Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia •

Department of Medicine, Geelong Hospital, Victoria, Australia.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 02/2005; 26(1):100-4. DOI: 10.1086/502494
Source: PubMed


Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We examined the rate of NI in our institution.
A point-prevalence study of NI and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for NI, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.
Tertiary-care referral center in Malaysia.
All inpatients during the time of the study.
Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.2%), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%). Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. NI treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for NI treatment was estimated to be approximately 2 million per year (Malaysian dollars).
Whereas the rate of NI is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.

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    • "Every year, several billions spent in healthcare sector was solely for the management of HCAI cases. In 2001, one of the tertiary-care referral hospital in Malaysia spent 1.98 million Ringgit Malaysia only on antibiotics for treating HCAI (Hughes et al., 2005). Hands play a major role in the transmission of infection in healthcare institutions. "
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    • "In Europe, out of 3 million HAI [3] approximately 50,000 resulted in death [4], and in Australia more than 177,000 HAI occur per year [5] whilst in the province of Quebec, Canada the rate of HAI are estimated to be around 11% [6]. The HAI rates in developing countries are significantly higher [7-9]. According to the USA Center for Disease Control (CDC) some of the predominant HAI organisms are Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacter species [10]. "
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    • "We had a high prevalence of BSIs, as compared to some other studies. However, an incidence varying from 13.9% to 29.3% has been reported from Malaysian hospitals,[181920] whereas an incidence of 17% was reported in an Italian surveillance[21] and 39% in a Mexican hospital,[22] showing tremendous geographic variation in the incidence. Trauma patients are on multiple invasive devices, which act as portals of colonization and invasion for pathogens. "
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    ABSTRACT: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices. A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome. A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens. Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.
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