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Hospital-acquired bloodstream infections in Hungary, 2011
The document details the prevalence and impact of hospital-acquired bloodstream infections (BSIs) in Hungary from 2006 to 2011, highlighting increased morbidity, mortality, and hospital costs. It includes surveillance data on BSI cases, demographic characteristics, common pathogens, and associated risk factors, as well as national guidelines for prevention. Limitations of the study include underreporting from hospitals and missing data on antibiotic resistance and risk factors.
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Hospital-acquired bloodstream infections in Hungary, 2011
- 1. Hospital-acquired bloodstream infectionsin Hungary, 2011 Rita Szabó MS-Track Developing Consultation 23-24 April 2012
- 2. The impact ofhospital-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
- 3. Surveillance of hospital-acquired bloodstream infections Characteristics: • a part of National Nosocomial Surveillance System • mandatory, continuous, patient based surveillance • standardized methodology • descriptive analyisis • feedback to all hospitals yearly
- 4. 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
- 5. Results Proportion ofreported BSI cases by overall number of 0.03% (692) hospital admission, 2006-2011 0.05% (1009) 0.05% (1218) 0.06% (1471) 0.08% (1993) 0.08% (1951) 2006 2007 2008 2009 2010 2011 Number of BSI cases Year
- 6. 1 951 BSIs ?????
- 7. Demographic characteristics ofBSI cases (n=1951) • Median age, y – 80.3 (range, 0-98) • Gender Male 60 % Female 40 %
- 8. Number of BSIcases by age groups (n=1951) 155 63 36 42 64 164 333 472 622 0 1-9 10-19 20-29 30-39 40-49 50-59 60-69 >70 Number of BSI cases Age groups Number of BSI cases
- 9. Number of BSIcases by age groups and gender (n=1951) 92 29 23 20 44 104 234 285 333 63 34 13 22 20 60 99 187 289 0 1-9 10-19 20-29 30-39 40-49 50-59 60-69 >70 Number of BSI cases Age groups Male Female
- 10. Proportion of primaryand secondary BSI cases by site of infection (n=1951) Primary 72% DIG 1% SSI 6% ÚTI 4% PULM 10% SST 1% OTH 7%
- 11. Number of BSIcases by type of wards (n=1951) 749 415 632 155 ICU Medical Surgery Number of BSI cases Type of wards Number of BSI cases by PICs Number of BSI cases by type of wards
- 12. The most frequentlyisolated micro-organisms (n=1556) 350 300 250 200 150 100 50 0 Number of isolated microorganisms Name of isolated micro-organisms XDRO MDRO Resistance Unknown
- 13. Number of BSIcases by risk factors 56 19 233 446 643 626 1029 1008 1937 0 500 1000 1500 2000 2500 Peripheral catheter CVC Urinary catheter Other ET-tube Parenteral feeding Tracheostoma Brain ventricle drain Gastrostoma Number of risk factors
- 14. Number of BSIcases by admission diagnosis 42 23 21 78 118 213 254 321 308 559 0 100 200 300 400 500 600 Circulatory system Digestive system Nervous system Blood Respiratory system Other Urinary tract Accidents Skin Skeletal and muscular system Number of BSI cases
- 15. 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 with death Unknown No connection with death
- 16. Number of deathsby involved micro-organisms (n=267) 80 70 60 50 40 30 20 10 0 Number of deaths Name of micro-organisms MDRO Resistance Unknown
- 17. Number of deaths(n=19) by type of involved micro-organisms – cause of death 8 7 6 5 4 3 2 1 0 Number of deaths Name of micro-organisms MDRO Resistence Unknown
- 18. The most frequentlydescribed antibiotics 217 203 200 241 294 285 280 278 333 410 0 50 100 150 200 250 300 350 400 450 Vancomycin (A07AA09) Amoxicillin (J01CA04) Ciprofloxacin (J01MA02) Imipenem (J01DH51) Meropenem (J01DH02) Ceftriaxon (J01DD04) Piperacillin (J01CA12) Amikacin (J01GB06) Fluconazole (J02AC01) Metronidazole (P01AB01) Number of described antibiotics
- 19. Antibiotic therapy bynumber of antimicrobial types during hospital staying per BSI cases 543 398 241 158 69 43 32 1 21 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 Number of patients Number of antimicrobial types Number of antimicrobials
- 20. Conclusion • Bloodstreaminfections cause more morbidity • 41% of all hospitals reported (n=175) • The number of reported cases is more and more increasing
- 21. Limitations • Manyhospitals 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
- 22. New guideline !!! Guidelines for the Prevention of Intravascular Catheter-Related Infections, CDC, 2011 Main topics: - Educating healthcare personnel who insert and maintain CVC - 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
- 23. 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
- 24. Acknowledgement •The hospitalIC personnel for the reports •Biagio Pedalino MD, EPIET scientific coordinator •Karolina Böröcz MD, supervisor •Ákos Tóth MD PhD, microbiologist
- 25. References • A.-P.Magiorakoset 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.
- 26. Thank you foryour attention!