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Epidemiological data of nosocomial infections in Belgium Anne IngenbleekMat GoossensSylvanus FonguhNaima HammamiMarie-Laurence LambertKarl MertensKatrien LatourBéatrice JansBoudewijn Catry*www.nsih.be
Anne IngenbleekMat GoossensSylvanus FonguhNaima HammamiMarie-Laurence LambertKarl MertensKatrien LatourBéatrice JansBoudewijn Catry*www.nsih.be
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | BelgiumT +32 2 642 51 11 | F +32 2 642 54 10 | email: [email protected] | http://www.nsih.be
CDC, 2013
http://www.cdc.gov/drugresistance/threat-report-2013/
http://www.cdc.gov/drugresistance/threat-report-2013/
This was USA, what about Europe….
Point prevalence survey: PPS (photo)
Surveillance contineously (film)
&
Nosocomial infection (1/3)
An active infection was defined as “healthcare-associated” (associated to acute care hospital stay only for the purpose of this protocol) when:
The onset of the signs and symptoms had started on Day 3 of the current admission or later (where Day 1 is the day of admission)
OR The signs and symptoms were present at
admission or became apparent before Day 3, but the patient had been discharged from another hospital less than two days before admission
Zarb et al., 2013 Eurosurveillance
OR The signs and symptoms of an active surgical site
infection were present at admission or started before Day 3, and the surgical site infection occurred within 30 days of a surgical intervention (or in the case of surgery involving an implant, a deep or organ/space surgical site infection that developed within a year of the intervention),
Nosocomial infection (2/3)
Zarb et al., 2013 Eurosurveillance
OR The signs and symptoms of a Clostridium difficile
infection were present at admission or started before Day 3, with the patient having been discharged from an acute care hospital less than 28 days before the current admission.
Nosocomial infection (3/3)
Zarb et al., 2013 Eurosurveillance
Point Prevalence Survey: Hai - ABU
Percentage patients with HAI: 7.0%
0%
5%
10%
15%
20%
25%
11 13 15 20 38 59 58 34 27 63 49 30 50 2 62 14 51 61 40 37 7 48 55 41 16 18 17 46 33 24 57 21 12 36 56 19 39 43 60 5 53 22 42 4 29 45 23 28 32 44 52 35 6 54 8 47 3 1 26 31 9 25 10
Hospital number
% p
atie
nts
wit
h H
AI
Mean prevalence: 7% [0%-23%]
Goossens, M WIV-ISP
Point Prevalence Survey: Hai - ABU
Zarb et al., 2012 Eurosurveillance
N pts (a) Prevalence% (95%CI) (b)
N HAI (c) Relative % HAI (d)
Pneumonia & other LRTI 392 2.0% (1.8-2.2) 394 25.7%
Surgical site infections (e) 290 1.5% (1.3-1.6) 290 18.9%
Urinary tract infections 263 1.3% (1.2-1.5) 264 17.2%
Bloodstream infections (BSI)(f) 216 1.1% (0.9-1.2) 217 14.2%
Gastro-intestinal system infections
118 0.6% (0.5-0.7) 119 7.8%
Skin and soft tissue infections 59 0.3% (0.2-0.4) 59 3.9%
Bone and joint infections 38 0.2% (0.1-0.3) 39 2.5%
Eye, Ear, Nose or Mouth infection 47 0.2% (0.2-0.3) 47 3.1%
Systemic infections(f) 40 0.2% (0.1-0.3) 40 2.6%
BELGIAN PPS 2011 hospitals-------------------------------------------------------------------------Belgian PPS-------------------------------------------------------------------
------PN/LRI------ ------SSI------ ------UTI------ ------BSI------ ------GI------ ------All HAI------
N Rel % N Rel % N Rel % N Rel % N Rel % N Rel %
FUNGI 20 8.1% 11 4.6% 13 5.3% 27 12.1% 4 5.4% 80 6.9%
Candida spp 8 3.2% 11 4.6% 13 5.3% 25 11.2% 3 4.1% 64 5.5%
Aspergillus spp 11 4.5% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 12 1.0%
Other 1 0.4% 0 0.0% 0 0.0% 2 0.9% 1 1.4% 4 0.3%
VIRUS 2 0.8% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 3 0.3%
total N of microorganisms 247 100.0% 241 100.0% 243 100.0% 224 100.0% 74 100.0% 1167 100.0%
Goossens M, WIV-ISP
Point Prevalence Survey: Hai - ABU
23%
44%
1%
13%
4% 4%
3%
8%
15%
Indication for Antimicrobial N=5543
HI
CI
LI
M
U
S1
S2
S3
On antimicrobials: 36.6%
Mean antimicrobials for those on antimicrobials: 1.5
:acute hospital-acquired:community-acquired :acquired in NH:medical prophylaxis :unknown reason:single dose:one day:> 1 day
Surg
Goossens, M WIV-ISP
MRSA versus Candida…
Healthcare-associated infections (HAI): 7%Within HAI:
S. aureus: MRSA: Candida:
Zarb et al., 2012 Eurosurveillance & ECDC 2013
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
Belgium 2011 PPS continued
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
Belgium 2011 PPS continued
MRSA 0.368*11%= 4.048%Candida spp = 6%
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
NURSING HOMES…….
Point prevalence survey: PPS (photo)
Surveillance contineously (film)
&
Courtesy: Jans B. & Latour K.
Risk factors and care load in LTCF
Latour K, HALT I final meeting, Lyon, 201124
(0-36.4) (0-52.1) (0-35) (0-56.5) (0-66.7) (0-100%)
Point prevalence survey: PPS (photo)
Surveillance contineously (film)
&
Surveillances
&
FEEDBACKMRSA
Campagnes
IndicateursUSI & ISO
Septicémies
C. difficile
Gram -
ABU
Rectangle = mandatory
Annual N casulties
+-2000 in 2008(www.wiv-isp.be)
Nosocomial infections: 2650 in 2007 (KCE 92A)
<750 in 2012 (bivv.be)
Surveillances
&
FEEDBACKMRSA
Campagnes
IndicateursUSI & ISO
Septicémies
C. difficile
Gram -
ABU
Rectangle = mandatory
AUTOMATIC FEEDBACK Local follow up
Materials & methods
Specialities to be reported (WHO, ESAC, pubMED)
ATC classification: A07A Antibiotics for gastro-intestinal useJ01, P01AB AntibioticsJ02, D01BA Antimycotics for systemic use J04A Tuberculostatics
Belgian hospitals
ATC Class
J01C Beta-lactam antibacterials, penicillins
J01D Other beta-lactam antibacterials
J01M Quinolone antibacterials
J01X Other antibacterials
J02A Antimycotics for systemic use
J01F Macrolides, lincosamides and streptogramins
J01G Aminoglycoside antibacterials
J04A Drugs for treatment of tuberculosis
J01E Sulfonamides and trimethoprim
A07A Intestinal anti-infectives
P01A Agents against amoebiasis/protozoal diseases
J01A3 Tetracyclines
D01B Antifungals for systemic use
J01B0 Amphenicols
Ingenbleek A, WIV-ISP
Non Pediatric Wards
DDD/1000 inh per day: DID = Good indicator for community (only!)
ESACNational level, all antimicrobials included
Year Participants Total DDD for the year DDD/1000 Nights
2008 121 7315319.20 579.734
2009 124 7273099.57 583.651
2010 120 6940067.65 585.087
2011* 106 6561559.15 581.215
2011*: The data collection for the year 2011* is on-going.
HOSPITALS
Stratified by ward: antibacterials
Ingenbleek A, WIV-ISP
Stratified by ward: antimycotics
Ingenbleek A, WIV-ISP
DDD/1000 inh per day: DID = Good indicator for community (only??)
DDD/1000 patient days 2012
Ingenbleek A & Goossens M, WIV-ISP in preparation
Conclusions
Denominator /1000 patient days is superior unit for hospitals (not DDD/1000 inhabitants per day).
Candida > MRSA in nosocomial infections (Europe & Belgium) (C. albicans +++ & glabrata ++)
Hotspots for antimicrobial use (ICU) does not equal hotspots for antimycotic use (Hae/Onco)
The detailed information is out there…
Acknowledgements: The NSIH team
The labs & hospitals & nursing homesMycology: Ann, Berdieke, Pierre, Marijke, Françoise
[email protected]@wiv-isp.be
Slides available on: www.nsih.be
Mission
To provide standardized definitions and tools for the containment of health care associated infections in hospitals and nursing
homes, and to establish national reference data on incidence of nosocomial infections and antimicrobial resistance.
SURVEILLANCE (1/2)
Four Mandatory Surveillances in Acute Care Hospitals
1. Methicillin resistant Staphylococcus aureus2. Clostridium difficile (optional: ribotyping)3. Antimicrobial use in hospitals4. One out of 4 optional surveillances:
• Septicaemias hospital wide• Surgical site infections • Intensive care units • Extended spectrum beta-lactamases
In progress: quality indicators
SURVEILLANCE (2/2)Volontary projects in Hospitals & Nursing homes
Hand hygiene campaigns (fifth in preparation, launch 2012)Point Prevalence survey on HCAI & AMMRSA, ESBL & VRE in Nursing homes (BAPCOC)
Other projects - Expertise
EARSS, ESAC, BelVet-SAC, ESVAC, PILGRIM…TATFAR, CODEX alimentarius (WHO/FAO/OIE)promotor Master Thesis, reviewing articles, parlementary questions