Microbiology of healthcare-associated infections and the definition accuracy to predict infection by potentially drug resistant pathogens: a systematic review

Abstract

BackgroundHealthcare-associated infections (HCAI) represent up to 50 % of all infections among patients admitted from the community. The current review intends to provide a systematic review on the microbiological profile involved in HCAI, to compare it with community-acquired (CAI) and hospital-acquired infections (HAI) and to evaluate the definition accuracy to predict infection by potentially drug resistant pathogens.MethodsWe search for HCAI in MEDLINE, SCOPUS and ISI Web of Knowledge with no limitations in regards to publication language, date of publication, study design or study quality. Only studies using the definition by Friedman et al. were included. This review was registered at PROSPERO Systematic Review Registration with the Number CRD42014013648.ResultsA total of 21 eligible studies with 12,096 infected patients were reviewed; of these 3497 had HCAI, 2723 were microbiologically documented. Twelve studies were on pneumonia involving 1051 patients with microbiological documented HCAI, the application of the current guidelines for this group of patients would result in an appropriate antibiotic therapy in 95 % of cases at the expense of overtreatment in 73 %; the application of community-acquired pneumonia guidelines would be adequate in only 73–76 % of the cases; an alternative regimen with piperacillin-tazobactam or aztreonam plus azithromycin would increase antibiotic adequacy rate to 90 %. Few studies were found on additional focus of infection: endocarditis, urinary, intra-abdominal and bloodstream infections. All studies included in this review showed an association of the HCAI definition with infection by PDR pathogens when compared to CAI [odds ratio (OR) 4.05, 95 % confidence interval (95 % CI) 2.60–6.31)]. The sensitivity of HCAI to predict infection by a PDR pathogen was 0.69 (0.65–0.72), specificity was 0.67 (0.66–0.68), positive likelihood ratio was 1.9 and the area under the summary ROC curve was 0.71.ConclusionsThis systematic review provides evidence that HCAI represents a separate group of infections in terms of the microbiology profile, including a significant association with infection by PDR pathogens, for the main focus of infection. The results provided can help clinician in the selection of empiric antibiotic therapy and international societies in the development of specific treatment recommendations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1304-2) contains supplementary material, which is available to authorized users.

Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

“…Among Gram positive pathogens, methicillin-resistant Staphylococcus aureus (MRSA) is the most frequent pathogen, particularly in immunocompromised patients [3]. Compared with community-acquired pneumonia, HAP are more likely to be infections caused by multidrug-resistant (MDR) pathogens [9]. The frequency of MDR pathogens as the etiologic agents of HAP and VAP is increasing [10, 11].…”

Intra-abdominal Infections: The Role of Anaerobes, Enterococci, Fungi, and Multidrug-Resistant Organisms

“…A detailed and much larger analysis of fungal IAI is warranted, with controlled analyses of independent predictors and outcomes. Such investigation could guide the appropriate empiric management of fungal IAI, stratified by the exact clinical syndrome and/or scenario, since the epidemiology of fungal IAI evolved considerably in the past years [17, 25, 26]. …”

“…The Duke-2002 HCAI definition describes an infection that is present at hospital admission or within 48 hours of admission in patients that fulfilled any of the following criteria: (1) received intravenous therapy at home or wound care or specialized nursing care in the previous 30 days; (2) attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the previous 30 days; (3) hospitalized in an acute care hospital for ≥2 days in the previous 90 days; or (4) resided in a nursing home or long-term care facility. The modified Duke-2002 definition simplified these criteria by altering the hospitalization criteria to ≥2 days in an acute-care hospital in the past year as the single criterion [17]. However, the performance of these definitions on an IAI cohort has not been measured or validated.…”

The Common Bacterial Infections in Patients with Leg or Hand Infections

“…Multiresistant gram-negative bacteria are the prime mover of nosocomial infections [2]. Healthcare-associated infections (HCAI) represent up to 50 % of all infections among patients admitted from the community [3].…”