Surgical Site Infections in Slovenian Acute Care Hospitals: Surveillance Results, 2013-2016.

INTRODUCTION: The objective was to present the results of the Slovenian National surgical site infections (SSIs) surveillance system from 2013 to 2016 and to compare them to the reference data for the European Union (EU) and European Economic Area (EEA) countries. METHODS: Surveillance was conducted according to the Slovenian protocol consistent with the European Centre for Disease Prevention and Control protocol. Descriptive analyses were performed. RESULTS: Data were collected for 1080 patients of whom 57.4% were patients with cholecystectomy (from three hospitals), 29.0% with caesarean sections (from four hospitals) and 4.7%, 4.5% and 4.4% patients with hip prosthesis, knee prosthesis and colon surgery (each surgical category from one hospital). The pooled in-hospital SSI incidence density for caesarean section was 3.7 (95% CI: 1.4-8.1; inter-hospital range: 0.0-11.5) and for cholecystectomy 6.8 (95% CI: 3.5-11.9; inter-hospital range: 4.1-11.9) per 1000 post-operative patient-days. The in-hospital SSI incidence density for colon surgery was 24.8 (95% CI: 12.5-44.0) and for hip prosthesis 2.6 (95% CI: 0.1-14.2) per 1000 post-operative patient-days. No SSIs were reported among the 49 patients with knee prostheses. CONCLUSIONS: The estimated SSIs incidence rates varied between different surgical categories and the different participating hospitals. In some of the participating hospitals and for some of the surgical procedures under surveillance they were rather high in comparison to the reference data for hospitals from EU/EEA countries. It is urgent to expand standardised SSIs surveillance to all Slovenian acute care hospitals with surgical wards to contribute to evidence-based SSIs prevention and control in Slovenia.

The prevalence of and risk factors for healthcare-associated infections in Slovenia: results of the second national survey.

INTRODUCTION: In the second Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute-care hospitals, we estimated the prevalence of all types of HAIs and identified risk factors. METHODS: Patients from acute-care hospitals were enrolled into a one-day cross-sectional study in October 2011. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors. RESULTS: Among 5628 patients, 3.8% had at least one HAI and additional 2.6% were still being treated for HAIs on the day of the survey; the prevalence of HAIs was 6.4%. The prevalence of urinary tract infections was the highest (1.4%), followed by pneumoniae (1.3%) and surgical site infections (1.2%). In intensive care units (ICUs), the prevalence of patients with at least one HAI was 35.7%. Risk factors for HAIs included central vascular catheter (adjusted odds ratio (aOR) 4.0; 95% confidence intervals (CI): 2.9-5.7), peripheral vascular catheter (aOR 2.0; 95% CI: 1.5-2.6), intubation (aOR 2.3; 95% CI: 1.4-3.5) and rapidly fatal underlying condition (aOR 2.1; 95% CI: 1.4-3.3). CONCLUSIONS: The prevalence of HAIs in Slovenian acute-care hospitals in 2011 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.

Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.

Cluster of Stenotrophomonas maltophilia endocarditis after prosthetic valve replacement.

Early postoperative prosthetic valve endocarditis due to Stenotrophomonas maltophilia was diagnosed in seven patients (two men) aged from 68 to 84 years (mean age 78.1 years) over a three-year period. All patients had undergone aortic valve replacement. S. maltophilia was isolated from at least two blood cultures per patient. Four patients experienced CNS embolic complications. Three patients died. All patients were treated with ceftazidime, one in combination with amikacin, one with ciprofloxacin and one with levofloxacin. Because a common source of infection in the operating theater was suspected, 24 environmental samples were taken, of which two contained S. maltophilia. Six of the seven clinical isolates from the patients and two isolates from the environment were analyzed using molecular typing by pulsed-field gel electrophoresis (PFGE). The patients' isolates were resistant to gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and, except in one case, to amikacin and piperacillin/tazobactam and susceptible to ceftazidime and levofloxacin. In contrast, the environmental isolates were resistant to ceftazidime, showed intermediate susceptibility to ciprofloxacin, and were susceptible to trimethoprim/sulfamethoxazole. PFGE demonstrated indistinguishable or closely related (1-3 band difference) PFGE patterns in isolates from the patients, but a different pattern in the environmental isolates. No common source of infection was found despite intensive investigation. Extensive cleaning and other measures of infection control were carried out and no new cases were recorded in the two year follow-up period.

Prevalence and nosocomial spread of methicillin-resistant Staphylococcus aureus in a long-term-care facility in Slovenia.

OBJECTIVES: To determine the prevalence and incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among residents and healthcare workers (HCWs) of a long-term-care facility (LTCF), to assess possible routes of nosocomial spread, and to determine genetic relatedness of the isolates. SETTING: A 351-bed community LTCF for the elderly. DESIGN AND PARTICIPANTS: Study investigators made two visits, approximately 3 months apart, to the facility. Samples for cultures were obtained from 107 residents during the first visit, 91 residents during the second visit, and 38 HCWs. RESULTS: The prevalence of MRSA colonization among residents was 9.3% during the first visit and 8.8% during the second visit. During the first visit, two HCWs were colonized. During the second visit, no HCWs were colonized. The colonization of HCWs suggested a potential role in the transmission of MRSA. Molecular typing showed that two of three roommates in one room had the same strain, whereas two in another room differed from one another. All isolates, except one, belonged to two related clonal groups. It seems that the clonal group to which most isolates belonged had the greatest potential for spreading among both residents and HCWs. CONCLUSIONS: Similar prevalence rates of MRSA colonization have been found in other European countries, but such studies have usually involved residents with better functional status than that of the participants in this study. Nosocomial spread of MRSA occurred in the facility examined, but not frequently. More attention should be focused on the hand hygiene of HCWs.

Risk factors for colonization with methicillin-resistant Staphylococcus aureus in a long-term-care facility in Slovenia.

OBJECTIVE: To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization in a long-term-care facility (LTCF) for the elderly in Slovenia. SETTING: A 351-bed community LTCF for the elderly. DESIGN AND PARTICIPANTS: This was a case-control study. MRSA carriage was identified in 102 of 127 residents of the facility's nursing unit. Two swabs were taken: one from the anterior nares and one from the largest skin lesion. If no skin lesions were present, the axillae and the groin area were swabbed. Data were collected regarding gender, age, length of stay in the facility, underlying conditions, functional status, presence of wounds or pressure sores, presence of catheters, antibiotic treatments, and hospital admissions. RESULTS: We detected MRSA in 12 participants. Risk factors independently and significantly associated with MRSA colonization on the multivariate analysis were antibiotic treatments within 1 month before the investigation (odds ratio, 5.087; 95% confidence interval, 1.02 to 25.48; P = .048) and multiple hospital admissions in the 3 months before the investigation (odds ratio, 6.277; 95% confidence interval, 1.31 to 30.05; P = .022). CONCLUSIONS: This is the first assessment of risk factors for colonization with MRSA in an LTCF in Slovenia. MRSA poses a problem in this LTCE Our observations may be valuable in implementing active surveillance cultures in infection control programs in Slovenian LTCFs.

Possibility of application of new pneumococcal conjugate vaccines in children in Slovenia.

The emergence of pneumococcal strains resistant to penicillin caused a lot of problems in the therapy of invasive diseases, and added new dimensions to the role of immunisation. In addition to the currently available 23-valent pneumococcal polysaccharide vaccine (PPV) and a new 7-valent conjugate vaccine (PCV) (Prevnar, Wyeth Lederle), two new conjugate vaccines-a 9- and a 11-valent-are being developed. So far, the choice of most appropriate vaccines has depended on the established prevalence of serotypes causing invasive diseases and their antibiotic resistance in the Slovene children population. Between 1993 and 2001, 263 invasive pneumococcal strains isolated from children with invasive diseases were typed. During the period 1998-2001, the same 161 invasive strains were tested for their antibiotic sensitivity. Streptococcus pneumoniae was identified as the major cause of invasive bacterial diseases in the Slovene children population, especially in children under 4 years of age. Distribution by age groups showed the highest incidence in children aged 0-1 years. The predominant serotypes in all age groups were serotypes 14, 1, 19F, 23F, 6B, 18C and 6A. The distribution of penicillin-intermediate and penicillin-resistant strains showed the predominance of serotypes 23F, 14 and 19F. As concerns infection with S. pneumoniae serotypes, we have proved that children aged less than 5 years are more likely to be infected with penicillin-nonsusceptible or intermediate susceptible strains than older children. The 7-valent conjugate vaccine covers 74% of invasive strains in toddlers, but is less effective in older children. We can conclude that the 9-valent vaccine formulation is optimal for our country, but further cost-effectiveness analysis must be done for recommendation of wide use. At that moment it is reasonable to use the 7-valent conjugate vaccine for children with chronic cardiovascular, pulmonary, urinary and liver diseases, with asplenia, neoplasmia, diabetes, meningomyelocoele, before or after bone marrow transplantation and in cases of immunodeficiency.

Susceptibilities to telithromycin and six other agents and prevalence of macrolide resistance due to L4 ribosomal protein mutation among 992 Pneumococci from 10 central and Eastern European countries.

The macrolide and levofloxacin susceptibilities of 992 isolates of Streptococcus pneumoniae from clinical specimens collected in 1999 and 2000 were determined in 10 centers in Central and Eastern European countries. The prevalences of penicillin G-intermediate (MICs, 0.125 to 1 microg/ml) and penicillin-resistant (MICs, < or =2 microg/ml) Streptococcus pneumoniae isolates were 14.3 and 16.6%, respectively. The MICs at which 50% of isolates are inhibited (MIC(50)s) and the MIC(90)s of telithromycin were 0.016 and 0.06 microg/ml, respectively; those of erythromycin were 0.06 and >64 microg/ml, respectively; those of azithromycin were 0.125 and >64 microg/ml, respectively; those of clarithromycin were 0.03 and >64 microg/ml, respectively; and those of clindamycin were 0.06 and >64 microg/ml, respectively. Erythromycin resistance was found in 180 S. pneumoniae isolates (18.1%); the highest prevalence of erythromycin-resistant S. pneumoniae was observed in Hungary (35.5%). Among erythromycin-resistant S. pneumoniae isolates, strains harboring erm(B) genes (125 strains [69.4%]) were found to be predominant over strains with mef(E) genes (25 strains [13.4%]), L4 protein mutations (28 strains [15.6%]), and erm(A) genes (2 strains [1.1%]). Similar pulsed-field gel electrophoresis patterns suggested that some strains containing L4 mutations from the Slovak Republic, Bulgaria, and Latvia were clonally related. Of nine strains highly resistant to levofloxacin (MICs, >8 microg/ml) six were isolated from Zagreb, Croatia. Telithromycin at < or =0.5 microg/ml was active against 99.8% of S. pneumoniae isolates tested and may be useful for the treatment of respiratory tract infections caused by macrolide-resistant S. pneumoniae isolates.

Susceptibility to telithromycin in 1,011 Streptococcus pyogenes isolates from 10 central and Eastern European countries.

Among 1,011 recently isolated Streptococcus pyogenes isolates from 10 Central and Eastern European centers, the MICs at which 50% of isolates are inhibited (MIC(50)s) and the MIC(90)s were as follows: for telithromycin, 0.03 and 0.06 microg/ml, respectively; for erythromycin, azithromycin, and clarithromycin, 0.06 to 0.125 and 1 to 8 microg/ml, respectively; and for clindamycin, 0.125 and 0.125 microg/ml, respectively. Erythromycin resistance occurred in 12.3% of strains. Erm(A) [subclass erm(TR)] was most commonly encountered (60.5%), followed by mef(A) (23.4%) and erm(B) (14.5%). At <0.5 microg/ml, telithromycin was active against 98.5% of the strains tested.