Healthcare Risk Factors Research Articles

Organizational and infrastructural risk factors for health care–associated Clostridioides difficile infections or methicillin-resistant Staphylococcus aureus in hospitals

This study explores the infrastructural and organizational risk factors for healthcare-associated (HCA) Clostridioides difficile infections (CDIs) and methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. This is a retrospective observational study involving all eligible inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020 to September 16, 2021. The outcomes were the average HCA CDI or MRSA rates. Covariates included, but were not limited to, infection control factors (eg, hand hygiene rate), infrastructural factors (eg, unit age), and organizational factors (eg, hallway bed utilization). Multivariable regression was performed to identify statistically significant risk factors. Older units were associated with higher HCA CDI rates (adjusted relative risk [aRR]: 0.012; 95%confidence interval (CI) [0.004, 0.020]). Higher HCA MRSA rates were associated with decreased hand hygiene rate (aRR: -0.035; 95%CI [-0.063, -0.008]), higher MRSA bioburden (aRR: 9.008; 95%CI [5.586, 12.429]), increased utilization of hallway beds (aRR: 0.680; 95%CI [0.094, 1.267]), increased nursing overtime rate (aRR: 5.018; 95%CI [1.210, 8.826]), and not keeping the clean supply room door closed (aRR: -0.283; 95%CI [-0.536, -0.03]). The study confirmed the multifaceted nature of infection prevention and emphasized the importance of interdepartmental collaboration to improve patient safety.

Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors —Emerging infections program, United States, 2012-2015

BackgroundCarbapenem-resistant Enterobacterales (CRE) are usually healthcare-associated but are also emerging in the community. MethodsActive, population-based surveillance was conducted to identify case-patients with cultures positive for Enterobacterales not susceptible to a carbapenem (excluding ertapenem) and resistant to all third-generation cephalosporins tested at 8 US sites from January 2012 to December 2015. Medical records were used to classify cases as health care-associated, or as community-associated (CA) if a patient had no known health care risk factors and a culture was collected <3 days after hospital admission. Enterobacterales isolates from selected cases were submitted to CDC for whole genome sequencing. ResultsWe identified 1499 CRE cases in 1194 case-patients; 149 cases (10%) in 139 case-patients were CA. The incidence of CRE cases per 100,000 population was 2.96 (95% CI: 2.81, 3.11) overall and 0.29 (95% CI: 0.25, 0.35) for CA-CRE. Most CA-CRE cases were in White persons (73%), females (84%) and identified from urine cultures (98%). Among the 12 sequenced CA-CRE isolates, 5 (42%) harbored a carbapenemase gene. ConclusionsTen percent of CRE cases were CA; some isolates from CA-CRE cases harbored carbapenemase genes. Continued CRE surveillance in the community is critical to monitor emergence outside of traditional health care settings.

Distinguishing neighborhood and individual social risk factors in health care.

To investigate (a) the magnitude of the independent associations of neighborhood-level and person-level social risk factors (SRFs) with quality, (b) whether neighborhood-level SRF associations may be proxies for person-level SRF associations, and (c) how the association of person-level SRFs and quality varies by neighborhood-level SRFs. 2015-2016 Medicare Advantage HEDIS data, Medicare beneficiary administrative data, and 2016 American Community Survey (ACS). Mixed effects linear regression models (1) estimated overall inequities by neighborhood-level and person-level SRFs, (2) compared neighborhood-level associations to person-level associations, and (3) tested the interactions of person-level SRFs with corresponding neighborhood-level SRFs. Beneficiary-level SES and disability administrative data and five-year ACS neighborhood-level SRF information were each linked to HEDIS data. For all or nearly all HEDIS measures, quality was worse in neighborhoods lower in SES and in neighborhoods with higher proportions of residents with a disability. Quality by neighborhood racial and ethnic composition was mixed. Accounting for corresponding person-level SRFs reduced neighborhood SRF associations by 25% for disability, 43% for SES, and 74%-102% for racial and ethnic groups. Person-level SRF coefficients were not consistently reduced in models that added neighborhood-level SRFs. In 19 of 35 instances, there were significant (p < 0.05) interactions between neighborhood-level and corresponding person-level SRFs. Significant interactions were always positive for disability, SES, Black, and Hispanic, indicating more negative neighborhood effects for people with SRFs that did not match their neighborhood and more positive neighborhood effects for people with SRFs that matched their neighborhood. Relying solely on neighborhood-level SRF models that omit similar person-level SRFs overattributes inequities to neighborhood characteristics. Neighborhood-level characteristics account for much less variation in these measures' scores than similar person-level SRFs. Inequity-reduction programs may be most effective when targeting neighborhoods with a high proportion of people with a given SRF.

PCO-005 - Assessing risk factors for health care associated transmission of SARS-Cov-2 virus infection among health care personnel in a tertiary care hospital, Sri Lanka; a case-control study

PCO-005 - Assessing risk factors for health care associated transmission of SARS-Cov-2 virus infection among health care personnel in a tertiary care hospital, Sri Lanka; a case-control study

Early Life RSV: Can Vaccines Help Fix Societal Ills?

* Abbreviations: LRI — : lower respiratory infection RSV — : respiratory syncytial virus SDOH — : social determinants of health During this pandemic, the impact of health disparities on mortality due to COVID-19 has been high among our concerns about this illness.1–4 Unfortunately, disparities related to respiratory infections are not limited to COVID-19. There are decades of research revealing that morbidity and mortality are strongly influenced by the social determinants of health (SDOH). Respiratory syncytial virus (RSV) is the leading cause of lower respiratory infection (LRI) in infants and a major cause of hospitalization in the first 2 years of life.5–7 In this issue of Pediatrics , Fitzpatrick et al8 report on the impact of sociodemographic and psychosocial factors on the risk for RSV hospitalization in children <3 years of age in Ontario, Canada. The authors used linked sociodemographic and health administrative data sets covering the period from 2012 to 2018 to identify factors associated with hospitalization. Their findings reveal the increased risk of hospitalization associated with maternal characteristics consistent with social vulnerability, including younger age, involvement with the criminal justice system, and mental health problems or addiction. The use of low-income drug benefits, a measure of socioeconomic status, was also associated with RSV hospitalization, as was an area level measure of income showing an increased risk of hospitalization with the lowest two quartiles of income. In their study, Fitzpatrick et al8 reinforce the important, enduring, and widespread influence of SDOH on our youngest patients. These … Address correspondence to Mary T. Caserta, MD, Department of Pediatrics, University of Rochester Medical Center, Golisano Children’s Hospital at Strong, 601 Elmwood Ave, Box 690, Rochester, NY 14642. E-mail: mary_caserta{at}urmc.rochester.edu

In vitro comparison of colistin- versus tigecycline-based combinations against carbapenem resistant Acinetobacter baumannii intensive care unit clinical isolates

Background: Acinetobacter baumannii (A. baumannii) has emerged as a nosocomial pathogen especially in the intensive care units (ICUS). It’s enlisted at the top of urgent threat level organisms in CDC’s antibiotic resistance threats report. Objectives: To assess prevalence, risk factors of health care associated infection by A. baumannii, and to compare the in-vitro efficacy of colistin sulfate- tigecycline combinations versus their individual combination with levofloxacin and meropenem against carbapenem resistant A. baumannii clinical isolates from an Egyptian tertiary care hospital ICUs. Methodology: The study included 250 ICU patients, samples were collected according to the site of infection. A. baumannii was isolated, identified and tested for antibiotic susceptibility by disc diffusion. Broth microdilution method was used for assessment of colistin, Tigecycline, levofloxacin, and meropenem. Thirty isolates resistant to all carbapenems were tested by the checkerboard method to assess effect of antibiotic combinations. Results: forty-six A. baumannii were isolated, with highest prevalence in respiratory secretions. Prior antibiotic administration and failure of empirical antibiotic therapy were found to be a major risk factors of infections by A. baumannii. Colistin combination with meropenem showed the highest synergy (50%). Tigecycline-meropenem combination had the highest antagonistic effect (66.7%). Conclusion: No antagonistic effect of colistin combination with meropenem was confirmed in this study. Only colistin-based combinations, particularly those with meropenem may confer therapeutic benefits against carbapenem-resistant A. baumannii.

Survey of Neonates in Pomerania (SNiP): Study design and cohort update

The health status of newborns is a major concern for parents and medical personnel. Recent studies have provided increasing evidence that factors from the foetal and perinatal periods of life influence health later in life. The "Follow-up of the Survey of Neonates in Pomerania" (SNiP-I-Follow-up) is the first follow-up of the population-based birth cohort study, SNiP-I, established in north-east Germany. The primary aim of SNiP-I-Follow-up study was the collection of longitudinal data on children and adolescents. The associations will be analysed between risk factors in pregnancy and the perinatal period and health status in infancy and later childhood. The population-based cohort study SNiP-I was conducted in Pomerania in north-east Germany between February 2002 and November 2008. All mothers from the SNiP-I birth cohort were recontacted when their children were from 9 to 15years of age. The SNiP-I-Follow-up study was carried out between December 2016 and August 2017 and is a questionnaire-based survey. Physical development, health status, and social behaviour (school and leisure behaviour) of children were analysed using a questionnaire comprising medical, epidemiological, and socio-economic data, associated health care risk factors, and life circumstances of newborns, children, and their parents. Out of 5725 children invited to participate in the SNiP-I-Follow-up study between December 2016 and August 2017, 29% (n=1665) children participated in the SNiP-I-Follow-up study, providing data on 1665 mothers-child dyads. Responders had higher socio-economic status, especially in relation to maternal education status. As a longitudinal birth cohort from rural Germany, the SNiP cohort will be a resource to address urgent research needs and contribute to overall population health.

Risk factors of health care\u2013associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China

BackgroundThe elderly inpatients are in high risk of suffering health-care associated infection (HAI). The study aimed to analyze the risk factors of health-care associated infection (HAI) in elderly hospitalized patients to prevent it and improve the recovery rate of elderly patients.MethodsThe study was a Retrospective Cohort Study based on a 3-year surveillance in elderly inpatients in a large tertiary hospital in China. A retrospective review of the elderly inpatients ≥60 years with or without HAI were conducted. Binary multivariable logistic regression was used to evaluate the potential association between HAI and risk factors.ResultsWe investigated a total of 60,332 subjects aged 60 years old or above. The incidence of HAI in elderly was 2.62%. With adjustment for some factors, advanced age, hospital days before HAI, intensive care unit (ICU) admission, use of ventilator, central line catheter or urinary catheter and cerebral hemorrhage, cerebral infarction, brain neoplasms, diabetes mellitus, coronary artery disease, malignant tumor and malignant hematonosis had significantly increased odds ratios (OR) of suffering from HAI compared with the control group but body weight and operation decreased OR.ConclusionOur findings suggested that advanced age, accompanied by some neurological and chronic noncommunicable diseases, hospital days before HAI, ICU admission, and use of devices were risk factors of suffering HAI in the elderly but the body weight and operation were the potential protective factors in this sample.

Disparities in Health Care-Associated Infections in the NICU.

This study aimed to examine multilevel risk factors for health care-associated infection (HAI) among very low birth weight (VLBW) infants with a focus on race/ethnicity and its association with variation in infection across hospitals. This is a population-based cohort study of 20,692 VLBW infants born between 2011 and 2015 in the California Perinatal Quality Care Collaborative. Risk-adjusted infection rates varied widely across neonatal intensive care units (NICUs), ranging from 0 to 24.6% across 5 years. Although Hispanic infants had higher odds of HAI overall, race/ethnicity did not affect the variation in infection rates. Non-Hispanic black mothers were more likely to receive care in NICUs within the top tertile of infection risk. Yet, among NICUs in this tertile, infants across all races and ethnicities suffered similar high rates of infection. Hispanic infants had higher odds of infection. We found significant variation in infection across NICUs, even after accounting for factors usually associated with infection.

Prevalence and risk factors of health care–associated infections in a limited resources country: A cross-sectional study

The aim of this study was to determine the prevalence of health care-associated infections (HAI) in our university hospitals (UH) and to delineate the risk factors associated with HAI. We conducted a cross-sectional study in the 2 UH of Sfax, Tunisia on July 2017, including all patients hospitalized for at least 48 hours. It was a 1-day pass per department and a 1-week prevalence survey per UH. Of 752 patients eligible for the study, the total number of HAI was 82, representing an overall prevalence of HAI of 10.9%. Respiratory tract infections were the most prevalent HAI (36.6%). In multivariate analysis, intrinsic risk factors independently associated with HAI were immune-suppression (adjusted odds ratio (AOR) = 2.8; P < .001), diabetes (AOR = 2.2; P = .008), and malnutrition (AOR = 2.2; P = .019). Extrinsic risk factors were endotracheal intubation (AOR = 17; P = .01), transfer to another department (AOR = 9; P = .019), parental feeding (AOR = 7.2; P = .014), tobacco use (AOR = 6.3; P = .004), as well as surgical wound class contaminated or dirty (AOR = 6.3; P = .002), and peripheral venous catheter(AOR = 4.7; P = .006). Our study highlighted the magnitude of the HAI problem threatening the quality of care in Southern Tunisia. A wise identification of HAI risk factors may help health care workers to ascertain the avoidability of these infections.

A comparison of blood stream infections with extended spectrum beta-lactamase-producing and non-producing Klebsiella pneumoniae in pediatric patients

BackgroundRapid development and global spread of multidrug resistant Klebsiella pneumonia (K. pneumoniae) as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes.MethodsA retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality.ResultsAmong 111 K. pneumoniae isolates 62% (n = 69) were ESBL –producing K. pneumoniae. The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively (p = 0.001). Previous aminoglycoside use was higher in cases with ESBL –producing isolates (p = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p = 0.01).ConclusionESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI.

Risk factors for health care–associated infections: From better knowledge to better prevention

Health care-associated infections (HCAIs) are preventable with adoption of recognized preventive measures. The first step is to identify patients at higher risk of HCAI. This study aimed to identify patient risk factors (RFs) present on admission and acquired during inpatient stay which could be associated with higher risk of acquiring HCAI. A case-control study was conducted in adult patients admitted during 2011 who were hospitalized for >48 hours. Cases were patients with HCAIs. Controls were selected in a ratio of 3:1, case matched by the admission date. The likelihood of increased HCAI was determined through binary logistic regression. RFs identified as being the more relevant for HCAI were being a man (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7), being aged >50 years (OR, 2.9; 95% CI, 1.3-6.9), and having an insertion of a central venous line during hospital stay (OR, 12.4; 95% CI, 5.0-30.5). RFs that showed statistical significance on admission were the patient's intrinsic factors, and RFs acquired during hospitalization were extrinsic RFs. When a set of RFs were present, the presence of a central venous line proved to be the more relevant one.

Active commuting and cardiovascular risk among health care workers.

Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for health care workers. Active commuting such as walking or cycling may be a good way to promote physical activity. To investigate the relationship between active commuting and cardiovascular disease risk factors in health care workers. A cross-sectional study of health care workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders. Among 3204 participants, fewer than half engaged in active commuting. After adjustment for poss ible confounders, low active commuting was associated with increased risk of hypertension [adjusted odds ratio (aOR) 1.3, 95% confidence interval (CI) 1.1-1.7]. High active commuting was associated with central obesity (aOR 1.4, 95% CI 1.0-1.8). Compared with non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI 0.2-1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI 1.1-2.3) and central obesity (aOR 1.5, 95% CI 1.1-2.1). We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further.

HIV and Latino migrant workers in the USA

Migrant workers from Latin America are an essential source of economic development in the US agricultural industry. A majority of migrants are from Mexico and are undocumented and they represent a vulnerable and marginalized group in American society. There is a growing concern for HIV disease in the migrant community. The HIV prevalence rate among migrants is higher than the average rates in USA and in countries of Latin America. There are many behavioural, social, cultural, and health care risk factors and barriers that place migrants at increased risk for HIV infection. Many migrant workers contract HIV while working and living in the USA, which has contributed to rising HIV infection rates in Mexico. In order to prevent an increasing epidemic of HIV disease in Latino migrant workers, there is an urgent call for new and improved health care policies at the international, federal, state, and local levels.

Health care risk factors among women and personal behaviours among men explain the high prevalence of hepatitis C virus infection in Karachi, Pakistan

To estimate the prevalence and identify factors associated with hepatitis C virus (HCV) infection among men and women in Karachi, Pakistan. We conducted a cross-sectional study of adult men and women in a peri-urban community of Karachi (Jam Kandah). Households were selected through systematic sampling from within all villages in the study area. All available adults within each household were interviewed about potential HCV risk factors. A blood specimen was collected to test for anti-HCV antibodies by enzyme immunoassay. We used generalized estimating equations while accounting for correlation of responses within villages to identify the factors associated with HCV infection. Of 1997 participants, 476 (23.8%) were anti-HCV positive. Overall, HCV infection was significantly associated with increasing age, ethnicity, and having received > or =2 blood transfusions, > or =3 hospitalizations, dental treatment and >5 injections among women. Among women, > or =2 blood transfusions [adjusted odds ratio (aOR) = 2.32], >5 injections during the past 6 months (aORs = 1.47), dental treatment (aOR = 1.31) and increasing age(aOR = 1.49), while among men, extramarital sexual intercourse (aOR = 2.77), at least once a week shave from barber (aOR = 5.04), > or =3 hospitalizations (aOR = 2.50) and increasing age (aOR = 1.28) were associated with HCV infection. A very high prevalence of HCV was found in the study population. Among women, unsafe health care practices, while among men extramarital sex, shaving from a barber and hospitalizations were associated with HCV infection. Efforts are needed to improve the safety of medical procedures to reduce the transmission of HCV in Pakistan [Corrections made in Summary after initial online publication.].

Methicillin-Resistant Staphylococcus aureus Colonization in Children With Atopic Dermatitis

Suh L, Coffin S, Leckerman KH, Gelfand JM, Honig PJ, Yan AC. Pediatr Dermatol. 2008;25(5): 528–534PURPOSE OF THE STUDY. To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in children with atopic dermatitis (AD).STUDY POPULATION. Observational cross-sectional study of 54 children seen in the dermatology clinic at the Children's Hospital of Philadelphia in October and November 2004.METHODS. Eczema severity was determined with the Eczema Area and Severity Index. Culture swabs (BBL CultureSwab [Becton, Dickinson, Sparks, MD]) were used. All cultures were plated for up to 5 days for the growth of S aureus, and methicillin-sensitivity tests were performed on positive S aureus cultures. Patients’ families provided information on medical histories, medication use, and other identifying risk factors for health care–associated MRSA, by completing a detailed, self-administered questionnaire.RESULTS. Eighty percent of the patients (43 of 54 patients) were colonized with S aureus, and 16% (7 of 54 patients) were colonized with MRSA. MRSA was associated with previous hospitalization, with an odds ratio of 26.2 (95% confidence interval: 2.1–316.0), and the combination use of calcineurin inhibitors and topical corticosteroids. Other risk factors for MRSA (health care worker in household, oral antibiotic therapy, previous skin infections, and history of previous MRSA) were not identified. Eczema severity, defined by Eczema Area and Severity Index score, was not a risk factor for S aureus or MRSA.CONCLUSIONS. AD patients have a high rate of S aureus colonization and MRSA (16%) colonization, compared with the general public (1%–3%).REVIEWER COMMENTS. The prevalence of MRSA was low in the study of patients with AD, which suggests that standard S aureus antibiotics can be used for first-line therapy. The possibility of local variation of MRSA colonization is important to consider before using oral cephalosporin treatment. Eczema severity might be a risk factor for MRSA, because the use of combination therapy or previous hospitalization as a marker for severe disease is associated with MRSA colonization.

Commentary: Making risk factors more cost-effective predictors of disease

This commentary will apply Michael Marmot’s 1 call for theories that make more accurate predictions to risk factors, which provide the etiological model for most chronic diseases. The use of risk factor research in health care will be compared with that in the life insurance industry, which developed the concept. Two proposals will be made to improve the predictive accuracy and cost-effectiveness of risk factors in health care. Marmot uses theories of the causes of coronary heart disease to examine models of causation in epidemiology and public health. He shows that science does not proceed in a straightforward inductive chain from facts to causal hypotheses and theories. Nor can hypotheses be refuted by simply producing facts that contradict them. Consequently, he suggests that a useful theory is one that produces relationships which accurately predict health outcomes. Accurate predictions, however, should not be the only objective of health care models, especially since predictions tend to be less accurate in chronic diseases than in most infectious diseases. A problem of equal urgency is cost-effectiveness. Too much health research fails to incorporate cost-effectiveness in its design or analyses and consequently too much health care produces only a small amount of benefit for the societal expenditures involved. Cost-effectiveness is a key issue because of the steep increases in health care expenditures that have afflicted all advanced countries. In the USA, health care expenditures have reached one-sixth of the gross domestic product and are climbing steadily. Individual states spend up to one-quarter of their budgets on medical care for the poor. Increased public and private expenditures for health care have reduced the standard of living in many ways, including less spending for education, social welfare, income security, the environment, infrastructure and public safety.

The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices

The Study of the Risk Factors of Health Care - Associated Infections in Patients' Care with Invasive Devices Introduction. Health care-associated infections (HAIs) are a major threat to patient safety. The spread of HAIs cases in intensive care units (ICUs) and in surgical units is influenced by the severity of the patients' condition, as well as the number of invasive procedures and the environment of the units. The immune systems of critically ill patients are in a severe state which increases the probability of beneficial conditions for a colonisation by pathogenic microorganisms due to invasive procedures. Furthermore, the action of inserting an invasive device (urinary catheter, peripheral vein catheter) disrupts the natural defence mechanisms by itself. Aim of the study. To determine risk factors of HAIs during invasive procedures: peripheral vein catheter and urinary catheter insertion and care at the time. Materials and methods. The research was performed in the ICUs and in the surgical units of Latvia's regional multi-profile hospitals (n=3), using the quantitative research method: questionnaire (n=188), and qualitative research methods: clinically structured empiric research (n=45) and microbiological tests (n=86): a) with a Count-Tact applicator and a special culture medium, b) with a swab, and c) with catheter sedimentation method. Results. The study results showed that surgical nurses take care of 18 to 40 patients per day, while intensive care nurses take care of 2 to 3 patients per day. A common problem identified in ICUs and in surgical units related to the lack of unified nursing protocols on performing invasive procedures in all cases (100%; 45/45). Microbiological investigations showed a high level of bio-contamination during invasive procedures: the amount of microorganisms on the nurses' hands considerably exceeded the acceptable levels in all cases (100%; 4/4), and medium to high levels of bio-contamination were discovered on patient's changed bed sheets (100%; 2/2) as well as in nurses' hair (85.7%; 48/56) and their work wear (78.5%; 44/56). In 25% of the observed cases Staphylococcus aureus was discovered in the sterile zone of the peripheral vein catheter 72 hours and 96 hours after the catheter's insertion. 72 hours after the catheter's insertion, as well as 7 days after the insertion of a urinary catheter, 100% of the cases revealed the presence of at least one and in some cases several of the following pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli , β haemolytic Streptococcus and fungi, such as Candida albicans and Candida tropicalis. Conclusions. The main risk factors of HAIs in patients' care using invasive devices are: the lack of unified nursing protocols, aseptic and antiseptic mistakes and excessive workload, as well as a high level of bio-contamination in the ICUs and in surgical units.

Prediction of Infection Due to Antibiotic-Resistant Bacteria by Select Risk Factors for Health Care–Associated Pneumonia

Pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa now cause pneumonia in patients presenting to the hospital. The concept of health care-associated pneumonia (HCAP) attempts to capture this, but its predictive value is unclear. We examined patients admitted with pneumonia; infection with a resistant pathogen served as the study end point. Health care-associated pneumonia was present if a patient met one of the following criteria: recent hospitalization, nursing home residence, long-term hemodialysis, or immunosuppression. We compared rates of resistant infection among patients meeting any criteria for HCAP with those who did not have HCAP and explored the individual components of the definition. Among the cohort (n = 639), resistant pathogens were recovered in 289 (45.2%). Although each component of HCAP occurred more frequently in persons with resistant infections, the broad definition had a specificity of only 48.6% and misclassified one-third of the subjects. Logistic regression showed 4 variables associated with resistant pneumonia: recent hospitalization, nursing home residence, hemodialysis, and intensive care unit admission. A scoring system assigning 4, 3, 2, and 1 points, respectively, for each variable had moderate predictive power for segregating those with and without resistant bacteria. Among patients with fewer than 3 points, the prevalence of resistant pathogens was less than 20% compared with 55% and more than 75% in persons with scores ranging from 3 to 5 and more than 5 points, respectively (P < .001). Although resistance is common in HCAP, not all component criteria for HCAP convey similar risk. Simple scoring tools may facilitate more accurate identification of persons with pneumonia caused by resistant pathogens.

Invasive Methicillin-Resistant &lt;EMPH TYPE="ITAL"&gt;Staphylococcus aureus&lt;/EMPH&gt; Infections in the United States

As the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed. To describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005. Active, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA). Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains. There were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100,000; interval estimate, 92.6-156.9), blacks (66.5 per 100,000; interval estimate, 43.5-63.1), and males (37.5 per 100,000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100,000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care-associated infections in all surveillance areas. Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.