Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece

Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4–7.8%) patients in ACH and 3.9% (95% cCI: 2.4–6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022–117,484) in ACH and 129,940 (95% cCI: 79,570–197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6–15.6 million), including 4.5 million (95% cCI: 2.6–7.6 million) in ACH and 4.4 million (95% cCI: 2.0–8.0 million) in LTCF; 3.8 million (95% cCI: 3.1–4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH.

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Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.296 ◽

2019 ◽

Vol 41 (1) ◽

pp. 1-18 ◽

Cited By ~ 30

Author(s):

Lindsey M. Weiner-Lastinger ◽

Sheila Abner ◽

Jonathan R. Edwards ◽

Alexander J. Kallen ◽

Maria Karlsson ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Acute Care ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Tract Infections ◽

Healthcare Associated ◽

Location Type

AbstractObjective:Describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).Methods:Data from central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical site infections (SSIs) were reported from acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities. This analysis included device-associated HAIs reported from adult location types, and SSIs among patients ≥18 years old. Percentages of pathogens with nonsusceptibility (%NS) to selected antimicrobials were calculated for each HAI type, location type, surgical category, and surgical wound closure technique.Results:Overall, 5,626 facilities performed adult HAI surveillance during this period, most of which were general acute-care hospitals with <200 beds. Escherichia coli (18%), Staphylococcus aureus (12%), and Klebsiella spp (9%) were the 3 most frequently reported pathogens. Pathogens varied by HAI and location type, with oncology units having a distinct pathogen distribution compared to other settings. The %NS for most pathogens was significantly higher among device-associated HAIs than SSIs. In addition, pathogens from long-term acute-care hospitals had a significantly higher %NS than those from general hospital wards.Conclusions:This report provides an updated national summary of pathogen distributions and antimicrobial resistance among select HAIs and pathogens, stratified by several factors. These data underscore the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

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Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.174 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1288-1301 ◽

Cited By ~ 461

Author(s):

Lindsey M. Weiner ◽

Amy K. Webb ◽

Brandi Limbago ◽

Margaret A. Dudeck ◽

Jean Patel ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Disease Control ◽

Acute Care ◽

Surgical Site Infections ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Resistance Patterns ◽

Healthcare Associated

OBJECTIVETo describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred in 2011–2014 and were reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.METHODSData from central line–associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical site infections were analyzed. These HAIs were reported from acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities. Pooled mean proportions of pathogens that tested resistant (or nonsusceptible) to selected antimicrobials were calculated by year and HAI type.RESULTSOverall, 4,515 hospitals reported that at least 1 HAI occurred in 2011–2014. There were 408,151 pathogens from 365,490 HAIs reported to the National Healthcare Safety Network, most of which were reported from acute care hospitals with greater than 200 beds. Fifteen pathogen groups accounted for 87% of reported pathogens; the most common included Escherichia coli (15%), Staphylococcus aureus (12%), Klebsiella species (8%), and coagulase-negative staphylococci (8%). In general, the proportion of isolates with common resistance phenotypes was higher among device-associated HAIs compared with surgical site infections. Although the percent resistance for most phenotypes was similar to earlier reports, an increase in the magnitude of the resistance percentages among E. coli pathogens was noted, especially related to fluoroquinolone resistance.CONCLUSIONThis report represents a national summary of antimicrobial resistance among select HAIs and phenotypes. The distribution of frequent pathogens and some resistance patterns appear to have changed from 2009–2010, highlighting the need for continual, careful monitoring of these data across the spectrum of HAI types.Infect Control Hosp Epidemiol 2016;1–14

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Prevalence of healthcare-associated infections and antimicrobial resistance in acute care hospitals in Kyiv, Ukraine

Journal of Hospital Infection ◽

10.1016/j.jhin.2019.03.008 ◽

2019 ◽

Vol 102 (4) ◽

pp. 431-437 ◽

Cited By ~ 4

Author(s):

A. Salmanov ◽

S. Vozianov ◽

V. Kryzhevsky ◽

O. Litus ◽

A. Drozdova ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Acute Care ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

Healthcare Associated

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Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2014–2018

Canada Communicable Disease Report ◽

10.14745/ccdr.v46i05a01 ◽

2020 ◽

Vol 46 (5) ◽

pp. 99-112 ◽

Cited By ~ 1

Author(s):

◽

Keyword(s):

Antimicrobial Resistance ◽

Acute Care ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

Healthcare Associated

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Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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Healthcare-associated infections in Finnish acute care hospitals: a national prevalence survey, 2005

Journal of Hospital Infection ◽

10.1016/j.jhin.2008.03.005 ◽

2008 ◽

Vol 69 (3) ◽

pp. 288-294 ◽

Cited By ~ 36

Author(s):

O. Lyytikäinen ◽

M. Kanerva ◽

N. Agthe ◽

T. Möttönen ◽

P. Ruutu

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

National Prevalence

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Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update

Infection Control and Hospital Epidemiology ◽

10.1017/s0899823x00193857 ◽

2014 ◽

Vol 35 (S2) ◽

pp. S48-S65 ◽

Cited By ~ 60

Author(s):

Erik R. Dubberke ◽

Philip Carling ◽

Ruth Carrico ◽

Curtis J. Donskey ◽

Vivian G. Loo ◽

...

Keyword(s):

Clostridium Difficile ◽

Acute Care ◽

Acute Care Hospitals ◽

Guidance Document ◽

Healthcare Associated Infections ◽

American Hospital ◽

American Hospital Association ◽

Healthcare Associated ◽

Healthcare Epidemiology ◽

Practical Recommendations

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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The prevalence of and risk factors for healthcare-associated infections in Slovenia: results of the second national survey

Slovenian Journal of Public Health ◽

10.1515/sjph-2016-0033 ◽

2016 ◽

Vol 55 (4) ◽

pp. 239-247 ◽

Cited By ~ 4

Author(s):

Irena Klavs ◽

Jana Kolman ◽

Tatjana Lejko Zupanc ◽

Božena Kotnik Kevorkijan ◽

Aleš Korošec ◽

...

Keyword(s):

Risk Factors ◽

Acute Care ◽

Prevention And Control ◽

Acute Care Hospitals ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Cross Sectional ◽

Tract Infections ◽

Healthcare Associated ◽

And Control

Abstract Introduction In the second Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute-care hospitals, we estimated the prevalence of all types of HAIs and identified risk factors. Methods Patients from acute-care hospitals were enrolled into a one-day cross-sectional study in October 2011. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. Results Among 5628 patients, 3.8% had at least one HAI and additional 2.6% were still being treated for HAIs on the day of the survey; the prevalence of HAIs was 6.4%. The prevalence of urinary tract infections was the highest (1.4%), followed by pneumoniae (1.3%) and surgical site infections (1.2%). In intensive care units (ICUs), the prevalence of patients with at least one HAI was 35.7%. Risk factors for HAIs included central vascular catheter (adjusted odds ratio (aOR) 4.0; 95% confidence intervals (CI): 2.9-5.7), peripheral vascular catheter (aOR 2.0; 95% CI: 1.5-2.6), intubation (aOR 2.3; 95% CI: 1.4-3.5) and rapidly fatal underlying condition (aOR 2.1; 95% CI: 1.4-3.3). Conclusions The prevalence of HAIs in Slovenian acute-care hospitals in 2011 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

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