Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey.

Background We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. Methods Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. Results Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. Conclusions This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.

[1]  Kazuya Ichikawa,et al.  The first point prevalence survey of health care-associated infection and antimicrobial use in a Japanese university hospital: A pilot study. , 2016, American journal of infection control.

[2]  D. Lye,et al.  Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures , 2011, Antimicrobial Agents and Chemotherapy.

[3]  Nguyen H. Tran,et al.  Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units , 2016, PloS one.

[4]  R. Gaynes,et al.  Measuring the scope and magnitude of hospital-associated infection in the United States: the value of prevalence surveys. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  A. Muller,et al.  Estimation of the Cumulative Incidence of Hospital-Acquired Bacteremia From Prevalence Data: A Formula , 2005, Infection Control & Hospital Epidemiology.

[6]  J. Wille,et al.  Prevalence of nosocomial infections in The Netherlands, 2007-2008: results of the first four national studies. , 2010, The Journal of hospital infection.

[7]  D. Cardo,et al.  Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002 , 2007, Public health reports.

[8]  J. Bartlett,et al.  Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  Carol A. Keohane,et al.  Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. , 2013, JAMA internal medicine.

[10]  D. Cardo,et al.  Moving toward Elimination of Healthcare-Associated Infections: A Call to Action , 2010, Infection Control & Hospital Epidemiology.

[11]  D. Pittet,et al.  Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients , 1995, Intensive Care Medicine.

[12]  H. Goossens,et al.  The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  Robert C Oh,et al.  Prolonged febrile illness and fever of unknown origin in adults. , 2014, American family physician.

[14]  A. Hidrón,et al.  Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007 , 2008, Infection Control & Hospital Epidemiology.

[15]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[16]  R. Lynfield,et al.  Multistate point-prevalence survey of health care-associated infections. , 2014, The New England journal of medicine.

[17]  E. P. Dellinger,et al.  Clinical practice guidelines for antimicrobial prophylaxis in surgery. , 2013, Surgical infections.

[18]  P. Gastmeier,et al.  Antibiotic usage in German hospitals: results of the second national prevalence study. , 2013, The Journal of antimicrobial chemotherapy.

[19]  P. Tambyah,et al.  The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study , 2015, Antimicrobial Resistance and Infection Control.

[20]  A. Apisarnthanarak,et al.  A Multicenter Case-Case Control Study for Risk Factors and Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Bacteremia , 2014, Infection Control & Hospital Epidemiology.

[21]  A. Kwa,et al.  Carbapenem Resistance in Gram-Negative Bacteria: The Not-So-Little Problem in the Little Red Dot , 2016, Microorganisms.

[22]  V. Tam,et al.  Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals , 2010, Antimicrobial Agents and Chemotherapy.

[23]  M. Ling,et al.  Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore , 2015, Antimicrobial Resistance and Infection Control.

[24]  M. Loeb,et al.  Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. , 2007, The Journal of hospital infection.

[25]  A. Apisarnthanarak,et al.  The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  T. Tan,et al.  Risk Factors, Molecular Epidemiology and Outcomes of Ertapenem-Resistant, Carbapenem-Susceptible Enterobacteriaceae: A Case-Case-Control Study , 2012, PloS one.

[27]  W. Sudderth,et al.  Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. , 1981, American journal of epidemiology.

[28]  H. Richet.  Seasonality in Gram-negative and healthcare-associated infections. , 2012, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[29]  A. Wilson,et al.  Recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct. , 2012, The Journal of antimicrobial chemotherapy.