Point-prevalence survey of healthcare-associated infections in Beijing, China: a survey and analysis in 2014

Eight year study on evolution of antimicrobial resistance in an antimicrobial-naïve trauma population

PURPOSE

Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). Moreover, the burden of HAIs is higher in ICU admitted patients. Long term studies are beneficial to evolution pattern of AMR. Therefore, this study aimed to evaluate the evolution of AMR pattern over the years in one of the ICUs of a level 1 Trauma Center. This will enable us to modify the prescribing practices according to emerging resistance patterns.

METHODS

This study was conducted at one of the ICU of level-1 trauma center of tertiary care hospital. The study reports the findings of the AMR surveillance from January 2012 to December 2019. Standard definitions were used to define HAI (www.hais.com). The clinical records of the patients were maintained using ASHAIN indigenous software. Outbreak analysis was done by WHONET.

RESULTS

From 1st January 2012-31st December 2019, 4305 isolates were obtained from 1969 patients. Most frequent occurring organism were gram negatives among which A. baumannii was common followed by K. pneumoniae, and P. aeruginosa. Retrospective analysis showed 7 outbreaks/clusters during the study period and all the outbreaks occurred from October to December in each year. The increasing trend of AMR pattern emphasizes to strengthen infection control practices and sustained AMR surveillance.

Effect of daily chlorhexidine bathing on reducing infections caused by multidrug-resistant organisms in intensive care unit patients: A semiexperimental study with parallel controls

OBJECTIVE

To assess the effectiveness of daily bathing by chlorhexidine bathing on multidrug-resistant organisms in ICU, especially on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE).

METHODS

Semiexperimental study which employed both precontrols and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.

RESULTS

The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1000 patient days, and bathing of every 19 patients (95CI% 13 to 41) and 39 patients (95CI% 24 to 110) were able to prevent one case of HAIs of total MDROs and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE, and CRE (p > 0.05).

CONCLUSION

Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.

Update on the epidemiology of healthcare-acquired bacterial infections: focus on complicated skin and skin structure infections

Healthcare-associated infections (HCAIs) are a threat to patient safety and cause substantial medical and economic burden in acute care and long-term care facilities. Risk factors for HCAIs include patient characteristics, the type of care and the setting. Local surveillance data and microbiological characterization are crucial tools for guiding antimicrobial treatment and informing efforts to reduce the incidence of HCAI. Skin and soft tissue infections, including superficial and deep incisional surgical site infections, are among the most frequent HCAIs. Other skin and soft tissue infections associated with healthcare settings include vascular access site infections, infected burns and traumas, and decubitus ulcer infections.

Review of Ceftazidime-Avibactam for the Treatment of Infections Caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that causes a range of serious infections that are often challenging to treat, as this pathogen can express multiple resistance mechanisms, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes. Ceftazidime–avibactam is a combination antimicrobial agent comprising ceftazidime, a third-generation semisynthetic cephalosporin, and avibactam, a novel non-β-lactam β-lactamase inhibitor. This review explores the potential role of ceftazidime–avibactam for the treatment of P. aeruginosa infections. Ceftazidime–avibactam has good in vitro activity against P. aeruginosa relative to comparator β-lactam agents and fluoroquinolones, comparable to amikacin and ceftolozane–tazobactam. In Phase 3 clinical trials, ceftazidime–avibactam has generally demonstrated similar clinical and microbiological outcomes to comparators in patients with complicated intra-abdominal infections, complicated urinary tract infections or hospital-acquired/ventilator-associated pneumonia caused by P. aeruginosa. Although real-world data are limited, favourable outcomes with ceftazidime–avibactam treatment have been reported in some patients with MDR and XDR P. aeruginosa infections. Thus, ceftazidime–avibactam may have a potentially important role in the management of serious and complicated P. aeruginosa infections, including those caused by MDR and XDR strains.

Point-Prevalence Survey for the Hospital-Acquired Infections in Intensive Care Units of Trauma Center in a Tertiary Care Hospital of Northern India

Background  The burden of hospital-acquired infections (HAIs) is all assumption based, and the true burden remains unknown in most countries, particularly in the developing countries where healthcare facilities are suboptimal and knowledge is limited.

Methodology  This cross-sectional study was conducted at the trauma center of a tertiary care institute from August to September 2019, to assess the burden of HAI and antibiotic resistance pattern of HAI. The total sample size in our study was 105. Our objective was to estimate the point prevalence of HAI and study the associated factors in a tertiary care hospital.

Result  In this study, the point prevalence of HAI was five to six times higher when compared with that of developed countries. Gram-negative organisms were the predominant bacteria; with Acinetobacter baumannii the most common among them.

Conclusion  Point-prevalence survey is an important objective of the antimicrobial stewardship program; it will be helpful in controlling antimicrobial resistance and this tool plays a significant role in hospital settings. Our study is quite pertinent to assess the point prevalence of HAI. It will help in knowing the current prevalence and pattern of the HAI. Therefore, as healthcare administrators, we can further decrease the HAI for better patient outcomes in the future.

Three-dimensional analysis of the effect of human movement on indoor airflow patterns

Human activity is known to leave significant effects on indoor airflow patterns. These patterns are carefully designed for many facilities such as cleanrooms, pharmaceutical settings, and healthcare environments, where human-induced wakes contribute to the transport of contaminants. Therefore, the knowledge about these wakes as it relates to indoor air quality is critical. As a result, a series of experiments were conducted in a controlled chamber to study the three-dimensional effects of true human walking on airflow. Experiments were designed to capture the effect of human walking under three different flow conditions, and for two different walking schemes. The results show that the effect of walking on the airflow is not negligible and can sustain up to 10 seconds after the moving body has passed. Walking on a straight line creates significant change in the velocity normal to the walking path and vertical to the plane of walking movement. These changes were detectable till 1.0 m away from the walking track. Also, the similarity between airflow patterns of walking once and twice illustrated a promising opportunity of predicting the flow patterns of random walk from a set of base cases.

Knowledge, attitude and practice concerning healthcare-associated infections among healthcare workers in Wuhan, China: cross-sectional study

OBJECTIVES

To assess the knowledge, attitude and practice (KAP) concerning healthcare-associated infections (HAIs) among healthcare givers and to identify the factors influencing KAP.

DESIGN

This was a hospital-based, cross-sectional study.

SETTING

Two public hospitals in Wuhan, central China.

PARTICIPANTS

Participants were recruited among healthcare workers (HCWs) of one general hospital and one children's hospital in Wuhan city between 1 June and 30 September 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcomes were KAPs concerning HAIs.

RESULTS

Data from 455 HCWs were included in the final data analysis. The mean scores of KAP and total KAP were 15.67±3.32, 25.00±2.75, 43.44±5.15 and 84.76±6.72, respectively. The following factors were significantly associated with the total KAP score concerning HAIs, explaining 61% of the variance (p<0.001): gender (β=2.36, 95% CI 1.11 to 4.40), age (β=6.65, 95% CI 5.07 to 7.74), position (β=7.02, 95% CI 3.88 to 8.45), type of employment (β=-1.08, 95% CI -2.08 to -0.07), with HAI education within last year (β=-2.98, 95% CI -4.23 to -1.72), with invasive operation authority (β=-4.22, 95% CI -5.46 to -2.99), antibacterial drug training (β=-4.38, 95% CI -5.45 to -3.31) and with antibacterial drug training and clinical consultation (β=-4.35, 95% CI -5.38 to -3.32).

CONCLUSION

The controllable factors identified in this study can be used by hospital managers to implement measures that improve KAP among HCWs. Moreover, these measures should be customised, based on uncontrollable factors to suit the specific characteristics of medical staff and to improve KAP. Training programmes should be designed for medical workers to increase their awareness of HAIs and to foster positive attitudes and practices.

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

Background

Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia.

Methods

We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg’s Institute quality assessment scale. Then, the funnel plot and Egger’s regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity.

Results

A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85–4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39–4.22) were at increased risk of healthcare-associated infection.

Conclusions

The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.

Risk factor for intestinal carriage of carbapenem-resistant Acinetobacter baumannii and the impact on subsequent infection among patients in an intensive care unit: an observational study

OBJECTIVES

To assess the incidence and the impact of carbapenem-resistant Acinetobacter baumannii (CRAB) intestinal carriage on subsequent CRAB infection and to study risk factors of acquiring CRAB intestinal carriage among patients in intensive care unit (ICU).

DESIGN

Observational study including a case-control study and a retrospective cohort study.

SETTING

A 50-bed general ICU of a university hospital, China.

METHODS

From May 2017 to April 2018, an observational study was conducted in a 50-bed general ICU of a university hospital in China. Rectal swabs were collected from ICU patients on admission and thereafter weekly. A case-control study was performed to analyse risk factors of the acquisition of CRAB intestinal carriage in ICU using multiple logistic regression. A retrospective cohort study was performed to address whether intestinal CRAB carriage could lead to an increased likelihood of subsequent CRAB infection using subdistribution hazard model regarding death in the ICU as a competing risk event.

RESULTS

CRAB intestinal carriage was detected in 6.87% (66/961; 95% CI 5.27% to 8.47%) of patients on ICU admission, whereas 11.97% (115/961; 95% CI 9.91% to 14.02%) of patients acquired CRAB intestinal carriage during the ICU stay. Pancreatitis (OR 2.16, 95% CI 1.28 to 3.67), haematological disease (OR 2.26, 95% CI 1.42 to 3.58), gastric tube feeding (OR 3.35, 95% CI 2.03 to 5.51) and use of carbapenems (OR 1.84, 95% CI 1.11 to 3.07) were independent risk factors for acquiring CRAB intestinal carriage. The incidence of subsequent CRAB infection was 2.24-fold in patients with CRAB intestinal carriage compared with that in patients without (95% CI 1.48 to 3.39, p<0.001).

CONCLUSION

More patients acquired CRAB intestinal carriage during their ICU stay than had on admission. Severity of illness, acute pancreatitis, tube feeding and use of carbapenems were independent risk factors of acquisition of CRAB intestinal carriage. Patients with CRAB intestinal carriage are more likely to develop CRAB infection.

Point-prevalence surveys of hospital-acquired infections in a Chinese cancer hospital: From 2014 to 2018

BACKGROUND

Both hospital-acquired infection (HAI) and cancer represents major health concerns worldwide, but there is a paucity of data describing HAI in Chinese cancer patients. The objective of this study is to demonstrate the prevalence, causative agents, antimicrobial use and risk factors for HAI in a cancer hospital in Southwestern China.

METHODS

We use the criteria of the Ministry of Health of the People's Republic of China to define hospital-acquired infections. One-day cross-sectional surveys were annually conducted from 2014 to 2018. Trained staff collected hospital-acquired infections, antimicrobial use and clinical characteristics data of inpatients. Multivariate logistic regression was used to determine the potential risk factors associated with HAIs.

RESULTS

Of the 6717 patients surveyed, there were 140 patients (2.1%, 95% confidence interval, 1.7-2.4%) with 144 distinct HAIs. Lower respiratory tract infections (47, 32.6%) and surgical-site infections (29, 20.1%) were the most common HAIs. Escherichia coli was the most common pathogen (29.6%). Risk factors for HAI included younger age (<18 years) or older age (>65 years), hospitalization in the intensive care unit, presence of central catheter and undergoing surgery in the previous 30 days. The overall prevalence of patients receiving antimicrobial agents was 15.2%.

CONCLUSION

To control hospital-acquired infections in cancer patients, surveillance and prevention strategies to infections associated with central catheters or related to surgery should be augmented.

Estimating extra length of stay and risk factors of mortality attributable to healthcare-associated infection at a Chinese university hospital: a multi-state model

Background

The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients.

Methods

Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality.

Results

A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54–2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients.

Conclusions

HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.

Identification of genomic loci associated with genotypic and phenotypic variation among Pseudomonas aeruginosa clinical isolates from pneumonia

In this work, a genotype-phenotype survey of a highly diversified Pseudomonas aeruginosa collection was conducted, aiming to detail pathogen-associated scenarios that clinicians face nowadays. Genetic relation based on RAPD-PCR of 705 isolates, retrieved from 424 patients and several clinical contexts, reported an almost isolate-specific molecular-pattern. Pneumonia-associated isolates HB13 and HB15, clustered in the same RAPD-PCR group, were selected to evaluate the genomic background underlying their contrasting antibiotic resistance and virulence. The HB13 genome harbors antibiotic-inactivating enzymes-coding genes (e.g. aac(3)-Ia, arr, bla_VIM-2) and single-nucleotide variations (SNVs) in antibiotic targets, likely accounting for its pan-resistance, whereas HB15 susceptibility correlated to predicted dysfunctional alleles. Isolate HB13 showed the unprecedented rhl-cluster absence and variations in other pathogen competitiveness contributors. Conversely, HB15 genome comprises exoenzyme-coding genes and SNVs linked to increased virulence. Secretome analysis identified signatures features with unknown function as potential novel pathogenic (e.g. a MATE-protein in HB13, a protease in HB15) and antibiotic resistance (a HlyD-like secretion protein in HB13) determinants. Detection of active prophages, proteases (including protease IV and alkaline metalloproteinase), a porin and a peptidase in HB15 highlights the secreted arsenal likely essential for its virulent behavior. The presented phenotype-genome association will contribute to the current knowledge on Pseudomonas aeruginosa pathogenomics.

Point prevalence surveys of health-care-associated infections: a systematic review

Health-care-associated infections (HAIs) are considered a serious public health issues that contribute substantially to the global burden of mortality and morbidity with respect to infectious diseases. The aim is to assess the burden of health-care-associated infections by collation of available data from published point prevalence surveys (PPS) on HAIs to give future guidance. Study protocol and methodology were designed according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Published research papers that conducted a point prevalence survey of HAIs in hospital settings by following the structured survey methodology employed by European Centre of Disease Prevention and Control (ECDC) were included. Of 1212 articles, 67 studies were included in the final analysis conducted across different countries. Overall, 35 studies were conducted in Europe, 21 in Asia, 9 in America, and 2 in Africa. The highest prevalence of HAIs was recorded in a study conducted in adult ICU settings of 75 regions of Europe (51.3%). The majority of the studies included HAI data on urinary tract infections, respiratory tract infections, and bloodstream infections. Klebsiella pneumonia, Pseudomonas aeruginosa and E. coli were the most frequent pathogens responsible for HAIs. PPS is an useful tool to quantify HAIs and provides a robust baseline data for policymakers. However, a standardize surveillance method is required. In order to minimize the burden of HAIs, infection prevention and control programs and antibiotic stewardship may be effective strategies to minimize the risk of HAIs.

The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the prevalence of healthcare-associated infections (HAIs) in mainland China.

DESIGN

Systematic review and meta-analysis.

SETTING

Adults and children from secondary and tertiary acute-care hospitals in mainland China.

METHODS

We searched PubMed, the China National Knowledge Infrastructure, and Wan Fang for multicenter point-prevalence surveys of acute-care hospitals in mainland China from January 2006 to August 2016. All reports related to HAI, using a point-prevalence methodology and published either in English or Chinese were eligible.

RESULTS

In total, 3,021 publications were identified; 115 were eligible for quality assessment and data abstraction. The weighted HAI prevalence (95% confidence interval [CI]) overall, in general hospitals, children’s hospitals, maternal and child health hospitals, and oncology hospitals were 3.12% (95% CI, 2.94%–3.29%), 3.02% (95% CI, 2.79%–3.26%), 4.43% (95% CI, 3.39%–5.47%), 1.88% (95% CI, 1.47%–2.29%), and 3.96% (95% CI, 3.12%–4.79%), respectively. In general hospitals, prevalence was highest in adult intensive care units (26.07%; 95% CI, 23.03%–29.12%), followed by surgery (3.26%; 95% CI, 2.96%–3.57%), and internal medicine (3.06%; 95% CI, 2.67%–3.46%). Overall, lower respiratory tract infection was the most frequent HAI (24,185, 47.28%), followed by urinary tract infection (5,773, 11.29%) and upper respiratory tract infection (5,194, 10.15%). Gram-negative bacilli were the most frequently isolated pathogens, and Pseudomonas aeruginosa (3,395, 14.91%), and Escherichia coli (2,918, 12.82%) were the most common single microorganisms.

CONCLUSIONS

This study is the largest systematic review on the prevalence of HAI in mainland China. These results provide a benchmark for future PPSs and a reference for infection prevention and control strategies in mainland China.

Infect Control Hosp Epidemiol 2018;39:701–709

Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study

Background

Hospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia.

Method

A matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis.

Result

The median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03–0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17–4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively.

Conclusion

Health providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.

Assessing antibiotic therapy effectiveness against the major bacterial pathogens in a hospital using an integrated index

AIM

To assess the effectiveness of antibiotic therapy against five indicator bacteria in a Chinese hospital using an index-based approach.

METHODS

The study population comprises 1031 patients who had one clinically significant bacterial isolate in 2008, 2010 and 2013. Drug resistance index (DRI) based on pathogens was calculated.

RESULTS

The adaptive DRIs for Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus decreased, while both adaptive and fixed DRIs for Acinetobacter spp. increased from 2008 to 2013. The adaptive DRIs for Escherichia coli increased from 2008 to 2013, while the fixed DRIs exhibited a decreasing trend.

CONCLUSION

DRI could be used to demonstrate the changes of antimicrobial resistance and prescribing over time as a result of evolutionary processes and governmental regulatory interference.

Burden of healthcare-associated infections in China: results of the 2015 point prevalence survey in Dong Guan City

BACKGROUND

Healthcare-associated infections (HCAIs) are a major health threat. There are few data about HCAI and antibiotic use in the People's Republic of China in the English literature.

AIM

To describe and discuss the prevalence of HCAI and antibiotic use from the 2015 point prevalence survey (PPS) in Dong Guan City.

METHODS

In 2015, the Dong Guan (City) Nosocomial Infection Control and Quality Improvement Centre organized its yearly PPS in the secondary and tertiary care hospitals of Dong Guan City. The survey was performed on one single calendar day.

FINDINGS

Thirty-seven secondary and 14 tertiary care hospitals assessed 9679 and 11,641 patients, respectively. A total of 616 patients had 681 HCAIs. The pooled HCAI prevalence (95% confidence interval) in secondary care, tertiary care, and all hospitals together was 2.3% (2.0-2.6), 3.4% (3.0-3.7), and 2.9% (2.6-3.1), respectively. Lower respiratory tract infection (LRTI), urinary tract infection (UTI), surgical site infection (SSI), and bloodstream infection together accounted for 73.1% of HCAIs. LRTI was the most frequently diagnosed HCAI (35.5%), followed by UTI (17.0%), and SSI (15.1%). Gram-negative bacteria were most frequently isolated (68.1%), followed by Gram-positive bacteria (19.3%), and fungi (10.9%). Escherichia coli was the most frequent pathogen (14.8%), and Acinetobacter baumannii accounted for 10.9%. A total of 34.8% of the patients received one or more antimicrobials.

CONCLUSION

The pooled prevalence is in the range of other recent Chinese studies, but lower compared to previous reports in Europe, and the USA. The use of antimicrobials for therapeutic purposes is similar to that in Europe, but lower than previous Chinese reports, and lower than in the USA.