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Introduction Patients with nursing and healthcare-associated pneumonia (NHCAP) commonly receive empiric antibiotic therapy according to the guideline's recommendation corresponding to the patient's deteriorated conditions. However, it is unclear whether guideline-concordant treatment (GCT) could be effective or not. Patients and methods To evaluate the efficacy and validity of GCT according to the current guideline for pneumonia, we conducted this retrospective study. NHCAP patients who were admitted to our institute between 2014 and 2017 were enrolled. Based on the initial antibiotic treatment, these patients were divided into two groups, the GCT group (n = 83) and the non-GCT group (n = 146). Propensity score matching (PSM) was used to balance the baseline characteristics and potential confounders between the two groups. After PSM, patients’ characteristics, microbial profiles, and clinical outcomes were evaluated. Results Both groups were well-balanced after PSM, and 78 patients were selected from each group. There were no differences in patients’ characteristics or microbial profiles between the two groups. As for outcomes, there were no differences in 30-day, in-hospital mortality rate, duration of antibiotic treatment, or admission. The severity of pneumonia was more severe in patients with the GCT group than those with the non-GCT group. Anti-pseudomonal agents as initial treatment were more frequently seen in patients with the GCT group than those in the non-GCT group. Conclusion Unlike previous studies, GCT's recommendation for management of pneumonia by the JRS in 2017 would appear to be valid and does not increase the mortality rate.

New or preexisting atrial fibrillation (AF) is frequent in patients undergoing aortic valve replacement. We evaluated whether the presence of AF during transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) impacts the length of stay, healthcare adjusted costs, and inpatient mortality. The median length of stay in the patients with AF increased by 33.3% as compared with those without AF undergoing TAVI and SAVR (5 [3 to 8] days vs 3 [2 to 6] days, p

Objective:To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting.Design:A quasi-experimental before-and-after study.Setting:A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.Methods:Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis.Results:After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%).Conclusions:The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.

The morbidity and mortality of cryptococcal meningoencephalitis (CM) in previously healthy, HIV-negative individuals is increasingly recognized. We administered a healthcare associated quality of life (QOL) survey to the largest longitudinally followed cohort of these patients in the United States. We identified moderate or severe self-reported impairment in at least one QOL domain in 61% of subjects at least one year following diagnosis. Self-reported cognitive impairment was noted in 52% and sleep disturbance was noted in 55%. This is the first comprehensive study of cross-sectional long-term QOL in previously healthy patients following cryptococcal infection.

Introduction: Healthcare-associated ventriculitis and meningitis occur after neurosurgical procedures, is associated with an adverse outcome in the majority of patients and represent a diagnostic c...

Objectives Nursing and healthcare-associated pneumonia (NHCAP) was proposed by the Japanese Respiratory Society to refer to healthcare-associated pneumonia. This study aimed to investigate whether antipseudomonal antibiotic therapy improved the prognosis of NHCAP patients at high risk for antimicrobial-resistant pathogens. Methods Consecutive hospitalised NHCAP patients in Kurashiki Central Hospital between October 2010 and December 2016 were prospectively enrolled. NHCAP patients who were at high risk for antimicrobial resistance were defined as those who received antimicrobials in the preceding 90 days and/or were on tube feeding. The patients who received antipseudomonal antibiotics were defined as the guideline-concordant (GC) therapy group, and the others were defined as the guideline-discordant (GD) therapy group. The primary outcome was 30-day mortality. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Results There were 277 patients with NHCAP; a majority (78.0%) were discharged from a hospital in the preceding 90 days. There were 52 patients in the GC group and 225 patients in the GD group. The 30-day mortality rate was significantly higher in the GC group than in the GD group (17.3%, 9/52 vs. 7.1%, 16/225; P = 0.03). After IPTW analysis, the GC therapy, compared with GD therapy, did not improve the 30-day mortality (OR 1.71, 95% CI 0.65–4.47; P = 0.28). Conclusions Not all NHCAP patients, even those at high risk for antimicrobial resistance, need antipseudomonal antimicrobial treatment. The treatment strategy for NHCAP patients should be individualised, according to the pneumonia severity, risk for antimicrobial-resistant pathogens, and antibiogram in each hospital.

Background Escherichia coli is the most common cause of bacteremia in high-income countries. To enable the development and implementation of effective prevention strategies, a better understanding of the current epidemiology of invasive E. coli infections is needed. Methods A systematic review of literature published between 1 January 2007 and 31 March 2018 on the burden and epidemiology of E. coli bacteremia in populations that include adults in high-income countries was conducted. Meta-analysis was performed for descriptive purposes. Results During the studied time interval, the estimated incidence rate of E. coli bacteremia was 48 per 100 000 person-years, but this increased considerably with age: rates per 100 000 person-years were >100 in 55-to-75-year-olds and >300 in 75-to-85-year-olds. Overall, E. coli accounted for 27% of documented bacteremia episodes: 18% if hospital acquired, 32% if community-onset healthcare associated, and 33% if community acquired. The estimated case fatality rate was 12%. Approximately 44% of episodes were community acquired, 27% community-onset healthcare associated, and 27% hospital acquired. Urinary tract infection (UTI) was the primary source for 53% of episodes. Conclusions This systematic review confirms the substantial burden of E. coli bacteremia in older adults and justifies the implementation of community-level programs to prevent E. coli bacteremia and ideally UTI in this age group.

Chryseobacterium species are recognized as an emerging opportunistic bacterial pathogen in nosocomial settings especially in debilitated or immunosuppressed patients and neonates. The ubiquitous distribution in nature, ability to form biofilms with inherent resistance to broad-spectrum antimicrobials, and lack of clinical studies pose a further diagnostic and therapeutic challenge. This case report describes an elderly male with relapsed diffuse large B-cell lymphoma (DLBCL) status post-chemotherapy and radiation who acquired healthcare-associated pneumonia with sputum isolates showing Chryseobacterium gleum and Stenotrophomonas maltophila. It also includes a review of literature compiling all the previously reported cases with antibiotic susceptibilities, clinical picture, and treatment outcomes.

Background Epidemiological data on secondary bacteremia associated with nosocomial urinary tract infections generally include adult patients with urinary catheters. Aim To evaluate the frequency and outcome of secondary bacteremia complicating healthcare-associated urinary tract infections. Material and methods This study was conducted between May 2013 and December 2017 at the Dr. Behcet Uz Children's Hospital and included symptomatic nosocomial urinary tract infections. A total of 117 patients with positive blood cultures were enrolled in the study. Results Six patients had bacteremia associated with nosocomial urinary tract infections yielding an incidence of 5.1%. The pathogens responsible for secondary bacteremia were: Klebsiella pneumonia in two patients, Enterococcus faecium in two patients, Klebsiella oxytoca in one patient, and Pseudomonas aeruginosa in one patient. Conclusion The incidence of bacteremia associated with nosocomial urinary tract infections was not different from bacteremia associated with community-acquired urinary tract infections, and was approximately 5%.

Background There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. Objective To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. Sources The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). Content Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. Implications HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.

To review the clinical data on the safety and effectiveness of intravenous (IV) and intraventricular (IVT) tigecycline in healthcare-associated Acinetobacter baumannii meningitis and ventriculitis. A literature search was performed in PubMed (from 2005 to December 2018). The bibliographies of the retrieved articles were searched for additional relevant studies. Articles were included if they described the use of tigecycline (IV and/or IVT) in patients with healthcare-associated A. baumannii meningitis or ventriculitis. Clinical studies as well as case series and case reports were included, while animal and in vitro studies were excluded. The use of IV and/or IVT tigecycline was described in 39 patients infected with healthcare-associated A. baumannii meningitis or ventriculitis in 14 reports; 12 were case reports, one was case series, and one was retrospective multicenter study evaluating 23 carbapenem-resistant A. baumannii healthcare-associated meningitis cases treated with IV tigecycline including regimens. Using tigecycline was successful in most cases. Treatment failed in two patients and two patients died. Despite the limited studies, IV and IVT tigecycline has been used successfully and safely for the treatment of healthcare-associated A. baumannii meningitis and ventriculitis. However, large randomized controlled trials are necessary to clearly evaluate the safety and effectiveness of IV and IVT tigecycline in healthcare-associated A. baumannii meningitis and ventriculitis.

The rise in indices of infectious diseases and antimicrobial resistance is a cause for concern and calls for multiple approaches for control to be considered. The most exposed parts of the body, such as hands, skin, head and the face are a leading source of these pathogens. Hands in particular are in frequent contact with contaminated surfaces of both animate and inanimate objects. Diseases transmitted by contaminated hands are both airborne (such as influenza, adenovirus, hand-foot-mouth disease and tuberculosis) waterborne via droplets or dust (such as hepatitis A, cholera, diarrhoea etc.) and foodborne (such as foodborne illnesses, shigellosis and aspergillosis). Causative agents of such diseases include Escherichia coli , Salmonella typhi , hepatitis A virus, norovirus, Mycobacterium tuberculosis among others. Human and animal faces, handrails, table-tops and toys are some of the sources of these pathogens. An effective preventive strategy is the thorough washing of hands using soaps and detergents or alcohol-based hand sanitizers.

Cutaneous mucormycosis in children is an opportunistic fungal infection associated with significant morbidity and mortality. We describe characteristics of 12 patients with healthcare-associated cutaneous mucormycosis at Texas Children's Hospital and results of an outbreak investigation. A definitive source was not identified. Skin lesions near medical device securement sites should raise concern for mucormycosis in patients with underlying medical conditions.

Healthcare-associated Legionnaires’ disease (HCA LD) can cause nosocomial outbreaks with high death rates. We compared community-acquired LD cases with HCA LD cases in Europe during 2008−2017 using data from The European Surveillance System. A total of 29 countries reported 40,411 community-acquired and 4,315 HCA LD cases. Of the HCA LD cases, 2,937 (68.1%) were hospital-acquired and 1,378 (31.9%) were linked to other healthcare facilities. The odds of having HCA LD were higher for women, children and persons 60 years of age. Out of the cases caused by Legionella pneumophila with a known serotype, community-acquired LD was more likely to be caused by L. pneumophila serogroup 1 (92.3%) than was HCA LD (85.1%). HCA LD patients were more likely to die. HCA LD is associated with specific patient demographics, causative strains, and outcomes. Healthcare facilities should consider these characteristics when designing HCA LD prevention strategies.

Objective: The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Methods: A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: "S. pneumoniae", "MRSA", "Others" and "Unknown". Patients were followed up 30 days after discharge. Results: A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%): S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p

BACKGROUND Healthcare-associated infective endocarditis (HAIE) has become increasingly recognized worldwide because the underlying patient conditions are completely different from those of community-acquired infective endocarditis (CIE). However, data on HAIE in the Japanese population is lacking. We sought to clarify the patient characteristics and prognosis of HAIE in a Japanese population.Methods and Results:A retrospective study was conducted in 158 patients who were diagnosed with infective endocarditis, 53 of whom (33.5%) were classified as HAIE. Compared with patients with CIE, those with HAIE were older (median age 72 vs. 61 years; P=0.0002) and received surgical treatment less frequently (41.5% vs. 62.9%; P=0.01). Regarding causative microorganisms, staphylococci,including methicillin-resistant pathogens, were more common in patients with HAIE (32.1% vs. 14.3%; P=0.01). Patients with HAIE had higher in-hospital mortality (32.1% vs. 4.8%; P

Healthcare-associated meningitis and ventriculitis are a common problem of modern public health, which are characterized by diverse etiological spectrum of multidrug resistant microorganisms, presented by difficulties for early diagnosis and adequate treatment, and are often accompanied by a high risk of secondary complications and an unfavorable outcome. This article presents the clinical guidelines of the American Society of Infectious Diseases (IDSA) for the diagnosis and treatment of healthcare-associated meningitis and ventriculitis published in 2017 and may be useful for professionals working with this category of patients.

Summary Objectives To assess real-world treatment patterns and clinical outcomes associated with initial antibiotic therapy (IAT, antibiotics received ≤ 48 h post-initiation of antibiotic therapy), including level of IAT failure, and potential risk factors for IAT failure in healthcare-associated infections. Methods Data were obtained from medical records of adult patients hospitalized with healthcare-associated pneumonia (HCAP) and nosocomial pneumonia (NP), including ventilator-associated pneumonia, from 1 July 2013 to 30 June 2014 in Brazil, France, Italy, Russia and Spain during the retrospective, observational study, RECOMMEND (NCT02364284; D4280R00005). Potential risk factors for IAT failure were explored using logistic regression analyses. Results Mean (standard deviation) age and Deyo-Charlson Comorbidity Score were 66.0 (16.2) years and 2.4 (2.4), respectively ( N = 451). Most patients (62.5%) received monotherapy. Mean (standard deviation) duration of IAT was 8.8 (7.2) days. Multidrug-resistant (MDR) pathogens were identified in 52.4% of patients with ≥ 1 pathogen isolated (154/294). IAT failure was recorded in 72.5% of patients and was significantly associated with isolation of a MDR pathogen and country using multivariate analyses. Conclusions Real-world data demonstrate the burden of HCAP/NP, with high rates of IAT failure. The association of IAT failure with MDR pathogens highlights the urgent need to understand and account for local prevalence of MDR pathogens when selecting IAT for the management of HCAP/NP.

The Japanese Respiratory Society newly updated the prognostic guidelines for pneumonia in 2017. Quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) score are used to evaluate the severity of pneumonia and to select the therapy for pneumonia. This is a retrospective study at Aichi Medical University hospital from January to December of 2016 to investigate the accuracy and usefulness of qSOFA and SOFA score in evaluating the severity and prognosis of healthcare-associated pneumonia (HCAP). A total of 81 HCAP patients were enrolled in this study. Both the 30-day and in-hospital mortality were 7.5% (6/81). qSOFA≧2 was in 33/78 patients (42%) and

Introduction Healthcare-associated pneumonia (HCAP) is the leading cause of infection in a hospital setting and is associated with a high mortality rate. This study aimed to evaluate the performance of the pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age≥65 (CURB-65) systems in predicting 30-day mortality in HCAP in adult patients. Patients and methods A cross-sectional study took place and data from 109 non-immunocompromised individuals aged>18 years were analyzed. The clinical diagnosis of HCAP included the presence of radiographic infiltrates in patients≥48hours after hospital admission. The PSI and CURB-65 scores were calculated and performance measures were estimated. Summary statistics were used to describe the study sample. The PSI and CURB-65 scores were calculated based on 20 and 5 criteria, respectively, and the performance indicators of the screening tools were estimated. Results The overall 30-day mortality was 59.6%. At every given threshold, PSI sensitivity was higher, but showed a lower specificity than the CURB-65, and the highest Youden index (0.392) was observed at cut-off V in the PSI. The area under the ROC curve was 0.737 (95% CI: 0.646-0.827) and 0.698 (95% CI: 0.600-0.797) using the PSI and CURB-65 systems, respectively (P=.323). Conclusion Our findings suggest that the performance of the PSI and CURB-65 is reasonable for predicting 30-day mortality in adult HCAP patients and may be used in healthcare settings.

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)., Pneumonia is one of the main causes of hospitalization and mortality. It's the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia.

Aim. Identification of possible risk factors, assessment of their information value, and compilation of a prognostic table for assessing the risk of healthcare associated infections in puerperas. Materials and Methods. Experimental and control groups were formed from among the puerperas. The experimental group included 147 women who developed purulent-septic infection within 30 days after delivery. The control group was formed by the mechanical selection of each 50th labor and delivery record for the aforementioned period and included 300 subjects. Possible risk factors were divided into groups: social factors, factors related to the state of woman's health, factors associated with the peculiarities of the pregnancy course, factors associated with the peculiarities of the labor course, factors associated with the postpartum period. Results. During the study, the following risk factors were identified: unregistered marriage, prenatal hospitalization to the Department of Pathology of Pregnancy for more than 1 bed-day, first labor, uncoordinated contractions, amniotomy, episiotomy, hysterocervicorrhexis, staying in the ward of separate residence in the postpartum period. Based on the sum of the values of prognostic indices, calculated for each risk factor, three prognostic groups were formed: high, average and low risk. Forecasting of the risk for healthcare associated infection development in a patient is carried out by simple arithmetic addition of prognostic indices. Conclusion. To prevent healthcare associated infections, it is recommended: to carry out bacteriological examination of an afterbirth and prescribing preventive course of antibiotics to puerperas of the high risk group in the postpartum period; to specify that a woman is at high or average risk, if any, in the discharge documentation to inform the Women's Health Department. The information on belonging of the puerperas to a particular risk group can be used by the hospital epidemiologist when carrying out operational and retrospective analysis.

Healthcare-associated Legionnaires’ disease (HCA LD) causes significant morbidity and mortality, with varying guidance on prevention. We describe the evaluation of a case of possible HCA LD and note the pitfalls of relying solely on an epidemiologic definition for association of a case with a facility. Our detailed investigation led to the identification of a new Legionella pneumophila serogroup 1 sequence type, confirmed a healthcare association and helped build the framework for our ongoing preventive efforts. Our experience highlights the role of routine environmental cultures in the assessment of risk for a given facility. As clinicians increasingly rely on urinary antigen testing for the detection of L. pneumophila, our investigation emphasises the importance of clinical cultures in an epidemiologic investigation.

The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections. Keywords. ventriculitis; meningitis; cerebrospinal fluid shunts; cerebrospinal fluid drains; central nervous system infections.

Background: In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice. Objectives: In this review, we assessed the clinical significance of severity assessment tools for HCAP. Methods: We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP. Results: Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥2 and ≥3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥2 and ≥3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients. Conclusions: The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.

We report a case of infective endocarditis secondary to healthcare-associated bloodstream infection caused by an uncommon etiologic agent, multidrug-resistant Enterobacter cloacae. The patient was treated with a combination of antimicrobial therapy and surgery, but could not be saved. With this case, we discuss the prevalence, risk factors, treatment options, and outcomes of the rarely encountered Enterobacter cloacae-associated infective endocarditis.

Objective: To determine the proportion of healthcare workers (HCWs) in smaller Victorian public healthcare facilities with documented evidence of measles immunity. Methods: A cross‐sectional survey, developed by the Victorian Healthcare Associated Surveillance System Coordinating Centre, was completed by all eligible facilities. HCWs were reported as having evidence or no evidence of measles immunity. Those without evidence of immunity were sub‐classified as incomplete, declined or unknown status. Results: Seventy‐five facilities reported measles immunity status of 17,522 employed HCWs. Of these, 11,751 (67.1%) had documented evidence of immunity. The proportion with evidence of immunity was lowest (45.6%) in facilities with ≤50 HCWs. The majority of HCWs without evidence of immunity (88.2%) had ‘unknown’ status. Declination or incomplete status comprised very low overall proportions (0.3% and 3.6%, respectively). Conclusions: Reported evidence of HCW measles immunity was moderate in surveyed facilities, with a large proportion having unknown status. HCW immunisation programs in some facilities require refinement to appropriately support public health responses to measles cases and prevention of occupational acquisition of measles. Implications for public health: Non‐immune HCWs are at increased risk for acquiring and transmitting measles. Timely access to accurate HCW immunisation records is required to ensure that public health responses are effective.

Healthcare-associated infections (HAIs) arise from exposure to infectious organisms within a healthcare setting, HAIs are a significant occupational risk for Medical Radiation Science (MRS) professionals which have a high degree of patient-contact. Methods: Systematic reviews and Meta-Analyses (PRISMA) guidelines were used in this research. The inclusion criteria were studies describing infectious organisms found directly in MRS departments or outlining a risk of infection to MRS professionals. Studies on infectious organisms on clothing or equipment used in these departments were also included. Results: Screening excluded 1655 articles that didn’t meet the criteria, twenty-one articles were included in the final review. Preliminary findings, published between 1998 and 2018, were from eleven countries. Three studies were set in radiotherapy and thirteen in diagnostic radiography departments. No studies were published from nuclear medicine departments. Twenty different organisms were identified. Conclusion: Preliminary findings indicate a lack of related published studies within nuclear medicine departments.

The usefulness of existing pneumonia severity indices for predicting mortality in nursing and healthcare-associated pneumonia (NHCAP) is unclear. This study compared the usefulness of existing pneumonia severity indices for predicting mortality in NHCAP and community-acquired pneumonia (CAP). Consecutive hospitalized pneumonia patients including NHCAP and CAP patients were prospectively enrolled between October 2010 and November 2017. Admission pneumonia severity was assessed using CURB-65, Pneumonia Severity Index (PSI), A-DROP, Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) severe pneumonia criteria, and I-ROAD. The primary outcome was 30-day mortality. The discriminatory ability of each severity index was evaluated by receiver operating characteristic curve analysis. Overall, 828 patients had NHCAP, and 1330 patients had CAP. Thirty-day mortality was 12.8% and 5.6% in NHCAP and CAP patients, respectively. The area under the curve of PSI (0.717, 95% confidence interval 0.673–0.761) was the highest among all pneumonia severity indices, with significant differences compared with CURB-65 (0.651, 95% confidence interval 0.598–0.705, P = 0.02) and IDSA/ATS severe pneumonia criteria (0.659, 95% confidence interval 0.612–0.707, P = 0.03). The predictive abilities for 30-day mortality of the pneumonia severity indices, excluding PSI and I-ROAD, were significantly inferior for NHCAP than for CAP. PSI may be the most useful pneumonia severity score for predicting mortality in NHCAP. However, the predictive ability for mortality of each pneumonia severity score was worse for NHCAP than for CAP; therefore, the prognostic factors in NHCAP need to be identified for better management of NHCAP patients.

Background:Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.Methods:We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.Results:Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.Conclusions:Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.

The impact of antibiotic therapy on the diagnosis of healthcare–associated ventriculitis and meningitis (HCAVM) is unknown. Antibiotics were administered before obtaining cerebrospinal fluid (CSF) in 217 out of 326 (66%) patients with HCAVM, and they impacted the sensitivity of the cerebrospinal fluid Gram stain and culture (P ≤ .004).

Background Klebsiella pneumoniae bacteremia is a major cause of morbidity and mortality worldwide. We aimed to compare the clinical characteristics, distribution of capsular types, and antimicrobial resistance of K. pneumoniae bacteremia among community-acquired (CA), healthcare-associated (HCA), and nosocomial infections. Methods This retrospective study of patients with K. pneumoniae bacteremia was conducted at Taipei Veterans General Hospital from January to December 2015. Clinical characteristics of K. pneumoniae bacteremia were collected. The K. pneumoniae isolates were subjected to antimicrobial susceptibility testing and capsular genotyping. Results In total, 337 patients with K. pneumoniae bacteremia were identified: 70 (20.8%), 102 (30.3%), and 165 (48.9%) presented with CA, HCA, and nosocomial infection, respectively. The 28-day mortality of HCA bacteremia was lower than that of nosocomial bacteremia (17.6% versus 30.9%, p = 0.016); however, that of the HCA and CA bacteremia was similar (17.6% versus 14.3%, p = 0.557). CA isolates had the highest prevalence of virulent capsular types (51.4%), followed by HCA (36.3%) and nosocomial isolates (19.4%). The proportion of multidrug-resistant (MDR) isolates was highest in nosocomial infections (41.8%), followed by HCA (23.5%) and CA infections (5.7%). Conclusion CA, HCA and nosocomial K. pneumoniae are distinct entities, as evidenced by the differences in clinical characteristics, antimicrobial resistance, and capsular types found in this study.

Background Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital. Methods A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period. Results Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission Conclusion HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.

Compared to chart review, a definition based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for healthcare-associated influenza-like illness (HA-ILI) among young children in a large pediatric network demonstrated high positive and negative predictive values. This finding suggests that electronic health record–based definitions for surveillance can accurately identify medically attended outpatient HA-ILI cases for research and surveillance.Infect Control Hosp Epidemiol 2016;1–4

본 증례는 감염성 심내막염으로 진단된 환자에서 CA-MRSA가 동정되었으며 분자형은 PVL 음성 SCCmec type IV A; the MLST ST 72; 1-4-1-8-4-4-3 MRSA clone이었다. 심내막염의 원인 병원체였던 MRSA는 지역사회가 아닌 병원에서 발생한 것으로 추정되며 vancomycin에 감수성이 있었음에도 치료 실패하여 linezolid로 변경하여 성공적으로 치료되어 문헌고찰과 함께 보고하는 바이다.

Background The burden of healthcare-associated viral respiratory infections (HAVRIs) in children is significant, with increased healthcare costs and risk of poor outcomes. However, while healthcare workers are the main target of infection prevention measures, little is known about the impact of sick contacts during hospitalization on the incidence of HAVRIs. The objective of our study was to determine the proportion of pediatric HAVRIs following contact with an ill caregiver or visitor. Secondary objectives were to describe the characteristics of affected patients as well as the complications associated with the HAVRI episodes. Methods This is a retrospective chart review that took place in a pediatric tertiary care center with both multiple and single-bed rooms. All cases of HAVRIs that occurred between December 2017 and July 2019 in patients aged less than 18 years old were included in the study. HAVRIs were defined as a laboratory confirmed respiratory viral illness occurring after 72 hours of admission. Results Forty-four HAVRIs were included in the analysis. The majority (n=32, 72.7%) were among patients aged less than 24 months. Only 2 patients had no comorbidities and almost half (n=21, 47.7%) had multiple complex medical conditions. Rhinovirus was the most frequently isolated virus (n=20, 45.5%). Nine patients (20.5%) had a documented contact with a sick caregiver (n=8, 88.9%) or sick visitor (n=2, 22.2%) in the 7 days prior to the onset of new respiratory symptoms and subsequent HAVRI diagnosis. In the 72 hours prior to HAVRI onset, 18 patients (40.9%) were in a single-bed room and 6 patients (13.6%) were already under droplet/contact precautions. Twelve patients (27.3%) had new or increased O2 requirements and 4 (9.1%) were transferred to the intensive care unit. There were no associated deaths. Conclusion Our study suggests that having a contact with a sick caregiver or visitor is a potential risk factor for acquiring a HAVRI. This reinforces the relevance of a strict visitor-screening policy and of educating caregivers on the importance of appropriate hand hygiene when caring for their child. Of note, more than one third of HAVRI cases occurred in patients already in a single-bed room, with or without additional precautions, suggesting that those measures are not entirely protective. Disclosures All Authors: No reported disclosures