GENERALIDADES. Cápsula: de naturaleza polisacárida (Ag K). Flagelo: naturaleza proteica (Ag H). Polisacárido Somático (Ag O). ENTEROBACTERIAS FERMENTADORAS vulneris Klebsiella pneumoniae Enterobacter cloacae FERMENTADOR LENTO Citrobacter. Klebsiella. 1. *GUILLEN RODRÍGUEZ VIRGINIA GUADALUPE. *RODRÍGUEZ BARDALES AVELINA JAQUELINE. 2. Klebsiella Los.

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Generalidades de enterobacterias by Estefania Zaragoza Hernandez on Prezi

Klebsiella pneumoniae outbreak in a cancer unit of a general hospital – predisposing factors and evaluation of the impact of intervention measures. We made a retrospective cohort study of a primary bloodstream infection outbreak in patients of a cancer unit in a general hospital, evaluated the impact of intervention measures and investigated the predisposing factors. The targeted predisposing factors were selected based on the medical literature. The presence of a long-term totally-implanted central venous catheter appears to be a predisposing factor, while a peripheral venous catheter appears to have offered protection from infection.

This is reinforced by fact that intervention measures controlled the outbreak, suggesting cross-contamination from a common source. These findings corroborate the fundamental role of the hospital infection control service in early intervention and reinforce the need for continued training of health professionals that perform this type of care. Nosocomial infection, hospital-acquired infection.

One of the greatest challenges for a Hospital Infection Control Service HICS is the identification and control of outbreaks of hospital infections HIwhich generally are identified by epidemiological surveillance ES and by an active search for HI cases.

According to Grinbaum [1], “one of the objectives of ES carried out by the HICS is to detect outbreaks before the propagation results in further harm. In addition to outbreak control intervention activities, the HICS is also charged with investigating the source of the agent and the means of transmission.

Usually HIs are a result of an imbalance between the patient’s defense mechanisms and microbiota. The most common route of transmission of nosocomial pathogens is on generalidsdes hands of enterobactdrias care team; however, other potential sources are water, fomites, instruments and solutions.

Invasion by these agents is most likely to occur due to poor aseptic techniques, failure of environment cleaning enterobactsrias, inefficient hand washing, ineffective material sterilization processes, etc. When an outbreak occurs, the HICS should establish an investigation protocol, and although this protocol cannot always be followed in an exact order, owing to the urgency of intervention measures, it should include an investigation of the patient, the environment and the agent, in order to establish possible risk factors for further investigation, and to prove or disprove the hypotheses that are developed.

The investigation of the outbreak of an infectious disease should consist of the following steps [3]: Initially, two cases of primary bloodstream infection BSI by K. These cases, by enerobacterias, were not considered exceptional for this unit; however, within a month, in January offive more cases and one more related to a peripheral venous catheter PVC appeared, for a total of eight cases with the same topography, the same agent, in the same environment and in the same population.

In addition to the classic signs and symptoms lsa bacteremia, these cases were diagnosed by culturing two pairs of central- and peripheral-blood samples from each patient.

The pattern of cases indicated a possible exposure of this patient population to an infectious agent. The cases appeared in rapid succession and then declined rapidly, suggesting a common source of infection and a short interval of exposure [3].


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The HICS acted to confirm the occurrence of the outbreak, carried generalidadfs intervention actions for its control and investigated the predisposing cause s.

The objectives of our study were: The population under investigation for predisposing causes consisted of 20 hospitalized patients in this unit over this period. The other 10 non-caseswhich did not present K. Initially, the following intervention measures were introduced to control the outbreak: An investigation into the predisposing causes was initiated, using computer patient charts as the data source. A number of predisposing factors were selected, based on the scientific literature [].

These factors were judged most relevant to this patient population: The base pathology, hospitalization stay and vascular insertion point were also indicated in the literature, but they were not evaluated because the generzlidades all presented the same pathology cancera similar mean time of hospitalization, which varied from five to nine days, and the same insertion point for the CVC subclavian vein.

A spreadsheet was created, containing patient identification, duration of hospitalization, blood culture and anal swab results, as well as the other selected predisposing factors.

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Univariate analysis was done for each factor, and the Epi-Info version 6. The Mantel-Haenszel chi-square test was used to evaluate the statistical significance of association p.

After the adoption of the intervention measures, only two cases of colonization were detected in February of From then until Augustno other case of infection or colonization was detected in the cancer unit. This indicates that the interventions that were adopted controlled the outbreak and broke the transmission chain. A fall in the incidence of HI related to the CVC was also observed when compared with indices prior to the outbreak. The results of the investigation into predisposing factors are presented in Tables 1 and 2.

According to Waldman [3], who discussed the limitations of such studies: In an enterboacterias to determine if there was a relationship between the event and Generqlidades use, the duration of use was analyzed.

The mean duration for the infected cases was far longer genegalidades than for the non-cases 64 days. The agent involved, K. Between half and three-quarters of all the bacteremias caused by this agent originate in the hospital; ed they are resistant to ampicillin and carbenicillin, and are frequently susceptible to cephalosporins, cotrimoxazole, aminoglycosides and imipenem [9].

This pattern was also found generalidadees our study, as the HI cases were caused by ampicillin-resistant K. Primary bacteremias can occur without apparent infectious sources, however there is often an association of disease with mechanisms enterobacferias access to the vascular system.

In the hospital environment, vascular access and contaminated intravenous infusions are often involved. Most of these infections occur in the ICU and in other units for the treatment of seriously ill patients [10]. Every patient in this study had a mechanism for vascular access and most of the BSI cases occurred in those with long-term CVC, of the Port-A-Cath type, already punctured and the only access in use.

The risks rise when enterobacteriad ill patients are grouped together, depending on the type of disease immunodepressionwhenever there are irregular insertion conditions elective vs. Catheter characteristics must also be considered, such as the polymer with which they are manufactured, as well as virulence factors of the microorganism. In vitro studies show that polyvinyl and polyethylene catheters are less resistant to the adherence of microbes than those made of Teflon, silicone and polyurethane [11].


Gfneralidades most common path of infection by short-term peripherally-inserted catheters is the migration of oas from the skin to the point of insertion. In long-term catheters, contamination from the catheter connection contributes substantially to intraluminar colonization. Occasionally, catheters can become hematogenically contaminated, and, less often, contamination may occur from intravenous infusion. The point at which the catheter is inserted also influences the subsequent risk of infection [11].

An implanted catheter is a type of CVC that is implanted in a subcutaneous chamber, in the subclavicular region [10]. The Port-A-Cath type is made of silicone or tunneled polyurethane and a reservoir, generally made of titanium, with a silicone membrane, which makes multiple punctures possible.

It is implanted in lass subcutaneous tissue with a chamber that secures it in place and which facilitates puncture with a special needle. It is lax long-term approximately five years catheter and is associated with a low risk of blood stream infection 0.

The infections found in our study were mainly related to long-term CVC use. The determining factor in this association may be the greater number of punctures in the cases than in the non-cases, since the mean duration of catheter use for the cases was days, while it was 64 days for the non-cases.

The occurrence of an outbreak caused by a single microorganism suggests a common exogenous contamination source, probably due to carelessness. Except for one case, all the patients had a CVC as the only means of access to the vascular system. This is reinforced by the suggestion that the PVC appearedto serve as a protective factor, since it receives less manipulation than the CVC and therefore presents a lower risk of contamination.

The determining factor of the outbreak appears to have been carelessness in handling during care procedures, since after the review of intervention measure techniques and retraining of hand hygiene, the outbreak was controlled. Although the reservoir and the source of this agent were not identified, it is clear that cross contamination was determinant for these occurrences during the care procedures, and that the hospital infection control service’s continuous and permanent oversight and the training of health professionals who directly care for patients are fundamentally important.

Fernandes A T ed. Atheneu,pp.

Causes for hospital acquired septicaemia – a case control study. Quarterly J Md ; Prevention and control of nosocomial infection. Savier,pp. Savier,Parte VI, pp.

Guidelines for the etnerobacterias of intravascular catheter-related infections CDC. Infection Control and Hospital Epidemiology. Infectious morbidity associated with long-term use of venous access devices in patients with cancer.

Ann Intern Med ; Nutr Clin Pract ; P – Zip code: All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal.

Results After the adoption of the intervention measures, only two cases of colonization were detected in February of Discussion The agent involved, K.

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