Stewardship / Resistance Scan for May 05, 2021

WHO highlights importance of good hand hygiene

To mark World Hand Hygiene Day, the World Health Organization (WHO) today called for countries to reduce inequalities in the availability of good hand hygiene and other infection prevention and control (IPC) measures.

While good hand hygiene is considered vital in preventing healthcare-associated infections and the spread of antibiotic-resistant pathogens, research has shown that in some low-income countries, only 1 in 10 healthcare workers practices proper hand hygiene, and that’s often because they lack the resources to do so. A 2020 WHO report found that globally, 1 in 4 healthcare facilities lacks basic water services, and 1 in 3 lacks hand hygiene supplies at the point of care.

Another WHO analysis found that, in 2018, only 45% of low-income countries had a functional national IPC program, compared with 70% of high-income countries. Overall, only 22% of countries monitored implementation roll-out and impact of IPC programs.

The lack of resources for good hand hygiene and IPC measures in poorer nations is reflected in healthcare-associated infection rates. The WHO notes that patients in low- and middle-income countries are more than twice as likely to acquire an infection during healthcare delivery as patients in high-income countries (15% vs 7%), and that the risk of infection in intensive care units (ICUs), especially among newborns, is two to 20 times higher.

The WHO also announced a new online monitoring IPC portal to help countries identify and address IPC gaps.

“Health care workers’ compliance with hand hygiene practices is one of the key performance indicators for IPC, patient safety and quality of health services worldwide,” the WHO said in a press release. “The new monitoring portal can play an important part in improving this.”
May 5 WHO press release

 

Study describes bacterial, fungal coinfections in COVID-19 patients

A study of hospitalized COVID-19 patients in New York during the first wave of the pandemic found that 17% had bacterial or fungal coinfections, and that antibiotic-resistant bacteria were increasingly isolated from patients with prolonged hospital stays, researchers reported today in Open Forum Infectious Diseases.

In the study, researchers from New York-Presbyterian Hospital/Columbia University Irving Medical Center examined data on COVID-19 patients who were hospitalized for more than 24 hours from Mar 2, 2020, through May 21, 2020, including culture and susceptibility results from all body sources. Microbiologically confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and healthcare-associated infections and describe temporal changes in predominant organisms and antibiotic resistance.

Of the 3,028 COVID-19 patients admitted during the study period, 516 (17%) had positive cultures. Community-associated infections (identified within 72 hours of admission) were identified in 183 patients (6%), and healthcare-associated infections were identified in 350 patients (12%), with the median onset of hospital infection on day 16.

Among the isolates identified as healthcare-associated, 57% were gram-negative bacteria, 25% were gram-positive bacteria, and 19% were fungi. ICU stay, mechanical ventilation, and steroid use were all independently associated with healthcare-associated infections.

Drug susceptibilities differed by source of infection and duration of hospitalization, with the proportion of vancomycin-resistant Enterococci, cephalosporin-resistant (Ceph-R) Enterobacterales, and carbapenem-resistant Enterobacterales infections increasing with the duration of hospitalization. Ceph-R Enterobacterales, identified in 159 isolates, was the most common organism group with multidrug resistance.

The analysis also found that among all 3,028 patients, 2,015 (67%) had exposure to at least one dose of an antibiotic, including 60% of the patients with no confirmed co-infection.

“High rates of antimicrobial use in conjunction with other risk factors, such as prolonged hospital and ICU stays, invasive devices, and the need for patient cohorting, may have contributed to the increasing incidence of multidrug-resistant infections over the course of hospitalizations,” the study authors wrote.

The authors say the findings highlight the importance of antibiotic stewardship principles in hospitalization of COVID-19 patients.
May 5 Open Forum Infect Dis abstract

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