CDC definitions for nosocomial infections

doi:10.1016/S0196-6553(89)80013-6

American Journal of Infection Control

Volume 17, Issue 1, February 1989, Page 42

https://doi.org/10.1016/S0196-6553(89)80013-6 Get rights and content

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CDC definitions for nosocomial infections
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Pitfalls in the diagnosis of nosocomial pneumonia
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Pneumonia and lung abscess

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Cited by (18)

Prognostic significance of lymphocyte subpopulations for ICU-acquired infections in patients with sepsis: a retrospective study
2023, Journal of Hospital Infection
To determine the prognostic value of lymphocyte subpopulations in predicting intensive care unit (ICU)-acquired infections among patients admitted to the ICU with sepsis.
Data on peripheral blood lymphocyte subpopulations [CD3+ T cells, CD4+ T cells, CD8+ T cells, CD16+CD56+ natural killer (NK) cells and CD19+ B cells] were collected continuously from 188 patients admitted to the study ICUs with sepsis between January 2021 and October 2022. Clinical data collected from these patients, including medical history, number of organ failures, severity of illness scores, and characteristics of ICU-acquired infections, were reviewed.
Lymphocyte subpopulation counts were significantly lower in patients who acquired an infection in the ICU compared with those who did not. Univariate analyses showed that the number of organ failures [odds ratio (OR) 3.37, 95% confidence interval (CI) 2.25–5.05], severity of illness scores [Sequential Organ Failure Assessment score – OR 1.69, 95% CI 1.41–2.02; Acute Physiology and Chronic Health Evaluation II score – OR 1.26, 95% CI 0.17–1.36], history of immunosuppressant use (OR 2.41, 95% CI 1.01–5.73) and lymphocyte subpopulations (CD3+ T cells – OR 0.60, 95% CI 0.51–0.71; CD4+ T cells – OR 0.51, 95% CI 0.41–0.63; CD8+ T cells – OR 0.32, 95% CI 0.22–0.47; CD16/CD56+ NK cells – OR 0.41, 95% CI 0.28–0.59; CD19+B cells – OR 0.52, 95% CI 0.37–0.75) were associated with ICU-acquired infections. Multi-factor logistic regression analysis demonstrated that APACHE II score (OR 1.25, 95% CI 1.13–1.38), CD3+ T cells (OR 0.66, 95% CI 0.54–0.81) and CD4+ T cells (OR 0.64, 95% CI 0.50–0.82) were independent significant risk factors for ICU-acquired infections.
Assessing CD3+ T cells and CD4+ T cells within 24 h of ICU admission may help in identification of patients at risk for developing ICU-acquired infections.
Clinical characteristics and outcome of bacteraemia caused by Enterobacter cloacae and Klebsiella aerogenes: more similarities than differences
2021, Journal of Global Antimicrobial Resistance
Citation Excerpt :
Variables were recorded using a standardised form and all patients were followed-up for 30 days or until death or hospital discharge, whichever occurred first. The following data were recorded: (i) demographic characteristics (age, sex, area of hospitalisation [medical, surgical or intensive care unit (ICU)] and hospital of origin); (ii) baseline clinical conditions, including underlying chronic diseases [heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus, liver disease, chronic renal failure, cancer, solid-organ or bone marrow transplantation, human immunodeficiency virus (HIV) infection or other causes of immunosuppression such as neutropenia], Charlson comorbidity index [15] and McCabe index [16], previous antimicrobial therapy (in the preceding 14 days), previous chemotherapy (in the preceding 30 days), previous corticosteroid therapy (defined as ≥10 mg of prednisone or equivalent daily for >10 days), prior admission to an oncology unit or ICU during the ongoing hospital stay, and performance of one or more invasive procedures (insertion of venous catheter, urinary catheter or nasogastric tube; mechanical ventilation; performance of gastroscopy, colonoscopy, bronchoscopy or surgical procedures) during the preceding 10 days; and (iii) clinical variables, including place of acquisition [hospital (onset >48 h after admission or transfer from another hospital; BSIs associated with a surgical site infection if the operation took place within 30 days) [17], healthcare-related (within 48 h from admission and: BSI associated with an ambulatory diagnostic or therapeutic invasive procedure, or outpatients carrying an indwelling urinary catheter or a venous catheter, or patients on chronic dialysis or living in a nursing home) [18], or community (within 48 h from admission and not meeting criteria for hospital or healthcare-related acquisition)], source of the bacteraemia [18], severity at onset of bacteraemia (Pitt bacteremia score [19,20]), presence of sepsis or septic shock at onset of bacteraemia [21] and Acute Physiology and Chronic Health Evaluation (APACHE) II score for ICU patients [22], empirical or pathogen-directed treatment, appropriate empirical treatment (defined as the prescription of at least one antimicrobial active against the strain isolated in blood cultures in the first 24 h following the onset of the BSI), length of hospital stay (from admission to death or hospital discharge), length of ICU stay (from ICU admission to ICU discharge or death) and mortality (death from any cause during the follow-up period). Enterobacter cloacae and K. aerogenes strains were identified and their antimicrobial susceptibility profile was determined according to each participating centre's clinical microbiology laboratory criteria.
The genus Enterobacter is a common cause of nosocomial infections. Historically, the most frequent Enterobacter species were those of Enterobacter cloacae complex and Enterobacter aerogenes. In 2019, E. aerogenes was re-classified as Klebsiella aerogenes owing to its higher genotypic similarity with the genus Klebsiella. Our objective was to characterise and compare the clinical profiles of bacteraemia caused by E. cloacae and K. aerogenes.
This 3-year multicentre, prospective cohort study enrolled consecutive patients with bacteraemia by E. cloacae or K. aerogenes. Baseline characteristics, bacteraemia features (source, severity, treatment), antibiotic susceptibility, resistance mechanisms and mortality were analysed.
The study included 285 patients with bacteraemia [196 (68.8%) E. cloacae and 89 (31.2%) K. aerogenes]. The groups showed no differences in age, sex, previous use of invasive devices, place of acquisition, sources or severity at onset. The Charlson score was higher among patients with E. cloacae bacteraemia [2 (1–4) vs. 1 (0.5–3); P = 0.018], and previous antibiotic therapy was more common in patients with K. aerogenes bacteraemia (57.3% vs. 41.3%; P = 0.01). Mortality was 19.4% for E. cloacae and 20.2% for K. aerogenes (P = 0.869). Antibiotic susceptibility was similar for both species, and the incidence of multidrug resistance or ESBL production was low (6% and 5.3%, respectively), with no differences between species.
Bacteraemias caused by E. cloacae and K. aerogenes share similar patient profiles, presentation and prognosis. Patients with E. cloacae bacteraemia had more co-morbidities and those with K. aerogenes bacteraemia had received more antibiotics.
Nosocomial infection by Klebsiella pneumoniae among neonates: a molecular epidemiological study
2021, Journal of Hospital Infection
Citation Excerpt :
Neonates with nosocomial infections of Kp from January 2013 to December 2018 were included in this investigation. The diagnostic criteria for nosocomial infections in neonates were recommended by the US Centers for Disease Control and Prevention guidelines for nosocomial infections in infants aged <1 year [29]. Kp strains cultured in nosocomial infections from January 2013 to December 2018 were kept frozen in the hospital laboratory department.
Nosocomial infection by Klebsiella pneumoniae (Kp) and drug resistance of Kp among neonates is a major concern. Hypervirulent K. pneumoniae (hvKp) infections are gradually increasing worldwide. Carbapenem-resistant hvKp infection has brought challenges to clinical treatment.
To evaluate the changes in drug resistance trends of Kp strains in neonatal intensive care unit (NICU) nosocomial infections, to analyse drug resistance genes and virulence genes of carbapenem-resistant K. pneumoniae (CRKP) and to identify whether these CRKP strains are hvKp.
A total of 80 neonates with Kp nosocomial infections from 2013 to 2018 were retrospectively studied. Drug susceptibility testing was performed on 80 Kp strains, among which the 12 CRKP strains were further studied.
Kp accounted for 26.9% of nosocomial infections in the NICU. CRKP strains accounted for 15.0%. Among the 80 nosocomial infection Kp strains, CRKP strains accounted for 33.3% and 53.3% in 2017 and 2018 respectively. One of the 12 CRKP strains was positive in the drawing test. The 12 CRKP strains were divided into four complete genome sequence types: cgST1 (N = 2), cgST2 (N = 1), cgST3 (N = 1), and cgST4 (N = 8). Among genes that mediated carbapenem resistance, strains of cgST4 carried NDM-5, strains of cgST2 and cgST3 carried NDM-1, and strains of cgST1 carried IMP-4. None of the 12 CRKP strains carried rmpA/rmpA2 (highly related with hvKp).
Nosocomial infections of CRKP among neonates are becoming common, but no hvKp was found among the CRKP strains in this study.
Identification and prognostic impact of malnutrition in a population screened for liver transplantation
2020, Clinical Nutrition ESPEN
Citation Excerpt :
New-onset or worsening hepatic encephalopathy was defined as newly diagnosed or an increase of neurocognitive changes according to the West-Haven clinical criteria [18,19]. Diagnosis of bacterial infection was made according to Centers of Disease Control and Prevention criteria [20,21]. Body mass index (BMI) was calculated by dividing weight in kg by square height in m2, and adjusted for ascites by subtracting 5% of weight in mild/moderate ascites, and 15% in refractory ascites [4].
Sarcopenia is prevalent in patients with liver cirrhosis and is negatively associated with clinical outcomes. In a population screened for liver transplantation we aimed to assess the prevalence of abnormal nutritional status and to what extent a clinical screening tool is able to reliably select patients for extensive nutritional assessment including CT. We also evaluated which nutritional parameters are independently associated with clinical outcomes.
Analysis of consecutive patients undergoing detailed nutritional assessment during pre-liver transplantation screening from October 2015 to April 2017.
In 102 included patients (66.7% male; median age of 56.3 years (IQR 43.9–64.0); median MELDNa score of 14.7 (IQR 9.4–19.0)), presarcopenia was diagnosed in 30/102 patients (29.4%), sarcopenia in 20/102 (19.6%), and impaired muscle quality in 19/102 (18.6%). Application of the European association for the Study of the Liver rapid screen tool as the primary instrument for nutritional assessment would have resulted in selection of 40/69 cases, thus 42.0% of patients with actual muscle mass depletion and/or impaired muscle function would not have been selected for further nutritional evaluation.
In contrast to muscle mass depletion, impaired muscle function was a significant predictor for 6-month decompensation-free (p = 0.006) and hospitalization-free (p = 0.003) survival, when adjusted for age and MELDNa score.
In our population the efficacy of a clinical screening tool for malnutrition was unsatisfactory. A detailed nutritional assessment is therefore recommended in all patients undergoing liver transplantation screening. Impaired muscle function might be clinically more relevant than muscle mass depletion, and muscle function testing should be considered an integral part of nutritional assessment in chronic liver disease.
Infectious complications in survivors of cardiac arrest admitted to the medical intensive care unit
2004, Resuscitation
Purpose: To describe the incidence, associated factors and outcome of infectious complications in patients admitted to the medical intensive care unit (MICU) after cardiopulmonary resuscitation (CPR). Materials and methods: We identified a retrospective cohort of 56 patients consecutively admitted to MICU after CPR. We collected data on demographics, the first MICU day APACHE III score, mode and location of cardiac arrest, CPR duration, witnessed aspiration, prior antibiotics, the lowest first MICU day Glasgow coma score (GCS), new infections, duration of mechanical ventilation and mortality. Results: Seventy-nine percent of the arrests occurred in the hospital. Pulseless electrical activity was the most common rhythm (52%). New infections developed in 46%. The most common infection was pneumonia (65%) and the most common pathogen Staphylococcus aureus (31%). Blood cultures were obtained in 40 patients during the first 48 h and pathogens were isolated in five (12.5%). Patients with infection were younger (53.7 vs. 70.4 years, P<0.001). Median first day GCS was eight in-patients with infection compared with ten in those without (P=0.032). Patients with infection had longer duration of mechanical ventilation (median 9 vs. 2 days, P=0.001) and MICU length of stay (median 8 vs. 3 days, P<0.001). Hospital mortality was 54% in-patients with infection versus 37% without (P=0.197). Conclusions: Infectious complications are common in survivors of cardiac arrest and are associated with increased morbidity.
Objectivo: Descrever a incidência, factores associados e prognóstico de complicações infecciosas nos pacientes admitidos numa unidade de Cuidados Intensivos Médica (MICU) após Reanimação Cardio-Pulmonar (CPR). Material e método: Identificamos de forma retrospectiva uma população de 56 doentes admitidos consecutivamente na MICU após CPR. Recolhemos dados demográficos, o score de APACHE III no primeiro dia MICU, modo e localização da paragem cardı́aca, duração da CPR, aspiração testemunhada, antibióticos prévios, a avaliação mais baixa da Escala de Coma de Glasgow (GCS) no primeiro dia na MICU, infecções novas, duração da ventilação mecânica e mortalidade. Resultados:Setenta e nove por cento das paragens ocorreram no hospital. A actividade Eléctrica sem pulso foi a forma mais comum (52%). Desenvolveram-se infecções novas em 46% dos casos. A infecção mais comum foi a pneumonia (65%) e o agente patogénico mais comum foi o Estafilococo aureus (31%). Obtiveram-se culturas de sangue em 40 doentes durante as primeiras 48 h e foram isolados patogénicos em cinco (12.5%).Os pacientes com infecções eram os mais jovens (53.7 vs 70.4 anos, P<0.001). A GCS média no primeiro dia foi oito em doentes com infecção comparativamente com dez naqueles sem infecção(P=0.032). Os doentes com infecção tiveram maior duração da ventilação mecânica (mediana 9 vs 2 dias, P=0.001) e maior tempo de permanência na MICU (mediana 8 vs 3 dias, P<0.001). A mortalidade hospitalar foi de 54 % em doentes com infecção versus 37% nos sem infecção (P=0.197). Conclusões:As complicações infecciosas são comuns nos sobreviventes de paragem cardı́aca e estão associadas com morbilidade aumentada.
Propósito: Describir la incidencia, factores asociados y resultado de las complicaciones infecciosas en pacientes admitidos en la unidad de tratamiento intensivo médico (MICU) después de la reanimación cardiopulmonar (CPR). Material y métodos: Identificamos una cohorte retrospectiva de 56 pacientes admitidos consecutivamente a MICU después de CPR. Recolectamos datos demográficos, la escala APACHE III de primer dı́a MICU, modo y localización del paro cardı́aco, duración de la RCP, aspiración presenciada, antibióticos previos, la mas baja puntuación de la escala de coma de Glasgow(GCS) en el primer dı́a de MICU, nuevas infecciones, duración de la ventilación mecánica y mortalidad. Resultados: 79% de los paros ocurrieron en el hospital. El modo mas común fue la actividad eléctrica sin pulso (52%). Se desarrolló nueva infección en 46%. La infección mas común fue la neumonı́a (65%) y el patógeno mas frecuente fue el Estafilococo aureo (31%).Los cultivos fueron obtenidos en 40 pacientes durante las primeras 48 horas y se aislaron patógenos en cinco (12.5%). Los pacientes con infección eran mas jóvenes (53.7 vs.70.4años, P<0.001). La mediana de puntaje de GCS del primer dı́a fue de 8 en pacientes con infección comparado con 10 en aquellos sin (P=0.032). Los pacientes con infección tuvieron mayor duración de ventilación mecánica (mediana 9 vs. 2 dı́as, P=0.001) y mayor estadı́a en MICU (mediana 8 vs. 3 dı́as, P<0.001). La mortalidad hospitalaria fue de 54% en pacientes con infección vs. 37% en aquellos sin infección (P=0.197). Conclusiones: Las complicaciones infecciosas son comunes en sobrevivientes de paro cardı́aco y están asociadas con morbilidad aumentada.
Clinical Characteristics and Prognosis of Bloodstream Infection with Carbapenem-Resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancies
2023, Infection and Drug Resistance

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CDC definitions for nosocomial infections

Am J Infect Control

Semin Nucl Med

Pitfalls in the diagnosis of nosocomial pneumonia

Pneumonia and lung abscess