Nosocomial Infection Surveillance Research Articles

Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015-2019.

We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.

Expert recommendations for prevention and management of Candida auris transmission.

Candida auris was first described as a yeast pathogen in 2009. Since then, the species has emerged worldwide. In contrast to most other Candida spp., C.auris frequently exhibits multi-drug resistance and is readily transmitted in hospital settings. While most detections so far are from colonised patients, C.auris does cause superficial and life-threatening invasive infections. During management of the first documented C.auris transmission in a German hospital, experts from the National Reference Centers for Invasive Fungal Infections (NRZMyk) and the National Reference Center for Surveillance of Nosocomial Infections screened available literature and integrated available knowledge on infection prevention and C.auris epidemiology and biology to enable optimal containment. Relevant recommendations developed during this process are summarised in this guidance document, intended to assist in management of C.auris transmission and potential outbreak situations. Rapid and effective measures to contain C.auris spread require a multi-disciplinary approach that includes clinical specialists of the affected unit, nursing staff, hospital hygiene, diagnostic microbiology, cleaning staff, hospital management and experts in diagnostic mycology / fungal infections. Action should be initiated in a step-wise process and relevant interventions differ between management of singular C.auris colonised / infected patients and detection of potential C.auris transmission or nosocomial outbreaks.

No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020

BackgroundThe COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019.MethodsWe utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019–2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models.ResultsThe number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed.ConclusionsThe lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.

Epidemiological surveillance of surgical site infections in large joint replacement

Joint replacement is a reliable and effective surgery that allows profound pain relief and restores joint function in patients. Despite the progress made and the experience gained in joint replacement, surgical site infection is one of the leading postoperative complications. It can proceed as a periprosthetic joint infection, osteomyelitis, sepsis and lead to disabled or dead outcomes. Systematization of risk factors for infectious complications plays an important role as an element of epidemiological surveillance system optimization. Age, the presence of concomitant diseases (for example, diabetes mellitus, cancer, arthritis and systemic collagenosis), carriage of antimicrobial-resistant microorganisms, infectious and inflammation both outside and in the area of surgery, and external factors (surgery duration, correct antibiotic prophylaxis and surgeon's experience) are the most significant risk factors for periprosthetic joint infection. In world practice, the National Nosocomial Infections Surveillance System surgical site infection risk index is used. This criterion does not consider all potential risk factors. It is important to analyze and rank the identified risk factors according to the impact on the development of infectious complications in organizing an epidemiological surveillance system process in a medical organization. Risk factors analysis will identify the most significant modifiable factors for the development, implementation and execution of organizational, preventive measures and epidemic control. The creation and implementation of a standardized preoperative protocol based on a risk factors assessment will allow predicting the surgery outcome and arguing the strategy and tactic of preventive measures.

Hand washing in operating room: a procedural comparison

&#x0D; BACKGROUND Hand washing has been considered a measure of personal hygiene for centuries and it is known that an improper hand hygiene by healthcare workers is responsible for about 40% of nosocomial infections. Therefore, surgical hand preparation is a critical element for healthcare safety in order to reduce microbial contamination of surgical wound in case of non detected break of the gloves. The aim of our study is to evaluate the efficacy three antiseptics: Povi-iodine scrub; EPG (Ethanol, Hydrogen Peroxide, Glycerol, recommended by WHO), and common marseille soap type in a liquid formulation.&#x0D; METHODS It was designed a randomized, double-blind, single-center study conducted in the University Hospital of Messina, from January to June 2013. We asked operators to put the fingertips of their right hand (if not left-handed) for one minute on the PCA medium, before washing with the three types of antiseptics, and after washing and drying. Drying was made using sterile gauzes or disposable wipes. Then, we measured the number of colony forming units per mL (CFU/mL) and calculated the percentage of microbial load reduction.&#x0D; RESULTS 211 samples have been considered for statistical analysis: in 42 samples, in fact, initial microbial load was lower than after washing. Washing with EPG reduced CFU/ml from a mean of 38,9 to 4,1 (86,5% reduction), washing with povi-iodine scrub from 59,55 to 12,9 (75,9% reduction) and washing with Marseille soap from 47,26 to 12,7 (64,3% reduction).&#x0D; CONCLUSIONS Our study shows that washing with EPG has superior efficacy in CFU reduction. Antiseptic hand washing, however, cannot be considered the only measure to reduce infections: the anomaly of some results (initial microbial load lower than after washing) demonstrates that drying is an essential phase in the presurgical preparation. Therefore, hand hygiene must be part of a more complex strategy of surveillance and control of nosocomial infections&#x0D;

Vancomycin-resistant Enterococcus sequence type 1478 spread across hospitals participating in the Canadian Nosocomial Infection Surveillance Program from 2013 to 2018.

To analyze the spread of a novel sequence type (ST1478) of vancomycin-resistant Enterococcus faecium across Canadian hospitals. Retrospective chart review of patients identified as having ST1478 VRE bloodstream infection. Canadian hospitals that participate in the Canadian Nosocomial Infection Surveillance Program (CNISP). From 2013 to 2018, VRE bloodstream isolates collected from participating CNISP hospitals were sent to the National Microbiology Laboratory (NML). ST1478 isolates were identified using multilocus sequence typing, and whole-genome sequencing was performed. Patient characteristics and location data were collected for patients with ST1478 bloodstream infection (BSI). The sequence and patient location information were used to generate clusters of infections and assess for intrahospital and interhospital spread. ST1478 VRE BSI occurred predominantly in a small number of hospitals in central and western Canada. Within these hospitals, infections were clustered on certain wards, and isolates often had <20 single-nucleotide variants (SNV) differences from one another, suggesting a large component of intrahospital spread. Furthermore, some patients with bloodstream infections were identified as moving from one hospital to another, potentially having led to interhospital spread. Genomic analysis of all isolates revealed close relatedness between isolates at multiple different hospitals (<20 SNV) not predicted from our epidemiologic data. Both intrahospital and regional interhospital spread have contributed to the emergence of VRE ST1478 infections across Canada. Whole-genome sequencing provides evidence of spread that might be missed with epidemiologic investigation alone.

Antimicrobial use in Canadian acute-care hospitals: Findings from three national point-prevalence surveys between 2002 and 2017.

The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use. Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%. In each survey, 28-47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%-37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%-41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%-40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60). The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.

Monitoring Multidrug-Resistant Acinetobacter baumannii Infections in the Neurosurgery ICU Using a Real-Time Surveillance System.

Multidrug-resistant Acinetobacter baumannii (MDR-AB) infections are becoming increasingly common. The Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was used to monitor MDR-AB NI in intensive care units (ICUs) to prevent NI outbreaks. Therefore, the RT-NISS was used in the current study to monitor MDR-AB infections in a neurosurgery ICU. Clinical interventions, including recommended antibiotics, bacterial distribution in the patient analysis, and bed adjustments, were carried out based on the monitoring results. The RT-NISS was also used to monitor clinical data, implement, and provide training on NI control. The RT-NISS detected a potential cluster of XDR-AB when five patients admitted to the neurosurgery ICU were tested positive for AB between 11 and 17 June 2019. Only two infected cases originated in the hospital, and there was no NI outbreak. The hospital Infection Control Department took appropriate measures to prevent cross-infection; specifically, an epidemiologic investigation and environmental assessment were conducted, and NI prevention and outbreak management training was provided. In summary, the RT-NISS enhanced the timeliness and efficacy of NI control and surveillance in a neurosurgery ICU. In order to prevent NI outbreaks, the Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was employed to monitor MDR-AB NI in critical care units (ICU). Based on the monitoring data, clinical actions such as required antibiotics, bacterial distribution in the patient analysis, and bed changes were carried out. In a neurosurgery ICU, the RT-NISS improved the timeliness and efficacy of NI control and surveillance.

Inadequate Timing Limits the Benefit of Antenatal Corticosteroids on Neonatal Outcome: Retrospective Analysis of a High-Risk Cohort of Preterm Infants in a Tertiary Center in Germany.

Introduction A common problem in the treatment of threatened preterm birth is the timing and the unrestricted use of antenatal corticosteroids (ACS). This study was performed to evaluate the independent effects of the distinct timing of antenatal corticosteroids on neonatal outcome parameters in a cohort of very low (VLBW; 1000 – 1500 g) and extreme low birth weight infants (ELBW; < 1000 g). We hypothesize that a prolonged ACS-to-delivery interval leads to an increase in respiratory complications. Materials and Methods Main data source was the prospectively collected single center data for the German nosocomial infection surveillance system (KISS) between 2015 and 2018. Multivariate regression analysis was performed to determine independent effects of the ACS-to-delivery interval on the need for ventilation, surfactant or the occurrence of bronchopulmonary dysplasia, neonatal sepsis or necrotizing enterocolitis. Subgroup analysis was performed for ELBW and VLBW neonates. Results A total of 239 neonates were included. We demonstrate a significantly increased risk of respiratory distress characterized by the need for ventilation (OR 1.045; CI 1.011 – 1.080) and surfactant administration (OR 1.050, CI 1.018 – 1.083) depending on the ACS-to-delivery interval irrespective of other confounders. Every additional day between ACS and delivery increased the risk for ventilation by 4.5% and for surfactant administration by 5%. Subgroup analysis revealed significant differences of respiratory complications in VLBW infants. Conclusions Our data strongly support the deliberate use and timing of antenatal corticosteroids in pregnancies with threatened preterm birth versus a liberal strategy. When given more than 7 days before birth, each day between application and delivery increases is relevant concerning major effects on the infant. Especially VLBW preterm neonates benefit from optimal timing.

Surveillance of multi-drug resistance phenotypes in Staphylococcus aureus in Japan and correlation with whole-genome sequence findings

Antimicrobial resistance in Staphylococcus aureus imposes a high disease burden. Both phenotypic and genotypic monitoring are key to understanding and containing emerging resistant strains. Phenotypic monitoring of emerging resistance in S.aureus and correlation of priority strain phenotypes with whole-genome sequencing (WGS) findings. Antimicrobial susceptibility test results of >40,000 isolates from 213 participating hospitals from 2011 to 2019 were exported from the national Japan Nosocomial Infections Surveillance (JANIS) database. Longitudinal and geographic distribution and prevalence of distinct multi-drug resistance phenotypes ('resistance profiles') of S.aureus were examined among hospitals and prefectures. We further conducted a genome sequence analysis of strains with specific resistance profiles of concern. The overall prevalence of meticillin-resistant S.aureus (MRSA) decreased from 40.3% to 35.1% from 2011 to 2019. However, among dozens of S.aureus resistance profiles, only one profile of a type of MRSA, exhibited a statistically significant increase in inpatient frequency, exceeding 10% during the nine years. This MRSA profile showed resistance to oxacillin, erythromycin and levofloxacin. Analysis of WGS results of S.aureus isolates with this phenotype revealed that most belonged to clonal complex 8, and all carried SCCmec IV, typical of community-acquired MRSA. Tracking distinct resistance profiles deepened our understanding of the overall decrease in MRSA and led to recognition of the emergence of a new resistance phenotype. This study provides a model for future epidemiological research on antimicrobial resistance correlating multi-drug resistance phenotypes with selective genome sequencing, which can be applied to other bacterial species.

Risk factors for nosocomial infection of carbapenem-resistant Klebsiella pneumoniae in children: a single-center matched case-case-control study

To identify risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and death in hospitalized children in pediatric hospitals, and to provide a basis for the prevention and control of such infection. This is a matched case-case-control study. The medical data of 81 children with CRKP infection and 81 children with carbapenem-sensitive Klebsiella pneumoniae (CSKP) infection who were hospitalized in Kunming Children's Hospital from January 2019 to October 2021 were retrospectively analyzed. A total of 162 children without CRKP or CSKP infection were enrolled as the control group. The association of underlying disease, previous hospitalization exposure, and current hospitalization exposure with CRKP infection and death was identified. Compared with the control group, there was a higher correlation between the history of hospitalization in the past 3 months and CRKP and CSKP infections (OR=14.25 and 10.07 respectively, P<0.01). The use of carbapenem in the past 3 months (OR=16.54, P<0.01) and central venous catheterization during the current hospitalization (OR=33.03, P<0.01) were risk factors for CRKP infection. The use of carbapenem in the past 3 months (OR=28.33, P<0.01) and empirical antibiotic use during the current hospitalization (OR=14.5, P<0.01) were risk factors for death of the children with CRKP infection. The history of hospitalization and the history of treatment with carbapenems in the past 3 months and invasive procedure after admission are leading influencing factors for CRKP infection and prognosis. It is necessary for pediatric hospitals to conduct CRKP screening on admission, standardize antibiotic use, and strengthen nosocomial infection surveillance, so as to decrease the incidence of CRKP infection.

Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018

SummaryIntroductionSurveillance of health care-associated infections (HAIs) is an essential part of an efficient healthcare system. This study is an update on incidence and mortality rates of HAIs in Iran in 2018.MethodsAlmost all hospitals across the country (940 hospitals) entered the data of HAIs and denominators to the Iranian Nosocomial Infections Surveillance (INIS) software. Statistics were derived from INIS.ResultsFrom 9,607,213 hospitalized patients, 127,953 suffered from HAI, 15.65% of whom died. The incidence rate of HAI was calculated as 4.2 per 1000 patient-days. Considering relative frequencies among HAIs, Pneumonia (29.1%) and UTIs (25.6%) were the most common types of infection. Ventilator-associated pneumonia (VAP) was the most frequent device-associated infection (DAI) 25.66 per 1000 ventilator-days, and had the highest mortality rate (43.08%). Incidence density of other DAIs was 5.43 for catheter-associated UTI and 2.86 for catheter-associated BSI per 1000 device-days. Medical ICUs had the highest incidence and percentage of deaths (15.35% and 37.63%, respectively). The most causative organisms were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumonia. The rate of methicillin-resistance Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria was about 49%, 57%, and 58% respectively.ConclusionThis study provided an overview of HAIs in Iran and indicated that HAIs required special attention both in detection/reporting and in infection control measures. Future studies could be done on adherence rate of DAIs’ preventive bundles, interventions via multimodal strategies, evaluating the effect of training, and effect of antibiotic stewardship programs.

Integrated surveillance of antimicrobial resistance and antimicrobial use: Evaluation of the status in Canada (2014\u20132019)

ObjectiveIntegrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada.Materials and methodsBased on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage.ResultsComponents that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program.ConclusionAction is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.

Prevalence and risk factors of nosocomial infections in different wards and seasons in two hospitals in northeastern Iran

The prevalence of nosocomial infections (NIs) is a significant health issue in developing countries, and the increased incidence rate of these infections results in longer hospital stays, more mental pressures, increased treatment costs, and higher antibiotic resistance. The present study aimed to evaluate the prevalence of NIs in two hospitals from 2011-2018. In total, 1123 patients with a history of NIs, as reported in the NIs surveillance systems of the hospitals, were included in the study. Data analysis was carried out by SPSS version 16 using Chi-square tests to evaluate the relationship between hospital wards, age, and gender. The prevalence of NIs was higher in the training hospital than in the social security hospital. Also, the prevalence of NIs decreased from 2011-2017 but has increased since 2018. The highest prevalence of NIs was related to E. coli (9.35%), with gram-negative bacteria having the highest frequency (36.2%). In addition, the most common location of NIs was the ICU (23.95%). In terms of the site of infection, postoperative infections had the highest prevalence (38.91%). The results were indicative of a significant relationship between mean age and various hospital wards. In addition, there was a significant relationship between the hospitalisation ward and gender. Meanwhile, no significant association was found between age and hospitalisation ward (P&lt;0.05). There is a need for periodic training for all hospital-based agents to reduce NIs, especially in wards where invasive measures are used for treatment.

Antibiotic Resistance Pattern of Bacteria Causing Hospital Acquired Infections in the New Mansoura General Hospital, Egypt

Abstract Background: This study aims to describe the antibiotic resistance pattern among patients with hospital acquired infections in Mansoura New General Hospital (MNGH), Egypt and to identify the multidrug resistant organisms. Methods: A descriptive study was carried out in different departments of MNGH. All the 272 microbiological samples (blood, urine, swabs and others) from 259 patients with hospital acquired infections during the study period were processed in the bacteriology laboratory on different culture media. Bacterial isolates were identified by Gram-stain, cultures on routine media (e.g Blood agar, MacConkey agar) and specific biochemical tests following standard procedures. Antibiotic susceptibility testing was performed using disk diffusion methods. Multidrug-resistant (MDR) was defined as isolate non-susceptible to at least one agent in more than three antimicrobial categories. Results: The prevalence of methicillin-resistant Staphylocoocus aureus spp. (S. aureus) (MRSA) was 55.8%, methicillin-resistant Coagulase-negative (CoNS) was 100%, and vancomycin-resistant Enterococcus spp. (VRE) was 20%. Carbapenem resistant E. coli was 8.2%. Cephalosporin resistant (CephRy-Klebsiella spp.) was 85%, and carbapenem resistant K. pneumoniae spp. was 21.6. MDR-P. aeruginosa was 43.6% and MDR A. baumannii spp. was 100%. Conclusion: There is a need to integrate testing bacteria for antibiotics sensitivity in all nosocomial infections surveillance system. Policies on the control of antibiotic usage have to be implemented to avoid the emergence of newer generations of resistant pathogens.

The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data

BackgroundMany factors contribute to the spreading of hospital-acquired infections (HAIs).ObjectiveThis study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method.MethodsIn this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs.ResultsThe mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected.ConclusionsThe results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

COMPLICATIONS POST-OPERATOIRES PRECOCES EN CHIRURGIE GENERALE AU CENTRE HOSPITALO-UNIVERSITAIRE BOCAR SIDI SALL (CHU BSS) DE KATI

Introduction: Postoperative complications (CPO) refer to all the incidents or accidents that can occur after any surgical intervention. Objectives: were to describe the epidemiological and therapeutic aspects of early postoperative complications. Methodology: This was a prospective, cross-sectional and descriptive study from January 1, 2018 to December 31, 2019 (2 years). Were included in this study patients aged 15 years or over, operated and hospitalized in the general surgery department, presenting complications within 30 postoperative days. Results: We collected 350 files of operated and hospitalized patients, among which 74 patients presented OOCs, ie 21.1%. The average age was 43.9 years old. The male sex represented 57%. The general condition according to WHO was grade I in 33.8% of cases. Hemoglobin levels were below normal in 37.8% of cases. Among the 74 cases of CPO, 56.8% were Altemeier class 3 and 4, 18.9% were ASA 3 and ASA 4, the mean duration of intervention was 125 min, 58.1% were National Nosocomial Infection Surveillance System (NNISS) score 2 and 3. Infectious complications were dominated by ISO in 31.1%. The most common germs were Escherichia coli in 46.7% of cases. Surgical treatment consisted of peritoneal lavage associated with drainage in 25 patients. According to the Clavien-Dindo classification, grade IIIa was the most represented in 36.5% of cases. The average length of hospital stay was 15 days. We recorded 15 cases of death. Conclusion: CPO are frequent in the general surgery department at the University Hospital of Kati, dominated by SSIs, despite new non-invasive surgical methods and progress in anesthesiaresuscitator. Compliance with aseptic and antisepsis measures, proper preparation of patients before surgery and rigorous monitoring of patients could reduce CPO. Keywords: postoperative complications, early, surgery, infection, peritonitis, Mali, Kati.

Nosocomial infections in an Iranian educational hospital: an evaluation study of the Iranian nosocomial infection surveillance system

BackgroundNosocomial infection (NI) or cross-infection is a major health problem in hospitals worldwide.AimThis study aimed to report the status of NIs and to evaluate the Iranian nosocomial infection surveillance system (INISS) in a teaching hospital in the south of Iran.MethodsThis is a comparative historical study on the records of hospital admitted patients from 2018 to 2019. Data on patients who were diagnosed with NI was extracted from the INISS database. The database includes data on the incidence of different types of NIs in each hospital ward, the patient’s infection outcome, the agents involved, and the site of infection.ResultsThe results indicated that the rate of NI (cases of NI/ 100 admissions) in the hospital was %2.95. The highest rate of NIs was reported from ICUs. Of the infected patients, 45.61% were female, 98.95% had underlying diseases, and 30.88% died due to nosocomial infections. The median (IQR) of the duration of hospital stay among infected patients was 13 (7–18). The most common site of infection was VAE (ventilator-associated events) (39.40%) and the most common isolated agent, irrespective of the organ involved, was Acinetobacter (spp.) (22.75%).ConclusionsWe reported ICU and Acinetobacter (spp.) as the most affected ward and most common agent involved in recorded NIs respectively. The rate of NI in the study hospital was exceptionally low when compared to its counterparts in a few other developed countries. The INISS needs to be further evaluated with regard to the completeness and representativeness of the surveillance system. Also, we need to evaluate the adherence to the INISS guidelines among staff and physicians in reporting the NIs.

Incidence, Risk Factors, and Mortality From Hospital-Acquired Infections at a Hospital in Mauritius.

IntroductionHospital-acquired infections can be associated with an increase in morbidity, length of stay, and cost. Data on this topic are very limited in Mauritius. This study seeks to identify (a) the most prevalent hospital-acquired infection locally, (b) the risk factors for acquiring nosocomial infections, and (c) the mortality rate linked to such infections.MethodsThis is an observational study that was conducted at a 600-bed hospital in Mauritius by going through the folders of 109 patients who were admitted in different wards. Cox regression was used to carry out the survival analysis.ResultsOver the past 25 years, the incidence of hospital-acquired infections has increased by two to three times in Mauritius to reach a value of 18 per 100 admitted patients. The most commonly identified nosocomial infection was ventilator-associated pneumonia. The presence of foreign devices increased the risk of acquiring nosocomial infections. The mortality rate from such infections was almost four times higher compared to the mortality rate from patients who did not suffer from these infections; however, after adjustment for potential confounders, this was not statistically significant. The incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was high at 46 per 1,000 ventilator-days and 25 per 1,000 central line days, respectively.ConclusionInfection prevention and control measures should be implemented to curtail the rise of hospital-acquired infections in Mauritius. Such measures should include the use of bundles of care. In addition, periodic surveillance of nosocomial infections needs to be encouraged.

Spectrum of all microorganism isolated from surgical site infection and their antimicrobial susceptibility profile

Surgical site infection are the most common nosocomial infection accounting for 14% healthcare associated infection and are estimated to double the post-operative stay and significantly increase the cost of care. Surgical site infection has been considered as the third regularly occurring infection according to national nosocomial infection surveillance system.To determine the bacterial agents causing surgical site infection and antimicrobial susceptibility pattern of isolated microorganisms.: Isolate and identify pathogens of surgical site infection. To determine antimicrobial resistance and sensitivity pattern of isolated wound microbes. To determine the frequency of pathogens of surgical site infection.: Samples were cultured on Blood agar and MacConkey agar then incubated at 37 C for 24 hours. Any growth for further confirmed by Gram stain and appropriate biochemical tests, and then Antibiotic sensitivity test was done.: In this study 106 (61.7) were of male and 66 (38.3) were of female total 172 were examined. In our study total 172 patients included in which 142 pathogenic organism were isolated. The most common pathogenic organism found to be 44 isolates (30.99%) followed by 41 isolates (28.87%) 23 isolates (16.20%), 18 isolates (12.68%), 9 isolates (6.34%), 5 isolates (3.52%), 1 isolate (0.70%) and 1 isolate (0.70%). Antimicrobial resistance always pose challenges for clinician for treating wound infection the present study guide clinician about common pathogens and countered in pus sample furthermore it help the clinician to select and treat patients with proper antibiotics and decreased mortality and morbidity.