Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

2016 ◽  
Vol 38 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Stefan Erb ◽  
Reno Frei ◽  
Marc Dangel ◽  
Andreas F. Widmer
Keyword(s):  
Infection Control ◽  
Hospital Admission ◽  
Diagnosis Related Groups ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Multidrug Resistant Organisms ◽  
Definition Of ◽  
The Impact

BACKGROUNDInfections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours after hospital admission are considered healthcare-acquired according to the definition of the Centers for Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups (DRGs).OBJECTIVEThe goal of the study was to estimate the preventable proportion of healthcare-acquired infections in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs.METHODSAll hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine whether there was evidence for nosocomial transmission. We utilized an additional work-up with epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of HAMICs.RESULTSOverall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs.CONCLUSIONSThe CDC definition overestimates the preventable proportion of HAMICs with MDROs by more than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact of infection control interventions and to inadequate reimbursement under the DRG system.Infect. Control Hosp. Epidemiol. 2016;1–6

Incidence rate of multidrug-resistant organisms in a tertiary care hospital, North Delhi

2015 ◽  
Vol 12 (4) ◽  
pp. 248-256
Author(s):  
Manoj Kumar ◽  
Sanjay Jain ◽  
Neetu Shree ◽  
Mukesh Sharma
Keyword(s):  
Incidence Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Multidrug Resistant Organisms

scholarly journals Coexistence of β-Lactamases in Community-Acquired Infections in a Tertiary Care Hospital in India

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Shahzad Mirza ◽  
Savita Jadhav ◽  
R. N. Misra ◽  
Nikunja Kumar Das
Keyword(s):  
Tertiary Care ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Clinical Samples ◽  
Care Hospital ◽  
Cross Sectional ◽  
Beta Lactamases ◽  
Antibiotic Susceptibility Test ◽  
Multidrug Resistant Organisms ◽  
Control And Prevention

Introduction. The trends of β-lactamases producing Enterobacteriaceae is ever increasing, and limited studies have reported investigating coexistence of β lactamases in Enterobacteriaceae. A cross-sectional study after approval from the Institutional Ethical committee was conducted between June 2014 and May 2016 in community-acquired infections due to multidrug-resistant organisms in our tertiary care. Nonrepetitive clinical samples from the out-patient department (OPD) were processed for bacteriological culture and identification of Enterobacteriaceae. An antibiotic susceptibility test, screening, and phenotypic confirmation for ESBLs and carbapenemases and AmpC producers were performed to check for coexistence of these enzymes. Results. Nonrepetitive clinical specimens processed for culture and identification in our hospital revealed 417 positive isolates in community acquired infections which were multidrug-resistant organisms, and on screening for β-lactamases, 293 isolates were positive for one of the three beta lactamases, ESBL, AmpC, or carbapnemases. Coproduction of ESBL and MBL was seen in 5 isolates, 35 isolates showed coproduction of ESBL and AmpC enzymes, and AmpC and MBL coproduction was exhibited in only in 5 isolates. Conclusions. Coexistence of ESBLs, AmpC producers, and carbapenemases has been described. Continuous monitoring and surveillance and proper infection control and prevention practices will limit the further spread of these superbugs within the hospital and beyond.

scholarly journals Microbial Disruption Indices to Detect Colonization With Multidrug-Resistant Organisms

2017 ◽  
Vol 38 (11) ◽  
pp. 1312-1318 ◽  
Author(s):  
Rafael Araos ◽  
Veronica Montgomery ◽  
Juan A. Ugalde ◽  
Graham M. Snyder ◽  
Erika M. C. D’Agata
Keyword(s):  
Hospital Admission ◽  
Microbial Diversity ◽  
Multidrug Resistant ◽  
Rrna Gene ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Fecal Microbiome ◽  
Culture Techniques ◽  
Multidrug Resistant Organisms

OBJECTIVETo characterize the microbial disruption indices of hospitalized patients to predict colonization with multidrug-resistant organisms (MDROs).DESIGNA cross-sectional survey of the fecal microbiome was conducted in a tertiary referral, acute-care hospital in Boston, Massachusetts.PARTICIPANTSThe study population consisted of adult patients hospitalized in general medical/surgical wards.METHODSRectal swabs were obtained from patients within 48 hours of hospital admission and screened for MDRO colonization using conventional culture techniques. The V4 region of the 16S rRNA gene was sequenced to assess the fecal microbiome. Microbial diversity and composition, as well as the functional potential of the microbial communities present in fecal samples, were compared between patients with and without MDRO colonization.RESULTSA total of 44 patients were included in the study, of whom 11 (25%) were colonized with at least 1 MDRO. Reduced microbial diversity and high abundance of metabolic pathways associated with multidrug-resistance mechanisms characterized the fecal microbiome of patients colonized with MDRO at hospital admission.CONCLUSIONSOur data suggest that microbial disruption indices may be key to predicting MDRO colonization and could provide novel infection control approaches.Infect Control Hosp Epidemiol 2017;38:1312–1318

scholarly journals Control of an Outbreak ofAcinetobacter baumanniiin Burn Unit in a Tertiary Care Hospital of North India

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shweta Sharma ◽  
Nirmaljit Kaur ◽  
Shalini Malhotra ◽  
Preeti Madan ◽  
Charoo Hans
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Hospital Environment ◽  
North India ◽  
Care Hospital ◽  
Burn Unit

Acinetobacterinfection is increasing in hospitals and now it is considered as a global threat, as it can be easily transmitted and remain viable in the hospital environment for a long time due to its multidrug-resistant status, resistance to desiccation, and tendency to adhere to inanimate surfaces. Outbreaks caused by multidrug-resistantAcinetobacter baumannii(MDRAB) are difficult to control and have substantial morbidity and mortality, especially in vulnerable host. Here we are describing an outbreak of multidrug-resistantAcinetobacter baumanniiin burn unit of a tertiary care hospital in India followed by its investigation and infection control measures taken to curtail the outbreak. Outbreak investigation and environmental sampling are the key factors which help in deciding the infection control strategies for control of outbreak. Implementation of contact precautions, hand hygiene, personnel protective equipment, environmental disinfection, isolation of patients, and training of health care workers are effective measures to control the outbreak of MDRAB in burn unit.

scholarly journals Characterization of Antibiotic Use, Documented Infection and Prevalence of Multidrug-Resistant Organisms in Palliative Care Patients Admitted to a Private Hospital in Brazil: A Retrospective, Cohort Study

2021 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Mara Graziele Maciel ◽  
Mayra Fruitg ◽  
Rebeca Pissolati Lawall ◽  
Alexandre Toledo Maciel
Keyword(s):  
Palliative Care ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Private Hospital ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Documented Infection ◽  
Multidrug Resistant Organisms ◽  
The Impact

Objectives: Antibiotic use in palliative care patients is a frequent dilemma. The benefits of their use in terms of quality of end-of-life care or survival improvement are not clear and the potential harm and futility of this practice not well established. Our aim was to characterise the prevalence of antibiotic use, documented infection and multidrug-resistant organisms (MDROs) colonisation among palliative care patients admitted to a private hospital in Brazil. Materials and Methods: Retrospective analysis of all palliative care patients admitted to our hospital during 1 year, including demographic characteristics, diagnosis of infectious disease at admission, antibiotic use during hospital stay, infectious agents isolated in cultures, documented MDRO colonisation and hospital mortality. Results: A total of 114 patients were included in the analysis. Forty-five (39%) were male and the median age was 83 years. About 78% of the patients had an infectious diagnosis at hospital admission and 80% of the patients not admitted with an infectious diagnosis used antibiotics during their stay, out of which a great proportion of large spectrum antibiotics. Previous MDRO colonisation and hospital mortality were similar between patients admitted with or without an infectious diagnosis. Conclusion: Infection is the leading cause of hospital admission in palliative care patients. However, antibiotics prescription is also very prevalent during hospital stay of patients not admitted with an infectious condition. Mortality is very high regardless of the initial reason for hospital admission. Therefore, the impact of multiple large spectrum antibiotics prescription and consequent significant cost burden should be urgently confronted with the real benefit to these patients.

scholarly journals 2391. Increased Risk of Systemic Infections with Multidrug-Resistant Organisms in Patients with Severe Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S825-S825
Author(s):  
Kierra M Dotson ◽  
Anne J Gonzales-Luna ◽  
Jacob McPherson ◽  
Chris Lancaster ◽  
Bradley T Endres ◽  
...  
Keyword(s):  
Disease Severity ◽  
Defense Mechanism ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Candida Spp ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
Antibiotic Associated Diarrhea

Abstract Background The gut microbiota is a defense mechanism against colonization of multidrug-resistant organisms (MDROs), including carbapenem-resistant Enterobacteriacae (CRE). Gut dysbiosis caused by broad-spectrum antibiotics favors MDRO colonization and increased susceptibility of intestinal infections, including C. difficile infection (CDI). Increased CDI severity may increase the risk of bacterial translocation due to damage to colonic epithelial layer. The aim of this study was to assess CDI disease severity and subsequent risk for MDRO systemic infection. Methods This was a prospective, observational study of adult hospitalized patients tested for CDI at a large, university-affiliated tertiary care hospital. Patients with a history of systemic MDRO infection in the past 90-days of stool testing were excluded. Patients were stratified by test positivity (CDI vs. antibiotic-associated diarrhea (AAD)), as well as, CDI disease severity and followed for 30-days for subsequent MDRO infections defined as presence of MDRO cultures from systemic, normally sterile sites (blood, urine, cerebrospinal fluid). Stool samples were collected and grown for MDRO colonization. Results A total of 335 CDI-positive and 135 antibiotic-associated diarrhea (AAD) hospitalized patients were included. No differences were found in rates of MDRO colonization by test positivity or disease severity (overall 68% VRE, 53% Candida spp., 30.4% MRSA, and 1.8% CRE). Significantly more patients with severe CDI had higher rates of developing systemic MDROs compared with mild-moderate CDI and AAD (23.2%, n = 112 vs. 8.1%, n = 223 P < 0.001; vs. 11.9%, p = 0.018). Severe CDI was found to be an independent risk factor for subsequent systemic MDRO infection via logistic regression. Conclusion Severe CDI disease is associated with an increased risk of systemic MDRO infections. Disclosures All authors: No reported disclosures.

Use of Longitudinal Surveillance Data to Assess the Effectiveness of Infection Control in Critical Care

2009 ◽  
Vol 30 (11) ◽  
pp. 1109-1112 ◽  
Author(s):  
John W. Ahern ◽  
W. Kemper Alston
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Surveillance Data ◽  
Simple Method ◽  
Academic Medical ◽  
Multidrug Resistant Organisms ◽  
The Impact

A simple method for quantifying nosocomial infection and colonization with multidrug-resistant organisms is described. This method is applied to the intensive care unit of an academic medical center where longitudinal surveillance data have been used to assess the impact of infection control interventions and antibiotic use.

scholarly journals Characteristics of Candida auris Patients at a Tertiary-Care Hospital, 2017–2019, Nairobi, Kenya

2020 ◽  
Vol 41 (S1) ◽  
pp. s162-s163
Author(s):  
Loice Ombajo ◽  
Malcolm Correia ◽  
Alice Kanyua ◽  
Cheptoo Bore ◽  
Phoebe Juma ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Care Hospital ◽  
Candida Auris ◽  
Environmental Disinfection

Background:Candida auris is of global concern due to its increasing frequency in intensive care units (ICUs), reported resistance to antifungal agents, propensity to cause outbreaks, and persistence in clinical environments. We investigated an increase in C. auris cases in an ICU in Kenya to determine the source of transmission and to control the spread of the disease. Methods: To identify cases, we reviewed laboratory records of patients with blood cultures yielding C. auris and organisms for which it is commonly misidentified by Vitek 2 v 8.01 software (ie, C. haemulonii, C. duobushaemulonii and C. famata) during January 2018–May 2019. We retrospectively reviewed medical charts of C. auris patients to extract information on demographics, underlying conditions, hospital procedures, treatments, and outcomes. We also enhanced infection control efforts by implementing contact precautions, equipment, and environmental disinfection, and hand hygiene training and compliance observations. Results: We identified 32 C. auris patients (Fig. 1). Median patient age was 55 years (IQR, 43–65), and 57% were male. Length of hospitalization before C. auris isolation was 30 days (IQR, 14–36). All had been admitted to the ICU. The most common reasons for admission were sepsis (50%), pneumonia (34%), surgery (25%), and stroke or other neurologic diagnosis (25%). Underlying comorbidities included hypertension (38%), diabetes mellitus (25%), and malignancy (29%). Two patients had HIV. Moreover, 61% of cultures yielded multidrug-resistant bacteria. Also, 33% of the patients had been admitted to this hospital in the preceding 3 months; 21% had been admitted to a hospital outside of Kenya; and 10% had been admitted to another hospital in Kenya in the previous year. Almost all (97%) had a central venous catheter, 45% had an acute dialysis catheter, 66% had an endotracheal tube, and 34% had a tracheostomy, with 69% receiving mechanical ventilation before C. auris isolation. Most (94%) had urinary catheters, 84% had nasogastric tubes, 91% had received total parenteral nutrition, and 75% had received blood products. All patients received broad-spectrum antibiotics and 49% received an antifungal before C. auris isolation. All-cause in-hospital mortality was 64% for the 28 patients whose outcomes were available. Following implementation of a hand hygiene campaign and improved equipment and environmental disinfection, no further cases were identified. Conclusions: We identified C. auris bloodstream infections associated with high all-cause mortality in a Kenyan hospital ICU. All patients had treatments and procedures suggesting severe underlying illness. Enhanced infection control contained the outbreak.Funding: NoneDisclosures: None

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