1
|
Skally M, Bennett K, Humphreys H, Fitzpatrick F. Rethinking Clostridioides difficile infection (CDI) surveillance definitions based on changing healthcare utilisation and a more realistic incubation period: reviewing data from a tertiary-referral hospital, Ireland, 2012 to 2021. Euro Surveill 2024; 29:2300335. [PMID: 38333935 PMCID: PMC10853979 DOI: 10.2807/1560-7917.es.2024.29.6.2300335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BackgroundCommunity-associated Clostridioides difficile infections (CA-CDI) have increased worldwide. Patients with CDI-related symptoms occurring < 48 hours after hospitalisation and no inpatient stay 12 weeks prior are classified as CA-CDI, regardless of hospital day attendances 3 months before CDI onset. Healthcare-associated (HA) CDIs include those with symptom onset ≥ 48 hours post hospitalisation.AimTo consider an incubation period more reflective of CDI, and changing healthcare utilisation, we measured how varying surveillance specifications to categorise patients according to their CDI origin resulted in changes in patients' distribution among CDI origin categories.MethodsNew CDI cases between 2012-2021 from our hospital were reviewed. For patients with CA-CDI, hospital day attendances in the 3 months prior were recorded. CA-CDI patients with hospital day attendances and recently discharged CDI patients (RD-CDI; CDI onset 4-12 weeks after discharge) were combined into a new 'healthcare-exposure' category (HE-CDI). Time from hospitalisation to disease onset was varied and the midpoint between optimal and balanced cut-offs was used instead of 48 hours to categorise HA-CDI.ResultsOf 1,047 patients, 801 (76%) were HA-CDI, 205 (20%) CA-CDI and 41 (4%) were RD-CDI. Of the CA-CDI cohort, 45 (22%) met recent HE-CDI criteria and, when reassigned, reduced CA-CDI to 15%. Sensitivity analysis indicated a day 4 cut-off for assigning HA-CDI. Applying this led to 46 HA-CDI reassigned as CA-CDI. Applying both HE and day 4 criteria led to 72% HA-CDI, 20% CA-CDI, and 8% HE-CDI (previously RD-CDI).ConclusionCDI surveillance specifications reflecting healthcare exposure and an incubation period more characteristic of C. difficile may improve targeted CDI prevention interventions.
Collapse
Affiliation(s)
- Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile - ESGCD, Basel Switzerland
- These authors contributed equally to this work and share first/last authorship
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile - ESGCD, Basel Switzerland
- These authors contributed equally to this work and share first/last authorship
| |
Collapse
|
2
|
Fitzpatrick F, Brennan R, van Prehn J, Skally M, Brady M, Burns K, Rooney C, Wilcox MH. European Practice for CDI Treatment. Adv Exp Med Biol 2024; 1435:57-84. [PMID: 38175471 DOI: 10.1007/978-3-031-42108-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Clostridioides difficile infection (CDI) remains a significant cause of morbidity and mortality worldwide. Historically, two antibiotics (metronidazole and vancomycin) and a recent third (fidaxomicin) have been used for CDI treatment; convincing data are now available showing that metronidazole is the least efficacious agent. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) management guidance for CDI were updated in 2021. This guidance document outlines the treatment options for a variety of CDI clinical scenarios and for non-antimicrobial management (e.g., faecal microbiota transplantation, FMT). One of the main changes is that metronidazole is no longer recommended as first-line CDI treatment. Rather, fidaxomicin is preferred on the basis of reduced recurrence rates with vancomycin as an acceptable alternative. Recommended options for recurrent CDI now include bezlotoxumab as well as FMT.A 2017 survey of 20 European countries highlighted variation internationally in CDI management strategies. A variety of restrictions were in place in 65% countries prior to use of new anti-CDI treatments, including committee/infection specialist approval or economic review/restrictions. This survey was repeated in November 2022 to assess the current landscape of CDI management practices in Europe. Of 64 respondents from 17 countries, national CDI guidelines existed in 14 countries, and 11 have already/plan to incorporate the ESCMID 2021 CDI guidance, though implementation has not been surveyed in 6. Vancomycin is the most commonly used first-line agent for the treatment of CDI (n = 42, 66%), followed by fidaxomicin (n = 30, 47%). Six (9%) respondents use metronidazole as first-line agent for CDI treatment, whereas 22 (34%) only in selected low-risk patient groups. Fidaxomicin is more likely to be used in high-risk patient groups. Availability of anti-CDI therapy influenced prescribing in six respondents (9%). Approval pre-prescription was required before vancomycin (n = 3, 5%), fidaxomicin (n = 10, 6%), bezlotoxumab (n = 11, 17%) and FMT (n = 10, 6%). Implementation of CDI guidelines is rarely audited.Novel anti-CDI agents are being evaluated; it is not yet clear what will be the roles of these agents. The treatment of recurrent CDI is particularly troublesome, and several different live biotherapeutics are being developed, in addition to FMT.
Collapse
Affiliation(s)
- Fidelma Fitzpatrick
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - Robert Brennan
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mairead Skally
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Melissa Brady
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Karen Burns
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Christopher Rooney
- Microbiology, Leeds Teaching Hospitals, Leeds, UK
- University of Leeds, Leeds, UK
| | - Mark H Wilcox
- University of Leeds, Leeds, UK.
- Leeds Teaching Hospitals and Leeds Regional Public Health Laboratory, UK Health Security Agency (UKHSA), Leeds, UK.
| |
Collapse
|
3
|
Skally M, Leonard M, O'Halloran PJ, Husien B, Bennett K, Burns K, Dinesh B, Humphreys H, Fitzpatrick F. Clostridioides difficile infection in neurosurgical patients in a national centre over 10 years: less common but associated with longer hospital stays. Acta Neurochir (Wien) 2023; 165:3585-3592. [PMID: 37971621 DOI: 10.1007/s00701-023-05883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated (HA) diarrhoea, contributing to patient morbidity and prolonged length-of-stay (LOS). We retrospectively assessed CDI over a decade in a national neurosurgical centre, with a multi-disciplinary approach to CDI surveillance and antimicrobial stewardship, by comparing CDI patients with other patient groups. METHODS Data on CDI in neurosurgical inpatients between January 2012 and December 2021 were collated. Disease-specific variables were compared to other inpatients with CDI. Rates per 10,000 bed days used were calculated. Patient-specific differences were compared with neurosurgical patients without CDI. CDI rates by patient group were explored using odds ratio (OR) and χ2 analyses. Negative binomial regression was used to investigate CDI rates over time. RESULTS Of 50 neurosurgical patients with CDI, all were HA; the average age was 53 years (standard deviation (SD) 16.3 years), 49 were first-episode CDI, and three had severe CDI. The majority (76.7%) had received recent antimicrobials. Compared with non-neurosurgical CDI patients, neurosurgical CDI rates differed significantly (1.9 versus 3.6 per 10,000 bed days used, p < 0.05), neurosurgical patients were younger (p ≤ 0.01), C. difficile testing was more likely to be requested by neurosurgeons (OR 2.4; p ≤ 0.01), and the proportion of severe CDI was higher (6% versus 2%, OR 3.0, p = 0.07, confidence interval (CI) 0.54 to 11.3). Within the neurosurgical cohort, CDI patients had an average LOS four times that of other patients (CI 15.2 to 35.1; p < 0.01) and were older (53.5 versus 47.8 years, CI 0.1 to 11 years; p < 0.05). Only one CDI outbreak was linked to neurosurgical patients. CONCLUSION CDI in neurosurgery patients differed from the wider hospital, with greater awareness of CDI testing. Longer LOS impacted bed utilisation with limited capacity. Robust surveillance supports proactive antimicrobial stewardship programmes in this vulnerable population.
Collapse
Affiliation(s)
- Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland.
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland.
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile - ESGCD, Basel, Switzerland.
| | - Maeve Leonard
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
| | - Philip J O'Halloran
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Department of Physiology & Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ben Husien
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Kathleen Bennett
- Data Sciences Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Burns
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Binu Dinesh
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile - ESGCD, Basel, Switzerland
| |
Collapse
|
4
|
Kelly L, Walsh J, Skally M, Dinesh B, Burns K, O'Connell K, MacNally S, Humphreys H, Fitzpatrick F. Candida meningitis/ventriculitis over a decade. Increased morbidity and length of stay a concern. Br J Neurosurg 2023; 37:227-230. [PMID: 35361033 DOI: 10.1080/02688697.2022.2054947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AIM The primary aim of this study was to review the diagnosis, management and outcome of Candida meningitis/ventriculitis in our hospital over a ten-year period. MATERIALS AND METHODS We retrospectively reviewed all culture and 18s rRNA nucleic acid positive CSF specimens processed between 1st January 2010 and 31st December 2020. Patient records were subsequently reviewed to assess the significance of the isolate. RESULTS Of 851 culture-positive cerebrospinal fluid (CSF) specimens, Candida spp. were isolated from 29 (3.4%), representing infection in 12 patients. One culture-negative specimen was positive for Candida on 18s rRNA testing. Of the 13 patients, eight were male; 61.5% and the median age was 47 years; range: 20-70. The median interval from admission to onset of infection and culture positivity was 24 days (range: 1-63 days). All patients had a central nervous system (CNS) device in situ (external ventricular drain: 11; ventriculoperitoneal shunt: 1; lumbar drain: 1). Four were colonised with Candida spp. before meningitis/ventriculitis diagnosis, from wounds (n = 3), respiratory (n = 3), and urine (n = 1) specimens. On culture, the most common species was Candida albicans (n = 8), followed by C. parapsilosis (n = 2), C. tropicalis (n = 1), and C. dubliniensis (n = 1). The median number of follow-up CSFs per patient was nine (range; 3-22), with a median of 6 days to CSF sterility (range 3-10 days). Treatment included; liposomal amphotericin B (n = 5), fluconazole (n = 2), liposomal amphotericin B, and flucytosine (n = 2), liposomal amphotericin B, fluconazole and flucytosine (n = 3), and intra-ventricular amphotericin B (n = 1). Median treatment duration was 25 days (range 11-76) and CNS device removal occurred in 12 patients. The median length-of-stay (LOS) was 58 days (range 24-406). On discharge, moderate to severe disability (Modified Rankin Scale [mRS] 3-5) was evident in eight patients. Two patients died and one was lost to follow-up. CONCLUSION Meningitis/ventriculitis due to Candida spp. is an uncommon but challenging infection, usually associated with a device, increased morbidity, LOS, and necessitating prolonged treatment. Neurosurgeons need to be aware of these issues in managing and in communicating with such complex patients.
Collapse
Affiliation(s)
- Louise Kelly
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Walsh
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Mairead Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Binu Dinesh
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karen Burns
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karina O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen MacNally
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
5
|
Creedon M, Humphreys H, Connolly R, Gaughan L, Skally M, Caird J, Duddy J, O'Halloran P, Mandiwanza T, Burns K, Dinesh B, Smyth E, O'Connell K, Fitzpatrick F. Multidisciplinary neurosurgical rounds incorporating antimicrobial stewardship. Are they of benefit? Brain and Spine 2022; 2:100885. [PMID: 36248101 PMCID: PMC9560698 DOI: 10.1016/j.bas.2022.100885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 01/01/2023]
Abstract
Background In an era of increasing antimicrobial resistance, appropriate antimicrobials are essential to optimise patient outcomes. In 2017, antimicrobial use prevalence (AMU) on the two neurosurgical wards in our tertiary teaching hospital varied from 23% on ward A to 33% on ward B with 67% and 100% ‘appropriate’ prescriptions, respectively. In July 2018, a weekly antimicrobial stewardship multidisciplinary round led by a senior neurosurgery registrar commenced, attended by the antimicrobial stewardship team (AST). Research question This report evaluates whether a multi-disciplinary approach on neurosurgical prescribing was beneficial, specifically in reducing AMU. Materials and methods The following data was collected on AST rounds for 30 weeks in total from August 2018 to July 2019: number of patients on antimicrobials, appropriateness and stewardship actions. A questionnaire was distributed to neurosurgical doctors on two occasions to canvass opinions and attitudes on antimicrobial prescribing. Results 1716 prescriptions were reviewed (mean 57.2 per week). Of these 321 (18.7%) included antimicrobial prescriptions; 200 on ward A (19.8%), and 121 on ward B (17%), representing a decrease in AMU from 2017. The majority of antimicrobial prescriptions, 271 (84.4%) were deemed appropriate. Stewardship actions were taken in 215 (67%) prescriptions. Fifteen questionnaires were completed by neurosurgical doctors. The majority, 87%, stated the AST round was helpful overall. 93% indicated that informal training on the AST round was a source of education in antibiotic prescribing. Discussion and conclusion The weekly AST round provided a timely opportunity for multidisciplinary discussion, implementation of antimicrobial stewardship actions and opportunistic antimicrobial stewardship education. Surgeons need to be directly involved in antimicrobial stewardship to optimise patient outcomes and reduce antimicrobial resistance. A multidisciplinary antimicrobial stewardship (AST) ward round led by neurosurgery commenced in our hospital in 2018. Antimicrobial stewardship actions were taken in 67% of prescriptions, and antimicrobial use prevalence reduced in 2018 compared to 2017. A questionnaire distributed to neurosurgical doctors on the value of the AST round indicated that 87% of neurosurgical doctors found it helpful. We believe leadership and accountability were crucial to the success of the ward round, as neurosurgeons contributed directly to decision making.
Collapse
|
6
|
Walsh J, Skally M, Duffy F, Kalukondanahally G, Dinesh B, O'Connell K, de Barra E, Burns K, Fitzpatrick F. The early test catches the case. Why wait? Frequent testing of close contacts aids COVID-19 control. J Hosp Infect 2021; 116:101-102. [PMID: 34403764 PMCID: PMC8364144 DOI: 10.1016/j.jhin.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 01/24/2023]
Affiliation(s)
- J Walsh
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - G Kalukondanahally
- Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - B Dinesh
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - E de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland; Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
7
|
Walsh J, Skally M, Traynor L, de Barra E, Dhuthaigh AN, Hayes B, Fitzpatrick F. Impact of first dose of BNT162b2 vaccine on COVID-19 infection among healthcare workers in an Irish hospital. Ir J Med Sci 2021; 191:961-962. [PMID: 34041693 PMCID: PMC8154332 DOI: 10.1007/s11845-021-02658-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/25/2022]
Affiliation(s)
- Jennifer Walsh
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Leah Traynor
- Occupational Health Department, Beaumont Hospital, Dublin, Ireland
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.,Dept. of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Blanaid Hayes
- Occupational Health Department, Beaumont Hospital, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
8
|
Foley M, Duffy F, Skally M, McCormack F, Finn C, O'Connor M, Cafferkey J, Thomas T, Burns K, Fitzpatrick F, O'Connell K, Smyth EG, Humphreys H. Evolving epidemiology of carbapenemase-producing Enterobacterales: one hospital's infection prevention and control response over nine years. J Hosp Infect 2021; 112:61-68. [PMID: 33812939 DOI: 10.1016/j.jhin.2021.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preventing carbapenemase-producing Enterobacterales (CPE) transmission is a significant challenge for hospital infection prevention and control teams (IPCTs). Control measures include screening at-risk patients, contact tracing, and the isolation of carriers with contact precautions. AIM The evolution of infection prevention and control measures was assessed in a tertiary acute care hospital with predominately multi-bedded patient accommodation, from 2011 to 2019 as cases of CPE increased. The implications for, and the response and actions of, the IPCT were also reviewed. METHODS CPE data collected prospectively from our laboratory, IPCT, and outbreak meeting records were reviewed to assess how the IPCT adapted to the changing epidemiology, from sporadic cases, to outbreaks and to localized endemic CPE. FINDINGS Of 178 cases, 152 (85%) were healthcare-associated and there was a marked increase in cases from 2017. The number of screening samples tested annually increased from 1190 in 2011 to 16,837 in 2019, and six outbreaks were documented, with larger outbreaks identified in later years. OXA-48 carbapenemase was detected in 88% of isolates and attendance at outbreak meetings alone accounted for 463.5 h of IPCT members, and related staff time. CONCLUSION Despite considerable efforts and time invested by the IPCT, the number of CPE cases is increasing year-on-year, with more outbreaks being reported in later years, albeit partly in response to increased screening requirements. Infrastructural deficits, the changing epidemiology of CPE, and national policy are major factors in the increasing number of cases.
Collapse
Affiliation(s)
- M Foley
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - F McCormack
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - C Finn
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - M O'Connor
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - J Cafferkey
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - T Thomas
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Burns
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Health Protection Surveillance Centre, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E G Smyth
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology and Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
9
|
Burns K, Foley M, Skally M, Cafferkey J, Duffy F, Sweeney E, Ni Dhuthaigh A, O'Connell K, Dinesh B, Humphreys H, de Barra E, Fitzpatrick F. Casting the net wide: universal testing of emergency admissions for SARS-CoV-2 to prevent onward transmission. J Hosp Infect 2020; 107:64-66. [PMID: 33176174 PMCID: PMC7832560 DOI: 10.1016/j.jhin.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/27/2022]
Affiliation(s)
- K Burns
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland; Health Protection Surveillance Centre, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - M Foley
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - J Cafferkey
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - E Sweeney
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland; Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Ireland
| | - A Ni Dhuthaigh
- Department of Occupational Medicine, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - B Dinesh
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland; Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Infection Prevention & Control, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
10
|
Cafferkey J, O’Connor M, Doyle D, Skally M, Fitzpatrick M, Burns K, O’Connell K, Fitzpatrick F, Smyth E, Humphreys H. Improving the processing time for the detection of carbapenemase-producing enterobacterales using an evolving algorithm. Br J Biomed Sci 2020; 77:97-100. [DOI: 10.1080/09674845.2019.1704357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Cafferkey
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M O’Connor
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - D Doyle
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - M Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
| | - K O’Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - E Smyth
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
11
|
O' Connell K, Kennedy C, Skally M, Foley M, Alex S, Magee C, Davis NF, Humphreys H, Burns K. Surveillance of common infections in the early period after renal transplantation in a national center: 2014-2017. Transpl Infect Dis 2020; 22:e13261. [PMID: 32037682 DOI: 10.1111/tid.13261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infection prevention and timely and effective treatment are among the major aims of care in kidney transplant recipients. Pre-transplant vaccination and pre-transplant viral screening have been extensively studied and are now considered standard practice. Early post-operative infection surveillance is mandatory in other vulnerable cohorts, but has not been extensively studied in this population. We hypothesized that surveillance of the most common bacterial infection types in the post-transplant setting would be beneficial and identify key areas for improvement. METHODS All adult kidney transplant recipients whose surgeries were performed in the Irish national kidney transplant unit over a 1-year period had prospective early post-transplant (first 30 days) infection surveillance in 2014 for surgical site infection, urinary tract infection, and secondary bloodstream infections (Group T0). Several key changes were implemented following scrutiny of infection patterns and clinical practice. Subsequently, infection surveillance was undertaken for 2016 and 2017 (Group T1) to assess the impact of these changes. RESULTS Between 2014 and 2017, the number of kidney transplants increased by 32%. The following aspects of clinical practice were the focus of change following analysis of Group T0 data: timing of surgical antimicrobial prophylaxis (SAP) administration, choice of SAP antimicrobial agent, and routine microbiological testing in the peri-operative period. Following implementation of these changes, the timing of SAP administration was greatly improved (45%-100% of cases appropriately timed). The infection rate decreased from 8.9% to 7.4% in 2016, with a further decrease to 4% in 2017 (OR 0.42 (95% CI: 0.16-1.10); P = .08). Compliance with pre-operative microbiological screening improved in Group T1. CONCLUSIONS Simple clinical practice changes, implemented upon analysis of common bacterial infection surveillance data in the first 30 days after kidney transplantation resulted in more effective SAP administration and improved compliance with routine microbiological testing in the peri-operative period. These interventions have potentially contributed to reduced early post-operative infection rates, despite increased transplant activity in the unit. Infection surveillance is an important and under-utilized way of reducing infections in this vulnerable patient cohort.
Collapse
Affiliation(s)
- Karina O' Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Claire Kennedy
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Margaret Foley
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Somy Alex
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Magee
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Karen Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Health Protection Surveillance Centre, Dublin, Ireland
| |
Collapse
|
12
|
Reilly A, Ali A, Skally M, Skelly E, Gaughan L, Hamilton V, Troy A, Humphreys H, McNamara D, Fitzpatrick F. Sepsis Six implementation on a general surgical ward. More work to be done. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Aoife Reilly
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ali Ali
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Emma Skelly
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Hilary Humphreys
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah McNamara
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
13
|
Skelly E, Foley M, Skally M, Reilly A, Humphreys H, Fitzpatrick F. CPE in Beaumont Hospital – Trying to understand an increasing and challenging pathogen. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emma Skelly
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Aoife Reilly
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
14
|
Skelly E, Skally M, Foley M, Gaughan L, Duffy F, Burns K, Humphreys H, Fitzpatrick F. Getting the timing right: is it worthwhile to vaccinate long-stay hospital inpatients to prevent influenza? J Hosp Infect 2020; 104:82-84. [DOI: 10.1016/j.jhin.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
|
15
|
Cafferkey J, Skally M, Finn C, Donlon S, Fitzpatrick M, Burns K, O'Connell K, Fitzpatrick F, Smyth E, Humphreys H. Value of a hospital-wide point prevalence survey of carbapenemase-producing Enterobacterales – low-level prevalence confirmed. J Hosp Infect 2019; 101:191-194. [DOI: 10.1016/j.jhin.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
|
16
|
Fitzpatrick F, Skally M, O'Hanlon C, Foley M, Houlihan J, Gaughan L, Smith O, Moore B, Cunneen S, Sweeney E, Dinesh B, O'Connell K, Smyth E, Humphreys H, Burns K. Food for thought. Malnutrition risk associated with increased risk of healthcare-associated infection. J Hosp Infect 2018; 101:300-304. [PMID: 30590089 DOI: 10.1016/j.jhin.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infection and malnutrition are interconnected. UK and Irish guidelines recommend the Malnutrition Universal Screening Tool (MUST) for nutritional risk screening. Patients with a MUST score of ≥2 are considered at high risk of malnutrition and referral for nutritional assessment is recommended. AIM To explore the association between healthcare-associated infection (HCAI) and the MUST score categories of patients. METHODS This was a cross-sectional study in May 2017 on ten representative wards in our institution. Patient demographics, MUST score, presence of medical devices, HCAI and antimicrobial use were collected. FINDINGS Of 240 patients, the HCAI prevalence was 10.4% (N = 25) and 26% (N = 63) were at high risk of malnutrition (MUST score ≥2). Patients with HCAI were more likely to have had surgery (odds ratio (OR): 5.5; confidence interval (CI): 2.1-14.3; P < 0.001), a central vascular catheter (OR: 10.0; CI: 3.6-27.2; P < 0.001), or a urinary catheter in situ (OR: 7.5; CI: 2.8-20.0; P < 0.001), and to have a high risk of malnutrition (OR: 4.3; CI: 1.7-11.2; P < 0.001). A higher MUST score remained a significant predictor of a patient having HCAI on multivariate regression analysis (CI: 0.2-0.6; P < 0.001). CONCLUSION Patients at risk of malnutrition when assessed with the MUST were more likely to have HCAI. However, prospective studies are required to investigate the temporal association between MUST and HCAI and which interventions best address malnutrition risk and HCAI reduction in different settings.
Collapse
Affiliation(s)
- F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - M Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - C O'Hanlon
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - M Foley
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - J Houlihan
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - L Gaughan
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - O Smith
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - B Moore
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - S Cunneen
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - E Sweeney
- Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland
| | - B Dinesh
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - E Smyth
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Health Protection Surveillance Centre, Dublin, Ireland
| |
Collapse
|
17
|
Abstract
Clostridium difficile infection (CDI) remains a significant cause of morbidity and mortality worldwide. Historically, two antibiotics (metronidazole and vancomycin) and a recent third (fidaxomicin) have been used routinely for CDI treatment; convincing data are now available showing that metronidazole is the least efficacious agent. The European Society of Clinical Microbiology and Infectious Diseases CDI treatment guidelines outline the treatment options for a variety of CDI clinical scenarios, including use of the more traditional anti-CDI therapies (e.g., metronidazole, vancomycin), the role of newer anti-CDI agents (e.g., fidaxomicin), indications for surgical intervention and for non-antimicrobial management (e.g., faecal microbiota transplantation, FMT). A 2017 survey of 20 European countries found that while the majority (n = 14) have national CDI guidelines that provide a variety of recommendations for CDI treatment, only five have audited guideline implementation. A variety of restrictions are in place in 13 (65%) countries prior to use of new anti-CDI treatments, including committee/infection specialist approval or economic review/restrictions. Novel anti-CDI agents are being evaluated in Phase III trials; it is not yet clear what will be the roles of these agents. Prophylaxis is an optimum approach to reduce the impact of CDI especially in high-risk populations; monoclonal antibodies, antibiotic blocking approaches and multiple vaccines are currently in advanced clinical trials. The treatment of recurrent CDI is particularly troublesome, and several different live bio therapeutics are being developed, in addition to FMT.
Collapse
Affiliation(s)
- Fidelma Fitzpatrick
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - Mairead Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Melissa Brady
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Karen Burns
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Christopher Rooney
- Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK
| | - Mark H Wilcox
- Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
- Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
| |
Collapse
|
18
|
O'Donnell S, Gaughan L, Skally M, Baker Z, O'Connell K, Smyth E, Fitzpatrick F, Humphreys H. The potential contribution of 16S ribosomal RNA polymerase chain reaction to antimicrobial stewardship in culture-negative infection. J Hosp Infect 2017; 99:148-152. [PMID: 28838799 DOI: 10.1016/j.jhin.2017.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
Empiric broad-spectrum antimicrobial therapy frequently results in culture-negative specimens making rationalization of therapy difficult. We retrospectively reviewed 16S rRNA polymerase chain reaction (PCR) results from 78 specimens in 60 patients. 16S rRNA was detected in 28 (47%) patients with de-escalation of therapy in five (21%). Microbial DNA was not detected in 32 (53%) patients with antimicrobials discontinued in two (8%). Neurosurgical patients had a higher proportion of positive results (53% vs 34%) and treatment rationalizations (17% vs 12%). In specific patient groups, 16s rRNA PCR is a useful antimicrobial stewardship tool for targeting antimicrobial therapy.
Collapse
Affiliation(s)
- S O'Donnell
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland.
| | - L Gaughan
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - M Skally
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - Z Baker
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - K O'Connell
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Smyth
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Humphreys
- Department of Microbiology and Pharmacy, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
19
|
Kennedy C, Waldron C, Skally M, Gaughan L, Magee C, Burns K, Fitzpatrick F. The epidemiology of Clostridium difficile
infection in a national kidney transplant center. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Claire Kennedy
- Department of Nephrology; Beaumont Hospital; Dublin Ireland
| | - Carmel Waldron
- Department of Nephrology; Beaumont Hospital; Dublin Ireland
| | - Mairead Skally
- Department of Clinical Microbiology; Beaumont Hospital; Dublin Ireland
| | - Leah Gaughan
- Department of Pharmacy; Beaumont Hospital; Dublin Ireland
| | - Colm Magee
- Department of Nephrology; Beaumont Hospital; Dublin Ireland
| | - Karen Burns
- Department of Clinical Microbiology; Beaumont Hospital; Dublin Ireland
- Health Protection Surveillance Centre; Dublin Ireland
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology; Beaumont Hospital; Dublin Ireland
- Department of Clinical Microbiology; Royal College of Surgeons in Ireland; Dublin Ireland
| |
Collapse
|
20
|
Earls MR, Kinnevey PM, Brennan GI, Lazaris A, Skally M, O’Connell B, Humphreys H, Shore AC, Coleman DC. The recent emergence in hospitals of multidrug-resistant community-associated sequence type 1 and spa type t127 methicillin-resistant Staphylococcus aureus investigated by whole-genome sequencing: Implications for screening. PLoS One 2017; 12:e0175542. [PMID: 28399151 PMCID: PMC5388477 DOI: 10.1371/journal.pone.0175542] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/28/2017] [Indexed: 11/19/2022] Open
Abstract
Community-associated spa type t127/t922 methicillin-resistant Staphylococcus aureus (MRSA) prevalence increased from 1%-7% in Ireland between 2010–2015. This study tracked the spread of 89 such isolates from June 2013-June 2016. These included 78 healthcare-associated and 11 community associated-MRSA isolates from a prolonged hospital outbreak (H1) (n = 46), 16 other hospitals (n = 28), four other healthcare facilities (n = 4) and community-associated sources (n = 11). Isolates underwent antimicrobial susceptibility testing, DNA microarray profiling and whole-genome sequencing. Minimum spanning trees were generated following core-genome multilocus sequence typing and pairwise single nucleotide variation (SNV) analysis was performed. All isolates were sequence type 1 MRSA staphylococcal cassette chromosome mec type IV (ST1-MRSA-IV) and 76/89 were multidrug-resistant. Fifty isolates, including 40/46 from H1, were high-level mupirocin-resistant, carrying a conjugative 39 kb iles2-encoding plasmid. Two closely related ST1-MRSA-IV strains (I and II) and multiple sporadic strains were identified. Strain I isolates (57/89), including 43/46 H1 and all high-level mupirocin-resistant isolates, exhibited ≤80 SNVs. Two strain I isolates from separate H1 healthcare workers differed from other H1/strain I isolates by 7–47 and 12–53 SNVs, respectively, indicating healthcare worker involvement in this outbreak. Strain II isolates (19/89), including the remaining H1 isolates, exhibited ≤127 SNVs. For each strain, the pairwise SNVs exhibited by healthcare-associated and community-associated isolates indicated recent transmission of ST1-MRSA-IV within and between multiple hospitals, healthcare facilities and communities in Ireland. Given the interchange between healthcare-associated and community-associated isolates in hospitals, the risk factors that inform screening for MRSA require revision.
Collapse
Affiliation(s)
- Megan R. Earls
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Peter M. Kinnevey
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Gráinne I. Brennan
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
- National MRSA Reference Laboratory, St. James’s Hospital, Dublin 8, Ireland
| | - Alexandros Lazaris
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Brian O’Connell
- National MRSA Reference Laboratory, St. James’s Hospital, Dublin 8, Ireland
- Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, St. James’s Hospital, Dublin 8, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Anna C. Shore
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - David C. Coleman
- Microbiology Research Unit, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
- * E-mail:
| |
Collapse
|
21
|
Ryan P, Skally M, Duffy F, Farrelly M, Gaughan L, Flood P, McFadden E, Fitzpatrick F. Evaluation of fixed and variable hospital costs due to Clostridium difficile infection: institutional incentives and directions for future research. J Hosp Infect 2017; 95:415-420. [PMID: 28320542 DOI: 10.1016/j.jhin.2017.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished. AIM To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015. METHODS A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure. FINDINGS The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included). CONCLUSION As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making.
Collapse
Affiliation(s)
- P Ryan
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - M Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - M Farrelly
- Department of Finance, Beaumont Hospital, Dublin, Ireland
| | - L Gaughan
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - P Flood
- General Services Department, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
22
|
Burns K, Skally M, Solomon K, Scott L, McDermott S, O'Flanagan D, Fanning S, Kyne L, Fenelon L, Fitzpatrick F. Clostridium difficileInfection in the Republic of Ireland: Results of a 1-Month National Surveillance and Ribotyping Project, March 2009. Infect Control Hosp Epidemiol 2015; 31:1085-7. [DOI: 10.1086/656376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
23
|
Skally M, Hanly P, Sharp L. Cost effectiveness of fecal DNA screening for colorectal cancer: a systematic review and quality appraisal of the literature. Appl Health Econ Health Policy 2013; 11:181-192. [PMID: 23549792 DOI: 10.1007/s40258-013-0010-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fecal DNA (fDNA) testing is a noninvasive potential alternative to current colorectal cancer screening tests. OBJECTIVE We conducted a systematic review and quality assessment of studies of cost-effectiveness of fDNA as a colorectal cancer screening tool (compared with no screening and other screening modalities), and identified key variables that impinged on cost-effectiveness. DATA SOURCES We searched MEDLINE, Embase, and the Centre for Reviews and Dissemination for cost-effectiveness studies of fDNA-based screening, published in English by September 2011. STUDY SELECTION Studies that undertook an economic evaluation of fDNA, using either a cost-effectiveness or cost-utility analysis, compared with other relevant screening modalities and/or no screening were included. Additional inclusion criteria related to the presentation of data pertaining to model variables including time horizon, costs, fDNA performance characteristics, screening uptake, and comparators. A total of 369 articles were initially identified for review. After removing duplicates and applying inclusion and exclusion criteria, seven articles were included in the final review. STUDY APPRAISAL Data was abstracted on key descriptor variables including screening scenarios, time horizon, costs, test performance characteristics, screening uptake, comparators, and incremental cost-effectiveness ratios. Quality assessment was undertaken using a standard checklist for economic evaluations. Studies cited by cost-effectiveness articles as the source of data on fDNA test performance characteristics were also reviewed. RESULTS Seven cost-effectiveness studies were included, from the USA (4), Canada (1), Israel (1), and Taiwan (1). Markov models (5), a partially observable Markov decision process model (1) and MISCAN and SimCRC (1) microsimulation models were used. All studies took a third-party payer perspective and one included, in addition, a societal perspective. Comparator screening tests, screening intervals, and specific fDNA tests varied between studies. fDNA sensitivity and specificity parameters were derived from 12 research studies and one meta-analysis. Outcomes assessed were life-years gained and quality-adjusted life-years gained. fDNA was cost-effective when compared with no screening in six studies. Compared with other screening modalities, fDNA was not considered cost-effective in any of the base-case analyses: in five studies it was dominated by all alternatives considered. Sensitivity analyses identified cost, compliance, and test parameters as key influential parameters. In general, poor presentation of "study design" and "data collection" details lowered the quality of included articles. LIMITATIONS Although the literature searches were designed for high sensitivity, the possibility cannot be excluded that some eligible studies may have been missed. Reports (such as Health Technology Assessments produced by government agencies) and other forms of grey literature were excluded because they are difficult to identify systematically and/or may not report methods and results in sufficient detail for assessment. CONCLUSION On the basis of the available (albeit limited) evidence, while fDNA is cost-effective when compared with no screening, it is currently dominated by most of the other available screening options. Cost and test performance appear to be the main influences on cost-effectiveness.
Collapse
Affiliation(s)
- Mairead Skally
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
| | | | | |
Collapse
|
24
|
Hanly P, Céilleachair AÓ, Skally M, O'Leary E, Staines A, Kapur K, Fitzpatrick P, Sharp L. Time costs associated with informal care for colorectal cancer: an investigation of the impact of alternative valuation methods. Appl Health Econ Health Policy 2013; 11:193-203. [PMID: 23549793 DOI: 10.1007/s40258-013-0013-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND A societal perspective in economic evaluation necessitates that all resources associated with a disease or intervention should be valued; however, informal care time costs are rarely considered. OBJECTIVE We estimated time allocated to care by informal carers of colorectal cancer survivors; and investigated the impact of applying alternative valuation methods to this time. METHODS Colorectal cancer cases (ICD10 C18-C20) diagnosed 6-30 months previously and identified from the National Cancer Registry Ireland were invited to provide details of informal carers. Carers completed a postal questionnaire. Time estimates per week associated with hospital-related and domestic-related care activities were collected for two phases: diagnosis and initial treatment (initial 3 months) and ongoing care (previous 30 days). Seven valuation scenarios, based on variants of the opportunity cost approach (OCA), and the proxy good approach (PGA), were considered. The base-case was OCA with all carer time valued at the average national wage. RESULTS We received 154 completed questionnaires (response rate = 68 %). Average weekly time allocated to caring was 42.5 h in the diagnosis and initial treatment phase and 16.9 h in the ongoing care phase. Under the base-case, average weekly time costs were <euro>295 (95 % CI 255-344) for hospital-related activities and <euro>630 (95 % CI 543-739) for domestic-related activities in the diagnosis and initial treatment phase and <euro>359 (95 % CI 293-434) in the ongoing care phase. PGA estimates were 23 % below the base-case. Only one alternative scenario (occupation and gender-specific wages for carers in paid work and replacement wages for non-working carers) surpassed base-case costs, and the difference was modest. CONCLUSIONS Overall, significant time is associated with informal caring in colorectal cancer. Different time valuation methods can produce quite different cost estimates. A standardised methodology for estimating informal care costs would facilitate better integration of these into economic evaluations.
Collapse
Affiliation(s)
- Paul Hanly
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Hanly P, Céilleachair AÓ, Skally M, O'Leary E, Kapur K, Fitzpatrick P, Staines A, Sharp L. How much does it cost to care for survivors of colorectal cancer? Caregiver's time, travel and out-of-pocket costs. Support Care Cancer 2013; 21:2583-92. [PMID: 23649879 PMCID: PMC6763575 DOI: 10.1007/s00520-013-1834-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/21/2013] [Indexed: 11/25/2022]
Abstract
Purpose Cancer treatment is increasingly delivered in an outpatient setting. This may entail a considerable economic burden for family members and friends who support patients/survivors. We estimated financial and time costs associated with informal care for colorectal cancer. Methods Two hundred twenty-eight carers of colorectal cancer survivors diagnosed on October 2007–September 2009 were sent a questionnaire. Informal care costs included hospital- and domestic-based foregone caregiver time, travel expenses and out-of-pocket (OOP) costs during two phases: diagnosis and treatment and ongoing care (previous 30 days). Multiple regression was used to determine cost predictors. Results One hundred fifty-four completed questionnaires were received (response rate = 68 %). In the diagnosis and treatment phase, weekly informal care costs per person were: hospital-based costs, incurred by 99 % of carers, mean = €393 (interquartile range (IQR), €131–€541); domestic-based time costs, incurred by 85 %, mean = €609 (IQR, €170–€976); and domestic-based OOP costs, incurred by 68 %, mean = €69 (IQR, €0–€110). Ongoing costs included domestic-based time costs incurred by 66 % (mean = €66; IQR, €0–€594) and domestic-based OOP costs incurred by 52 % (mean = €52; IQR, €0–€64). The approximate average first year informal care cost was €29,842, of which 85 % was time costs, 13 % OOP costs and 2 % travel costs. Significant cost predictors included carer age, disease stage, and survivor age. Conclusion Informal caregiving associated with colorectal cancer entails considerable time and OOP costs. This burden is largely unrecognised by policymakers, service providers and society in general. These types of studies may facilitate health decision-makers in better assessing the consequences of changes in cancer care organisation and delivery. Electronic supplementary material The online version of this article (doi:10.1007/s00520-013-1834-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Paul Hanly
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Solomon K, Fanning S, McDermott S, Murray S, Scott L, Martin A, Skally M, Burns K, Kuijper E, Fitzpatrick F, Fenelon L, Kyne L. PCR ribotype prevalence and molecular basis of macrolide-lincosamide-streptogramin B (MLSB) and fluoroquinolone resistance in Irish clinical Clostridium difficile isolates. J Antimicrob Chemother 2011; 66:1976-82. [DOI: 10.1093/jac/dkr275] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
27
|
Martin J, Barry J, Skally M. Alcohol attributable hospitalisations and costs in Ireland, 2000-2004. Ir Med J 2011; 104:140-144. [PMID: 21736089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to calculate the number and costs of hospital bed-days due to alcohol use in Ireland over the five year period 2000 to 2004. Age and sex specific Irish alcohol-attributable-fractions (AAFs) were developed by combining international risk estimates with Irish consumption data where available; where not available international AAFs were used. These were applied to national datasets to count the number and costs of bed-days wholly caused and prevented by alcohol and that proportion of bed-days that were partially caused and prevented by alcohol. Between 2000 and 2004, alcohol was estimated to have caused 3,428,973 (10.3%) and prevented 529,239 (1.6%) of hospital bed-days, giving a net number of bed-days due to alcohol of 2,899,734 (8.7%). Over this period the hospital inpatient costs attributed to the negative effects of alcohol were 953,126,381 euros, the costs attributed to hospitalisations prevented were 147,968,164 euros; giving net costs of alcohol-attributed bed-days of 805,158,217 euros. Chronic conditions accounted for 3,262,408 (95%) hospital bed-days due to the harmful effects of alcohol. Conditions not wholly due to alcohol accounted for 2,297,412 (67%) hospital bed-days due to the harmful effects of alcohol. The negative impacts of alcohol were greater than previously thought and spread across the whole population.
Collapse
Affiliation(s)
- J Martin
- Department of Health and Children, Hawkins House, Dublin 2.
| | | | | |
Collapse
|
28
|
Solomon K, Murray S, Scott L, McDermott S, Drudy D, Martin A, O'Donoghue C, Skally M, Burns K, Fenelon L, Fitzpatrick F, Kyne L, Fanning S. An investigation of the subtype diversity of clinical isolates of Irish Clostridium difficile ribotypes 027 and 078 by repetitive-extragenic palindromic PCR. J Med Microbiol 2011; 60:1080-1087. [PMID: 21459905 DOI: 10.1099/jmm.0.029983-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A repetitive-extragenic palindromic PCR (rep-PCR) subtyping method (DiversiLab) in conjunction with ribotyping, toxinotyping and antimicrobial-susceptibility testing was used to detect subtypes within Clostridium difficile ribotypes 027 and 078. Clinical isolates of ribotypes 027 (toxinotype III) (n = 30) and 078 (toxinotype V) (n = 23) were provided by health-care facilities across the Republic of Ireland over 2 months in 2006 and 1 month in 2009. Ribotype 027 isolates were significantly more related to each other (9 different subtype profiles) when compared to ribotype 078 isolates (14 different profiles) (P = 0.001; cut-off >90 % similarity). Almost half of ribotype 078 isolates (45.5 %) showed no relationship to each other. The clonality of ribotype 027 isolates suggests effective adaptation to the human niche, whereas the considerable genetic diversity within ribotype 078 isolates suggests that they may have originated from a variety of sources. Subtyping correlated well with antimicrobial susceptibility, in particular clindamycin susceptibility for ribotype 027, but diverse antimicrobial-susceptibility profiles were seen in ribotype 078 isolates, even within a single health-care facility. Between 2006 and 2009, a change in the predominant subtype of ribotype 027 was seen, with the recent clone representing half of all ribotype 027 isolates studied. This strain exhibited 89 % similarity to a rep-PCR profile of the North American NAP-1 strain.
Collapse
Affiliation(s)
- K Solomon
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - S Murray
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - L Scott
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S McDermott
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Drudy
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Martin
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - C O'Donoghue
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - M Skally
- Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K Burns
- Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - L Fenelon
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
- Health Protection and Surveillance Centre, Gardiner Street, Dublin 1, Ireland
| | - L Kyne
- Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - S Fanning
- UCD Veterinary Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| |
Collapse
|
29
|
de Kraker MEA, Wolkewitz M, Davey PG, Koller W, Berger J, Nagler J, Icket C, Kalenic S, Horvatic J, Seifert H, Kaasch A, Paniara O, Argyropoulou A, Bompola M, Smyth E, Skally M, Raglio A, Dumpis U, Melbarde Kelmere A, Borg M, Xuereb D, Ghita MC, Noble M, Kolman J, Grabljevec S, Turner D, Lansbury L, Grundmann H. Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother 2010; 66:398-407. [PMID: 21106563 DOI: 10.1093/jac/dkq412] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe. METHODS A prospective parallel matched cohort design was used. Cohort I consisted of patients with third-generation-cephalosporin-resistant E. coli BSI (REC) and cohort II consisted of patients with third-generation-cephalosporin-susceptible E. coli BSI (SEC). Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI. Thirteen European tertiary care centres participated between July 2007 and June 2008. RESULTS Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls. REC patients had a higher mortality at 30 days (adjusted odds ratio = 4.6) and a higher hospital mortality (adjusted hazard ratio = 5.7) than their controls. LOS was increased by 8 days. For SEC patients, these figures were adjusted odds ratio = 1.9, adjusted hazard ratio = 2.0 and excess LOS = 3 days. A 2.5 times [95% confidence interval (95% CI) 0.9-6.8] increase in all-cause mortality at 30 days and a 2.9 times (95% CI 1.2-6.9) increase in mortality during entire hospital stay as well as an excess LOS of 5 days (95% CI 0.4-10.2) could be attributed to resistance to third-generation cephalosporins in E. coli BSI. CONCLUSIONS Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant. If prevailing resistance trends continue, high societal and economic costs can be expected. Better management of infections caused by resistant E. coli is becoming essential.
Collapse
Affiliation(s)
- M E A de Kraker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|