Background: The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial–temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. Methods: A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identified by the use of Vitek-2 system (BioMérieux), were extracted from the hospital's microbiology laboratory database. A basic scaled map of the hospital’s physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profiles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space–time permutation probability scan tests were used for cluster signals detection. Results: Of the total 759 studied isolates, a significant increase in the resistance profile of K. pneumoniae complex was detected during the studied years. We also identified two space–time clusters affecting adult and paediatric patients harbouring CRKp complex on different floors, unnoticed by regular antimicrobial resistance surveillance. Conclusions: In-hospital GIS with space–time statistical analysis can be applied in hospitals. This spatial methodology has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection.

A clinical–epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case–case–control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76–0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17–28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.

The present study aimed to assess the degree of orientation for PHC from the perspective of adult and child users in the city of Rio de Janeiro. The design was a cross-sectional observational study and included independent samples of child and adult users leaving medical appointments at different health units in Rio de Janeiro (RJ). The study outcome was the essential and general scores of the PCATool Brazil, categorized as High Score above 6.6 and Low Score below 6.6. Socioeconomic, health-related, service use, and general characteristic variables were also collected. A total of 889 adults and 956 children answered the questionnaire and were analyzed. The core and overall PCATool scores were slightly higher in children than in the adult sample. The overall score was 6.72, 95%CI (6.63-6.81) and 6.40, 95%CI (6.30-6.50) in adults. In the adjusted models, individuals with five or more consultations in the last year: children - (OR=1.33, 95%CI [1.01-1.75])/adults - (OR=2.63, 95%CI [1.68-4.11]) and consultation with the same doctor: children - (OR=2.34, 95%CI [1.77-3.08])/adults - (OR=3.42, 95%CI [2.19-5.32]) were associated with a higher overall score.

Resumo O estudo tem como objetivo avaliar o grau de orientação à APS na perspectiva dos usuários adultos e crianças no município do Rio de Janeiro. O desenho foi observacional transversal e incluiu amostras independentes de usuários infantis e adultos que saíam de consulta médica em diferentes unidades de saúde do Rio de Janeiro (RJ). O desfecho do estudo foram os escores essencial e geral do PCATool Brasil categorizados em Alto Escore acima de 6,6 e Baixo Escore abaixo de 6,6. Variáveis socioeconômicas, relacionadas à saúde, uso de serviços e características gerais foram também coletadas. Um total de 889 adultos e 956 para crianças responderam ao questionário e foram analisadas. As pontuações essenciais e gerais do PCATool foram ligeiramente maiores em crianças do que na amostra de adultos. O escore geral foi de 6,72, IC95% (6,63-6,81) e 6,40, IC95% (6,30-6,50) em adultos. Nos modelos ajustados, indivíduos com cinco ou mais consultas no último ano: crianças - (OR=1,33, IC95% [1,01-1,75])/adultos - (OR=2,63, IC95% [1,68-4,11]) e consulta com o mesmo médico: crianças - (OR=2,34, IC95% [1,77-3,08])/adultos - (OR=3,42, IC95% [2,19-5,32]) foram associados a maior escore geral.