Use of a Victorian statewide surveillance programme to evaluate the burden of healthcare‐associated Staphylococcus aureus bacteraemia and Clostridioides difficile infection in patients with cancer

Abstract

Background Patients with cancer are at high risk for infection, but the epidemiology of healthcare‐associated Staphylococcus aureus bacteraemia (HA‐SAB) and Clostridioides difficile infection (HA‐CDI) in Australian cancer patients has not previously been reported. Aims To compare the cumulative aggregate incidence and time trends of HA‐SAB and HA‐CDI in a predefined cancer cohort with a mixed statewide patient population in Victoria, Australia. Methods All SAB and CDI events in patients admitted to Victorian healthcare facilities between 1 July 2010 and 31 December 2018 were submitted to the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre. Descriptive analyses and multilevel mixed‐effects Poisson regression modelling were applied to a standardised data extract. Results In total, 10 608 and 13 118 SAB and CDI events were reported across 139 Victorian healthcare facilities, respectively. Of these, 89 (85%) and 279 (88%) were healthcare‐associated in the cancer cohort compared with 34% (3561/10 503) and 66% (8403/12 802) in the statewide cohort. The aggregate incidence was more than twofold higher in the cancer cohort compared with the statewide cohort for HA‐SAB (2.25 (95% confidence interval (CI): 1.74–2.77) vs 1.11 (95% CI: 1.07–1.15) HA‐SAB/10 000 occupied bed‐days) and threefold higher for HA‐CDI (6.26 (95% CI: 5.12–7.41) vs 2.31 (95% CI: 2.21–2.42) HA‐CDI/10 000 occupied bed‐days). Higher quarterly diminishing rates were observed in the cancer cohort than the statewide data for both infections. Conclusions Our findings demonstrate a higher burden of HA‐SAB and HA‐CDI in a cancer cohort when compared with state data and highlight the need for cancer‐specific targets and benchmarks to meaningfully support quality improvement.

Sources of healthcare-associated Staphylococcus aureus bacteraemia in New Zealand acute hospitals

“…The proportion of intravascular device-related HA-SAB events was approximately twofold higher in the cancer cohort than the state-wide comparator. 12 Fifty percent of all HA-SAB events in this study were associated with a CVC. CVCs are widely recognised as a significant source of bloodstream infection.…”

Performance of ICD-10-AM codes for quality improvement monitoring of hospital-acquired pneumonia in a haematology-oncology casemix in Victoria, Australia

“…This is particularly relevant for the administrative code-based HAC definition in a cancer casemix, where healthcare-associated infection rates are higher than mixed patient cohorts. Increased risk for infection onset in haematology-oncology patients is ascribed principally to cumulative periods of immunosuppression, the periodic requirement for hospitalisation, surgical debridement of malignant tissue and the recurrent need for in situ catherisation (Smibert et al, 2020; Teh et al, 2015; Valentine et al, 2021). Furthermore, significantly poorer clinical outcomes of hospital-acquired pneumonia are observed in these high-risk patients (Valentine et al, 2020b).…”