HEALTHCARE-ASSOCIATED INFECTIONS IN THE INTENSIVE CARE UNIT
Sažetak
Bolničke infekcije predstavljaju značajan rizik po pacijente i veliko opterećenje za bolnice i zdravstvene sisteme. Zbog toga što mogu značajno uticati na ishod lečenja, rigorozne mere prevencije i kontrole su ključni vidovi intervencije u smanjivanju njihove učestalosti. Usled sve rastućeg problema antimikrobne rezistencije, dodatno pogoršanog COVID-19 pandemijom, terapijskih opcija za bolničke infekcije je sve manje, pogotovu u intenzivnim negama gde su uzročnici rezistentni na mnoge antibiotike koji su trenutno dostupni i u upotrebi. Nadzor nad bolničkim infekcijama uključuje kontinuirano praćenje uzročnika, tipova infekcija, kao i stepena antimikrobne rezistencije. Ovi podaci pomažu u izboru intervencija za sprečavanje, ali i daju smernice u izboru empirijske i ciljane terapije. Uz kliničke, epidemiološke, i mikrobiološke podatke, ekonomske analize su neophodan aspekt nadzora nad bolničkim infekcijama, jer daju uvid u finansijsko opterećenje na bolnice koje su odgovorne za sprovođenje adekvatnih mera. Srbija je, prema nacionalnim podacima, zemlja sa niskom stopom prevalencije bolničkih infekcija, ali sa jednim od najvećih indeksa antimikrobne rezistencije u Evropi. Ovakvi rezultati pokazuju da su neophodne sistemske promene, uključujući i racionalniju primenu antibiotika i obrazovanje opšte populacije ali i lekarskog osoblja, kako bi se sprečilo dalje širenje ovog problema koji može značajno uticati na dalje lečenje bolničkih infekcija.
Reference
1. Marković-Denić Lj, Šuljagić V, Mijović B, Dragovac G, Đorđević Z. Bolnicke infekcije: definicije. Ministarstvo zdravlja Republike Srbije: 2017.
2. Haque M, Sartelli M, McKimm J, Abu Bakar MB. Health care-associated infections – an overview. Infect Drug Resist. 2018;Volume 11:2321–33.
3. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Eurosurv. 2018;23(46).
4. Kärki T, Plachouras D, Cassini A, Suetens C. Burden of healthcare-associated infections in European acute care hospitals. Wien Med Wochenschr. 2019;169(S1):3–5.
5. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs. Infect Control Hosp Epidemiol. 2011;32(2):101–14.
6. Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, et al. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. Harbarth S, editor. PLOS Med. 2016;13(10):e1002150.
7. Voidazan S, Albu S, Toth R, Grigorescu B, Rachita A, Moldovan I. Healthcare Associated Infections—A New Pathology in Medical Practice? Int J Environ Res Public Health. 2020;17(3):760.
8. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629–55.
9. Halverson T, Mikolajczak A, Mora N, Silkaitis C, Stout S. Impact of COVID-19 on hospital acquired infections. Am J Infect Control. 2022;50(7):831–3.
10.Grasselli G, Scaravilli V, Mangioni D, Scudeller L, Alagna L, Bartoletti M, et al. Hospital-Acquired Infections in Critically Ill Patients With COVID-19. Chest. 2021;160(2):454–65.
11.European Centre for Disease Prevention and Control. Healthcare-associated infections acquired in intensive care units. In: ECDC. Annual epidemiological report for 2017. Stockholm: ECDC:2019.
12.Klavs I, Serdt M, Korošec A, Lejko Zupanc T, Pečavar B. Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals: Results of the third national survey. Slov J Public Health. 2019;58(2):62–9.
13.Rodríguez-Acelas AL, de Abreu Almeida M, Engelman B, Cañon-Montañez W. Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis. Am J Infect Control. 2017;45(12):e149–56.
14.van der Kooi TII, de Boer AS, Manniën J, Wille JC, Beaumont MT, Mooi BW, et al. Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Med. 2007 Feb;33(2):271.
15.Behnke M, Hansen S, Leistner R, Diaz LAP, Gropmann A, Sohr D, et al. Nosocomial Infection and Antibiotic Use. Dtsch Ärztebl Int. 2013:110(38):627-33.
16.Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–81.
17.Wu Q, Sabokroo N, Wang Y, Hashemian M, Karamollahi S, Kouhsari E. Systematic review and meta-analysis of the epidemiology of vancomycin-resistance Staphylococcus aureus isolates. Antimicrob Resist Infect Control. 2021;10(1):101.
18.Brinkwirth S, Ayobami O, Eckmanns T, Markwart R. Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020. Eurosurv. 2021;26(45).
19.Balfousias T, Apostolopoulos A, Angelis S, Filippou D, Maris S. Pandrug-resistant Acinetobacter Baumannii Infection Identified in a Non-intensive Care Unit Patient: A Case Study. Cureus. 2019;11(12):e6321.
20.Cao Z, Yue C, Kong Q, Liu Y, Li J. Risk Factors for a Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection: A Five-Year Retrospective Study. Infect Drug Resist. 2022;15:641–54.
21.Manoukian S, Stewart S, Graves N, Mason H, Robertson C, Kennedy S, et al. Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK. J Hosp Infect. 2021;114:43–50.
22.Marchetti A, Rossiter R. Economic burden of healthcare-associated infection in US acute care hospitals: societal perspective. J Med Econ. 2013;16(12):1399–404.
23.Pravilnik o sprečavanju, ranom otkrivanju i suzbijanju bolničkih infekcija. Ministarstvo zdravlja Republike Srbije. Sl. glasnik RS;2020(1).
24.Dimitrijević D, Drakulović M, Kanazir M, Lončarević G, Milinković M, Milosavljević Z, et al. Izveštaj o zaraznim bolestima u Republici Srbiji za 2019. godinu. Institut za Javno Zdravlje Srbije "Dr Milan Jovanović Batut":2020.
25.Ćirković I, Marković-Denić L, Bajčetić M, Dragovac G, Đorđević Z, Mioljević V, et al. Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia. Antibiotics. 2022;11(9):1161.
26.Tomas A, Pavlović N, Stilinović N, Horvat O, Paut-Kusturica M, Dugandžija T, et al. Increase and Change in the Pattern of Antibiotic Use in Serbia (2010–2019). Antibiotics. 2021;10(4):397.
27.Scott RD, Culler SD, Rask KJ. Understanding the Economic Impact of Health Care-Associated Infections: A Cost Perspective Analysis. J Infus Nurs. 2019;42(2):61–9.
28.Arefian H, Vogel M, Kwetkat A, Hartmann M. Economic Evaluation of Interventions for Prevention of Hospital Acquired Infections: A Systematic Review. Zeeb H, editor. PLOS ONE. 2016;11(1):e0146381.
29.Nanao T, Nishizawa H, Fujimoto J, Ogawa T. Additional medical costs associated with ventilator-associated pneumonia in an intensive care unit in Japan. Am J Infect Control. 2021;49(3):340–4.
30.Restrepo MI, Anzueto A, Arroliga AC, Afessa B, Atkinson MJ, Ho NJ, et al. Economic Burden of Ventilator-Associated Pneumonia Based on Total Resource Utilization. Infect Control Hosp Epidemiol. 2010;31(05):509–15.
31.Puchter L, Chaberny IF, Schwab F, Vonberg RP, Bange FC, Ebadi E. Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob Resist Infect Control. 2018;7(1):1.
32.Graves N, Page K, Martin E, Brain D, Hall L, Campbell M, et al. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. Deshpande A, editor. PLOS ONE. 2016;11(2):e0148190.
33.Barmpouni M, Gordon JP, Miller RL, Pritchard CRJ, Dennis JW, Grammelis V, et al. Estimating the Clinical and Economic Impact of Introducing a New Antibacterial into Greek Clinical Practice for the Management of Hospital-Acquired Infections with Limited Treatment Options. Infect Dis Ther. 2022.
34.Bordino V, Vicentini C, D’Ambrosio A, Quattrocolo F, Zotti CM, Novati R, et al. Burden of healthcare-associated infections in Italy: incidence, attributable mortality and disability-adjusted life years (DALYs) from a nationwide study, 2016. J Hosp Infect. 2021;113:164–71.