Epidemiology, antimicrobial resistance, and incremental medical costs of hospital-acquired infections in the Intensive Care Unit: 2-year experience from Serbia

2019 ◽  
Author(s):  
Aleksa Jovan Despotovic ◽  
Branko Milosevic ◽  
Ivana Milosevic ◽  
Andja Cirkovic ◽  
Snezana D Jovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Fold Increase ◽  
Antimicrobial Treatment ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Resistance Rates ◽  
Hospital Acquired

Abstract Background: Hospital-acquired infections are a major complication of hospital treatment. The growing presence of multidrug-resistant pathogens contributes to increased mortality and costs, particularly in intensive care units where patients are predisposed to numerous risk factors. Comprehensive data about hospital-acquired infections from Serbian intensive care units is scarce. The aim of this study was to determine the presence of hospital-acquired infections among intensive care unit patients and look into the patterns of antimicrobial resistance, risk factors, and incremental costs of diagnosis and antimicrobial treatment. Methods: This retrospective study included 355 patients over a two-year period. Etiology, antimicrobial resistance patterns, and incremental costs of diagnosis and antimicrobial treatment were examined. Risk factors for infection acquisition, as well as length of stay, were statistically analyzed using Pearson’s chi-square tests and logistic regression analysis. Results: At least one hospital-acquired infection was identified in 32.7% of patients. A total of 204 infection episodes were documented, the most common type being urinary tract infections (36.3%). Clostridium difficile , Klebsiella spp. , and Acinetobacter baumanii were the most common isolates. Antimicrobial resistance rates < 20% were observed for linezolid (0%), colistin (9%), and tigecycline (14%). Resistance rates > 50% were seen in all other tested antibiotic agents. Mortality rates were not higher in patients who acquired only one hospital-acquired infection (p=0.09), but were significantly higher for patients in whom more than one episode occurred (p=0.038). Length of stay > 20 days carried a 7.5-fold increase in odds of acquiring an infection (CI 4.4-12.7, p<0.001), whereas length of stay > 30 days carried a 10-fold increase (CI 5.5-16.1, p<0.001). During the study period, over 37,000 EUR was incrementally spent on diagnosis and antimicrobial treatment for hospital-acquired infections. Conclusion: Our results suggest a high prevalence of hospital-acquired infections and very high antimicrobial resistance rates compared to most European countries. Together with the first published results regarding incremental costs from Serbia, our observations require large-scale prospective follow-up studies in order to obtain a deeper insight into the actual burden of hospital-acquired infections.

scholarly journals Nosocomial Infection in an Iranian Neonatal Intensive Care Unit: Hospital Epidemiology and Risk Factors

2020 ◽  
Vol 8 (4) ◽  
Author(s):  
Farhad Choobdar ◽  
Zahra Vahedi ◽  
Nastaran Khosravi ◽  
Nasrin Khalesi ◽  
Asma Javid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Hospital Stay ◽  
Neonatal Intensive Care ◽  
Infected Group ◽  
Control Group ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Hospital Infection Control ◽  
Hospital Acquired

Background: Hospital-acquired infection is one of the main concerns in Neonatal Intensive Care Units (NICUs), leading to increased mortality, hospital stay, and costs. Objectives: This study aimed to investigate the risk factors of hospital-acquired infection in NICUs. Methods: A descriptive, cross-sectional, prospective study was conducted in the NICU of Ali Asghar Children Hospital for one year. All admitted newborns were sampled on a simple basis. The criteria for the diagnosis of hospital-acquired infection were based on the definitions of the CDC and the NNIS system. Risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. The data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the NNIS system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the NICU. The STATA software was used for data analysis. Results: In our study, 654 newborns were enrolled. The rate of hospital-acquired infections was 13.5%. Moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). Statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. The average time to the occurrence of hospital-acquired infection was 13.5 days after admission. All risk factors were significantly higher in the infected group than in the control group (P = 0.0001). Furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, P = 0.0001). The prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (P = 0.0001). The most common etiologic microorganism was Acinetobacter baumannii. Conclusions: Factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. Reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.

scholarly journals Hospital-Acquired Infections among Adult Patients Admitted for COVID-19

2021 ◽  
pp. 1-15
Author(s):  
Leigh Smith ◽  
Sara M Karaba ◽  
Joe Amoah ◽  
George Jones ◽  
Robin Avery ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Antibiotic Exposure ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Multicenter Cohort ◽  
Hospital Acquired

Abstract In a multicenter cohort of 963 adults hospitalized due to COVID-19, 5% had a proven hospital-acquired infection (HAI) and 21% had a proven/probable or possible HAI. Risk factors for proven/probable HAIs included intensive care unit admission, dexamethasone use, severe COVID-19, heart failure and antibiotic exposure upon admission.

scholarly journals Postoperative Burden of Hospital-Acquired Clostridium difficile Infection

2015 ◽  
Vol 36 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Zaid M. Abdelsattar ◽  
Greta Krapohl ◽  
Layan Alrahmani ◽  
Mousumi Banerjee ◽  
Robert W. Krell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Lower Extremity ◽  
Bowel Resection ◽  
Hospital Acquired Infection ◽  
Incidence Risk ◽  
Multivariable Regression Models ◽  
Hospital Acquired ◽  
The Impact

OBJECTIVEClostridium difficile infection (CDI) is a common hospital-acquired infection. Previous reports on the incidence, risk factors, and impact of CDI on resources in the surgical population are limited. In this context, we study CDI across diverse surgical settings.METHODSWe prospectively identified patients with laboratory-confirmed postoperative CDI after 40 different general, vascular, or gynecologic surgeries at 52 academic and community hospitals between July 2012 and September 2013. We used multivariable regression models to identify CDI risk factors and to determine the impact of CDI on resource utilization.RESULTSOf 35,363 patients, 179 (0.51%) developed postoperative CDI. The highest rates of CDI occurred after lower-extremity amputation (2.6%), followed by bowel resection or repair (0.9%) and gastric or esophageal operations (0.7%). Gynecologic and endocrine operations had the lowest rates (0.1% and 0%, respectively). By multivariable analyses, older age, chronic immunosuppression, hypoalbuminemia (≤3.5 g/dL), and preoperative sepsis were associated with CDI. Use of prophylactic antibiotics was not independently associated with CDI, neither was sex, body mass index (BMI), surgical priority, weight loss, or comorbid conditions. Three procedure groups had higher odds of postoperative CDI: lower-extremity amputations (adjusted odds ratio [aOR], 3.5; P=.03), gastric or esophageal operations (aOR, 2.1; P=.04), and bowel resection or repair (aOR, 2; P=.04). Postoperative CDI was independently associated with increased length of stay (mean, 13.7 d vs 4.5 d), emergency department presentations (18.9 vs 9.1%) and readmissions (38.9% vs 7.2%, all P<.001).CONCLUSIONSIncidence of postoperative CDI varies by surgical procedure. Postoperative CDI is also associated with higher rates of extended length of stay, emergency room presentations, and readmissions, which places a potentially preventable burden on hospital resources.Infect Control Hosp Epidemiol 2015;36(1): 40–46

scholarly journals An evaluation of six-year Stenotrophomonas maltophilia infections in a university hospital

2020 ◽  
Vol 20 (3) ◽  
pp. 1118-1123
Author(s):  
Nevin Ince ◽  
Dilek Yekenkurul ◽  
Ayşe Danış ◽  
Emel Çalışkan ◽  
İdris Akkaş
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Stenotrophomonas Maltophilia ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Invasive Procedures ◽  
Tract Infections ◽  
Rational Use Of Antibiotics ◽  
Resistance Rates ◽  
Hospital Acquired

Background: Stenotrophomonas maltophilia is a Gram-negative bacillus and opportunistic emergent pathogen causing hospi- tal-acquired infections (HAIs). Due to risk factors such as prolonged intensive care unit stay and invasive procedures, it has become one of the leading causes of HAIs. Objective: The aim of this study was to evaluate the epidemiology of S.maltophilia infections over a six-year period at Düzce University Hospital, Turkey. Methods: The incidence, clinical characteristics, antimicrobial susceptibility and outcomes of nosocomial S. maltophilia in- fections during this period were retrospectively analyzed. Results: During the study period, 67 samples obtained from 61 patients were identified. Pneumonias (82%) were the most common HAIs, followed by bloodstream infections (10.5%), urinary tract infections (3%), skin and soft tissue infections (3%) and surgical site infection (1.5%). Admission to intensive care, hospitalization exceeding 30 days, and previous use of broad-spectrum antibiotics constituted risk factors. Resistance to cotrimoxazole (6%) was lower than that to levofloxacin (18%). Conclusion: The most important risk factors for S.maltophilia infection in patients are previous exposure to antibiotics, pro- longed hospitalization and invasive procedures such as mechanic ventilation. Discharging patients as early as possible with the rational use of antibiotics may be effective in reducing S. maltophilia infections and resistance rates. Keywords: Stenotrophomonas maltophilia; hospital-acquired infections; epidemiology; risk factors.

scholarly journals Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Raquel Pacheco Duro ◽  
Paulo Figueiredo Dias ◽  
Alcina Azevedo Ferreira ◽  
Sandra Margarida Xerinda ◽  
Carlos Lima Alves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Descriptive Analysis ◽  
Univariate Analysis ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Hospital Acquired Infection ◽  
Positive Smear ◽  
Laboratory Investigations ◽  
Hospital Acquired

Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors.Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death.Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR forMycobacterium tuberculosisin patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p<0.05).Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention.

scholarly journals The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1146
Author(s):  
Aleksa Despotovic ◽  
Branko Milosevic ◽  
Andja Cirkovic ◽  
Ankica Vujovic ◽  
Ksenija Cucanic ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Health Concern ◽  
Positive Trend ◽  
Hospital Acquired Infections ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Resistance Rates ◽  
Hospital Acquired ◽  
The Impact

Hospital-acquired infections (HAIs) are a global public health concern. As the COVID-19 pandemic continues, its contribution to mortality and antimicrobial resistance (AMR) grows, particularly in intensive care units (ICUs). A two-year retrospective study from April 2019–April 2021 was conducted in an adult ICU at the Hospital for Infectious and Tropical Diseases, Belgrade, Serbia to assess causative agents of HAIs and AMR rates, with the COVID-19 pandemic ensuing halfway through the study. Resistance rates >80% were observed for the majority of tested antimicrobials. In COVID-19 patients, Acinetobacter spp. was the dominant cause of HAIs and more frequently isolated than in non-COVID-19 patients. (67 vs. 18, p = 0.001). Also, resistance was higher for imipenem (56.8% vs. 24.5%, p < 0.001), meropenem (61.1% vs. 24.3%, p < 0.001) and ciprofloxacin (59.5% vs. 36.9%, p = 0.04). AMR rates were aggregated with findings from our previous study to identify resistance trends and establish empiric treatment recommendations. The increased presence of Acinetobacter spp. and a positive trend in Klebsiella spp. resistance to fluoroquinolones (R2 = 0.980, p = 0.01) and carbapenems (R2 = 0.963, p = 0.02) could have contributed to alarming resistance rates across bloodstream infections (BSIs), pneumonia (PN), and urinary tract infections (UTIs). Exceptions were vancomycin (16.0%) and linezolid (2.6%) in BSIs; tigecycline (14.3%) and colistin (0%) in PNs; and colistin (12.0%) and linezolid (0%) in UTIs. COVID-19 has changed the landscape of HAIs in our ICUs. Approval of new drugs and rigorous surveillance is urgently needed.

Structural Risk Factors for Hospital-Acquired Infections in Intensive Care Unit

2020 ◽  
pp. 193758672097882
Author(s):  
Sai Saran ◽  
Mohan Gurjar ◽  
Afzal Azim ◽  
Indubala Maurya
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Acquired Infections ◽  
The Future ◽  
Structural Risk ◽  
Prevention Guidelines ◽  
Materials Used ◽  
Hospital Acquired ◽  
Ventilation Systems

There are risk factors related to architecture and designing labeled as “structural risk factors,” causing hospital-acquired infections (HAIs) which are less highlighted in the literature. Through this communication, we wish to reiterate the importance of structural risk factors such as space surrounding the patient, furniture with focus on construction and finishing materials used, and ventilation systems surrounding the patient as risk factors for HAIs and expect that these find a place in HAI prevention guidelines in the future.

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