Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Heterogeneity of treatment effect of higher dose dexamethasone by geographic region in patients with COVID-19 and severe hypoxemia - Apost hocevaluation of the COVID STEROID 2 trial

“…(6-8) For treatments such as higher doses of corticosteroids, additional factors limited to lower-middle income countries (LMICs) may also play a role such as the higher potential for harm due to the differing comorbidity burden, and the higher prevalence of both healthcare associated infections including infections caused by multidrug resistant organisms. (9)(10)(11)(12)(13) In this post hoc analysis, the differences in baseline characteristics such as the higher prevalence of diabetes and the higher proportion of patients being enrolled from ICUs in India may have contributed to the heterogeneity of effects.…”

“…There was a suggestion of heterogeneity of treatment effect (HTE) on the primary outcome (days alive without life support at 28 days) when comparing the subgroup of patients enrolled in Europe vs. India [adjusted mean difference (MD) in Europe: 1.8 days (95% confidence interval (CI) 0.2 to 3.4 days) vs India: 0.5 days (95% CI: -1.7 to 2.6)]; however, this was not statistically significant (test of interaction P = 0.57). Potential reasons for HTE between India and Europe include important differences in patient and healthcare system characteristics, resource availability and intensive care capacity, (6,7) the burden of the pandemic, (8) the overall prevalence of healthcare associated infections, (9)(10)(11) including the prevalence of infection by multidrug resistant organisms, (12) and concerns of fungal infection outbreaks in India following corticosteroid use. (13,14) Whether there is HTE according to the geographical regions for the remaining prespecified patientcentred outcomes is unclear.…”

Health-care-associated infection surveillance in India

“…6 High levels of resistance, including against carbapenems among Acinetobacter spp, Pseudomonas spp, and Klebsiella spp have been reported from India. 7 In The Lancet Global Health, Purva Mathur and colleagues 8 report results of health-care-associated bloodstream and urinary tract infections in 89 intensive care units of 26 tertiary care hospitals in India. 8 The authors modified the NHSN and ECDC case definitions to facilitate standardised HAI surveillance, adjusting for the available resources in Indian hospitals.…”

“…7 In The Lancet Global Health, Purva Mathur and colleagues 8 report results of health-care-associated bloodstream and urinary tract infections in 89 intensive care units of 26 tertiary care hospitals in India. 8 The authors modified the NHSN and ECDC case definitions to facilitate standardised HAI surveillance, adjusting for the available resources in Indian hospitals. In adult and paediatric ICU types, the pooled rates of BSI ranged between 5•3-7•3 per 1000 patient days and CLABSI rates ranged between 8•3-12•1 per 1000 central line days.…”

“…The HAI surveillance established by Mathur and colleagues 8 represents a well laid foundation that needs to be continued and expanded further as a nationallevel surveillance system for major HAI, including ventilator-associated pneumonia and surgical site infection. However, the modified case definitions used in the study need to be validated before its large-scale implementation.…”