Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate?

BACKGROUND: In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM: To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS: In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS: The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION: Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.

Point prevalence study of antimicrobial usage in acute care hospitals in the Slovak Republic.

BACKGROUND: Antimicrobial use and resultant resistance is still increasing worldwide. Close monitoring and strict implementation of policies are important to tackle this issue. AIM: To assess the use of antimicrobials in acute care hospitals in the Slovak Republic. METHODS: Antimicrobial use was monitored as part of a point prevalence survey (PPS) of healthcare-associated infections. Surveillance was performed in 40 hospitals in the Slovak Republic according to the standardized methodology developed by the European Centre for Disease Prevention and Control. Data were collected according to a standard protocol. FINDINGS: In total, 8397 patients in 40 Slovak hospitals were surveyed. Of these, 30.7% were receiving antibiotics at the time of the survey. In 630 cases, patients were receiving more than one antimicrobial agent. The prevalence of antimicrobial use was highest in intensive care units (54.3%). Antimicrobials were prescribed most frequently for treatment of community-acquired infections (48.1%) and healthcare-associated infections (11.4%). Surgical prophylaxis was the indication for 22.2% of all prescribed antimicrobials, and exceeded 24h in 81.5% of cases. The antimicrobials used most often were fluoroquinolones (20.9%), especially for non-surgical prophylaxis (26.8%) and treatment (21.9%). The antimicrobials prescribed most frequently for surgical prophylaxis were first-generation cephalosporins (23.0%), fluoroquinolones (14.7%) and second-generation cephalosporins (11.4%). The use of antimicrobials was higher in patients with invasive medical devices. CONCLUSION: This study found excessive use of broad-spectrum antibiotics, prolonged surgical prophylaxis, frequent use of parenteral antibiotics and inadequate documentation of the indication for prescription. These findings present opportunities for improving the management of antimicrobials in Slovak hospitals.

Rotavirus type profile in nosocomial and community infections in Western Slovakia.

The surveillance study of rotavirus gastroenteritis at the University Teaching Hospital Trencín area, Slovakia, during 2006-2011 confirmed that the genotype profile of circulating rotaviruses was not stable. While G1P[8] dominating genotype dropped from 75 to 7.3 % in the period 2009-2011, genotype G2P[4] that was not detected in 2009 raised to 45.1 % in 2011. Vaccination coverage rose from 4.4 to 22.1 % in the period 2008-2011. Among the community and hospital cases, we observed that the average age of patients with nosocomial infections was significantly less (10.6 months) than in the cases of community rotavirus gastroenteritis (RVGE) cases. Compared to the nosocomial infection cases, the duration of the disease and the duration of hospitalization among the community cases were significantly longer by 0.22 and 3.63 days, respectively, during 2006-2011. Though the vaccination coverage was found to correlate with changes in the type of the circulating rotaviruses, the natural circulation in rotavirus genotypes may not be excluded as important factor contributing to the emergence of G2P[4] strain during the survey period.

[A point prevalence survey of healthcare-associated infections in the Slovak Republic - a part of the EU project]. / Bodové prevalencné sledovanie nozokomiálnych nákaz na Slovensku - súcast projektu Európskej únie.

AIM: The aim of this survey was to estimate the prevalence of healthcare-associated infections (HAI) in the Slovak Republic (SR), distribution of causative pathogens, and risk factors. METHODS: The point prevalence survey (PPS) of HAI in the SR was carried out in 40 acute care hospitals, according to a standardized methodology developed by the European Centre for Disease Prevention and Control (ECDC). Data were collected according to the standard protocol at the country, hospital, and patient levels. RESULTS: Of 8 397 patients included in the survey in the SR, 298 (3.5%) had HAI. The highest prevalence of HAI (12.4%) was found in the intensive care units (ICU) and Anaesthesiology and Intensive Care Medicine Units (AICMU). Nevertheless, intensive care medicine patients only represented 6.5% of all patients. The following six most common types of HAI accounted for 87.3% of all HAI: urinary tract infection (26.2%), pneumonia and other lower respiratory tract infections (22.0%), surgical site infection (15.7%), bloodstream infection (9.9%), infection of the eye, ear, and upper respiratory tract (8.3%), and skin and soft tissue infection (5.2%). The most often isolated pathogens were Escherichia coli (15.0%), Klebsiella spp. (12.5%), and Pseudomonas aeruginosa (10.8%). Of 8 397 surveyed patients, 60.5% had a medical device inserted: central vascular catheter (CVC)(3.4%), peripheral vascular catheter (PVC)(40.8%), urinary catheter (14.1%), or endotracheal tube (2.1%). The prevalence of HAI was higher in patients with than without a medical device inserted. CONCLUSION: By participating in the PPS, the SR has collected the most recent data on HAI and antimicrobial use in acute care hospitals. The adherence to the standard methods, standard definitions of HAI, and PPS protocol allows to repeat the survey, to analyse the HAI prevalence trend, and to take effective interventions.

[Exotic pets as a potential source of Salmonella]. / Exotickí domáci milácikovia ako potenciálny zdroj salmonel.

STUDY AIM: To clarify the source of infection with the exotic serovar Salmonella Urbana and the route of transmission in a 2-year-old child. MATERIAL AND METHODS: To identify the source of infection and the route of transmission, we used epidemiological investigation of the case of salmonellosis and microbiological methods for the detection of Salmonella from biological specimens, epidemiologically suspected food, turtle tank water and feed, and serotyping of isolated strains of Salmonella. RESULTS: Salmonella Urbana was confirmed in a rectal swab of the infected child and in a sample of turtle tank water. Laboratory analyses of farm eggs eaten by the investigated family, of rectal swabs of the other family members and of a turtle feed sample did not reveal the presence of salmonellae. CONCLUSION: The confirmed source of Salmonella infection caused by the exotic serovar Salmonella Urbana in a two-year-old child were pet water turtles. In the case of the isolation of exotic serovars of Salmonella, the epidemiological and laboratory investigation needs to be aimed at the contact with pet animals, especially reptiles. It is desirable to raise the awareness of both the public and health professionals of this issue.

Temperature and pH affect the production of bacterial biofilm.

The effect of different cultivation temperatures (30 and 37 degrees C) and pH of the media (5.5, 7.5, 8.5) on the biofilm production was compared in Pseudomonas aeruginosa, Klebsiella pneumoniae, and Vibrio cholerae non-O1 and O1 using the crystal-violet test for estimation of quantitative production of the biofilm. Decrease (46.4-98.4 %) in the biofilm production was observed at 37 degrees C in 8 of the tested strains (P. aeruginosa three strains, K pneumoniae two, V. cholerae non-O1 two, and V. cholerae O1 one strain) compared with the production at 30 degrees C. On the other hand, five strains (P. aeruginosa 1, K. pneumoniae 3, V. cholerae non-O1 1) exhibited under these conditions a higher biofilm production (103-143 %). However, this difference was not significant (p = 0.196). Increased pH lead to a higher biofilm production using all media tested. In P. aeruginosa the biofilm production at pH 8.5 was 139-244 %, at pH 7.5 136-164 % in comparison with pH 5.5. Similarly, in K. pneumoniae the biofilm production increased to 151-319 % at pH 8.5 while with the drop of pH to 7.5 the biofilm production was 113-177 % compared with pH 5.5. In V. cholerae non-O1 and O1 the biofilm production reached 204-329 % at pH 8.5, and 123-316 % at pH 7.5 (compared with the production at pH 5.5). An increase in biofilm production represented an average of 169 % (p = 0.001) at pH change from 5.5 to 7.5, with the rise of pH from 5.5 to 8.5 caused an average difference of 229 % (p = 0.001).

Outbreaks of epidemic kerato-conjunctivitis in two hospital wards.

The authors analyzed two hospital outbreaks of epidemic keratoconjunctivitis (EKC), one at the Department of Ophthalmology (30 cases) and another one at the Department of Premature Newborns (22 cases). In both outbreaks, EKC was diagnosed in inpatients (16 and 6 respectively), outpatients (5 and 3 respectively), healthcare workers (HCWs) (3 and 5 respectively), and relatives of EKC patients (6 and 8 respectively). Implemented infection control measures included isolation precautions, improved disinfection and hand-washing of both hospital and outpatient department personnel. Shortly after implementation of control measures the rate of infection transmission started to decrease significantly.

Mother's milk--unusual factor of infection transmission in a salmonellosis epidemic on a newborn ward.

The submitted study analyzes a salmonellosis epidemic with a nosocomial character of occurrence on newborn ward Area National Health Authority in Trencín with an unusual factor of infection transmission--mother's milk. At the same time the authors point out the possibility of inapparent disease manifestation in connection with the stopped intake of mother's milk.