentos-dia) de IPCSL associada a cateter venoso central (CVC), PAV e Infecção do Trato Urinário associada a sonda vesical de demora foram, respectivamente, 17,1, 10,1, 2,6. Entre os microrganismos multirresistentes, o mais frequente foi Klebsiella pneumoniae, seguido por Acinetobacter baumannii e Pseudomonas aeruginosa, resistentes a carbapenêmico. Houve uma associação entre infecção e o tempo de uso de CVC (20,42 × 10,16 dias, p < 0,001). Uso prévio de meropenem também se associou à infecção (p < 0,01). Conclusão: COVID-19 é uma doença de elevada letalidade. A ocorrência de IRAS contribui para os óbitos. A IPCSL é a infecção mais frequente, tornando fundamental o treinamento das equipes quanto aos cuidados na manipulação de CVC. Uso prévio de carbapenêmico associa-se à ocorrência de IRAS por microrganismos MR, sendo importante o funcionamento de programas de stewardship de antimicrobianos.

Abstract During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.

Introdução: A participação das mulheres nos diversos segmentos profissionais tem aumentado nas últimas décadas. No entanto, a transição para cargos de liderançaa apresenta algumas barreiras, de modo que planos estratégicos têm sido propostos em vários estudos. Métodos: Descrever a experiência da organização Women in Transplantation (WIT) / The Transplantation Society (TTS), fundada em 2009, nos Estados Unidos, além de analisar outros estudos que investigaram a equidade de gêneros nas diversas áreas profissionais. Resultados: A WIT vem desenvolvendo atividades durante todos os anos, após sua fundação, e estabeleceu dois pilares: (i) avançar e inspirar profissionais mulheres nas áreas do transplante; (ii) defender questões relacionadas ao sexo e gênero na área do transplante. Similarmente, os capítulos WIT australiano e neozelandês e The Initiative on Women in Science and Engineering Working Group propuseram identificar possíveis problemas de equidade de gênero, conceber e implementar estratégias e intervenções potenciais para enfrentar esses desafios e estabelecer metas realistas e alcançáveis para melhorar e facilitar a igualdade, a equidade e a diversidade de gênero no transplante. Mais de 60% das mulheres acreditam que flexibilidade no trabalho, mentoria e treinamento para liderança são aspectos chaves para o desenvolvimento da carreira profissional, além do estabelecimento de uma network robusta. Conclusão: Nosso grupo de trabalho inspirou-se nessas iniciativas e discutiu estratégias para verificar o perfil profissional das mulheres que trabalham nas diversas áreas do transplante e da doação de órgãos no Brasil. Observamos uma oportunidade para identificar possíveis barreiras durante o desenvolvimento de suas carreiras e transição para liderança. Intencionamos, portanto, fundar o Capítulo Brasileiro WIT no próximo Congresso da Associação Brasileira de Transplante de Órgãos (ABTO), em outubro de 2019, na cidade de Campinas, São Paulo, Brasil, além de propor que seja criado um comitê acessório da WIT junto à ABTO

Coagulase-negative Staphylococcus has been identified as the main nosocomial agent of neonatal late-onset sepsis. However, based on the pharmacokinetics and erratic distribution of vancomycin, recommended empirical dose is not ideal, due to the inappropriate serum levels that have been measured in neonates. The aim of this study was to evaluate serum levels of vancomycin used in newborns and compare the prediction of adequate serum levels based on doses calculated according to mg/kg/day and m2/day. This is an observational reprospective cohort at a referral neonatal unit, from 2011 to 2013. Newborns treated with vancomycin for the first episode of late-onset sepsis were included. Total dose in mg/kg/day, dose/m2/day, age, weight, body surface and gestational age were identified as independent variables. For predictive analysis of adequate serum levels, multiple linear regressions were performed. The Receiver Operating Characteristic curve for proper serum vancomycin levels was also obtained. A total of 98 patients received 169 serum dosages of the drug, 41 (24.3%) of the doses had serum levels that were defined as appropriate. Doses prescribed in mg/kg/day and dose/m2/day predicted serum levels in only 9% and 4% of cases, respectively. Statistical significance was observed with higher doses when the serum levels were considered as appropriate (p

Objective: The aim of this study was to compare two different empiric treatments for late‐onset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase‐negative Staphylococcus. Methods: A cross‐sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at‐risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program. Results: There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram‐negative bacterial or fungal infections. An increase in coagulase‐negative Staphylococcus infections was observed (p = 0.022). However, there was no measured increase in related morbidity and mortality. There was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p

Backgound and Objectives: Considering the use of active surveillance assists in infection identification and the need for studies that use Surgical Risk Index (SRI) for assessment of Surgical Site Infection (SSI) in cesareans, this study aims to determine the incidence of SSI and analyze the applicability of SRI in the prediction of SSI in women in the postpartum period after being submitted to a cesarean section at a university hospital between April 2012 and March of 2013. Methods: Prospective cohort study. Information notifying SSI by active surveillance was collected daily from the medical records. After hospital discharge, the mothers were contacted through telephone calls to identify infection criteria within 30 days after the cesarean. Descriptive and comparative analyses were performed. The chi-square test was used to compare groups. Results: 737 cesareans were performed. Telephone contact was achieved with 507 (68.8%) women up to 30 days postpartum, with loss of follow-up of 230 cases (31.2%). The medical consultation in the post-partum period occurred with 188 (37.08%) women, with whom telephone contact was obtained, on average, 17.28 days (SD=8.39) after delivery. It was verified that 21 patients met the criteria for SSI, with a 4.14% rate. A total of 12 cases (57.1%) were classified as superficial SSI, 5 (23.8%) as deep and 4 (19.1%) as infection of organs and cavities. The SRI and its risk variables were not associated with SSI in patients submitted to cesarean sections. Conclusion: The SRI and the risk variables included in this index were not associated to SSI in patients submitted to cesarean sections. KEYWORDS: Cesarean Section; Surgical Wound Infection; Epidemiological Surveillance; Infection Control; Risk Index; Disease Notification.

Background: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. Objective: To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. Methods: This case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. Results: During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). Conclusions: Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection. Keywords: Newborn intensive care units, Infection control, Surgery, Sepsis

Backgound and Objectives: Surgical wound infections (SWI) postoperative complications are common and present significant morbidity and mortality with increased time and cost of hospitalization, especially for women undergoing cesarean delivery. Therefore, the aim of this study was to evaluate risk factors for IFC in the reference in high-risk pregnancies from public Belo Horizonte. Methods: A cohort study performed in a referral Maternity - HC / UFMG, 2011-2012, with notification of SWI by active surveillance. All patients undergoing cesarean section were included and telephone contact was performed up to 30 days postpartum. The database was entered in the Statistical Package for Social Sciences. Results: We identified 708 women undergoing cesarean section and telephone contact was achieved with 487 of them during postpartum period. In 14 cases criteria for diagnosis of SWI was full filled (2.9% rate). When comparing groups of women with and without SWI, only the number of digital vaginal examination (≥ 2) was statistically significant for SWI cases. Conclusion: In the case of IFC, the average of digital vaginal examination was below reported in literature. It is emphasized that the procedure should be performed when absolutely necessary, respecting the rules of asepsis. KEYWORDS: Cesarean section. Surgical wound infection. Epidemiological surveillance. Diseases notification. Postpartum period.

Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods:This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agência Nacional de Vigilância Sanitária. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates.

OBJETIVO: Descrever a ocorrência de infecções relacionadas à assistência à saúde em uma unidade neonatal de serviço público de referência em Belo Horizonte, MG, baseando-se em critérios internacionais. MÉTODOS: Trata-se de estudo descritivo, realizado por busca ativa, na Unidade Neonatal de Cuidados Progressivos do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), de 2008 a 2009. A notificação de infecções baseou-se nos critérios do National Healthcare Safety Network (NHSN). O banco de dados e análise foi realizado em programa interno do serviço. RESULTADOS: Foram notificados 325 episódios de infecção nos recém-nascidos, com densidade de incidência de 22,8/1.000 pacientes-dia e incidência proporcional geral de infecção de 36,7%. A sepse foi a principal infecção (62,5%) notificada. A densidade de incidência de infecções foi maior em neonatos com peso menor que 750g (42,4/1.000 pacientes-dia). Observou-se 18,15 episódios de Sepse Relacionada a Cateter/1.000 Cateter Venoso Central-dia e 19,29/1.000 episódios de Sepse Relacionada a Cateter Umbilical/1.000 Cateter umbilical-dia. Em 122 (37,5%) casos de infecção notificada houve isolamento de microorganismos, predominando Staphylococcus coagulase negativo e Staphylococcus aureus (51 casos). A mortalidade e letalidade foram 4,3% e 17,12%, respectivamente. CONCLUSÃO: A utilização de critérios padronizados para notificação de infecções é necessária para a construção de indicadores em neonatologia, que são escassos no país e ressaltam a necessidade de avaliação dos critérios nacionais propostos pela Agencia Nacional de Vigilância Sanitária (ANVISA). OBJECTIVE: To describe occurence of Healthcare Related Infections in a neonatal unit of public reference service in Belo Horizonte-MG, based on international criteria. METHODS: This is a descriptive study, performed by active searching, in the Progressive Care Unit Neonatal Hospital das Clinicas, Federal University of Minas Gerais (HC / UFMG), from 2008 to 2009. Notification of infections was based on National Healthcare Safety Network (NHSN) criteria. The database and analysis were performed in a internal program. RESULTS: A total of 325 episodes of infection in newborns were notified and overall incidence density of infections was 22.8/1,000 patient-days, with a rate of 36.7% of newborns. Sepsis was the main infection (62.5%) reported. The incidence density of infections was higher in neonates weighing lower than 750g (42.4/1,000 patient-days). There were 18.15 episodes of central venous catheter related sepsis/1,000 central venous catheter-day and 19.29 umbilical catheter related sepsis /1,000 umbilical catheter-days. Microorganisms were isolated in 122 (37.5%) cases of reported infections, mainly defined as Staphylococcus coagulase negative and Staphylococcus aureus (51 cases). Mortality and lethality rates were 4.3% and 17,12%, respectively. CONCLUSION: The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA).

OBJECTIVE: The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. METHODS: A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. RESULTS: One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-riskhad a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5)vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. CONCLUSION: Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.

OBJETIVO: Comparar quatro métodos laboratoriais no diagnóstico de tuberculose pulmonar. MÉTODOS: Foram realizadas pesquisa direta pelas colorações de Ziehl-Neelsen e auramina, cultura para micobactérias em meio Löwenstein-Jensen (LJ) e polymerase chain reaction (PCR, reação em cadeia da polimerase) para Mycobacterium tuberculosis em 160 amostras de secreção respiratória de pacientes com suspeita de tuberculose pulmonar. As cepas isoladas foram identificadas por método radiométrico utilizando-se p-nitro-alfa-acetilamino-beta-hidroxipropiofenona (NAP) e métodos clássicos. A sensibilidade dos métodos foi comparada com o padrão ouro para o diagnóstico da tuberculose pulmonar, definido por critérios clínicos, radiológicos e microbiológicos. RESULTADOS: Dos 160 pacientes, 142 foram diagnosticados com tuberculose pulmonar de acordo com o padrão ouro. As técnicas de Ziehl-Neelsen e auramina, cultura em meio LJ e PCR apresentaram sensibilidade de 54,2%, 58,4%, 67,6% e 77,5%, respectivamente, quando comparados ao critério diagnóstico adotado. A especificidade dos quatro métodos foi de 100%. A concordância na identificação da micobactéria entre PCR e o método radiométrico utilizando NAP foi alta (96,8%). A sensibilidade da PCR foi de 50,8% nas amostras com baciloscopia negativa e de 98,8% naquelas com baciloscopia positiva. Nas amostras com resultados negativos na baciloscopia e cultura, a sensibilidade da PCR foi menor que nas com resultados positivos (25,6% e 99,0%, respectivamente). CONCLUSÕES: A PCR é método promissor no diagnóstico da tuberculose pulmonar, mesmo em amostras paucibacilares. Além disso, apresenta a vantagem da identificação simultânea e rapidez do resultado.OBJECTIVE: To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. METHODS: Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen and auramine staining. In addition, culture in Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR) were used. The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. RESULTS: Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture in LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). CONCLUSIONS: We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.

OBJETIVO: A infecção do sítio cirúrgico constitui um grave problema dentre as infecções hospitalares por sua incidência, morbidade e mortalidade. Devido ao curto período de internação, a maioria dessas infecções se manifesta após a alta hospitalar, sendo subnotificada quando não há o seguimento do paciente cirúrgico. Programas de vigilância específicos do paciente após a alta são considerados fundamentais para controlar as infecções. O objetivo do estudo foi determinar a incidência de infecção do sítio cirúrgico e comparar sua freqüência durante a internação e após a alta. MÉTODOS: Realizou-se um estudo epidemiológico, tipo coorte, em um hospital universitário, com acompanhamento durante o período de internação e no seguimento pós-alta hospitalar, de 504 pacientes que se submeteram à cirurgia do aparelho digestivo no primeiro semestre de 2000. RESULTADOS: Das 504 cirurgias realizadas no período do estudo, 398 (79,0%) dos pacientes retornaram ao ambulatório de egressos. Do total de infecções do sítio cirúrgico diagnosticadas, a maioria (62,9%) foi notificada no ambulatório de egressos, sendo 88,0% superficiais, e 67,0% notificadas até o sétimo dia após a alta. CONCLUSÕES: Comprovou-se a importância do seguimento pós-alta para a obtenção de dados fidedignos sobre as infecções do sítio cirúrgico devido à manifestação tardia na maioria dos casos, levando a subnotificação quando o seguimento do paciente é realizado somente durante a internação.OBJECTIVE: Surgical wound infection (SWI) is a serious hospital infection due to its incidence, morbidity and mortality. Because of the short hospital stay, the majority of SWI appears post-discharge, and its incidence is often underreported when there is no follow-up of the surgical patient post discharge. The need of a surveillance system for surgical patient after discharge is critical for infection control. The study objective was to determine the incidence of SWI in surgical patients and to compare the frequency of SWI diagnosed in-hospital and after discharge. METHODS: A prospective cohort study was carried out in a university hospital. Patients admitted to the general surgery unit (504) and underwent digestive tract surgery in the first semester of the year 2000 were followed up during their hospital stay and after discharge. RESULTS: Of 504 surgical patients, 398 (79.0%) returned to follow up in the post discharge outpatient clinic. Of the total surgical wound infections diagnosed, most (62.9%) was detected in the post discharge outpatient clinic, and 88% of SWI diagnosed were classified as superficial, and 67% reported up to day 7 after discharge. CONCLUSIONS: This study showed the importance of following up surgical patients after discharge to achieve reliable incidence data on surgical wound infection because of the late occurrence of infection in the majority of cases, which results in underreporting when the patient is followed up only during the hospital stay.

The management of tuberculosis (TB) in candidates and recipients of solid organs poses several challenges. Among them, TB diagnosis is often delayed by the atypical presentation of the disease and difficulties related to the anti-TB drugs toxicity and the interaction with immunosuppressive drugs. This review includes relevant articles published in the last 20 years and also takes into account the current Brazilian recommendations for the diagnosis and therapeutic management of TB in solid organ transplant (SOT) recipients. It also attempts to provide useful recommendations to assist physicians as to the patient care, and presents the main limitations for a better approach upon considering the Brazilian scenario.

Abstract Objective: The aim of this study was to compare two different empiric treatments for late-onset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase-negative Staphylococcus. Methods: A cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at-risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program. Results: There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram-negative bacterial or fungal infections. An increase in coagulase-negative Staphylococcus infections was observed (p = 0.022). However, there was no measured increase in related morbidity and mortality. There was a reduction in the median number of days of treatment with oxacillin from 11.5 to 6 days (p < 0.001) and an increase of one day in the median number of days of treatment with vancomycin (p = 0.046). Conclusions: Modification of the empiric treatment regimen for neonatal late-onset sepsis with use of oxacillin showed a significant reduction in S. aureus infections, as well as a reduction in the frequency of infections with major organ system involvement and mortality due to infection with this microorganism. As a result, oxacillin can be considered as an effective treatment for late-onset sepsis, making it possible to avoid broad-spectrum antibiotics.

Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

OBJETIVO: A infecção do sítio cirúrgico constitui um grave problema dentre as infecções hospitalares por sua incidência, morbidade e mortalidade. Devido ao curto período de internação, a maioria dessas infecções se manifesta após a alta hospitalar, sendo subnotificada quando não há o seguimento do paciente cirúrgico. Programas de vigilância específicos do paciente após a alta são considerados fundamentais para controlar as infecções. O objetivo do estudo foi determinar a incidência de infecção do sítio cirúrgico e comparar sua freqüência durante a internação e após a alta. MÉTODOS: Realizou-se um estudo epidemiológico, tipo coorte, em um hospital universitário, com acompanhamento durante o período de internação e no seguimento pós-alta hospitalar, de 504 pacientes que se submeteram à cirurgia do aparelho digestivo no primeiro semestre de 2000. RESULTADOS: Das 504 cirurgias realizadas no período do estudo, 398 (79,0%) dos pacientes retornaram ao ambulatório de egressos. Do total de infecções do sítio cirúrgico diagnosticadas, a maioria (62,9%) foi notificada no ambulatório de egressos, sendo 88,0% superficiais, e 67,0% notificadas até o sétimo dia após a alta. CONCLUSÕES: Comprovou-se a importância do seguimento pós-alta para a obtenção de dados fidedignos sobre as infecções do sítio cirúrgico devido à manifestação tardia na maioria dos casos, levando a subnotificação quando o seguimento do paciente é realizado somente durante a internação.