scholarly journals No Device, No Problem? Healthcare-Associated Bloodstream and Urinary Tract Infections in a Children’s Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s73-s74
Author(s):  
Wendi Gornick ◽  
Beth Huff ◽  
Jasjit Singh
Keyword(s):  
Staphylococcus Aureus ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bloodstream Infections ◽  
Central Line ◽  
Gram Negative ◽  
Common Etiology ◽  
The Mean ◽  
Tract Infections ◽  
Healthcare Associated

Background: Central-line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) definitions continue to be refined to ensure accuracy. As facilities decrease CLABSI and CAUTI, and as midline catheters become more widely utilized, we sought to understand our non–central-line bloodstream infections (NCLBSI) and non–catheter-associated urinary tract infections (NCAUTI). Total healthcare-associated bloodstream infections (HABSIs) and urinary tract infections (HAUTIs) may provide more objective measures. Methods: The CHOC Children’s Hospital is a 334-bed quaternary-care hospital in Orange, California, with 146 intensive care unit (ICU) beds. We retrospectively reviewed all HABSIs (CLABSIs + NCLBSIs) and HAUTIs (CAUTIs + NCAUTIs) from July 1, 2016, to June 30, 2019, for demographic and microbiologic data. Both HABSI and HAUTI were defined as healthcare-associated infection when the date of event occurs on or after the third calendar day of admission. CLABSI and CAUTI were both defined using CDC-NHSN criteria. Mucosal barrier injury laboratory-confirmed bloodstream infections were excluded. Results: In a 3-year period, there were 100 HABSIs, of which 26 (26%) were NCLBSIs. The mean age for HABSI was 81 months. Enteric gram-negative infections (42%) and Staphylococcus aureus (35%) were the most common etiology for NCLBSI. The most common etiologies for CLABSI were coagulase-negative staphylococci (23%), Staphylococcus aureus (22%), and enteric gram-negatives (22%). Pseudomonas aeruginosa accounted for 16% of CLABSIs, but no NCLBSIs (Fig. 1). There was 1 midline catheter NCLBSI. There were 49 HAUTIs, of which 39 (80%) were NCAUTIs. One asymptomatic bacteremic urinary tract infection was included with the CAUTIs. The mean age for HAUTI was 55 months. The most common etiology of CAUTI was Pseudomonas aeruginosa (50%), whereas for NCAUTI the most common etiology was enteric gram-negative organisms (69%) (Fig. 2). In total, 11 HAUTIs (22%) resulted in secondary sepsis. Most HABSIs and HAUTIs occurred in the ICU setting. There were 6 deaths (6%) among HABSI patients and 3 deaths (8%) among HAUTI patients within 2 weeks of infection (Fig. 3). Conclusions: A preponderance of HABSIs were CLABSIs, but most HAUTIs were NCAUTIs. Although patient demographic and microbiologic differences exist in CLABSIs and NCLBSIs as well as CAUTIs and NCAUTIs, S. aureus and P. aeruginosa are important pathogens, particularly in device-associated infections. Trending total numbers of HABSIs and HAUTIs may be less subjective and may avert the shifting of categories seen with increased use of midline catheters. In addition, non–device-associated infections are potential causes of morbidity and mortality.Funding: NoneDisclosures: None

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

2020 ◽  
Vol 41 (11) ◽  
pp. 1292-1297
Author(s):  
Michael L. Rinke ◽  
Suzette O. Oyeku ◽  
William J. H. Ford ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ambulatory Surgery ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Retrospective Case ◽  
Additional Costs ◽  
Tract Infections ◽  
Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

scholarly journals Prevalence And Antimicrobial Susceptibility Patterns Of Bacteria Isolated From Urinary Tract Infections (UTIs) In Children At Children Hospital In Baghdad

2019 ◽  
Vol 13 (1) ◽  
pp. 102-107
Author(s):  
Nadheema Hammood Hussein
Keyword(s):  
Staphylococcus Aureus ◽  
Urinary Tract ◽  
Old Age ◽  
Urinary Tract Infections ◽  
Antimicrobial Susceptibility ◽  
Age Group ◽  
Gram Positive ◽  
Gram Negative ◽  
Tract Infections ◽  
Susceptibility Patterns

Background: First six to twelve months after initial urinary tract infection, most infections are caused by Escherichiacoli, although in the first year of life Klebsiella pneumoniae, Pseudomonas, Enterobacter spp andEnterococcus spp, are more frequent than later in life, and there is a higher risk of urosepsis compared with adulthood Objectives: To determine the prevalence of bacterial isolates from Urinary Tract Infections of children at a children hospital in Baghdad and their antimicrobial susceptibility patterns. Type of the study: Cross-sectional study. Methods: During six months of study (1 June to 31 December, 2016), 117urine specimens were collected from a children hospital in Baghdad. Results: Out 38 isolates of Gram positive and Gram negative bacteria were obtained from urine specimens in a percentage of 5(13.2%) and 33(86.8%),respectively. The lowest incidence was among the 11-15 years old age group (11.9%) whereas the highest incidence was among the 1-5 years old age group (43.6%)(P≤0.05).Also out of 38positive cultures, the incidence was higher in females 31(81.6%)than that of males 7(18.4%). Out of 38 positive cultures, the isolation rate was 5(13.2%) for Gram positive isolates and 33(86.8%)for Gram negative isolates. The most frequently isolated bacteria was Escherichia coli19(50%)(P-value ≤ 0.05), while the only isolated Gram positive was Staphylococcus aureus5(42.86%) isolates.The most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor (100%) and for Gram negative isolates wasimipenem (100%). Ampicillin showed the highest resistance rate for both Gram positive and Gram negative isolates(100%) and Pesudomonas aeruginsa isolates showed the highest resistant rates to most antibiotics under study. Conclusions: The most frequently isolated bacteria was E. coli from all urine cultures and the most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor

Carriage of Staphylococcus aureus and of Gram-Negative Bacilli Resistant to Third-Generation Cephalosporins in Cirrhotic Patients A Prospective Assessment of Hospital-Acquired Infections

2001 ◽  
Vol 22 (7) ◽  
pp. 427-432 ◽  
Author(s):  
Catherine Dupeyron ◽  
Bernard Campillo ◽  
Nicole Mangeney ◽  
Muriel Bordes ◽  
Jean-Philippe Richardet ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Third Generation ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Prospective Assessment ◽  
Cirrhotic Patients ◽  
Tract Infections ◽  
Third Generation Cephalosporins

AbstractObjective:To study the relation between Staphylococcus aureus nasal and stool colonization, stool carriage of gram-negative bacilli resistant to third-generation cephalosporins (CephR), and subsequent infections during hospitalization.Design:Prospective study.Patients:551 cirrhotic patients with 589 consecutive hospital stays. All patients were screened within 48 hours of admission; 589 nasal swabs, 417 stool specimens, and 589 urine samples were analyzed.Results:Carriage rates were 18.8% for methicillin-sensitive S aureus (MSSA), 16.3% for methicillin-resistant S aureus (MRSA), and 13.7% for CephR. We observed 87 episodes of spontaneous bacterial peritonitis, 63 cases of bacteremia, and 167 urinary tract infections occurred. Only 1 case of bacteremia and 4 urinary tract infections due to CephR occurred in patients carrying the same organism in their stools. The risk of MRSA ascitic fluid infections, bacteremia, and urinary tract infections was 3.1% versus 1% (not significant), 8.3% versus 0.8% (P<.001), and 11.4% versus 0.6% (P<.001) in carriers and noncarriers, respectively. Pulsed-field gel electrophoresis (PFGE) of isolates from 16 patients infected by MSSA (3 cases) and MRSA (13 cases) demonstrated that the colonizing strains matched the invasive strains in the 3 MSSA cases and in 8 of 13 MRSA cases.Conclusion:Carriage of CephR strains is not associated with subsequent infection by these organisms in hospitalized cirrhotic patients. In contrast, MRSA carriage was an important risk factor for MRSA bacteremia and urinary tract infection.

scholarly journals Surveillance of Healthcare-Associated Bloodstream and Urinary Tract Infections in a National Level Network of Indian Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s398-s399
Author(s):  
Purva Mathur ◽  
Paul Malpiedi ◽  
Kamini Walia ◽  
Rajesh Malhotra ◽  
Padmini Srikantiah ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Data Quality ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
National Level ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Utilization Ratio ◽  
Tract Infections ◽  
Healthcare Associated

Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.Funding: NoneDisclosures: None

scholarly journals 1230Impact of Nonpayment for Preventable Infections on Billing Rates for Central Line Associated Bloodstream Infections and Catheter-Associated Urinary Tract Infections

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S44-S44
Author(s):  
Alison Tse Kawai ◽  
Robert Jin ◽  
Stephen Soumerai ◽  
Louise Elaine Vaz ◽  
Melisa Rett ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bloodstream Infections ◽  
Central Line ◽  
Tract Infections

Comparison of metrics used to track central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) across a regional network

2021 ◽  
pp. 1-3
Author(s):  
Sonali D. Advani ◽  
Becky A. Smith ◽  
Jessica Seidelman ◽  
Nicholas Turner ◽  
Deverick J. Anderson ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Bloodstream Infections ◽  
Central Line ◽  
Regional Network ◽  
Utilization Ratio ◽  
Tract Infections

Abstract The paradoxical relationship between standardized infection ratio and standardized utilization ratio for catheter-associated urinary tract infections (CAUTIs) in contrast to central-line–associated bloodstream infections (CLABSIs), in addition to CAUTI definition challenges, incentivizes hospitals to focus their prevention efforts on urine culture stewardship rather than catheter avoidance and care.

scholarly journals Frequency of Healthcare-Associated Infections in the Elderly Patient Hospitalized

2021 ◽  
Author(s):  
Aria Rahmani ◽  
Alireza Namazi Shabestari ◽  
Maryam Sadeh ◽  
Reza Bidaki ◽  
Saeidreza Jamalimoghadamsiahkli ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Hospital Stay ◽  
Urinary Tract Infections ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Central Line ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Associated Infections ◽  
Tract Infections ◽  
Healthcare Associated

Introduction: Healthcare- Associated Infections (HAI) are known to be one of the most important health issues in developed and developing countries. The most common infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia and surgical site infection. The aim of this study was to investigate the incidence of nosocomial infections in the elderly patients. Methods: In this cross-sectional study, 1279 patients were 60 years of age or older. Patients who had been admitted for more than 48 hours in the hospital and had no signs of infection at the time of admission, were entered into the study. It was evaluated four most common HAI, according to CDC include bacteremia, central line-associated blood stream infections, urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections. The Chi-square and T- test or analysis of variance was used for data analysis. Results: Of the total patients, 93 (7.3%) developed HAI at duration admission. The highest rate of infection was bacteremia, which was 48.4 % and then urinary tract infection 21.5%. The prevalence of HAI among patients with cardiovascular diseases was relatively higher than underlying diseases. The frequency of length of hospital stay was significant in patients > 7 days with 68.8% in the HAI group. Conclusion: Our findings showed that patients with cardiovascular, renal and pulmonary disease are more susceptible to HAIs. Due to the increased length of hospital stay increases the risk of infection, it is recommended to discharge patients as soon as possible.

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