Cases Of Healthcare-associated Infections Research Articles

Healthcare-associated infections: prospective rotational surveillance data of a training and research hospital

Aims: Monitoring and prevention of healthcare-associated infections (HAI) are considered to be one of the key measures to improve the effectiveness and quality of healthcare services. This study aimed to ascertain the prevalence of HAI in various hospital departments, identify the causative bacterial profile, risk factors, and the association with mortality. Methods: This prospective study included 3117 patients who were monitored in various departments of a Training and Research Hospital. The identified HAI cases were monitored using an active, prospective, rotational surveillance method. Patient data on HAI was daily recorded on pre-established tracking forms. Results: The mean hospital stay of patients was 9.9±7.5 days. The HAI prevalence was 4.5% and the HAI rate was 5.5%. The HAI rate showed no difference between internal medicine and surgical departments (5.7% vs 5.5%, p>0.05), but it was higher in intensive care units (ICU) (p<0.001). The majority of the isolated agents (65.2%) were gram-negative bacteria. Advanced age, intrinsic risk factors such as malignancy, and invasive procedures (use of central, peripheral, and urinary catheters) were associated to the development of HAI. The frequency of HAI was higher in deceased patients compared to survivors (25.4% vs 4.1%, p<0.001). Conclusion: HAI remains a major concern in hospital settings, particularly in ICU, and strongly correlates with intrinsic risk factors and invasive procedures. Optimized infection control measures with these risk factors can make a significant contribution to improving patient outcomes.

Healthcare-associated infections in postoperative patients with intracranial aneurysm in Ukraine.

Aim: to investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) in postoperative patients with intracranial aneurysm in Ukraine. Materials and Methods: Retrospective cohort study was conducted from January 2018 to December 2022 in four tertiary care hospitals of Ukraine. The diagnostic criteria were based on specific HAI site were adapted from the CDC/NHSN case definitions. Results: Of 1,084 postoperative patients with intracranial aneurysm, 128 (11.4%) HAIs were observed. The most common of HAI type was possible ventilatorassociated pneumonia (38.2%) followed by central line-associated bloodstream infections (33.8%), catheter -associated urinary tract infection (18.5%), and surgical site infection (9.6%). Inpatient mortality from HAI was 5.1%. Emergency admission, mechanical ventilation, taking antiplatelet aggregation drugs, albumin reduction, hyperglycaemia, hyponatremia, surgical procedure, operation time > 4 h, mechanical ventilation, urinary catheter, and central venous catheterization were risk factors associated with HAI in patients with intracranial aneurysm surgery. A total of 26% cases of HAIs by MDROs were notified over the study period. Klebsiella spp. - essentially K. pneumoniae - were the most frequent, followed by Enterobacter spp. and Escherichia coli. Carbapenemase production in Enterobacterales constituted the most frequent mechanism of resistance, while ESBL-production in Enterobacterales and meticillin-resistance in Staphylococcus aureus (MRSA) were detected in 65,7% 62,3% and 20% of cases, respectively. Conclusions: The present study showed that HAIs is a common complication in postoperative patients with intracranial aneurysm in Ukraine and multidrugresistant organisms the major pathogen causing infection.

Analysis of Healthcare-associated Infections before and during the COVID-19 pandemic in a Colombian hospital

Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent.

Healthcare-associated infections in the constituents of Ural and Siberian Federal Districts: results of monitoring their identification and registration in 2022 and in long-term dynamics

Rationale. Monitoring of HAI (health care-associated infections) detection and registration of is one of the key components in the information subsystem of epidemiological surveillance for these infections. Despite a well-established HAI recording system in the Russian Federation as a whole, the constituents of the Ural and Siberian Federal Districts have different approaches to detection of these infections, which is confirmed by the final rating scores of their detection and registration.
 Objective. We studied HAI detection and registration in the constituents of the Ural and Siberian Federal Districts for ranking and rating their systems of epidemiological HAI surveillance.
 Materials and methods: The data of federal statistical monitoring forms No. 2 "Information on infectious and parasitic diseases" and No. 23-17 "Information on outbreaks of infectious diseases as well as from additional enquiry materials "Information on medical manipulations and cohorts treated" in 20182022 submitted by the Rospotrebnadzor offices of the respective Russian Federation constituents compared with the long-term and Russias nationwide averages. The quality of HAI registration in the healthcare institutions of the Ural and Siberian Federal Districts was rated using grouping by intensive incidence indicators, and the most significant groups of infections and risk cohorts were selected for analysis.
 Results: The results of the HAI detection and registration by the most significant groups of infections and risk cohorts among the patients and healthcare workers were analyzed. The data on the group and outbreak HAI morbidity in the healthcare institutions are presented. The quality of HAI detection and registration in the constituents of the Ural and Siberian Federal Districts was rated, and the subjects were ranked with regard to the activity of their epidemiological surveillance system.
 Conclusion: Active detection and registration of HAI cases over several years is typical for the healthcare institutions of Sverdlovsk and Chelyabinsk Oblasts as well as Yamalo-Nenets Autonomous District. Consistently low rating scores of the studied parameters are typical for the healthcare institutions of the Republics of Tyva, Altai and Krasnoyarsk Krai.

Грампозитивна мікробіота як потенційні чинники інфекцій, пов’язаних із наданням медичної допомоги, у дітей та дорослих

In the Lviv region, cases of healthcare-associated infections (HAIs) in children occur, but are practically not registered. For the period 2019-2021, not a single case was registered. Purpose - to identify and compare the species composition of potential HAIs pathogens in children and adults in Lviv hospitals. Materials and methods. Material for the study was collected from children from various biological niches who were undergoing inpatient treatment in Lviv hospitals. Identification was carried out using MIKRO-LA-TEST kits manufactured by Erba Lachema. Antibiotic susceptibility was determined according to EUCAST recommendations. Results. Among the isolated gram-positive microbiota that meets the criteria of HAIs, enterococci were most often detected in adults (30,8%), among children (from 0 to 17 years) - in 35,4% of cases. Staphylococcus epidermidis was detected in 21,5% from children's patients, as the causative agent of the purulent-septic process, while in adults – 27,2%. A significant part of S. aureus cultures (63,6%) isolated from children was resistant to amoxicillin (among adults - 56,5%), ceftazidime (54,5%) and cefuroxime (45,4%). Among adult patients, the percentage of isolated resistant strains to ceftriaxone (65,2%), cefotaxime (52,2%), cefepime (87,0%) was significantly higher compared to such indicators in children – 9,1%, 18,2% and 36,4%. The antibiotic ceftizoxime, widely used in recent years in the treatment of children, was not effective in 45,5% of cases. Conclusions. Despite the low level of registration of HAIs in children, this problem exists. The number of resistant strains is increasing. The sensitivity of strains to antibiotics isolated in children and adults differs significantly, so general recommendations may not be effective. The role of the clinical microbiologist and epidemiologist is extremely important for effective infection control and quality empiric antibiotic therapy in individual healthcare settings. The research was carried out in accordance with the standarts of bioethics, approved by the ethics committee of the Danylo Halytskyi LNMU. The informed consent of the child's parents and the patient was obtained for the description of the clinical case. No conflict of interests was declared by the authors.

Assessment of Healthcare Associated Infections in a Medical Intensive Care Unit

Objective: This study was undertaken to assess the current status of healthcare associated infections (HAIs) in our institution during a 2-year period in relation to causative agents and their distribution, use and duration of invasive mechanical ventilation, and infection rate and incidence in comparison with national data.
 Methods: Patients admitted to Medical ICUs of Meram State Hospital between 1st Jan 2019 and 31st Dec 2020 wereincluded. During a 2-year period a total of 47 patients were diagnosed with HAIs based on Centers for Disease Control and Prevention (CDC) and National Nosocomial Infection Surveillance Network (NNISN) criteria.
 Results: During 6041 follow-up days for 922 patients admitted to ICU, a total of 47 HAIs cases were detected. The most common types of HAIs included healthcare-associated pneumonia in 21 patients (45.6%) and other infections of the respiratory system in 12 patients (26.1%). The most common causative agent was Acinetobacter baumannii, which was found in 27 patients (50.9%).
 Conclusion: HAIs is an unavoidable condition in ICUs owing to a number of factors such as frequent use of invasive devices, prolonged length of admission, and increased number of complications. One of the major health targets in healthcare facilities is to control an manage HAIs. Avoidance from unnecessary catheterizations, timely removal of invasive catheters, increased adherence to infection control measures, prevention of inappropriate antibiotic use, compliance with isolation procedures, and initiation of appropriate antibiotherapy based on documentation of causative organisms will significantly reduce HAIs incidence.

Active surveillance and contact precautions for preventing MRSA healthcare-associated infections during the COVID-19 pandemic

Background: Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Health Administration (VA) facilities from 2007 to 2019 using active surveillance for facility admissions and contact precautions for patients colonized (CPC) or infected (CPI) with MRSA, but the value of these interventions is controversial. Objective: To determine the impact of active surveillance, CPC, and CPI on prevention MRSA HAIs, we conducted a prospective cohort study between July 2020 and June 2022 in all 123 acute-care VA medical facilities. In April 2020, all facilities were given the option to suspend any combination of active surveillance, CPC, or CPI to free up laboratory resources for COVID-19 testing and conserve personal protective equipment. We measured MRSA HAIs (cases per 1,000 patient days) in intensive care units (ICUs) and non-ICUs by the infection control policy. Results: During the analysis period, there were 917,591 admissions, 5,225,174 patient days, and 568 MRSA HAIs. Only 20% of facilities continued all 3 MRSA infection control measures in July 2020, but this rate increased to 57% by June 2022. The MRSA HAI rate for all infection sites in non-ICUs was 0.07 (95% CI, 0.05–0.08) for facilities practicing active surveillance plus CPC plus CPI compared to 0.12 (95% CI, 0.08–0.19; P = .01) for those not practicing any of these strategies, and in ICUs the MRSA HAI rates were 0.20 (95% CI, 0.15–0.26) and 0.65 (95% CI, 0.41–0.98; P < .001) for the respective policies. Similar differences were seen when the analyses were restricted to MRSA bloodstream HAIs. Accounting for monthly COVID-19 admissions to facilities over the analysis period using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates in the ICUs or non-ICUs. There was no statistically significant difference in monthly facility urinary catheter-associated infection rates, a nonequivalent dependent variable, in the categories during the analysis period in either ICUs or non-ICUs. Conclusions: In Veterans Affairs medical centers, there were fewer MRSA HAIs when facilities practiced active surveillance and contact precautions for colonized or infected patients during the COVID-19 pandemic. The effect was greater in ICUs than non-ICUs.Disclosures: None

Electrifying the case review process for better speed, reach, and impact

Background: Prevention of healthcare-associated infections (HAIs) requires timely feedback to and input from all staff involved in patient care to best identify practice gaps and improvement targets. However, multidisciplinary review of HAI events can be challenging to promptly complete given staffing shortages and the excess administrative burden of emailed and printed forms and disjointed analyses, reporting, and visualization tools. Plagued by a lack of feedback from attending and ordering physicians, difficulty transcribing and analyzing nonstandardized data, and challenges in summarizing and distributing actionable findings, we sought to reduce turnaround time (TAT), improve data collection, and broaden communication of HAI contributing factors and proposed solutions. Methods: A secure web application for electronic data capture and reporting, Research Electronic Data Capture (REDCap), was used; the software application is free to nonprofit organizations. The review process is now initiated by an infection preventionist entering HAI information into an initial survey, which automatically cascades information into 4 subsequent surveys, distributed through automated email links, providing an opportunity for individual responses from the nursing unit, the attending provider, an infectious disease physician, and the ordering provider for the positive test that detected the HAI. Survey questions focus on evaluation of adherence to CDC and SHEA HAI prevention strategies. Reminders are automatically generated and continue to be sent to involved staff until their portion is completed. Survey responses are automatically summarized upon completion of all reviews and are shared with several stakeholders, including hospital leadership, the care team, infection prevention staff, and quality-control partners (Fig.). Discrete qualitative and quantitative data are exported in a standard application-programming interface (API) format for immediate analysis and interpretation. Results: After the review process was launched using new electronic technology, the average TAT and completion rate improved from 23 days and 40% to 7 days and 95%, respectively. Input from ordering and attending physicians, once extremely rare, became frequent. Nuanced insight into causative and preventive factors, previously unachievable, occurred during review of all 38 HAIs reported in December 2022. Reviewers believed that 48% of HAIs reviewed could have been prevented. Conclusions: Applying electronic technology to HAI case review improved completion and timeliness of reviews by both providers and nurses. By sharing data and insights with all stakeholders in real time, the new procedure permitted multidirectional communication between the care teams and increased awareness of patient harm as well as ownership of patient safety. Our process is freely and readily generalizable to any nonprofit healthcare facility.Disclosures: None

Epidemiology of healthcare-associated SARS-CoV-2 outbreaks in Germany between March 2020 and May 2022

Outbreaks in healthcare facilities played a pivotal role in the course of the coronavirus (COVID-19) pandemic. To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in hospitals, outpatient care, and rehabilitation facilities in Germany from March 2020 to May 2022. Data from the German mandatory notification system were used to describe outbreaks by number of cases and case fatality ratio (CFR), and outbreak cases by age and gender. Using Pearson correlation, the dynamics of cases in the general population were compared with cases in healthcare-associated infection (HAI) SARS-CoV-2 outbreaks before and after the start of the vaccination campaign. Additionally, a counterfactual scenario was used to estimate numbers of prevented HAI cases, using the phase before vaccination as baseline. By the end of May 2022, 8941 healthcare-associated outbreaks were observed with 73,626 cases: 51,504 in hospitals, 15,524 in outpatient care, and 6598 in rehabilitation facilities. Median number of cases per outbreak was 4 (range: 2-342) and cases were more frequently reported in women with 46,818 (63.6%). Overall CFR was 8.1%, higher in men (12.4%) than in women (5.7%). After the vaccination campaign was fully introduced, the association between increasing incidence in the general population and consecutive outbreak cases was decreased by a factor of 10. Furthermore, our counterfactual analysis suggests that more than 55,000 outbreak cases could have been prevented until the end of 2021. The vaccination campaign in combination with non-pharmaceutical measures was key to reduce number, size and CFR of healthcare-associated outbreaks.

SG-APSIC1086: Case series: Examining healthcare-associated infection cases caused by Candida auris at Cho Ray Hospital, Vietnam

Objectives:Candida auris was first detected in Japan in 2009 and has been reported in >47 countries, typically causing outbreaks in healthcare settings. According to the US Centers for Disease Control and Prevention, this pathogen causes death in more than one-third of infected patients. This study describes characteristics of healthcare-associated infections (HAIs) related to C. auris and infection prevention and control (IPC) measures applied to control transmission in Cho Ray Hospital, a tertiary-care, referral, general hospital in southern Vietnam. Methods: We reviewed medical records of all patients with HAIs caused by C. auris at Cho Ray Hospital between April 2020 and March 2021, as well as the IPC measures applied for these patients. Results: Overall, 5 HAI cases caused by C. auris were identified in 5 patients, including 2 catheter-associated urinary tract infections, 2 ventilator-associated pneumonia cases, and 1 surgical site infection. These cases were sporadically detected in 4 different clinical departments; 2 cases occurred in the respiratory department in April and August 2020. The average age of the patients was 63, and 4 of 5 patients were male. The average hospital stay was 27.2 days; 4 patients died and 1 was discharged. IPC interventions were implemented to immediately respond to C. auris infection cases, including isolating the patients, applying standard and transmission-based precautions, supplying adequate personal protective equipment, cleaning environment surfaces and medical equipment in the patient’s room, and marking isolation areas with signage. No additional cases of C. auris infection were detected in the affected units. Conclusions:C. auris can spread in healthcare settings via contact with contaminated equipment and surfaces or from person to person, causing outbreaks in hospitals and leading to severe illness and high mortality for patients. Prompt application of appropriate IPC measures effectively helped prevent additional cases of C. auris in our hospital.

Trending prevalence of healthcare-associated infections in a tertiary hospital in China during the COVID-19 pandemic

BackgroundThe purpose of this study was to demonstrate both the four-year prevalence trend of healthcare-associated infections (HAIs) in a large tertiary hospital and the trend regarding the prevalence of HAIs following the outbreak of coronavirus disease 2019 (COVID-19) in order to provide evidence of hospital infection management during the COVID-19 pandemic.MethodsBased on the hospital’s electronic nosocomial infection databases related to HAIs, we retrospectively identified the HAI cases to assess the epidemiological characteristics of HAIs from January 1, 2018, to December 31, 2021, in a large tertiary hospital in China. Similarly, the trends of HAIs after the COVID-19 outbreak and the seasonal variation of HAIs were further analyzed.ResultsThe HAI cases (n = 7833) were identified from the inpatients (n = 483,258) during the 4 years. The most frequently occurring underlying cause of HAIs was respiratory tract infections (44.47%), followed by bloodstream infections (11.59%), and urinary tract infections (8.69%). The annual prevalence of HAIs decreased from 2.39% in 2018 to 1.41% in 2021 (P = 0.032), with the overall prevalence of HAIs significantly decreasing since the outbreak of COVID-19 (2.20% in 2018–2019 vs. 1.44% in 2020–2021, P < 0.001). The prevalence of respiratory tract infections decreased most significantly; whereas, overall, the prevalence of HAIs was significantly greater during the winter compared with the rest of the year.ConclusionsNot only did the annual prevalence of HAIs decrease from 2018 to 2021, but it also significantly decreased since the start of the COVID-19 pandemic, particularly respiratory tract infections. These results provide evidence for the need to prevent HAIs, especially during the winter season.

Value Stream Mapping applied to information management in infection control

Infection control teams collect and produce information on epidemiologic surveillance for prevention of Healthcare Associated Infections (HAIs). Value Stream Mapping (VSM) is a Lean method for developing process through flow efficiency. The aim of the study was to use VSM to identify opportunities for improvement in the infection control department. Flow of information and infection control activities were reviewed using VSM and a questionnaire, where time required for each task was measured. The actual VSM went through multidisciplinary analysis and an ideal VSM was created without considering resource limits. The ideal VSM was reviewed to identify the improvements easily implemented and the ones that would require more time or resources. The actual VSM analysis addressed work overload for Key Performance Indicators (KPI) production, data management (fragmentation, access and redundant work, storage, time between tasks, time typing) and tasks performed retrospectively, when less information is available and with no opportunity to correct protocol deviation. The implementation of the ideal VSM provided a faster and more efficient HAIs analysis, London protocol for HAI cases and surgical prophylaxis evaluation became real time tasks, and all surgical surveillance was improved. A mobile app was proposed as an intervention and became a long-term project. If completely implemented, the ideal VSM would result in 15.7 less work hours/month, having the working time optimized for patient care. VSM is an important tool for epidemiologic surveillance in infection control allowing better data management, continuous workflow, and new information production with potentially fewer work hours.

Hospital-acquired infections due to carbapenem-resistant Providencia stuartii.

During the course of a retrospective survey on healthcare associated infections (HAIs) due to carbapenem-resistant organisms, an unusual prevalence of HAIs due to carbapenem-resistant Providencia stuartii (CRPS) was found. Hence this study aimed to conduct the occurrence of P. stuartii associated HAIs with special reference to the drug resistance profiling of these isolates. Of the eight total HAI cases (7.5% of total HAIs and 33.3% of HAIs due to Enterobacterales) of CRPS infections included in this study, three were reported from ventilator-associated pneumonia (VAP), three were surgical site infections (SSIs), one was a catheter-associated urinary tract infection (CAUTI) and one was a bloodstream infection. All the eight CRPS isolates were tested for extended-spectrum β-lactamases production, AmpC hyperproduction as well as carbapenem resistance. Typing of the isolates was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR). All the eight isolates of CRPS were found to be AmpC hyperproducers, carbapenemase producers, and harboured chromosomally located blaNDM in seven isolates and blaIMP genes in one. All the cases with CRPS infections had prior history of colistin therapy along with prolonged hospital stay (>20 days). The cases were located in five different wards/intensive care unit (ICU) within the hospital in one year. However, strain typing by REP-PCR revealed 100 per cent similarity and clonal relatedness in all the seven isolates carrying blaNDM genes. Interestingly, routine hospital surveillance revealed a high carriage of P. stuartii in the axilla of patients admitted to the ICU. The study findings suggest CRPS as an important cause of HAIs. This organism often goes unnoticed due to the burden of carbapenem resistance in other Enterobacterales and non-fermenters.

Analysis of healthcare-associated infection in patients with pulmonary arterial hypertension associated with congenital heart disease in PICU: Evidence from a tertiary hospital in western China.

The present study intends to analyze the targeted surveillance and risk factors for healthcare-associated infection (HAI) in patients with pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH) in a Pediatric intensive care unit (PICU), and provide basis for formulating relevant prevention and control measures of HAI. Children (≤14 years old) who were admitted to the PICU for ≥2 calendar days from January 2018 to December 2021 were included. Targeted surveillance of HAI was described. A total of 7,828 patients in PICU were monitored, and the total hospitalization days of the patients were 36,174. 108 cases of HAI occurred, with a per-case infection rate of 1.38% and a per-thousand day infection rate of 2.99. 1,129 patients with CHD-PAH were included, among which the total hospitalization days were 1,483. In this subpopulation, 38 cases of HAI were diagnosed, with a per-case infection rate of 3.37% and a per-thousand day infection rate of 25.62. The main site of HAI was lower respiratory tract (43.51%), followed by blood infection (34.26%) and surgical site infection (9.26%). 36 strains of pathogenic bacteria were detected from patients with HAI. The top three pathogens with the highest detection rate were Klebsiella pneumoniae (6 episodes, 16.67%), Enterococcus faecium (6 episodes, 16.67%) and Acinetobacter baumannii (4 episodes, 11.11%). The incidence of VAP, CAUTI and CLABSI was 2.78, 0.08 and 1.66 per 1,000 catheter days respectively. Analysis revealed that patients with CHD-PAH were younger and prone to receive surgical corrections. CHD-PAH could significantly increase the length of ICU stay, ventilator days, times of central venous catheterization and central venous catheterization days. The choice of different central venous catheter types differed significantly between the two groups. Patients with CHD-PAH are characterized with excessive central venous catheterization operations, prolonged indwelling time, and more types of catheterization, which are considered to be risk factors for HAI, thus increasing the length of hospital stay. The clinical etiology is mainly G-bacteria, which requires reasonable selection of antibiotics and strict aseptic operation. Limiting unnecessary invasive procedures is helpful for reducing the incidence of postoperative HAI in PICU.

Epidemiology of healthcare-associated infections and mechanisms of antimicrobial resistance of responsible pathogens in Ukraine: a multicentre study

Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) have a high impact in terms of morbidity, mortality, and costs. To estimate the prevalence and incidence of HAIs, and to describe phenotypic and genotypic features of antimicrobial resistance in responsible pathogens in Ukraine. Prospective multicentre surveillance was conducted from January 2019 to December 2021 in 17 regional hospitals of Ukraine. Definitions of HAIs were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Among 37,968 patients, 6218 (16.4%) HAIs were observed. Of all HAI cases, 14.8% were detected after hospital discharge. The most frequently reported HAI types were pneumonia (24.4%), urinary tract infections (19.8%), surgical site infections (15.3%), and bloodstream infections (11.2%). Of all HAIs, 11.9% were defined as part of an outbreak. Death during hospitalization was reported in 12.6% of HAI cases. In total, 85.1% isolates from patients were found to be MDROs. Meticillin resistance was found in 41.2% of S.aureus (MRSA) isolates, and vancomycin resistance was found in 11.8% of enterococci. Antimicrobial resistance to third-generation cephalosporins was detected in 48.4% of all Enterobacterales. Antimicrobial resistance to carbapenems was detected in 71.3% of all non-fermentative Gram-negative bacteria. Of the all isolates tested, 25.1% were found to be multidrug-resistant (MDR). This study found a high prevalence of HAIs; those caused by MDROs varied widely depending on the bacterial species, antimicrobial group, and geographical region of Ukraine. MDROs were one of the main causes of HAI-associated deaths.

ANALYSIS OF DETECTION AND REGISTRATION OF INFECTIONS RELATED TO MEDICAL CARE IN THE URAL AND SIBERIAN FEDERAL DISTRICTS IN 2021

Despite of significant advances in the development of healthcare as well as the introduction of new safe diagnosis and treatment technologies of various diseases, the problem of preventing health care-associated infections (HAIs) does not lose its relevance.&#x0D; The article presents an data analysis of officially registered HAIs cases within medical organizations of Ural and Siberian Federal Districts. The analysis was carried out on the basis of data from Federal Statistical Observation Forms No. 2 "Information on infectious and parasitic diseases", No. 23-17 "Information on outbreaks of infectious diseases" and additional request materials "Information on medical manipulations and contingents treated" for 2021 and in dynamics for 7 years (2015-2021) in comparison with indicators for whole Russian Federation.&#x0D; Statistical data were provided by the Departments of Rospotrebnadzor from Irkutsk, Kemerovo, Kurgan, Novosibirsk, Omsk, Sverdlovsk, Tomsk, Tyumen, Chelyabinsk regions; Altai, Transbaikal, Krasnoyarsk Territory; republics of Altai, Buryatia, Tyva, Khakassia; Khanty-Mansi Autonomous Okrug Yugra, Yamalo-Nenets Autonomous Okrug. Data for Russian Federation were provided by Federal Center for Hygiene and Epidemiology of Rospotrebnadzor according the duties of Ural-Siberian Scientific and Methodological Center for the Prevention of Health Care-associated Infections.&#x0D; Based on the analysis results the rating assessment of HAIs detection and registration quality in subjects of Ural and Siberian Federal Districts and the ranking of subjects taking into account the HAIs epidemiological surveillance system functioning activity was carried out. The information presented in the article is intended for employees of Rospotrebnadzor bodies and organizations, medical organizations, educational organizations, executive authorities in the field of healthcare.

Healthcare-associated infections in COVID-19 ICU patients - two-centre study.

The aim of this retrospective study was to estimate the prevalence of healthcare-associated infections (HAI), microbiological data including resistance patterns and impact of HAI on patients' survival. Two-centre study on 172 patients was performed. Medical records of patients hospitalized in the two COVID-19 intensive care units (ICU) localized in Bydgoszcz between 1 October 2020 and 30 March 2021 were analysed retrospectively. Data collection included demographics, microbiological, clinical variables, and patient outcome. All infections were defined according to the HAI-Net ICU protocol of the European Centre for Disease Prevention and Control (ECDC). Detailed data concerning bloodstream infection (BSI), pneumonia (PN) and urinary tract infection (UTI) were collected. In 97 patients (56.4%), 138 HAI cases were identified. Patients with HAI statistically more often had been administered antimicrobial therapy prior to the admission to ICU (59.8% vs. 34.7%, p < 0.05), and needed catecholamines during hospitalization (93.8% vs. 70.7%, p < 0.001). The risk of HAI increased by 50% if antimicrobial therapy had been applied before the admission to ICU, and was three times higher if during the hospitalization in ICU catecholamines infusion was needed. Mortality was higher in patients diagnosed with HAI (72.2% vs. 65.3%) but the difference was not statistically significant (p = 0.34). Further investigation of co-infections in critically ill patients with COVID-19 is required in order to identify HAI risk factors, define the role of empiric antimicrobial therapy and proper prevention strategies.

Risk factors of healthcare-associated infections in recipients of bone marrow transplant

Bone marrow recipients are the most immunocompromizied patients who are susceptible to multiple infections. It is especially true for long-term episodes of drug-associated granulocytopenia. Our research goal was to identify risk factors of healthcare-associated infections (HAIs) in patients after bone marrow transplantation (BMT). Risk factors of developing HAIs were identified by accomplishing an analytical epidemiological “case – control” study with 973 patients participating in it. They all underwent BMT in the Hematology, Chemotherapy and Bone Marrow Transplantation Department of the Pirogov National Medical and Surgical Center on a period from 2015 to 2018. The following diseases were diagnosed in them: lymphoma (n = 158), multiple myeloma (n = 96), and multiple sclerosis (n = 719). HAIs cases were selected based on the standard (epidemiological) case definition in accordance with the Federal Clinical Recommendations on Epidemiological Surveillance over HAIs approved by the National Association of Experts responsible for Control over Healthcare-Associated Infections. Retrospective analysis established 75 HAIs cases or 7.7 % of the total number of the analyzed patients after BMT. Catheter-related bloodstream infections took the leading place among all the HAIs accounting for 52.0 ± 2.4 %. They were followed by bloodstream infections, 28.0 ± 3.1 %; lower respiratory tracts infections, 17.0 ± 3.2 %; and post-injection complications, 3.0 ± 0.6 %. Oncological diseases were established to cause HAIs in bone marrow recipients more frequently (ОR = 5.603; 95 % CI = 3.422÷9.174) than multiple sclerosis (ОR = 0.178; 95 % CI = 0.109÷0.292). This indicates that an underlying disease has its influence on a risk of infectious complications. We established a direct correlation between HAIs frequency and contamination with opportunistic microorganisms detected in objects in the hospital environment (r = 0.79, p = 0.01). This calls for implementing up-to-date disinfection provided for such objects.

Факторы риска развития инфекций, связанных с оказанием медицинской помощи, у реципиентов костного мозга

Bone marrow recipients are the most immunocompromizied patients who are susceptible to multiple infections. It is especially true for long-term episodes of drug-associated granulocytopenia. Our research goal was to identify risk factors of healthcare-associated infections (HAIs) in patients after bone marrow transplantation (BMT). Risk factors of developing HAIs were identified by accomplishing an analytical epidemiological “case – control” study with 973 patients participating in it. They all underwent BMT in the Hematology, Chemotherapy and Bone Marrow Transplantation Department of the Pirogov National Medical and Surgical Center on a period from 2015 to 2018. The following diseases were diagnosed in them: lymphoma (n = 158), multiple myeloma (n = 96), and multiple sclerosis (n = 719). HAIs cases were selected based on the standard (epidemiological) case definition in accordance with the Federal Clinical Recommendations on Epidemiological Surveillance over HAIs approved by the National Association of Experts responsible for Control over Healthcare-Associated Infections. Retrospective analysis established 75 HAIs cases or 7.7 % of the total number of the analyzed patients after BMT. Catheter-related bloodstream infections took the leading place among all the HAIs accounting for 52.0 ± 2.4 %. They were followed by bloodstream infections, 28.0 ± 3.1 %; lower respiratory tracts infections, 17.0 ± 3.2 %; and post-injection complications, 3.0 ± 0.6 %. Oncological diseases were established to cause HAIs in bone marrow recipients more frequently (ОR = 5.603; 95 % CI = 3.422÷9.174) than multiple sclerosis (ОR = 0.178; 95 % CI = 0.109÷0.292). This indicates that an underlying disease has its influence on a risk of infectious complications. We established a direct correlation between HAIs frequency and contamination with opportunistic microorganisms detected in objects in the hospital environment (r = 0.79, p = 0.01). This calls for implementing up-to-date disinfection provided for such objects.

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. For the Hindi translation of the abstract see Supplementary Materials section.