Antibiotic use in patients with severe acute respiratory syndrome due to SARS-CoV-2 in a Brazilian University Hospital (2020–2021) Valeria Paes Lima, Gustavo Adolfo Sierra Romero Antimicrobial Stewardship and Healthcare Epidemiology, 2026 Background: The COVID-19 pandemic has profoundly affected healthcare systems worldwide. High and often inappropriate antimicrobial use has been reported in COVID-19 care, potentially increasing the risk of bacterial resistance and other adverse events. This study aimed to characterize and quantitatively assess antimicrobial use among Brazilian patients hospitalized with severe acute respiratory syndrome (SARS) due to SARS-CoV-2 infection. Methods: This retrospective observational cohort study included patients hospitalized with SARS caused by SARS-CoV-2 at the University Hospital of Brasília (HUB) during 2020 and 2021. Data on antimicrobial regimens, duration of therapy, and days of use were extracted from medical records. Results: The median age was 61 years (IQR, 49–72); most patients were unvaccinated against COVID-19 (76.3%), and comorbidities were highly prevalent (90.1%). Patients were stratified by clinical severity at hospital discharge: 301 (47.2%) were classified as Severe COVID-19 and 337 (52.8%) as Critical COVID-19. Greater clinical severity was consistently associated with increased antimicrobial exposure across multiple indicators, including the proportion of patients receiving antimicrobials, days of therapy (DOT), length of therapy (LOT), and the DOT/LOT ratio and an inverse association was observed for antimicrobial-free days (AFD). According to the World Health Organization (WHO) AWaRe classification, Watch-group antibiotics were most frequently prescribed (91.9% of patients); however, Reserve-group antibiotics showed the greatest increases in both frequency and duration of use with increasing disease severity. Conclusions: In this single-center Brazilian cohort, antimicrobial therapy was highly prevalent (94.4%). Higher clinical severity was strongly associated with greater antimicrobial exposure and fewer AFD.
Institutional Risk Factors Associated With Healthcare-Associated Infections in Brazilian ICUs: A Nested Cohort Within the IMPACTO-MR Platform Bruno Adler Maccagnan Pinheiro Besen, Camila Dietrich, Carla Cristina Gomes Pinheiro, Débora Patrício Silva, Renata Rodrigues de Mattos, et al. Critical Care Medicine, 2025 Objectives: Healthcare-associated infections are common and potentially preventable, especially in low- and middle-income countries (LMICs), due to substandard staffing, structure, and process-of-care. We evaluated institutional risk factors associated with ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) rates. Design: Multicenter cohort study. Setting: Fifty Brazilian ICUs. Patients: All patients admitted from September 2019 to December 2021 to the participating ICUs, exposed to at least 2 days of invasive mechanical ventilation (MV) or central venous catheter (CVC). Interventions: None. Measurements and Main Results: Individual patient data were prospectively collected, and cross-sectional hospital-level data were collected at baseline. VAP and CLABSI were reported in accordance with Brazilian regulatory agency guidance. Negative binomial or Poisson multiple regression were used to model risk factors, adjusted for individual-level covariates. Of 75,164 ICU admissions, there were 19,108 at-risk (≥ 48 hr of MV) patients with a total of 244,059 MV-days for a VAP incidence rate of 6.03 (95% CI, 5.73–6.35) per 1,000 MV-days. There were 26,560 patients with a total of 375,078 CVC-days for a CLABSI incidence rate of 1.63 per 1,000 CVC-days (95% CI, 1.51–1.77 per 1,000 CVC-days). The median rate ratios of hospital random-effects were 4.39 (95% CI, 2.72–6.06) for VAP and 3.53 (95% CI, 2.30–4.76) for CLABSI. Hospital-level fixed effects explained 39.9% (95% CI, 33.6–46.1%) of the between-hospital variability for VAP and 44.7% (95% CI, 35.0–54.5%) for CLABSI. Prevention protocols, flexible family visitation policies, and hand hygiene training were associated with reduced rates of VAP and CLABSI. Nursing staffing ratios, single-use gowns, and alcohol availability were associated with a lower CLABSI rate. Sedation titration by nurses, weaning by respiratory therapists, and dentist availability were associated with a lower rate of VAP. Conclusions: Processes-of-care and ICU structure measures are associated with the burden of VAP and CLABSI in LMICs.
HUMAN FASCIOLIASIS IN BRAZIL: A CASE REPORT Cleudson Castro, Walcymar Pereira Santiago, Shigueru Ofugi, Valeria Paes Lima Journal of Tropical Pathology, 2024 We report a case of fascioliasis in a 50-year-old man who probably acquired the infection in 2006, when he presented with epigastric pain that forced him to walk bent over. Chronic symptoms, included postprandial dyspepsia, dysphagia, odynophagia, headaches, belching, and epigastric pain, that persisted until 2016. He consulted health clinics in Santa Catarina and Brasília and several diagnostic hypotheses have been proposed, including cholangiocarcinoma and indolent neoplasm. Between 2009 and 2017, he performed images of the upper abdomen such as computed tomography, magnetic resonance imaging and ultrasound examinations. They all revealed dilation, especially of the extrahepatic bile ducts that contained amorphous material. Blood counts showed anemia and significant eosinophilia. Previously low serum iron and ferritin levels normalized after treatment. After the detection of F. hepatica eggs in three stool samples examination, he was diagnosed with fascioliasis. The patient was treated with triclabendazole 15 mg/kg/day in two doses in a single day. Four post-treatment parasitological exams showed negative results, and symptoms resolved within six months after the therapy. KEY WORDS: Fasciola hepatica; fascioliasis; triclabendazole
Substance Use and Risky Sexual Behavior in the PrEP Outpatient Clinic at the University Hospital of Brasília Alan Rodrigues da Costa, Jônatas Ferreira Barros, Valéria Paes Lima, Camila Magalhães, Hellen Kássia Rezende Silva, et al. Tropical Medicine and Infectious Disease, 2023 (1) Background: To evaluate the epidemiological profile of people who use drugs at the PrEP outpatient clinic of the University Hospital of Brasília; (2) Methods: Cross-sectional study with a review of data from medical records referring to the first medical consultation. The prevalence ratio was calculated using a Poisson regression model with robust variance; (3) Results: A total of 53% of subjects reported drug use in the last 3 months. The unadjusted prevalence ratio of drug use in trans women was PR: 9.0 (95%CI: 1.4–57.5). people who use drugs have a 1.9 times higher prevalence of STI diagnosis, and a 2.4 times higher prevalence of partners compared to non-users; (4) Conclusions: Substance use was associated with a higher STI prevalence ratio and number of sexual partners.
Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study Beatriz Arns, Crepin Aziz Jose Oluwafoumi Agani, Guilhermo Prates Sesin, Jaqueline Driemeyer C. Horvath, Débora Vacaro Fogazzi, et al. Antimicrobial Stewardship and Healthcare Epidemiology, 2023 Objective: Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods: This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results: In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions: In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.
