Automated surveillance systems for healthcare-associated infections: results from a European survey and experiences from real-life utilization.

BACKGROUND: As most automated surveillance (AS) methods to detect healthcare-associated infections (HAIs) have been developed and implemented in research settings, information about the feasibility of large-scale implementation is scarce. AIM: To describe key aspects of the design of AS systems and implementation in European institutions and hospitals. METHODS: An online survey was distributed via e-mail in February/March 2019 among (i) PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network members; (ii) corresponding authors of peer-reviewed European publications on existing AS systems; and (iii) the mailing list of national infection prevention and control focal points of the European Centre for Disease Prevention and Control. Three AS systems from the survey were selected, based on quintessential features, for in-depth review focusing on implementation in practice. FINDINGS: Through the survey and the review of three selected AS systems, notable differences regarding the methods, algorithms, data sources, and targeted HAIs were identified. The majority of AS systems used a classification algorithm for semi-automated surveillance and targeted HAIs were mostly surgical site infections, urinary tract infections, sepsis, or other bloodstream infections. AS systems yielded a reduction of workload for hospital staff. Principal barriers of implementation were strict data security regulations as well as creating and maintaining an information technology infrastructure. CONCLUSION: AS in Europe is characterized by heterogeneity in methods and surveillance targets. To allow for comparisons and encourage homogenization, future publications on AS systems should provide detailed information on source data, methods, and the state of implementation.

Early discontinuation of empirical antibiotic treatment in neutropenic patients with acute myeloid leukaemia and high-risk myelodysplastic syndrome.

INTRODUCTION: Current guidelines advocate empirical antibiotic treatment (EAT) in haematological patients with febrile neutropenia. However, the optimal duration of EAT is unknown. In 2011, we have introduced a protocol, promoting discontinuation of carbapenems as EAT after 3 days in most patients and discouraging the standard use of vancomycin. This study assesses the effect of introducing this protocol on carbapenem and vancomycin use in high-risk haematological patients and its safety. METHODS: A retrospective before-after study was performed comparing a cohort from 2007 to 2011 (period I, before restrictive EAT use) with a cohort from 2011 to 2014 (period II, restrictive EAT use). Neutropenic episodes related to chemotherapy or stem cell transplantation (SCT) in patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS) were analysed. The primary outcome was the use of carbapenems and vancomycin as EAT during neutropenia, expressed as days of therapy (DOT)/100 neutropenic days and analysed with interrupted time series (ITS). Also the use of other antibiotics was analysed. Safety measurements included 30-day mortality, ICU admittance within 30 days after start of EAT and positive blood cultures with carbapenem-susceptible microorganisms. RESULTS: Three hundred sixty-two neutropenic episodes with a median duration of 18 days were analysed, involving 201 patients. ITS analysis showed decreased carbapenem use with a step change of - 16.1 DOT/100 neutropenic days (95% CI - 26.77 to - 1.39) and an overall reduction of 21.6% (8.7 DOT/100 neutropenic days). Vancomycin use decreased with a step change of - 13.7 DOT/100 neutropenic days (95% CI - 23.75 to - 3.0) and an overall reduction of 54.7% (14.6 DOT/100 neutropenic days). The use of all antibiotics combined decreased from 155.6 to 138 DOT/100 neutropenic days, a reduction of 11.3%. No deaths directly related to early discontinuation of EAT were identified, also no notable difference in ICU-admission (9/116 in period I, 9/152 in period II) and positive blood cultures (4/116 in period I, 2/152 in period II) was detected. CONCLUSION: The introduction of a protocol promoting restrictive use of EAT resulted in reduction of carbapenem and vancomycin use and appears to be safe in AML or high-risk MDS patients with febrile neutropenia during chemotherapy or SCT.

Predictors of adherence to isoniazid preventive therapy in people living with HIV in Ethiopia.

BACKGROUND: Although isoniazid preventive therapy (IPT) is effective in the prevention of tuberculosis (TB) in people living with the human immunodeficiency virus (PLHIV), patient adherence to this strategy is suboptimal. METHODS: This prospective cohort study was conducted in the HIV/AIDS (acquired immune-deficiency syndrome) out-patient chronic care unit of Dilla University Hospital, Dilla, Ethiopia, from May 2014 to February 2015. Adherence was defined as completion of the 6-month course of treatment with 90% of pills taken, as measured by diary and pill count. Data were collected on potential predictors, including patients' demographic and clinical characteristics. Univariable and multivariable logistic regression models were fitted to identify independent predictors of adherence to IPT. RESULTS: Of 162 PLHIV included, 104 (64.2%) were adherent to IPT. In the final multivariable model, concomitant use of antiretroviral therapy (ART) and/or cotrimoxazole preventive therapy (CPT) was associated with adherence to IPT (OR 2.66, 95%CI 1.15-6.17). Experiencing a high level of HIV stigma and episodes of opportunistic infections tended to be associated with non-adherence to IPT (OR 0.51, 95%CI 0.25-1.04 and OR 0.14, 95%CI 0.02-1.15) in comparison to low stigma and no opportunistic infections, respectively. CONCLUSION: PLHIV receiving ART or CPT were more likely to adhere to IPT.

Preventing ventriculostomy-related infections with antibiotic-impregnated drains in hospitals: a two-centre Dutch study.

This observational cohort study assessed the effect of the introduction of antibiotic-impregnated external ventricular drains (AI-EVDs), as opposed to plain silicone EVDs, on the occurrence of ventriculostomy-related infections (VRIs) in two Dutch hospitals, with no other changes to their clinical practice. VRI was defined using the criteria of the Centers for Disease Control and Prevention, and with a culture-based definition. A propensity-score-adjusted competing risks survival analysis showed that introduction of AI-EVDs did not significantly decrease the risk of VRIs in routine care, nor affect the bacterial aetiology, even after adjustment for confounding and competing events.