Hospital-acquired bloodstream

infections in Hungary, 2011

Rita Szabó

MS-Track Developing Consultation

23-24 April 2012

The impact of hospital-acquired

bloodstream infections (BSIs)

• Increased morbidity – more serious illness– 16-40% of critically ill patients with bloodstream infections– Antimicrobial resistance - XDRO, PDRO !!!

• Increased mortality > 20% mortality

• Increased hospital length of stay– An average of 7-21 days / bloodstream infection

• Increased costs – EU estimate an average of 20 USD / patient / day

• Patient impact – suffering, pain, loss of income, long term disability

Surveillance of hospital-acquiredbloodstream infections

Characteristics:

• a part of National Nosocomial Surveillance System

• mandatory, continuous, patient based surveillance

• standardized methodology

• descriptive analyisis

• feedback to all hospitals yearly

Surveillance of hospital-acquired

bloodstream infections (2)

Aims:

• describe bloodstream infections and related

pathogens, antibiotic use and risk factors at patient

level

• follow up trends

• define priorities (consider impact of disease)

• disseminate and use these results to:

- raise awareness

- identify problems and set up priorities

- evaluate national strategies and guidelines

Results

0.03%(692)

0.05%(1009)

0.05%(1218)

0.06%(1471)

0.08%(1993)

0.08%(1951)

2006 2007 2008 2009 2010 2011

Nu

mb

er

of

BS

I c

as

es

Year

Proportion of reported BSI cases by overall number of hospital admission, 2006-2011

?????

1 951 BSIs

Demographic characteristics of BSI

cases (n=1951)

• Median age, y – 80.3 (range, 0-98)

• Gender

Male 60 %

Female 40 %

Number of BSI cases by age groups

(n=1951)

155

6336 42 64

164

333

472

622

0 1-9 10-19 20-29 30-39 40-49 50-59 60-69 >70

Nu

mb

er

of

BS

I c

as

es

Age groups

Number of BSI cases

Number of BSI cases by age groups

and gender (n=1951)

92

29 23 20

44

104

234

285

333

63

34

1322 20

60

99

187

289

0 1-9 10-19 20-29 30-39 40-49 50-59 60-69 >70

Nu

mb

er

of

BS

I c

as

es

Age groups

Male

Female

Proportion of primary and secondary BSI

cases by site of infection (n=1951)

Primary72%

PULM10%

SSI6%

ÚTI4%

DIG1%

SST1%

OTH7%

Number of BSI cases by type of

wards (n=1951)

749

415

632

155

ICU Medical Surgery

Nu

mb

er

of

BS

I c

as

es

Type of wards

Number of BSI cases by PICs

Number of BSI cases by type of wards

The most frequently isolated micro-

organisms (n=1556)

0

50

100

150

200

250

300

350

Nu

mb

er

of

iso

late

d m

icro

org

an

ism

s

Name of isolated micro-organisms

XDRO

MDRO

Resistance

Unknown

Number of BSI cases by risk factors

19

56

233

446

626

643

1008

1029

1937

0 500 1000 1500 2000 2500

Gastrostoma

Brain ventricle drain

Tracheostoma

Parenteral feeding

ET-tube

Other

Urinary catheter

CVC

Peripheral catheter

Number of risk factors

Number of BSI cases by admission

diagnosis

21

23

42

78

118

213

254

308

321

559

0 100 200 300 400 500 600

Skeletal and muscular system

Skin

Accidents

Urinary tract

Other

Respiratory system

Blood

Nervous system

Digestive system

Circulatory system

Number of BSI cases

Number of deaths (n=267) related to

BSI cases by type of link -

14 % of all BSI cases

7%

21%

17%55%

Cause of death

Connection withdeath

Unknown

No connectionwith death

Number of deaths by involved micro-

organisms (n=267)

0

10

20

30

40

50

60

70

80

Nu

mb

er

of

de

ath

s

Name of micro-organisms

MDRO

Resistance

Unknown

Number of deaths (n=19) by type of

involved micro-organisms – cause of

death

0

1

2

3

4

5

6

7

8

Nu

mb

er

of

dea

ths

Name of micro-organisms

MDRO

Resistence

Unknown

The most frequently described

antibiotics

200

203

217

241

278

280

285

294

333

410

0 50 100 150 200 250 300 350 400 450

Metronidazole (P01AB01)

Fluconazole (J02AC01)

Amikacin (J01GB06)

Piperacillin (J01CA12)

Ceftriaxon (J01DD04)

Meropenem (J01DH02)

Imipenem (J01DH51)

Ciprofloxacin (J01MA02)

Amoxicillin (J01CA04)

Vancomycin (A07AA09)

Number of described antibiotics

Antibiotic therapy by number of

antimicrobial types during hospital

staying per BSI cases

543

398

241

158

6943 32

121 18 15 14 8 4 9 6 4 9 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Nu

mb

er

of

pa

tie

nts

Number of antimicrobial types

Number ofantimicrobials

Conclusion

• Bloodstream infections cause more morbidity

• 41% of all hospitals reported (n=175)

• The number of reported cases is more and more

increasing

Limitations

• Many hospitals not represented (59%)

• Missing denominators (e.g. denominators - overall number of admission by age group and gender device-use days)

impossible to obtain interhospital, national and international estimates

• Missing data on micro-organisms

antibiotic resistance

antibiotics

risk factors

• Differently microbiological panels

New guideline !!!

Guidelines for the Prevention of IntravascularCatheter-Related Infections, CDC, 2011

Main topics:

- Educating healthcare personnel who insert and maintainCVC

- Using maximal sterile barrier precautions during CVC insertion

- Using chlorhexidine skin preparation for antisepsis

- Avoiding routine replacement of CVC

- Using antiseptic impregnated short-term CVC and chlorhexidine impregnated dressing

www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

Some interesting webpages

• International Sepsis Forum (www.sepsisforum.org)

The mission of the ISF is to improve the care of patients with sepsis by:

- promoting an improved understanding of the basic biology and pathology of sepsis

- enhancing the understanding of the epidemiology of sepsis

- improving the design and conduct of clinical research to improve the management of septic patients

- educating health professionals in the optimal management of patients with sepsis

- raising the profile of sepsis as a global health challenge with the public, with healthcare practitioners, with industry, and with global health agencies

• Surviving Sepsis Campaign (www.survivingsepsis.org)The mission of the Surviving Sepsis Campaign is:

- to raise awareness of sepsis and to reduce the mortality of sepsis

• Global Sepsis Alliance (www.globalsepsisalliance.org)The aims of GSA are:

- to elevate public, philanthropic and governmental awareness

- to understand and support of sepsis

- to accelerate collaboration among researchers, clinicians, associated working groups

- to supporting them

Acknowledgement

•The hospital IC personnel for the reports

•Biagio Pedalino MD, EPIET scientific

coordinator

•Karolina Böröcz MD, supervisor

•Ákos Tóth MD PhD, microbiologist

References

• A.-P.Magiorakos et al: Multidrug-resistant, extensively drug-

resistant and pandrug-resistant bacteria: an international

expert proposal for interim standard definitions for acquired

resistance. Clin Microbiol Infect 2011

• D. Pittet et al: Nosocomial bloodstream infections: secular

trends in rates, mortality and contribution to total hospital

deaths. Arch Intern Med. 1995; 155 (11):1177-1184

• W.R. Jarvis: Selected aspects of the socioeconomic impact of

nosocomial infections: morbidity, mortality, cost and

prevention. Inf Control Hosp Epid. 1996; 17 (8):552-559

• M. Kilgore et al: Cost of bloodstream infections. Am J Inf

Control. 2008; 36 (10):1721-1723

• A nosocomialis surveillance során alkalmazandó módszerek.

EPINFO 9. évf. 3. különszám, 2002. május 31.

Thank you for your attention!