Special articleCDC definitions for nosocomial infections, 1988
Abstract
The Centers for Disease Control (CDC) has developed a new set of definitions for surveillance of nosocomial infections. The new definitions combine specific clinical findings with results of laboratory and other tests that include recent advances in diagnostic technology; they are formulated as algorithsm. For certain infections in which the clinical or laboratory manifestations are different in neonates and infants than in older persons, specific criteria are included. The definitions include criteria for common nosocomial infections as well as infections that occur infrequently but have serious consequences. The definitions were introduced into hospitals participating in the CDC National Nosocomial Infections Surveillance System (NNIS) in 1987 and were modified based on comments from infection control personnel in NNIS hospitals and others involved in surveillance, prevention, and control of nosocomial infections. The definitions were implemented for surveillance of nosocomial infections in NNIS hospitals in January 1988 and are the current CDC definitions for nosocomial infections. Other hospitals may wish to adopt or modify them for use in their nosocomial infections surveillance programs.
References (3)
- JS Garner et al.
Surveillance of nosocomial infections
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High fibrinogen-prealbumin ratio (FPR) predicts stroke-associated pneumonia
2024, Journal of Stroke and Cerebrovascular DiseasesAlthough numerous factors had been found to be associated with stroke-associated pneumonia (SAP), the underlying mechanisms of SAP remain unclear. Fibrinogen-prealbumin ratio (FPR) is a novel indicator that could balance the effects of inflammation and nutrition, which might reflect biological status of patients more comprehensively than other biomarkers. To date, FPR has not been explored in acute ischemic stroke patients. This study aims to explore the relationship between FPR and SAP.
900 stroke patients participated in this retrospective study and 146 healthy controls were recruited. Fibrinogen and prealbumin were measured within 24 hours on admission. FPR was calculated after dividing fibrinogen (g/L) by prealbumin (mg/L) × 1000. SAP was defined according to the modified Centers for Disease Control criteria.
121 patients were diagnosed with SAP. Log10FPR was higher in stroke patients than healthy controls. In logistic regression analysis, log10FPR was independently associated with SAP (OR 15.568; 95% CI: 3.287-73.732; P=0.001). Moreover, after using ROC curve, the predictive power of “current standard”(defined as A2DS2 plus leukocyte count and log10hs-CRP) plus log10FPR (0.832[0.804-0.857]) was higher than “current standard” (0.811[0.782-0.837], P=0.0944) and A2DS2 plus log10FPR (0.801[0.772-0.828], P=0.0316). No significant difference was found between the predictive power of A2DS2 plus log10FPR and “current standard” (P =0.6342).
Higher FPR was observed in stroke patients compared with healthy controls and was significantly associated with SAP. FPR might provide useful clues for timely identification and treatment of SAP.
The Linkoping burn centre in Sweden has, even though being a high income country, reported high burn wound infections (BWI) frequencies in scalded children compared to similar populations in other parts of the world.
The aim was to investigate possible explanations for differences in frequency of BWI among children with partial thickness burns treated at the Linköping burn centre in Sweden, and that reported in other studies.
In order to investigate what BWI criteria that were used in similar studies a literature search on PubMed Central was done along with a retrospective analysis of children previously diagnosed as infected to confirm or reject the high infection frequency reported earlier.
Of the 34 selected publications reporting on BWI frequency 16 (47%) did not define a criteria for the BWI diagnosis and almost a third did not report on wound culturing. Of those who did report the use a third do not mention any bacterial growth found is these cultures. The retrospective analysis on children at the centre did not show any decrease in infection frequency even with some disagreement on onset for the BWI.
The reporting of criteria and diagnosis of burn wound infection is highly variable making it difficult to interpret results and come to conclusions. The high frequency of BWI at the centre might be a result of close monitoring due to study participation, use of clean instead of sterile routine at dressing changes or low thresholds for the diagnosis in respect to changes in infection markers.
Bacterial Infections After Liver Transplantation and the Role of Oral Selective Digestive Decontamination: A Retrospective Cohort Study
2024, Transplantation ProceedingsBacterial infections are common after liver transplantation (LT) and cause serious morbidity and mortality. In our center, prolonged selective digestive decontamination (SDD) is the standard of care, which may lead to a reduced number and severity of bacterial infections. The aim of the current study was to investigate bacterial infection rates, the causative pathogens, localization, and the possible influence of SDD within the first year after LT.
A retrospective single-center cohort study was performed. Patients within their first year after LT between 2012 and 2017 were included. Patients received SDD for 3 weeks immediately after LT. The type of infection, bacterial subtype, CSI classification, severity, and potential interventions were recorded.
One hundred eighty-six patients were included in the study. Seventy-eight patients (41.9%) had a bacterial infection within the first year after LT. The most common types of infection were cholangitis (25.8%) and secondary infected abdominal fluid collections (25.3%). The most common bacteria were Gram-positive enterococcal- (36.5%) and Gram-negative enterobacterial species (34.2%). 35.5% of the infections occurred within the first month after LT, mainly caused by Gram-positive bacteria (76.7%).
Cholangitis and infected abdominal fluid are the most common types of infection within one year after LT, mainly caused by enterococcal- and enterobacterial species. Within the first month after LT, infections were mostly caused by Gram-positive bacteria, which could be a consequence of protocol use of SDD. The results can be used for the choice of empirical antibiotic therapy based on the most common types of bacteria and the time frame after LT.
Antibiotic use and outcome in patients with negative blood cultures, a new target population for antimicrobial stewardship interventions: A prospective multicentre cohort (NO-BACT)
2024, Journal of InfectionTo evaluate the appropriateness of antimicrobial treatment and the risk factors for mortality in patients with negative blood cultures (BC), in order to evaluate whether this population would be a suitable target for antimicrobial stewardship (AMS) interventions.
A multicentre prospective cohort study of patients with negative BC in three Spanish hospitals between October 2018 and July 2019 was performed. The main endpoints were the appropriateness of antimicrobial treatment (evaluated by two investigators according to local guidelines) and 30-day mortality. Cox-regression was performed to estimate the association between variables and 30-day mortality.
Of 1011 patients in whom BC was obtained, these were negative in 803 (79%) and were included; 30-day mortality was 9% (70 patients); antibiotic treatment was considered inappropriate in 299 (40%) of 747 patients evaluated at day 2, and in 266 (46%) of 573 at day 5–7. The variables independently associated with increased risk of 30-day mortality were higher age (HR 1.05; 95% CI 1.03–1.07), neoplasia (HR 2.73; 95% CI 1.64–4.56), antibiotic treatment in the 48 h prior to BC extraction (HR 2.06; 95% CI 1.23–3.43) and insufficient antibiotic coverage at day 2 after BC obtainment (HR 2.35; 95% CI 1.39–4.00). Urinary, catheter and biliary sources of infection were associated with lower risk (HR 0.40; 95% CI 0.20–0.81).
Antimicrobial treatment is frequently inappropriate among patients with negative BC; insufficient antibiotic coverage at day 2 was associated with mortality. These results suggest that patients with negative BC are a suitable population for AS interventions.
Antimicrobial treatment in patients with negative blood culture was frequently inappropriate, and inappropriate coverage at day 2 was associated with increased risk of death. These data support the consideration of this population as a potential target for antimicrobial stewardship interventions.
Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: A systematic review with meta-analysis
2024, American Journal of Infection ControlRecommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI.
Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus, and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions.
A total of 84,462 studies were examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (risk ratio 0.52; 95% confidence interval, 0.37-0.73), and this is moderate-quality evidence. The reduction in length of stay in the intensive care unit and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear.
This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult intensive care unit patients.
We aimed to investigate the characteristics of nosocomial infections (NIs) and the impact of prophylactic antibiotic administration on NI outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR).
This retrospective study analyzed the rate, type, pathogens, outcomes, and risk factors of NIs that developed in adult patients who underwent ECPR at our institution between January 2002 and January 2022.
Among 105 patients (median age, 58.59 [interquartile range, 46.53-67.32] years), 57 (54.29%) patients developed NIs during their extracorporeal membrane oxygenation courses. The incidence rates per 1000 extracorporeal membrane oxygenation days were 135.91 for overall infections and 40.06 for multidrug-resistant (MDR) infections. Ventilator-associated pneumonia was the most common type of NI (73.68%), followed by bloodstream infections (17.89%). Prophylactic antibiotics with Pseudomonas aeruginosa coverage were protective factors against NI (hazard ratio [HR], 0.518; 95% confidence interval [CI], 0.281-0.953; P = .034). High dynamic driving pressure of the ventilator (cmH2O) was a prognostic factor for hospital mortality (HR, 1.096; 95% CI, 1.008-1.192; P = .032). An Acute Physiology and Chronic Health Evaluation II score of ≥24 (HR, 6.443; 95% CI, 1.380-30.088; P = .018) was a risk factor for developing MDR infections.
In patients who undergo ECPR, prophylactic antibiotic treatment with P aeruginosa coverage is associated with a lower incidence of NIs, whereas an Aeruginosa Acute Physiology and Chronic Health Evaluation II score of ≥24 is a risk factor for MDR infections. In the modern era of antibiotic therapy, the development of NIs does not increase hospital mortality among patients undergoing ECPR.