if u isolate pathogens from outpatients admitted to certain hospitals , how u can determine source of infections nosocomial or community-acquired infection?
Dear Alla,
for HAI-health-care associated infections, the symptoms of the disease occur in day 3 (after 48 hrs) of the hospitalization.
You have to also consider the previous hospitalization of the patient.
If an infection becomes manifest 48 hrs or later after admission, a nosocomial infection is likely. A nosocomial infection. however, does not necessarily mean that the pathogen has been transmitted during hospital stay. A hospital acquired infection may be caused by endogenous flora or by exogenous flora (i.e. transmitted to the patient in whatsoever way).
Pointing towards the pathogens itself it means, if you isolate a pathogen within the first 48 hrs after admission, and the patient has had no previous hospitalization or health care stay (nursing home, ...) than it is pretty much likely a community and not a hospital acquired pathogen. A pathogen, isolated later during hospital stay can be reliably categorized as hospital acquired (i.e. nosocomial acquired) only, if you can rule out that the patient was not colonized upon admission. (Make sure to discriminate between colonization and infection; a patient may acquire MRSA in a hospital without getting sick – i.e. he becomes colonized. A patient without MRSA colonization upon admission may get a wound infection with MRSA after surgery – he acquires a nosocomial infection.)
Am J Infect Control. 2016 Dec 1;44(12):1495-1504. doi: 10.1016/j.ajic.2016.08.007. Epub 2016 Oct 11.
International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module.
Rosenthal VD1, Al-Abdely HM2, El-Kholy AA3, AlKhawaja SA4, Leblebicioglu H5, Mehta Y6, Rai V7, Hung NV8, Kanj SS9, Salama MF10, Salgado-Yepez E11, Elahi N12, Morfin Otero R13, Apisarnthanarak A14, De Carvalho BM15, Ider BE16, Fisher D17, Buenaflor MC18, Petrov MM19, Quesada-Mora AM20, Zand F21, Gurskis V22, Anguseva T23, Ikram A24, Aguilar de Moros D25, Duszynska W26,Mejia N27, Horhat FG28, Belskiy V29, Mioljevic V30, Di Silvestre G31, Furova K32, Ramos-Ortiz GY33, Gamar Elanbya MO34, Satari HI35, Gupta U36, Dendane T37, Raka L38, Guanche-Garcell H39, Hu B40, Padgett D41, Jayatilleke K42, Ben Jaballah N43,Apostolopoulou E44, Prudencio Leon WE45, Sepulveda-Chavez A46, Telechea HM47, Trotter A48, Alvarez-Moreno C49, Kushner-Davalos L50.
Author information
Abstract
BACKGROUND:
We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.
METHODS:
During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.
RESULTS:
Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.
CONCLUSIONS:
Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.
Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Antibiotic resistance; Bloodstream infection; Catheter-associated urinary tract infection; Central line-associated bloodstream infections; Developing countries; Health care-associated infection; Hospital infection; Limited resources countries; Urinary tract infection; Ventilator-associated pneumonia
PMID:
27742143
DOI:
10.1016/j.ajic.2016.08.007
You could use control groups, to establish a percentage error in making the data.
Pointing towards the pathogens itself it means, if you isolate a pathogen within the first 48 hrs after admission, and the patient has had no previous hospitalization or health care stay (nursing home, ...) than it is pretty much likely a community and not a hospital acquired pathogen. A pathogen, isolated later during hospital stay can be reliably categorized as hospital acquired (i.e. nosocomial acquired) only, if you can rule out that the patient was not colonized upon admission
Nosocomial and community-acquired infection?. Available from: https://www.researchgate.net/post/Nosocomial_and_community-acquired_infection [accessed May 8, 2017].
http://www.healthline.com/health/hospital-acquired-nosocomial-infections
http://www.healthline.com/health/hospital-acquired-nosocomial-infections
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