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Bloodstream infection (BSI) associated and related to Central Venous Catheter (CVC) resulted in increasing rates of morbidity, mortality and hospital costs. The aim of this study was to investigate the incidence, etiopathogenesis and risk factors related to BSI associated and related to CVC, in a assorted adults Intensive Care Unit (ICU). A longitudinal study of patients using CVC, and case (patients with bacteremia) versus control (patients without infection) of adults in the ICU was carried in Hospital das Clínicas of the Federal University of the Uberlândia, from April 2007 to march 2008 by the NNIS system ( National Nosocomial Infection Surveillance ). Samples from nasal, hub, and insertion site of the catheter were made with swab and cultures on blood agar, MacConkey, Salt Mannitol and Sabouraud. The microorganisms from blood were recovered in the microbiology laboratory of the hospital and the tips of CVC, analyzed by quantitative technique. We evaluated 502 patients admitted to the ICU, of which 435 were using CVC, with 11.2% developing BSI and only tree related to catheter, with an incidence rate of primary bacteremia of 9.5 per 1000 CVC days. The incidence rate of sepsis was 21.3%, with the acquired in hospital accounting for 61.9% of the total, and the acquired in the community was 30.9%. The frequencies of total mortality of these patients were 9.3%, 40.5% and 54.5% in those patients with clinical sepsis, severe sepsis and septic shock, respectively, the majority of deaths (60.6%), during the period of investigation, related to hospital sepsis The investigation of the origin of this microorganisms causing this bacteremias, including those defined as asymptomatic infections (N=17) showed no relation with the hub and skin. The significant risk factors, by univariate analysis, for all bacteremia, including primary (N=34) and secondary (N=15) were: use CVC ≥ 15 days, parenteral nutrition, use ≥ 2 antibiotics and nasal colonization by S. aureus. The independent risk factors for the development of bacteremia included the use of ≥ 2 ATB and Parenteral Nutrition. The coagulase-negative Staphylococci was the most common microorganism causing BSI related to CVC (52.9%). The incidence of bacteremia was right (11.2%), most primary (69.0%) associated with CVC, with the coagulasenegative Staphylococci as the main casual agent.

House dust mites have been reported as important allergen sources which have been characterized by biochemical assays. Some of these allergens are constituted by glycoconjugates that may show affinity with lectins, such as Concanavalin A (ConA). Material and methods: FNLConA and FLConA components were obtained from Dermatophagoides pteronyssinus crude extract after fractionation on Con A-Sepharose affinity chromatography. Dp crude extract and its fractions were evaluated by ELISA and both Dp and FLConA were evaluated by Immunoblot for IgE in sera of 43 patients with allergy to house dust mites and 41 non-allergic subjects selected by skin prick test. Results: Skin prick test analysis showed that all allergic patients were sensitized to D. pteronyssinus (DP+) and co-sensitized to D. farinae (100%) and Blomia tropicalis (86%). Low molecular weight protein bands was detected in FNLConA, however a broad spectrum of protein bands (14-116 kDa) was visualized in both Dp crude and FLConA extract. ELISA analysis showed absence of difference between IgE reactivity to FNLConA when compared to Dp crude among DP+ patients. On the other hand, a lower IgE reactivity between FLConA and Dp crude was observed. Positive correlations were found when Dp crude was compared to FNLConA and FLConA. Inhibition ELISA showed a partial cross-reactivity between D. pteronyssinus and D. farinae when both Dp crude and FLConA were applied on solid phase. Immunoblot analysis revealed several bands ranging from 14 to 116 kDa in Dp-crude and 22 to 116 kDa in FLConA, although there was heterogeneity among the patients. Conclusions: Concanavalin-A bound components from D. pteronyssinus constitute important glycoconjugate antigens which are involved in mite sensitization.

Neospora caninum is an apicomplexan parasite that causes neuromuscular diseases in dogs and abortion in cattle worldwide, leading to significant economic losses. Studies using murine models have contributed to characterize novel antigens and strategies for successful protocols of vaccination. CpG oligodeoxynucleotides (ODN) have shown to be potent immunoadjuvants for several pathogens, but there is limited information concerning its utilization in vaccination for neosporosis. This study aimed to evaluate the potential of Neospora lysate antigen (NLA) or excreted-secreted antigen (NcESA) combined with CpG-ODN in inducing enhanced immune response and protection against N. caninum infection in mice. Six groups of C57BL6 mice were vaccinated subcutaneously three times at 2-week intervals with NLA, NLA+CpG, NcESA, NcESA+CpG, CpG (adjuvant control) or PBS (infection control). Serological assays showed an increased IgG2a response in groups of animals immunized with either antigen plus adjuvant and elevated levels of the IgG1 isotype in those presenting antigen preparations alone. Splenocyte proliferative responses upon antigen stimulation in vitro were higher in groups immunized with either antigen plus CpG, with increased IL-12 production, but mice immunized with NcESA or NcESA+CpG exhibited higher IFN-g levels and IFN-g/IL-10 ratio. After a month of the 3rd booster and challenge with 2 x 107 N. caninum tachyzoites, mice vaccinated with NLA+CpG or NLA alone had lower morbidity score and body weight changes in comparison to other groups, and no animal succumbed to infection. In contrast, mice vaccinated with NcESA+CpG or NcESA exhibited the highest morbidity scores, body weight changes and mortality rates after challenge, associated with a greater brain parasite burden determined by PCR and immunohistochemistry. In conclusion, CpG-ODN was able to induce an increased Th1- type immune response as determined by higher levels of IgG2a than IgG1 for either antigen, NLA or NcESA, and a strong cellular immune response associated with high levels of IFN-g was related to the NcESA antigen rather than the adjuvant used. Also, vaccination with NLA+CpG or NLA alone resulted in total protection of mice, while NcESA alone or combined with CpG became mice more susceptible to parasite challenge.

Neurocysticercosis (NC), presence of Taenia solium metacestodes in the central nervous system is the most serious form of cysticercosis and is the cause of epilepsy in countries under development. The improvement of immunodiagnostic tests which use recombinant antigens is importance because of the difficulty of obtaining parasites from naturally infected pigs for the preparation of metacestodes T. solium metacestodes crude antigen. The aim of this study was to select phagotopes by phage display peptide library specific to IgG present in serum samples from patients with NC and confirm the immunoreactivity from the selected phagetopes in the ELISA test for the diagnosis of human neurocysticercosis in serum samples. We used in the selection procedure a phage display peptide library in a selection strategy against the immunoglobulins (IgG) purified from serum samples positively diagnosed for NC, other parasitoses and apparently health individuals. The DNA sequences corresponding to the inserts of the selected phage clones were sequenced, translated and analyzed by bioinformatics. ELISA tests were performed with the ten phagetopes selected against the three groups of patients (NC, other parasitoses and healthy). The binding specificities of the recombinant phages to the pool of serum samples were analyzed by competitive ELISA. Peptides showed significant similarities with important proteins from T. solium. All phagetopes presented satisfactory sensitivities and specificities in the ELISA test, varying from 52.5% to 100% and 86.3% to 100%, respectively. Some phagetopes did not reacted with serum samples from patients infected with Echinococcus granulosus, what is an advance since this cross reaction is very commonly reported. The recognition data indicated that the selected peptides could indeed mimic the epitopes on T. solium and bind specifically to the pool of serum with NC. We concluded that the identified phage clones displayed specific peptides to NC, and are potential biomarkers for NC diagnosis in serum samples.

Conselho Nacional de Desenvolvimento Científico e Tecnológico

According to hygiene hypothesis, a lower exposure to infection is associated with the increase in allergic disease prevalence. This study aimed to investigate the association between atopy and Toxoplasma gondii (Tg) infection by analyzing the humoral and cellular immune responses in Tg-seropositive and -seronegative, atopic and non-atopic patients. A total of 275 individuals were assessed and divided into atopics (n=129) and non-atopics (n=146) based on markers of allergy (positive skin prick test and ELISA-IgE to mite allergens) or Tg-seropositive (n=116) and Tg-seronegative (n=159) groups according to infection serological markers (positive ELISA-IgG to T. gondii). Tg-seropositive individuals presented lower allergenic sensitization (37%) to Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) mite than Tg-seronegative subjects (54%). The odds ratio (OR) of belonging to an atopic group with positive serology to T. gondii was 0.50 (95% CI: 0.31-0.81; p<0.05) while the association between atopy and negative serology to T. gondii resulted in OR of 2.0 (95% CI, 1.23-3.26; p<0.05). Cellular immune response evaluated by proliferative responses and cytokine production after antigenic or allergenic stimulation showed predominant synthesis of Th1-cytokines as IFN-&#947; in Tg-seropositive patients, whether atopics or non-atopics. Conversely, Th2-cytokines as IL-5 prevailed in atopics compared to non-atopics, regardless the seropositivity to T. gondii. Response of regulatory cytokines, such as IL-10, was evidenced in all groups, markedly after stimulation with the Df allergen. Hence, the negative association between atopy and T. gondii infection was evidenced, indicating that the presence of parasite infection can influence negatively in the induction of allergenic sensitization rather than the manifestation of allergic symptoms, reinforcing the protective role of this infection in the development of allergic diseases.

The study aim was to determine the incidence and evolution of sepsis, severe sepsis and septic shock, from hospitalar and community sample, if it was primary or secondary according to its origin and with or without microbiological identification. Furthermore it was assessed the etiology, the antibiotic susceptibility and their relationship with the antibiotic consume by patients of a mix adult Intensive Care Unit (ICU). It was realized an prospective observational study through active watchfullness at Hospital de Clínicas of Universidade Federal de Uberlândia (HC-UFU), for a nine months period (from april to december 2007). The total of 75 from 403 patients (18,6%, 15,9/1000 patient day) had sepsis, being 72% acquired inside the hospital and 28% from the community. The patient/day rate was 442, with patient/day rate for 1000 days of sepsis, severe sepsis and septic shock with respetive rate of 8,2; 5,0 and 3,1. The sepsis patient confinement time was 22,0 days. The sepsis patient mortality rate was ~ 35%, being higher in that patients with septic shock (50%). The microbiological identification presence was evident in 58% of the cases, with primary or secondary sepsis frequencies of 50,8% and 49,2% respectively, with the lung being the main place in the last group. The antibiotic usage rate was higher (60,3%) when compared to another studies. The sepsis risk factors were: confinement time higher than 5 days, parenteral nutrition, use of Central Vascular Catheter higher than 5 days and antibiotic usage. The main recovered pathoogens were those from Enterobacteriaceae family and Staphylococcus coagulase-negative, being observed the high proportion of antibiotic resistant phenotype. The nasal colonization by the S.aureus was expressive, appearing in almost 53% of the patients, being the most part (~ 61%) acquired outside the ICU, despite its frequencies as a sepsis agent was low (8%).

The Taenia solium metacestodes localization in humans occours mainly in the central nervous system (CNS) promoting the disease named neurocysticercosis (NC), the most frequent parasitosis in the CNS. The pathological presentation of NC differs about localization and viability of metacestodes, and host immunological response. For its diagnosis stabelishment is necessary a right interpretation of clinical signs, neuroimagin and immunological tests, and epidemiological data. The frequent inviability of parasite material has stimutaled the development and usage of recombinant antigens in the immunodiagnosis, and since describition of the phage-display tecnology this technique has presented increseier utilization in several cientific areas, as selection of peptides that could be used for immunodiagnostic test. The aim of this study was to obtain mimetopes of T. solium through biopanning using IgY specific to T. solium metacestodes. The IgY obtained from immunizated chicken with T. solium metacetodes saline extract was coated on microplate wells to select peptides from phage library in a three rounds biopanning. The phagetopes selected were tested in NC diagnosis by ELISA assay with 110 serum samples, 40 from NC patients and patients infected with others parasitic diseases, and 30 samples of health individuals. Seven mimetopes shown the best results in diagnostic patients with NC, and also they were capable to distinguish active from inactive NC form, detecting almost even 100% of inactive NC patients. None of the clones reacted with Echinococcus granulosus sera and the specificity ranged from 85.7% to 94.3%. This study was the first utilizing chicken immunization using T. solium metacetodes saline extract. The phage clones Cc6, Cc8, Cc25, Cc27, Cc30, Cc45 e Cc48, shown the better results, can be potentials candidates as NC inactive phase markers and a uselles tool in disease prognostic, and reinforcement to neuroimaging tests.

Paracoccidioidomycosis (PCM) caused by a dimorphic fungus Paracoccidioides brasiliensis, is the main systemic mycosis of Latin America. Experimental models are important in the PCM study. The objective of this study was evaluate the specific humoral response (IgG, IgG1 and IgG2a) of Calomys callosus infected experimentally with P. brasiliensis and to identify patterns of antigenic recognition comparatively to susceptible (B10.A) and resistant (A/Sn) mice. The animals were infected with 0.6 x 105 yeasts de P. brasiliensis (Pb18 isolate). Lung, liver, spleen and serum samples were collected at 7, 15, 30, 60, 90 and 120 days after infection. We noticed that in the histological findings the infection evolved gradually in the studied groups, with more prominent inflammation in C. callosus, especially in the lung. In ELISA assay, the levels of IgG and IgG1 were similar for the three groups, but when we consider the IgG2a levels, C. callosus presented the lowest levels. In immunoblotting assays, the immunodominant bands (antigens) that were common to the three animals groups recognized by IgG1 were 117, 110, 95-100, 70, 43, 36 and 24kDa and by IgG2a were 95-100, 43 and 29kDa. Considering the IgG2a response, the frequency of antigenic recognition by the C. callosus serum and the band intensity were lesser than B10.A and A/Sn mice. In conclusion, C. callosus, inoculated with 0.6 x 105 P. brasiliensis yeasts, presented greater susceptibility to the infection, with a higher degree of tissue injuries, lower response of IgG2a and a lesser recognition of antigenic fractions with a lower intensity, when as compared to murine experimental model.

DNA is often damaged by environmental agents which lead to the up-regulation of several genes involved in different repair pathways. The regulation of DNA repair is important for cell survival following exposure to DNA-damaging agents. Schistosoma mansoni is a parasite that undergoes several modifications in its complex life cycle, being exposed to a subset of DNA-damaging agents, such as the environment and host immune response, and therefore, such as many other organisms, it is likely to be provided for efficient repair mechanisms. Recently, studies have shown that Nucleotide Excision Repair (NER) consists in an indispensable mechanism for removing a broad spectrum of DNA lesions. In the current study, it was analyzed the gene expression of Nucleotide Excision Repair Factor 2 (NEF2) - SmRad23 and SmRad4, in different developmental stages of S. mansoni, as well as the expression level of these genes in S. mansoni adult worms treated with DNA-damaging agents. Together, the results have confirmed the expression of these two proteins in all of the evolutive stages studied of the parasite, and shown a differential expression in front of the treatment with the different chemical agents. Furthermore, it was revealed the correlation of these genes with their orthologues in other eukaryotes. Therefore, the presence of SmRad23 and SmRad4 in all of the developmental stages of S. mansoni, as well as their differential expression following exposition to DNA-damaging agents, suggest that the NER is an important repair pathway during the complex life cycle of this parasite.

Canine demodicosis is one of the more common skin diseases encountered in veterinarypractice. Typical lesions are erythematous and alopecic patches on the head and / or forelegs. In order to verify the specific IgG and IgE antibody production against homologous, Demodex canis soluble antigen (SDAg), and heterologous, Dermatophagoides pteronyssinus (SDpt) and Myocoptes musculinus (SMAg) soluble antigens, this study was done. Skin scrapes, blood and serum samples, were collected to analyze the presence of the acarian in the skin, eosinophils and antibody production by ELISA, respectively. The samples were collected from 27 dogs, 3 from healthy dogs that were more than 12 months old, 20 from dogs with skin lesions and 4 from healthy young dogs (less than 12 months old). The homologous antigen was not able to discriminate between positive and negative control serum samples. When heterologous antigens were used to detect IgG antibodies, both of them were not able to discriminate symptomatic and non symptomatic dogs. In addition, it was observed that young dogs (those with less than 12 months old) symptomatic and non symptomatic dogs were reactive to heterologous ntigen. However, when heterologous antigens were used to detect IgE antibodies, it was observed that symptomatic dogs presented IgE specific antibodies when they were more than 12 months old. The non symptomatic dogs did not presented specific antibody against heterologous antigens. Additionally, soluble antigens from D. canis, D. pteronyssinus and M. musculinus presented some proteins with similar molecular weigth. These data suggest that D. canis and related parasites D. pteronyssinus and M. musculinus shared some antigens that induce production of cross reactive antibodies.

The human metapneumovirus (hMPV) is a pathogen of the respiratory tract first identified in The Netherlands in 2001 and since then has already been detected in all continents. The purpose of this study was to identify and characterize hMPV in samples collected from children <5 years presenting acute respiratory disease seen at a public hospital in Uberlândia, in Southeast Brazil. One hundred fourteen nasopharyngeal aspirates samples that were negative for nine other respiratory viruses were tested by RT-PCR to the presence of hMPV RNA. PCR products obtained by the amplification reaction of the N hMPV gene, were sequenced and compared with sequences deposited in GenBank. Fourteen out of 114 (12.3%) samples were positive for presence of hMPV RNA; sequences from eight samples were obtained and all four subtypes were identified, including the novel sublineages A2a and A2b; mean age was 21 months old; upper respiratory tract infection was the most common clinical symptom; the virus was detected in samples collected from March to November, a period that corresponds to late summer to mid-spring in Brazil. As far as is known, this is the first study to describe the circulation of the four subtypes of hMPV in Brazil

The efficiency of different methods of control on oocysts of Eimeria acervulina in broilers was evaluated. Preventive methods in the reused bed had been tested as the fermentation and the disinfection for quaternary ammonia, beyond the anticoccidian treatment of the chickens of cut with Diclazuril. 300 broilers of the Cobb strain had been used equally distributed in two stages of 150 birds each. Each stage was carried through in delineation of blocks entirely casualized, with five groups of 30 broilers. In 1ª stage, 150 birds had been inoculated experimentally, at 12 days of age, orally, with 3x103 oocysts. After sanitary interval of 15 days, in which the bed passed for the different tested methods of control was carried through 2ª stage. The others 150 birds had been lodged on the same bed of the inoculated birds, to evaluate the dynamics of the coccidian ambient reinfeccion after the treatments. Counting of oocysts per gram of excrements had been carried through (OOPG), comment of clinical signals, evaluation of zootechnical performance for the indices of weight profit and alimentary conversion, determination of scores of intestinal macroscopic injuries and intestinal histomorphometric analysis. The results had demonstrated that the disinfection of the bed reused with quaternary ammonia did not control the reinfeccion of the broilers. The method of fermentation of the bed associated or not with the disinfection for quaternary ammonia, was capable to reduce the number of oocysts recouped of excrements of the birds for controlling the ambient contamination. Although Diclazuril have reduced the infectant load of oocysts in the birds, this was not capable to control the ambient recontamination. The fermentation of the reused bed can be considered an efficient method of control of avian coccidiosis for E. acervulina.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais

The central vascular catheter (CVC) is the main factor of bloodstream infections. The aims of this study were to determine the prevalence of CVC usage, etiology and pathogenesis of those infections in eighty patients submitted to gastrointestinal surgery in use of long-term vascular access at HC-UFU. Prevalence inquiries were done of CVC usage at the hospital and cultures of the nostril, site of insertion, tip and hub of the catheter, besides hemoculture on those sepse suspicious. In the inquiry, it was noticed that 15,4 % of patients were CVC users, from which 60,4% were intern in non-critical unities. From eighty patients investigated, it was verified an average time of 10,7 ± 4,0 days/ CVC. The incidence of assimptomatic infection was of 12,5/ 1000 catheter days and to the infection associated to CVC of 3,1/1000 catheter days. The colonization rates of sites of insertion, cannon and tip of catheter were 13,8%, 8,9% and 13,3%, respectively. The Coagulase-negative staphylococci were most isolated from the nostril (75%), site of insertion (45,4%) and hub of the catheter (75%). The gram- negative bacilli (50%) followed by S. aureus (25%), were the most isolated from catheter tip. Detected three cases of bacteremia associated to CVC usage (3,8%) with S. aureus, responsable for two of the episodes of infection and K. pneumoniae for the third. There was no association of skin colonization and of the catheter hub in these patients, but the S. aureus was recovered from the patients nostril who had infection by this pathogenous. One suggests a higher concern about preventive actions and control of these infections, considering the frequency of CVC usage at the hospital with about 60% of these patients in non-critical unities.

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Background: Components from species of mites found in the house dust showed an important role in respiratory diseases. Many of these components are glycosylated and some lectins, like Concanavalin A (ConA) showed an affinity to those molecules. Objectives: To determine the levels of speific IgE to Df crude extract and Df- ConA bound fraction in allergic patients and their cross-reaction between D. pteronyssinus and B. tropicalis crude extracts by ELISA and Inhibition ELISA, respectively. The presence of allergic components in Df crude extract and Df- ConA bound reactive to IgE by Immunoblot also was verified. Methods: Concanavalin A affinity chromatography was used to obtain glycosylated fraction with &#945;-D-mannose and &#946;-D-glucose residues from Dermatophagoides farinae (Df) crude extract. ConA-unbound and ConA-bound fractions and also Df crude extract were used to evaluate IgE reactivity by ELISA and Immunoblot in sera from 41 mite-sensitive patients with allergic rhinitis history and 31 non-allergic subjects selected by skin prick test. Results: All allergic patients were positive SPT to D. farinae and D. pteronyssinus, and 93% of co-positivity to B. tropicalis. ELISA showed a great positivity in all extracts, but higher levels of IgE were found in Df crude extract and ConA-unbound fractions when comparing with ConA-bound fraction. However, both ConA-unbound and ConA-bound fractions showed a significant positive correlation with Df crude extract. Inhibition ELISA assay showed a high cross-reactivity between Dermatophagoides farinae and Dermatophagoides pteronyssinus extracts. High frequency IgE reactivity to apparently high molecular bands in the ConA-bound fraction was observed by Immunoblot analysis. Conclusion: Dermatophagoides farinae represent an important source of glycosylated allergens with Concanavalin A affinity which are involved in the mechanisms of IgE induction in allergic rhinitis.

Surgical site infections (SSI) after cardiac surgery is a significant problem for patients operated in terms of morbidity, mortality and costs. The objective of this study was to investigate epidemiological aspects of these infections in the main types of heart surgeries, including incidence, etiology, pathogenesis and risk factors of nosocomial infection, divided into ISC and other anatomical sites and hospital mortality in adult patients. We conducted a study case vs. control in patients undergoing cardiac surgery between November 2005 and August 2009. The most common surgical procedure was coronary artery bypass grafting (CABG) (53%), followed by surgery to repair valve (CRV) (25.2%), other surgeries (14.7%) and surgery combined CRM and CRV (6.9%). The rate of surgical site infection was 17.6%, with almost two thirds of patients diagnosed before hospital discharge. The ISC site infections were detected in 65 (14.5%) patients and organ/space in 10 patients (2.2%). The following independent risk factors were associated with the development of CSI: Body Mass Index (BMI) &#8805; 30 kg/m2 (OR: 2.20, 95% CI 1.16 to 4.16, P = 0.0154), Risk index for surgical site infection "2" (IRIC) (OR: 1.81, 95% CI 1.00 to 3.29, P = 0.0506), CABG (OR: 2.36; 95% CI 1.22 to 4.58, P = 0.0109), postoperative hospitalization greater than 7 (seven) days (OR: 3.60, 95% CI 1.70 to 7.66, P = 0,0008). The nasal colonization prior patient with S. aureus, was also a predisposing factor (13.7% vs. 0% in the control group, P = 0.0011) only when the analysis. The rate of nosocomial infection episodes observed in other sites including the blood stream (CS) and urinary tract infection (UTI) and lungs (pneumonia), considered as a group exceeded (68.6%) of the ISC (31.3% ) with a ratio of 2.1 for each ISC These infections in other anatomical sites presented as independent risk factors for co-morbidity renal failure (OR: 3.55, 95% CI 2.00 to 6.32, P = <0.0001) and postoperative hospitalization longer than 7 (seven) days (OR: 5.76, 95% CI 2.93 to 11.33, P<0.0001). Microbiological criteria were used in the diagnosis of the majority of SSI (52.0%) and other IHS (59.0%), highlighting a predominance of gram-negative bacilli (GNB) (63.5%), absent in the air the operating room, Klebsiella spp. (24.1%) and Staphylococcus aureus (20.6%) as the most common pathogens. Microorganisms multidrug resistant (66.3%) predominated among the isolates recovered from clinical specimens. Mortality was significant both in patients with SSI (OR: 3.09, 95% CI 1.26 to 7.59, P<0.0134) and in those with severe infections like PNM and infections of CS (P<0, 05). Although the ISC, which are common in hospital practice, are increasingly recognized as a measure of quality of care offered to patients, more significant results in terms of morbidity, mortality, and therefore costs, especially when the inclusion of infections in other anatomical sites after cardiac surgery, as observed in this study, should be examined critically.

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