Objective. To describe antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) during 2009-2010. Methods. Central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections were included. Pooled mean proportions of isolates interpreted as resistant (or, in some cases, nonsusceptible) to selected antimicrobial agents were calculated by type of HAI and compared to historical data. Results. Overall, 2,039 hospitals reported 1 or more HAIs; 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%). The percentage of resistance was similar to that reported in the previous 2-year period, with a slight decrease in the percentage of S. aureus resistant to oxacillins (MRSA). Nearly 20% of pathogens reported from all HAIs were the following multidrug-resistant phenotypes: MRSA (8.5%); vancomycin-resistant Enterococcus (3%); extended-spectrum cephalosporin-resistant K. pneumoniae and K. oxytoca (2%), E. coli (2%), and Enterobacter spp. (2%); and carbapenem-resistant P. aeruginosa (2%), K. pneumoniae/oxytoca (<1%), E, coli (<1%), and Enterobacter spp. (<1%). Among facilities reporting HAIs with 1 of the above gram-negative bacteria, 20%-40% reported at least 1 with the resistant phenotype. Conclusion. While the proportion of resistant isolates did not substantially change from that in the previous 2 years, multidrug-resistant gram-negative phenotypes were reported from a moderate proportion of facilities.

/pdf/antimicrobial-resistant-pathogens-associated-with-healthcare-3i9f6huim6.pdf

Antimicrobial-Resistant Pathogens Associated with Healthcare- Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010

Naomi P. O'Grady, M.D., Mary Alexander, R.N. Lillian A. Burns, M.T., M.P.H., C.I.C. E. Patchen Dellinger, M.D. Jeffery Garland, M.D., S.M. Stephen O. Heard, M.D. Pamela A. Lipsett, M.D. Henry Masur, M.D. Leonard A. Mermel, D.O., Sc.M. Michele L. Pearson, M.D. Issam I. Raad, M.D. Adrienne Randolph, M.D., M.Sc. Mark E. Rupp, M.D. Sanjay Saint, M.D., M.P.H. and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

/pdf/guidelines-for-the-prevention-of-intravascular-catheter-4xarsoczlz.pdf

Guidelines for the prevention of intravascular catheter-related infections, 2011

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)61458-4.pdf

Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-1gq1adk8ux.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.

/pdf/acog-practice-bulletin-2e7yp8vork.pdf

Acog practice bulletin

National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009

Background: The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) has included surveillance of laboratory-identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) bacteremia events since 2009. In 2013, the Centers for Medicare & Medicaid Services (CMS) began requiring acute-care hospitals (ACHs) that participate in the CMS Inpatient Quality Reporting program to report MRSA LabID events to the NHSN and, in 2015, ACHs were required to report MRSA LabID events from emergency departments (EDs) and/or 24-hour observation locations. Prior studies observed a decline in hospital-onset MRSA (HO-MRSA) rates in national studies over shorter periods or other surveillance systems. In this analysis, we review the national reporting trend for HO-MRSA bacteremia LabID events, 2010–2018. Method: This analysis was limited to MRSA bacteremia LabID event data reported by ACHs that follow NHSN surveillance protocols. The data were restricted to events reported for overall inpatient facility-wide and, if applicable, EDs and 24-hour observation locations. MRSA events were classified as HO (collected >3 days after admission) or inpatient or outpatient community onset (CO, collected ≤3 days after admission). An interrupted time series random-effects generalized linear model was used to examine the relationship between HO-MRSA incidence rates (per 1,000 patient days) and time (year) while controlling for potential risk factors as fixed effects. The following potential risk factors were evaluated: facility’s annual survey data (facility type, medical affiliation, length of facility stay, number of beds, and number of intensive care unit beds) and quarterly summary data (inpatient and outpatient CO prevalence rates). Result: The number of reporting ACHs increased during this period, from 473 in 2010 to 3,651 in 2018. The crude HO-MRSA incidence rates (per 1,000 patient days) have declined over time, from a high of 0.067 in 2011 to 0.052 in 2018 (Table 1). Compared to 2014, the adjusted annual incidence rate increased in 2015 by 16.38%, (95% confidence interval [CI], 10.26%–22.84%; P < .0001). After controlling for all significant risk factors, the estimated annual HO-MRSA incidence rates declined by 5.98% (95% CI, 5.17%–6.78%; P < .0001) (Table 2). Conclusions: HO-MRSA bacteremia incidence rates have decreased over the past 9 years, despite a slight increase in 2015. This national trend analysis reviewed a longer period while analyzing potential risk factors. The decline in HO-MRSA incidence rates has been gradual; however, given the current trend, it is not likely to meet the Healthy People 2020 objectives. This analysis suggests the need for hospitals to continue and/or enhance HO-MRSA infection prevention efforts to reduce rates further.
 Funding: None
 Disclosures: None

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Yi Mu

Papers

National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009

National Reporting Trend for HO-MRSA Bacteremia LabID Events, 2010–2018