Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study,The Lancet Global Health

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Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study
The Lancet Global Health ( IF 34.3 ) Pub Date : 2022-08-09 , DOI: 10.1016/s2214-109x(22)00274-1
Purva Mathur ₁ , Paul Malpiedi ₂ , Kamini Walia ₃ , Padmini Srikantiah ₄ , Sunil Gupta ₅ , Ayush Lohiya ₆ , Arunaloke Chakrabarti ₇ , Pallab Ray ₇ , Manisha Biswal ₇ , Neelam Taneja ₇ , Priscilla Rupali ₈ , Veeraraghavan Balaji ₈ , Camilla Rodrigues ₉ , Vijaya Lakshmi Nag ₁₀ , Vibhor Tak ₁₀ , Vimala Venkatesh ₁₁ , Chiranjay Mukhopadhyay ₁₂ , Vijayshri Deotale ₁₃ , Kanne Padmaja ₁₄ , Chand Wattal ₁₅ , Sanjay Bhattacharya ₁₆ , Tadepalli Karuna ₁₇ , Bijayini Behera ₁₈ , Sanjeev Singh ₁₉ , Reema Nath ₂₀ , Raja Ray ₂₁ , Sujata Baveja ₂₂ , Bashir A Fomda ₂₃ , Khumanthem Sulochana Devi ₂₄ , Padma Das ₂₅ , Neeta Khandelwal ₂₆ , Prachi Verma ₂₇ , Prithwis Bhattacharyya ₂₈ , Rajni Gaind ₂₉ , Lata Kapoor ₃₀ , Neil Gupta ₂ , Aditya Sharma ₂ , Daniel VanderEnde ₄ , Valan Siromany ₄ , Kayla Laserson ₄ , Randeep Guleria ₁ ,

Affiliation

All India Institute of Medical Sciences, New Delhi, India.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Indian Council of Medical Research, New Delhi, India.
Centers for Disease Control and Prevention, New Delhi, India.
Ministry of Health and Family Welfare, New Delhi, India.
Kalyan Singh Super Specialty Cancer Institute, Lucknow, India.
Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Christian Medical College, Vellore, India.
P D Hinduja National Hospital and Medical Research Centre, Mumbai, India.
All India Institute of Medical Sciences, Jodhpur, India.
King George's Medical University, Lucknow, India.
Kasturba Medical College, Manipal, India.
Mahatma Gandhi Institute of Medical Sciences, Sevagram, India.
Nizam's Institute of Medical Sciences, Hyderabad, India.
Sir Ganga Ram Hospital, New Delhi, India.
Tata Medical Center, Kolkata, India.
All India Institute of Medical Sciences, Bhopal, India.
All India Institute of Medical Sciences, Bhubaneswar, India.
Amrita Institute of Medical Sciences, Kochi, India.
Assam Medical College, Dibrugarh, India.
Institute of Post Graduate Medical Education and Research, Kolkata, India.
Lokmanya Tilak Municipal Medical College, Mumbai, India.
Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.
Regional Institute of Medical Sciences, Imphal, India.
All India Institute of Medical Sciences, Raipur, India.
Government Medical College, Surat, India.
Mahatma Gandhi Medical College, Jaipur, India.
North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India.
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
National Centre for Disease Control, New Delhi, India.

Background

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available.

Methods

A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis.

Findings

26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp.

Interpretation

The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies.

Funding

US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi.

Translation

For the Hindi translation of the abstract see Supplementary Materials section.

中文翻译：

印度医院网络中与医疗保健相关的血流和尿路感染：一项多中心、基于医院的前瞻性监测研究

背景

卫生保健相关感染 (HAI) 在全球范围内导致严重的发病率和死亡率，包括在低收入和中等收入国家 (LMIC)。实施标准化 HAI 监测的医院网络可以提供有关 HAI 负担的宝贵数据，并识别和监测 HAI 预防差距。许多 LMIC 的医院使用为资源丰富的环境开发的 HAI 病例定义，这需要人力资源以及通常无法获得的实验室和影像学测试。

方法

在印度建立了一个由 26 家三级医院组成的网络，以实施 HAI 监测和预防活动。修改了现有的 HAI 病例定义，以促进跨医院的标准化、资源适当的监测。医院确定了与医疗保健相关的血流感染和尿路感染 (UTI)，并将临床和微生物学数据报告给网络进行分析。

发现

26 家网络医院在 2017 年 5 月 1 日至 2018 年 10 月 31 日期间报告了来自 89 个重症监护病房 (ICU) 的 2622 例与医疗保健相关的血流感染和 737 例与医疗保健相关的尿路感染。新生儿重症监护室（>20 每 1000 个中心线日）。儿科内科 ICU 的导管相关 UTI 发生率最高（每 1000 导尿管日 4·5）。克雷伯菌属 (24·8%) 是血流感染中最常见的微生物，而念珠菌属 (29·4%) 是尿路感染中最常见的微生物。碳青霉烯类耐药在革兰氏阴性菌感染中很常见，发生在 72% 的血流感染和 76% 的由克雷伯菌属引起的 UTI，77% 的血流感染和 76% 的由不动杆菌引起的 UTIspp，以及由假单胞菌属引起的 64% 的血流感染和 72% 的尿路感染。