Skip to main content

Table 1 Summary of abstracts presented at the 2013 World Healthcare-Associated Infections Forum

From: Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum

I. Antimicrobial use and resistance
Author Short title Study design Setting Key findings
Balkhy et al. Susceptibility of isolates from patients with VAP in Saudi Arabia Retrospective susceptibility study Single adult ICU, Saudi Arabia, 2004 – 2009 • Acinetobacter spp. was highly resistant (70 – 90%) to all tested antimicrobials including carbapenems (78% had four-class MDR)
• Klebsiella spp. had low (0 – 14%) resistance with no detected MDR
Carrel et al. MRSA and proximity to concentrated animal feeding operations Retrospective unmatched case-control study Veterans Affairs Hospital, Iowa, USA, 2009 – 2011 High swine exposure (residential proximity to CAFOs) was associated with an increased risk of MRSA colonization
Dantes et al. National burden of invasive MRSA infections, USA 2011 Prospective, population-based surveillance study USA, 2011 Compared to 2005, hospital-onset MRSA infections decreased by 54%, but community-associated infections remain stable
Invasive MRSA infections are now more common among persons in the community than hospitalized patients
Datta et al. Quantifying MDRO exposure from patients in a single hospital to all California facilities Retrospective case-cohort study California hospitals and long-term-care facilities, 2005 – 2009 Within a 5-year period, 1,198 patients with MRSA in a single hospital later exposed 137 hospitals and 103 LTCF
Gastmeier et al. Dramatic increase of vancomycin-resistant enterococci in Germany with a belt of high proportions Prospective surveillance study > 600 ICUs and > 300 surgical wards throughout Germany, 2007 – 2012 Healthcare-associated VRE colonization and infections are increasing dramatically in Germany, particularly SSI and primary BSI
There is a belt of significantly higher VRE proportions running through the middle of Germany
Gikas et al. Antimicrobial use and HAI prevalence in Greek hospitals Antimicrobial and HAI point prevalence study 37 hospitals, Greece, 2012 54.7% of hospitalized patients were receiving an antimicrobial (a slight increase from 51.4% ten years before)
ICU and surgery patients received the highest proportion of antimicrobials
9% of patients had documentation of a HAI
Gniadkowski et al. Obstacles in controlling KPC spread in Poland Retrospective surveillance study Poland, 2008 – June 2013 KPC-producing enterobacteriaceae have spread rapidly throughout Poland since their emergence in 2008
Most common infection type is UTI; infections are most commonly reported by ICUs
Hsueh PR Antimicrobial drug resistance in Asia Pacific Prospective and retrospective surveillance studies Taiwan, 2002 – 2011 VRE infections in Taiwanese ICUs are increasing dramatically
ESBL-producing Escherischia coli infections have been increasing in Asia Pacific
Resistance to colistin (polymyxin B) is emerging in A. baumannii and Pseudomonas aeruginosa
Kaku et al. Trends of antimicrobial resistance in a Japanese hospital Retrospective surveillance study Tertiary care hospital, Japan, 2012 – April 2013 ESBL-producing bacteria are increasing in prevalence
Trends in MRSA and multi-resistant Pseudomonas are stable
Mushtaq et al. Prevalence of carbapenemase carriage among inpatients in Karachi Prospective surveillance study Tertiary care hospital, Pakistan, 2012 Of 469 patients sampled on admission by rectal swab, 36% were positive for blaNDM and 92% for blaCTX-M-15
Reuland et al. Risk factors for carriage of ESBL-producing enterobacteriaceae in the community Prospective cohort study with nested, unmatched case-control study Adult, community-dwelling volunteers, Netherlands, 2012 Of 1713 stool samples from community-dwelling volunteers, 8% were positive for ESBL-producing enterobacteriaceae
Significant risk factors were hospital admission in a foreign country, antimicrobial use, and antacid use
ESBL-encoding genes CTX-M-15 and -14 were significantly associated with travel to Africa and the Middle and Far East, while CTX-M-1 had no association with travel
Thu le et al. Antimicrobial use and resistance in surgical patients in Vietnam Literature review Vietnamese hospitals, 2010 – 2012 Antimicrobials are prescribed inappropriately in Vietnamese surgical patients
     The chief reason for prolonging antimicrobial therapy was the perception of a “poor environment”
II. Emergence and control of endemic resistance
Author Short title Study design Setting Key findings
Adler et al. Characteristics of an outbreak caused by OXA-48-producing CRE in a neonatal ICU in Jerusalem Combined retrospective and prospective before-after cohort study Neonatal ICU, Israel, 2012 At the peak of the outbreak, one third of ICU patients acquired OPE
After the implementation of a bundled intervention, which included cohorting colonized patients, frequent rectal surveillance, and improving the implementation of infection control practices, no new cases were detected over the following three months
Baltieri et al. Prevention of Staphylococcus aureus infection in the NICU: routine surveillance and decolonization Combined retrospective and prospective before-after cohort study Brazilian NICU, 2010 – 2012 In response to increasing MRSA prevalence, universal NICU screening and decolonization (nasal mupirocin and oral hygiene with chlorhexidine for one week) were implemented
The fraction of MRSA infections decreased from 2% to 0.4% after bundle implementation; there was no significant impact on MSSA infections
There was no microorganism replacement phenomenon
Cheung et al. Overcoming hand hygiene fatigue by involving the link nurses Before-after study Tertiary care hospital, Hong Kong, 2008 – 2012 The activities of link nurses helped to increase compliance with hand hygiene practices from 50% to 83%
Fournier et al. Emerging MDRO: same risk of outbreaks? Prospective surveillance study 38 hospitals, France, 2010 – March 2013 Incidence of secondary cases of VRE and CRE was significantly lower if cohorting and dedicated nursing staff and/or barrier precautions were employed within two days of detection of the index case
If these measures were delayed beyond two days, VRE spread was more significant than that of CRE
Grall et al. Can the medical device DAV132 decrease the impact of antibiotics on fecal microbiota? Experimental animal models (porcine, canine, murine) France, 2013 DAV132 is an oral medical device designed to deliver an adsorbent to the distal ileum that interferes with antibiotic absorption distal to the ileocecal junction
     DAV132 captured gut antibiotic residues in dogs treated with intravenous levofloxacin without impacting blood pharmacokinetics and, in mice, significantly reduced the impact of cefotaxime on resistance to colonization by beta-lactam resistant enterobacteriaceae
III. Antimicrobial conservation
Author Short title Study design Setting Key findings
Awang Jalil et al. Infection prevention and control strategies of MDR infections in a neonatal ICU Before-after study Neonatal ICU, Malaysia, 2012 – April 2013 An antimicrobial conservation program with dedicated staff was implemented, with resultant improvement in hand hygiene practices (95% compliance) and a sharp decline in HAI sepsis rates
Bailin et al. Antimicrobial treatment for UTI among patients with total hip or knee arthroplasty Two-stage combined retrospective and prospective cohort study Tertiary care hospital,
USA, 2011 – 2012
Pre-operative screening for UTI was conducted in 95% of patients undergoing total hip or knee arthroplasty, regardless of symptoms; post-operative removal of the urinary catheter was also followed by urinalysis in 99% of patients regardless of symptoms
Nearly half (45.5%) of patients received antimicrobials pre- or post-operatively
In the prospective study, receipt of antimicrobials was not associated with signs and symptoms of UTI
Bavestrello et al. Impact of intervention on antimicrobial consumption in aquaculture in Chile Before-after economic analysis Chile, 2008 – 2009 After regulations on antimicrobial use in the salmon industry were introduced in late 2008, importation of fluoroquinolones decreased dramatically
Edmunds et al. Assessing the need for antimicrobial use guidelines among staff of a Saudi Arabian hospital Voluntary survey Tertiary care hospital, Saudi Arabia, 2013 Physicians’ responses to clinical vignettes in this survey showed good awareness of appropriate antibiotic options for various infections
Correct answers were not associated with age group, gender, or training status
Glass-Kaastra et al. Variation in antimicrobial use patterns in Canadian Provinces Retrospective population-level surveillance study Canadian provinces, 2000 – 2010 Although overall antimicrobial use is declining, patterns of use vary by province
Quebec had the lowest overall antimicrobial use, Newfoundland the highest
Guzman-Blanco et al. Pan-American Health Organization guideline for treatment of infectious diseases in Latin America International guideline Latin America, 2013 This guideline was recently updated to include recent surveillance data from Central and South America
Koo et al. Appropriateness of continued use of empirical vancomycin Retrospective cohort study Tertiary care hospital, South Korea 2012 Only 37.8% of systemic vancomycin prescriptions for 339 hospitalized patients over the year were deemed appropriate
Ling et al. Case-control study to determine risk factors for CRE carriage Retrospective matched (1:2) case-control study Tertiary care hospital, Singapore, 2011 – 2013 Significant risk factors were overseas hospitalizations in the past year, ICU admission, and exposure to carbapenems and fluoroquinolones
Mehtar and Hara Antimicrobial stewardship in Africa-humble beginnings Descriptive epidemiologic study African hospitals, 2011 – 2012 Only 14% of hospitals responding to a ESCMID survey reported having an ACP in place
The new Infection Control Africa Network is implementing ACP education programs in some African countries; long-distance learning and communication will employ mobile phone technology
Moro et al. Impact of a regional intervention program to control carbapenemase-producing Klebsiella pneumonia (CPKP) Before-after study 17 hospitals, Italy (Emilia-Romagna), 2011 – 2013 Given the rapid spread of CRE in Italy, a bundled intervention targeting patients at increased risk for CRE was implemented in mid-2011 in the county of Emilia-Romagna
A significant deceleration in the spread of CRE was observed overall; in 5 hospitals the incidence rate of CPKP decreased from 32 to 15 cases/100,000 hospital patient-days
Ndoye Antibiotic control in Senegal Before-after study Community hospitals, Senegal, 2008 – 2012 Despite a national initiative issued in 2008 to establish site-based antibiotic conservation, regular assessments through 2012 reveal that nearly 60% of facilities have not begun any preparatory activity, and no facility has implemented recommended interventions fully
The chief reason appears to be a shortage of dedicated human resources
Nicolle Antimicrobial stewardship in long-term-care facilities: what is effective? Systematic literature review Published studies retrieved through Medline & Embase, 1998 – 2013 Engagement of internists and promoting infectious diseases consultations were very effective; strategies incorporating education, local guidelines, and feedback were less so
Specific programs to decrease UTI prophylaxis and treatment of asymptomatic bacteriuria were successful
Nussenblatt et al. Inappropriate diagnosis and treatment of VAP is common in ICUs Prospective observational study ICUs in a single tertiary care center, USA, 2009 – 2010 Antibiotics were continued for more than 3 days in patients without VAP (77%)
Those patients with inappropriately long antibiotic courses trended toward more symptomatic CDI and longer hospital stays
Pulcini and Carlet for WAAAR A multidisciplinary initiative to save antibiotics: the World Alliance Against Antibiotic Resistance Cross-disciplinary alliance 42 countries represented, 2011 – This alliance of nearly 500 individuals from 42 countries was formed in 2011
Non-profit organization composed of antimicrobial prescribers (physicians, veterinarians) and consumers, including politicians and environmentalists) open to all people worldwide
Goal is to decrease AMR’s prevalence
Skov et al. Reducing antibiotic usage in Denmark: a campaign launch Ongoing campaign Danish general practitioners and general public, 2012 – In response to increasing AMR prevalence, a campaign to reduce unnecessary antimicrobial consumption has been launched
The campaign targets prescribers (physicians) and consumers (general public)
  1. ACP: antimicrobial conservation program; AMR: antimicrobial resistance; BSI: bloodstream infections; CAFO: concentrated animal feeding operation; CDI: Clostridium difficile infection; CRE: carbapenem-resistant enterobacteriaceae; ESBL: extended-spectrum beta-lactamase; ESCMID: European Society of Clinical Microbiology and Infectious Diseases; HAI: healthcare-associated infection; ICU: intensive care unit; KPC: Klebsiella pneumoniae carbapenemase; LTCF: long-term-care facility; MDR: multi-drug resistant; MDRO: multidrug-resistant organism; MRSA: methicillin-resistant Staphylococcus aureus; MSSA: methicillin-susceptible S. aureus; NICU: neonatal intensive care unit; OPE: OXA-48-producing enterobacteriacae; SSI: surgical site infections; UTI: urinary tract infection; VAP: ventilator-associated pneumonia; VRE: vancomycin-resistant enterococci.