Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

In recent years, there has been a great advancement in technology for wireless communication. This facilitates the availability of devices using Bluetooth and Wi-Fi that allows other devices to exchange information and actions. Consequently, the paradigm of pervasive computing is increasingly present in several areas assisting to conduct various types of activities. Healthcare is one of the important sectors that benefits from this paradigm. The clinical monitoring associated with the control of Electronic Health Record from patients has the potential to offer better care for their health and improve their everyday life. This chapter presents a study about the use of the pervasive computing paradigm for health care through the development of a multiplatform tool for mobile devices.

Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides and polymyxin B, and significant increases for penicillins, and tigecycline.Conclusions: In general, the intervention of infectious diseases specialistsin intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

Objetivo: O estudo tem como objetivo descrever o perfil microbiano dos internos em Unidade de Tratamento de Queimados (UTQ) do Hospital de Urgência de Sergipe (HUSE) em resposta à implementação do Plano de Capacidade Plena (PCP) entre novembro de 2021 e março de 2022 em comparação com o apresentado pela mesma unidade de janeiro de 2020 a outubro de 2021, quando não haviam pacientes PCP. Método: Trata-se de um estudo retrospectivo, descritivo, com abordagem quantitativa, sendo realizada a análise de dados através dos prontuários existentes na UTQ do HUSE, com foco no perfil de infecção microbiana dos pacientes internados no período de novembro de 2021 e março de 2022. Resultados: Foram avaliados 298 prontuários, sendo 290 provenientes de pacientes queimados e 8 de pacientes não queimados remanejados para a unidade. Desses, foram feitas 47 coletas de culturas, com presença de 43 bactérias (91,5%) e 4 fungos (8,5%). No comparativo entre os dois grupos estudados, o microrganismo mais prevalente no período sem o PCP foi a Acinetobacter baumannii complex (38,2%) e a Stenotrophomonas maltophilia prevaleceu (30,8%) no grupo exposto por 5 meses ao plano, destacando-se a detecção de fungos como Candida tropicalis (7,7%) e Trichosposon asahii (7,7%) Conclusão: Apesar de se tratar de um estudo com amostragem baixa, é possível perceber uma mudança de padrão no perfil microbiano da unidade, abrindo espaço para bactérias e fungos oportunistas mais resistentes aos antibióticos tradicionalmente utilizados na unidade.

Objetivo: definir a prevalência e as características dos principais patógenos associados a infecções nos pacientes da Unidade de Tratamento de Queimados (UTQ) do Hospital de Urgências de Sergipe (HUSE) no período de 2015 a 2019. Método: Trata-se de um estudo retrospectivo, descritivo, com abordagem quantitativa, referente à análise de dados através dos registros realizados pela equipe de Cirurgia Plástica da Unidade de Tratamento de Queimados do HUSE com foco para as informações epidemiológicas e etiológicas das infecções dos pacientes nessa unidade no período de janeiro de 2015 a dezembro de 2019, o que totalizou a análise de 991 registros. Resultados: Foram analisados 991 prontuários. Houve maior prevalência do público adulto (média de 22,9 anos), do gênero masculino (59,4%), com queimaduras de médio porte (71,1%) e segundo grau (88,2%). 82 pacientes apresentaram o resultado positivo nas culturas. O microrganismo mais encontrado em todas as faixas etárias foi o Acinetobacter baumannii, exceto nos idosos, que foi a Pseudomonas aeruginosa. O sítio mais comumente infectado foi a corrente sanguínea e o tempo médio de internamento foi de 13,2 dias estando o aumento desse tempo relacionado com o aparecimento de microrganismos mais potencialmente lesivos. Foram registrados 64 óbitos, dos quais 22 apresentaram culturas positivos e em 20,3% desses casos o Acinetobacter baumannii esteve presente. Conclusão: O perfil epidemiológico do paciente queimado relaciona-se diretamente com o tipo de microrganismo colonizador.