Hearn Pasco, Miliya Thyl, Seng Soklin, Ngoun Chanpheaktra, Day Nicholas P J, Lubell Yoel, Turner Claudia, Turner Paul
Cambodia-Oxford Medical Research Unit, Microbiology Department, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.
Angkor Hospital for Children, Siem Reap, Cambodia.
Antimicrob Resist Infect Control. 2017 Jan 23;6:16. doi: 10.1186/s13756-017-0172-5. eCollection 2017.
Healthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities. Data from low-income countries are scarce. We sought to prospectively define HAI incidence at Angkor Hospital for Children (AHC), a Cambodian pediatric referral hospital.
Prospective HAI surveillance was introduced for medical admissions to AHC. Cases were identified on daily ward rounds and confirmed using locally adapted Centers for Disease Control and Prevention (CDC) definitions. During the surveillance period, established infection prevention and control (IPC) activities continued, including hand hygiene surveillance. In addition, antimicrobial stewardship practices such as the creation of an antimicrobial guideline smartphone app were introduced.
Between 1st January and 31st December 2015 there were 3,263 medical admissions and 102 HAI cases. The incidence of HAI was 4.6/1,000 patient-days (95% confidence interval 3.8-5.6) and rates were highest amongst neonates. Median length of stay was significantly longer in HAI cases: 25 days versus 5 days for non-HAI cases ( < 0.0001). All-cause in-hospital mortality increased from 2.0 to 16.1% with HAI ( < 0.0001). Respiratory infections were the most common HAI (54/102; 52.9%). Amongst culture positive infections, Gram-negative organisms predominated (13/16; 81.3%). Resistance to third generation cephalosporins was common, supporting the use of more expensive carbapenem drugs empirically in HAI cases. The total cost of treatment for all 102 HCAI cases combined, based on additional inpatient days, was estimated to be $299,608.
Prospective HAI surveillance can form part of routine practice in low-income healthcare settings. HAI incidence at AHC was relatively low, but human and financial costs remained high due to increased carbapenem use, prolonged admissions and higher mortality rates.
医疗保健相关感染（HAI）是入住医疗机构后最常见的可预防不良事件。来自低收入国家的数据稀缺。我们试图前瞻性地确定柬埔寨一家儿科转诊医院吴哥儿童医院（AHC）的HAI发病率。
对AHC的内科住院患者引入前瞻性HAI监测。通过每日病房查房识别病例，并使用当地改编的美国疾病控制与预防中心（CDC）定义进行确诊。在监测期间，继续开展既定的感染预防与控制（IPC）活动，包括手卫生监测。此外，还引入了抗菌药物管理措施，如创建抗菌药物指南智能手机应用程序。
2015年1月1日至12月31日期间，共有3263例内科住院患者，发生102例HAI病例。HAI发病率为4.6/1000患者日（95%置信区间3.8 - 5.6），新生儿中的发病率最高。HAI病例的中位住院时间显著更长：HAI病例为25天，非HAI病例为5天（<0.0001）。HAI患者的全因住院死亡率从2.0%增至16.1%（<0.0001）。呼吸道感染是最常见的HAI（54/102；52.9%）。在培养阳性感染中，革兰氏阴性菌占主导（13/16；81.3%）。对第三代头孢菌素耐药很常见，这支持在HAI病例中经验性使用更昂贵的碳青霉烯类药物。根据额外住院天数估算，所有102例HAI病例的总治疗费用为299,608美元。
前瞻性HAI监测可成为低收入医疗环境中常规实践的一部分。AHC的HAI发病率相对较低，但由于碳青霉烯类药物使用增加、住院时间延长和死亡率升高，人力和财务成本仍然很高。
