RESUMEN
OBJECTIVE: Hospital-acquired urinary tract infections (UTIs) are common complications in patients with diabetic nephropathy (DN), leading to increased mortality and increased medical resource utilisation. This study investigated hospital-acquired UTIs in patients with DN, focusing on prevalent pathogens and drug resistance to inform clinical management. METHODOLOGY: This retrospective study analysed 141 patients with hospital-acquired UTIs admitted to The Affiliated Hospital of Qingdao University from January 1, 2013 to December 31, 2022, using the Yidu Cloud database. Among them, 109 had DN, and 32 had nondiabetic nephropathy (NDN). Patient demographics, pathogen distribution, and antibiotic resistance were statistically evaluated. RESULTS: The incidence of hospital-acquired UTIs was significantly higher in patients with DN compared to those with NDN (p < 0.0001), with a higher prevalence in women (p = 0.004). Gram-negative bacteria, particularly Escherichia coli (E. coli) and Klebsiella pneumoniae, were the primary pathogens in patients with DN and NDN. E. coli infections were more common in the DN group (p = 0.017). These pathogens exhibited high susceptibility to carbapenems, ß-lactamase inhibitors, amikacin, nitrofurantoin, and minocycline; However, they showed significant resistance to quinolones, cephalosporin, and penicillins. CONCLUSIONS: Preventing hospital-acquired UTIs in patients with DN is crucial. Effective treatment requires selecting antibacterial drugs based on pathogen resistance profiles.
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Infección Hospitalaria , Nefropatías Diabéticas , Farmacorresistencia Bacteriana , Infecciones Urinarias , Humanos , Infecciones Urinarias/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Femenino , Estudios Retrospectivos , Masculino , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Persona de Mediana Edad , Nefropatías Diabéticas/complicaciones , Anciano , Antibacterianos/uso terapéutico , Antibacterianos/farmacologíaRESUMEN
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management. METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients. RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed. CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
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Infecciones por Acinetobacter , Acinetobacter baumannii , Carbapenémicos , Infección Hospitalaria , Control de Infecciones , Acinetobacter baumannii/genética , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Humanos , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Alemania/epidemiología , Carbapenémicos/farmacología , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Anciano , Adulto , Control de Infecciones/métodos , Epidemiología Molecular , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Quemaduras/microbiología , Quemaduras/complicaciones , Cirugía Plástica , Unidades de Quemados , Secuenciación Completa del Genoma , Incidencia , Pruebas de Sensibilidad MicrobianaRESUMEN
Objective: To understand the occupational stress and mental health status of hospital infection prevention and control practitioner (HIPCPs) in medical institutions, and analyze their main influencing factors. Methods: In November 2021, 550 nosocomial infection managers in Tianjin were randomly selected to conduct a questionnaire survey using the Concise Occupational Stress Questionnaire, Depression Screening Scale (PHQ-9) and Self-Rating Anxiety Scale (SAS). 497 valid questionnaires were obtained, and the total recovery efficiency was 90.36%. Single factor analysis and multivariate logistic regression method were used to analyze the main influencing factors of occupational stress and mental health status of psychiatric managers. Results: The detection rate of anxiety and depression among 497 HIPCPs was 22.73% (113/497) and 58.95% (293/497), respectively. Gender and major were the influencing factors of depression (P=0.000, 0.001). Average working hours>52 hours per week and night shift days>1 days per week were the influencing factors of anxiety (P=0.035, 0.014). Average working hours>52 h per week, night shift days >1 d per week and different majors were the influencing factors of occupational stress (P=0.000, 0.025, 0.010). Multivariate logistic regression results showed that the risk of anxiety in those who worked more than 52 hours per week was 1.753 times that of those who worked less than 52 hours per week (P=0.038), and the risk of depression in women was 3.071 times that of men (P=0.006) . Conclusion: Working hours are an important influencing factor for occupational stress and anxiety among HIPCPs. In order to reduce the occurrence of occupational stress and mental health problems, it is necessary to strengthen psychological counseling for HIPCPs and balance work and rest.
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Ansiedad , Depresión , Estrés Laboral , Humanos , Masculino , Femenino , Encuestas y Cuestionarios , Depresión/epidemiología , Depresión/psicología , Ansiedad/epidemiología , Adulto , Estrés Laboral/psicología , Estrés Laboral/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/epidemiología , Salud Mental , China/epidemiología , Análisis Multivariante , Persona de Mediana Edad , Modelos LogísticosRESUMEN
BACKGROUND: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE: This study aims to systematize and enhance efforts to prevent health care-associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. METHODS: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. RESULTS: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS: This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60099.
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Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Casas de Salud , Infecciones Urinarias , Humanos , Antibacterianos/uso terapéutico , Infecciones Urinarias/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Europa (Continente)/epidemiología , Control de Infecciones/métodos , Infección Hospitalaria/prevención & control , Infección Hospitalaria/epidemiologíaRESUMEN
Clostridioides difficile, a cause of healthcare-associated infections, poses a significant global health threat. This multi-institutional retrospective study focuses on epidemic dynamics, emphasizing minor and toxin-negative clinical isolates through high-resolution genotyping. The genotype of the C. difficile clinical isolates during 2005 to 2022 was gathered from 14 hospitals across Japan (N = 982). The total number of unique genotypes was 294. Some genotypes were identified in every hospital (cross-regional genotypes), while others were unique to a specific hospital or those in close geographic proximity (region-specific genotypes). Notably, a hospital located in a sparsely populated prefecture exhibited the highest prevalence of region-specific genotypes. The isolation rate of cross-regional genotypes positively correlated with the human mobility flow. A 6-month interval analysis at a university hospital from 2019 to 2021 revealed a temporal transition of the genotype dominance. The frequent isolation of identical genotypes over a brief timeframe did not always align with the current criteria for defining nosocomial outbreaks. This study highlights the presence of diverse indigenous C. difficile strains in regional environments. The cross-regional strains may have a higher competency to spread in the human community. The longitudinal analysis underscores the need for further investigation into potential nosocomial spread.
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Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Genotipo , Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Clostridioides difficile/clasificación , Humanos , Japón/epidemiología , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Estudios Retrospectivos , Masculino , Femenino , HospitalesRESUMEN
BACKGROUND: Antimicrobial resistance is a major global public health issue. Infections caused by resistant species are associated with higher mortality rates, longer hospital stays, medication failure, and rising medical costs. The World Health Organisation has declared multidrug resistance-associated infections as an epidemic of public health concern. OBJECTIVE: This study aimed to evaluate the antimicrobial resistance profile and associated factors of hospital-acquired Gram-negative bacterial pathogens among hospitalized patients in Northeast Ethiopia. MATERIALS AND METHODS: A health facility-based cross-sectional study was conducted among hospitalized patients from March 2021 to February 2022. About 810 clinical specimens were collected, transported, and processed from admitted patients following the standard bacteriological procedures. The clinical samples were inoculated onto blood agar, MacConkey agar, and chocolate agar. Furthermore, the species identification was done using gram reactions, colony morphology, and color and biochemical tests. Antimicrobial susceptibility tests, extended-spectrum beta-lactamase, and carbapenemase production were performed as per the clinical laboratory standard institute guidelines. For analysis, the information was entered into Epi-data and exported to SPSS. A P value of < 0.05 with a 95% confidence interval was considered as a statistically significant association. RESULTS: Out of 810 clinical specimens, 285/810 (35.2%) developed bacterial infections. From the isolated bacteria, E. coli was the predominant bacteria accounting for 78/285 (27.4%) followed by K. pneumoniae, 69/285(24.42%), whereas P. vulgaris accounted for the least, 7/285 (2.5%). Overall, 132/285 (46.3%) and 99/285 (34.7%) of culture-positive patients were infected by extended-spectrum beta-lactamase and carbapenemase-producing bacteria. The overall multidrug resistance rate of the isolated bacteria was 89.4%. The highest antibiotic resistance rates were detected for doxycycline (92.9%), amoxicillin-clavulanic acid (83.9%), and ampicillin (93%). The least antibiotic resistance rate was observed for meropenem at 41.1% and amikacin at 1.7%, respectively. CONCLUSIONS AND RECOMMENDATIONS: In the study area, significant health concerns include a range of hospital-acquired bacterial infections associated with elevated rates of multidrug resistance, Extended-spectrum beta-lactamase (ESBL), and carbapenemase-producing bacterial pathogens. Consequently, it is recommended to conduct drug-susceptibility testing of isolates and molecular detection at a national level to optimize antibiotic usage for treating prevalent bacterial infections in this area.
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Antibacterianos , Infección Hospitalaria , Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas , Infecciones por Bacterias Gramnegativas , Pruebas de Sensibilidad Microbiana , Humanos , Etiopía/epidemiología , Estudios Transversales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Antibacterianos/farmacología , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/clasificación , Bacterias Gramnegativas/genética , Adulto Joven , Adolescente , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple/genética , beta-Lactamasas/genética , beta-Lactamasas/metabolismo , Anciano , Niño , Preescolar , Lactante , Hospitalización/estadística & datos numéricos , Proteínas Bacterianas/genética , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Extended-spectrum ß-lactamase -producing Enterobacterales (ESBL-E) are important zoonotic pathogens that can cause serious clinical infections, also in horses. Preventing the spread of ESBL-E, especially in the equine hospital environment, is key to reducing the number of difficult-to-treat infections. Estimating the local prevalence of ESBL-E in horses is crucial to establish targeted infection control programs at equine hospitals. We conducted a prevalence and risk factor study in equine patients on admission to an equine teaching hospital in Finland through a rectal ESBL-E screening specimen of the horse and a questionnaire. RESULTS: The prevalence of ESBL-E in admitted horses was 3% (5/161, 95% CI 1-7%); none of the tested factors remained statistically significant in multivariate analysis, although antimicrobial treatment within three months was borderline significant (p = 0.052). Extended-spectrum ß-lactamase -producing Klebsiella pneumoniae ST6179:CTX-M-15 was detected in three horses using whole-genome sequencing, which in combination with patient records suggested nosocomial transmission. Escherichia coli isolates were ST1250:CTX-M-1 (n = 1), ST1079:CTX-M-1 (n = 1), and ST1245:CTX-M-14 (n = 1). Multiple virulence genes were detected in the ESBL-E isolates. In the ESBL-E positive horses enrolled in a one-year follow-up study, ESBL-E were unlikely to be isolated in rectal screening specimens after the initial positive specimen. CONCLUSIONS: The prevalence of ESBL-E in horses visiting a veterinary teaching hospital in Finland is low, indicating an overall low prevalence estimate in the country's equine population. No statistically significant risk factors were identified, likely due to the low number of cases. The duration of ESBL-E carriage is likely to be very short in horses.
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Infecciones por Enterobacteriaceae , Enfermedades de los Caballos , Hospitales Veterinarios , beta-Lactamasas , Animales , Caballos , Enfermedades de los Caballos/microbiología , Enfermedades de los Caballos/epidemiología , beta-Lactamasas/metabolismo , beta-Lactamasas/genética , Prevalencia , Factores de Riesgo , Finlandia/epidemiología , Infecciones por Enterobacteriaceae/veterinaria , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Masculino , Femenino , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Infección Hospitalaria/epidemiología , Infección Hospitalaria/veterinaria , Infección Hospitalaria/microbiología , Escherichia coli/enzimología , Escherichia coli/aislamiento & purificación , Enterobacteriaceae/enzimología , Enterobacteriaceae/aislamiento & purificación , Enterobacteriaceae/efectos de los fármacos , Antibacterianos/farmacologíaRESUMEN
BACKGROUND: The WHO Infection Prevention and Control Assessment Framework (IPCAF) is a standardized tool to assess infection prevention and control (IPC) structures in healthcare facilities. The IPCAF reflects the eight WHO core components (CC) of IPC. Besides facility self-assessment, the IPCAF can be used for national surveys, and repeated usage can aid in describing trends concerning IPC structures. A previous survey in over 700 German hospitals conducted in 2018, yielded an overall high IPC level in participating hospitals, albeit with potentials for improvement. In 2023, the survey was repeated to describe once again the state of IPC implementation in German hospitals and compare findings to data from 2018. METHODS: The German National Reference Center for the Surveillance of Nosocomial Infections (NRC) invited 1,530 German acute care hospitals participating in the national surveillance network "KISS", to complete a translated online version of the IPCAF between October 2023 and January 2024. The questionnaire-like nature of the IPCAF, where each answer corresponds to a number of points, allows for calculating an overall IPC score. Based on the overall score, hospitals were allocated to four different IPC levels: inadequate (0-200), basic (201-400), intermediate (401-600), and advanced (601-800). Aggregated scores were calculated and compared with results from 2018. RESULTS: Complete datasets from 660 hospitals were received and analyzed. The median overall IPCAF score was 692.5 (interquartile range: 642.5-737.5), with 572 hospitals (86.6%) classified as advanced, and 87 hospitals (13.2%) as intermediate. One hospital (0.2%) fell into the basic category. The overall median score was virtually unchanged when compared to 2018 (690; data from 736 hospitals). The median score for the CC on workload, staffing and bed occupancy was markedly higher (85 vs. 75), whereas the median score for the CC on multimodal strategies was slightly lower than in 2018 (75 vs. 80). CONCLUSIONS: Repeated assessments of IPC structures at the national level with the IPCAF are feasible and a means to gain insights into the evolution of IPC structures. When comparing aggregated scores, a stable and high level of IPC key aspects in Germany was observed, with improvements over time in IPC indicators related to workload and staffing.
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COVID-19 , Infección Hospitalaria , Hospitales , Control de Infecciones , Organización Mundial de la Salud , Humanos , Alemania/epidemiología , COVID-19/prevención & control , COVID-19/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Encuestas y Cuestionarios , SARS-CoV-2 , PandemiasRESUMEN
OBJECTIVE: This study aimed to develop and validate a nomogram for assessing the risk of nosocomial infections among obstetric inpatients, providing a valuable reference for predicting and mitigating the risk of postpartum infections. METHODS: A retrospective observational study was performed on a cohort of 28,608 obstetric patients admitted for childbirth between 2017 and 2022. Data from the year 2022, comprising 4,153 inpatients, were utilized for model validation. Univariable and multivariable stepwise logistic regression analyses were employed to identify the factors influencing nosocomial infections among obstetric inpatients. A nomogram was subsequently developed based on the final predictive model. The receiver operating characteristic (ROC) curve was utilized to calculate the area under the curve (AUC) to evaluate the predictive accuracy of the nomogram in both the training and validation datasets. RESULTS: The gestational weeks > = 37, prenatal anemia, prenatal hypoproteinemia, premature rupture of membranes (PROM), cesarean sction, operative delivery, adverse birth outcomes, length of hospitalization (days) > 5, CVC use and catheterization of ureter were included in the ultimate prediction model. The AUC of the nomogram was 0.828 (0.823, 0.833) in the training dataset and 0.855 (0.844, 0.865) in the validation dataset. CONCLUSION: Through a large-scale retrospective study conducted in China, we developed and independently validated a nomogram to enable personalized postpartum infections risk estimates for obstetric inpatients. Its clinical application can facilitate early identification of high-risk groups, enabling timely infection prevention and control measures.
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Infección Hospitalaria , Nomogramas , Humanos , Femenino , Estudios Retrospectivos , Infección Hospitalaria/epidemiología , China/epidemiología , Embarazo , Adulto , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Curva ROC , Medición de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Measles remains a major public health burden worldwide. Parents often hesitate to vaccinate children with chronic diseases. We investigated the association between the percentage of vaccination and chronic diseases and explore hospital infections' role in the 2017-2019 measles outbreak across northern Vietnam provinces. METHODS: A total of 2,064 children aged 0-15 years old admitted for measles to the National Children's Hospital during the outbreak were included in the study. Demographic information, clinical characteristics, vaccination statuses and laboratory examination were extracted from electronic medical records, vaccination records, or interviews with parents when other sources were unavailable. RESULTS: The incidence rate that provincial hospitals sent to the National Children's Hospital was proportional to the population density of their provinces of residence. Early nosocomial transmission of measles was observed before community-acquired cases emerged in many provinces. Among patients aged over 18 months, those with chronic diseases had a proportion of vaccination of 9.4%, lower than patients without chronic diseases at 32.4%. Unvaccinated patients had a higher proportion of hospital-acquired infections with aOR = 2.42 (1.65-3.65), p < 0.001 relative to vaccinated patients. The proportion of hospital-acquired infections was higher among children with chronic diseases compared to those without, with aOR = 3.81 (2.90-5.02), p < 0.001. CONCLUSION: Measles spread in healthcare settings prior to community cases that occurred in several provinces. We recommend enhancing hospital infection control by increasing staff training and improving early detection and isolation during non-outbreak periods. Measles patients with chronic diseases exhibited lower proportions of vaccination and faced a higher risk of hospital-acquired infections. It is crucial to establish comprehensive vaccination guidelines and enhance parental awareness regarding the significance and safety of measles vaccination to protect these vulnerable individuals.
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Infección Hospitalaria , Brotes de Enfermedades , Vacuna Antisarampión , Sarampión , Vacunación , Humanos , Vietnam/epidemiología , Sarampión/epidemiología , Sarampión/prevención & control , Preescolar , Niño , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Masculino , Lactante , Adolescente , Femenino , Enfermedad Crónica/epidemiología , Vacunación/estadística & datos numéricos , Recién Nacido , Vacuna Antisarampión/administración & dosificación , IncidenciaRESUMEN
Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.
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Costo de Enfermedad , Infección Hospitalaria , Tuberculosis , Humanos , Infección Hospitalaria/epidemiología , Infección Hospitalaria/economía , China/epidemiología , Factores de Riesgo , Masculino , Femenino , Tuberculosis/epidemiología , Persona de Mediana Edad , Adulto , Anciano , Pueblos del Este de AsiaRESUMEN
BACKGROUND AND OBJECTIVES: Candidaemia is a potentially life-threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare-associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID-19 had on the rates and associated mortality of candidaemia. METHODS: This study included adult patients from 67 Indian ICUs in the AIIMS-HAI surveillance network that conducted BSI surveillance in COVID-19 and non-COVID-19 ICUs during and before the COVID-19 pandemic periods. Hospitals identified healthcare-associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols. RESULTS: A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID-19 ICUs (2.52/1000 patient days) was significantly higher than in non-COVID-19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID-19 ICUs (4.53/1000 central line days) was also significantly higher than in non-COVID-19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID-19 ICUs associated with candidaemia (61%) was higher than that in non-COVID-19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality. CONCLUSION: Patients in ICUs with COVID-19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country.
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COVID-19 , Candidemia , Infección Hospitalaria , Unidades de Cuidados Intensivos , Humanos , COVID-19/epidemiología , Candidemia/epidemiología , India/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Femenino , Adulto , Infección Hospitalaria/epidemiología , SARS-CoV-2 , Anciano , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , PandemiasRESUMEN
OBJECTIVES: To determine the prevalence, trends, and potential nosocomial transmission events of the hidden reservoir of rectal carriage of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E). METHODS: From 2013 to 2022, yearly point prevalence surveys were conducted in a large Dutch teaching hospital. On the day of the survey, all admitted patients were screened for ESBL-E rectal carriage using peri-anal swabs and a consistent and sensitive selective culturing method. All Enterobacterales phenotypically suspected of ESBL production were analysed using whole genome sequencing for ESBL gene detection and clonal relatedness analysis. RESULTS: On average, the ESBL-E prevalence was 4.6% (188/4,119 patients), ranging from 2.1 to 6.6% per year. The ESBL-prevalence decreased on average 5.5% per year. After time trend correction, the prevalence in 2016 and 2020 was lower compared to the other year. Among the ESBL-E, Escherichia coli (80%) and CTX-M genes (85%) predominated. Potential nosocomial transmission events could be found in 5.9% (11/188) of the ESBL-E carriers. CONCLUSIONS: The ESBL-E rectal carriage prevalence among hospitalized patients was 4.6% with a downward trend from 2013 to 2022. The decrease in ESBL-E prevalence in 2020 could have been due to the COVID-19 pandemic and subsequent countrywide measures as no nosocomial transmission events were detected in 2020. However, the persistently low ESBL-E prevalences in 2021 and 2022 suggest that the decline in ESBL-E prevalence goes beyond the COVID-19 pandemic, indicating that overall ESBL-E carriage rates are declining over time. Continuous monitoring of ESBL-E prevalence and transmission rates can aid infection control policy to keep antibiotic resistance rates in hospitals low.
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Portador Sano , Infección Hospitalaria , Infecciones por Enterobacteriaceae , Enterobacteriaceae , Hospitales de Enseñanza , Secuenciación Completa del Genoma , beta-Lactamasas , Humanos , beta-Lactamasas/genética , Países Bajos/epidemiología , Prevalencia , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/transmisión , Portador Sano/epidemiología , Portador Sano/microbiología , Masculino , Femenino , Enterobacteriaceae/genética , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Anciano , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Persona de Mediana Edad , Adulto , Recto/microbiología , Anciano de 80 o más Años , Adulto JovenRESUMEN
Biofilm formation and toxin production are some of the virulence factors of Clostridioides difficile (C. difficile), which causes hospital-acquired C. difficile infection (HA-CDI). This work investigated the prevalence and distribution of different strains recovered from HA-CDI patients hospitalized in 4 medical centres across Israel, and characterized strains' virulence factors and antibiotic susceptibility. One-hundred and eighty-eight faecal samples were collected. C. difficile 's toxins were detected by the CerTest Clostridium difficile GDH + Toxin A + B combo card test kit. Toxin loci PaLoc and PaCdt were detected by whole-genome sequencing (WGS). Multi-locus sequence typing (MLST) was performed to classify strains. Biofilm production was assessed by crystal violet. Antibiotic susceptibility was determined using Etest. Fidaxomicin susceptibility was tested via agar dilution. Sequence type (ST) 42 was the most (13.8%) common strain. All strains harboured the 2 toxins genes; 6.9% had the binary toxin. Most isolates were susceptible to metronidazole (98.9%) and vancomycin (99.5%). Eleven (5.85%) isolates were fidaxomicin-resistant. Biofilm production capacity was associated with ST (p < 0.001). In conclusion, a broad variety of C. difficile strains circulate in Israel's medical centres. Further studies are needed to explore the differences and their contribution to HA-CDI epidemiology.
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Antibacterianos , Biopelículas , Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Pruebas de Sensibilidad Microbiana , Factores de Virulencia , Clostridioides difficile/genética , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Clostridioides difficile/patogenicidad , Humanos , Israel/epidemiología , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/epidemiología , Antibacterianos/farmacología , Factores de Virulencia/genética , Masculino , Femenino , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Infección Hospitalaria/microbiología , Infección Hospitalaria/epidemiología , Anciano , Persona de Mediana Edad , Tipificación de Secuencias Multilocus , Adulto , Anciano de 80 o más Años , Secuenciación Completa del Genoma , Heces/microbiologíaRESUMEN
BACKGROUND: To mitigate hospital-acquired transmission of coronavirus disease 2019 (COVID-19), various prevention and control measures have been strictly implemented in medical institutions. These stringent measures can potentially reduce the incidence of hospital-acquired respiratory infections. This study aimed to assess if there were changes in the prevalence of hospital-acquired respiratory infections during a period of national attention focused on COVID-19 prevention. METHODS: A retrospective analysis of the clinical data from adult patients with hospital-acquired respiratory infections admitted between October and December 2019 and during the same period in 2020 was performed. All patients were referred from a general hospital in Beijing China and COVID-19 patients were not treated at the hospital. Hospital-acquired respiratory infections were diagnosed based on the criteria of the Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN). A comparison of the incidence and mortality rate of hospital-acquired respiratory infections between the two selected time periods was conducted. Additionally, multivariate logistics regression analysis was used to identify mortality-associated risk factors. RESULTS: This study included 2,211 patients from October to December 2019 (pre-COVID-19 pandemic) and 2,921 patients from October to December 2020 (during the COVID-19 pandemic). The incidence of hospital-acquired respiratory infections in 2019 and 2020 was 4.7% and 2.9%, respectively, with odds ratio (OR): 0.61, 95% confidence interval (CI): 0.46-0.81, and P = 0.001. In-hospital mortality of hospital-acquired respiratory infections in 2019 and 2020 was 30.5% and 38.4%, respectively, with OR: 1.42, 95%CI: 0.78-2.59, and P = 0.25. Multivariate logistics regression analysis revealed that a history of previous malignancy (OR: 2.50, 95%CI: 1.16-5.35, P = 0.02), was associated with in-hospital mortality. CONCLUSIONS: The incidence of hospital-acquired respiratory infections was significantly decreased following the implementation of various prevention and control measures during the COVID-19 pandemic. A history of previous malignancy was associated with higher in-hospital mortality in older inpatients with hospital-acquired respiratory infections.
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COVID-19 , Infección Hospitalaria , Hospitales Generales , Infecciones del Sistema Respiratorio , Humanos , COVID-19/epidemiología , COVID-19/mortalidad , Estudios Retrospectivos , Masculino , Femenino , Anciano , Hospitales Generales/estadística & datos numéricos , Persona de Mediana Edad , China/epidemiología , Incidencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Infecciones del Sistema Respiratorio/mortalidad , Infección Hospitalaria/epidemiología , Anciano de 80 o más Años , SARS-CoV-2 , Adulto , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Mortalidad HospitalariaRESUMEN
PURPOSE OF REVIEW: This review explores the similarities and differences between coronavirus disease 2019 (COVID-19)-related and non-COVID-related nosocomial pneumonia, particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It critically assesses the etiology, prevalence, and mortality among hospitalized patients, emphasizing the burden of these infections during the period before and after the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS: Recent studies highlight an increase in nosocomial infections during the COVID-19 pandemic, with a significant rise in cases involving severe bacterial and fungal superinfections among mechanically ventilated patients. These infections include a higher incidence of multidrug-resistant organisms (MDROs), complicating treatment and recovery. Notably, COVID-19 patients have shown a higher prevalence of VAP than those with influenza or other respiratory viruses, influenced by extended mechanical ventilation and immunosuppressive treatments like corticosteroids. SUMMARY: The findings suggest that COVID-19 has exacerbated the frequency and severity of nosocomial infections, particularly VAP. These complications not only extend hospital stays and increase healthcare costs but also lead to higher morbidity and mortality rates. Understanding these patterns is crucial for developing targeted preventive and therapeutic strategies to manage and mitigate nosocomial infections during regular or pandemic care.
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COVID-19 , Neumonía Asociada a la Atención Médica , Neumonía Asociada al Ventilador , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada a la Atención Médica/epidemiología , Prevalencia , Respiración Artificial , Infección Hospitalaria/epidemiología , Infección Hospitalaria/mortalidadRESUMEN
BACKGROUND: The prevention of methicillin-resistant S. aureus (MRSA) transmission in the healthcare setting is a priority in Infection Control practices. A cornerstone of this policy is contact tracing of nosocomial contacts after an unexpected MRSA finding. The objective of this retrospective study was to quantify the rates of MRSA transmission in different clinical settings. METHODS: This multi-centre study included MRSA contact screening results from two regional hospitals and one academic hospital. MRSA contact tracing investigations from 2000 until 2019 were reviewed and post-contact screening results were included of index patients with an MRSA-positive culture and their unprotected contacts. Available typing results were used to rule out incidental findings. RESULTS: Of 27,377 contacts screened after MRSA exposure, 21,488 were Health Care Workers (HCW) and 4816 patients. Post-contact screening was initiated for a total of 774 index cases, the average number of screened contacts per index case was 35.7 (range 1 to 640). MRSA transmission was observed in 0.15% (41) of the contacts, 19 (0.09%) HCW and 22 (0.46%) patients. The number needed to screen to detect one MRSA transmission was 667. The highest risk of MRSA transmission occurred during patient-to-patient contacts, with transmission rates varying from 0.32 to 1.32% among the participating hospitals. No transmissions were detected in HCW (n=2834) in the outpatient setting, and the rate of transmissions among HCW contacts on the wards was 0.13% (19 of 15,874). Among 344 contacts of patients with contact precautions, no transmissions were detected. CONCLUSIONS: Reconsidering current MRSA contact tracing practices may lead to a more targeted approach with a lower number needed to screen.
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Trazado de Contacto , Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Humanos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/transmisión , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Infección Hospitalaria/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Estudios Retrospectivos , Femenino , Masculino , Personal de Salud , Persona de Mediana Edad , Adulto , Control de Infecciones/métodos , Anciano , Adulto JovenRESUMEN
BACKGROUND: Hospital infections with SARS-CoV-2 continued during the initial waves of the pandemic worldwide. So far, Data on the dynamics of these infections and the economic burden of outbreaks are rare. METHODS: We retrospectively analysed SARS-CoV-2 infections in patients, hospital employees and nosocomial infections resulting in outbreaks in two hospitals of a secondary care hospital network in Germany during the initial 3 pandemic waves (03/2020-06/2021). In addition to hospital infections, we evaluated infection prevention strategies and the economic burden of hospital outbreaks. RESULTS: A total of 396 patients with SARS-CoV-2 infection were hospitalized in both hospitals. The risk factors for severe disease and death increased with age, male sex and a CRB-65 score > 0. The most frequent symptom was dyspnoea (30.1%). Sixty-five patients died, most of whom were in the 2nd wave. A total of 182 (12.5%) hospital employees were infected, 63 (34.6%) of whom were involved in outbreaks. An occupational risk of infection during outbreaks was particularly common among nurses and HCWs working on regular wards. Eleven hospital outbreaks led to high economic impact on both hospitals through the loss of manpower as result of infected employees, temporary locked wards, blocked beds, a reduced number of total hospitalized patients and increased personnel costs. CONCLUSION: Continuously adaptation of infection prevention strategies is a valuable tool to keep hospitals safe places for patients and employees. We do need more analyses of the different pandemic waves and applied infection prevention strategies to learn from weak points. TRIAL REGISTRATION: This research was conducted in accordance with the Declaration of Helsinki and national standards. The study protocol was approved by the relevant ethics committee of the Chamber of Physicians Westphalia-Lippe and University of Münster (no. 2021-475-f-S). The study was registered on 25th August 2021 at the German Clinical Trials Register (DRKS00025865).
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COVID-19 , Infección Hospitalaria , Personal de Salud , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Alemania/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Infección Hospitalaria/epidemiología , Adulto , Personal de Salud/estadística & datos numéricos , Anciano de 80 o más Años , Centros de Atención Secundaria/estadística & datos numéricos , Brotes de Enfermedades , Factores de Riesgo , Adulto Joven , Pandemias , Hospitalización/estadística & datos numéricosRESUMEN
Clostridioides difficile infection (CDI) is a significant public health threat, associated with antibiotic-induced disruption of the normally protective gastrointestinal microbiota. CDI is thought to occur in two stages: acquisition of asymptomatic colonization from ingesting C. difficile bacteria followed by progression to symptomatic CDI caused by toxins produced during C. difficile overgrowth. The degree to which disruptive antibiotic exposure increases susceptibility at each stage is uncertain, which might contribute to divergent published projections of the impact of hospital antibiotic stewardship interventions on CDI. Here, we model C. difficile transmission and CDI among hospital inpatients, including exposure to high-CDI-risk antibiotics and their effects on each stage of CDI epidemiology. We derive the mathematical relationship, using a deterministic model, between those parameters and observed equilibrium levels of colonization, CDI, and risk ratio of CDI among certain antibiotic-exposed patients relative to patients with no recent antibiotic exposure. We then quantify the sensitivity of projected antibiotic stewardship intervention impacts to alternate assumptions. We find that two key parameters, the antibiotic effects on susceptibility to colonization and to CDI progression, are not identifiable given the data frequently available. Furthermore, the effects of antibiotic stewardship interventions are sensitive to their assumed values. Thus, discrepancies between different projections of antibiotic stewardship interventions may be largely due to model assumptions. Data supporting improved quantification of mechanistic antibiotic effects on CDI epidemiology are needed to understand stewardship effects better.
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Antibacterianos , Clostridioides difficile , Infecciones por Clostridium , Humanos , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/tratamiento farmacológico , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Clostridioides difficile/efectos de los fármacos , Programas de Optimización del Uso de los Antimicrobianos , Instituciones de Salud , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/tratamiento farmacológico , Factores de Riesgo , Modelos Teóricos , Microbioma Gastrointestinal/efectos de los fármacosRESUMEN
Staphylococcus aureus infection and colonization in patients may be transmitted to healthcare providers and the environment and subsequently cause healthcare-associated infections in other patients. Pathogenic S. aureus strains produce virulence factors, such as Panton-Valentine Leukocidin (PVL), that contribute to the severity of infections and aid in their spread. The emergence of antimicrobial resistance (AMR) is additional concern with respect to S. aureus infection. In this study, the virulence genes and antibiotic resistance profiles of S. aureus were characterized from patients' clinical isolates, healthcare workers' (HCWs') nasal colonization screenings, and the environment at a tertiary healthcare hospital in Addis Ababa, Ethiopia. A total of 365 samples were collected from September 2021 to September 2022: 73 patients' clinical specimens, 202 colonization screenings from HCWs, and 90 hospital environment's swabs. Fifty-one (25.2%) HCW and 10/90 (11.1%) environment S. aureus isolates were identified. Among the 134 isolates, 10 (7.5%) were methicillin-resistant S. aureus (MRSA). Three (4.1%), five (9.8%), and two (20.0%) of the MRSA isolates were identified from the patients, HCWs, and the environment, respectively. Overall, 118 (88.1%) were ampicillin and penicillin resistant; 70 (52.2%) were trimethoprim sulfamethoxazole resistant; and 28 (20.9%) were erythromycin resistant. S. aureus isolates from patients were more resistant to antibiotics than isolates from HCWs or the hospital environment (p<0.05). A total of 92/134 (68.6%) isolates possessed the lukfF-PV gene, which was identified in 62 (85.0%), 26 (51.0%), and 4 (40.0%) of the patient, HCWs, and the environment, respectively. The proportion of lukfF-PV gene containing S. aureus isolated from patient samples was statistically significant. Four (40.0%) of the MRSA isolates also had the lukfF-PV gene. The identification of highly AMR and virulence factors from patients, HCWs and the environment is concerning. Further studies are needed to identify potential transmission links and improve infection prevention and control.