Clinical Background
Health care associated (nosocomial) infections may cause infectious outbreaks in hospitals, extended-care facilities and communities at large and can be associated with substantial morbidity and mortality.
Epidemiology
- Prevalence - 5-10% of patients admitted to a U.S. hospital will develop HCAI
- Transmission - acquisition of healthcare associated infections may occur from poor hand hygiene, prosthetic-related devices, inadequate decontamination (e.g., doorknobs, handrails, etc.)
Microorganisms
- Staphylococcus aureus
- >50% are methicillin resistant (MRSA)
- Enterococcus
- >30% are vancomycin resistant
- Enterobacteriaceae
- >30% are resistant to beta lactams
- Clostridium difficile
- Acinetobacter sp
Risk Factors
- Presence of an indwelling catheter
- Majority are associated with a central venous catheter
- Prolonged hospitalization
- Prior exposure to antibiotics
- Prolonged ventilation
Anatomic Distribution
- Urinary tract - 35%
- Surgical site - 10%
- Lung - 10%
- Blood stream - 10%
- Other - 10%
Clinical Presentation
- Nonspecific - worsening clinical condition without obvious symptoms
- Fever
- New infiltrate on chest X-ray
Prevention
- Hand washing
- Appropriate catheter insertion and maintenance
- Avoidance of non-necessary antibiotics
See Also
Diagnosis
Diagnosis
- Laboratory testing
- Specific site cultures to identify pathogen and antimicrobial resistance
- Bacterial strain characterization - assists in infection control for the investigation of outbreaks
Tests generally appear in the order most useful for common clinical situations
| Test name: Bacterial Strain Characterization by Pulsed-Field Gel Electrophoresis
|
| ARUP #: 0060182 |
| Methodology: Pulsed-Field Gel Electrophoresis
|
| Use: Bacterial Strain Characterization by Pulsed-Field Gel Electrophoresis (0060182)
- Determine organism causing outbreak
- Distinguish reinfection from relapse |
| Limitations: |
| Follow-up:
|
References
General References
Blot S, Depuydt P, Vandewoude K, De Bacquer D. Measuring the impact of multidrug resistance in nosocomial infection. Curr Opin Infect Dis.
2007;
20(
4):
391-396.
Casey AL, Lambert PA, Elliott TS. Staphylococci. Int J Antimicrob Agents.
2007;
29 Suppl 3:
S23-S32.
Chinen J, Shearer WT. Advances in basic and clinical immunology in 2006. J Allergy Clin Immunol.
2007;
120(
2):
263-270.
Elston DM. Status update: hospital-acquired and community-acquired methicillin-resistant Staphylococcus aureus. Cutis.
2007;
79(
6 Suppl):
37-42.
Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, Swaminathan B. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol.
1995;
33(
9):
2233-2239.
Wenzel RP. Health care-associated infections: major issues in the early years of the 21st century. Clin Infect Dis.
2007;
45 Suppl 1:
S85-S88.
References from the ARUP Institute for Clinical and Experimental Pathology Research®
Jackson BR, Thomas A, Carroll KC, Adler FR, Samore MH. Use of strain typing data to estimate bacterial transmission rates in healthcare settings. Infect Control Hosp Epidemiol.
2005;
26(
7):
638-645.
Medical Reviewers
Petti, Cathy A., M.D. Medical Director, Infectious Diseases at ARUP Laboratories; Assistant Professor, Pathology and Medicine, University of Utah
Comprehensive Review: January 2008
Last Update: March 2008
