Abstract INTRODUCTION: Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals. METHODS: In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization. RESULTS A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age >60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection. CONCLUSIONS: This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity.

ABSTRACT Cryptococcosis, a systemic disease caused by the fungus Cryptococcus neoformans/ Cryptococcus gattii is more severe in immunocompromised individuals. This study aimed to analyze the epidemiology of the disease, the molecular characteristics and the antifungal susceptibility of C. neoformans isolated from patients treated in a Brazilian university hospital. This retrospective study was conducted in the Clinical Hospital, Federal University of Uberlândia, and evaluated cases of cryptococcosis and strains of C. neoformans isolated from 2004 to 2013. We evaluated 41 patients, 85% of whom were diagnosed with AIDS. The fungus was isolated from the cerebrospinal fluid (CSF) of 21 patients (51%); 19.5% had fungemia and in 24% the agent was isolated from the CSF and blood, concurrently. Meningoencephalitis was the most frequent (75%) manifestation of infection. Despite adequate treatment, the mortality of the disease was 58.5%. Most isolates (97.5%) presented the VNI genotype (serotype A, var. grubii) and one isolate was genotyped as C. gattii (VGI); all the isolates were determined as mating type MATa and showed susceptibility to the tested antifungals (fluconazole, voriconazole, amphotericin B and 5-flucytosine). Although AIDS detection rates remain stable, opportunistic infections such as cryptococcosis remain as major causes of morbidity and mortality in these patients.

Abstract Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14–70%). Aim This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. Methods This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. Findings De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Conclusion Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

Abstract Objectives The aim of this study was to evaluate the impact of a bundle called FAST HUG in ventilator-associated pneumonia, weigh the healthcare costs of ventilator-associated pneumonia patients in the intensive care unit, and hospital mortality due to ventilator-associated pneumonia. Material and methods The study was performed in a private hospital that has an 8-bed intensive care unit. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data was obtained from each patient: age, gender, reason for hospitalization, use of three or more antibiotics, length of stay, intubation time, and outcome. Results After the implementation of FAST HUG, there was an observable decrease in the occurrence of ventilator-associated pneumonia (p < 0.01), as well as a reduction in mortality rates (p < 0.01). In addition, the intervention resulted in a significant reduction in intensive care unit hospital costs (p < 0.05). Conclusion The implementation of FAST HUG reduced the number of ventilator-associated pneumonia cases. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.

RESUMO A colonização da cavidade oral pode ser considerada um pré-requisito para o desenvolvimento de candidíase orofaríngea. Os objetivos deste estudo foram: avaliar e quantificar espécies de Candidaisoladas da cavidade oral, para determinar os fatores predisponentes para a colonização, e correlacionar os níveis de células CD4+ e carga viral em indivíduos HIV-positivos atendidos em um hospital universitário. Foram coletadas amostras de saliva de 147 pacientes portadores do HIV, as quais foram semeadas em Ágar Sabouraud Dextrose (ASD) e ágar cromogênico e incubadas a 30 °C por 72 horas. As colônias com morfologia semelhante em ambos os meios foram contadas e o resultado expresso em unidade formadora de colônias por mililitro (UFC/mL). Dos 147 pacientes HIV positivos, 89 apresentaram culturas positivas para Candidaspp., totalizando 111 isolados, e C. albicansfoi a espécie mais frequente (67,6%). A contagem média de colônias foi de 8.8 × 10³ UFC/mL. Os principais fatores predisponentes para colonização oral por Candidaspp. foram a utilização de antibióticos e de próteses orais. O uso de antirretroviral da classe de inibidores da transcriptase reversa pareceu ter maior efeito protetor para a colonização. Baixa contagem de linfócitos T CD4+ está relacionada com maior densidade de leveduras na saliva de indivíduos HIV positivos.

The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. Aims: The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. Results: Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.

As infecções causadas por espécies de Candida são problema de grande impacto para a saúde pública, devido à alta incidência em pacientes hospitalizados e como causa de mortalidade. O presente estudo teve como objetivo avaliar a frequência de Candida spp. isoladas de pacientes hospitalizados, assim como a sensibilidade aos antifúngicos e o polimorfismo genético por RAPD-PCR. Os microrganismos incluíram isolados de hemocultura, líquido abdominal e ponta de cateter venoso central de pacientes internados no Hospital de Clínicas da Universidade Federal de Uberlândia, região do Triângulo Mineiro, Minas Gerais, Brasil, no período de julho de 2010-junho de 2011. Os testes de sensibilidade aos antifúngicos foram realizados por microdiluição em caldo e na análise por RAPD-PCR foram utilizados os oligonucleotídeos OPA09, OPB11, e OPE06. Dos 63 isolados, 18 (28,5%) foram C. albicans, 20 (31,7%) C. parapsilosis, 14 (22,2%) C. tropicalis, quatro (6,4%) C. glabrata, quatro (6,4%) C. krusei, dois (3,3%) C. kefyr, e um (1,6%) C. lusitaniae. Resistência in-vitro à anfotericina B foi observada em 12,7% dos isolados. Não foi observada resistência in-vitro aos azólicos, exceto para os isolados de C. krusei. Os oligonucleotídeos OPA09 e OPB11 possibilitaram distinguir diferentes espécies. Isolados de C. albicans apresentaram seis clusters e o complexo C. parapsilosis, cinco clusters, com o iniciador OPA09, por RAPD-PCR, mostrando a variabilidade genética daquelas espécies. Conclui-se que o complexo C. parapsilosis foi a espécie mais frequente, e a maioria dos isolados foi sensível in vitro aos antifúngicos testados. Alto polimorfismo genético foi observado para os isolados de C. albicanse complexo C. parapsilosis, principalmente com o oligonucleotídeo OPA09.

Infections by Candida species are a high-impact problem in public health due to their wide incidence in hospitalized patients. The goal of this study was to evaluate frequency, susceptibility to antifungals, and genetic polymorphism of Candida species isolated from clinical specimens of hospitalized patients. The Candida isolates included in this study were obtained from blood cultures, abdominal fluids, and central venous catheters (CVC) of hospitalized patients at the Clinical Hospital of the Federal University of Uberlândia during the period of July 2010 - June 2011. Susceptibility tests were conducted by the broth microdilution method. The RAPD-PCR tests used employed initiator oligonucleotides OPA09, OPB11, and OPE06. Of the 63 Candida isolates, 18 (28.5%) were C. albicans, 20 (31.7%) were C. parapsilosis complex species, 14 (22.2%) C. tropicalis, four (6.4%) C. glabrata, four (6.4%) C. krusei, two (3.3%) C. kefyr, and one (1.6%) C. lusitaniae. In vitro resistance to amphotericin B was observed in 12.7% of isolates. In vitroresistance to azoles was not detected, except for C. krusei. The two primers, OPA09 and OPB11, were able to distinguish different species. Isolates of C. albicans and C. parapsilosis complex species presented six and five clusters, respectively, with the OPA09 marker by RAPD-PCR, showing the genetic variability of the isolates of those species. It was concluded that members of the C. parapsilosis complex were the most frequent species found, and most isolates were susceptible to the antifungals amphotericin B, flucozanole, and itraconazole. High genetic polymorphisms were observed for isolates of C. albicans and C. parapsilosis complex species, mainly with the OPA09 marker.

OBJECTIVE: To investigate the pathogenesis of bloodstream infection by Staphylococcus epidermidis, using the molecular epidemiology, in high-risk neonates. METHODS: We conducted a prospective study of a cohort of neonates with bloodstream infection using central venous catheters for more than 24 h. "National Healthcare Safety Network" surveillance was conducted. Genotyping was performed by DNA fingerprinting and mecA genes and icaAD were detected by multiplex-PCR. RESULTS: From April 2006 to April 2008, the incidence of bloodstream infection and central venous catheter-associated bloodstream infection was 15.1 and 13.0/1000 catheter days, respectively, with S. epidermidis accounting for 42.9% of episodes. Molecular analysis was used to document the similarity among six isolates of bloodstream infection by S. epidermidis from cases with positive blood and central venous catheter tip cultures. Fifty percent of neonates had bloodstream infection not identified as definite or probable central venous catheter-related bloodstream infection. Only one case was considered as definite central venous catheter-related bloodstream infection and was extraluminally acquired; the remaining were considered probable central venous catheter-related bloodstream infections, with one probable extraluminally and another probable intraluminally acquired bloodstream infection. Additionally, among mecA+ and icaAD+ samples, one clone (A) was predominant (80%). A polyclonal profile was found among sensitive samples that were not carriers of the icaAD gene. CONCLUSIONS: The majority of infections caused by S. epidermidis in neonates had an unknown origin, although 33.3% appeared to have been acquired intraluminally and extraluminally. We observed a polyclonal profile between sensitive samples and a prevalent clone (A) between resistant samples.

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 device-associated 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.

INTRODUÇÃO: As infecções de corrente sanguínea associadas ao cateter (ICS-AC) são as infecções hospitalares mais frequentes em unidades de terapia intensiva neonatais. O objetivo do nosso estudo foi reduzir as ICS-AC através de um pacote de medidas de cuidados incluindo algumas estratégias de controle e prevenção destas infecções. MÉTODOS: Foi realizada uma intervenção desenhada para reduzir as infecções de corrente sanguínea associadas ao cateter com cinco procedimentos de base. RESULTADOS: Um total de 67 (26,7%) ICS-AC foi observado. Houve 46 (32%) episódios de sepse com critério microbiológico (24,1 por 1.000 catater dias(CVC-dias). Os neonatos do grupo, após a implementação da intervenção, tiveram 21 (19,6%) episódios de ICS-AC (14,9 por 1.000 CVC-dias). A incidência de ICS-AC reduziu significantemente entre os grupos pré-intervenção e pós-intervenção após a implementação das medidas (32% para 19.6%, 24.1 por 1.000 CVC-dias para 14.9 por 1.000 CVC-dias, p=0.04). Na análise de regressão logística múltipla, o uso de > três antibióticos e tempo de hospitalização > 8 dias foram fatores de risco independentes para ICS. CONCLUSÕES: A introdução de uma intervenção baseada em evidências e a educação intensiva e continuada de todos os profissionais de saúde são efetivas para a redução de ICS-AC.

INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

INTRODUÇÃO: O objetivo deste estudo foi estabelecer a taxa de sepse de ataque tardio (LOS) do nosso serviço, caracterizar a microbiota intestinal e avaliar uma possível associação entre a flora intestinal e sepse em recém-nascidos cirúrgicos que estavam recebendo nutrição parenteral (NP). MÉTODOS: Culturas do intestino foram colhidas no início da nutrição parenteral e, posteriormente, uma vez por semana. As amostras para a cultura de sangue foram coletadas com base em critérios clínicos estabelecidos pela equipe médica. A ponta do cateter venoso central (CVC) foi removida sob condições assépticas. Métodos laboratoriais padrão foram usados para identificar os microrganismos que cresceram em culturas de sangue, do intestino, e da ponta do CVC. RESULTADOS: Foram analisados 74 recém-nascidos de muito baixo peso. Todas as crianças estavam recebendo nutrição parenteral e antibióticos quando a cultura do intestino foi iniciada. No total, 21 (28,4%) crianças apresentaram 28 episódios de sepse tardia sem fonte identificada. Os estafilococos coagulase negativo foram os mais comuns das bactérias identificadas, tanto no intestino (74,2%) como no sangue (67,8%). Todas as infecções ocorreram em pacientes que receberam nutrição parenteral através de um cateter venoso central. Seis crianças experimentaram episódios de translocação microbiana. CONCLUSÕES: Neste estudo LOS foi o episódio mais frequente em recém-nascidos recebendo nutrição parenteral e submetidos a cirurgia, 28,6% da infecção provavelmente foi um fenômeno derivado do intestino o que exige novas estratégias para a prevenção.

INTRODUCTION: The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). METHODS: Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. RESULTS: 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. CONCLUSIONS: In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.

INTRODUÇÃO: Avaliou-se o nível da contaminação do ar em cirurgias ortopédicas. MÉTODOS: O ar das salas cirúrgicas foi analisado microbiologicamente através da exposição de placas próximas à mesa cirúrgica por uma hora. RESULTADOS: Foram evidenciados valores acima do recomendado (369 UFC/m³) nas salas convencionais, assim como naquelas com ar ultralimpo. A contaminação foi predominantemente por Staphylococcus sp (86,9%). verificou-se um número alto de pessoas presentes no interior das salas cirúrgicas, assim como de abertura da porta. CONCLUSÕES: Os níveis de contaminação se apresentaram acima dos valores aceitos por agências reguladoras, representando risco para os pacientes.

INTRODUCTION: The air contamination levels during orthopedic surgeries were evaluated. METHODS: The air of operating rooms (ORs) was examined through exposure to microbiological plates placed near the surgical table for an hour. RESULTS: values above that recommended (369 CFU/m³) for conventional ORs and ORs with ultraclean air were determined. Contamination was predominantly by Staphylococcus sp (86.9%). In all surgeries a high number of people were present inside the ORs and the doors were opened frequently. CONCLUSIONS: The contamination levels are above the values accepted by regulatory agencies, representing risk for patients.

Os objetivos desse estudo foram investigar a participação de Candida albicans e não-albicans como agente de colonização e sepse, bem como os fatores de risco associados aos neonatos internados na Unidade de Terapia Intensiva Neonatal do Hospital de Clínicas da Universidade Federal de Uberlândia. Foi realizada vigilância epidemiológica pelo sistema National Healthcare Safety Network no período entre agosto de 2007 e abril de 2008. A taxa de incidência de sepse com critério microbiológico foi de 6,7/1.000 paciente/dia, constatando-se apenas um caso de candidemia. Aproximadamente, 19% dos neonatos estavam colonizados por Candida, identificadas como Candida albicans (50%) e Candida não-albicans (50%). Os fatores de risco significantes para colonização por Candida spp foram a idade gestacional entre 26 e 30 semanas, o uso prévio de antibiótico e o cateter vascular central umbilical. A mortalidade total foi de 11,8% nos neonatos internados durante o período de estudo com sepse, porém o recém-nascido com candidemia não evoluiu para óbito.

The objectives of this study were to investigate the participation of Candida albicans and non-albicans as colonization and sepsis agents, along with the risk factors associated with the neonates in the neonatal intensive care unit of the clinical hospital of the Federal University of Uberlândia. Epidemiological surveillance was implemented through the National Healthcare Safety Network between August 2007 and April 2008. The incidence rate for sepsis with microbiological criteria was 6.7/1,000 patients/day, which was shown as only one case of candidemia. Approximately 19% of the neonates were colonized by Candida, which was identified as Candida albicans (50%) and Candida not-albicans (50%). The significant risk factors for Candida spp colonization were gestational age of between 26 and 30 weeks, previous antibiotic use and umbilical central vascular catheter. The overall mortality among the neonates hospitalized with sepsis over the study period was 11.8%. However, the neonate with candidemia did not die.

Staphylococcus aureus e Estafilococos coagulase-negativa (ECN) estão entre os patógenos hospitalares mais importantes em pacientes de unidades de terapia intensiva neonatal, principalmente em infecções da corrente sanguínea. O principal objetivo deste estudo foi determinar a ocorrência de infecções hospitalares por estes microrganismos usando dois sistemas de vigilância (laboratorial e "National Nosocomial Infection Surveillance" - NNIS) e determinar os fatores de risco mais importantes durante o período de dois anos (2001-2002). Dois surtos por ambos S. aureus suscetível a meticilina (1.5%) e ECN resistente à meticilina (1.0%) foram observados, de janeiro a fevereiro/02 e agosto a setembro/02. Taxas de incidência endêmica de 3.77% e 5.16% para S.aureus e ECN foram detectadas respectivamente. Fatores de risco incluíram idade <=7 dias, hospitalização > ou = 7 dias e utilização de cateter vascular central (CVC) de polietileno através de dissecação de veia (flebotomia), mas, nenhum desses fatores independentes foram confirmados pela análise multivariada. Por outro lado, ECN resistente à oxacilina prevaleceu (66.0%) nos episódios epidêmicos. Análise molecular através de gel de eletroforese em campo pulsátil mostrou a natureza policlonal das amostras de S. aureus. Em conclusão, nós identificamos dois surtos de etiologia mista por S. aureus suscetível à meticilina e ECN resistente à meticilina associados à falta de material adequado (cateter vascular central) para neonatos, relacionados a procedimento invasivo. Os dois surtos foram controlados com a substituição de CVC de polietileno pelo cateter central de inserção periférica.

Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are among the most important nosocomial pathogens in patients from neonatal intensive care units, mainly in bloodstream infections. The main objective of this study is to determine the occurrence of nosocomial infections by these microorganisms using two surveillance systems (Laboratorial Surveillance and National Nosocomial Infection Surveillance System) and to determine the most important risk factors during a two-year period (2001-2002). Two outbreaks by both methicillin susceptible S. aureus (MSSA) (1.5%) and methicillin resistant CoNS (MRCoNS) (1.0%) were observed, from January to February/02 and August to September/02. Endemic incidence rates of 3.77% and 5.16% of S. aureus and CoNS, respectively were detected. Risk factors included age <=7 days, hospitalization > or = 7 days and utilization of polietilene central vascular catheter (CVC) through vein dissection (phlebotomy), but none of these independent factors were confirmed by the multivariate analysis. However, oxacillin resistant CoNS prevailed (66.0%) in the epidemic episodes. Molecular analysis by pulsed field gel electrophoresis showed the polyclonal nature of S. aureus isolates. In conclusion, two outbreaks were identified of mixed etiology by MSSA and MRCoNS associated to the lack of an adequate material (central venous catheter) for neonates, related invasive procedure. The outbreaks were controlled with the substitution of polietilene CVC for peripherally inserted central catheter.

We studied an outbreak of two multi-drug resistant clones of Acinetobacter baumannii in the Neonatal Intensive Care Unit of the Uberlândia Federal University Hospital in Minas Gerais state, Brazil, and we analyzed the contribution of cross-transmission in the rise in infection rates. Eleven neonates who developed multi-drug resistant A. baumannii nosocomial infection were matched to 22 neonates who were admitted to the same unit and did not develop an infection during the outbreak period, in order to identify risk factors for infection. Three out of the 11 neonates died. Epidemiological investigation included molecular typing, using pulsed field gel electrophoresis. Prior to the outbreak, from December 2001 to March 2002, no case of infection by this microorganism was diagnosed. Environmental and healthcare worker hand cultures were negative. Nine isolates had similar pulsed field gel electrophoresis patterns and two had another clone. The first clone was brought into the unit by an infected patient who was transferred from another hospital without a history of antibiotic use. The second clone did have its origin clearly defined. Both infected groups led us to conclude that several factors contributed to infection with A. baumannii. These factors were: exposure to antibiotics and invasive devices, birth weight < 1500g, age < 7 days and duration of hospitalization > 7 days. Based on logistic regression, infected neonates were more exposed to carbapenem and mechanical ventilation than the control group. Cross transmission between infants contributed to the rise in the rates of multi-drug resistant A. baumannii infection.

O objetivo foi relatar a ocorrência de dois surtos subseqüentes na UTIN do HC-UFU, por amostras epidêmicas de P. aeruginosa e A. baumannii multirresistentes nos períodos de Mar - Set/01 e Out - Mar/02, respectivamente. O surto por P. aeruginosa incluiu sete neonatos com conjuntivite e três com bacteremia e um estudo caso-controle foi realizado no surto por A. baumannii com 11 e 22 neonatos respectivamente. Os isolados de A. baumannii foram resistentes a gentamicina e ciprofloxacina e os de P. aeruginosa a ampicilina/sulbactam além de gentamicina e ciprofloxacina. As culturas ambientais e das mãos dos profissionais de saúde foram negativas. O surto por P. aeruginosa resultou no aumento do uso de imipenem o que pode ter favorecido a emergência do surto por A. baumannii que embora suscetível a este beta-lactâmico apresentou uma multiresistência importante. A análise univariada relacionou os fatores de risco predisponentes para infecção por A. baumannii: peso < 1500g, idade < 7 dias, hospitalização > 7 dias e uso de carbapenema. O término dos surtos foi alcançado através medidas de controle de infecção e isolamento de coorte dos neonatos infectados, não sendo possível definir o reservatório e a via de transmissão.

The study documents the occurrence of two subsequent outbreaks in the NICU of HC-UFU, caused by epidemic strains of multiresistant Pseudomonas aeruginosa and Acinetobacter baumannii, that occurred between March/01 and September and between October/01 and March/02, respectively. The P. aeruginosa outbreak included seven neonates with conjunctivitis and three with bacteremia. A case-control study was conducted for the A. baumannii outbreak, with 11 and 22 neonates, respectively. The isolates of A. baumannii were resistant to gentamacin and ciprofloxacin. P. aeruginosa isolates were resistant to ampicillin/sulbactam gentamicin and ciprofloxacin. The hands of healthcare workers and environmental cultures were negative. The outbreak of P. aeruginosa resulted in the increase of use of imipenem, which could have favoured the emergence of a A. baumannii epidemic strain, despite of its susceptibility to this antibiotic. The risk factors for A. baumannii infection were: weight <1500g, age < 7 days, hospitalization > 7 days and use of carbapenems. Containment of the two outbreaks was achieved by introduction of strict hygiene measures and careful nursing care of the infected infants. The reservatory and the route of transmission were not found.