Risk Factors for Primary Clostridium difficile Infection; Results From the Observational Study of Risk Factors for Clostridium difficile Infection in Hospitalized Patients With Infective Diarrhea (ORCHID).

Background: There are inconsistent data on the risk factors for Clostridium difficile infection (CDI) in the literature. Aims: To use two C. difficile infection (CDI) case-control study groups to compare risk factors in hospitalized patients with diarrhea across different countries. Methods: A multi-center group of CDI cases/controls were identified by standardized testing from seven countries from the prior EUropean, multi-center, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea (EUCLID). A second group of CDI cases/controls was identified from a single center in Germany [parallel study site (PSS)]. Data were extracted from the medical notes to assess CDI risk factors. Univariate analyses and multivariate logistic regression models were used to identify and compare risk factors between the two groups. Results: There were 253 and 158 cases and 921 and 584 controls in the PSS and EUCLID groups, respectively. Significant variables from univariate analyses in both groups were age ≥65, number of antibiotics (OR 1.2 for each additional antibiotic) and prior hospital admission (all p < 0.001). Congestive heart failure, diabetes, admission from assisted living or Emergency Department, proton pump inhibitors, and chronic renal disease were significant in PSS (all p < 0.05) but not EUCLID. Dementia and admitted with other bacterial diseases were significant in EUCLID (p < 0.05) but not PSS. Following multivariate analyses, age ≥ 65, number of antibiotics and prior hospital admission were consistently identified as CDI risk factors in each individual group and combined datasets. Conclusion: Our results show that the same CDI risk factors were identified across datasets. These were age ≥ 65 years, antibiotic use and prior hospital admission. Importantly, the odds of developing CDI increases with each extra antibiotic prescribed.

Содействие надлежащему использованию антибиотиков для сдерживания развития устойчивости к антибиотикам в медицине человека в Венгрии: Аналитический обзор EVIPNet для формирования политики, номер 2

Министерством человеческих ресурсов Венгрии была инициирована подготовка аналитического обзора – к публикации под эгидой Европейской сети по вопросам использования данных научных исследований при формировании политики (EVIPNet-Европа) – в целях выработки научно обоснованных вариантов реагирования на проблему ненадлежащего использования антибиотиков в стране. Эта задача выполнялась в рамках Двухгодичного соглашения о сотрудничестве (ДСС) между Министерством человеческих ресурсов и ВОЗ с участием национальных политикоформирующих учреждений высокого уровня и национальных экспертов, при поддержке технических специалистов Европейского регионального бюро ВОЗ. Национальным центром медицинских услуг Венгрии была создана рабочая группа, в которую вошли представители из областей клинической медицины, фармакологии, общественного здравоохранения и управления услугами здравоохранения. Участники рабочей группы осуществили поиск, отбор, оценку и синтез актуальных данных научных исследований по данной проблеме, определили три варианта для ее решения и рассмотрели соответствующие аспекты их реализации. К рассмотрению были предложены следующие варианты: разработка национальной программы ответственного руководства в сфере антибиотиков, предусматривающей выпуск научно обоснованных клинических руководств по диагностике и лечению распространенных инфекционных заболеваний; усиление программ высшего и последипломного образования в области медицины, стоматологии и фармацевтики и организация обучения разумному использованию антибиотиков; и повышение осведомленности о разумном использовании антибиотиков с помощью информационных кaмпаний, инфоматериалов и межличностного общения.

Az antibiotikumok felelős alkalmazásának ösztönzése az antibiotikum-rezisztencia visszaszorítására a humán gyógyászatban Magyarországon: EVIPNet Europe Szakpolitikai bizonyíték-összefoglaló, 2. szám

Az Emberi Erőforrások Minisztériuma (EMMI) megbízásából, az Egészségügyi Világszervezet (WHO) Bizonyítékokkal Támogatott Szakpolitikai Hálózatának (EVIPNet) égisze alatt szakpolitikai összefoglaló készült, amely bizonyítékokkal alátámasztott beavatkozási opciókat mutat be a nem megfelelő antibiotikum-alkalmazás problémájának kezelésére Magyarországon. A munkát vezető hazai szakpolitikai intézetek és szakértők végezték, az EMMI és a WHO közötti kétéves együttműködési megállapodás keretében, a WHO Európai Irodájának szakmai támogatásával. Az Állami Egészségügyi Ellátó Központ által létrehozott munkacsoportban infektológus, gyógyszerész, epidemiológus és egészségügyi menedzsmenttel foglalkozó szakemberek vettek részt. A munkacsoport azonosította, értékelte és feldolgozta a problémával, három szakpolitikai opcióval és azok implementációs megfontolásaival kapcsolatos kutatási bizonyítékokat. A három opció a következő: (1) nemzeti antibiotikum stewardship program (ASP) kialakítása, a gyakori fertőzések diagnosztizálására és kezelésére vonatkozó, bizonyítékalapú klinikai ajánlásokkal; (2) az antibiotikumok felelős felírásának hangsúlyosabb oktatása a graduális és posztgraduális orvosi, fogorvosi és gyógyszerészi tanulmányok és képzések során; és (3) a figyelem felhívása a helyes antibiotikum-alkalmazásra tájékoztató kampányok, szórólapok és interperszonális kommunikáció segítségével.

Promoting the appropriate use of antibiotics to contain antibiotic resistance in human medicine in Hungary: EVIPNet evidence brief for policy, number 2

The Ministry of Human Capacities of Hungary commissioned a policy brief, to be published under the aegis of the WHO Evidence-informed Policy Network (EVIPNet) Europe, to develop evidence-informed options for the country to consider in tackling the problem of antibiotic misuse. The task was implemented in frame of the Biennial Collaborative Agreement (BCA) between the Ministry of Human Capacities and WHO, involving high level national policy institutions and national experts, supported by the technical experts of WHO Regional Office for Europe. The National Healthcare Service Center of Hungary convened a working group comprising representatives from the clinical field, pharmacology, public health and health care management. The working group identified, selected, appraised, and synthesized relevant research evidence on the problem, three options for tackling it and considerations in implementing them. The three options are: developing a national antibiotic stewardship programme, complemented by evidence-informed clinical guidelines on the diagnosis and treatment of common infections; strengthening undergraduate and postgraduate medical, dental, and pharmacy education and training on the prudent use of antibiotics; and raising awareness of prudent antibiotic use through information campaigns, leaflets and interpersonal communication.

Phylogenetic analysis of a nosocomial transmission of hepatitis B virus at a paediatric haematology ward.

A nosocomial Hepatitis B virus (HBV) outbreak at a paediatric onco-haematology unit was investigated using molecular biological methods to determine the origin of the infections. The National Reference Laboratory of Hepatitis Viruses received seven HBsAg positive sera from patients and one from the brother of a patient. A fragment of the preS1/preS2/S genes from all samples was amplified, the PCR products were sequenced and a rooted phylogenetic tree was constructed. All nucleotide sequences from the different patients were very similar and 6 of the 8 sequences were identical, suggesting a common origin of the infections. These sequences were closely related to those amplified from a nosocomial HBV epidemic in another hospital in Hungary. The on-scene investigation revealed several malpractices. The two hospital departments had close connections and some of the patients were treated in both institutions. Present report underlines the importance of developing screening protocols for hepatitis viruses and that of the introduction of regular training programs for health care professionals in the field of hospital hygiene.

Epidemiology of MRSA and current strategies in Europe and Japan.

The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems.In 2006, a workshop was initiated at the 8(th) International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place.

Risk factors and outcomes for bloodstream infections with extended-spectrum beta -lactamase-producing Klebsiella pneumoniae ; Findings of the nosocomial surveillance system in Hungary.

Risk factors for and outcomes of bloodstream infections (BSIs) caused by ESBL-producing and by ESBL-non-producing Klebsiella pneumoniae were compared in a four-year multicenter study in Hungary. One hundred ESBL-positive and one hundred ESBL-negative patients were included as cases and controls. Investigated risk factors were related to demographics, comorbid conditions, treatments, invasive procedures, surgery prior bacteremia, presence of additional nosocomial infections and preceding hospital admission within a year. Measured outcomes were crude mortality, mortality related to infection and delay in introducing appropriate therapy (DAT). Though some risk factors for infection (admission to intensive care units, having central venous and/or urinary catheter, mechanical ventilation) were shared by both groups, in other respects cases and controls were found to differ substantially. The 36 percent of patients with BSIs with ESBL-producing Klebsiella died versus 23 percent of controls (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0-5.4; p = 0.02). The 18 percent of deaths in cases versus 9% in controls could be attributed to infection (OR: 5.0; 95% CI: 1.5-16.2; p = 0.006). Cases more often received previous antibiotic therapy than controls (OR: 2.7; 95% CI: 1.1-6.7; p = 0.02) and delay in the introduction of appropriate antibiotic treatment was observed in 44% of cases versus 19% of controls (OR: 3.4; 95% CI: 1.6-7.3; p = 0.001). The results demonstrate that BSIs caused by ESBL-producing K. pneumoniae are related to previous antibiotic therapy and are associated with a high rate of mortality that is often linked to delay in the introduction of appropriate antibiotic therapy. This confirms that besides infection control measures the early identification and antibiotic resistance profiling of the infecting pathogen is salient in the control of BSIs caused by ESBL-producing K. pneumoniae .

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control.

PURPOSE: To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control. METHODS: Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a web-application. Results were validated locally, aggregated by project leaders and fed back to support local audit and benchmarking. RESULTS: Median (range) antibiotic consumption was 1,254 (range 348-4,992) DDD per 1,000 occupied bed days. The proportion of MRSA was median 11.6% (range 0-100), for ESBL phenotype of E. coli and K. pneumoniae 3.9% (0-80) and 14.3% (0-77.8) respectively, and for carbapenem-resistant P. aeruginosa 22.5% (0-100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of single rooms for isolation. CONCLUSIONS: The surveillance programme demonstrated wide variation in antibiotic consumption, microbial resistance and infection control measures. The programme may, by providing rapid access to aggregated results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.