scholarly journals Towards a Definition for Health Care–Associated Infection

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
N Deborah Friedman ◽  
Dana Levit ◽  
Eyal Taleb ◽  
Gil Marcus ◽  
Leah Michaeli ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Daily Practice ◽  
Multidrug Resistant ◽  
Duke University ◽  
Health Care Associated Infection ◽  
Management Recommendations ◽  
Epidemiological Characteristics ◽  
Present On Admission

Abstract Background Health care–associated infection (HcAI) is a term frequently used to describe community-onset infections likely to be caused by multidrug-resistant organisms (MDROs). The most frequently used definition was developed at Duke University Medical Center in 2002 (Duke-2002). Although some professional societies have based management recommendations on Duke-2002 (or modifications thereof), neither Duke-2002 nor other variations have had their performance measured. Methods A case–control study was conducted at Assaf Harofeh Medical Center (AHMC) of consecutive adult bloodstream infections (BSIs). A multivariable model was used to develop a prediction score for HcAI, measured by the presence of MDRO infection on admission. The performances of this new score and previously developed definitions at predicting MDRO infection on admission were measured. Results Of the 504 BSI patients enrolled, 315 had a BSI on admission and 189 had a nosocomial BSI. Patients with MDRO-BSI on admission (n = 100) resembled patients with nosocomial infections (n = 189) in terms of epidemiological characteristics, illness acuity, and outcomes more than patients with non-MDRO-BSI on admission (n = 215). The performances of both the newly developed score and the Duke-2002 definition to predict MDRO infection on admission were suboptimal (area under the receiver operating characteric curve, 0.76 and 0.68, respectively). Conclusions Although the term HcAI is frequently used, its definition does not perform well at predicting MDRO infection present on admission to the hospital. A validated score that calculates the risk of MDRO infection on admission is still needed to guide daily practice and improve patient outcomes.

Health Care–Associated Infections

2012 ◽  
pp. 458-463
Author(s):  
Rodney L Thompson ◽  
Priya Sampathkumar
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Health Care Associated Infections ◽  
Health Care Associated Infection ◽  
Tract Infections ◽  
And Control ◽  
And Training

Health care–associated infection (HAI) is an infection that occurs in hospitals, nursing homes, clinics, or home health care programs. Infection control departments have been constituted to prevent and control infectious complications in health care settings. Prevention and control require combinations of education and training, procedures and policies, surveillance and reporting, and interventions that include isolation and teamwork. Common HAIs (nosocomial infections) include urinary tract infections, surgical site infections, bloodstream infections, and ventilator-associated pneumonia. Diagnosis and treatment of each type of infection are reviewed.

scholarly journals Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical Center

2006 ◽  
Vol 50 (12) ◽  
pp. 4114-4123 ◽  
Author(s):  
Kristine M. Hujer ◽  
Andrea M. Hujer ◽  
Edward A. Hulten ◽  
Saralee Bajaksouzian ◽  
Jennifer M. Adams ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Resistance Genes ◽  
Medical Center ◽  
Antibiotic Resistance Genes ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Walter Reed Army Medical ◽  
Army Medical ◽  
Starting Point ◽  
The Impact

ABSTRACT Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR) Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of bla OXA-58-like and bla PER-like genes in the U.S. MDR A. baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a “snapshot” of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections.

scholarly journals Epidemiological characteristics of infections associated with delivery of health care in surgical departments

2014 ◽  
Vol 19 (6) ◽  
pp. 20-27 ◽  
Author(s):  
O. A Orlova ◽  
V. G Akimkin ◽  
A. V Chistova ◽  
N. P Efremova
Keyword(s):  
Health Care ◽  
Delivery Of Health Care ◽  
Respiratory Tract Infections ◽  
Surgical Intervention ◽  
Bloodstream Infections ◽  
Surgical Interventions ◽  
Duration Of Hospital Stay ◽  
The One ◽  
Tract Infections ◽  
Epidemiological Characteristics

For the present time the problem ofprevention and treatment of infections associated with the delivery of health care (IAHC) in surgical departments remains to be the one of the most important worldwide. IAHC aggravate the general state ofpatients and increase the duration of hospital stay. Aim: to perform the analysis of IAHC in surgical departments with bearing in mind their nosological forms and etiological features. At the base of the analysis there was taken an analysis of4504 cases of IAHC, recorded in surgical departments in Chelyabinsk for 9 years. In the structure of IAHC the prevalent place was occupied by infections in the area of surgical interventions and respiratory tract infections - 44.5% and 43.3%, respectively. There was noted the change in the structure of IAHC: the number of recorded infections in surgery tends to decrease (from 66.4% in 2004 to 31.1% in 2012), while the number of recorded bloodstream infections and urinary tract infections is increasing annually (from 0 in 2004 to 8.6% and 7.0% respectively in 2012). In the etiological interpretation of IAHC the plenty large enough part (from 5.8% of infections of the urinary system and 19.7% of infections in the surgical intervention) remains to be unexplained, that indicates to the defects of the samplings of the biological material and precludes to perform the adequate etiotropic therapy. There was shown the needfor the realization of the differentiated approach to the development of the measuresfor the prevention of IAHC.

The Effects of Chlorhexidine Dressing on Health Care-Associated Infection in Hospitalized Patients: A Meta-Analysis

2019 ◽  
Author(s):  
Hou-Xing WANG ◽  
Shu-Yuan XIE ◽  
Hao WANG ◽  
Hao-Kai CHU
Keyword(s):  
Health Care ◽  
English Language ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Cochrane Library ◽  
Control Group ◽  
Forest Plot ◽  
Catheter Colonization ◽  
Health Care Associated Infection

Background: To assess the effects of chlorhexidine dressing on health care-associated infection in hospitalized patients. Methods: We searched for English-language published randomized controlled trials (RCTs) in Cochrane Library, EMBASE and PubMed between January 1998 and January 2018. We used meta-analysis to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) of the data, and using the I2 assessment to summarize the heterogeneity of RCTs and the funnel plot and Egger regression test to evaluate publication bias. Results: A total of 13 RCTs were included in our meta-analysis, including 7555 patients and 11,931 catheters. The effects of chlorhexidine dressing on the incidence of catheter-related bloodstream infections (CRBSIs) were reported in 13 RCTs, and the incidence of CRBSIs were 1.3% (80/6160) in the chlorhexidine group and 2.5% (145/5771) in the control group. We used a forest plot to determine the risk ratio (RR) of chlorhexidine dressing on the incidence of CRBSIs, and our results showed that chlorhexidine dressing significantly reduced the incidence of CRBSIs (RR 0.55, 95% CI 0.39-0.77, P<0.001). Moreover, we also analyzed the effects of chlorhexidine dressing on the incidence of catheter colonization and catheter-related infections (CRIs), and our forest plot results showed that chlorhexidine dressing significantly reduced the incidence of catheter colonization (RR 0.52, 95% CI 0.40-0.67, P<0.001) and the incidence of CRIs (RR 0.43, 95% CI 0.28-0.66, P<0.001) in hospitalized patients. Conclusion: The use of chlorhexidine dressings for hospitalized patients significantly reduce the incidence of CRBSIs, catheter colonization and CRIs.

scholarly journals Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1016
Author(s):  
Amanda Chamieh ◽  
Rita Zgheib ◽  
Sabah El-Sawalhi ◽  
Laure Yammine ◽  
Gerard El-Hajj ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
P Value ◽  
Tertiary Care Center ◽  
Antimicrobial Consumption ◽  
Dynamic Collaboration

Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.

scholarly journals Antibiotic resistance patterns in infections associated with health care in a Third Level Center with hospital reconversion in the COVID-19 pandemic

2021 ◽  
Author(s):  
Jorge Almeida ◽  
José Alfonso Gutiérrez Gutiérrez ◽  
Silvia León Quirino ◽  
Patricia Albarrán Calzonzin ◽  
Alejandro Acosta Ramírez ◽  
...  
Keyword(s):  
Health Care ◽  
Antibiotic Resistance ◽  
Medical Center ◽  
Demographic Data ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Resistance To Antibiotics ◽  
Improper Use ◽  
Resistance Patterns ◽  
Antibiotic Resistance Patterns

Abstract Objective:Description of the different isolated microorganisms and their prevalence in infections associated with health care, in addition to determining their patterns of resistance to antibiotics in patients admitted with a confirmed or suspected diagnosis of COVID-19 in the Intensive Care Unit, during a third-level medical center with hospital reconversion.Method:Patient demographic data was obtained from the clinical record, with defined criteria. Antibiotic resistance patterns were evaluated as well as the identification of isolated bacteria in cultures of expectoration, pleural fluid, catheter tips. For bacterial identification and resistance mechanisms, automated equipment and phenotypic tests were used, following the CLSI criteria.ResultsA total of 100 patients with bacterial infection added to the main COVID-19 picture were obtained, of which he represented pneumonia, urinary tract infection, catheter infections and bacteremia. A total of 100 strains were isolated, of which 84 are Extremely Drug Resistant, 12 Multidrug Resistant and only 4 variable sensitivity. The bacteria with the highest prevalence is Staphylococcus aureus with, followed by Peudonomas aeruginosa and Stenotrophomonas maltophilia. 100% of the patients admitted to the ICU had death.ConclusionThe increase in resistance to antibiotics in the COVID-19 pandemic has set off alarms due to the complication that this brings, and the improper use of drugs as prophylaxis or attempted treatment only generates selective pressure that leads to an increase in resistance as observed in the isolated strains in this study, where the vast majority present enzymes as well as other resistance mechanisms that confer them to be XDR

scholarly journals Antimicrobial Resistance in Enterococci

2022 ◽  
Vol 66 (9-10) ◽  
pp. 12-16
Author(s):  
N. E. Barantsevich ◽  
S. V. Volkova ◽  
A. Yu. Zaritsky ◽  
E. P. Barantsevich
Keyword(s):  
Antimicrobial Resistance ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Vancomycin Resistance ◽  
Hospitalized Patients ◽  
Linezolid Resistance ◽  
Enterococcus Spp ◽  
Major Medical Center

Background. Enterococcus spp. are opportunistic agents of community-acquired and in-hospital infections, which have been considered a threat to public health due to their antimicrobial resistance, primarily to glycopeptides, in recent years.The aim of the study is to determine the prevalence of various Enterococcus species causing infections in hospitalized patients and their antimicrobial resistance.Methods included identification by MALDI-TOF mass spectrometry and antimicrobial susceptibility testing in accordance with the EUCAST or, in their absence, CLSI guidelines.Results. Antimicrobial resistance in 1562 consecutive Enterococcus strains isolated from hospitalized patients was determined in a major medical center admitting patients from various regions of the Russian Federation in 2019. The predominance of E.faecalis and E.faecium (99.5%) was revealed; the frequency of isolation of the former was 56% higher than that of the latter. E.avium, E.casseliflavus, E.gallinarum, E.durans were isolated from 0.5% of biological samples. The highest level of resistance of enterococci was observed to erythromycin (84.8%), tetracycline (75.0%), and rifampicin (68.2%). Multidrug, as well as vancomycin resistance, prevailed in E.faecium. All E.faecium strains isolated from blood were multidrug resistant. Resistance to vancomycin in enterococci, causing bloodstream infections, was observed solely in 19.5% of E.faecium; all vancomycin-resistant isolates were also resistant to teicoplanin. Linezolid resistance was detected in 2 community-acquired strains of E.faecalis (0.1%). Rare enterococci have shown diverse patterns of antimicrobial resistance.Conclusions. E.faecalis and E.faecium prevailed among Enterococcus spp. causing infections in hospitalized patients. Multidrug resistance and vancomycin resistance were observed predominantly in E.faecium, especially in strains causing blood-stream infections. Further monitoring of the spread and antimicrobial resistance of various Enterococcus spp. in hospital and community-acquired infections is needed.

Health Care–Associated Infection Prevention and Control Programs

2012 ◽  
pp. 31-40
Author(s):  
W. Charles Huskins
Keyword(s):  
Health Care ◽  
Prevention And Control ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Basic Knowledge ◽  
Infection Prevention And Control ◽  
Control Programs ◽  
Health Care Associated Infection ◽  
Tract Infections ◽  
And Control

Infectious diseases subspecialists should have basic knowledge of interventions necessary to prevent and control health care–associated infections (HAIs). This chapter reviews key components and activities of HAI prevention and control programs. Subtopics addressed in other chapters include the following: interventions to prevent specific HAIs, such as intravascular catheter–associated bloodstream infections, ventilator-associated pneumonia, urinary catheter–associated urinary tract infections, and surgical site infections.

scholarly journals Future Challenges in Pediatric and Neonatal Sepsis: Emerging Pathogens and Antimicrobial Resistance

2019 ◽  
Vol 08 (01) ◽  
pp. 017-024 ◽  
Author(s):  
Laura Folgori ◽  
Julia Bielicki
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Pediatric Population ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Emerging Pathogens ◽  
Future Challenges ◽  
Severe Infections ◽  
Sepsis And Septic Shock

AbstractThe incidence of severe infections caused by multidrug-resistant (MDR) pathogens is currently rising worldwide, and increasing numbers of neonates and children with serious bloodstream infections due to resistant bacteria are being reported. Severe sepsis and septic shock due to gram-negative bacteria represent a significant cause of morbidity and mortality, and contribute to high health care costs. Antimicrobial resistance among Enterobacteriaceae represents a major problem in both health care-associated and community-acquired infections, with extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE) now presenting the main threat. These infections in adult populations have been associated with poor clinical outcomes, but very limited data have been published so far about risk factors and clinical outcome of ESBL-associated and CRE sepsis in the pediatric population. The treatment of these infections in neonates and children is particularly challenging due to the limited number of available effective antimicrobials. Evidence-based use of new and older antibiotics based on both strategic and regulatory clinical trials is paramount to improve management of these severe infections in neonates and children.

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