epidemiological data of nosocomial infections in … ·  · 2013-12-06epidemiological data of...

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: nsih@wiv-isp.be | 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

Boudewijn.Catry@wiv-isp.beBoudewijn.Catry@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