Frequent Healthcare-associated Infections Research Articles

Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies

ObjectivesResidents of long-term care facilities (LTCFs) are especially vulnerable to acquiring healthcare-associated infections (HAIs). Our systematic review and meta-analysis estimated the burden of HAIs, identified the most frequent HAIs and...

Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in orthopedic surgery reduces surgical site infection.

Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention"). Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I. The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P=.019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P<.0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P<.0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures. Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.

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&gt;0.05), but it was higher in intensive care units (ICU) (p&lt;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&lt;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.

Effect of COVID-19 on infections associated with medical devices in critical care

ObjectivesThis study explores the hypothesis that COVID-19 patients are at a heightened risk of healthcare-associated infections (HAIs) associated with medical device usage compared to non-COVID-19 patients. Our primary objective was to investigate the correlation between COVID-19 infection in ICU patients and subsequent HAIs following invasive medical device insertion. Additionally, we aim to assess the impact of SARS-CoV-2 infection on onset times concerning specific microorganisms and the type of medical device, providing valuable insights into this intricate relationship in intensive care settings.MethodologyA retrospective cohort study was conducted using ICU patient records at our hospital from 2020 to 2022. This investigation entailed evaluating the timing of HAIs while distinguishing between patients with and without SARS-CoV-2 infection. We identified and analyzed the type of isolation and infection attributed to the medical device while controlling for ICU duration and ventilator days using Cox regression.ResultsOur study included 127 patients without SARS-CoV-2 infection and 140 patients with SARS-CoV-2 infection. The findings indicated a higher incidence of HAI caused by various microorganisms associated with any medical device in patients with SARS-CoV-2 (HR = 6.86; 95% CI-95%: 3.26–14.43; p < 0.01). After adjusting for ICU duration and ventilator days, a heightened frequency of HAIs persisted in SARS-CoV-2-infected individuals. However, a detailed examination of HAIs revealed that only ventilation-associated pneumonia (VAP) displayed a significant association (HR = 6.69; 95% CI: 2.59–17.31; p < 0.01). A statistically significant correlation between SARS-CoV-2 infection and the isolation of S. aureus was also observed (p = 0.034). The prevalence of S. aureus infection was notably higher in patients with SARS-CoV-2 (RR = 8.080; 95% CI: 1.052–62.068; p < 0.01).ConclusionsThe frequency of pathogen isolates in invasive medical devices exhibited an association with SARS-CoV-2 infection. Critically ill patients with SARS-CoV-2 are more prone to developing early-onset VAP than those without SARS-CoV-2 infection.

Health care-associated infections in neonatology

Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.

Infecciones relacionadas con la asistencia sanitaria en neonatología

Health care-associated infections are common in neonatology, but there is no consensus on their definitions. This makes it difficult to compare their incidence or assess the effectiveness of prevention bundles. This is why we think it is very important to achieve a consensus on the definitions and diagnostic criteria for one of the most frequent causes of morbidity in hospitalised neonates. This document aims to standardise the definitions for the most frequent health care-associated infections, such as catheter-associated bloodstream infection, ventilator-associated pneumonia and surgical wound infection, as well as the approach to their diagnosis and treatment.

Reporting the adverse events and healthcare-associated infections in relation to the work environment

Abstract Aim. The aim of this multicenter study was to analyze the reporting of the adverse events and health care-associated infections (HAIs) in relation to work environment. Material and methods. This cross-sectional multicenter study was conducted in 14 acute care hospitals throughout the Czech Republic. A total of 105 acute care hospital wards were included in the study. The Practice Environment Scale of the Nursing Work Index was used to assess the practice environment. The questionnaire to assess the practice environment were completed by 805 nurses. The data on adverse events and HAIs were weekly reported. Results. The overall mean number of adverse events including healthcare-associated infections was 27.7 (±36.10) per 100 patients, the most frequent being pressure ulcers and falls. The most frequent healthcare-associated infections were urinary tract, gastrointestinal tract and surgical site infections. Analysis of all adverse events and HAIs failed to confirm a statistically significant relationship between the nursing practice environment and occurrence of adverse events or healthcare-associated infections. Conclusions. Adverse events and healthcare-associated infections are important indicators of quality of care in hospitalized patients. No type of the nursing practice environment aff ected the reporting of adverse events and HAIs.

An Antibiotic-Loaded Silicone-Hydrogel Interpenetrating Polymer Network for the Prevention of Surgical Site Infections.

Surgical site infections (SSIs) are among the most frequent healthcare-associated infections, resulting in high morbidity, mortality, and cost. While correct hygiene measures and prophylactic antibiotics are effective in preventing SSIs, even in modern healthcare settings where recommended guidelines are strictly followed, SSIs persist as a considerable problem that has proven hard to solve. Surgical procedures involving the implantation of foreign bodies are particularly problematic due to the ability of microorganisms to adhere to and colonize the implanted material and form resilient biofilms. In these cases, SSIs may develop even months after implantation and can be difficult to treat once established. Locally applied antibiotics or specifically engineered implant materials with built-in antibiotic-release properties may prevent these complications and, ultimately, require fewer antibiotics compared to those that are systemically administered. In this study, we demonstrated an antimicrobial material concept with intended use in artificial vascular grafts. The material is a silicone-hydrogel interpenetrating polymer network developed earlier for drug-release catheters. In this study, we designed the material for permanent implantation and tested the drug-loading and drug-release properties of the material to prevent the growth of a typical causative pathogen of SSIs, Staphylococcus aureus. The novelty of this study is demonstrated through the antimicrobial properties of the material in vitro after loading it with an advantageous combination, minocycline and rifampicin, which subsequently showed superiority over the state-of-the-art (Propaten) artificial graft material in a large-animal study, using a novel porcine tissue-implantation model.

Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit.

Health care-associated infections (HAIs) are a common cause of morbidity and mortality. There is little information on the risk factors associated with HAI in surgical newborns. To identify the risk factors associated with healthcare-associated infections in surgical newborns. Nested case-control study carried out during 2016-2017. Cases were newborns with healthcare-associated infections and controls were newborns without infection. Perinatal characteristics, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, age, and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, postsurgical HAIs and type of infection were registered. Univariate and multivariate analyses were performed. Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. Independent risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2, 95% CI = 3.8-49.1), ≥ 2 surgeries (aOR = 16.5, 95% CI 5.8 -42.1) and abdominal surgery (aOR = 2.6, 95% CI = 1.2-6.6). Newborns undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

SG-APSIC1117: Healthcare-associated infections among the obstetrics and gynecology patients with confirmed COVID-19 in Hung Vuong Hospital, Vietnam

Objectives: During the COVID-19 surge, our hospital was overloaded due to the increasingly high volume of patients and lack of resources, which resulted in difficulties in complying with infection control and prevention (IPC) practices. In this study, we estimated healthcare-associated infection (HAI) incidence and relevant factors among COVID-19 patients in Hung Vuong hospital. Methods: This study included all SARS-CoV-2–positive adult patients hospitalized between September 1 and October 31, 2021. The Centers for Disease Control and Prevention definition of HAI in the acute-care setting was used. Results: Among 773 patients, 21 (2.72%) developed 26 separate HAIs. The cumulative days of hospitalization were 5,607. The incidence of HAI among COVID-19 patients was 4.64 per 1,000 days of hospitalization. The most frequent HAI was clinically defined pneumonia (46.2%), for which the ventilator-associated pneumonia (VAP) rate was 41.9 per 1,000 ventilator days. Among 21 positive cultures, the most frequently isolated microorganisms were pseudomonas aeruginosa, Klebsiella pneumoniae, and escherichia coli. HAIs were significantly associated with the number of central-line days (OR, 1.74; 95% CI, 1.33–2.78), the number of indwelling urinary catheter days (OR, 1.46; 95% CI, 1.05–2.03), the length of administration days (OR, 1.25; 95% CI, 1.07–1.45), antibiotics use prior to HAIs (OR, 0.01; 95% CI, 0.01–0.21), and the number of nasal cannula days (OR, 0.62; 95% CI, 0.44–0.85). Conclusions: COVID-19 makes patients more vulnerable and may require more invasive procedures, increasing the infection risk by opportunistic pathogens like gram-negative Enterobacteriaceae. Hence, fundamental IPC recommendations should be strongly implemented.

Predictors and Outcomes of Healthcare-Associated Infections among Patients with COVID-19 Admitted to Intensive Care Units in Punjab, Pakistan; Findings and Implications.

Healthcare-associated infections (HAIs) have a considerable impact on morbidity, mortality and costs. The COVID-19 pandemic resulted in an appreciable number of hospitalized patients being admitted to intensive care units (ICUs) globally with a greater risk of HAIs. Consequently, there is a need to evaluate predictors and outcomes of HAIs among COVID-19 patients admitted to ICUs. A retrospective study of patients with COVID-19 admitted to ICUs of three tertiary care hospitals in the Punjab province over a five-month period in 2021 was undertaken to ascertain predictors and outcomes of HAIs. Of the 4534 hospitalized COVID-19 patients, 678 were admitted to ICUs, of which 636 patients fulfilled the inclusion criteria. Overall, 67 HAIs were identified among the admitted patients. Ventilator-associated lower respiratory tract infections and catheter-related urinary tract infections were the most frequent HAIs. A significantly higher number of patients who developed HAIs were on anticoagulants (p = 0.003), antithrombotic agents (p &lt; 0.001), antivirals (p &lt; 0.001) and IL-6 inhibiting agents (p &lt; 0.001). Secondary infections were significantly higher in patients who were on invasive mechanical ventilation (p &lt; 0.001), had central venous access (p = 0.023), and urinary catheters (p &lt; 0.001). The mortality rate was significantly higher in those with secondary infections (25.8% vs. 1.2%, p &lt; 0.001). Our study concluded that COVID-19 patients admitted to ICUs have a high prevalence of HAIs associated with greater mortality. Key factors need to be addressed to reduce HAIs.

INTERNET OF THINGS-ASSISTED LORAWAN-ENABLED HAND HYGIENE MONITORING AND TRACKING SYSTEM FOR PREVENTING COMMUNITY-ACQUIRED PNEUMONIA AND HEALTHCARE-ASSOCIATED INFECTIONS

Healthcare-associated infections (HAI) are a primary concern in critical care units, dialysis centers, and nursing stations. Practicing Alcohol-Based Hand Hygiene (ABH) is predicted to reduce the risk of disease transmission. Recent technological breakthroughs in the Internet of Things (IoT) and Long Range communication (LoRa) protocols provide cutting-edge solutions to reduce HAIs, particularly community and hospital-acquired pneumonia. This research uses an IoT-enabled LoRa network to monitor and track hand hygiene practices to avoid pneumonia and other HAI infections. The ABH dispenser can recognize the subjects, activate the hand sanitizer, permit the subject admission, and record hand-washing activities to a server powered by an NVIDIA Jetson Nano Graphical Processing Unit computer. All the data, with a user ID and GPS location, is deployed in a cloud server and an application server for storage and display and relayed to a LoRa gateway using the ESP32 IoT platform equipped with a LoRaWAN and short-range Bluetooth Low Energy. A series of field tests was conducted in various hospital buildings and simulated scenarios. Real-world LoRa network situations have brought an overall success rate of 92%, whereas laboratory testing has an overall success rate of 98%. As individuals grew more conscious of the need for personal and institutional hygiene during the Covid-19 pandemic, the frequency of HAIs increased. The IoT-enabled intelligent ABH network is a cost-effective infection prevention and control mechanism, and it reduces pneumonia, HAI rate, and stress of healthcare workers and critical care unit patients.

Prevalence of Healthcare-Associated Infections Among Newborns in Maternity Hospitals of the Kyrgyz Republic

The strategic objective of healthcare is to ensure the quality of medical care and create a safe environment for patients and staff in organizations engaged in medical activities. Infections associated with the provision of medical care are the most important component of this problem due to the widespread negative consequences for the health of patients, staff and the economy of the state. Currently, the problem of prevention and control of infections associated with the provision of medical care remains relevant, because reflects the quality of medical care provided to the population and causes significant economic damage to the country’s healthcare. Infections associated with the provision of medical care is a term for a group of infections, which displays a modern understanding of hospital-acquired infections in accordance with international approaches. The general criterion for classifying infections as infections related to medical care is that their occurrence is associated with the provision of medical care (treatment, diagnosis, prevention, etc.). The largest number of healthcare-associated infections in Kyrgyzstan is registered annually in maternity hospitals and accounts for 33.0% of all cases of this group of infections. As before, the risk of infection with hospital strains of microorganisms remains high in the departments of newborns and premature infants, intensive care units and intensive care units, and according to official statistics, the frequency of healthcare-associated infections in newborns is 16.8%. According to selective studies, the true incidence of infections associated with medical care in maternity institutions is several times higher than the officially registered one, cases of concealing cases of morbidity among newborns and maternity hospitals are not uncommon.

Burden of five healthcare associated infections in Australia

BackgroundHealthcare associated infections are of significant burden in Australia and globally. Previous estimates in Australia have relied on single-site studies, or combinations thereof, which have suggested the burden of these infections is high in Australia. Here, we estimate the burden of five healthcare associated infections (HAIs) in Australian public hospitals using a standard international framework, and compare these estimates to those observed in Europe.MethodsWe used data from an Australian point prevalence survey to estimate the burden of HAIs amongst adults in Australian public hospitals using an incidence-based approach, introduced by the ECDC Burden of Communicable Diseases in Europe.ResultsWe estimate that 170,574 HAIs occur in adults admitted to public hospitals in Australia annually, resulting in 7583 deaths. Hospital acquired pneumonia is the most frequent HAI, followed by surgical site infections, and urinary tract infections. We find that blood stream infections contribute a small percentage of HAIs, but contribute the highest number of deaths (3207), more than twice that of the second largest, while pneumonia has the higher impact on years lived with disability.ConclusionThis study is the first time the national burden of HAIs has been estimated for Australia from point prevalence data collected using validated surveillance definitions. Per-capita, estimates are similar to that observed in Europe, but with significantly higher occurrences of bloodstream infections and healthcare-associated pneumonia, primarily amongst women. Overall, the estimated burden is high and highlights the need for continued investment in HAI prevention.

Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019.

BackgroundCatheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death.AimTo analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat).MethodsA cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007–2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported.ResultsDuring the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients’ median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93–0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87–0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87–0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05–1.11; IRR PVC: 1.03; 95% 1.00-1.05).ConclusionsOver the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.

Prevalence of Healthcare-Associated Infections at the National Hospital During the COVID-19 Pandemic in Peru

Background: Healthcare-associated infections are important because they constitute a public health problem due to the increase in morbidity and mortality that they produce in hospitalized patients, increased hospitalization costs due to prolonged stay, expensive antibiotic treatments and surgical reinterventions, not counting the social costs due to loss of wages and production, among others. Methods: We report the specific prevalence of healthcare-associated infections (HCAIs) in Edgardo Rebagliati Martin National Hospital, Perú, in 2020. We performed a descriptive cross-sectional study from July 27 to July 31, 2020. The medical records of hospitalized patients were reviewed according to the inclusion criteria. STATA software was used for descriptive statistical analyses. Results: In total, 1,217 hospitalized patients were included in the study. The prevalence of HCAI was 12.2% (149 patients). The prevalence of HCAI in areas where patients with the diagnosis of COVID-19 were hospitalized was higher (8.1%) than in common hospitalization areas (4.1%). Men represented 92% of the total number of patients with HCAIs. The most frequent infections were clinically defined pneumonia (30.9%) and bloodstream infections (20.1%). The most frequently isolated microorganism was Pseudomonas aeruginosa. Conclusions: The prevalence of HCAI was 12.2%. The most frequent HCAIs were pneumonia and bloodstream infection.Funding: NoDisclosures: None

Frequency of Healthcare-Associated Infections in the Elderly Patient Hospitalized

Introduction: Healthcare- Associated Infections (HAI) are known to be one of the most important health issues in developed and developing countries. The most common infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia and surgical site infection. The aim of this study was to investigate the incidence of nosocomial infections in the elderly patients.&#x0D; Methods: In this cross-sectional study, 1279 patients were 60 years of age or older. Patients who had been admitted for more than 48 hours in the hospital and had no signs of infection at the time of admission, were entered into the study. It was evaluated four most common HAI, according to CDC include bacteremia, central line-associated blood stream infections, urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections. The Chi-square and T- test or analysis of variance was used for data analysis.&#x0D; Results: Of the total patients, 93 (7.3%) developed HAI at duration admission. The highest rate of infection was bacteremia, which was 48.4 % and then urinary tract infection 21.5%. The prevalence of HAI among patients with cardiovascular diseases was relatively higher than underlying diseases. The frequency of length of hospital stay was significant in patients &gt; 7 days with 68.8% in the HAI group.&#x0D; Conclusion: Our findings showed that patients with cardiovascular, renal and pulmonary disease are more susceptible to HAIs. Due to the increased length of hospital stay increases the risk of infection, it is recommended to discharge patients as soon as possible.

Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice

Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice.Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study.Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001).Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.

Patterns of antibiotic use in hospital-acquired infections

Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data. We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile. Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S.aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E.coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E.coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem. This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.

Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated: The AGATE Multicenter Randomized Controlled Study

Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma? In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for≥ 48h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants. A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95%CI, 0.76-1.20; P= .71). No serious adverse events related to the use of the pneumatic device were noted. Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma. ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.