Nosocomial Infection Surveillance Research Articles

Evaluating the Use of Neonatal Colonization Screening for Empiric Antibiotic Therapy of Sepsis and Pneumonia

(1) Background: Since 2013, weekly screening for multidrug-resistant Gram-negative (MDRGN) bacteria has been performed in German neonatal intensive care units (NICU). National guidelines recommend considering these colonization analyses for antibiotic treatment regimens. Our retrospective single center study provides insight into the clinical dichotomy of bacterial colonization and infection rates in neonates. (2) Methods: We analyzed microbiological data of neonates admitted to our tertiary level NICU over nine years. Colonization with MDRGN/Serratia marcescens (SERMA) was compared to microbiological findings in sepsis and pneumonia. (3) Results: We analyzed 917 blood and 1799 tracheal aspirate samples. After applying criteria from the Nosocomial Infection Surveillance for Neonates (NEO-KISS), we included 52 and 55 cases of sepsis and pneumonia, respectively; 19.2% of sepsis patients and 34.5% of pneumonia patients had a prior colonization with MDRGN bacteria or SERMA. In these patients, sepsis was not attributable to MDRGN bacteria yet one SERMA, while in pneumonias, ten MDRGN bacteria and one SERMA were identified. We identified late-onset pneumonia and cesarean section as risk factors for MDRGN/SERMA acquisition. (4) Conclusions: Colonization screening is a useful tool for hygiene surveillance. However, our data suggest that consideration of colonization with MDRGN/SERMA might promote extensive use of last resort antibiotics in neonates.

Epidemiological features of healthcare-associated Acinetobacter baumannii infections in Taiwan during 2008 − 2019

Background: Acinetobacter baumannii can reside in humans without causing infection or symptoms but can opportunistically cause community and nosocomial infections. Few studies from Taiwan have used national-level data to investigate antibiotic resistance rates of A. baumannii infections in the intensive care units (ICUs) of medical centers. Aim: This study determined the number of infection sites of A. baumannii and the resistance rates of carbapenem-resistant A. baumannii (CRAB) infections in ICUs in Taiwan, and identified trends over time, variations of infection site, and factors associated with resistance. Methods: This study used the database provided by Taiwan's Centers for Disease Control. Yearly, Taiwan Nosocomial Infections Surveillance System Surveys from 2008 to 2019 were analyzed, including data on the site of infection and resistance rates of A. baumannii and patient and hospital characteristics. Results: On average, 21 hospitals as medical center/year participated in the survey, and 6803 A. baumannii isolates were identified. All isolates were health care-related infections. The most frequent sites of infection were the urinary tract (50.6%), respiratory tract (19.6%), bloodstream (18.2%), surgical wounds (4.3%), and others (7.4%). Infection rates were the highest in the urinary tract in 2019 (63.6%; P < 0.001). On average, the rate of carbapenem resistance was 66.6% (95% confidence interval: 63.1–70.1) among ICU patients at medical centers. Considerable regional differences were observed, with the highest rates of resistance in the central regions. Higher resistance rates were observed between 2019 and 2020 COVID-19 pandemic (74.2%). Conclusion: This is the first report on the prevalence of health care-related A. baumannii infection in Taiwan in 2008–2019. Several invasive diseases, such as urinary tract infections, are associated with higher rates of carbapenem resistance. The resistance rate of CRAB in Taiwan is exceptionally high. The current big-data-derived findings may inform future surveillance and research efforts in Taiwan.

Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Pattern in ICU and Non-ICU Wards: A Four-Year Retrospective Study in Isfahan, Iran.

Bloodstream infections (BSIs) are one of the causes of morbidity and mortality in hospitalised patients. This study evaluated BSI's incidence, trend, antimicrobial susceptibility patterns and mortality in AL Zahra Hospital in Isfahan, Iran. This retrospective study was conducted in AL Zahra Hospital from March 2017 to March 2021. The Iranian nosocomial infection surveillance system was used for data gathering. The data included demographic and hospital data, type of bacteria, and antibiotic susceptibility findings and were analysed in SPSS-18 software. The incidence of BSIs was 1.67% and 0.47%, and the mortality was 30% and 15.2% in the intensive care unit (ICU) and non-ICU wards, respectively. In the ICU, the mortality was correlated with the use of the catheter, type of organism and year of study, but in non-ICU, correlated with age, gender, use of the catheter, ward, year of study and duration between the incidence of BSIs and discharging/death. Staphylococcus epidermidis, Acinetobacter spp. and Klebsiella spp. were the most frequent germs isolated in all wards. Vancomycin (63.6%) and Gentamycin (37.7%) for ICU and Vancomycin (55.6%) and Meropenem (53.3) for other wards were the most sensitive antibiotics. Despite the few rate of BSI in the last four years in AL Zahra Hospital, our data showed that its incidence and mortality in the ICU ward are significantly more than in other hospital wards. We recommend prospective multicentre studies to know the total incidence of BSI, local risk factors and patterns of pathogens causing BSI.

A Prospective Study of Surgical Site Infection with its Risk Factors and Their Correlation with the NNIS Risk Index.

Surgical site infection (SSI) is the third most commonly reported nosocomial infection, accounting for 10%-40% of all nosocomial infections and is a major cause of postoperative morbidity. Knowledge of factors related to SSI can help in reducing its incidence and related morbidity, which in many studies is shown to account for 38% of all infections in surgical patients. Lack of extending nosocomial infection surveillance programme and prevention measures in countries like India is viewed as a major challenge for the future. The aims of this work were (1) to study the SSI rate in patients undergoing both elective and emergency abdominal surgery and SSI with CDC, and NNIS risk index; and (2) to assess SSI along with body mass index (BMI), glycaemic status, smoking and duration of pre-operative hospital stay of patients. In total, 300 patients who underwent elective and emergency abdominal surgery were enrolled in the study as per inclusion and exclusion criteria. SSI with CDC's NNIS risk index were analysed considering BMI, glycaemic status, smoking and duration of pre-operative hospital stay of patients. In total, 300 cases of abdominal surgeries (elective and emergency) were analysed, out of which 60 cases were diagnosed to have SSI as per the criteria. This study demonstrated that there is a significant increase in SSI with increasing NNIS score that is, the greater the NNIS score, the greater the risk of SSI. With an increase in age, BMI, glycaemic index and preoperative hospital stay, the risk of SSI increases. Smoking and associated comorbidities also increase the risk of SSI.

Overview of Canada's Antimicrobial Resistance Network (AMRNet): A data-driven One Health approach to antimicrobial resistance surveillance.

The Antimicrobial Resistance Network (AMRNet) is a laboratory-based antimicrobial resistance (AMR) surveillance system under development at the Public Health Agency of Canada's (PHAC's) National Microbiology Laboratory. The AMRNet surveillance system captures information on antimicrobial susceptibility testing from clinical and veterinary laboratories including both public and private facilities. In the future, the AMRNet system will also capture relevant data from existing PHAC surveillance systems for AMR including the Canadian Integrated Program for Antimicrobial Resistance Surveillance, the Canadian Nosocomial Infection Surveillance Program and the Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea program, and contribute to the Canadian Antimicrobial Resistance Surveillance System. AMRNet's integrated "One Health" approach will allow health professionals and researchers to take a multi-dimensional perspective of AMR in both human and animal health in Canada and will make Canada a leader in AMR surveillance. AMRNet is a collaboration between PHAC, provincial and territorial public health organizations as well as clinical and veterinary laboratories across the country. As part of a phased rollout, AMRNet is now collecting human clinical data from three provinces, from both inpatients and outpatients. Ultimately, AMRNet aims to capture all antimicrobial susceptibility testing results from all bacterial and fungal pathogens across Canada. This article describes the AMRNet surveillance system, including program objectives, system structure and the data collected. The integration of human and animal data in AMRNet will inform One Health responses to AMR issues. The capacity to collect and to disseminate data to stakeholders in real time is a critical step to addressing emerging AMR issues in Canada.

The Canadian Nosocomial Infection Surveillance Program: Keeping an eye on antimicrobial resistance in Canadian hospitals since 1995.

Surveillance is essential to inform evidence-based policy and control measures that combat antimicrobial resistance (AMR). The Canadian Nosocomial Infection Surveillance Program (CNISP) collaborates with 88 sentinel hospitals across Canada to conduct prospective surveillance of infections and antimicrobial resistant organisms important to hospital infection prevention and control. This article aims to increase awareness of CNISP hospital-based surveillance activities. Since its inception in 1995, the scope of CNISP has expanded to include community-associated infections, outpatient Clostridioides difficile infections, viral respiratory infections such as coronavirus disease 2019, and emerging pathogens such as Candida auris. This change in scope, along with expansion to include rural, northern and community hospitals, has improved the generalizability of CNISP surveillance data. To generate actionable surveillance data, CNISP integrates demographic and clinical data abstracted from patient charts with molecular and microbiological data abstracted from laboratory testing. These data serve as a benchmark for participating hospitals and stakeholders to assess the burden of AMR in hospital and intervene as needed. Further, CNISP surveillance data are now available on a public-facing data blog that provides interactive visualizations and data syntheses sooner than peer-reviewed publications. Future directions of CNISP include the Simplified Dataset, which will capture aggregate AMR data from hospitals outside of the CNISP network, surveillance in long-term care facilities and a fourth point prevalence survey. Given its strengths and future directions, CNISP is well positioned to serve as the reference point for hospital-based AMR data in Canada.

Surgical site infections in thyroid and parathyroid surgery in Japan: An analysis of the Japan Nosocomial Infections Surveillance database from 2013 to 2020.

Surgical site infections (SSIs) after thyroid surgery are rare complications, with incidence rates of 0.3%-1.6%. Using a Japanese database, we conducted exploratory analyses on the incidence of SSIs, investigated the incidence of SSIs by the National Nosocomial Infections Surveillance risk index, and identified the causative bacteria of SSIs. SSIs occurred in 50 (0.7%) of 7388 thyroid surgery cases. Risk index-0 patients had the lowest incidence rate of SSIs (0.41%). The incidence of SSIs in risk index-1 patients was 3.05 times the incidence of SSIs in risk index-0 patients. The rate of SSI occurrence for risk index-2 patients was 4.22 times the rate of SSI occurrence for risk index-0 patients. Thirty-one bacterial species were identified as the cause of SSIs in thyroid surgery cases, of which 12 (38.7%) SSIs were caused by Staphylococcus aureus and Staphylococcus epidermidis. Of the nine SSIs caused by Staphylococcus aureus, 55.6% (five cases) were attributed to methicillin-resistant Staphylococcus aureus. Therefore, routine prophylactic antibiotic administration should be avoided, while the target for administration should be narrowed, according to the SSI risk. Administration of prophylactic antibiotics, such as 2 g piperacillin or 1 g cefazolin, is considered appropriate.

Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis

ObjectivesTo establish the implications of frailty as a predictor of outcome in patients with head and neck cancer requiring flap repair.DesignRetrospective cohort.Data sourceWe captured data from patients above 60 years...

NNIS risk score or COLA score: which predicts better the risk of surgical site infection among patients undergoing colorectal resection in a tertiary care hospital setting?

Background: By using predictive scores to identify and quantify risk of Surgical site infections (SSI), preventive measures can be directed effectively to improve patient outcome post operatively. This study was undertaken to compare the National Nosocomial Infections Surveillance (NNIS) risk index and COLA (contamination, obesity, laparotomy and ASA grade) scores to predict risk of SSI among patients undergoing colorectal resection.Methods: A total of 77 patients who underwent colorectal resection at a tertiary care hospital were enrolled in this study. Wound surveillance was performed in all patients during the hospital stay and follow-up information for 30 days postoperatively was collected. Data analysis was done in SPSS version 20.0 for windows. Descriptive analysis was used to exhibit the clinical parameters. Differences between groups were tested by Pearson chi-square and fisher’s exact test. ROC curves were utilized. All the statistical tests were examined with 5% (p≤0.05) level of significance.Results: Incidence of overall SSI was 28.6%. Superficial SSI was more common (14.3%). Serious organ/deep space infection occurred only in 9.1%. Area under the curve (AUC) for NNIS score was 0.645 (95% CI: 0.510-0.781, p&lt;0.05) and 0.611 for the COLA score. (95% CI: 0.472-0.750, p&gt;0.05). Therefore, both these scores have less than acceptable accuracy in this data set to predict SSI.Conclusions: The risk prediction models (NNIS, COLA) although simple, did not accurately predict the risk of SSI in the given study population.

Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control

BackgroundThe systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.MethodsA retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.ResultsA total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).ConclusionThe adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.

Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma.

Multidrug-resistant (MDR) Gram-negative bacteria (GNB) have raised concerns as common, frequent etiologic agents of nosocomial infections, and patients admitted to intensive care units (ICUs) present the highest risk for colonization and infection. The incidence of colonization and infection in trauma patients remains poorly investigated. The aim of this study was to assess the risk factors for Carbapenem-resistant (CR)-GNB colonization and the clinical impact of colonization acquisition in patients with severe trauma admitted to the ICU in a CR-GNB hyperendemic country. This is a retrospective observational study; clinical and laboratory data were extracted from the nosocomial infection surveillance system database. Among 54 severe trauma patients enrolled in the study, 28 patients were colonized by CR-GNB; 7 (12.96%) patients were already colonized at ICU admission; and 21 (38.89%) patients developed a new colonization during their ICU stay. Risk factors for colonization were the length of stay in the ICU (not colonized, 14.81 days ± 9.1 vs. colonized, 38.19 days ± 27.9; p-value = 0.001) and days of mechanical ventilation (not colonized, 8.46 days ± 7.67 vs. colonized, 22.19 days ± 15.09; p-value &lt; 0.001). There was a strong statistical association between previous colonization and subsequent development of infection (OR = 80.6, 95% CI 4.5-1458.6, p-value &lt; 0.001). Factors associated with the risk of infection in colonized patients also included a higher Charlson comorbidity index, a longer length of stay in the ICU, a longer duration of mechanical ventilation, and a longer duration of treatment with carbapenem and vasopressors (not infected vs. infected: 0(0-4) vs. 1(0-3), p = 0.012; 24.82 ± 16.77 vs. 47 ± 28.51, p = 0.016; 13.54 ± 15.84 vs. 31.7 ± 16.22, p = 0.008; 1.09 ± 1.14 vs. 7.82 ± 9.15, p = 0.008). The adoption of MDR-GNB colonization prevention strategies in critically ill patients with severe trauma is required to improve the quality of care and reduce nosocomial infections, length of hospital stay and mortality.

Categorical principal component analysis to characterize patients at Intensive Care Unit admission

Abstract Background Healthcare-associated infections (HAIs) are the most frequent complications in healthcare settings, with a major impact on adverse outcomes. Here, we aimed to identify the relationships between patients’ characteristics admitted to Intensive Care Units (ICUs). Methods We used data of patients included in the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 2 days. Using Categorical principal component analysis (CATPCA) two components of risk were assessed. Values of variance accounted for (VAF) &amp;gt;0.3 were accepted as the significant effect of a variable on each component. A Chronbach’s alpha &amp;gt;0.7 was accepted as a measure of the internal consistency of the model. Results A total of 22402 admissions (62% female) were included. The average age was 65.7 years (SD = 16.6). Our model explains 35.3% of the total variability, with a Cronbach's alpha value of 0.847. The visual examination of component loading plot allows to evaluate the correlation between the quantified variables and each of the two components. In particular, the first component is explained by the presence of intubation (VAF=0.826), central venous catheter (VAF=0.749), and urinary catheter (VAF=0.727), patient’s origin (VAF=0.584), antibiotic treatment (VAF=0.479), non-surgical treatment for acute coronary disease (VAF=0.375), type of admission (VAF=0.509), surgical intervention (VAF=0.419). In the second component, the variables with the greatest contribution were the SAPS II (VAF=0.660), age (VAF=0.583), type of admission (VAF=0.531), surgical intervention (VAF=0.522). Thus, the first component would represent the exposure to invasive devices and medical procedures, and the second component the severity of patients. Conclusions Our results proposed the usefulness of CATPCA to identify factors involved in the development of adverse outcomes, highlighting the role of exposure to invasive devices and severity of patients. Key messages • There are several relationships between patients clinical and personal characteristics. • CATPCA represents a useful approach for the analytical exploitation of healthcare data.

Effect of Supplemental Oxygen on Risk of Surgical Wound Infection

Background: There is a risk of different complication after the surgery but delaying in wound healing or infection is one of most common risk. Oxidative killing is a process of tissues partial pressure of oxygen throughout the observed values ranges. The main defense against foreign particles in result of surgery is oxidative killing through neutrophils. In a study by Greif et al4 indicated oxygen 80% during the surgery and after 2 hours later of surgery 50% risk get lesser as compared to the patient who had administrated with 30% oxygen.4 Another study proved that chances of risk for infection get increase in patients who were administrated oxygen 11 % as compared to the patients with 25% oxygen administration.5 The current study was conducted to test the hypothesis that supplemental oxygen decreases the risk of post-operative wound infection. Objective: The objective of the study was to determine the effects of supplemental oxygen on risk of surgical wound infection. Materials and Methodology: A randomized Clinical Trial- double- blinded was conducted at DHQ hospital, Karachi from March 1, 2011 to October, 31, 2016. A total of 300 subjects with age around 18 to 80 years who underwent elective colorectal surgery and satisfying the inclusion and exclusion criteria were recruited in the study. Non-probability Purposive sampling technique was used to collect the data. Double-blinded technique was used. Blinded investigators diagnosed the wounds infection by following the criteria of centers of disease control and prevention. Patients were randomly allocated in two groups by sealed-envelope method. Baseline assessment was performed on each patient which included patient’s medical history, physical examination and Lab tests i.e. complete blood picture and biochemical analysis. Characteristics for patient’s baseline and aesthetic treatment were confound factors. 3rd generation antibiotics cephalosporin were administrated 1 to 2 hours before of surgery. Patients of Group 1 received oxygen fraction of inspired oxygen FIO2 of 30 and group 2 of 80 percent. Randomly chosen concentration flow of oxygen 16l/min was given. Patient was breathing ambient air. Supplemental oxygen was given to maintain the patient’s oxygen saturation to 92% that is measured by pulse oximetry. Patient’s treatment was slandered with antibiotics and anesthesia administration. For wound evaluation, tools used were National nosocomial infection surveillance scale 6 and Efficacy of infection control,7 Wounds were checked for infection on daily basis by surgeons who were blinded. And wound thought to be infected when they full fill the criteria of Centers for Disease control and prevention standard. Main outcome measure was surgical site for infection and secondary outcomes were recovery of bowl function, duration of hospital stay, ambulation and ability to absorb the solid food. Statistical Analysis: Analysis was done on SPSS by applying parametric and non-parametric test according to normality. Results: Results showed no significant difference in %age Surgical infection site, Daily ASEPSIS value ≥20 at any time (p-value&lt;0.06), Admission in ICU (p-value= 0.74), Bowel function recovery (p-value=0.74), Solid food intake (p-value=0.54), Walking (p-value=0.57), Removal of Staples( 0.72), Duration of post-surgery hospitalization(p-value=0.09) of both the groups as p-value &gt;0.05 of all variables. Practical implication: If we provide pre-operative supplemental oxygen it will be helpful to decrease SSI. Conclusion: Patients who received supplemental oxygen showed significantly decrease in the risk of wound infection. Hence, Pre-operative supplemental oxygen proved to be an effective intervention to decrease SSI in the patients having rectal or colon surgery. Keywords: ASEPSIS, Surgical Wound, Infection, Supplemental Oxygen

Distribution, trends, and antifungal susceptibility of Candida species causing candidemia in Japan, 2010-2019: A retrospective observational study based on national surveillance data.

The increasing incidence of candidemia and the emergence of drug-resistant Candida species are major concerns worldwide. Therefore, long-term surveillance studies are required. Here, we provide one of the largest longitudinal overviews of the trends in the prevalence of Candida species using national data of 57 001 candidemia isolates obtained from > 2000 hospitals for the 2010–2019 period in the Japan Nosocomial Infections Surveillance database. The proportion of Candida species, except Candida krusei and Candida guilliermondii, was almost the same during the study period. The proportion of C. guilliermondii surpassed that of C. krusei in 2014. The incidence of candidemia due to C. albicans (P < 0.0001), C. parapsilosis (P = 0.0002), and C. tropicalis (P < 0.0001) have decreased significantly over this period. Azole susceptibility of C. tropicalis was low, with 17.8% of isolates resistant to fluconazole and 13.5% resistant to voriconazole. The micafungin susceptibility of C. glabrata was low, with 8.0% of isolates showing resistance. The resistance rate of C. krusei toward amphotericin B fluctuated considerably (between 3.2% and 35.7%) over this period. The incidence rate of candidemia caused by C. parapsilosis and C. guilliermondii in hospitals responsible for bone marrow transplantation was significantly higher than that in other hospitals. Overall, our study suggests that in Japan, the species distribution of Candida was almost the same in this period and similar to that reported in North America and Europe. A relatively high resistance to azoles and micafungin was observed in C. glabrata, C. tropicalis, and C. krusei isolates, which require continued surveillance.

Features of nosocomial infections in patients with severe burn injury

Nosocomial infections in patients with burn injury is one of the leading problems of modern healthcare. In terms of prevalence, they exceed those in patients with any other pathology. In the conditions of man-made disasters and in everyday life, violation of safety rules leads to burn injury.&#x0D; To study the prevalence of nosocomial infections in patients with burns, identify risk factors and evaluate the effectiveness of the existing system of epidemiological surveillance of these infections, an analysis of publications on this topic on several information resources was carried out: eLibrary.ru, Google Scholar, PubMed and NCBI.&#x0D; It was found that the most common form of nosocomial infections in burn patients is a burn wound infection, which is treated by 38.8%, lower respiratory tract infections, including those associated with ventilation aids (19.7%), are in the second position, and bloodstream infections (8.1%) are in the third position. Urinary tract infections do not occupy such a significant place, however, their significant prevalence among patients outside the intensive care and intensive care units has been noted in foreign literature. Despite the available data on the prevalence of certain clinical forms of nosocomial infections, data on risk factors and a number of problematic issues that may be the subject of discussion and require their solution remain controversial. The risks of death are high due to the specifics of burn injury, with its frequent combination with inhalation trauma.&#x0D; The system of epidemiological surveillance of nosocomial infections in burn centers, including in the intensive care and intensive care units, has some differences in approaches to identifying, recording, registering, and collecting information about the place and time of the greatest risk.

Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has placed significant burden on healthcare systems. We compared Clostridioides difficile infection (CDI) epidemiology before and during the pandemic across 71 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Using an interrupted time series analysis, we showed that CDI rates significantly increased during the COVID-19 pandemic.

Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing Enterobacterales (CPE) in Canada from 2019 to 2020.

ABSTRACTData regarding the epidemiology of extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) in Canada are scarce. Among CPE patients identified by the Canadian Nosocomial Infection Surveillance Program, the following were each significantly associated with XDR status: international travel history; CPE acquisition from a health care exposure abroad; presence of the New Delhi metallo-β-lactamase (NDM) carbapenemase gene; E. coli sequence type (ST) 167, ST405, and ST648; E. cloaceae ST177; C. freundii ST22; and resistance to all antimicrobials except colistin, tigecycline, and ceftazidime-avibactam.IMPORTANCE Extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) are a global public health concern. XDR CPE are among the most drug-resistant and difficult-to-treat bacteria, and infected patients are likely to experience adverse outcomes. Because XDR status further reduces effective therapeutic options, it is critical for clinicians to consider resistance and therapeutic options not only in the context of a patient with CPE but also in the context of potential XDR status. Our study reports on patient characteristics associated with the acquisition of an XDR CPE. Our study also reports on the species and carbapenemases associated with XDR status among Enterobacterales identified in Canada. Among a panel of 22 antibiotics, including novel combination drugs, we showed which retained the highest activity against XDR CPE, which may help guide the selection of antibiotic treatments.

Device and surgical procedure-related infections in Canadian acute care hospitals from 2011 to 2020.

Healthcare-associated infections (HAIs) continue to place a burden on patient health and safety as well as on the healthcare system. In Canada, national surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes ten years of device and surgical procedure-related HAI epidemiology in Canada from 2011 to 2020. Data were collected from over 40 Canadian sentinel acute care hospitals between January 1, 2011, and December 31, 2020, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions, and antimicrobial resistance are presented. Between 2011 and 2020, 4,751 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units (ICUs) representing 67% (n=3,185) of all reported infections. Over the surveillance period, significant rate increases were observed in adult mixed ICU CLABSIs (0.8 to 1.6 per 1,000 line days, p=0.004) while decreases were observed in neonatal ICU CLABSIs (4.0 to 1.6 per 1,000 line days, p=0.002) and SSIs following knee arthroplasty (0.69 to 0.29 infections per 100 surgeries, p=0.002). No trends were observed in the other reported HAIs.Of the 5,071 pathogens identified, the majority were gram-positive (68%), followed by gram-negative (23%) and fungi (9%). Coagulase-negative staphylococci (27%) and Staphylococcus aureus (16%) were the most frequently isolated pathogens. This report describes epidemiological and microbiological trends among select device and surgical procedure-related HAIs, essential for benchmarking infection rates nationally and internationally, to identify any changes in infection rates or antimicrobial resistance patterns and to help inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2016–2020

Epidemiologic and laboratory characteristics of healthcare-associated infections and antimicrobial resistance from 2016 to 2020 using surveillance data provided by Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program.

The Prevalence of Nosocomial Infections and Related Microbial Agents Based on the NNIS System in Sabzevar During 2011-2015

Background: Nosocomial infection is an infection that hospitalized patients get while receiving health care. This study aimed to determine the prevalence and factors involved in the incidence of nosocomial infections, related microbial agents, and antibiotic resistance profiles. Methods: This cross-sectional study was conducted on 390 patients with nosocomial infection admitted to Shahid Beheshti Hospital in Sabzevar from 2011 to 2015. The acquired data were assessed by the standard checklist of the National Nosocomial Infections Surveillance (NNIS) system of the Ministry of Health. The collected data were analyzed using the Stata 12 software. Results: Of the 41979 admitted patients during the mentioned period, 390 patients with an average age of 48.08 years suffered from a hospital-acquired infection. The prevalence of nosocomial infections was 1% with the highest rate related to the respiratory tract in men and surgical sites in women. Intravenous catheters, surgical wounds, urinary catheters, suction, ventilator, tracheotomy, and tracheostomy were the most commonly encountered factors (invasive measures) of nosocomial infection, respectively. The most prevalent causes of nosocomial infections were Klebsiella, Staphylococcus aureus, and Acinetobacter. Conclusions: Based on our findings, several factors play a pivotal role in preventing hospital-associated infections, including proper follow-up and timely reporting of nosocomial infection cases. The other influential factors were accurate identification of microorganisms involved, allocation of sufficient funds to provide appropriate facilities for infection prevention, the appropriate and timely medical interventions, and the rational use of antibiotics.