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Half of MDR-HAIs have evidence of nosocomial transmission
Only half of patients with suspected health care-associated infections caused by multidrug-resistant organisms had documented exposure or an epidemiological link indicating nosocomial transmission, according to recent data.
The CDC defines health-care associated infections as those occurring more than 48 hours after hospital admission in patients with no evidence of infection upon initial examination. Stefan Erb, MD, of the division of infectious diseases and hospital epidemiology at University Hospital Basel, Switzerland, and colleagues, however, suggest that some community-acquired infections may be detected more than 2 days after admission because of a delay in sampling, a lack of universal screening upon admission and variation in incubation periods of infections. Therefore, the number of preventable infections in health care centers may be lower than expected, which could have an impact on the economic burden for these facilities, according to the researchers.
“The distinction between community-acquired and truly hospital-acquired infections is important for adequate patient management, to guide infection control activities, and to estimate the economic burden for healthcare facilities,” they wrote. “The trend toward ‘pay for performance’ may result in lower reimbursements of [HAIs], particularly in countries where financial reimbursement is based on the prospective diagnosis-related group system. With a DRG system, the amount paid to a hospital for a patient is determined in advance and depends only on the diagnosis and major procedures reported at discharge and does not cover additional expenses caused by, for example, HAIs.”
To investigate the proportion of preventable CDC-defined HAIs at their facility, Erb and colleagues examined data on 1,190 patients hospitalized with infections or colonization caused by multidrug-resistant organisms (MDROs). The researchers conducted molecular typing by pulsed-field gel electrophoresis on all MDROs and spa-typing for MRSA to determine whether they were acquired in the hospital.
According to the data, 23% of patients had health care-acquired MDRO infections or colonization (HAMIC) based on CDC guidelines. However, only 51.8% of all HAMICs occurred in patients who had evidence of being exposed to a pathogen or index patient in the facility. Overall, 57% of MRSA cases, 83.3% of vancomycin-resistant enterococci cases, 43.9% of extended-spectrum beta-lactamase (ESBL) cases and 74.1% of non-ESBL MDRO cases may have been prevented.
“Relying only on the CDC-definition of HAIs may lead to inaccurate measure of the impact of infection control interventions,” Erb and colleagues concluded. “Our estimates may … be of interest in countries using a DRG system where the additional costs for treatment of HAIs are not fully reimbursed by insurance payers to healthcare facilities.” – by Stephanie Viguers
Disclosures: The researchers report no relevant financial disclosures.
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