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[Urinary tract infections in older adults: Etiology and antimicrobial susceptibilities in a southern area of Spain]. Rev Esp Geriatr Gerontol 2023; 58:22-26. [PMID: 36707356 DOI: 10.1016/j.regg.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice and increases in patients older than 65years compared to middle-aged patients. In order to improve empirical treatment, the etiology and antibiotic sensitivity profile of the most frequent bacteria that produce UTIs in older people have been studied. MATERIAL AND METHODS Cross-sectional, descriptive and retrospective study in which isolated micro-organisms with significant counts in urine samples from patients with UTI were included. The global etiology and according to sex were analyzed. Only one urine sample per patient and UTI episode was considered. RESULTS Regarding the origin of the sample, the highest proportion was in primary care with 4853 urine cultures (51.6% of positive urine cultures), followed by hospital care with 3565 urine cultures (46.4% of positive urine cultures) and 94 urine cultures in nursing homes elderly (2% positive urine cultures). Escherichia coli was the most isolated micro-organism both in the population as a whole (54%) and in each of the analyzed groups. It was observed that E.coli isolated in women was significantly higher than in men (χ2, P=.044). Their sensitivity was: 80% fosfomycin and 75% amoxicillin-clavulanic acid. CONCLUSIONS E.coli continues to be the most frequently isolated micro-organism in UTI. Empirical treatment of UTI in our environment should include fosfomycin or amoxicillin-clavulanic acid, regardless of the health care unit and gender.
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He Y, Wu L, Liao P, Shen L, Yang H. Phenotypic and genotypic characterization of multi-drug resistance Pseudomonas aeruginosa isolated from urinary tract infections of non-catheterized and catheterized Chinese patients: A descriptive study over 3 years. Medicine (Baltimore) 2022; 101:e31373. [PMID: 36451381 PMCID: PMC9704882 DOI: 10.1097/md.0000000000031373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Urinary tract infections (UTI) are commonest infections, especially in catheterized patients. It is responsible of mortality and morbidity among hospitalized patients. The objectives of the study were to demonstrate the virulence factors and their genes of multi-drug resistance Pseudomonas aeruginosa causing UTI. A total of 366 non-catheterized and 171 catheterized patients' (in whom the catheter was in > 48 hours duration) urine samples (one sample/patient) from both sexes were collected and processed. >105 colony forming unit was considered as Pseudomonas aeruginosa culture-positive. Antimicrobial susceptibility testing was done by the Kirby Bauer disc diffusion method (The Clinical and laboratory standards institute guidelines 2019). The virulence factors were detected by in vitro assay method and polymerase chain reaction was done to detect the resistance genes present in Pseudomonas aeruginosa. Biofilm production was detected by the microtiter plate method. Out of 537 urine samples a total of 280 (52%) were females and 257 (48%) were male patients. Out of 366 non-catheterized urine samples 42 (23.6%) grew Pseudomonas aeruginosa and out of 171 catheterized urine 23 (25.84%) grew Pseudomonas aeruginosa. All were multi-drug resistance strains. A total of 10 (23.80%), 42 (100%), 8 (19.05%), 24 (57.14%), and 36 (85.71%) produced the Metallo-β-lactamases, AmpC-β-lactamase, carbapenemase, strong biofilm, and twitching motility positive, respectively in non-catheterized urine samples. A total of 11, 34, 9, 28, and 37 were oxacillinases-23, multidrug efflux protein resistance, New Delhi metallo-ß-lactamase-1, Verona Integron-encoded MBL, and Pseudomonas specific enzyme gene detected in non-catheterized urine samples. A total of 8 (34.8%), 6 (26.01%), 4 (17.39%), 15 (65.2%), and 18 (78.26%) were produced Metallo-β-lactamases, carbapenemase, AmpC-β-lactamase, strong biofilm, and twitching motility positive, respectively in catheterized urine samples. A total of 6, 18, 4, 16, and 15 were oxacillinases 23, multidrug efflux protein resistance, New Delhi metallo-ß-lactamase-1, Verona Integron-encoded MBL, and Pseudomonas specific enzyme, respectively genes detected in catheterized urine samples. Biofilm formation and twitching motility showed correlation among culture-positive Pseudomonas aeruginosa strains from catheterized patients (Correlation coefficients = 6.2, 95% confidence interval: 5.4-7.2). A better hospital infection control practice and detailed investigation of the microevolution of Pseudomonas aeruginosa in UTI are needed.
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Affiliation(s)
- Yanhong He
- Department of Clinical Laboratory, Anting Hospital, Anting Town, Jiading District, Shanghai, China
| | - Lamei Wu
- Department of Clinical Laboratory, Anting Hospital, Anting Town, Jiading District, Shanghai, China
| | - Pingming Liao
- Department of Clinical Laboratory, Anting Hospital, Anting Town, Jiading District, Shanghai, China
| | - Lili Shen
- Department of Clinical Laboratory, Anting Hospital, Anting Town, Jiading District, Shanghai, China
| | - Huijian Yang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Pudong New Area, Shanghai, China
- * Correspondence: Huijian Yang, Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Pudong New Area, Shanghai, China (e-mail: )
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Manseck AS, Otto W, Schnabel M, Denzinger S, Burger M, Spachmann PJ. Geriatric Patients and Symptomatic Urinary Tract Infections: Analysis of Bacterial Range and Resistance Rates at a 3rd Level of Care Hospital in Germany. Urol Int 2022; 106:298-303. [PMID: 34175852 PMCID: PMC8985023 DOI: 10.1159/000516677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing life expectancy and demographic change result in a rising number of geriatric patients, but knowledge about geriatric treatment options and adapted diagnostic pathways is low. Simultaneously, urinary tract infections (UTIs) are common in older people and often difficult to treat. METHODS Patients with a UTI at a urological outpatient department between January 01, 2016, and December 31, 2017, were retrospectively identified in the data system. One thousand one hundred fifteen patients with "N30" and "N39" diagnosis were included in this study, 965 of which were under the age of 75 (group 1) and 150 of which 75 years or older (group 2). RESULTS Of 150 patients in group 2, 41.6% had nitrite-positive urine (vs. 20.9% in group 1, p < 0.05 in χ2 testing). Patients in group 2 often had indwelling devices (30.3 vs. 6.0%, p < 0.05) and presented a sterile urine culture in only 20.7% (vs. 40.1% in group 1). Regarding calculated antibiotic therapy, there were significant differences concerning prescription of ciprofloxacin (34.9 vs. 25%, p < 0.05) and fosfomycin (12.7 vs. 40.7%, p < 0.05). CONCLUSION UTI in geriatric patients should be treated differently than in younger patients because antibiotic resistance is high. The group with indwelling devices is complex. Individual strategies for geriatric patients should be considered.
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Affiliation(s)
- Ann-Sera Manseck
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany,Urologie im Gesundheitsforum, Regensburg, Germany,Nierenzentrum Eichstätt, Ambulanz für Urologie, Eichstätt, Germany
| | - Marco Schnabel
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Philipp Julian Spachmann
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany,*Philipp Julian Spachmann,
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Higashibata T, Hamano J, Hisanaga T, Hagiwara S, Shimokawa M, Yabuki R, Yokomichi N, Shimoinaba J, Kamura R, Baba M, Funaki H, Mori M, Morita T, Tsuneto S, Kizawa Y. Does Urinary Catheterization Affect the Quality of Death in Patients with Advanced Cancer? A Secondary Analysis of Multicenter Prospective Cohort Study. J Palliat Med 2021; 25:205-212. [PMID: 34637627 DOI: 10.1089/jpm.2021.0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with life-limiting illnesses frequently experience urinary difficulties, and urinary catheterization is one of the interventions for managing them. However, evidence supporting the effects of urinary catheters on the quality of death (QoD) is lacking in this population. Objectives: To investigate whether urinary catheterization affects QoD in patients with advanced cancer in palliative care units. Design: A secondary analysis of a multicenter, prospective cohort study. Setting/Subjects: The study enrolled consecutive patients with advanced cancer admitted to palliative care units in Japan between January and December 2017. Those who were not catheterized on admission and who died while in a palliative care unit were analyzed. Measurements: QoD was evaluated at death using the Good Death Scale (GDS). Results: Of 885 patients, 297 (33.6%) were catheterized during their palliative care unit stay. Females and patients with a long palliative care unit stay were more likely to be catheterized. In inverse probability-weighted propensity score analysis, patients with urinary catheterization during their palliative care unit stay had higher total GDS scores than those without catheterization (coefficient 0.410, 95% confidence interval 0.068-0.752). In subgroup analyses stratified by sex, age, and length of palliative care unit stay, urinary catheterization was associated with higher total GDS scores in patients younger than 65 years of age and those who died after a palliative care unit stay of 21 days or fewer. Conclusions: This study suggested that urinary catheterization during a palliative care unit stay may have a positive impact on overall QoD in patients with advanced cancer. This study was registered in the UMIN Clinical Trials Registry (UMIN000025457).
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Affiliation(s)
- Takahiro Higashibata
- Palliative Care Team, Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Shingo Hagiwara
- Department of Palliative Medicine, Yuai Memorial Hospital, Koga, Japan
| | - Miho Shimokawa
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ritsuko Yabuki
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Rena Kamura
- Hospice Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Japan
| | - Hiromi Funaki
- Department of Palliative Care, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
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Higashibata T, Hisanaga T, Hagiwara S, Shimokawa M, Yabuki R, Odagiri T, Ito T, Kamura R, Maeda I, Kosugi K, Mori M, Morita T, Tsuneto S, Hamano J. Differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units: A multicenter prospective cohort study (EASED). Palliat Med 2021; 35:799-805. [PMID: 33478365 DOI: 10.1177/0269216321989564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies on the appropriate use of urinary catheters for cancer patients at the end of life are limited. AIM To clarify the differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units. DESIGN Pre-planned secondary analysis of a multicenter, prospective cohort study; East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). SETTING/PARTICIPANTS This study enrolled consecutive advanced cancer patients admitted to palliative care units between January and December 2017. The final study group comprised 1212 patients from 21 institutions throughout Japan. RESULTS Out of the 1212 patients, 380 (31.4%; 95% confidence interval, 28.7%-34.0%) underwent urinary catheterization during their palliative care unit stay, and the prevalence of urinary catheterization in patients who died at palliative care units by institution ranged from 0.0% to 55.4%. When the 21 participating institutions were equally divided into three groups according to the institutional prevalence of catheterization, patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation were more likely to be catheterized in institutions with a high prevalence of catheterization than in those with a low or moderate prevalence (p < 0.008, p = 0.008, and p < 0.008, respectively). CONCLUSION This study revealed that the institutional prevalence of urinary catheterization in advanced cancer patients at palliative care units widely varied. Further studies are needed to establish the appropriate use of urinary catheters, especially in patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation.
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Affiliation(s)
- Takahiro Higashibata
- Palliative Care Team, Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Shingo Hagiwara
- Department of Palliative Medicine, Yuai Memorial Hospital, Koga, Japan
| | - Miho Shimokawa
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ritsuko Yabuki
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Rena Kamura
- Hospice Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review. J Hosp Infect 2019; 102:200-218. [DOI: 10.1016/j.jhin.2018.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
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Net P, Karnycheff F, Vasse M, Bourdain F, Bonan B, Lapergue B. Urinary tract infection after acute stroke: Impact of indwelling urinary catheterization and assessment of catheter-use practices in French stroke centers. Rev Neurol (Paris) 2018; 174:145-149. [PMID: 29395254 DOI: 10.1016/j.neurol.2017.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 04/12/2017] [Accepted: 06/15/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Urinary catheterization and acute urinary retention increase the risk of urinary tract infection (UTI). Our study aimed to investigate the incidence of UTI following acute stroke at our stroke center (SC) and to assess urinary catheter-care practices among French SCs. METHODS Stroke patients hospitalized within 24h of stroke onset were prospectively enrolled between May and September 2013. Neurological deficit level was assessed on admission using the US National Institutes of Health Stroke Scale (NIHSS). Patients were followed-up until discharge. Indwelling urinary catheterization (IUC) was the only technique authorized during the study. An electronic survey was also conducted among French SCs to assess their practices regarding urinary catheterization in acute stroke patients. RESULTS A total of 212 patients were included, with 45 (21.2%) receiving indwelling urinary catheters. The overall estimated incidence of UTI was 14.2%, and 18% among patients receiving IUC. On univariate analysis, IUC was significantly associated with older age, longer hospital stays and higher NIHSS scores. Of the 30 SCs that responded to our survey, 19 (63.3%) declared using IUC when urinary catheterization was needed. The main argument given to justify its use was that it was departmental policy to adopt this technique. Also, 27 participants (90%) stated that conducting a study to assess the impact of urinary catheterization techniques on UTI rates in acute stroke patients would be relevant. DISCUSSION Our results are in accord with previously reported data and confirm the high burden of UTI among acute stroke subjects. However, no association was found between IUC and UTI on univariate analysis due to a lack of statistical power. Also, our survey showed high heterogeneity in catheter-use practices among French SCs, but offered no data to help determine the best urinary catheterization technique. CONCLUSION Urinary catheterization is common after acute stroke and a well-known risk factor of UTI. However, as high heterogeneity in catheter-use practices is found among French SCs, randomized studies comparing the efficacy of urinary catheterization techniques in terms of UTI prevention in acute stroke patients are now warranted.
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Affiliation(s)
- P Net
- Department of pharmacy, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Department of infectious disease control, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - F Karnycheff
- Department of infectious disease control, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - M Vasse
- Department of clinical microbiology, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - F Bourdain
- Department of neurology, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - B Bonan
- Department of pharmacy, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - B Lapergue
- Department of neurology, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
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Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization. Rehabil Nurs 2017; 44:171-180. [PMID: 29244034 DOI: 10.1097/rnj.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization. DESIGN Cross-sectional survey with principal component analysis. METHODS Survey development and administration based on national guidelines. FINDINGS Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables. CONCLUSION The modified survey is a reliable measure of KAB. CLINICAL RELEVANCE The survey assists with identifying knowledge gaps, customizing education, and changing practice.
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Girard R, Gaujard S, Pergay V, Pornon P, Martin-Gaujard G, Bourguignon L. Risk factors for urinary tract infections in geriatric hospitals. J Hosp Infect 2017; 97:74-78. [PMID: 28526270 DOI: 10.1016/j.jhin.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is the most frequent nosocomial infection in geriatric units. An understanding of risk factors for infection may help to identify prevention strategies. AIM Identification of the risk factors for UTI in elderly patients. METHODS Retrospective analysis of three prospective cohorts. All hospitalized patients present in, or admitted to, a geriatric unit from June 1st to June 28th, for the years 2009, 2012, and 2015 were included and followed until discharge or until June 30th of the year concerned. For each patient, type and dates of stay, type and dates of catheter, risk factors, and nosocomial UTI (NUTI) data were collected. Univariate and multivariate (Cox model) analyses were made using SPSS software. FINDINGS A total of 4669 patients were included and were followed for a total of 83,068 days. There were 189 NUTIs (4.0% patients). NUTIs were significantly more frequent among female patients, in rehabilitation units, in immunosuppressed patients, among those with acute retention, post-void residual, history of urinary tract infection in the previous six months, and in case of dependency. NUTIs were significantly more frequent among those who had a catheter (Z-test, P < 0.001). NUTIs were more frequent among patients with intermittent, indwelling, or suprapubic catheters. They were also more frequent in acute/subacute care or rehabilitation units, in women, in immunosuppressed patients, and in those with a history of previous UTI; they were less frequent in dementia patients. CONCLUSION The occurrence of NUTI is an important issue in both catheterized and non-catheterized patients; prevention programmes should be widened to include non-catheterized patients.
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Affiliation(s)
- R Girard
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France.
| | - S Gaujard
- Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - V Pergay
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - P Pornon
- Service Hygiène et Prévention, Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - G Martin-Gaujard
- Institut du vieillissement, Hospices Civils de Lyon, Lyon, France
| | - L Bourguignon
- Hôpital Pierre Garraud, UMR CNRS 5558, Laboratoire de biométrie et biologie évolutive, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
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Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect 2016; 93:92-9. [DOI: 10.1016/j.jhin.2016.01.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
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