Introduction: Surveillance of nosocomial infections (NIs) is an essential part of quality patient care; however, there are few reports of National Healthcare Safety Network (NHSN) surveillance in neonatal intensive care units (NICUs) and none in developing countries. The purpose of this study was to report the incidence of NIs, causative organisms, and antimicrobial susceptibility patterns in a large cohort of neonates admitted to the NICU during a 16-year period. Methods: The patients were followed 5 times per week from birth to discharge or death, and epidemiological surveillance was conducted according to the NHSN. Results: From January 1997 to December 2012, 4,615 neonates, representing 62,412 patient-days, were admitted to the NICU. The deviceassociated infection rates were as follows: 17.3 primary bloodstream infections per 1,000 central line-days and 3.2 pneumonia infections per 1,000 ventilator-days. A total of 1,182 microorganisms were isolated from sterile body site cultures in 902 neonates. Coagulase-negative staphylococci (CoNS) (34.3%) and Staphylococcus aureus (15.6%) were the most common etiologic agents isolated from cultures. The incidences of oxacillin-resistant CoNS and Staphylococcus aureus were 86.4% and 28.3%, respectively. Conclusions:The most important NI remains bloodstream infection with staphylococci as the predominant pathogens, observed at much higher rates than those reported in the literature. Multiresistant microorganisms, especially oxacillin-resistant staphylococci and gram-negative bacilli resistant to cephalosporin were frequently found. Furthermore, by promoting strict hygiene measures and meticulous care of the infected infants, the process itself of evaluating the causative organisms was valuable.

Introduction. Bloodstream infection is one of the most frequent and challenging hospital-acquired infections and it is associated with high morbidity, mortality and additional use of healthcare resources. Hypothesis/Gap Statement: Bloodstream infections have consequences for the patient, such as the evolution to mortality and inappropriate empirical antibiotic prescription, especially when caused by multidrug-resistant Gram-negative bacilli. Objective. To assess the impact of bloodstream infection and the status of multidrug resistance (MDR) in the evolution of patients who received inappropriate initial antibiotic therapy. Methods. A retrospective surveillance was conducted on nosocomial bloodstream infections caused by Gram-negative bacilli (GNB) from January 2012 to December 2018 in an adult intensive care unit of a Brazilian tertiary teaching hospital. Results. We identified 270 patients with GNB nosocomial bacteremia. Non-survivors were older (with an average age of 58.8 years vs 46.9 years, P=<0.0001), presented more severe illnesses, were immunosuppressed (73.7 vs 37.6%, P=<0.0001), were more likely to have septic shock (55.8 vs 22.4%, P=<0.0001) and had an increased usage of mechanical ventilators (98.6 vs 89.6%, P=0.0013) than survivors. In a logistic regression model, inappropriate empirical antibiotic therapy was not an independent predictor of mortality, different from mechanical ventilator (P=<0.0001; OR=28.0; 95% CI=6.3–123.6), septic shock (P=0.0051; OR=2.5; 95% CI=1.3–4.9) and immunosuppression (P=0.0066; OR=2.6; 95% CI=1.3–5.2). In contrast, in a separate model, MDR was strongly associated with the prescription of inappropriate initial antibiotic therapy (P=0.0030; OR=5.3; 95% CI=1.7–16.1). The main isolated pathogens were Acinetobacter baumannii (23.6 %) and Klebsiella pneumoniae (18.7 %). The frequency of MDR organisms was high (63.7 %), especially among non-fermenting bacilli (60.9 %), highlighting A. baumannii (81.6 %) and Pseudomonas aeruginosa (41.8 %). Conclusion. Illness severity (septic shock and immunosuppression) and mechanical ventilation were identified as predictors of mortality. Additionally, MDR was a major determinant of inappropriate antibiotic empirical therapy, but not associated with mortality, and both characteristics were not statistically associated with death.

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Á Deus, que foi meu porto seguro, iluminou meus passos e permitiu que eu chegasse ao fim de mais uma etapa com sucesso.A todos os amigos do Hospital de Clínicas de Uberlândia que acompanharam e minha trajetória com palavras de incentivo.A todos os colegas e alunos da Gestão de Segurança em Saúde (Setores de Processos, Auditoria e Controle Ambiental do HCU-UFU) que torceram por mim, em especial,Vitor, Elza, Elisandro e Caio que participaram e me auxiliaram nesta conquista.A minha família, meu esposo Adalberto, pela paciência, compreensão e tolerância em todas as minha ausências, as minha filhas, Simone, pela parceria, confiança e compartilhamento de conhecimentos, Suzanne, pela generosidade, desprendimento e colaboração nas minha ausências, e Sarah, que confiou em mim e sempre acreditou que eu sou vencedora, e aos meus genros que comemoraram comigo esta conquista.As minhas irmãs, Maria e Expedita e todos os sobrinhos que acreditaram e torceram por mim. Aos colegas doServiço de Controle de Infecção Hospitalar do HCU da UFU, Astrídia, Jane, Pâmela, Roger, Simone, Jaqueline, Samuel e Henrique, que contribuíram de forma especial para o alcance deste objetivo. Aos meus orientadores, Prof. Dr. Paulo P. Gontijo e Profª Dra. Rosineide Marques Ribas, pelos ensinamentos, durante o tempo que passei no ICBIM. Obrigada pela dedicação e pela oportunidade de aprendizado. Foram fundamentais, sem estes mestres talvez este trabalho não existisse. Aos novos colegas do Laboratório de Microbiologia Molecular (UFU), Luiz Gustavo, Paola, Iara, Sabrina, Bruna e Melina, pela paciência, cortesia, respeito e colaboração. As técnicas Laboratório de Microbiologia Molecular (MICROMOL-UFU), Cristiane e Lícia, pelo apoio participação especial nesta minha jornada. As secretárias do curso de Pós-Graduação de Ciências da Saúde, Gisele e Viviane, pela atenção e cordialidade. Aos colegas da Tecnologia de Informações do HC da UFU, representados pelos coordenadores, Marcos e Galeno, que me auxiliaram nos momentos decisivos. Aos colegas do Setor de Faturamento do HCU da UFU, Marilson e Wanderson, pela generosidade, atenção e presteza. Aos colegas da Biblioteca do HCU, Shirley e Vilmar pela atenção, cortesia, e cordialidade. E a todos que torceram por mim e de uma forma ou de outra contribuiram para que alcançasse mais este degrau em minha carreira profissional, meus sinceros agradecimentos. A Fundação de Amparo á Pesquisa do Estado de Minas Gerais (FAPEMIG), pelo suporte financeiro na confecção de material didático para congressos. Obrigada a todos! "A mente que se abre a uma nova ideia jamais volta ao seu tamanho original". Albert Einstein RESUMO Introdução: As infecções de corrente sanguínea (ICS) em pacientes de Unidades de Terapia Intensiva (UTI) representam um desafio em hospitais de países em desenvolvimento, como o Brasil, principalmente pela participação expressiva de bactérias resistentes aos antimicrobianos. Objetivos: Analisar os indicadores de incidência de Infecções Relacionadas á Assisitência á Saúde-IRAS e ICS, sua etiologia, fenótipos re...

Introduction: Infections, mainly bloodstream infections (BSI), acquired in the intensive care unit (ICU) are associated with significant rates of morbidity and mortality, especially when caused by pathogens. The objectives the study were to determine risk factors and mortality rates in 30 days for patients with BSI caused by microorganisms resistant versus microorganisms susceptible to antimicrobials. Methods: A case-vs-control study was carried out, in which patients were identified with BSI acquired in the ICU. Control patients were paired, considering: age, acute mean severity classification (ASIS), and chronic disease scores, Charlson's Comorbidity Index (CHARLSON) both ≥ 3. Results: Retrospective cohort study of 531 patients, 254 with bloodstream infection (BSI), and 277 uninfected controls during hospital stay. Of those infected, 181 presented multidrug-resistant isolates (MDR) and 73, isolates susceptible to antibiotics. The univariate analysis showed statistically significant frequencies for BSIs, when compared with controls, of isolates resistant to multiple drugs and susceptible. There was also significance in the mortality rate among patients with resistant and susceptible pathogens (40.3% vs 34.2%, P<0.05). Multivariate analysis showed that only trauma and previous use of antibiotics were independent risk factors for BSIs in critically ill patients with infection, both by MDR and antibiotic-sensitive isolates. Conclusion: Mortality and bacteremia were higher in BSIs due to antibiotic-resistant isolates in a cohort of intensive care patients. The lack of financial and human resources results in multiple barriers in developing countries like Brazil and the prevention of these infections becomes a major challenge.