HEALTHCARE-ACQUIRED INFECTIONS AND ANTIMICROBIAL RESISTANCE

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1 Universidade de São Paulo Departamento de Moléstias Infecciosas e Parasitárias HEALTHCARE-ACQUIRED INFECTIONS AND ANTIMICROBIAL RESISTANCE Anna S. Levin

2 4 main lines! Epidemiology of HAS and resistance! Interface between hospital practices/problems and laboratory! Antimicrobial drug use! Miscellaneous/Incidental

3 Setting 1 Hospital da Clínicas! Tertiary care! University of São Paulo! 2,200 bed! Different institutes! Central! Heart! Children s! Orthopedics! Cancer! Radiology! Psychiatry/ Neurosurgery! 2 long term care! Physical rehabilitation

4 Hospital das Clínicas! 250 ICU beds! Neonatal and pediatric ICUs! Transplantation! Kidney/kidney-pancreas! Heart! Lung! Bone marrow

5 Studies! Application of mathematical model as a strategy to reduce colonization and infection by carbapenemresistant K. pneumoniae in an ICU.

6 Mathematical model Admissã o Admissã o Alta Alta

7 Modelo de Ross-Macdonald R 0 R 0 >1 R 0 <1

8 Mathematical model

9 22% 45%?? 10%

10 Impact of different hand hygiene compliance rates if 80% compliance with contact precautions ρ: adesão à higiene das mãos

11 What happened...

12 Studies! Evaluation of factors associated with MRSA carriage in newborns - cohort study.

13 MRSA in neonatal unit 16 Figure 2: Distribution of molecular patterns of methicillin-resistant Staphylococcus aureus in colonized newborns between February 2009 through January 2010 at Hospital das Clínicas of University of São Paulo, Brazil Molecular PFGE patterns time (days)

14 Studies! Impact of chlorhexedine bathing on HAI caused by MDR in HSCT patients! Chlorhexedine breakpoints, PCR for chlorhexedine resistance genes! Study of human difficulties and adherence to infectionprevention measures (Collaboration with Institute of Psychology and Nursing School, USP)! Impact of bacteremic infections caused by Acinetobacter baumannii on mortality in ICU patients in comparison with other bacteria (K. pneumoniae, P.aeruginosa, S. aureus).- a retrospective cohort study (two hospitals)

15 Setting 2 São Paulo State Health Department São Paulo State Health Department! 40,000 inhabitants! 838 hospitals: 383 have ICUs.! Since 2004 reporting of HA-infection rates! Surgical site infections in clean surgery! Infection rates in ICU (includes neonatal)! Blood culture results! Frequency of specific patterns of resistance

16 State of São Paulo Device-associated infection rates in ICU VA-Pneumonia Urinary tract infections Bloodstream infections

17 State of São Paulo Bloodcultures

18 State of São Paulo Patterns of resistance

19 Epidemiology of HAS and resistance Collaboration with the São Paulo State Health Department! Statewide evaluation of the prevalence of BSI by resistant bacteria and potential association with sales of antimicrobials and socio-demographic factors- Databases: drug sales , compulsory notification of resistant BSI to State Government and 2010 census spacial analysis (Public Health School, USP)! Evaluation of the effect of climate on nosocomial BSI in ICU of the State- comparison with seasonal behaviour of other diseases notified to the Government. (Institute of Oceanography, USP)

20 Epidemiology of HAS and resistance Collaboration with the São Paulo State Health Department! Evaluation of strategy to reduce nosocomial BSI in ICU of State of São Paulo (SSP)

21 Setting 3 Medical Investigation Laboratory 54 (LIM-54)! Medical Investigation Laboratory 54 (LIM-54)! Located in Institute for Tropical Medicine-USP! Capabilities:! Basic microbiology (bacterial and fungal)! Mechanisms of antimicrobial resistance! Typing! Sequencing

22 Perdigão et al. Antimicrob. Agents Chemother. 2014, 58(3): Studies! Study of susceptibility of clinical isolates of MDR gramnegative bacteria to fosfomycin

23 Studies! Development of PCR method of detection of Fusarium spp. in water.! In vitro activity of Silver nanoparticles (NanoAg) against multidrug resistant bacteria and yeast:! breakpoints; time-kill and activity on biofilm

24 Studies! Polymyxins heteroresistance in A. baumannii isolates.! Mechanisms of resistance in carbapenem-resistant E. aerogenes and E. cloacae.! S. maltophila: genome of TMP-SMX and levofloxacin isolates (comparison of susceptible and resistant isolates)! Whole genome sequencing! VRE in HSCT patients! Virulence, resistance and clonality

25 Microbiome! Study of microbiome in women with recurrent cystitis.! Evaluation of microorganisms that cause postoperative meningitis using sequencing.

26 Microbiome! Study of microbiome in women with recurrent cystitis.! Evaluation of microorganisms that cause postoperative meningitis using sequencing.

27 4 main lines! Epidemiology of HAS and resistance! Interface between hospital practices/problems and laboratory! Antimicrobial drug use! Miscellaneous/Incidental

28 Antimicrobial drug use Collaboration with School of Pharmaceutical Sciences, USP! Effect of the use of prescribing antimicrobial with adjustment based of serum levels and PK/PD parameters, on outcome of infections in burn patients (time series)! Evaluation of drug pharmacockinetics and pharmacodynamics of antimicrobial drugs in sustained low-efficiency dialysis (SLED) in critically ill patients.

29 Antimicrobial drug use! Case-series of patients with severe MDR infections treated with IV fosfomycin! Retrospective evaluation of outcomes of patients with severe infections caused by KPC-carrying organisms and effect of different antimicrobial treatments (two hospitals)! National survey of the patterns of antimicrobial use in terminally ill patients Brazil, Portugal and Argentina.! Randomized, double-blind controlled study of cetriaxone ± azythromycin in comunity-acquired pneumonia in HIVinfected patients (Collaboration with Emilio Ribas Infectious Disease Hospital).

30 Universidade de São Paulo Departamento de Moléstias Infecciosas e Parasitárias Infection Control Department and LIM 54 (Medical Investigation Lab- 54)! Anna Sara Levin! Silvia F. Costa! gcih.adm@hc.fm.usp.br! Phone/fax:

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