Point Prevalence Survey Research Articles

Management of Bacterial and Fungal Infections in the ICU: Diagnosis, Treatment, and Prevention Recommendations.

Bacterial and fungal infections are common issues for patients in the intensive care unit (ICU). Large, multinational point prevalence surveys have identified that up to 50% of ICU patients have a diagnosis of bacterial or fungal infection at any one time. Infection in the ICU is associated with its own challenges. Causative organisms often harbour intrinsic and acquired mechanisms of drug-resistance, making empiric and targeted antimicrobial selection challenging. Infection in the ICU is associated with worse clinical outcomes for patients. We review the epidemiology of bacterial and fungal infection in the ICU. We discuss risk factors for acquisition, approaches to diagnosis and management, and common strategies for the prevention of infection.

Recognizing Local Champions in Infection Prevention and Control.

Recognizing Local Champions in Infection Prevention and Control.

Point Prevalence Survey of Antimicrobial Prescription and Indicators in a Tertiary Healthcare Center in Southern Nigeria

Background: Antimicrobial stewardship programmes are interventions which have been developed to address irrational and inappropriate use particularly in health care centers. Antimicrobial stewardship programmes involve a set of activities which promote appropriate use of antimicrobials in terms of selection, dosing, route and duration of antimicrobial therapy.
 Methods: A Point-prevalence survey (PPS) was organized in line with Global point prevalence patient-based protocol for PPS and antimicrobial use was carried out in the paediatrics department of a tertiary healthcare institution in southern Nigeria. A total of 66 inpatients on admission for at least 24hours and still on admission at 8am on the day of the survey were included in the study.
 Results: The results show that 34 (51.50%) patients were on at least one antimicrobial drug and this included 19 (55.80%) males and 15 (44.20%) females. The highest proportion (n=15; 44%) of these patients were admitted in the children emergency ward while the least number (n=5; 14.7%) were found in children medical ward 1. The average age of patients on antimicrobials was 53 months. Thirty-four (51.50%) patients were on at least one antimicrobial drug and this included 19 (55.8%) males and 15 (44.2%) females. The three most prescribed antimicrobials were, ceftriaxone (23.88%), aminoglycoside gentamicin (20.90%), cefuroxime (16.42%) and Ceftazidime was the least common antibiotic prescribed (1.49%). Only 10.45 % were targeted therapy (based on microbiological results) while there was missing information for 10.45% of prescriptions.
 Conclusion: The findings of the study shows that it is important to initiate antimicrobial stewardship programmes within our hospital to optimize antimicrobial use to improve patient care in the hospital.

Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications.

Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.

Point prevalence survey of healthcare associated infections in acute-care hospitals: a validation study in Italy, 2022

Point prevalence survey of healthcare associated infections in acute-care hospitals: a validation study in Italy, 2022

A point prevalence survey on healthcare-associated infections in an acute care hospital in central Italy: preliminary results

A point prevalence survey on healthcare-associated infections in an acute care hospital in central Italy: preliminary results

Prevalence of antimicrobial use and healthcare-associated infections in China: Results from the first point prevalence survey in 18 hospitals in Shanxi Province

Inappropriate antimicrobial use (AMU) and healthcare-associated infections (HAIs) are important drivers of antimicrobial resistance, but data from the developing world are scarce. We conducted the first point prevalence survey (PPS) to determine the prevalence of AMU and HAIs and the suggested targeted interventions for appropriate AMU and HAI prevention in Shanxi Province, China. A multicentre PPS was performed in 18 hospitals in Shanxi. Detailed data on AMU and HAI were collected using the Global-PPS method developed by the University of Antwerp and the methodology developed by the European Centre for Disease Prevention and Control, respectively. There were 2171 (28.2%) of the 7707 inpatients receiving at least one antimicrobial. The most commonly prescribed antimicrobials were levofloxacin (11.9%), ceftazidime (11.2%), and cefoperazone and beta-lactamase inhibitor (10.3%). Out of the total indications, 89.2% of antibiotics were prescribed for therapeutic, 8.0% for prophylaxis, and 2.8% for either unknown or other. Of the total surgical prophylaxis, 96.0% of antibiotics were given for more than one day. In general, antimicrobials were given mainly parenterally (95.4%) and empirically (83.3%). A total of 264 active HAIs were identified in 239 patients (3.1%), of which 139 (52.3%) were culture positive. The most common HAI was pneumonia (41.3%). This survey indicated the relatively low prevalence of AMU and HAIs in Shanxi Province. However, this study has also highlighted several priority areas and targets for quality improvement, and repeated PPSs in the future will be useful to gauge progress at controlling AMU and HAIs.

Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report.

The purpose of this study is to implement point prevalence survey (PPS), assess antimicrobial prescribing and resistance in general hospitals and clinical specialties in China, and compare them with similar data from other parts of the world. Twenty general hospitals in China were surveyed in October or November, 2019. A standardized surveillance protocol was used to collect data on patient demographics, diagnosis of infection, the prevalence and intensity of antimicrobial use, prescribing quality, bacterium type and resistance spectrum, and the prevalence and type of healthcare-associated infections (HAIs). Overall, 10,881 beds and 10,209 inpatients were investigated. The overall prevalence of antibiotic use was 37.00%, the use of antibiotic prophylaxis in surgical patients was high (74.97%). The intensity of antimicrobial use was 61.25 DDDs/100 patient days. Only 11.62% of antimicrobial prescriptions recorded the reason for prescribing. Intravenous or combination treatments comprised 92.02% and 38.07%, respectively, and only 30.65% of prescriptions referred to a microbiological or biomarker tests. The incidence of HAIs in all patients was 3.79%. The main associated factors for HAIs included more frequent invasive procedures (27.34%), longer hospital stay (> 1-week stay accounting for 51.47%), and low use of alcohol hand rubs (only 29.79% placed it bedside). Most of the resistant bacteria declined; only carbapenem-resistant Enterobacter is higher than previously reported. The prevalence of antibiotic use in general hospitals fell significantly, the overall bacterial resistance declined, and the incidence of HAI was low. However, the low quality of antimicrobial use requires urgent attention.

Point Prevalence Survey on Antibiotic Use and Class-1 Integron Associated Antibiotic Resistance In No (1) DSGH, Yangon

Point Prevalence Survey on Antibiotic Use and Class-1 Integron Associated Antibiotic Resistance In No (1) DSGH, Yangon

Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020.

Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation. A case was defined as polymerase chain reaction detection of blaVIM in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS). In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring blaVIM-1 and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions. A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients.

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications.

The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.

Hospital-Based Antibiotic Therapy in Benin: A Point Prevalence Survey at the Departmental and Teaching Hospital of Borgou-Alibori in 2022

Hospital-Based Antibiotic Therapy in Benin: A Point Prevalence Survey at the Departmental and Teaching Hospital of Borgou-Alibori in 2022

A Point Prevalence Survey of Antibiotic Prescribing in three Nigerian public children’s hospitals.

Background: Antibiotic resistance continues to impact public health globally hence the need to monitor antibiotic use in hospitals and  in children in order to identify gaps in prescribing practices for possible intervention. This study investigated the prevalence and  characteristics of antibiotic prescribing in three government hospitals in Lagos Nigeria in November/December 2015 using the Global point prevalence survey of antimicrobial consumption and resistance (G-PPS) as a tool. Data were analysed using the Statistical  Package for Social Sciences (SPSS) software version 22. Results: Of the 207 inpatients, 180 (87%) were prescribed at least one antibiotic  during the survey period. Furthermore, 81% and 89.3% of neonates and paediatric patients respectively were on antibiotics. The most  commonly prescribed antibiotic class for neonates were the aminoglycosides (38.1%) and the third- generation cephalosporins (31%).  In paediatric patients, the third-generation cephalosporins were the most prescribed (26.2%). Most common diagnosis in neonates  was sepsis (38.3%) while lower respiratory tract infections (25.7%) were most occurring in paediatric patients. Community acquired  infections were the most common indications for prescribing accounting for 48.8% and 56.6% of neonatal and paediatric prescriptions  respectively. Overall, parenteral antibiotic accounted for 96.4% and 80.5% of antibiotics prescribed for neonates and paediatric  patients. Targeted antibiotic prescribing was observed in 8.3% and 5.8% of neonatal and paediatric prescriptions. Furthermore, biomarker was used to guide prescribing in only 1.2 % of neonatal prescriptions. Antibiotic stop /review dates were documented in  11.9% and 12.5% of neonatal and paediatric prescriptions. Conclusion: A high prevalence of antibiotic prescribing was observed in the  surveyed children's hospitals. The high use of third generation cephalosporins, the predominant use of parenteral antibiotic  formulations and the low documentation of stop review dates were among the identified areas for improving prescribing practices at  these hospitals. The identified gaps can form the basis for implementing Antibiotic Stewardship Interventions in the hospitals of study.   &nbsp

Point Prevalence Survey and Patterns of Antibiotic Use at Kirinyaga County Hospitals, Kenya

Background: Antibiotics are useful in treating and managing infections in outpatient and inpatient care settings. However, irrational antibiotic use can lead to improper patient care, antimicrobial resistance, wastage of resources and sometimes even death. The pattern of antibiotic use varies from one medical practitioner to another, infection, patient, wards, country and region. The study was a conducted as a baseline to describe the prevalence and patterns of antibiotic use in Kirinyaga County hospitals. Methodology: The study was a point prevalence survey of antibiotics use among patients admitted to four hospitals in Kirinyaga county and the study utilised the World Health Organization methodology for point prevalence survey of antibiotics in hospitals. Data were abstracted from patients’ files of patients who consented using a pretested tool. The data was exported to MS Excel for cleaning and analysed descriptively Results: The prevalence of antibiotic use in the four hospitals in Kirinyaga county was 44.0% (95%CI 38.6-49.5%). Penicillins were the most prescribed antibiotic class at 29.1%, followed by cephalosporins at 23.0%. Ceftriaxone and metronidazole were the highest prescribed at 22.0% and 19.8%, respectively. Antibiotics were mainly prescribed for community-acquired infections at 58.2%, followed by surgical prophylaxis at 26.0%. Most patients (52.5%) received two antibiotics, predominantly benzylpenicillin and gentamicin, at 40.3%. The majority, 63.0%, of all antibiotics were administered parenterally. There was poor documentation of the administration of medicines on the treatment sheet. Conclusion: There was a relatively high prevalence of antibiotic use, all prescribed empirically. Community acquired infections were the most common indication for antibiotics. There was extensive use World Health Organization “watch” category of antibiotics without microbiological tests. There is a need for antibiotic stewardship program to ensure judicial use of antibiotics.

Gaps in data collection for sex and gender must be addressed in point prevalence surveys on antibiotic use

OPINION article Front. Antibiot., 17 March 2023Sec. Antibiotic Resistance Volume 2 - 2023 | https://doi.org/10.3389/frabi.2023.1154506

Antibiotics Use in a Tertiary Care Hospital Using Point Prevalence Survey Method.

Point prevalence survey on antibiotic use developed by WHO are already in use in acute care hospitals around the world. The aim of this study was to collect prescribing of antibiotics using Point prevalence survey method in KIST Medical College and Teaching Hospital. This was a cross sectional descriptive study and data collection was completed within 8 working days in the study site. The study was conducted among inpatients admitted at or before 8:00AM on the day of survey in various wards. Patient sampling was done as per the Point Prevalence Survey methodology. Data analysis was done and presented as frequencies and percentages. Out of 32 patients, maximum patients were of age group 20-30 years and 19 (59%) patients were females. Most patients, 8 (32%) were from the surgery ward. There were patients from 8 different wards including a patient who had renal transplant. Blood, sputum, urine and CSF culture were done in 11 patients, only 2 urine cultures were positive. At least one antibiotic was used among 18 patients. Ceftriaxone (34.4%) was maximally used followed by levofloxacin (3%). One or two antibiotics were used in prophylaxis with a duration of one to five days. WHO Point prevalence survey methodology has been used in this study. Ceftriaxone was the most commonly used antibiotics. Parenteral administration was the commonest method of administration. At least one antibiotic was used among 18 patients. There is presence of a functioning Drugs and Therapeutics Committee, Infection Prevention and Control Committee and committee on pharmacovigilance. However, many indicators for hospital infrastructure, policy and practice and monitoring and feedback were not present.

Hospital-acquired infections and antibiotic use in a geriatric hospital: a point prevalence study

Background: Healthcare-Associated Infections (HAIs) are the most common healthcare-associated complications, particularly in elderly patients. The aim of this study is to describe the prevalence of HAIs and associated risk factors in the IRCCS INRCA of Ancona. Methods: A cross-sectional study has been carried out. Data has been collected in accordance with the European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey 2022-2023 (PPS3) protocol in the IRCCS INRCA of Ancona in November 2022. Results: Out of the 128 patients included in our study, 75.0% were over 78 years old and 9.1% presented an active HAI on the day of the survey. The prevalence of HAIs varied based on the length of the hospital stay (OR 1.1, CI 95% 1.05 - 1.17, p < 0.001) and hospitalization > 7 days (OR 5.9, CI 95% 1.2 - 28.7, p = 0.02). Conclusion: It is clear from our findings that HAIs are associated with advanced patient age, prolonged hospital stay, and use of medical devices, especially in those patients that, due to their clinical situation, are more vulnerable. Although some of these infections can easily be treated, it is important to develop effective infection control strategies thanks to antimicrobial stewardship programs.

Establishing an Antimicrobial Stewardship Program in Sierra Leone: A Report of the Experience of a Low-Income Country in West Africa

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone's national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic.

High-Molecular-Weight Plasmids Carrying Carbapenemase Genes blaNDM-1, blaKPC-2, and blaOXA-48 Coexisting in Clinical Klebsiella pneumoniae Strains of ST39

Klebsiella pneumoniae, a member of the ESKAPE group of bacterial pathogens, has developed multi-antimicrobial resistance (AMR), including resistance to carbapenems, which has increased alarmingly due to the acquisition of carbapenemase genes located on specific plasmids. Four clinical K. pneumoniae isolates were collected from four patients of a neuro-intensive care unit in Moscow, Russia, during the point prevalence survey. The AMR phenotype was estimated using the Vitec-2 instrument, and whole genome sequencing (WGS) was done using Illumina and Nanopore technologies. All strains were resistant to beta-lactams, nitrofurans, fluoroquinolones, sulfonamides, aminoglycosides, and tetracyclines. WGS analysis revealed that all strains were closely related to K. pneumoniae ST39, capsular type K-23, with 99.99% chromosome identity. The novelty of the study is the description of the strains carrying simultaneously three large plasmids of the IncHI1B, IncC, and IncFIB groups carrying the carbapenemase genes of three types, blaOXA-48, blaNDM-1, and blaKPC-2, respectively. The first of them, highly identical in all strains, was a hybrid plasmid that combined two regions of the resistance genes (blaOXA-48 and blaTEM-1 + blaCTX-M-15 + blaOXA-1 + catB + qnrS1 + int1) and a region of the virulence genes (iucABCD, iutA, terC, and rmpA2::IS110). The spread of K. pneumoniae strains carrying multiple plasmids conferring resistance even to last-resort antibiotics is of great clinical concern.

Multicentre surveillance of epidemiologically important pathogens causing nosocomial bloodstream infections and pneumonia trials in Brazilian adult intensive care units.

Introduction. Healthcare-associated infections (HAIs) are the most recurrent adverse event in hospitals worldwide and represent an important public health problem.Gap statement. There are a paucity of multicentric data describing severe HAIs such as bloodstream infection (BSI) and pneumonia in Brazil.Aim. To provide an up-to-date picture of the extent and patterns of HAIs in adult intensive care units (ICUs), as well as to identify variables associated with the risk of development of severe infections.Methodology. Point prevalence surveys were conducted using standardized protocols in 35 ICUs from Minas Gerais state, Brazil. Medical records of eligible inpatients at or before 8 am on the survey day were reviewed to identify HAIs present at the time of the survey. A matched-pairs case-control study was performed on a total of 66 pairs for BSI and 115 pairs for pneumonia according to the selection criteria developed.Results. Overall, 171 patients (45.7%) had at least one HAI, with most (78.4%) acquired in the ICU. These patients presented a total of 240 infections; including 123 pneumonia (51.3%) and 66 BSI (27.5%), and 78.9 and 80.3 %, respectively, were acquired in the ICU. Their aetiology showed a predominance of Gram-negative bacteria versus Gram-positive bacteria (48.9 versus 43.3 %), with Acinetobacter baumannii (13.7%) and Pseudomonas aeruginosa (12.8%) being prominent. One striking observation from our data was the higher prevalence of Staphylococcus aureus (14.5%) and coagulase-negative staphylococci (10.2%) observed in the overall HAIs.Conclusion. A high severe ICU-acquired HAI burden was found when compared with findings from other low- and middle-income countries. These data can be utilized for better planning of nosocomial infection surveillance programmes in our hospitals.