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14 results

  • Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

  • Juliana da Silva Oliveira, Natalie Carlos Ferreira Melo Sampaio, Gabriela Silveira Leite, Milena Aparecida Del Masso Pereira, Carlos Magno Castelo Branco Fortaleza
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 43 / Issue 11 / November 2022
    Published online by Cambridge University Press:
    14 February 2022, pp. 1575-1579
    Print publication:
    November 2022
  • Objective:

    To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems.

    Design:

    An ecological study and a cohort study.

    Setting:

    Two medical surgical intensive care units (ICUs) in inner Brazil.

    Participants:

    Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed.

    Methods:

    In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the “carbapenem pressure,” described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models.

    Results:

    The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02–0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001–1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam).

    Conclusions:

    Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population (“herd effect”-like) impact of antimicrobial use in the ICUs.

  • Two hundred days of COVID-19 in São Paulo State, Brazil

  • Gabriel Berg de Almeida, Micheli Pronunciate, Rejane Maria Tommasini Grotto, Edmur Azevedo Pugliesi, Raul Borges Guimarães, Thomas Nogueira Vilches, Renato Mendes Coutinho, Rafael de Castro Catão, Claudia Pio Ferreira, Carlos Magno Castelo Branco Fortaleza
  • Journal:
    Epidemiology & Infection / Volume 148 / 2020
    Published online by Cambridge University Press:
    02 December 2020, e295
    • Article
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  • Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analysed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission.