Healthcare-associated infection surveillance: time to rethink blood stream infection classification

Ms Frances Sheehan1,2, Dr Meru Sheel1, Dr Kathryn Daveson2, Dr Karina Kennedy1,2

1Australian National University, Canberra, Australia, 2The Canberra Hospital, Canberra, Australia

Background

The rise in extended spectrum beta-lactamase (ESBL) Escherichia coli (E. coli) bacteraemia is considered to be driven by community onset. Current Australian healthcare-associated infection surveillance guidelines classify blood stream infections (BSI) as hospital onset when blood cultures are collected >48 hours after hospital admission. All other infections are classified as community onset. This does not consider recent interactions with acute health care or aged care services causing misleading impressions from surveillance data.

Method

Using data from ACT Pathology, we identified all ESBL E. coli blood stream isolates from 2016 – 2019. We then reviewed the relevant patient records and classified isolates according to an adapted Staphylococcus aureus BSI definition. We then compared our classifications with those used by the Australian Group for Antimicrobial Resistance (AGAR) for the same BSI episodes.

Results

A total of 111 isolates were reviewed. AGAR classified 72.1% (80/111) as community onset. Our enhanced surveillance framework identified only 15.3% (17/111) as community acquired. We found 9.0% (10/111) were aged care associated. The remaining 75.7% (84/111) had health care contact or a previous ESBL E.coli blood stream isolate that was attributable to health care.

Conclusion

Time-based classifications for BSI place of onset are simply defined and easily collected. However, our analysis suggests they may be misleading to inform infection control strategies and assess trends of antimicrobial resistance in the community. A more sensitive classification will better represent factors contributing to acquisition of infection leading to more targeted infection control strategies. Revised definitions should be considered.


Biography:

Fran is a registered nurse with 15 years experience in a variety of health settings, specialising in public health and critical care nursing. She is currently completing her Master of Applied Epidemiology at the Department of Infectious Diseases, The Canberra Hospital. Fran is focussed on the use of data to inform decision making to drive better health outcomes and responsible resource allocation.

Date

Nov 10 2021
Expired!

Time

1:20 pm - 1:40 pm

Local Time

  • Timezone: America/New_York
  • Date: Nov 09 2021
  • Time: 9:20 pm - 9:40 pm