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Kinross P, Latour K, Ricchizzi E, Kärki T, Suetens C. Infection prevention and control and antimicrobial stewardship in European long-term care, 2016-2017. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Europe's population is ageing. Long-term care facilities (LTCFs) for this vulnerable population are often relatively homelike with low staff-to-resident ratios. In 2016-2017, ECDC coordinated its third point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European long-term care facilities (LTCFs). It included collection of data on structure and process indicators (SPIs) of infection prevention and control (IPC) and antimicrobial stewardship, to support countries' identification of national and local interventions in LTCFs.
Methods
In each country, national contacts recruited a convenience sample of LTCFs. National/LTCF PPS teams used a standard protocol that included case definition algorithms (adapted US CDC/SHEA definitions) applied to each resident with signs/symptoms of infection on the PPS day, and questions for LTCF staff on SPIs of IPC and antimicrobial stewardship activities. Denominators indicate the number of responses available for analysis.
Results
3,052 LTCFs in 24 EU/EEA countries were recruited, with 102,301 residents included. The prevalence of HAIs (residents with ≥1 HAI) was 3.7%. Although 1,524/1,623 (94%) LTFS had a hand hygiene (HH) protocol, only 1,046/1,585 (66%) LTCFs had organised ≥1 HH training session for care professionals during the previous year. 1,185/1,561 (76%) LTCFs reported IPC training of nursing and paramedical staff. Only 340/1,639 (21%) of LTCFs reported training on appropriate prescribing and 493/1,623 (30%) LTCFs had provided feedback to GPs on antimicrobial consumption. On the PPS day, annual antimicrobial consumption data were available to only 530/1,623 (32%) LTCFs.
Conclusions
Even in LTCFs with the capacity to perform this PPS, IPC training was non-ubiquitous and antimicrobial stewardship activities, including training, were rarely reported. ECDC encourages EU/EEA countries to recruit LTCFs to participate in future PPSs, to allow them to benchmark HAI rates and practices.
Key messages
The prevalence of healthcare-associated infections in European long-term care facilities (LTCFs) highlights their requirement for infection prevention and control (IPC) and antimicrobial stewardship. This multi-national point prevalence survey (PPS) indicates that European countries can consider reinforcing IPC, antimicrobial stewardship practices and participation in PPSs in LTCFs.
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Affiliation(s)
- P Kinross
- Disease Programme Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - K Latour
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - E Ricchizzi
- Regional Health and Social Agency - Emilia Romagna, Bologna, Italy
| | - T Kärki
- Disease Programme Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - C Suetens
- Disease Programme Unit, European Centre for Disease Prevention and Control, Solna, Sweden
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Ricchizzi E, Latour K, Kärki T, Buttazzi R, Jans B, Moro ML, Nakitanda OA, Plachouras D, Monnet DL, Suetens C, Kinross P. Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458913 PMCID: PMC6247460 DOI: 10.2807/1560-7917.es.2018.23.46.1800394] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.
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Affiliation(s)
- Enrico Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Tommi Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Rossella Buttazzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | | | | | - Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
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Walter J, Haller S, Quinten C, Kärki T, Zacher B, Eckmanns T, Abu Sin M, Plachouras D, Kinross P, Suetens C, Ecdc Pps Study Group. Healthcare-associated pneumonia in acute care hospitals in European Union/European Economic Area countries: an analysis of data from a point prevalence survey, 2011 to 2012. ACTA ACUST UNITED AC 2019; 23. [PMID: 30107871 PMCID: PMC6092912 DOI: 10.2807/1560-7917.es.2018.23.32.1700843] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An aim of the ECDC point prevalence survey (PPS) in European Union/European Economic Area acute care hospitals was to acquire standardised healthcare-associated infections (HAI) data. We analysed one of the most common HAIs in the ECDC PPS, healthcare-associated pneumonia (HAP). Standardised HAI case definitions were provided and countries were advised to recruit nationally representative subsets of hospitals. We calculated 95% confidence intervals (CIs) around prevalence estimates and adjusted for clustering at hospital level. Of 231,459 patients in the survey, 2,902 (1.3%; 95% CI: 1.2–1.3) fulfilled the case definition for a HAP. HAPs were most frequent in intensive care units (8.1%; 95% CI: 7.4–8.9) and among patients intubated on the day of the survey (15%; 95% CI: 14–17; n = 737 with HAP). The most frequently reported microorganism was Pseudomonas aeruginosa (17% of 1,403 isolates), followed by Staphylococcus aureus (12%) and Klebsiella spp. (12%). Antimicrobial resistance was common among isolated microorganisms. The most frequently prescribed antimicrobial group was penicillins, including combinations with beta-lactamase inhibitors. HAPs occur regularly among intubated and non-intubated patients, with marked differences between medical specialities. HAPs remain a priority for preventive interventions, including surveillance. Our data provide a reference for future prevalence of HAPs at various settings.
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Affiliation(s)
- Jan Walter
- Unit of Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sebastian Haller
- Unit of Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Chantal Quinten
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Tommi Kärki
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Benedikt Zacher
- Unit of Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit of Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Muna Abu Sin
- Unit of Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Diamantis Plachouras
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Pete Kinross
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Carl Suetens
- Surveillance and Response Support Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Meijs AP, Prantner I, Kärki T, Ferreira JA, Kinross P, Presterl E, Märtin P, Lyytikäinen O, Hansen S, Szőnyi A, Ricchizzi E, Valinteliėnė R, Zerafa S, de Greeff SC, Berg TC, Fernandes PA, Štefkovičová M, Asensio A, Lamagni T, Sartaj M, Reilly J, Harrison W, Suetens C, Koek MBG. Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate? J Hosp Infect 2019; 103:404-411. [PMID: 31265856 DOI: 10.1016/j.jhin.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/13/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.
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Affiliation(s)
- A P Meijs
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - I Prantner
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - T Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - J A Ferreira
- Department of Statistics, Informatics and Modelling, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - P Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - E Presterl
- Medical University Vienna, Vienna, Austria
| | - P Märtin
- West Tallinn Central Hospital, Health Board, Tallinn, Estonia
| | - O Lyytikäinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Hansen
- Institute of Hygiene and Environmental Health Charité, University Medicine Berlin, Berlin, Germany
| | - A Szőnyi
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - E Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - S Zerafa
- Mater Dei Hospital, Msida, Malta
| | - S C de Greeff
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T C Berg
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - M Štefkovičová
- Alexander Dubcek University in Trenčín and Regional Public Health Authority in Trenčín, Slovakia
| | - A Asensio
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - T Lamagni
- Public Health England, London, England, UK
| | - M Sartaj
- HSC Public Health Agency, Belfast, Northern Ireland, UK
| | - J Reilly
- Health Protection Scotland National Services Scotland and Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - C Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - M B G Koek
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Kärki T, Plachouras D, Cassini A, Suetens C. Burden of healthcare-associated infections in European acute care hospitals. Wien Med Wochenschr 2019; 169:3-5. [PMID: 30680486 DOI: 10.1007/s10354-018-0679-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals in 28 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4-7.8%) patients in acute care hospitals had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022-117,484) in acute care hospitals had an HAI; 3.8 million (95% cCI: 3.1-4.5 million) patients acquired an HAI each year. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA.
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Affiliation(s)
- Tommi Kärki
- European Centre for Disease Prevention and Control, Gustav III:s Boulevard 40, 16973, Solna, Sweden.
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van Hauwermeiren E, Iosifidis E, Kärki T, Suetens C, Kinross P, Plachouras D. Development of case vignettes for assessment of the inter-rater variability of national validation teams for the point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. J Hosp Infect 2019; 101:455-460. [PMID: 30682398 DOI: 10.1016/j.jhin.2019.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/19/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 2016-17 the European Centre for Disease Prevention and Control (ECDC) organized the second point prevalence survey (PPS) of healthcare-associated infections (HCAIs) and antimicrobial use in European acute care hospitals. This survey included a validation study to maximize the accuracy of case identification and classification. AIM ECDC developed case vignettes to assess the performance of the national validation teams. METHODS Case vignettes were developed by two medical doctors with experience in the management of HCAIs and antimicrobial stewardship. The case vignettes were based on actual clinical cases. The distribution of HCAIs among the case vignettes reflected the distribution of HCAIs in the previous PPS. All case vignettes were pilot-tested by three expert raters. Agreement among the expert raters was measured using kappa statistics. FINDINGS Sixty case vignettes were developed. Twenty-nine of them were HCAI cases and 31 were cases without an HCAI. The inter-rater reliability using kappa statistics was 0.78 for the presence of HCAI and 0.89 for the antimicrobial use, respectively. CONCLUSION The agreement between the expert raters was very good for antimicrobial use and good for the presence of HCAI. Case vignettes can be a tool to support standardization of surveillance, improving the validity and comparability of the data.
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Affiliation(s)
- E van Hauwermeiren
- Clinic of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - E Iosifidis
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - C Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - P Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - D Plachouras
- European Centre for Disease Prevention and Control, Solna, Sweden
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Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, Reilly J, Zarb P, Zingg W, Kinross P, Weist K, Monnet DL, Suetens C. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill 2018; 23:1800393. [PMID: 30458917 PMCID: PMC6247463 DOI: 10.2807/1560-7917.es.23.46.1800393] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
Antimicrobial agents used to treat infections are life-saving. Overuse may result in more frequent adverse effects and emergence of multidrug-resistant microorganisms. In 2016-17, we performed the second point-prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals. We included 1,209 hospitals and 310,755 patients in 28 of 31 European Union/European Economic Area (EU/EEA) countries. The weighted prevalence of antimicrobial use in the EU/EEA was 30.5% (95% CI: 29.2-31.9%). The most common indication for prescribing antimicrobials was treatment of a community-acquired infection, followed by treatment of HAI and surgical prophylaxis. Over half (54.2%) of antimicrobials for surgical prophylaxis were prescribed for more than 1 day. The most common infections treated by antimicrobials were respiratory tract infections and the most commonly prescribed antimicrobial agents were penicillins with beta-lactamase inhibitors. There was wide variation of patients on antimicrobials, in the selection of antimicrobial agents and in antimicrobial stewardship resources and activities across the participating countries. The results of the PPS provide detailed information on antimicrobial use in European acute care hospitals, enable comparisons between countries and hospitals, and highlight key areas for national and European action that will support efforts towards prudent use of antimicrobials.
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Affiliation(s)
| | - Tommi Kärki
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Outi Lyytikäinen
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | - Jacqui Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
- Glasgow Caledonian University, Glasgow, United Kingdom
| | | | | | - Pete Kinross
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Klaus Weist
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Jans B, Hopkins S, Hansen S, Lyytikäinen O, Reilly J, Deptula A, Zingg W, Plachouras D, Monnet DL. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill 2018; 23:1800516. [PMID: 30458912 PMCID: PMC6247459 DOI: 10.2807/1560-7917.es.2018.23.46.1800516#abstract_content] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/20/2018] [Accepted: 11/07/2018] [Indexed: 06/17/2023] Open
Abstract
Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4-7.8%) patients in ACH and 3.9% (95% cCI: 2.4-6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022-117,484) in ACH and 129,940 (95% cCI: 79,570-197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6-15.6 million), including 4.5 million (95% cCI: 2.6-7.6 million) in ACH and 4.4 million (95% cCI: 2.0-8.0 million) in LTCF; 3.8 million (95% cCI: 3.1-4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH.
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Affiliation(s)
- Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Tommi Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Enrico Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | - Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | | | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Helsinki, Finland
| | - Jacqui Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
- Glasgow Caledonian University, Glasgow, United Kingdom
| | - Aleksander Deptula
- Department of Propaedeutics of Medicine, Nicolaus Copernicus University, Toruń; Ludwik Rydygier Collegium Medicum; Bydgoszcz, Poland
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9
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Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Jans B, Hopkins S, Hansen S, Lyytikäinen O, Reilly J, Deptula A, Zingg W, Plachouras D, Monnet DL. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill 2018; 23:1800516. [PMID: 30458912 PMCID: PMC6247459 DOI: 10.2807/1560-7917.es.2018.23.46.1800516] [Citation(s) in RCA: 341] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4-7.8%) patients in ACH and 3.9% (95% cCI: 2.4-6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022-117,484) in ACH and 129,940 (95% cCI: 79,570-197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6-15.6 million), including 4.5 million (95% cCI: 2.6-7.6 million) in ACH and 4.4 million (95% cCI: 2.0-8.0 million) in LTCF; 3.8 million (95% cCI: 3.1-4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH.
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Affiliation(s)
- Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Tommi Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Enrico Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | - Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | | | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Helsinki, Finland
| | - Jacqui Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
- Glasgow Caledonian University, Glasgow, United Kingdom
| | - Aleksander Deptula
- Department of Propaedeutics of Medicine, Nicolaus Copernicus University, Toruń; Ludwik Rydygier Collegium Medicum; Bydgoszcz, Poland
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Lucarelli C, Dionisi AM, Trezzi L, Farina C, Passera M, Kärki T, D'Ancona F, Luzzi I. Molecular and Epidemiological Analysis of aCampylobacter jejuniOutbreak in Northern Italy in November 2013. Foodborne Pathog Dis 2016; 13:490-4. [DOI: 10.1089/fpd.2015.2104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Claudia Lucarelli
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Istituto Superiore di Sanità, Rome, Italy
| | | | - Livia Trezzi
- Azienda Sanitaria Locale di Bergamo, Rome, Italy
| | | | - Marco Passera
- Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Tommi Kärki
- Istituto Superiore di Sanità, Rome, Italy
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Ida Luzzi
- Istituto Superiore di Sanità, Rome, Italy
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11
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Martelius T, Jalava J, Kärki T, Möttönen T, Ollgren J, Lyytikäinen O. Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality. Infect Dis (Lond) 2015; 48:229-34. [PMID: 26577519 DOI: 10.3109/23744235.2015.1109135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few systematically collected multi-centre surveillance data on nosocomial bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae have been published. AIM To evaluate trends, patient characteristics and mortality of such infections, nosocomial BSI data reported by the 4-17 hospitals participating in the prospective laboratory-based surveillance during 1999-2013 were analysed. METHODS Data were collected by local infection control nurses, patient-days were obtained from the hospital's administrative database, and dates of deaths from the population registry. Resistance to third-generation cephalosporins was further examined in the national reference laboratory. FINDINGS A total of 16 028 nosocomial BSIs were identified; 2217 (14%) were caused by E. coli and 661 (4%) by K. pneumoniae; 207 (7%) were non-susceptible to third-generation cephalosporins, with an increasing trend from 0% in 1999 to 17% in 2013. Patient characteristics did not differ significantly between BSIs caused by third-generation susceptible and resistant E. coli and K. pneumonia, but the case fatality tended to be higher. Most (88%) of the isolates reported as non-susceptible to third-generation cephalosporins had ESBL phenotype, CTX-M (79%) being the most common enzyme. CONCLUSION A sharp increase in nosocomial BSIs caused by ESBL producing bacteria was observed. Identification of patients for screening pose a challenge, emphasising the role of infection control guidelines and antibiotic policy in prevention.
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Affiliation(s)
- Timi Martelius
- a Department of Infectious Diseases , Inflammation Centre, Helsinki University Hospital and University of Helsinki, Inflammation Centre , Helsinki , Finland ;,b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Jari Jalava
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Tommi Kärki
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Teemu Möttönen
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Jukka Ollgren
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Outi Lyytikäinen
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
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12
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Åttman E, Aittoniemi J, Sinisalo M, Vuento R, Lyytikäinen O, Kärki T, Syrjänen J, Huttunen R. Etiology, clinical course and outcome of healthcare-associated bloodstream infections in patients with hematological malignancies: a retrospective study of 350 patients in a Finnish tertiary care hospital. Leuk Lymphoma 2015; 56:3370-7. [DOI: 10.3109/10428194.2015.1032967] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Riccardo F, Dente MG, Kärki T, Fabiani M, Napoli C, Chiarenza A, Giorgi Rossi P, Munoz CV, Noori T, Declich S. Towards a European Framework to Monitor Infectious Diseases among Migrant Populations: Design and Applicability. Int J Environ Res Public Health 2015; 12:11640-61. [PMID: 26393623 PMCID: PMC4586696 DOI: 10.3390/ijerph120911640] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/06/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022]
Abstract
There are limitations in our capacity to interpret point estimates and trends of infectious diseases occurring among diverse migrant populations living in the European Union/European Economic Area (EU/EEA). The aim of this study was to design a data collection framework that could capture information on factors associated with increased risk to infectious diseases in migrant populations in the EU/EEA. The authors defined factors associated with increased risk according to a multi-dimensional framework and performed a systematic literature review in order to identify whether those factors well reflected the reported risk factors for infectious disease in these populations. Following this, the feasibility of applying this framework to relevant available EU/EEA data sources was assessed. The proposed multidimensional framework is well suited to capture the complexity and concurrence of these risk factors and in principle applicable in the EU/EEA. The authors conclude that adopting a multi-dimensional framework to monitor infectious diseases could favor the disaggregated collection and analysis of migrant health data.
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Affiliation(s)
- Flavia Riccardo
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for disease Prevention and Control (ECDC), Tomtebodavägen 11a, 171 83 Stockholm, Sweden.
| | - Maria Grazia Dente
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
| | - Tommi Kärki
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for disease Prevention and Control (ECDC), Tomtebodavägen 11a, 171 83 Stockholm, Sweden.
| | - Massimo Fabiani
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
| | - Christian Napoli
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
| | - Antonio Chiarenza
- Research and Innovation Unit AUSL (Azienda Unità Sanitaria Locale) Reggio Emilia, Reggio Emilia 42122, Italy.
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, AUSL (Azienda Unità Sanitaria Locale) Reggio Emilia, Reggio Emilia 42122, Italy.
| | - Cesar Velasco Munoz
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11a, 171 83 Stockholm, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11a, 171 83 Stockholm, Sweden.
| | - Silvia Declich
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health (Istituto Superiore di Sanità, ISS), viale Regina Elena, 299-00161 Rome, Italy.
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14
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Hoxha A, Kärki T, Giambi C, Montano C, Sisto A, Bella A, D'Ancona F. Attributable mortality of carbapenem-resistant Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013. J Hosp Infect 2015; 92:61-6. [PMID: 26319590 DOI: 10.1016/j.jhin.2015.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 02/18/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infected patients. AIM To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection. METHODS We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression. FINDINGS The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1). CONCLUSION CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.
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Affiliation(s)
- A Hoxha
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - T Kärki
- Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - C Giambi
- Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - C Montano
- Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A Sisto
- Ospedale Bambino Gesù, Rome, Italy
| | - A Bella
- Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy
| | - F D'Ancona
- Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy
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15
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Del Grosso M, Kärki T, D'Ancona FP, Pantosti A. Decrease of vancomycin resistance in Enterococcus faecium isolates from bloodstream infections in Italy from 2003 to 2013. Antimicrob Agents Chemother 2015; 59:3690-1. [PMID: 25824233 PMCID: PMC4432216 DOI: 10.1128/aac.00513-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Maria Del Grosso
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Tommi Kärki
- National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Fortunato Paolo D'Ancona
- National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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16
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Huttunen R, Åttman E, Aittoniemi J, Outinen T, Syrjänen J, Kärki T, Lyytikäinen O. Nosocomial bloodstream infections in a Finnish tertiary care hospital: a retrospective cohort study of 2175 episodes during the years 1999-2001 and 2005-2010. Infect Dis (Lond) 2014; 47:20-6. [PMID: 25351869 DOI: 10.3109/00365548.2014.956791] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nosocomial infections are major causes of morbidity in hospitalized patients. METHODS Retrospective laboratory-based surveillance during 1999-2001 and 2005-2010 identified 2175 cases of nosocomial bloodstream infections (BSIs) in Tampere University Hospital (TAUH), Finland. RESULTS Analysis revealed that 57% of BSIs were caused by a gram-positive organism, 27% by a gram-negative organism, 5% by a fungal organism, and 11% were polymicrobial. The most common cause of nosocomial BSI was coagulase-negative staphylococci (23%). Candida species caused 5% of the infections. The 7-day and 30-day case fatalities were 8% (161/2158) and 15% (313/2175), respectively, and were highest in BSIs caused by Candida albicans (22% and 44%) and Pseudomonas aeruginosa (17% and 25%). The median age of patients was 54 years in 1999-2001, 57 years in 2005-2007, and 60 years in 2008-2010 (p < 0.001). The median time from hospital admission to the onset of BSI was 11 days (quartiles 5-18 days). This period was shortest for Streptococcus agalactiae BSI and longest for Candida non-albicans fungemia (1 vs 19 days). The case fatality rate in nosocomial BSI decreased during the years studied: 7-day and 30-day case fatalities were 9% and 16% during 1999-2001, 8.5% and 16% during 2005-2007, and 5% and 12% during 2008-2010, respectively (p < 0.003 and p = 0.022, respectively). CONCLUSIONS Gram-positive infections predominate in nosocomial BSIs. The median age of patients with nosocomial BSI has risen during the study years. The case fatality associated with nosocomial BSI has decreased.
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Affiliation(s)
- Reetta Huttunen
- From the Department of Internal Medicine, Tampere University Hospital , Tampere
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17
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Kärki T, Ollgren J, Lyytikäinen O. O063: Healthcare-associated bloodstream infections in Finland, 1999-2011 – adjusted ranking of hospitals by Staphylococcus aureus rates. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688212 DOI: 10.1186/2047-2994-2-s1-o63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Kanerva M, Mentula S, Virolainen-Julkunen A, Kärki T, Möttönen T, Lyytikäinen O. Reduction in Clostridium difficile infections in Finland, 2008–2010. J Hosp Infect 2013. [DOI: 10.1016/j.jhin.2012.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Rummukainen ML, Kärki T, Kanerva M, Haapasaari M, Ollgren J, Lyytikäinen O. Antimicrobial prescribing in nursing homes in Finland: results of three point prevalence surveys. Infection 2012; 41:355-60. [PMID: 22983808 DOI: 10.1007/s15010-012-0331-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/04/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to analyse the Finnish European Surveillance of Antimicrobial Consumption (ESAC) nursing home (NH) point prevalence surveys' (PPSs) data in detail, i.e. to evaluate the variability in the prevalence of antimicrobial prescription between NHs and its relationship to resident characteristics. METHODS All residents present in NHs for ≥ 24 h and receiving systemic antimicrobials on the day of the survey were included. Data on antimicrobials and their indications (prophylaxis or treatment, type of infection) were collected. RESULTS Three PPSs were performed: eight NHs participated in April and November 2009 and nine in May-September 2010. In total, there were 5,691 eligible residents (range by survey, 1,706-2,320; range by NH, 60-688), 716 (12.6 %; range by NH, 3.2-33.3 %) of which received at least one antimicrobial and 40 residents received two. The most common indication was prophylaxis (487/5,691, 8.6 %), mainly for urinary tract infection (UTI) (460/487, 94.5 %). Of the residents, 269/5,691 (4.7 %, range by NH, 1.5-6.0 %) were on antimicrobial treatment. UTI (119/269; 44.2 %) was the most common indication for treatment. Methenamine (306/756, 40.5 %) was the most commonly used antimicrobial, followed by trimethoprim (13.6 %) and pivmecillinam (11.0 %). In the eight NHs participating in all three surveys, the prevalence of residents receiving antimicrobials decreased from 16.6 to 9.7 %. CONCLUSIONS Antimicrobial use was common in NHs in Finland and most were used for UTI prophylaxis and treatment. The usage, however, varied among NHs and tended to decrease during the surveys. NHs may benefit from antimicrobial stewardship interventions focused on UTI.
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Affiliation(s)
- M-L Rummukainen
- Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
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20
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Lipponen JA, Kemppainen J, Karjalainen PA, Laitinen T, Mikola H, Kärki T, Tarvainen MP. Hypoglycemia detection based on cardiac repolarization features. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:4697-700. [PMID: 22255386 DOI: 10.1109/iembs.2011.6091163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypoglycemia is known to affect repolarization characteristics of the heart. These changes are shown from ECG by prolonged QT-time and T-wave flattening. In this study we constructed a classifier based on these ECG parameters. By using the classifier we tried to detect hypoglycemic events from measurements of 22 test subjects. Hypoglycemic state was achieved using glucose clamp technique. Used test protocol consisted of three stages: normoglycemic period, transition period (blood glucose concentration decreasing) and hypoglycemic period. Subjects were divided into three groups: 9 healthy controls (Healthy), 6 otherwise healthy type 1 diabetics (T1DM) and 7 type 1 diabetics with disease complications (T1DMc). Detection of hypoglycemic event could be made passably from 15/22 measurements. In addition, we found that detection process is easier for healthy and T1DM groups than T1DMc group diabetics because in T1DMc group subjects' have lower autonomic response to hypoglycemic events. Also we noticed that changes in ECG occurs few minutes after blood glucose is decreased below 3.5 mmol/1.
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Affiliation(s)
- J A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
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21
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Lipponen JA, Kemppainen J, Karjalainen PA, Laitinen T, Mikola H, Kärki T, Tarvainen MP. Dynamic estimation of cardiac repolarization characteristics during hypoglycemia in healthy and diabetic subjects. Physiol Meas 2011; 32:649-60. [PMID: 21508439 DOI: 10.1088/0967-3334/32/6/003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypoglycemia is known to affect the repolarization characteristics of the heart, but the mechanisms behind these changes are not completely understood. We analyzed repolarization characteristics continuously from 22 subjects during normoglycemic period, transition period (blood glucose concentration decreasing) and hypoglycemic period from nine healthy controls (Healthy), six otherwise healthy type 1 diabetics (T1DM) and seven type 1 diabetics with disease complications (T1DMc). An advanced principal component regression (PCR)-based method was used for estimating ECG parameters beat-by-beat, and thus, continuous comparison between the repolarization characteristics and blood glucose values was made. We observed that hypoglycemia related ECG changes in the T1DMc group were smaller than changes in the Healthy and T1DM groups. We also noticed that when glucose concentration remained at a low level, the heart rate corrected QT interval prolonged progressively. Finally, a few minutes time lag was observed between the start of hypoglycemia and cardiac repolarization changes. One explanation for these observations could be that hypoglycemia related hormonal changes have a significant role behind the repolarization changes. This could explain at least the observed time lag (hormonal changes are slow) and the lower repolarization changes in the T1DMc group (hormonal secretion lowered in long duration diabetics).
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Affiliation(s)
- J A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
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22
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Sarvikivi E, Kärki T, Lyytikäinen O. Differences in surveillance definitions for neonatal healthcare-associated laboratory-confirmed bloodstream infection and clinical sepsis. J Hosp Infect 2011; 77:275-7. [DOI: 10.1016/j.jhin.2010.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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23
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Rummukainen M, Kanerva M, Haapasaari M, Kärki T, Lyytikäinen O, Jans B, Muller A, Goossens H. P01.03 Point prevalence survey of antimicrobial prescriptions in Finnish nursing homes. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60034-5] [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] [Indexed: 11/26/2022]
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24
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Sarvikivi E, Kärki T, Lyytikäinen O. Repeated prevalence surveys of healthcare-associated infections in Finnish neonatal intensive care units. J Hosp Infect 2010; 76:156-60. [PMID: 20579770 DOI: 10.1016/j.jhin.2010.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
More than one-fifth of patients in neonatal intensive care units (NICUs) have been reported to suffer from healthcare-associated infections (HAIs). The aim of this study was to assess prevalence, onset and types of HAI in Finnish NICU patients. We conducted six monthly point-prevalence surveys in all Finnish NICUs (N=24) between November 2008 and May 2009. For all patients present on the day of survey, the underlying conditions and invasive devices or treatments used on the day of survey and during the preceding six days were recorded on standardised forms. All HAIs active or under treatment on the day of survey were included. HAIs were categorised into early-onset (onset within the first 72 h of life) and late-onset (onset after the first 72 h of life) infections. During the six surveys, 1281 forms were obtained. Among them, 164 HAIs in 163 patients were identified (overall prevalence, 13%); 63 (38%) of the HAIs were late-onset infections (prevalence, 6.5%). Main types of HAI were clinical sepsis, laboratory-confirmed bloodstream infection, conjunctivitis, and pneumonia. Of all HAIs, 24% were microbiologically confirmed. Patients with birth weight <1500 g suffered from late-onset HAIs more commonly than those with birth weight > or =1500 g (10% vs 4%, P<0.01). Also hospitalisation of > or =7 days was associated with increased prevalence of HAI (8% vs 3%, P=0.01). The study was useful in terms of increasing awareness of HAI in the participating NICUs. These results can be used to strengthen incidence surveillance of HAIs in the Finnish NICUs in the future.
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Affiliation(s)
- E Sarvikivi
- Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Helsinki, Finland.
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25
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Georgiadis SD, Tarvainen MP, Kaskinoro K, Maksimow A, Kärki T, Jääskeläinen S, Scheinin H, Karjalainen PA. Kalman smoother based time-varying spectrum estimation of EEG during single agent propofol anesthesia. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:5709-5712. [PMID: 19963912 DOI: 10.1109/iembs.2009.5332660] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A time-varying parametric spectrum estimation method for analyzing EEG dynamics is presented. EEG signals are first modeled as a time-varying auto-regressive stochastic process and the model parameters are estimated recursively with a Kalman smoother algorithm. Time-varying spectrum estimates are then obtained from the estimated parameters. The proposed method was applied to measurements collected during low dose propofol anesthesia. The method was able to detect changes of event related (de)synchronization type elicited by verbal command.
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Affiliation(s)
- S D Georgiadis
- Department of Physics, University of Kuopio, Kuopio, Finland.
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26
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Valve K, Ruotsalainen E, Kärki T, Pekkanen E, Siikamäki H. Cluster of imported malaria from Gambia in Finland--travellers do not listen to given advice. Euro Surveill 2008; 13:19068. [PMID: 19094918] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Twelve Finnish tourists contracted falciparum malaria from Gambia in the period between 3 and 27 November 2008. None of them had used adequate malaria chemoprophylaxis.
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Affiliation(s)
- K Valve
- Department of Infectious Disease Epidemiology and Control, National Public Health Institute, Helsinki, Finland.
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27
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Valve K, Ruotsalainen E, Kärki T, Pekkanen E, Siikamäki H. Cluster of imported malaria from Gambia in Finland – travellers do not listen to given advice. Euro Surveill 2008. [DOI: 10.2807/ese.13.51.19068-en] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twelve Finnish tourists contracted falciparum malaria from Gambia in the period between 3 and 27 November 2008. The travellers came from different parts of Finland and all except one had booked the trip from the same travel agency. Ten of them had received information about the risk of malaria in Gambia and protection from mosquito bites but none of them had used adequate malaria chemoprophylaxis.
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Affiliation(s)
- K Valve
- National Public Health Institute, Department of Infectious Disease Epidemiology and Control, Helsinki, Finland
| | - E Ruotsalainen
- National Public Health Institute, Department of Infectious Disease Epidemiology and Control, Helsinki, Finland
| | - T Kärki
- National Public Health Institute, Department of Infectious Disease Epidemiology and Control, Helsinki, Finland
| | - E Pekkanen
- National Public Health Institute, Department of Infectious Disease Epidemiology and Control, Helsinki, Finland
| | - H Siikamäki
- Helsinki University Central Hospital, Division of Infectious Diseases, Department of Medicine, Helsinki, Finland
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Abstract
OBJECTIVE A cortical cognitive auditory evoked potential, mismatch negativity (MMN), reflects automatic discrimination and echoic memory functions of the auditory system. For this study, we examined whether this potential is dependent on the stimulus intensity. DESIGN The MMN potentials were recorded from 10 subjects with normal hearing using a sine tone of 1000 Hz as the standard stimulus and a sine tone of 1141 Hz as the deviant stimulus, with probabilities of 90% and 10%, respectively. The intensities were 40, 50, 60, 70, and 80 dB HL for both standard and deviant stimuli in separate blocks. RESULTS Stimulus intensity had a statistically significant effect on the mean amplitude, rise time parameter, and onset latency of the MMN. CONCLUSION Automatic auditory discrimination seems to be dependent on the sound pressure level of the stimuli.
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Affiliation(s)
- S Salo
- Department of Audiology, Turku University Hospital, Finland
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29
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Affiliation(s)
- E M Kotilainen
- Department of Neurosurgery and Surgery, Turku University Central Hospital, Finland
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30
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Tahvanainen K, Länsimies E, Tikkanen P, Hartikainen J, Kärki T, Lyyra T, Mäntysaari M. Microcomputer-based monitoring of cardiovascular functions in simulated microgravity. Adv Space Res 1992; 12:227-236. [PMID: 11536961 DOI: 10.1016/0273-1177(92)90287-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A microcomputer-based system for non-invasive monitoring of cardiovascular system in simulated microgravity is described. The system evaluates automatically, accurately and interactively heart beat intervals, beat-to-beat non-invasive finger arterial blood pressure (systolic, diastolic, mean and pulse pressure) using a Finapres device and beat-to-beat changes of thoracic blood volume using impedance changes. In addition, beat-to-beat evaluation of cardiac mechanical function including left ventricular ejection time, diastolic time, systolic time intervals, left ventricular ejection fraction estimate and several other contractility parameters, left ventricular volume, stroke volume and cardiac output estimates are performed with high degree of automaticity.
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Affiliation(s)
- K Tahvanainen
- Department of Clinical Physiology, Kuopio University Hospital, Finland
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Kärki T, Hakkola E, Hassinen IE, Hiltunen JK. Beta-oxidation of polyunsaturated fatty acids in peroxisomes. Subcellular distribution of delta 3,delta 2-enoyl-CoA isomerase activity in rat liver. FEBS Lett 1987; 215:228-32. [PMID: 3582650 DOI: 10.1016/0014-5793(87)80151-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The metabolism of the double bonds at the delta 3 position in fatty acids was studied in rat liver. Infusion of delta 3-trans-dodecenoic acid into isolated perfused liver and subcellular fractionation studies showed the presence of both peroxisomal and mitochondrial delta 3,delta 2-enoyl-CoA isomerase activity (EC 5.3.3.8). These findings together with the previous demonstration of peroxisomal 2,4-dienoyl-CoA reductase (EC 1.3.1.34) [(1981) J. Biol. Chem. 256, 8259-8262] and D-3-OH-acyl-CoA epimerase (EC 5.1.2.3) [(1985) FEBS Lett. 185, 129-134] activities show that peroxisomes possess all the auxiliary enzymes required for the beta-oxidation of unsaturated fatty acids.
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Hiltunen JK, Kärki T, Hassinen IE, Osmundsen H. beta-Oxidation of polyunsaturated fatty acids by rat liver peroxisomes. A role for 2,4-dienoyl-coenzyme A reductase in peroxisomal beta-oxidation. J Biol Chem 1986; 261:16484-93. [PMID: 2877988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
beta-Oxidation of unsaturated fatty acids was studied with isolated solubilized or nonsolubilized peroxisomes or with perfused liver isolated from rats treated with clofibrate. gamma-Linolenic acid gave the higher rate of beta-oxidation, while arachidonic acid gave the slower rate of beta-oxidation. Other polyunsaturated fatty acids (including docosahexaenoic acid) were oxidized at rates which were similar to, or higher than, that observed with oleic acid. Experiments with 1-14C-labeled polyunsaturated fatty acids demonstrated that these are chain-shortened when incubated with nonsolubilized peroxisomes. Spectrophotometric investigation of solubilized peroxisomal incubations showed that 2,4-dienoyl-CoA esters accumulated during peroxisomal beta-oxidation of fatty acids possessing double bond(s) at even-numbered carbon atoms. beta-Oxidation of [1-14C]docosahexaenoic acid by isolated peroxisomes was markedly stimulated by added NADPH or isocitrate. This fatty acid also failed to cause acyl-CoA-dependent NADH generation with conditions of assay which facilitate this using other acyl-CoA esters. These findings suggest that 2,4-dienoyl-CoA reductase participation is essential during peroxisomal beta-oxidation if chain shortening is to proceed beyond a delta 4 double bond. Evidence obtained using arachidionoyl-CoA, [1-14C]arachidonic acid, and [5,6,8,9,11,12,14,15-3H]arachidonic acid suggests that peroxisomal beta-oxidation also can proceed beyond a double bond positioned at an odd-numbered carbon atom. Experiments with isolated perfused livers showed that polyunsaturated fatty acids also in the intact liver are substrates for peroxisomal beta-oxidation, as judged by increased levels of the catalase-H2O2 complex on infusion of polyunsaturated fatty acids.
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