Nosocomial Infections: Epydemiology, Pathogenesis, Prevention and Control

Clinical Microbiology and Antimicrobial Chemotherapy. 2000; 2(1):16-30

​ Kozlov R.S.
nosocomial infections epidemiology antimicrobial resistance
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2000; 2(1):16-30

Abstract

This review is devoted to the one of the actual problems of modern medicine - nosocomial infections (NI). Criteria, epidemiology, pathogenesis, origin, risk factors for the development of NI are listed. A special attentionis drawnto the economical burdenof NI onthe basis of data of controlled trials of the cost of therapy of patients with different NI. Phenotypes and mechanisms of antimicrobial resistance are also described. Modern approaches to prophylaxis and control of NI are discussed with a special attention to the advantages and disadvantages of widely used methods. Data onstructure of NI, their specific features in multi-purpose hospitals depending on patient’ groups are indicated. Independent risk factors of development of different NI are reviewed. General principles of antimicrobial chemotherapy of NI are listed. The importance of multicenter studies of resistance of nosocomial pathogens in accordance with internationally recognised methodology is emphasised by the fact that the data from such studies of resistance provide not only epidemiological information, but could be used as a basis for development of recommendations for updating of hospital formularies of antimicrobials.

  • 1. Внутрибольничные инфекции: Пер. с англ. Под. ред. Р.П. Венцела. М.: Медицина; 1990.
  • 2. Семина Н.А., Ковалева Е.Н. Состояние эпидемиологического надзора за нозокомиальными инфекциями в России. Материалы международной конф. "Нозокомиальные инфекции в отделениях интенсивной терапии". Москва; 1998.
  • 3. A preliminary report of the Steering Group of the Second National Prevalence Survey. National prevalence survey of hospital-acquired infections: definitions. J Hosp Infect 1993; 24: 69-76.
  • 4. Aerdts S.J.A., Clasener H.A.L., Van Dalen R. et al. Prevention of bacterial colonization of the respiratory tract and stomach of mechanically ventilated patients by a novel regimen of selective decontamination in combination with initial systemic cefotaxime. J Antimicrob Chemother 1990; 26 Suppl A: 59-76.
  • 5. Ayliffe G.A.J. Nosocomial infection: the irreducible minimum. Infect Control 1986; 7: 92-95.
  • 6. Balow C.H. Utilizing in vitro Surveillance in Clinical Decision Making for the Hospital and Community Environments. In: J.A. Bosso editor. Emerging Resistance with Gram-Positive Aerobic Infections: Fact or Fictions" 1997. p.41-49.
  • 7. Banerjee S.N., Emori T.G., Culver D.H. et al. Seculartrends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Amer J Med 1991; 91 Suppl 3B: 86S-89S.
  • 8. Bergogne-Berezin E., Decre D., Joly Guillou M.-L. Opportunistic nosocomial multiply resistant bacterial infections their treatment and prevention. J Antimicrob Chemother 1993; 32 Suppl A: 39-47.
  • 9. Bergogne-Berezin E. Current guidelines for the treatment and prevention of nosocomial infections. Drugs 1999; 58 Suppl 1: 51-67.
  • 10. Bouza E., Cosin J. Grupo Cooperativo para el Estudio dela Infeccion. Estudio de prevalencia de infeccion hospitalaria y consumo de antimicrobianos. Med Clin 1986; 87: 353-358.
  • 11. Britt M.R., Schleupner C.J., Matsumiya S. Severity of underlying disease as a predictor of nosocomial infection: utility in the control of nosocomial infection. JAMA 1978; 329: 1047-1051.
  • 12. Bryan C.S., Hornung C.A., Reynolds K.L., Brenner E.R. Endemic bacteremia in Columbia, South Carolina. Amer J Epidemiol 1986; 123: 113-127.
  • 13. Buirma R.J.A., Horrevorts A.M., Wagenvoort J.H.T. Incidence of multi-resistant Gram-negative isolates in eight Dutch hospitals. Scand J Infect Dis 1991: 5 Suppl 78: 35-44.
  • 14. Byl B., Clevenbergh P., Kentos A. et al. Risk factors of inappropriate antimicrobial therapy of bacteremia, relation with outcome. 36th ICAAC Conference; 1996.
  • 15. CDC NNIS System. National Nosocomial Infection Surveillance (NNIS) Semiannual Report. May 1996.
  • 16. Centers for Disease Control. Nosocomial infection surveillance, 1984. MMWR 1986; 35 Suppl 1SS: 17SS-29SS.
  • 17. Centers for Disease Control. Increase in national hospital discharge survey rates for septicemia United States. MMWR 1990; 39: 31-34.
  • 18. Centers for Disease Control and Prevention. Annual summary of births, marriages, divorces and deaths: United States, 1993. Monthly Vit Stat Rep 1994; 42: 4-10.
  • 19. Chatzinikolaou I., Abi Said D., Tarrand J.J. et al. Recent Experience in Pseudomonas aeruginosa Bacteremia in Cancer Patients. 37th ICAAC Conference; 1997.
  • 20. Christinsen G.D., Bisno A.L., McLaughlin B. et al. Nosocomial septicemia due to multiple antibiotic resistant. Ann Intern Med 1987; 96: 1-10.
  • 21. Cookson B.D. Epidemiology and control of nosocomial methicillin-resistant Staphylococcus aureus. Cur OpinInfect Dis 1991; 4: 530-535.
  • 22. Coyle M.B., Lipsky B.A. Coryneform bacteria in infectious diseases: clinical and laboratory aspects. ClinMicrob Rev 1990; 3: 227-246.
  • 23. Craven D.E. Nosocomial pneumonia in the intubated patient: role of gastric colonization. Eur J Clin MicrobInfect Dis 1989; 8: 40-50.
  • 24. Daschner F.D. editor. Proven and unproved methods in hospital infection control; 1978.
  • 25. Daschner F.D., Frank U. Controversies in hospital infection control. Eur J Clin Microb 1987; 6: 335-340.
  • 26. Daschner F.D., Frey P., Wolff G. et al. Nosocomial infection in intensive care wards: a multicentre prospective study. Intensive Care Med 1982; 8: 5-9.
  • 27. Di Nubile M.J. "Antibiotics: the antipyretics of choice". Amer J Med 1990; 89: 787-788.
  • 28. Dunagan W.C., Woodward R.S., Medoff G. et al. Antimicrobial misuse in patients with positive blood cultures. Amer J Med 1989; 87: 253-259.
  • 29. Emmerson M. Surveillance strategies for nosocomial infections. Cur Opin Infect Dis 1995; 8: 272-274.
  • 30. Emori T.G., Banerjee S.N., Culver D.H. et al. Nosocomial infection in elderly patients in the United States, 1986-90. Amer J Med 1991; 91 Suppl 3B: 289S-293S.
  • 31. Emori T.G., Gaynes R.P. An overview of nosocomial infections, including the role of microbiology laboratory. Clin Microb Rev 1993; 6: 428-442.
  • 32. EPINE Working Group. Prevalence of hospital acquired infections in Spain. J Hosp Infect 1992; 20: 1-13.
  • 33. Fagon J.Y., Chastre J., Domart Y. et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Amer Rev Respir Dis 1989; 139: 877-884.
  • 34. Felmingham D., Gruneberg R.N. and The Alexander Project Group. A multicentre collaborative study of the antimicrobial susceptibility of community-acquired, lower respiratory tract pathogens 1992 1993: The Alexander Project. J Antimicrob Chemother 1996; 38 Suppl A: 1-57.
  • 35. Filice G.A., Van Etta L.L., Darby C.P., Fraser D.W. Bacteremia in Charlestone County, South Carolina. Amer J Epidemiol 1986; 123: 128-136.
  • 36. Finch R.G., Wilcox M.H., Wood M.J. Preface. J Antimicrob Chemother 1996; 38 Suppl A.
  • 37. Flaherty J.P., Weinstein R.A. Infection Control and Pneumonia Prophylaxis Strategies in the Intensive Care Unit. Seminars Respir Infect 1990; 5: 191-203.
  • 38. Frank U., Sterk Y., Daschner F. Incidence and Epidemiology of Nosocomial Infections (NI) in HIV-Infected Patients in a German University Hospital. 35th ICAAC Conference; 1995.
  • 39. Galvez-Vargas R., Bueno-Cavanillas A., Garcia-Martin M. Epidemiology, Therapy and Costs of Nosocomial Infection. Pharmacoeconomics 1995; 7(2): 128-140.
  • 40. Garner J.S., Favero M.S. Guideline for handwashing and hospital environmental control. Infect Control 1985; 7: 231-243.
  • 41. Garner J.S., Hierzholzer Jr.W.J. Controversies in isolation policies and practices. In: R.P. Wenzel editor. Prevention and Control of Nosocomial Infectionsy. 2nd ed. 1993. p.70-81.
  • 42. Garner J.S., Jarvis W.R., Emori T.G. et al. CDC definitions for nosocomial infections, 1988. Amer J Infect Control 1988; 16(3):128-140.
  • 43. Gastmeier P., Sohr D., Schumacher M. et al. "To What Extent can Antibiotic use be Reduced by Preventing Nosocomial Infections". 8th ECCMID Congress; 1997.
  • 44. Gatell J.M., Trilla A., Latorre X. et al. Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis. Rev Infect Dis 1988; 10: 203-210.
  • 45. Gentry L.O. Future developments in nosocomial infections; the perspective in the United States. J Hosp Infect 1990; 15 Suppl A: 3-12.
  • 46. Haley R.W. Nosocomial infection in surgical patients: developing valid measures of intrinsic patient risk. Amer J Med 1991; 91 Suppl 3B: 145S-151S.
  • 47. Haley R.W., Culver D.H., White J.W. et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals. Amer J Epidemiol 1985; 13: 97-108.
  • 48. Hierzholzer W.J., Zervos M.J. Bacterial Infections of Humans. In: A.S. Evans, P.S. Brachman editors. Epidemiology and Control. 2nd ed. 1991. p.467-497.
  • 49. V. Bennett, P.S. Brachman editors. Hospital Infections. 3rd ed. 1992.
  • 50. Hospital Infection Program, National Center for Infectious Diseases. CDC. 1998.
  • 51. Jackson G.G. Considerations of antibiotic prophylaxis in non-surgical high risk patients. Amer J Med 1981; 70: 467-473.
  • 52. Jarvis W.R. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost and prevention. Infect Control Hosp Epidemiol 1996; 17: 552-557.
  • 53. Jarvis W.R., Edwards J.R., Culver D.H. et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Amer J Med 1991: 91 Suppl 3B: 185S-191S.
  • 54. Kerver A.J.H., Rommes J.H., Mevissen-Verhage E.A.E. et al. Colonization and infection in surgical intensive carepatients: a prospective study. Intensive Care Med 1987; 13: 347-351.
  • 55. Kerver A.J.H., Rommes J.H., Mevissen Verhage E.A.E. et al. Prevention of colonization and infection in critically ill patients: a prospective randomized study. Critical Care Med 1988; 16: 1087-1093.
  • 56. Khardori N., Reuben A., Rosenbaum B. et al. In vitro susceptibility of Xanthomonas maltophilia (Pseudomonas maltophilia) to newer antimicrobial agents. Antimicrob Agents Chemother 1990; 34: 1609-1610.
  • 57. Kirby W.M.M. Extraction of a highly potent penicillin inactivator from penicillin-resistant Staphylococci. Science 1944; 99: 452-453.
  • 58. LaForce M. The control of infections in hospitals: 1750 to 1950. In: R.P. Wenzel. Prevention and Control of Nosocomial Infections. 2nd ed. 1993. p.1-12.
  • 59. Larson E. "A casual link between handwashing and risk of infection" Examination of evidence. Infect Control Hosp Epidemiol 1988; 9: 28-36.
  • 60. Leclercq R., Derlot E., Weber M. et al. Transferable vancomycin and teicoplanin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1989; 33: 10-15.
  • 61. Lee S.C., Gerding D.N., Cleary P.P. Hospital distribution, persistence, and reintroduction of related gentamicin R plasmid. Antimicrob Agents Chemother 1986; 29: 654-659.
  • 62. Maillet J.M., Somme D., Novara A. et al. Nosocomial Infections in Patients older than 75 Years Admitted in a Multidisciplinary Intensive Care Unit. 37th ICAAC Conference;1997.
  • 63. Maki D.G. Nosocomial bacteremia: an epidemiological overview. Amer J Med 1981; 70: 719-732.
  • 64. Marshall W.F., Keating M.R., Anhalt J.P., Steckelberg J.M. Xanthomonas maltophilia: an emerging nosocomial pathogen. Mayo Clin Proceed 1989; 64: 1097-1104.
  • 65. Martone W.J., Jarvis W.R., Culver D.H. et al. Incidence and nature of endemic and epidemic nosocomial infections. In: J.V. Bennet, P.S. Brachman editors. Hospital Infections; 1992. p.577-596.
  • 66. Mayer K.H., Zinner S.H. Bacterial pathogens of increasing significance in hospital acquired infections. Rev Infect Dis 1985; 7 Suppl 3: S371-S379.
  • 67. McLaws M., Gold J., King K. et al. The prevalence of nosocomial and community acquired infections in Australian hospitals. Med J Aust 1988; 149: 582-590.
  • 68. Millership S.E., Patel N., Chattopadhyay B. The colonization of patients in an intensive treatment unit with gram-negative flora: the significance of oral route. J Hosp Infect 1986; 7: 226-235.
  • 69. Morrison A.J.Jr., Freer C.V., Searcy M.A. et al. Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia. Infect Control 1986; 7: 550-553.
  • 70. NCCLS. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved Standard. 3rd ed. NCCLS Document M7 A4. 1996; 16(2).
  • 71. O-Brien T.F., Ross D.G., Guzman M.A.et al. Dissemination of an antibiotic resistance plasmid in hospital patient flora. Antimicrob Agents Chemother 1980; 17: 537-543.
  • 72. Page C.P., Bohnen J.M.A., Fletcher J.R. et al. Antimicrobial Prophylaxis for Surgical Wounds: Guidelines for Clinical Care. Arch Surg 1993; 128: 79-88.
  • 73. Pallares R., Dick R., Wenzel R.P. et al. Trends in antimicrobial utilization at a tertiary teaching hospital during a 15-year period (1978-1992). Infect Control Hosp Epidemiol 1993; 14: 376-382.
  • 74. Pfaller M.A. Microbiology: the role of the clinical laboratory in hospital epidemiology and infection control.In: R.P. Wenzel editor. Prevention and Control of Nosocomial Infections. 2nd ed. 1993. p.385-405.
  • 75. Philippon A., Mensah K., Fournier G., Freney J. Two resistance phenotypes to b-lactams of Alcaligenes denitrificans subsp. xylosoxydans in relation to lactamase types. J Antimicrob Chemother 1990; 25: 698-700.
  • 76. Pittet D. Nosocomial bloodstream infections. In: R.P. Wenzel editor. Prevention and Control of Nosocomial Infections. 2nd ed. 1993. p. 512-555.
  • 77. Platt R., Polk B.F., Murdock B., Rosner B. Reduction of mortality associated with nosocomial urinary tract infections. Lancet 1982; i: 893-897.
  • 78. Preston G.A., Larson E.L., Stamm W.E. Effect of private isolation rooms on patient care practices: colonization and infection in an intensive care unit. Amer J Med 1981; 70: 641-645.
  • 79. Price J., Ekleberry A., Johnson M. et al. Evaluation of Clinical Practice Guidelines on Infection Outcome and Antibiotic Resistance in an Intensive Care Unit. 37th ICAAC Conference; 1997.
  • 80. Quinn J.P., Studemeister A.E., Divincenzon C.A., Lerner S.A. Resistance to imipenem in Pseudomonas aeruginosa: clinical experience and biochemical mechanisms. Rev Infect Dis 1988; 10: 892-895.
  • 81. Riebel W., Frantz N., Adelstein D., Spagnuolo P.J. Corynebacterium JK: a cause of nosocomial device related infection. Rev Infect Dis 1986; 8: 42-49.
  • 82. Roberts F.J., Geere I.W., Coldman A. A three year study of positive blood cultures with emphasis on prognosis. Rev Infect Dis 1991; 13: 34-46.
  • 83. Roe E., Lowbury E.J.L. Changes in antibiotic sensitivity patterns of gram negative bacilli in burns. J Clin Path 1972; 25: 176-178.
  • 84. Ruef C. "Epidemiology of Nosocomial Infections in Europe: Can We Better" 8th ECCMID Congress; 1997.
  • 85. Sabath L.D. Current concepts: drug resistance of bacteria. N Engl J Med 1969; 280: 91-94.
  • 86. Sartor C., Edwards J.R., Gaynes R.P., Culver D.H. Evolution of hospital participation in the National Nosocomial Infections Surveillance System, 1986 to 1993. Amer J Infect Control 1995; 223: 364-368.
  • 87. SCRIP. 1997; 2269: 5.
  • 88. Selective Decontamination of the Digestive Tract Trialists- Collaborative Group. Meta-analysis of randomized controlled trials of selective decontamination of the digestive tract. Brit Med J 1993; 307: 525-532.
  • 89. Sentry Antimicrobial Surveillance Study that Tracks world wide Speed of Pathogen and Antibiotic Resistance. 21 th ICC Conference; 1999.
  • 90. Shah P.M., Asanger R., Kahan F.M. Incidence of multiresistance in Gram-negative aerobes from Intensive-Care Units of 10 German Hospitals. Scand J Infect Dis 1991; 5 Suppl 78: 22-34.
  • 91. Shapiro M., Townsend T.R., Rosner B. et al. The use of antimicrobial drugs in general hospitals; patterns of prophylaxis. N Engl J Med 1979; 301: 351-355.
  • 92. Sirot D., Sirot J., Labia R. et al. Transferable resistance to third generation cephalosporins in clinical isolates of Klebsiella pneumoniae: identification of CTX-1, a novel beta-lactamase. J Antimicrob Chemother 1987; 20: 323-334.
  • 93. Snydman D.R. Clinical implications of multi drug resistance in the Intensive Care Unit. Scand J Infect Dis 1991; 5 Suppl 78: 54-63.
  • 94. Spencer R.C., Wheat P.F., Magee J.E., Brown E.H. A three year survey of clinical isolates in the United nKingdom and their antimicrobial susceptibility. J Antimicrob Chemother 1990; 26: 435-446.
  • 95. Stamm W.E. Infections related to medical devices. Ann Intern Med 1978; 89: 764-769.
  • 96. Stoutenbeek C.P., Van Saene H.K.F., Miranda D.R., Zandstra D.F. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 1984; 10: 185-192.
  • 97. Survey Data: Experience with 271 French Hospitals (South-Eastern Region). 8th ECCMID Congress; 1997.
  • 98. Utley A.H.C. ,George R.C. Nosocomial enterococcal infection. Cur Opin Infect Dis 1991; 4: 525-529.
  • 99. Vanderbroucke-Grauls C.M.J.E., Vanderbroucke J.P. Effects of the selective decontamination of the digestive tract on respiratory infections and mortality in the intensive care unit. Lancet 1991; 338: 859-862.
  • 100. Van Saene H.K., Stoutenbeek C.P., Stoller J.K. Selective decontamination of the digestive tract in theintensive care unit; current status and future prospects. Critical Care Med 1992; 20: 691-703.
  • 101. Vaque J., Rosello J., Campins M. et al. Prevalencia de infecciones en un hospital medico-quirurgica de lercer nivel:II. Uso de antibioticos. Med Clin 1987; 89: 362-365.
  • 102. Verbist L. Incidence of multi-resistance in gram-negative bacterial isolates from Intensive-Care-Units in Belgium: a surveillance study. Scand J Infect Dis 1991; 5 Suppl 78: 45-53.
  • 103. Vovis G.F. Pathogenome: A Database for Identifying Gene Targets in Pathogens. 37th ICAAC Conference; 1997.
  • 104. Weinstein M.P., Murphy J.R., Reller L.B. et al. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II: clinical observations with special reference to factors influencing prognosis. Rev Infect Dis 1983; 5: 54-70.
  • 105. Weinstein R.A. Epidemiology and Control of Nosocomial Infections in Adult Intensive Care Units. Amer J Med 1990; 91 Suppl: 179-184.
  • 106. Wenzel R.P. "The mortality of hospital-acquired bloodstream infections: need for a new vital statistics". Int; J Epidemiol 1988; 17: 225-227.
  • 107. Wenzel R.P. Introduction. to Outcomes Data. 37 th ICAAC Conference; 1997.
  • 108. Wenzel R.P., Thompson R.L., Landry S.M. et al. Hospital-Acquired Infections in Intensive Care Unit Patients: An Overview with Emphasis on Epidemics. Infect Control 1983; 4: 371-375.
  • 109. Williams H., King A., Shannon K., Phillips I. Amoxycillin/clavulanate resistant Escherichia coli. Lancet 1988; i: 304-305.
  • 110. Williams J.D. Antibiotic Policy. Scand J Infect Dis 1986; 49 Suppl: 175-181.
  • 111. World Health Organization. Manual on Antimicrobial Resistance and Susceptibility Testing. Geneva; 1997.
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