Navegando por Palavras-chave "Surgical Wound Infection"
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- ItemAcesso aberto (Open Access)Avaliação das infecções de sítio cirúrgico e do trato urinário em pacientes submetidos a transplante simultâneo de rim-pâncreas(Universidade Federal de São Paulo (UNIFESP), 2008) Perdiz, Luciana Baria [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetivos: 0 estudo procurou determinar os fatores de risco associados a infeccao de sitio cirurgico e do trato urinario pos-transplante simultaneo de rim-pancreas. Foi tambem estudada a incidencia de infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes e os principais patogenos causadores destas infeccoes. Metodo: 0 estudo foi realizado no Hospital São Paulo, hospital terciario de ensino da Universidade Federal de São Paulo. 0 estudo utilizou uma coorte de pacientes que incluiu todos os pacientes que realizaram transplante simultaneo de rim-pancreas no periodo de 01 de dezembro de 2000 a 31 de dezembro de 2006 (119 receptores). Estes pacientes foram acompanhados atraves do prontuario, por um periodo de um mes pos-transplante, para desenvolvimento de infeccao de sitio cirurgico, e durante todo 0 periodo de internacao apos 0 transplante para 0 desenvolvimento de infeccao do trato urinario hospitalar. Os criterios usados para 0 diagnostico de infeccao hospitalar foram definidos pelo Centers for Disease Control and Prevention (CDC). E foram realizados dois estudos tipo caso-controle aninhado (do ingles Nested Case Control), onde foram avaliados os fatores de risco para infeccao de sitio cirurgico e infeccao do trato urinario nesta coorte de pacientes. A analise multivariada foi realizada pela tecnica de regressao logistica multipla, utilizando as variaveis com p≤ 0,05 na analise univariada. 0 metodo utilizado foi 0 Stepwise forward. Resultados: A mortalidade nos primeiros 30 dias apos 0 transplante foi 11,8%. A infeccao de sitio cirurgico ocorreu em 55 (46,2%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae, 10 (28%); Staphylococcus aureus, 8 (22%); Pseudomonas aeruginosa, 8 (22%); Acinetobacter baumannii, 4 (11 %). Ap6s a regressao logistica multivariada, as variaveis independentemente associadas a ISC foram: necrose tubular aguda (OR=4,4; IC95%= 1,77 - 10,99; p=0,001); fistula renal ou pancreatica pos-transplante (OR=7,25; IC95%= 1,35 - 38,99; p=0,02) e rejeicao do enxerto (OR=4,28; IC95%= 1,59 - 11,48; p=0,004). A infeccao do trato urinario ocorreu em 29 (24,4%) pacientes submetidos ao transplante. Os principais microrganismos foram: Klebsiella pneumoniae 13 (43,5%), Acinetobacter baumannii 7 (23,5%), Enterobacter spp 2(7%), Pseudomonas aeruginosa 2 (7%).Apos a regressao logistica multivariada, as variaveis independentemente associadas a ITU foram: tempo de hipertensao arterial (OR=1, 1; IC95%= 1,00 - 1,02; p=0,01); uso de alcool pelo doador (OR=7,49; IC95%= 1,01 - 55,66; p=0,04) e uso de drogas vasoativas no doador (OR=0,08; IC95%= 0,01 - 0,84; p=0,03) e, como fator protetor: diurese residual pre-transplante (OR=0,16; IC95%= 0,04 - 0,59; p=0,006). Conclusao: Nosso estudo demonstrou que variaveis relacionadas ao procedimento cirurgico estao mais relacionadas ao desenvolvimento de infeccao de sitio cirurgico e que variaveis relacionadas ao receptor e doador estao mais relacionadas ao surgimento de infeccao do trato urinario em pacientes submetidos a transplante simultaneo rim-pancreas. Nosso estudo e um dos primeiros a avaliar fatores de risco para essas duas importantes infeccoes nosocomiais nessa coorte de pacientes.
- ItemAcesso aberto (Open Access)Avaliação de pacientes submetidos à craniotomia: incidência, evolução e fatores de risco para infecção de sítio cirúrgico(Universidade Federal de São Paulo (UNIFESP), 2010-05-26) Sola, Angela Figueiredo [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Surgical site infection is one of the most feared complications of a procedure. The incidence of surgical site infection in neurosurgery is low, but consequences can be dire in terms of both morbidity and mortality. Few studies on the national level have assessed this issue. Objective: Determinate the incidence of surgical site infections and analyze the risk factors of the development of these infections on patients submitted to craniotomy. Examine the impact of these infections in mortality rates and length of stay in hospitalization. Casuistry and Methodology: Retrospective cohort type study, done on Hospital Estadual de Diadema (Diadema State Hospital). All patients submitted to craniotomy between January 1st 2006 and December 31st 2007 were included in the study. All diagnostics of infection were compliant to the definitions of the Centers for Disease Control and Prevention (CDC). The surgical site infections were classified as superficial, deep or organ space. Results: 352 craniotomies were conducted. The average age was 46.24 years. Admittance diagnosis most prominent were cranioencephalic trauma 101 (28.7%), subdural hematoma 61 (17.3%) and neoplasm 54 (15.3%). In the time span were observed 46 (13.1%) surgical site infections. Length of stay of patients that suffered infections was on average 58.26 days (3 and 187 days), against 16.07 days (0 and 122 days) for patients that showed no sign of infections. We found a predominance of Gram-negative bacteria 34 (72.4%), with prominence of Acinetobacter baumannii 11 (37.9%) and Klebsiella pneumoniae 5 (17.2%). After multi-valued analysis, the factors independently related to the incidence of infections were necessity of surgery repetition (OR=13,22; IC95%=5,61-31,16; p<0,0001) and external ventricular derivation presence (OR=5,61; IC95%=2,21 -14,22; p<0,0001). In the sample, 78.3% of patients with organ space surgical site infections expired. Conclusions: In our study we found a high rate of surgical site infections, mostly Gram-negative bacteria. The use of external ventricular derivation and surgery repetition were the main risk factors. We found a relation between the rise of mortality and patients suffering organ space surgical site infections, and the occurrence of surgical site infection had a significant impact in patient length of stay increase.
- ItemSomente MetadadadosEfeito da infecção hospitalar de ferida cirúrgica sobre o tempo de hospitalização e análise dos principais fatores de risco(Universidade Federal de São Paulo (UNIFESP), 1991) Turcato Junior, Gilberto [UNIFESP]; Wey, Sérgio Barsanti [UNIFESP]; Wey, Sérgio Barsanti [UNIFESP]
- ItemSomente MetadadadosProfilaxia Cirúrgica: Desenvolvimento De Aplicativo Para Dispositivos Móveis(Universidade Federal de São Paulo (UNIFESP), 2017-05-25) Coelho, Andre Afonso Machado [UNIFESP]; Gales, Ana Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To develop an application for iPhone and iPad that assists in the selection of the appropriate antimicrobial for surgical prophylaxis. Methods: The application was developed using Xcode 7.2 in Swift 2.1 (Apple Inc.). The content was based on international recommendations regarding surgical prophylaxis, especially from the Infectious Diseases Society of America (IDSA). Results: The content was divided into six main links on the home screen, plus one for the referrals. The items "Antibioticoprophylaxis", "Table", "Doses", "Single dose" and "Protocols" are designed for a rapid bedside consultation, providing a concise answer on which antimicrobials (and their respective dosages) are recommended for a given procedure surgical. The "General Concepts" section has as its objective a conceptual deepening on topics relevant to surgical prophylaxis. In the topic "Antibioticoprofilaxia" were created sequential windows that direct the user to pages with each of the surgical procedures, where are the data related to the following items - type of procedure, microorganisms, first choice antibiotics, alternatives to beta-lactams and duration of prophylaxis. The dosages, half-lives and the interval for a new dose referring to the main antimicrobials used in surgical prophylaxis are shown on the link "Doses". The main advantages of using a single dose of prophylactic antimicrobial are highlighted in the topic "Single dose". In "Table" the first antimicrobial choice and two alternatives are presented for each type of surgery, besides the duration of the prophylaxis. The "Protocols" item has been designed for the user to insert the protocols of his own institution (in image format or PDF file) so that access to the general recommendations and those of his institution are in the same application, facilitating access, navigation and query. Finally, the "General Concepts" session is subdivided into 14 topics for further study on the following topics: surgery classification, decolonization and decontamination, renal and hepatic dysfunction, additional doses, indication of prophylaxis, current infection, resistant microorganisms, dose momentum preoperative, obesity, pediatrics, prophylaxis for prevention of endocarditis, prophylaxis for prevention of joint prosthesis infection, reoperation and hospitalized patients and treatment of surgical site infection. Conclusion: The application is expected to assist the attending physician in the most appropriate antimicrobial choice for each ix clinical situation, contributing to a better outcome for the patient and lower selective pressure in the hospital environment, thus reducing the emergence and maintenance of resistant bacterial strains, in addition to reducing hospital costs and the occurrence of adverse reactions.