Stewardship / Resistance Scan for Mar 12, 2018

Infection risk tool and stewardship
Multidrug resistance in Ghana

Infection risk tool shows promise in Dutch study

Research by Dutch investigators suggests that a user-friendly, visual instrument for measuring the quality of infection control and antimicrobial use could be useful for targeting interventions in hospitals and nursing homes.

In a new study in Antimicrobial Resistance and Infection Control, the investigators describe the application of the Infection Risk Scan (IRIS) method at a hospital, several nursing homes, and a rehabilitation clinic in the Netherlands. IRIS consists of a bundled set of objective, reproducible measurements combining patient- and healthcare-related variables, which are used to establish a risk profile for the patient population and an improvement plot for the facility. Results are visualized in a spider plot using traffic light colors to make the results straightforward and easy to understand.

The IRIS variables include hand hygiene compliance, environmental contamination using adenosine triphosphate (ATP) measurements, prevalence of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E), availability of infection control preconditions, personal hygiene of healthcare workers, appropriate use of indwelling medical devices, and appropriate antimicrobial use. But risk factors can be added or switched.

The implementation of IRIS at five hospital wards showed high levels of environmental contamination and provided the basis for targeted actions that resulted in measurable improvements. Hand hygiene compliance increased from 43% to 66%, and ATP levels were significantly reduced. In 19 nursing homes, large differences were observed, with environmental contamination as the common denominator. In addition, a significant difference in ESBL-E prevalence (mean 11%, range 0% to 21%) was observed. At the rehabilitation center, 17% of residents were found to be ESBL-E carriers.

"In conclusion, the bundle approach and visualization of the IRIS makes it a complete and useful infection prevention tool," the authors write. "The broader implementation of IRIS can raise the standard of infection control and make it more transparent in various healthcare settings, e.g. nursing homes."
Mar 9 Antimicrob Resist Infect Control study

High rates of multidrug resistance found in Ghana hospital

In another new study in Antimicrobial Resistance and Infection Control, a team of African researchers reports high rates of multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana.

In the study, conducted at a 1,000-bed tertiary care government hospital in the Ashanti region of Ghana from February through August 2015, researchers examined 200 clinical, non-duplicate gram-negative bacteria randomly selected from urine, pus, wound swab, pleural fluid endotracheal tubes, gastric lavage, and blood specimens. Multidrug resistance was defined as isolates that were resistant to at least one agent in three or more antibiotic classes.

Of the 200 isolates obtained, Escherichia coli was the most frequent pathogen (49 isolates, 24.5%), followed by Pseudomonas aeruginosa (39, 19.5%), Klebsiella pneumoniae (38, 19%), and Enterobacter spp. (12, 6%). Multidrug resistance was observed in 89.5% of the isolates, ranging from 53.8% in Enterobacter to 100% in Acinetobacter spp. and P aeruginosa, with high resistance to ampicillin (94.4%), trimethoprim sulfamethoxazole (84.5%), cefuroxime (79%), cefotaxime (71.3%), cefoxitin (57.5%), and amoxacillin-clavulanate (51.5%).

Urinary tract infection was diagnosed in 34.5% of patients, sepsis in 14.5%, wound infection (surgical and chronic wounds) in 11%, and pulmonary tuberculosis in 9%. The largest proportion of patients were those 60 years and over (24.5%), followed by children under 10 (24%). The lowest prevalence was in those 10 to 19 years old (9.5%).

The authors of the study say the results should inform the empiric treatment of infections at the hospital.
Mar 9 Antimicrob Resist Infect Control study

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