HCAI - Prevalence and Trends Flashcards

Question

What hospital factors affect HCAIs

Answer 1

space ventilation cleanliness

Answer 2

Diagnostics Therapy Care Rehabiblitation

Answer 3

MDROs virulence factors of orgnaism

Answer 4

Old age Dehibilitation Immunosuppression

Answer 5

A persons susceptibiliity to the infection The nature of the persons exposure to the microbe The virulence of the microbe causing the infection

Answer 6

Immunocompromised people such a transplant patients The very young due to immaturity of their immune system The elderly because of predisposing underlying disease, impaired blood supply and immobility

Answer 7

CPE BSIs have a mortality of 50% You are twice as likely to die with MRSA BSI then MSSA You are twice as likely to die with VRE BSI then VSE Patients with C. diff are twice as likely to die as those without C. diff

Answer 8

Underlying disease in any age group and the treatment of that disease e.g. cytotoxic drugs or steroids can predispose to infection Invasive procedures allowing organisms easier access to previously protected tissues such as instrumentation procedures e.g. catherisation and those on drips of those receiving nasogastric feeds etc

Answer 9

Catheter associated UTI Ventilator associated pneumonia Central venous catheter or periphperal venous cannula -> central line associated bsi

Answer 10

Through point prevalence studies done every few years: - determining the incidence and prevalence

Answer 11

Incidence is the rate of new cases of the disease Its reported as the number of new cases occurring within a period of time

Answer 12

Prevalence is the actual number of cases with the disease - during a period of time (period prevalence) - at a particular date in time (point prevalence)

Answer 13

By knowing how many people have the HAI and by knowing the number of people in the population at risk: Rate = number of infections/population at risk (x10,000) NB: can also be done for each month

Answer 14

1. measure the overall prevalence of HAI, types of HAI, HAI causative pathogens and key antimicrobial resistance profiles 2. measure the overall prevalence of antimicrobial use, types of antimicrobial prescribed, as well as compliance with local guidelines 3. identify priority areas for future interventions to prevenet and control HAI for antimicrobial stewardship and for future targeted incidence surveillance f HAI 4, Contribute data from Ireland and N. Ireland to the European report 5. Disseminate the PPS results to those who need to know at local, regional, national and EU level to identify problems and set up priorities accordingly

Answer 15

3 mjor studies have been done Disappointing as very limited information on organisms in infection - just provided a big list of organisms not related to each infection etc

Answer 16

Co ordinated by ECDC throughout EU/EEA countries Took place in Ireland in May 2023 65 hospitals from 50 pubic and 15 private hospitals 12,650 patients on 707 wards ad 14, 695 beds 34% single rooms The irish pps was done as part of a larger european pps

Answer 17

Pneumoniae and lower respiratory tract infections including covid accounted for 29.3% of HCAI UTIs accounted for 19.2% BSIs accounted for 11.9% NB: remember you can have more than one HAI at a time

Answer 18

Mostly due to a change int he defiition of pneumoniae: - removed the need for chest xray t diagnose - led to an increase in HCAI pneumoniae we also include sars cov2 as a HCAI in 2023 We also now included nursing home cases in 2023 We were below the EU average prio to these changes but now were above it

Answer 19

2012 = 34% AMU 2017 = 39.7% AMU 2023 = 40.4% AMU

Answer 20

901 patients had at least one HCAI HCAI prevalence of 7.4% 966 HCAIs were reported: 31 patients had>1 HCAI 19.7% had at les one invasive device, compared to: - 18.7% in 2017 - 16.3% in 2012

Answer 21

There was significantly more in IU than outside ICU which was attributed to more devices and catheters: - 55.3% had CVCs compared to 6.8% outside - 34.8% had intubation compared to 0.4% - 60.2% had urinary catheters compared to 12.8%

Answer 22

There was lower prevalence in certain specialities: - 7.8% prevalence in general surgery compared to: - 2.0% in obstetrics/maternity - 2.3% in paediatrics - 2.8% in cardiology

Answer 23

Penumonia Surgical site infections UTIs BSIs systemic infection C. difficile infection Skin and soft tissue infection

Answer 24

Penumonia: - 28.9% in 2017 - 27.4% in 2023 Surgical site infections: - 18.0% in 2017 - 13.6% in 2023 - fell to third most common in 2023 vs 2nd in 2017 UTIs: - 14.5% in 2017 - 14.6% in 2023 - now the 2nd most common vs 3rd in 2017 BSIs: - 9.9% in 2017 - 8.6% in 2023 systemic infection: - 6.2% in 2017 - 8.5% in 2023 - was the 5th most common but now the 6th in 2023 C. difficile infection: - 4.4% in 2017 - now grouped in with GI infections at 8.5% in 2023 - has rose to 5th most common vs 6th in 2017 Skin and soft tissue infection: - 3.8% in 2017 - 3.7% in 2023 - fell from 7th to 8th in 2023

Answer 25

SSI was the top HCAI in private hospitals vs PN in public hospitals Private hospitals had smaller numbers of infections but a higher frequency of HCAI e.g. - public had 0.9% SSIs in 205 patients while public had 1.9% SSIs in 26 patients

Answer 26

Pneumonia is the commonest HAI at n=265 cases 27.4% of all HAI 2.1% of study population 23 (8.7%) were associated with intubation of the respiratory tract: - compared to 16% in 2017) VAP is the most common ICU-acquired infection

Answer 27

Prevalence is increasing but proportion is decreasing i.e. amount of PN increasing but other HAI increasing more: - 2017 PN accounted for 29% of HAI and 1.9% prevalence - 2023 PN accounted for 27.4% of HAI but had a 2.1% prevalence NB: remember there was a change in definition that lead to PN going from second most frequet to most fequent - rates are stable when you take this into account

Answer 28

GNB such as: K. pneumonia: 11% Enterobacter: 3% Pseudomonas: 11% Staphylococcus 7% Covid 19: 20%

Answer 29

there were 141 UTIs which accounted for 14.6% total HAI 1.1% of UTIs were inpatients Only 56% were microbiologically confirmed 38.3% were associated with the presence of a catheter - was 29% in 2017

Answer 30

Proportion of 14.5% remains the same from 2017 to 2023 Prevalence of 1.1% in 2023 and 1.2% in 2017 However its ranking has increased from 3rd in 2017 to 2nd in 2023

Answer 31

32% E. Coli 15% Klebsiella 15% Enterococcus 9% Pseudomonas

Answer 32

Common HAI with n=131, accounts for 13.6% of all HAI 1% of inpatients 33% were classified as superficial incisional 42% were deep surgical site infections

Answer 33

accounted for 18% of SSIs in 2017 but now 13.6% in 2017 Prevalence of 1.2% in 2017 and now 1% in 2023 Proportion nad prevalence both decreasing its rank fell from 2nd in 2017 to 3rd in 2023, it had been 1st in 2012

Answer 34

It depended on the location and type of surgery but: - S. aureus accounted for 15% - E. Coli 10% - Klebsiella, GNBs in GI and GUT surgeries - MDRO?

Answer 35

83 cases accounting for 8.6% of BSIs 0.7% of inpatients 45.8% primary vs 45.8% secondary 26 cases or 31.3% had an invasive device

Answer 36

9.9% of HAI in 2017 with a prevalence of 0.6% Fell to 8.6% of HAI in 2023 with a prevalence of 0.7% Rank remains same at 4th most common

Answer 37

S, aureus at 15% CNS at 16% S. pneumonia at 2.2% Enterobacterales at 33% (significant) E. Coli at 12% Klebsiella at 12% P. aeruginosa at 7% Enterococcus species at 11% Anaerobes Candida at 7,2%

Answer 38

Surgery since hospital admission increased prevalence to 10.9 from 6.8% in non surgery CVS presence increased HAI prevalence to 17.7% vs 6.4% in those without Intubation presen increased HAI prevalence to 23.1% vs 7.1% in those without Urinary catheter present increased HAI prevalence to 15.5% vs 6.0% in those without

Answer 39

The 5th commonest HAI with 82 cases (8.5%) Prevalence of 0.6%

Answer 40

Was 8% in 2017 vs 9.8% in 2012 Figures not really available for 2023 as C. diff was grouped in with GI infections Prevalence of 0.5% in 2017 vs 0.54% in 2012 Ranking 5th remains same

Answer 41

4.8% in 2023 Accounts for 4.4% of HAI in 2017 vs 5.7% in 2012

Answer 42

Results are only available for 616 HAIs Only 62.7% of these had a pahogen detected No microbiology data provided on 12.5% Specimens not sent on 12.1% Results not available or missing for 6.7% Pathogen not isolated in 6% All in all really poor microbiology results

Answer 43

E. Coli accounted for 15.1% of HAI S. aureus accounted for 14.7% of HAIs SARS Cov 2 accounted for 9.3% C. difficile accounted for 8.9% E. faecium accounted for 6.0% K. pneumoniae accounted for 5.6%

Answer 44

105/126 Enterobacterales were tested for susceptibility to 3GC - 7 of these of 6.7% were resistant 108 were tested for susceptibility to carbapenems, one or 1% was determined to be a CRE - but this was susceptible to 3GC 1/12 P. aeruinosa wer carbapenemase resistant

Answer 45

15/69 s. aureus were tested for susceptibility to oxacillin and 15 or 23.4% were determined to be MRSA 49/52 Enterococcus species were tested for susceptibility to vancomycin of which nine (18.4%) were determined to be VREs

Answer 46

23.4% in 2023 28% in 2017 3% in 2012 NB: rate decreasing year on year

Answer 47

18.4% in 2023 39% in 2017 26% in 2012 trending downwards

Answer 48

5% of Pseudomonas were carbapenem resistant in 2023 15% were resistant in 2017

Answer 49

Overall AMU orevalence at 40.2% Prevalence higher in private hospitals (48.1%) compared to 39.3% in public Prevalence highest in adults in ICU (70.4%) followed by surgical specialities at 51.0% The lowest prevalence was in rehabilitation at 13.0%

Answer 50

European centre for disease prevention and control On any given day there are 670 inpatients with a HAI in irish hospitals 30,000 patients in Ireland are affected annually

Answer 51

Endogenous Exogenous

Answer 52

Endogenous are from the patients own inestinal, skin, oral or microflora Exogenous are from ieither another person in the hospital - cross infection or a contamination item of equipment or building service - environmental infection

Answer 53

It depends upon the nature of the source: - moist areas tend to be colonised with GNBS such as E. Coli, Klebsiella and Pseudomonas Air and dustborne organisms are those that can withstand drying, e.g. streptococci, staphylococci, mycobacteria and acinetobacter

Answer 54

Cross infection or contact tranmission - S. aureus Environmental infection through contaminated sources such as water, sinks, air, dust, medications e.g. IV fluids, medical devices, catheters, endoscopes, food etc

Answer 55

Catheters - S. aureus or CNS Dust - S. aureus of CNS Medical equipment - Endoscopes, enterobacterales, pseudomonas, c. difficile Fluids - p. aeruginosa from disinfectants food - salmonella or campylobacter

Answer 56

Many citations of water as a souce of HAI Many reports have identified the presence of GNBs in hospital sinks CRE outbreak in Limerick Patients exposed by hand-washing, bedpans, enteral feeding, respiratory equipment, drinking, showering, bed bathing etc

Answer 57

P. aeruginosa and S. marcescens These can survive for over 250 days on sink surfaces

Answer 58

The sink splash zone -> study looked at how far water spread from sink from doing normal hand hygiene -> theres often lots of medical equipment near the sink which has potential to be contaminated etc

Answer 59

Direct contact with water - hydrotherapy Ingestion of water through contaminaed ice Indirect contact transmission through improperly repossessed medical devices Inhalation of aerosols dispoersed from water sources Aspiration of contaminated ater Contamination of splash zones

Answer 60

A systenatic review has shown the following: 32 reports of CROs in the hospital water environement These are associated with clinical outbreaks in the ICU setting Drainks, sinks and faucets were most frequently colonised Pseudomonas aeruinosa was the predominant orgnism Imipenemase (IMP), Klebsiella pneumonia carbapenemase (KPC) and Verona integron metallo B lactamase (VIM) were the most common carbapenemase s found Replacement of colonised water reservoirs maybe required for long term clearance - there is also debate on wheterh or not ICU should go sink free

Answer 61

Pseudomonas aeruinosa was the predominant orgnism Imipenemase (IMP), Klebsiella pneumonia carbapenemase (KPC) and Verona integron metallo B lactamase (VIM) were the most common carbapenemase s found

Answer 62

airborne spread as seen with staphylococci and c. difficile Some diseases such as pulmonary TB and Legionnaires can also spread through airborne outes Other airborne agents include sars CoV2, apergillus, varicella zoster, influenza and RSV

Answer 63

Direct contact with infected or colonised patient or health care staff (also through their hand transmission) Also through infected droplets including coughing and sneezing

Answer 64

Infected patient contaminates surfaces, next patient in that room infected Sinks contaminated - splash zone contaminates nearby equipment then used on patient - infected patient

Answer 65

MRSA: 7 das up to 12 months VRE: 5 days up to 46 months P. aeruginosa: 6 hours up to 16 months C. difficile: >5monhs due to spores Acinetobacter baumannii: 3 days to 11 months CRE only 19 days Norovirus 8 hours to 7 days Rotavirus 6-60days

Answer 66

Prior room occupacy Increased risk if prior occupant of room had an infection

Answer 67

if MRSA then risk increased by 1.5% If VRE then risk increased by 2.25% If P, aeruginosa then increased by 1.75% I C. diff then 2.5% I A.baumannii then 3.5%

Answer 68

Pattern of HCAI has changed over the years due to advancements in medicine and the development of antimicrobials Initially majority of infections were caused by gram-positive organisms particularly S. aureus With the advent of antimicrobials active against staphylococci, GN organisms such as E. Coli, K. pneumoniae and P. aeruginosa have emerged as important pathogens e.g. MRSA shows great decline More recently the development of invasive medical techniques has had further impact

Answer 69

ESKAPE pathogens Enterobacteriacea predominate with 37% (includes E. Coli) S. aureus at 15% Enterococci at 9% CNS at 9% Candida species at 6% Pseudomonas at 4%

Answer 70

Carbapenemase resistant acinetobacter: pneumonia, wound, bsi, utis, 700 deaths in 2017 and 8,500 cases Drug resistant candida auris: emerging MDR, severe infections and spread, 323 cases in 2018 Clostidioides difficile: life-threatening diarrhea and colitis, 223,900 infections per year, 12,800 deaths per year Carbapenem resistant enterobacterales: MDR and PDR, 1,100 deaths and 13,100 cases in 2017 Drug-resistant gonorrhea: life threateneing ectopic pregnancy and infertility as well as increased HIV risk, 550,000 MDR infections per year

Answer 71

Very significant in last 2 years affecting both healthcare and patients Viruses acquired by respiratory route: SARS, Cov2, Inluenza and RSV Viruses acquired by contact with vesicular lesions such as VZV and Herpes simplex virus Viruses acquired by contact with contaminated fomites such as norovirus and rotavirus Viruses acquired by contact with blood-contaminated fomites, needle

Answer 72

Gram negatives: - enterobacterales such as E. Coli, K. oneumonia and enterobacter spp - non fermenters such as pseudomonas spp, acinetobacer spp and stenotrophomas spp Gram positives: - C. difficile - Enterococcus species VRE - staph auerus (MRSA/VISA/VRSA)

Answer 73

Leading cause of HCAI in the US: - 453,000 per year and 29,600 deaths 126,000 cases per year in Europe - 3% attributable to mortality In Ireland 4.4% of HAI in 2017 vs 5.7% in 2012 A major pathogen in the community despite substantial under-diagnosis Changing epidemiology

Answer 74

Endogenous: - colonised human gastrointestinal tract Exogenous: - Asymptomatic carriers: very high carriage rate in babies as theyre born sterile but in a hospital environemnt where c, diff is present - symptomatic patients - contaminated equipment - the hands of health care works Animal reservoirs: - pigs -> potential for zoonotic transmission but not food contamination

Answer 75

0-3% of European adults carry C. diff 15% of Japanese population 20-35% hospitilised patients following antibiotic exposure (asymptomatic) Neonates 15-70% Infants 1 to 2 years old - 30-65%

Answer 76

Person-to-person via oral faecal route Contact with spores left behind in the environment Either by patients who have CDI or who are colonised with CDI asymptomatically

Answer 77

3-26% of patients in acute care hospitals 5-7% of patients in long term care facilities <2% of normal adults with no exposure to the healthcare setting Rates go up with age and lenngth of hospital stay

Answer 78

Spores are highly resistant to desiccation, chemicals and extreme temperatures Spores frequently contaminate the environment around patients with CDI, potentially persistin for months and even years Transmitted by direct spread from an infected surface Epidemic strains greater sporulation capacity Sub inhibitory concentrations of non chlorine based cleaning agents significanly increased sporulation capacity Increasing evidence of airborne dissemination Germination not extensively studied

Answer 79

If we could stop spore germination then c diff would never be able to get to the gut

Answer 80

Some outbreak strains have increased sporulation Ribotype o27 could sporulate much more readily than other strains

Answer 81

Broad spectrum antibiotics such as ampicillin or amoxycillin, 2nd or 3rd GC such as clindamycin and since 2000 fluoroquinolones have been associated with C. diff Duration of antibiotics - prolongred treatment and repeated treatments etc Combintion therapies Antibiotics with high biliary excretion

Answer 82

Age Underlying pathologes Previous AAD Severe underying disease Chronic disease of the digestive system Hospitilisation: - length of hospital stay - gastro - intestinal surgery - major surgery - gastric catheter etc

Answer 83

Mutations within toxin genes and regulators that can make some strains more likely to casue serious infection or persist in the environment

Answer 84

Non toxigenic C. diff = asymptomatic colonisation Toxigenic C. diff but IgG response to ToxA = asymptomat colonisation Toxigenic C. diff but no IgG response to ToxA = symptomatic CDI

Answer 85

Elderly generally get an infection which is treated with broad spectrum antibiotics resulting in C. diff More antibiotics are then given to treat the ifection Patient recovers but more C. diff comes back again etc Cycle repeats This is associatd with pseudomembraneous colitits and toxic megacolon -> end of life

Answer 86

The c diff pathogenicity locus which encodes the large clostridial toxins e.g. tcdA and tcdB The CDT locus (c. difficile toxin) locus -> which encodes the binary toxins CdtA and CdtB without this pathogenicity locus strains are rarely toxic, there are maybe one or two strains that have just the binary toxin Therefore we say the pathogenicity locus is required for pathogenicity

Answer 87

TcdR = positive regulator a factor TcdB = toxin B TcdE = extracellular release of toxins out of bacterial cell TcdA = toxin A TcdC = negative regulator -> it swithes off transcription and translation of tcdb

Answer 88

Theyre both glycosyltransferass

Answer 89

There is 63% similarity bettween TcdA and TcdB TcdB027 is much more cytotoxic on several cell line than TcdB(historical strain), due to variations within the C-terminal binding domain

Answer 90

CROPs = binding domain The region prone to repeats - much more likely to get mutations here Binding region Strains can have deletions and insertions in this regions - could result in strains expressing only one toxin etc

Answer 91

Notifiable disease since 2008. Mandatory Surveillance Prior to 2012 only new cases were notifiable New and Recurrent cases now reported Enhanced voluntary surveillance

Answer 92

2023 = 4.8% 2017 = 4.4% 2012 = 5.7% relatively stable

Answer 93

Theres no C. diff reference lab where ibotyping is done atm Cherry orchard is our acting reference lab and has started doing whole genome sequencing for c. dif However this lab is operating on a schedule i.e. you can only send strains for typing during certain periods etc

Answer 94

There are 45 different squence types There is significant heterogeneity 6 STs predominate in >17 isolates There is broad correlation between ribotypes (RT) and WGS derived ST

Answer 95

ST11 (16%) to Ribotype 078 ST8 (13%) to RT O02 ST2 (12%) to RTs O14, o20, 076, 220 ST6 (7%) to RT O05 ST10 (6%) to RT O15 ST3 (4.5%) to RT O01, O09,O72, 115

Answer 96

Rates are increasing Higher mortality rates Higher colectomy rates - more severe diseas More recurrences Outbreaks were difficult to control Association with fluoroquinolone use -> especialy newer fluoros such as moxifloxacin Effectiveness of metronidazole questioned NB: Increased community acquired without historical risk factors -> used to be a HCAI in elderly on antibiotics -> theres even been reports of young patients dieing from the disease

Answer 97

Since 2004 there has been the emergence of a hypervirulent epidemic strain NAP1/027 which has been associated with a changing pattern of disease severity

Answer 98

North America Pulse Type 1

Answer 99

This epidemic strain produced 16 times more toxin A and 23 times more toxin B than control strains These enterotoxic and proinflammatory proteins are the primary virulence factors of C. difficile NAP1/027 has been found to have spread from hospitals into communities and is increasingly resistant to all fluoroquinolones

Answer 100

tcdc = toxin regulator gene responsible for turning toxin a and b production off was truncated leading to increased production

Answer 101

increase in toxin production and fluoroquinolone resistance different mutation in the tcdc regulator gene Definitely an association with this type and animals - potential zoonotic transmision -> humans to animals and animals to humans but not food borne

Answer 102

A couple strains which usually have large deletions in the tcdc gene resulting in a truncated gene These can be missed when using EIAs for toxin A only

Answer 103

Ribotyping reported for 395 (19% of cases): 22% 002 11% 014 11% 078 7% 015 5% 005

Answer 104

All inpatient diarrhoeal samples Two sampling days 482 participating hospitals across 19 countries Both C, diff culture and for free toxin were carried out looking for infection and carriage 027 predominated in both infection and carriage both 001/072 and 014/020 rates were higher in carriage group In general infection and carriage tended to be caused by the same strains

Answer 105

Currently: - Metronidazole - used to be our firt line - Vancomycin - Nitazoxanide - Teicoplanin - Fidaxomicin Future: - Ramplanin

Answer 106

Toxin-Neutralising agents: - Cholestyramine Biotherapeutic agents: - Saccharomyces boulardii - faecal transplants Immune-mediated agents: - Intravenous Immunoglobulin IVIG

Answer 107

Bovine whey protein 'mucomilk' Tolevamer Human monoclonal antibodies (HuMabs) Toxoid vaccines (toxinis A and B) Active vaccines (SLP, flagella antigens)

Answer 108

Toxoid vaccines tha have been developed Dont induce enough of a response in the elderly as humeral response declines with age -> vaccine just dont work on the old Hence why no point in vaccination as these are the most at rism

Answer 109

Pooled human sera that contains antibodies - as most people have antibodies Limited evidence Case reports Case seried for sever or refractory One single group evaluation: - response in 10/17 cases (59%) - single dose of 400mg/kg may be considered

Answer 110

Not recommended for the treatment of a first episode of CDI No significant difference in clinical effectiveness when compared to vancomycin FMT is recommended in patients who have had 2 or more episodes of CDI Works by replacing the microbiome and stopping C. diff from growing No difference compared to treatment with vancomycin

Answer 111

A randomised, double-blind placebo controlled trial was carried out in septemebt 2022 42 prs, 21 got placebo, 21 got treatment 19/21 (90%) in the FMT group and 7/21 (33%) in the placebo group had resolution of CDAD at week 8 The aboslute risk reduction was 57% Found to be highly effective and superior to the standard of care vancomycin alone in achieving sustained resolution from C. difficile

Answer 112

13 trials and 610 patients FMT found to be associated with lower clinical cure rates in RCTs than in open-label or observational studies (67% vs 82%) Delivery of FMT by colonoscopy or oral tubes e.g. nasojejunal tubes was more effective than by enema Cost and safety are important considerations Each treatment costs 3000 euro Serious associated advense events including deaths due to the transmission of pathogenic and or MDRO

Answer 113

3,000 is nothing compared to the ongoing cost of keeping a patient in hospital and treating them for weeks

Answer 114

Bezlotoxumab is a human monoclonal antibody against toxin B Used adjunct to antibiotics to prevent recurrence of CDI Significantly lower rate of recurrence (17% recurrence compared to 28% with placebo) Not recommended due to cost but can be used along side other antibiotics with specialist input

Answer 115

It emerged in the 1960s In 2017 PPS s. aureus was responsible for 15% of all HCAI and 37% of these were MRSA In 2023 were down to 9.7% MRSA - a huge drop 2 strains of MRSa Spread between hospitals is a major problem -> epidemic MRSA

Answer 116

Sporadic MRSA: - encountered only sporadically and are rarely a cause of infection - epidemic MRSA - strains that have a propensity to spread in the hospital environment

Answer 117

Nasal carriage Old age Male Admission to ICU Surgery Exposure to MRSA-colonised patient

Answer 118

Underlying chronic disease Repeated hospital admissions Prolonged/repeated antibiotics especially the B-lactams

Answer 119

Occurs primarily from colonise or infected patients via the hands of healthcare workers Contact transmission to other patients or staff very common Airborne transmission important in the acquisition of nasal carriage

Answer 120

HA-MRSA has been limited to five predominant lineages worldwide The previously predominant HA-MRSA clone has been displaced Now ST22-MRSA-IV predominates in Irish hospitals: - caused 80% of BSIs Isolates from non BSIs are more diverse: - ST8, ST5, ST1

Answer 121

ST22 ST8 ST5 ST1

Answer 122

Currently Irish MRSA guidelines are only recommended testing HCws for S. aureus carriage during infection outbreaks and in high-risk units

Answer 123

First isolated in enterococci in UK and France in 1986 - 11% of all HCAI are ents and 26% of these are VRE in 2012 pps - 9% of all HCAI and 39% of these were VRE in 2017 i.e. proportion of VRE increasing

Answer 124

Alteration of cell wall precursors 8 acquired resistance phenotypes VanA and VanB phenotypes most clinically significant VanA: High level, inducible resistance to vancomycin and teicoplanin VanB: moderate to high level resistance to vancomycin but susceptible to teicoplanin

Answer 125

Close physical proximity to VRE i.e patient in the room Long period of hospitalisation Hospitilisation in long term care facilities, surgical units or ICUs Presence of urinary catheter/feeding tubes Multiple course of antibiotics - increases the density of VRE in the GI tract

Answer 126

directly from patients Contaminated fomites Contaminated hands of staff or equipment Study revealed that your just as likely to have contaminated gloves after touching environment as touchin a positive patient Increased risk if previous room occupant was positive

Answer 127

Really sharp increase in BSI with VRE - a noted problem in liver unit in st. vincents Study was done to investigate this using gel electrophoresis ran from january 1s 2009 to june 30th 2012 50 isolates were typed, 20 were from outside of st. vincents to get a representative of ireland as well as control strains a polyclonal outbreak with 8 clusters were identified 40% of non SVUH isolates were clustered

Answer 128

We have had our first linezolid resistant E. faecium in 2014

Answer 129

Done to investigat VRE carriage in an acute irish hospital - gut colonisation cohort of patients in 2014 cross-sectioooooonal study at Cork University hosp 350 faecal specimens submitted to the microbiology laboratory for routine investigation hospital inpatients and community-based patients Overall prevalence of 19.1%, 31.4% in CUH 0% in non hospitilisated patients 22.2% in external hospital samples 86.6% were vanA only, remainder were vanA and vanB2/3

Answer 130

39.4% recovery of VRE from 157 patients and their bed spaces pt and bed space 29.8% recovery of vre Envionmental sits 6.5% Most frequent sites were drip stands, bed control panel and chart holders - 61% We were able to detect far more vre when looking in the environment but we couldnt prove the link between patients

Answer 131

NB: rates are coming down but still wok to do however theyre not really a priority Not an isolation priority Lack of local and national VRE data to inform Infection prevention and control: - emerging locally from VSE - antimicrobial pressure Poor ineffective evironmental decontamination HCW and patients Hand hygiene, shared toilets etc

Answer 132

Important and increasing threat to healthcare worldwide Reservoirs of GN bacteria in healthcare facilities - they account for about 28% of total HCAI isolates Implicated in the most common HAIs BSIs, UTIs, VAPs and SSI Acinetobacter, pseudomonas and enterobacterales

Answer 133

An opportunistic pathogen - can persist in the environment - acquisition of antimicrobial resistance especially carbapenems - can dessicate - can readilt form bibofilm Emerged as important healthcare associated pathogens 1st WHO critial priority pathogen ICU and Burns units A triple threat: opportunistic pathogen, biofilm, environmenta reservoir of mobile genetic elements

Answer 134

Its highly resistant through mobile genetic elements Were limited in terms of treatment options, possibly tetracycline and colistin but were kind of out of options It frequently cause persistent outbreaks within and across healthcare facilities 8 genetically well distinguishable clonal complexes Multi resistant strains are particularly problematic CRAB

Answer 135

increased mortality - recent caase studies report mortality rates of up to 70% Longer hospital stays Higher hospital costs Frequency and severity of infections have increased Growing numbers of epidemic outbreaks

Answer 136

BSI central lines Pneumoniae - ventilator UTIs - cathetor associated HCAI are associated with larger hospitals, ICU admission and prolonged hospital stays

Answer 137

Recent exposure to antibiotics, especially carbapenems and 3GC Presence of CVC or urinary catheter Severity of illness largre hospita size >500 Prolonged ICU stays

Answer 138

Aqueous reservoirs Drains Sinks Toilets 5-30% of surfaces can remain contaminate Existing detergent and disinfectant formulations cannot disrupt biofilms Enhanced focus on cleaning practices ID of environmental contamination early in outbreaks is critical to limiting their spread

Answer 139

B-lactamases, the most prevalent being AmpC cephalosporinases and OXA-carbapenemases porin alterations Multi drug effluc pumps Aminoglycoside modifying enzymes mutations within the fluoroqunolone target sites

Answer 140

MDR is a growing threat in Europe No data from pps 2017 or 2023 Recent outbreak in conolly hospital of oxa-48 rates increasing: Acinetobacter outbreaks: - 0 in 2022 - 1 in 2023 - 3 in 2024 Acinetobacter resistant: - 5 in 2022 - 16 in 2023 - including 2 clusters (5 isolates each) both OXA-23 in 2023

Answer 141

CRAB surveillance initiated by the ECDC - three labs have been recruited - going to collect information on the first 10 infections submitted -started across EU/EEA in October 2024 -one lab recruited from each NUT2 l3vel (3 in Ireland) - if no CRAB infections then colonisation - if no CRAB then CSAB infections - if no CSAB infections then colonisations Survey in OI will run until 30th of pril 2025