Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs

BACKGROUND

The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety.

OBJECTIVE

The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital.

METHODS

The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant'Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost.

RESULTS

Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient.

CONCLUSION

The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.

Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection

Introduction

Patients with burn wounds are more susceptible to develop healthcare associated (HA) infection. Bacterial isolates from HA burn wound infection vary from one place to the other and also differ in terms of antimicrobial susceptibility pattern. The aim of our study was to assess the incidence of HA burn wound infection, risk factors and to determine the microbiological profile and antimicrobial susceptibility pattern of isolated pathogens.

Methods

This was a one-year retrospective descriptive study conducted between January 2017 and December 2017, in Al-Babtain Burn and Plastic Surgery center, Kuwait. The identification of bacterial isolates was conducted by conventional biochemical methods according to standard microbiological techniques and commercially available kits using analytical profile index procedure.

Results

Total body surface area >35% affected and length of stay more than 14 days were statistically significant risk factors for HA burn infection (RR of 10.057 and 5.912, respectively). Analysis of microbiological profile of these positive cultures indicated that the most common isolated organism was Acinetobacter baumannii followed by Klebsiella pneumoniae. Multidrug resistant organisms composed 65.85% of the positive isolates. Vancomycin, tigecycline, teicoplanin and linezolid showed 100% effectiveness for all Gram positive isolates. For Gram negative organisms, imipenem and meropenem showed 38.71% and 41.93% efficacy, respectively.

Conclusion

Identification of antimicrobial susceptibility patterns helps to tailor the required antibiotic policy to minimize the acquired infections among these vulnerable patients.

Predictable and Preventable: Historical and Current Efforts to Improve Child Injury Prevention

BACKGROUND

Childhood injuries are a global epidemic. Accidents resulting in childhood injury and death were first identified as a concern over a century ago. However, "accidents" leading to injury were not recognized as being predictable and preventable until more recently.

OBJECTIVES

To describe the worldwide epidemic of childhood injuries, and look at international successes in the field of injury prevention.

METHODS

Literature pertaining to injury prevention was reviewed to describe the history of childhood injury prevention, guiding principles of injury prevention, successful strategies for prevention, and future directions.

RESULT AND CONCLUSION

Through surveillance, evidence-based injury prevention initiatives, and multi-disciplinary collaboration, we anticipate further reduction in childhood injuries.

Medical surveillance for occupational asthma-how are cases detected?

Background

In Finland, medical surveillance, including spirometry, is periodically performed for workers who are exposed to agents capable of causing occupational asthma (OA). Although it has been shown that surveillance can detect OA at an early stage, few studies have assessed its benefits or the role of surveillance spirometry.

Aims

To assess the role of surveillance and spirometry in detecting OA and to evaluate the quality of spirometry.

Methods

We retrospectively reviewed the medical files of patients in health surveillance programmes who were diagnosed with sensitizer-induced OA at the Finnish Institute of Occupational Health in 2012‒14. We collected information on work exposure, respiratory symptoms, healthcare visits that initiated the diagnostic process, first spirometry and other diagnostic tests.

Results

Sixty files were reviewed. Medical surveillance detected 11 cases (18%) and 49 cases (82%) were detected at doctors' appointments that were not related to surveillance. The median delay from the onset of asthma symptoms to diagnosis was 2.2 years. Delay did not differ between these groups. No cases were detected on the basis of abnormal spirometry without respiratory symptoms. However, five patients (8%) initially reported solely work-related rhinitis symptoms. Spirometry was normal in half of the cases and quality criteria were fulfilled in 86% of the tests.

Conclusions

Fewer than one in five OA cases were detected through medical surveillance. Investigations were initiated by respiratory symptoms. No asymptomatic worker was referred because of abnormal spirometry. Our results highlight the importance of work-related nasal symptoms in detecting OA.

Virological surveillance of Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus as support for decision making for dengue control in Medellín

INTRODUCTION

Dengue represents an important public health problem in Colombia. No treatment is available and the vaccine has not been approved in all countries, hence, actions should be strengthened to mitigate its impact through the control of Aedes aegypti, the vector mosquito. In Colombia, surveillance is done using entomological indexes and case notification, which is usually informed late, leading to untimely interventions. Viral detection in urban mosquitoes using molecular techniques provides more accurate entomological information for decision-making.

OBJECTIVE

To report results of virological surveillance in Aedes specimens collected during routine entomological activities of the Secretaría de Salud de Medellín.

MATERIALS AND METHODS

Specimens were collected during two periods in each of which we selected 18 dwellings around each one of the 250 larva traps arranged for mosquitoe surveillance, as well as 70 educational institutions and 30 health centers. Specimens were identified morphologically, and divided in pools for viral detection using reverse transcription polymerase chain reaction (RT-PCR). We calculated the minimum infection rate and the adult infestation index for each group.

RESULTS

We collected 1,507 adult mosquitoes, 10 of which were identified as A. albopictus. Out of the 407 pools, 132 (one of them Ae. albopictus) were positive, and 14.39% were A. aegypti males. The minimum infection rates for Ae. aegypti were 120.07 and 69,50 for the first and second periods, respectively, and the adult infestation index was higher in educational institutions (23.57%).

CONCLUSIONS

Using RT-PCR we identified natural infectivity and vertical transmission of dengue virus in A. aegypti and A. albopictus. We suggest the use of molecular techniques in arbovirosis surveillance and control programs in Colombia.

A Report of Adult Human Adenovirus Infections in a Tertiary Hospital

We describe a review of human adenovirus (HAdV) infections occurring among adults in a tertiary hospital in Singapore from February to May 2013. A similar increase in cases was observed among children and military personnel during the same time period. The majority of isolates were identified as HAdV-7, likely an emerging pathogen in Asia.

Increasing trend in syphilis

OBJECTIVES

The aim of this study was to evaluate the epidemiological situation of syphilis in the Slovak Republic in the period of the past two decades.

BACKGROUND

In last decade, the incidence of syphilis has decreased in European countries by 13%. However, several countries reported an increase in the trend of syphilis.

METHODS

Cases of syphilis reported to the National Health Information Center in the Slovak Republic were statistically evaluated.

RESULTS

In the first decade syphilis possessed an increase rate 262.5% and 127.6% in five subsequent year intervals, and then the rate fluctuated and showed minimal decrease in the last three years. The highest rate 7.3 per 100,000 population documented in 2009. The peak in the Bratislava region reached 36.36 in 2000. Epidemic was documented in marginalized group in East region. Early syphilis was the most frequent stage observed in both decades but late and no specified cases increased in the last period. The M/F rate was up to 1.7, the most frequently recorded age category was 15-24 years.

CONCLUSION

These results indicate a requirement for developing a comprehensive control and educational program in the overall population, particularly in marginalized groups, and improving case management by health providers (Fig. 3, Ref. 20).

Systematic review of the use of data from national childhood obesity surveillance programmes in primary care: a conceptual synthesis

This study reviewed the use in primary care of national surveillance data for children to determine the data's potential utility to inform policy and practice decisions on how to prevent and treat childhood obesity. We reviewed the 28 countries identified by the World Obesity Federation as having high-quality comparable body mass index data for children. Literature published from any period up to December 2013 was included. Peer review literature was searched using Web of Science (Core Collection, MEDLINE). Grey literature was searched using the Internet by country name, programme name and national health and government websites. We included studies that (i) use national surveillance obesity data in primary care, or (ii) explore practitioner or parent perspectives about the use of such data. The main uses of national surveillance data in primary care were to identify and recruit obese children and their parents to participate in school and general practice-based research and/or interventions, and to inform families of children's measurements. Findings indicate a need for school staff and practitioners to receive additional training and support to sensitively communicate with families. Translation of these findings into policy and practice could help to improve current uses of national child obesity surveillance data in primary care.

Sharp truth: health care workers remain at risk of bloodborne infection

BACKGROUND

In 2013, new regulations for the prevention of sharps injuries were introduced in the UK. All health care employers are required to provide the safest possible working environment by preventing or controlling the risk of sharps injuries.

AIMS

To analyse data on significant occupational sharps injuries among health care workers in England, Wales and Northern Ireland before the introduction of the 2013 regulations and to assess bloodborne virus seroconversions among health care workers sustaining a blood or body fluid exposure.

METHODS

Analysis of 10 years of information on percutaneous and mucocutaneous exposures to blood or other body fluids from source patients infected with a bloodborne virus, collected in England, Wales and Northern Ireland through routine surveillance of health care workers reported for the period 2002-11.

RESULTS

A total of 2947 sharps injuries involving a source patient infected with a bloodborne virus were reported by health care workers. Significant sharps injuries were 67% higher in 2011 compared with 2002. Sharps injuries involving an HIV-, hepatitis B virus- or hepatitis C virus (HCV)-infected source patient increased by 107, 69 and 60%, respectively, between 2002 and 2011. During the study period, 14 health care workers acquired HCV following a sharps injury.

CONCLUSIONS

Our data show that during a 10-year period prior to the introduction of new regulations in 2013, health care workers were at risk of occupationally acquired bloodborne virus infection. To prevent sharps injuries, health care service employers should adopt safety-engineered devices, institute safe systems of work and promote adherence to standard infection control procedures.

Evaluating New Definitions of Acute and Early HIV Infection from HIV Surveillance Data

BACKGROUND

The U.S. HIV staging system is being revised to more comprehensively track early and acute HIV infection (AHI). We evaluated our ability to identify known cases of AHI using King County (KC) HIV surveillance data.

METHODOLOGY

AHI cases were men who have sex with men (MSM) with negative antibody and positive pooled nucleic acid amplification (NAAT) tests identified through KC testing sites. We used KC surveillance data to calculate inter-test intervals (ITI, time from last negative to first positive test) and the serologic algorithm for recent HIV seroconversion (STARHS). For surveillance data, AHI was defined as an ITI of ≤ 30 days and early infection as an ITI ≤ 180 days or STARHS recent result. Dates of last negative HIV tests were obtained from lab reports in the HIV surveillance system or data collected for HIV Incidence Surveillance.

RESULTS

Between 2005 and 2011, 47 MSM with AHI were identified by pooled NAAT. Of the 47 cases, 36% had ITI < 1 day, 60% had an ITI < 30 days, and 70% (95% CI=55-82%) had an ITI ≤ 6 months and would have been identified as early HIV infection. Of the 47, 38% had STARHS testing and 94% were STARHS recent.

CONCLUSION

MSM with known AHI were not identified by proposed definitions of AHI and early infection. These known AHI cases were frequently missed by HIV surveillance because concurrent negative antibody tests were not reported. Successful implementation of the revisions to the HIV staging system will require more comprehensive reporting.

A probability sample for monitoring the HIV-infected population in care in the U.S. and in selected states

Epidemiologic and clinical changes in the HIV epidemic over time have presented a challenge to public health surveillance to monitor behavioral and clinical factors that affect disease progression and HIV transmission. The Medical Monitoring Project (MMP) is a supplemental surveillance project designed to provide representative, population-based data on clinical status, care, outcomes, and behaviors of HIV-infected persons receiving care at the national level. We describe a three-stage probability sampling method that provides both nationally and state-level representative estimates.In stage-I, 20 states, which included 6 separately funded cities/counties, were selected using probability proportional to size (PPS) sampling. PPS sampling was also used in stage-II to select facilities for participation in each of the 26 funded areas. In stage-III, patients were randomly selected from sampled facilities in a manner that maximized the possibility of having overall equal selection probabilities for every patient in the state or city/county. The sampling methods for MMP could be adapted to other research projects at national or sub-national levels to monitor populations of interest or evaluate outcomes and care for a range of specific diseases or conditions.