Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

BMC Medicine

Luís Azevedo¹  António E Sarmento²  Altamiro Costa-Pereira¹  Irene Aragão⁴  N Deborah Friedman⁵  Mónica Almeida³  Teresa Cardoso⁴ 

[1] Department of Health Information and Decision Sciences, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;Department of Infectious Diseases, Hospital de São João, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;Internal Medicine Department, Hospital de Braga, Sete Fontes - São Vitor, 4710-243 Braga, Portugal;Intensive Care Unit, Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal;Department of Medicine, Barwon Health, Geelong, VIC 3220, Australia

关键词: Intra-abdominal infections;    Urinary tract infections;    Endocarditis;    Bloodstream infections;    Pneumonia;    Multidrug resistant pathogens prevalence;    Classification;    Healthcare-associated infection;   

Others  :  854958
DOI  :  10.1186/1741-7015-12-40

 received in 2013-11-27, accepted in 2014-02-11,  发布年份 2014

【 摘 要 】

Background

Ten years after the first proposal, a consensus definition of healthcare-associated infection (HCAI) has not been reached, preventing the development of specific treatment recommendations. A systematic review of all definitions of HCAI used in clinical studies is made.

Methods

The search strategy focused on an HCAI definition. MEDLINE, SCOPUS and ISI Web of Knowledge were searched for articles published from earliest achievable data until November 2012. Abstracts from scientific meetings were searched for relevant abstracts along with a manual search of references from reports, earlier reviews and retrieved studies.

Results

The search retrieved 49,405 references: 15,311 were duplicates and 33,828 were excluded based on title and abstract. Of the remaining 266, 43 met the inclusion criteria. The definition more frequently used was the initial proposed in 2002 - an infection present at hospital admission or within 48 hours of admission in patients that fulfilled any of the following criteria: received intravenous therapy at home, wound care or specialized nursing care in the previous 30 days; attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the previous 30 days; were hospitalized in an acute care hospital for ≥2 days in the previous 90 days, resided in a nursing home or long-term care facility. Additional criteria founded in other studies were: immunosuppression, active or metastatic cancer, previous radiation therapy, transfer from another care facility, elderly or physically disabled persons who need healthcare, previous submission to invasive procedures, surgery performed in the last 180 days, family member with a multi-drug resistant microorganism and recent treatment with antibiotics.

Conclusions

Based on the evidence gathered we conclude that the definition initially proposed is widely accepted. In a future revision, recent invasive procedures, hospitalization in the last year or previous antibiotic treatment should be considered for inclusion in the definition. The role of immunosuppression in the definition of HCAI still requires ongoing discussion.

【 授权许可】

   
2014 Cardoso et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988, 16:128-140.
• [2]American Thoracic Society; Infectious Diseases Society of America: Guidelines for the management, of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005, 171:388-416.
• [3]Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ: Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002, 137:791-797.
• [4]Park SC, Kang YA, Park BH, Kim EY, Park MS, Kim YS, Kim SK, Chang J, Jung JY: Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia. Respir Med 2012, 106:1311-1319.
• [5]Benito N, Miró JM, de Lazzari E, Cabell CH, del Río A, Altclas J, Commerford P, Delahaye F, Dragulescu S, Giamarellou H, Habib G, Kamarulzaman A, Kumar AS, Nacinovich FM, Suter F, Tribouilloy C, Venugopal K, Moreno A, Fowler VG Jr, ICE-PCS (International Collaboration on Endocarditis Prospective Cohort Study) Investigators: Health care-associated native valve endocarditis: importance of non-nosocomial acquisition. Ann Intern Med 2009, 150:586-594. Erratum in: Ann Intern Med 2010, 152:480
• [6]Aguilar-Duran S, Horcajada JP, Sorlí L, Montero M, Salvadó M, Grau S, Gómez J, Knobel H: Community-onset healthcare-related urinary tract infections: comparison with community and hospital-acquired urinary tract infections. J Infect 2012, 64:478-483.
• [7]Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A, Schwartz D, Giladi M: Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis 2002, 34:1431-1439.
• [8]Vallés J, Alvarez-Lerma F, Palomar M, Blanco A, Escoresca A, Armestar F, Sirvent JM, Balasini C, Zaragoza R, Marín M, Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine: Health-care-associated bloodstream infections at admission to the ICU. Chest 2011, 139:810-815.
• [9]Park HK, Song J-U, Um S-W, Koh W-J, Suh GY, Chung MP, Kim H, Kwon OJ, Jeon K: Clinical characteristics of health care-associated pneumonia in a Korean teaching hospital. Respir Med 2010, 104:1729-1735.
• [10]Carratalà J, Mykietiuk A, Fernández-Sabé N, Suárez C, Dorca J, Verdaguer R, Manresa F, Gudiol F: Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med 2007, 167:1393-1399.
• [11]Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH: Healthcare-associated bloodstream infection: a distinct entity? Insights from a large US database. Crit Care Med 2006, 34:2588-2595.
• [12]Kollef MH, Zilberberg MD, Shorr AF, Vo L, Schein J, Micek ST, Kim M: Epidemiology, microbiology and outcomes of healthcare-associated and community-acquired bacteremia: a multicenter cohort study. J Infect 2011, 62:130-135.
• [13]Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS: Epidemiology and outcomes of healthcare-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005, 128:3854-3862. Erratum in Chest 2006, 129:831
• [14]Grenier C, Pepin J, Nault V, Howson J, Fournier X, Poirier M-S, Cabana J, Craig C, Beaudoin M, Valiquette L: Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community-acquired pneumonia. J Antimicrob Chemother 2011, 66:1617-1624.
• [15]Pop-Vicas AE, D’Agata EM: The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. Clin Infect Dis 2005, 40:1792-1798.
• [16]Marschall J, Fraser VJ, Doherty J, Warren DK: Between community and hospital: healthcare-associated gram-negative bacteremia among hospitalized patients. Infect Control Hosp Epidemiol 2009, 30:1050-1056.
• [17]Evans CT, Hershow RC, Chin A, Foulis PR, Burns SP, Weaver FM: Bloodstream infections and setting of onset in persons with spinal cord injury and disorder. Spinal Cord 2009, 47:610-615.
• [18]Son JS, Song J-H, Ko KS, Yeom JS, Ki HK, Kim S-W, Chang H-H, Ryu SY, Kim Y-S, Jung S-I, Shin SY, Oh HB, Lee YS, Chung DR, Lee NY, Peck KR: Bloodstream infections and clinical significance of healthcare-associated bacteremia: a multicenter surveillance study in Korean hospitals. J Korean Med Sci 2010, 25:992-998.
• [19]Rodríguez-Baño J, López-Prieto MD, Portillo MM, Retamar P, Natera C, Nuño E, Herrero M, del Arco A, Muñoz A, Téllez F, Torres-Tortosa M, Martín-Aspas A, Arroyo A, Ruiz A, Moya R, Corzo JE, León L, Pérez-López JA, SAEI/SAMPAC Bacteraemia Group: Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect 2010, 16:1408-1413.
• [20]Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, Imaizumi K, Sato T, Hasegawa Y: Health-care-associated pneumonia among hospitalized patients in a Japanese Community Hospital. Chest 2009, 135:633-640.
• [21]Pascual V, Salvador M, Calvo E, Freixas N, Riera M, Xercavins M, Garau J: Healthcare-associated pneumonia: a category under review. Abstr Intersci Conf Antimicrob Agents Chemother 2010, 50:P1658.
• [22]Umeki K, Tokimatsu I, Yasuda C, Iwata A, Yoshioka D, Ishii H, Shirai R, Kishi K, Hiramatsu K, Matsumoto B, Kadota J: Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia. Respirology 2011, 16:856-861.
• [23]Seki M, Hashiguchi K, Tanaka A, Kosai K, Kakugawa T, Awaya Y, Kurihara S, Izumikawa K, Kakeya H, Yamamoto Y, Yanagihara K, Tashiro T, Kohno S: Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan. J Infect Chemother 2011, 17:363-369.
• [24]Garcia-Vidal C, Viasus D, Roset A, Adamuz J, Verdaguer R, Dorca J, Gudiol F, Carratalà J: Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect 2011, 17:1659-1665.
• [25]Jung JY, Park MS, Kim YS, Park BH, Kim SK, Chang J, Kang YA: Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital. BMC Infect Dis 2011, 11:61. doi:10.1186/1471-2334-11-61 BioMed Central Full Text
• [26]Jeon EJ, Cho S-G, Shin JW, Kim JY, Park IW, Choi BW, Choi JC: The difference in clinical presentations between healthcare-associated and community-acquired pneumonia in university-affiliated hospital in Korea. Yonsei Med J 2011, 52:282-287.
• [27]Depuydt P, Putman B, Benoit D, Buylaert W, De Paepe P: Nursing home residence is the main risk factor for increased mortality in healthcare-associated pneumonia. J Hosp Infect 2011, 77:138-142.
• [28]Lee JH, Kim YH: Comparison of clinical characteristics between healthcare-associated pneumonia and community-acquired pneumonia in patients admitted to secondary hospitals. Braz J Infect Dis 2012, 16:321-328.
• [29]Wu KS, Lee SS, Tsai HC, Wann SR, Chen JK, Sy CL, Wang YH, Tseng YT, Chen YS: Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome. BMC Infect Dis 2011, 11:221. doi:10.1186/1471-2334-11-221 BioMed Central Full Text
• [30]Kao CH, Kuo YC, Chen CC, Chang YT, Chen YS, Wann SR, Liu YC: Isolated pathogens and clinical outcomes of adult bacteremia in the emergency department: a retrospective study in a tertiary referral center. J Microbiol Immunol Infect 2011, 44:215-221.
• [31]Al-Hasan MN, Eckel-Passow JE, Baddour LM: Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study: healthcare-associated Gram-negative BSI. Eur J Clin Microbiol Infect Dis 2012, 31:1163-1171.
• [32]Lenz R, Leal JR, Church DL, Gregson DB, Ross T, Laupland KB: The distinct category of healthcare associated bloodstream infections. BMC Infect Dis 2012, 12:85. doi:10.1186/1471-2334-12-85 BioMed Central Full Text
• [33]Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH: Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007, 51:3568-3573.
• [34]Schreiber MP, Chan CM, Shorr AF: Resistant pathogens in Nonnosocomial pneumonia and respiratory failure is it time to refine the definition of health-care-associated pneumonia? Chest 2010, 137:1283-1288.
• [35]Guimaraes C, Lares Santos C, Costa F, Barata F: Pneumonia associated with health care versus community acquired pneumonia: different entities, distinct approaches. Rev Port Pneumol 2011, 17:168-171.
• [36]Chalmers JD, Taylor JK, Singanayagam A, Fleming GB, Akram AR, Mandal P, Choudhury G, Hill AT: Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis 2011, 53:107-113.
• [37]Taşbakan MS, Bacakoğlu F, Kaçmaz Başoğlu O, Gürgün A, Başarik B, Çitim Tuncel S, Sayiner A: The comparison of patients with hospitalized health-care-associated pneumonia to community-acquired pneumonia. Tüberküloz ve Toraks Dergisi 2011, 59:348-354.
• [38]Ishida T, Tachibana H, Ito A, Yoshioka H, Arita M, Hashimoto T: Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Intern Med 2012, 51:2537-2544.
• [39]Miyashita N, Kawai Y, Akaike H, Ouchi K, Hayashi T, Kurihara T, Okimoto N: Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between a teaching university hospital and a community hospital. Intern Med 2012, 51:585-594.
• [40]Wu CL, Ku SC, Yang KY, Fang WF, Tu CY, Chen CW, Hsu KH, Fan WC, Lin MC, Chen W, Ou CY, Yu CJ: Antimicrobial drug-resistant microbes associated with hospitalized community-acquired and health care-associated pneumonia: a multi-center study in Taiwan. J Formos Med Assoc 2013, 112:31-40.
• [41]Sugisaki M, Enomoto T, Shibuya Y, Matsumoto A, Saitoh H, Shingu A, Narato R, Nomura K: Clinical characteristics of healthcare-associated pneumonia in a public hospital in a metropolitan area of Japan. J Infect Chemother 2012, 18:352-360.
• [42]Giannella M, Pinilla B, Capdevila JA, Martínez Alarcón J, Muñoz P, López Álvarez J, Bouza E, on behalf of the Estudio de Neumonía En Medicina Interna (ENEMI) study Group from the Sociedad Española de Medicina Interna (SEMI): Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia. Clin Microbiol Infect 2012, 18:786-794.
• [43]Swenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, Chong TW, Popovsky KA, Pruett TL, Sawyer RG: Choosing antibiotics for intra-abdominal infections: what do we mean by “high risk”? Surg Infect 2009, 10:29-39.
• [44]Merli M, Lucidi C, Giannelli V, Giusto M, Riggio O, Falcone M, Ridola L, Attili AF, Venditti M: Cirrhotic patients are at risk for health care-associated bacterial infections. Clin Gastroenterol Hepatol 2010, 8:979-985.
• [45]Ha YE, Kang C-I, Joo E-J, Park SY, Kang SJ, Wi YM, Chung DR, Peck KR, Lee NY, Song J-H: Clinical implications of healthcare-associated infection in patients with community-onset acute pyelonephritis. Scand J Infect Dis 2011, 43:587-595.
• [46]Sy RW, Kritharides L: Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J 1890–1897, 2010:31.
• [47]Liu X, Han X, Ge Y, Wei F: Clinical analysis of healthcare-associated pneumonia. Chin J Infect Chemother 2011, 11:452-456.
• [48]Falcone M, Venditti M, Shindo Y, Kollef MH: Healthcare-associated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis 2011, 15:E545-E550.
• [49]Attridge RT, Frei CR: Health care-associated pneumonia: an evidence-based review. Am J Med 2011, 124:689-697.
• [50]Lopez A, Amaro R, Polverino E: Does health care associated pneumonia really exist? Eur J Intern Med 2012, 23:407-411.
• [51]Seddon J, Bhagani S: Antimicrobial therapy for the treatment of opportunistic infections in HIV/AIDS patients: a critical appraisal. HIV Aids 2011, 3:19-33.
• [52]Donowitz GR, Maki DG, Crnich CJ, Pappas PG, Rolston KV: Infections in the neutropenic patient--new views of an old problem. Hematology Am Soc Hematol Educ Program 2001, 113-139. doi:10.1182/asheducation-2001.1.113
• [53]Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, Johnson SK, Vandenesch F, Fridkin S, O’Boyle C, Danila RN, Lynfield R: Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003, 290:2976-2984.
• [54]Zahar JR, Lanternier F, Mechai F, Filley F, Taieb F, Mainot EL, Descamps P, Corriol O, Ferroni A, Bille E, Nassif X, Lortholary O: Duration of colonisation by Enterobacteriaceae producing extended-spectrum beta-lactamase and risk factors for persistent faecal carriage. J Hosp Infect 2010, 75:76-78.
• [55]Chen SY, Wu GH, Chang SC, Hsueh PR, Chiang WC, Lee CC, Ma MH, Hung CC, Chen YC, Su CP, Tsai KC, Chen TH, Chen SC, Chen WJ: Bacteremia in previously hospitalized patients: prolonged effect from previous hospitalization and risk factors for antimicrobial-resistant bacterial infections. Ann Emerg Med 2008, 51:639-646.
• [56]Collins AS: Preventing health care-associated infections. In Patient Safety and Quality: an Evidence-Based Handbook for Nurses. Edited by Hughes RG. Rockville (MD): Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; 2008.
• [57]Polverino E, Dambrava P, Cilloniz C, Balasso V, Marcos MA, Esquinas C, Mensa J, Ewig S, Torres A: Nursing home-acquired pneumonia: a 10 year single-centre experience. Thorax 2010, 65:354-359.
• [58]El Solh AA, Pietrantoni C, Bhat A, Bhora M, Berbary E: Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis 2004, 39:474-480.
• [59]Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America; American Thoracic Society: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007, 44:S27-S72.
• [60]Brito V, Niederman MS: Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Curr Opin Infect Dis 2009, 22:316-325.
• [61]Centers for Disease Control and Prevention: Multidrug resistant organism & Clostridium difficile infection (MDRO/CDI) module. [http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf webcite]