Hospital-Acquired Infections Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What are hospital-acquired infections?

Nosocomially acquired infections that are not present or incubating at the time of admission to a hospital.

Which of the following is a type of hospital-acquired infection (HAI)? (Select all that apply)

all correct

Ventilator-associated pneumonia (VAP) (correct)

Central line-associated bloodstream infections (CLABSI) (correct)

Catheter-associated urinary tract infections (CAUTI) (correct)

Healthcare-acquired Pneumonia (HCAP) is still widely used as a term.

False

Infections acquired after hospitalization that manifest 48 hours after admission are known as __________.

hospital-acquired infections Signup and view all the answers

Which pathogen is commonly associated with Clostridioides difficile infections (CDI)?

Clostridioides difficile Signup and view all the answers

What are common symptoms favoring a hospital-acquired infection?

Productive cough, shortness of breath, abdominal pain, rebound tenderness, altered mental status. Signup and view all the answers

Match the following types of infections with their definitions:

Hospital-acquired pneumonia (HAP) = Pneumonia that occurs 48 hours or more after admission to the hospital. Ventilator-associated pneumonia (VAP) = Pneumonia that develops more than 48 to 72 hours after endotracheal intubation. Surgical site infections (SSI) = Infections that occur after surgery in the area of the surgical procedure. Catheter-associated urinary tract infections (CAUTI) = Urinary tract infections associated with the use of catheters. Signup and view all the answers

The dominant infections causing hospital-acquired infections include pneumonias and surgical site infections.

True Signup and view all the answers

What is the primary risk factor for the development of antimicrobial resistance?

Receipt of intravenous antibiotics within the last 90 days. Signup and view all the answers

Which of these pathogens is included in the 'ESKAPE' group associated with hospital-acquired infections?

Enterococcus faecium Signup and view all the answers

Which mechanism is involved in the extrusion of multidrug and toxic compounds?

RND system Signup and view all the answers

Which of the following is a component of the major facilitator superfamily?

MATE Signup and view all the answers

What is the primary function of ATP-binding cassette (ABC) transporters?

Energy-dependent transport Signup and view all the answers

Which process may lead to reduced antibiotic accumulation in a bacterial cell?

Porin loss Signup and view all the answers

Which of the following is NOT a mechanism related to antibiotic resistance?

Plasmid replication Signup and view all the answers

What sampling method is recommended for patients with HAP/VAP according to recent guidelines?

Tracheal aspirates Signup and view all the answers

Which of the following bacteria is NOT classified as one of the ESKAPE pathogens?

Escherichia coli Signup and view all the answers

What is one of the mechanisms through which bacteria develop drug resistance?

Enzyme-mediated antimicrobial inactivation Signup and view all the answers

How do biofilm-embedded cells differ from planktonic bacteria in terms of antibiotic tolerance?

They have drastically higher tolerance to antibiotics Signup and view all the answers

Which of these mechanisms is involved in drug binding site modification?

16S RNA methylation Signup and view all the answers

What does the acronym ESKAPE stand for in the context of bacterial pathogens?

Enterococcus, Staphylococcus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter Signup and view all the answers

What is a common characteristic of the ESKAPE pathogens?

They have increasing multi-drug resistance Signup and view all the answers

Which method does not contribute to reducing intracellular drug accumulation in bacteria?

Increased metabolic rate Signup and view all the answers

What percentage of hospitalized patients suffered from at least one healthcare-associated infection according to the 2014 CDC survey?

4% Signup and view all the answers

Which of the following infections has the highest prevalence among hospital-acquired infections?

Pneumonia Signup and view all the answers

Which pathogen is identified as the leading cause of healthcare-associated infections?

Clostridium difficile Signup and view all the answers

What is a significant laboratory finding that may indicate serious bacterial illness?

Elevated blood urea nitrogen Signup and view all the answers

Which laboratory test is generally not indicated for diagnosing infections if the pretest probability of HAI is high?

Procalcitonin Signup and view all the answers

What percentage of hospital-acquired infections are caused by urinary tract infections?

12.9% Signup and view all the answers

Which of the following factors can complicate the interpretation of white cell counts?

Inflammation Signup and view all the answers

Why is obtaining cultures before starting antibiotics important in patients with infections?

To identify the pathogen and its susceptibility Signup and view all the answers

What is the primary purpose of monitoring hospital-acquired infections by agencies like the CDC?

To prevent hospital-acquired infections and improve patient safety Signup and view all the answers

Which of the following is NOT a symptom associated with hospital-acquired infections?

Weight gain Signup and view all the answers

What is the definition of Hospital-acquired Pneumonia (HAP)?

Pneumonia occurring 48 hours or more after admission without prior incubation Signup and view all the answers

Why have the definitions of pneumonia been changed concerning multidrug-resistant pathogens?

To better identify at-risk patients and reduce antibiotic overuse Signup and view all the answers

Which of the following infections does NOT fall under hospital-acquired infections?

Appendicitis Signup and view all the answers

What is a key consideration in identifying patients at risk for hospital-acquired infections?

Presence of chronic conditions and prior antibiotic usage Signup and view all the answers

What has replaced the term Healthcare-acquired Pneumonia (HCAP)?

Hospital-acquired Pneumonia (HAP) Signup and view all the answers

What impact do hospital-acquired infections have beyond individual patient cases?

They are linked to multidrug-resistant infections affecting the community Signup and view all the answers

What type of enzyme is responsible for modifying aminoglycosides through acetylation?

AACs Signup and view all the answers

What is defined as pneumonia that develops more than 48 to 72 hours after endotracheal intubation?

Ventilator-associated pneumonia Signup and view all the answers

Which of the following is NOT a risk factor for hospital-acquired infections?

Competitive sports participation Signup and view all the answers

Which of the following is NOT a mechanism by which bacteria can inactivate antibiotics?

Increased cell wall turnover Signup and view all the answers

What does 'LPS' stand for in the context of bacterial structures?

Lipopolysaccharide Signup and view all the answers

Which pathogen is NOT commonly associated with catheter-associated urinary tract infections (CAUTI)?

Clostridioides difficile Signup and view all the answers

Which of the following describes the function of aminoglycoside-modifying enzymes?

They modify aminoglycoside antibiotics. Signup and view all the answers

What is a major risk factor contributing to antimicrobial resistance?

Receipt of intravenous antibiotics within the last 90 days Signup and view all the answers

What role do persister cells play in bacterial survival?

They survive during antibiotic treatment. Signup and view all the answers

Which of the following organisms is commonly associated with surgical site infections (SSI)?

Escherichia coli Signup and view all the answers

What percentage of patients in the ICU were reported to have at least one hospital-acquired infection in a point prevalence study?

19.5% Signup and view all the answers

Which enzyme is involved in modifying aminoglycosides by adding a phosphate group?

APHs Signup and view all the answers

What is a common consequence of lipopolysaccharide (LPS) alterations in bacteria?

Reduced immune recognition Signup and view all the answers

Which of the following is among the most common pathogens for hospital-acquired pneumonia (HAP)?

S. aureus Signup and view all the answers

Which condition is primarily influenced by the infection control practices at a healthcare facility?

Hospital-acquired infections Signup and view all the answers

Which of the following components is directly involved in the interaction between antibiotics and bacterial cell walls?

PBP Signup and view all the answers

Study Notes

Hospital-Acquired Infections (HAIs)

HAIs are infections present or incubating at admission to a hospital
Infections typically manifest 48 hours after admission
Monitored by agencies like the CDC's NHSN (USA) and NIZP PZH (Poland)
Surveillance prevents HAIs and improves patient safety

Types of HAIs

Central line-associated bloodstream infections (CLABSI)
Catheter-associated urinary tract infections (CAUTI)
Surgical site infections (SSI)
Hospital-acquired pneumonia (HAP)
Ventilator-associated pneumonia (VAP)
Clostridioides difficile infections (CDI)

Symptoms of HAIs

Productive cough
Shortness of breath
Abdominal pain
Rebound tenderness
Altered mental status
Palpitations
Suprapubic pain
Polyuria
Dysuria
Costovertebral angle tenderness

Impact of HAIs

HAIs are linked to multidrug-resistant infections
Identifying patients at risk is crucial for prevention
Definitions of "Pneumonia" changed for better identification of MDR risk, aiming for reduced antibiotic overuse
"Hospital-acquired Pneumonia" (HAP) now replaces "Healthcare-acquired Pneumonia" (HCAP)
HAP is pneumonia that appears more than 48 hours after admission and was not present at admission
Ventilator-associated pneumonia (VAP) is pneumonia developing >48-72 hours after endotracheal intubation
Both HAP and VAP have poorer outcomes and high morbidity and mortality worldwide

HAI Etiology

Factors impacting HAI risk include infection control practices, patient immune status, and community pathogen prevalence
Risk factors:
- Immunosuppression
- Older age
- Length of hospital stay
- Multiple comorbidities
- Frequent visits to healthcare facilities
- Mechanical ventilatory support
- Recent invasive procedures
- Indwelling devices
- Intensive care unit (ICU) stay

HAI Epidemiology

2014 CDC multi-state survey of 11,282 patients from 183 US hospitals found about 4% of hospitalized patients suffered from at least one HAI.
In 2011, an estimated 648,000 hospitalized patients suffered approximately 721,800 infections.
Leading HAIs include pneumonia (21.8%), surgical infections (21.8%), GI infections (17.1%), urinary tract infections (12.9%).
Leading pathogens in HAIs are C. difficile, Staphylococcus aureus, Klebsiella, and Escherichia coli

HAI Evaluation

Laboratory testing helps in diagnosis.
Checking serum levels (lactic acid, liver transaminases, prothrombin time, blood urea nitrogen (BUN), and serum creatinine) for organ dysfunction.
Reviewing white blood cell counts, band counts, thrombocytopenia, hypoglycemia, hyperglycemia and mixed venous blood saturation.

Importance of Early HAI Identification

Obtaining cultures and assessing susceptibility patterns helps target treatment rather than using broad spectrum antibiotics.
Culture sampling is vital for early pathogen detection and susceptibility testing.
Ancillary tests (such as CRP and procalcitonin) are not recommended if the pretest probability is high (VAP, HAP).
For suspected HAP/VAP, noninvasive tracheal aspirates are recommended instead of more invasive tests unless quantitative tracheal lavage or bronchoscopy is needed.

ESKAPE Pathogens

ESKAPE pathogens are a group of six common and heavily antibiotic-resistant bacteria causing HAIs:
- Enterococcus faecium
- Staphylococcus aureus
- Klebsiella pneumoniae
- Acinetobacter baumannii
- Pseudomonas aeruginosa
- Enterobacter spp
These Gram-positive and Gram-negative bacteria are developing multidrug resistance (MDR).

Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens

Mechanisms include:
- Drug inactivation/alteration
- Modification of drug binding sites/targets
- Changes in cell permeability reduction
- Biofilm formation (antimicrobial resistance increased)
- Reduced antibiotic accumulation

Urinary Tract Infections (UTIs)

Fifth most frequent type of healthcare-associated infection
Approximately 12-16% of adult inpatients have indwelling urinary catheters
Increased risk of CAUTI (catheter-associated UTI) with each further day of indwelling catheter presence (3-7%)
CAUTIs can cause further complications: prostatitis, epididymitis, orchitis, cystitis, pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis, and endophthalmitis.

UTI Definitions

Symptomatic UTI (SUTI): Must meet 1, 2 and 3 criteria,
- Indwelling catheter (>2 days), patient has signs/symptoms of UTI
- No indwelling >2 days catheter but patient has signs/symptoms of UTI
- Urine culture showing ≥ 105 CFU/mL and no more than 2 species,
Asymptomatic Bacteremic UTI (ABUTI): Patient has no UTI symptoms, urine culture showing ≥ 105 CFU/ml and urine organism matching blood organism at >100,000 CFU/ml.

Hospital-Acquired Pneumonia (HAP)

Defined as pneumonia occurring >48 hours after admission and not incubating at the time of admission
Diagnosis isn't based solely on pneumonia diagnosis
Confirmed through imaging (X-ray/CT scan, demonstrating new or progressive/persistent infiltrates, consolidations, cavitation, and pneumatoceles (less than one year)), clinical findings (e.g. fever, purulent sputum), and laboratory criteria
Patients with underlying pulmonary or cardiac issues, serial chest imaging within 7 days is important to distinguish infectious from noninfectious causes.

Laboratory Criteria for PNU2

Organism identified from blood, pleural fluid;
Positive quantitative culture; or corresponding semi-quantitative culture result from appropriately collected lower respiratory tract (LRT)specimen.

Ventilator-Associated Pneumonia (VAP)

VAP is pneumonia occurring 48 to 72 hours after endotracheal intubation
Prior inpatient ventilator use counts from the admission date.

Signs/Symptoms of Infection

Fever (> 38.0°C or > 100.4°F),
Leukopenia (≤ 4000 WBC/mm3) or leukocytosis (≥ 12,000 WBC/mm3),
Altered mental status (in adults ≥70)
New or worsening dyspnea, tachypnea, productive cough, increased respiratory secretions and suctioning needs.
New or worsened cough,
Increasing gas exchange issues (e.g. worsened O2 sats).

Bartlett score

Measures sputum quality for microbiology via microscopic exam.
- High neutrophils/low epithelial cells indicate infection;
- High epithelial cells/low neutrophils indicate contamination.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz provides an overview of hospital-acquired infections (HAIs), including their definition, types, symptoms, and impact on patient safety. Understanding HAIs is crucial for health professionals, as it helps in preventing and managing these infections effectively. Test your knowledge on this important topic!