National surveillance of nosocomial bloodstream infections New trends and changes in the protocol
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1 Scientific Institute of Public Health National surveillance of nosocomial bloodstream infections New trends and changes in the protocol Dr. Carl Suetens, Scientific Institute of Public Health NSIH seminar, , Copyright, 1996 Dale Carnegie & Associates, Inc.
2 Material National surveillance of nosocomial bloodstream infections (BSI), Hospital-wide Aggregated denominator: admissions + patient-days per surveillance-quarter N=32620 BSI-episodes>48h
3 Participation à NSIH, (situation au 31/1/2004), hôpitaux fusionnés (n=116) SSI ICU SEP MREA MRSA >=1 Surveillance N hospitals >=1 Surveillance MRSA 20 SEP MREA 0 ICU SSI
4 National surveillance of nosocomial BSI 154 hospital (sites), 87% of hosp. fusions Laboratory confirmed: Recognized pathogens: 1 pos. hemoculture Skin contaminant: 2 HC+ Trend analysis: n=91 regular hospitals, corrected for n of hemocultures/1000 patient-days Estimates of total n of BSI: based on mean of 15 M patient-days/year in Belgian acute care hospitals (source MOH, Statbel, 2001,1996)
5 Belgian hospital-wide data Incidence of nosocomial bloodstream infections: 5.9 BSI/1000 admissions 7.3/10000 patient-days = nosocomial BSI/year (= 14% of est ) BSI-associated mortality 32% Definite relationship: 243 ( ) Probable relationship: 1165 ( ) Incidence of nosocomial MRSA-cases: 3/1000 admissions, = 5500 n-mrsa/year
6 Top 10 des micro-organismes organismes isolées dans les septicémies nosocomiales, % 90% 80% 70% 60% 50% 40% 30% 20% Acinetobacter spp. Streptococcus spp. Pseudomonas spp. Klebsiella spp. Enterococcus spp. Enterobacter spp. Candida spp. Staphylococcus aureus Escherichia spp. Coagulase-neg. staphy 10% 0%
7 Evolution du taux d incidenced des septicémies nosocomiales dans 91 hôpitaux avec participation régulière,, n SEP/10000 journées d hospitalisation p tendance Tous les épisodes de septicemies p<0.05 Septicémies associées aux cathéters NS Septicémies d origine inconnue p<0.05 Septicémie secondaire NS Incidence SEP suivant région Flandre NS Bruxelles NS Wallonie p<0.05 Sensibilité de la surveillance N hémocultures/1000 j.d hospit p<0.05
8 n SEP/10000 journées d hospitalis. Evolution du taux d incidenced par pathogène ne,, p- tendance Coques Gram-positif p<0.05 CNS NS S.aureus p<0.05 Enterococcus spp p<0.05 E.faecalis p<0.05 Streptococcus spp p<0.05 S.pneumoniae p<0.05 Enterobacteriaceae p<0.05 Eschericia spp p<0.05 Enterobacter spp p<0.05 E.aerogenes p<0.05 E.cloacae NS Klebsiella spp p<0.05 K.pneumoniae p<0.05 K.oxytoca NS Proteus spp NS Serratia spp NS Citrobacter spp NS
9 Evolution du taux d incidenced par pathogène ne,, , Enterococcus spp # SEP/ pd Vlaanderen Brussel Wallonië 0
10 Evolution du taux d incidence d par pathogène ne,, , enterobactéries ries productrices de BSLE SEP K.pn/E.aer per hd Dec SEP E.coli per hd K. pneumoniae E. aerogenes E. coli
11 Evolution du taux d incidence d par régionr gion,, , 2003, enterobactéries ries # SEP/ pd Vlaanderen BXL Wallonie 0
12 Evolution du taux d incidence d par régionr gion,, , 2003, E. coli # SEP/ pd Vlaanderen Brussel Wallonië
13 n SEP/10000 journées d hospitalis. Evolution du taux d incidence d par pathogène ne,, , non-fermenters & fungi p- tendance Non-fermentants NS Pseudomonas spp NS Acinetobacter spp NS A.baumannii p<0.05 Stenotrophomonas spp NS Candida spp p<0.05 C.albicans NS Candida non-albicans p<0.05
14 Evolution du taux d incidence d par pathogène ne,, , Acinetobacter spp # SEP/10000 pd Acinetobacter spp. A.baumannii
15 Evolution of the incidence of Candida -BSI in Belgium, national surveillance of nosocomial BSI, n CAN-BSI/10000 patient-days P adj.trend <0.01 Candida albicans Candida non-albicans 0
16 Distribution of Candida species in nosocomial candidemia, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% OTHER CANDIDA CANDIDA sp., unspecif ied CANDIDA TROPICALIS CANDIDA PARAPSILOSIS CANDIDA KRUSEI CANDIDA GLABRATA CANDIDA ALBICANS
17 Evolution du taux d incidence d par pathogène ne,, , Candida spp # SEP/ pd Vlaanderen Brussel Wallonië 0.1 0
18 Discussion Augmentation globale de l incidence des SEP, Wallonie>Fl/Bxl Augmentation ~ AMR Modification protocol: Nouveau DQ en Flandre (>définitions Helics) Lien avec une collection centrale de souches des hémocultures (GDEPIH) Données de résistance aux AB Participation simultanée à NSIH
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