scholarly journals Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Pathogens ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 667
Author(s):  
Claire Hayward ◽  
Kirstin E. Ross ◽  
Melissa H. Brown ◽  
Harriet Whiley
Keyword(s):  
Antimicrobial Resistance ◽  
Hot Spot ◽  
Developed Countries ◽  
Healthcare Associated Infections ◽  
Carbapenem Resistant ◽  
The Us ◽  
Waterborne Infection ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

2022 ◽  
pp. 1-6
Author(s):  
Robert J. Clifford ◽  
Donna Newhart ◽  
Maryrose R. Laguio-Vila ◽  
Jennifer L. Gutowski ◽  
Melissa Z. Bronstein ◽  
...  
Keyword(s):  
Control Charts ◽  
Bloodstream Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Full Time ◽  
Staffing Levels ◽  
Clostridioides Difficile ◽  
Carbapenem Resistant ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

scholarly journals Nosocomial Pathogens: An In-Depth Analysis of the Vectorial Potential of Cockroaches

2019 ◽  
Vol 4 (1) ◽  
pp. 14 ◽  
Author(s):  
Eric S. Donkor
Keyword(s):  
Nosocomial Infections ◽  
Social Consequences ◽  
Antibiotic Resistant ◽  
Nosocomial Pathogens ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Depth Analysis ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Nosocomial or healthcare-associated infections are regarded as the most frequent adverse event that threatens patients’ safety and has serious economic and social consequences. Cockroach infestation is common in many hospitals, especially in the developing world. Common nosocomial pathogens isolated from cockroaches include Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. Cockroaches also harbor epidemiologically significant antibiotic-resistant organisms, such as carbapenem-resistant Enterobacteriaceae, which complicate nosocomial infections. Therefore, cockroaches constitute an important vector for nosocomial pathogens, and there should be zero tolerance for their presence in healthcare facilities. This paper aims to elucidate the possible role of cockroaches in nosocomial infections by reviewing the relevant research publications.

scholarly journals Current Promising Antibiotics and Future Approaches in Combating Carbapenemase-Producing Enterobacteriaceae

Proceedings ◽  
2021 ◽  
Vol 66 (1) ◽  
pp. 25
Author(s):  
Corneliu Ovidiu Vrancianu ◽  
Elena Georgiana Dobre ◽  
Irina Gheorghe ◽  
Ilda Barbu ◽  
Roxana Elena Cristian ◽  
...  
Keyword(s):  
Carbapenem Resistance ◽  
Healthcare Associated Infections ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
High Incidence ◽  
Low Probability ◽  
Almost All ◽  
Healthcare Associated ◽  
Review Current ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant (CR) Gram-negative bacilli, including Enterobacteriaceae and the non-fermenters, represent the most notorious pathogens due to the high incidence of morbidity and mortality, especially in immunocompromised patients in intensive care units. Carbapenem resistance is mainly associated with the production of carbapenemases, which are β-lactamases belonging to different Ambler classes (A, B, D) that can be encoded by both chromosomal and plasmid-mediated genes. These enzymes represent the most potent β-lactamases, hydrolyzing a wide variety of β-lactams, including carbapenems, cephalosporins, penicillin, and aztreonam. The major issues associated with carbapenemase production are both clinical, posing significant challenges in the treatment of healthcare-associated infections by compromising the activity of the last-resort antibiotics, and epidemiological, due to their dissemination across almost all geographic regions. An important advancement is a handful of newly launched antibiotics targeting some of the current most problematic Gram-negative pathogens, namely carbapenem-resistant Enterobacteriaceae (CRE). The most appropriate antimicrobial therapy to treat CRE infections is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage, synergic activity, and low probability of selecting resistance. In this mini-review, current and future promising antibiotics that are currently under investigation for winning the war against the emerging CRE are discussed.

scholarly journals Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare–associated Infections Surveillance Data, 2011–2017

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Sara Kotb ◽  
Meghan Lyman ◽  
Ghada Ismail ◽  
Mohammad Abd El Fattah ◽  
Samia A. Girgis ◽  
...  
Keyword(s):  
Intensive Care ◽  
Surveillance System ◽  
Carbapenem Resistance ◽  
Surveillance Data ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Specimen Type ◽  
Carbapenem Resistant ◽  
Healthcare Associated ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Objective To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system. Methods Design: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011–2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13. Results There were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09). Conclusions This analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU’s .

scholarly journals The Role of ZntA in Klebsiella pneumoniae Zinc Homeostasis

2022 ◽  
Author(s):  
Eve A. Maunders ◽  
Katherine Ganio ◽  
Andrew J. Hayes ◽  
Stephanie L. Neville ◽  
Mark R. Davies ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Zinc Homeostasis ◽  
Healthcare Associated Infections ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Tract Infections ◽  
Healthcare Associated

Klebsiella pneumoniae is a leading cause of healthcare-associated infections, including pneumonia, urinary tract infections, and sepsis. Treatment of K. pneumoniae infections is becoming increasingly challenging due to high levels of antibiotic resistance and the rising prevalence of carbapenem-resistant, extended-spectrum β-lactamases producing strains.

Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007

2008 ◽  
Vol 29 (11) ◽  
pp. 996-1011 ◽  
Author(s):  
Alicia I. Hidron ◽  
Jonathan R. Edwards ◽  
Jean Patel ◽  
Teresa C. Horan ◽  
Dawn M. Sievert ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Healthcare Associated Infections ◽  
E Coli ◽  
National Healthcare ◽  
Carbapenem Resistant ◽  
National Healthcare Safety Network ◽  
Extended Spectrum ◽  
Tract Infections ◽  
Healthcare Associated

Objective.To describe the frequency of selected antimicrobial resistance patterns among pathogens causing device-associated and procedure-associated healthcare-associated infections (HAIs) reported by hospitals in the National Healthcare Safety Network (NHSN).Methods.Data are included on HAIs (ie, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections) reported to the Patient Safety Component of the NHSN between January 2006 and October 2007. The results of antimicrobial susceptibility testing of up to 3 pathogenic isolates per HAI by a hospital were evaluated to define antimicrobial-resistance in the pathogenic isolates. The pooled mean proportions of pathogenic isolates interpreted as resistant to selected antimicrobial agents were calculated by type of HAI and overall. The incidence rates of specific device-associated infections were calculated for selected antimicrobial-resistant pathogens according to type of patient care area; the variability in the reported rates is described.Results.Overall, 463 hospitals reported 1 or more HAIs: 412 (89%) were general acute care hospitals, and 309 (67%) had 200-1,000 beds. There were 28,502 HAIs reported among 25,384 patients. The 10 most common pathogens (accounting for 84% of any HAIs) were coagulase-negative staphylococci (15%), Staphylococcus aureus (15%), Enterococcus species (12%), Candida species (11%), Escherichia coli (10%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (6%), Enterobacter species (5%), Acinetobacter baumannii (3%), and Klebsiella oxytoca (2%). The pooled mean proportion of pathogenic isolates resistant to antimicrobial agents varied significantly across types of HAI for some pathogen-antimicrobial combinations. As many as 16% of all HAIs were associated with the following multidrug-resistant pathogens: methicillin-resistant S. aureus (8% of HAIs), vancomycin-resistant Enterococcus faecium (4%), carbapenem-resistant P. aeruginosa (2%), extended-spectrum cephalosporin-resistant K. pneumoniae (1%), extended-spectrum cephalosporin-resistant E. coli (0.5%), and carbapenem-resistant A. baumannii, K. pneumoniae, K. oxytoca, and E. coli (0.5%). Nationwide, the majority of units reported no HAIs due to these antimicrobial-resistant pathogens.

The Direct Economic Disease Burden of Healthcare-associated Infections (HAIS) and Antimicrobial Resistance (AMR): A Preliminary Study in a Teaching Hospital of Nepal

2020 ◽  
Author(s):  
Xinliang Liu ◽  
Rajeev Shrestha ◽  
Pramesh Koju ◽  
Bedana Maharjan ◽  
Poonam Shah ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Teaching Hospital ◽  
Economic Burden ◽  
Health Expenditure ◽  
Disease Burden ◽  
Developed Countries ◽  
Medical Expenditure ◽  
Healthcare Associated Infections ◽  
Healthcare Associated ◽  
Length Of Hospitalization

Abstract Background: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) have been becoming the public and global health issues. The purpose of this study is to estimate the direct economic burden attributable to HAIs and AMR.Methods: This study applied propensity score matching (PSM) methodology to conduct a prospective case-control study of direct disease burden attributable to HAIs and AMR 16th December, 2017 to 16th April, 2018 in a teaching hospital in Nepal. Clinical information was retrieved from Hospital Health Information and electronic medical record systems, as well as the microbiology lab system. The finance system was used to determine the health expenditure and length of hospitalization of HAIs, HAIs-AMR and Non-HAIs patients. STATA 12.0 was used to conduct descriptive analysis, (bivariate) χ2 test, paired/independent T test, PSM (B=0.25a, nearest neighbour 1:1 matching, General Boosted Model, GBM). The statistically significant level was set at P < 0.05.Results: HAIs patients and HAIs-AMR patients had statistically significant higher expenditures and longer length of hospital days than Non-HAI inpatients during the study period (P<0.05). The additional average total medical expenditure, medicines expenditure, out-of-pocket expenditure and length of hospitalization per patient caused by HAIs were 17,224.93 Rupees, 11,947.49 Rupees, 15,776.57 Rupees and 7 days, respectively. In the meantime, the extra total medical expenditure, medicines expenditure, out-of-pocket expenditure and length of hospitalization attributable to HAIs-AMR were 39,879.63 Rupees, 21,173.63 Rupees, 38,770.87 Rupees and 9 days, respectively. Moreover, the percentage of out-of-pocket expenditure accounting for total medical expenditure of HAIs Group was 94.24% while it was 96.75% of HAIs-AMR Group.Conclusions: It was the first time to apply the research framework of the previous study in China to estimate the direct economic burden caused by HAIs and AMR in a teaching hospital of Nepal. HAIs and AMR have substantially led to excess direct economic burden for patients and their family due to the low Gross Domestic Product (GDP) and low health expenditure in Nepal. This calls for active collaboration with developed countries to reduce the threat caused by HAIs and AMR to prevent the transnational communication.

Epidemiology and antimicrobial resistance of Acinetobacter

2018 ◽  
Vol 2 (4) ◽  
pp. 46-59
Author(s):  
A.G. Salmanov ◽  
O.M. Verner ◽  
L.F. Slepova
Keyword(s):  
Antibiotic Resistance ◽  
Laboratory Testing ◽  
Immunocompromised Host ◽  
Clinical Problem ◽  
Healthcare Associated Infections ◽  
Opportunistic Bacteria ◽  
Acinetobacter Spp ◽  
Healthcare Associated ◽  
Major Clinical Problem

Species of the Acinetobacter represent opportunistic bacteria with a growing clinical significance for Healthcare-associated infections (HAIs). In this literature review, we focus on the current role of Acinetobacter in infectious pathology and describe taxonomy, pathogenicity, and antibiotic resistance of these bacteria. Pathogenesis and regulation of virulence factors in Acinetobacter spp. are described in detail. The majority of acinetobacterial infections are associated with A. baumannii and occur predominantly in an immunocompromised host. Usually, acinetobacterial  infections  are characterized by local purulent inflammation; in severe cases, meningitis and sepsis may develop. Antibiotic resistance of Acinetobacter is a major clinical problem; therefore we give special attention to laboratory testing of resistance to antibiotics as well as identification of Acinetobacter.

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