TY - JOUR
T1 - Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India
T2 - a multicentre, hospital-based, prospective surveillance study
AU - Indian Healthcare Associated Infection Surveillance Network collaborators
AU - Mathur, Purva
AU - Malpiedi, Paul
AU - Walia, Kamini
AU - Srikantiah, Padmini
AU - Gupta, Sunil
AU - Lohiya, Ayush
AU - Chakrabarti, Arunaloke
AU - Ray, Pallab
AU - Biswal, Manisha
AU - Taneja, Neelam
AU - Rupali, Priscilla
AU - Balaji, Veeraraghavan
AU - Rodrigues, Camilla
AU - Lakshmi Nag, Vijaya
AU - Tak, Vibhor
AU - Venkatesh, Vimala
AU - Mukhopadhyay, Chiranjay
AU - Deotale, Vijayshri
AU - Padmaja, Kanne
AU - Wattal, Chand
AU - Bhattacharya, Sanjay
AU - Karuna, Tadepalli
AU - Behera, Bijayini
AU - Singh, Sanjeev
AU - Nath, Reema
AU - Ray, Raja
AU - Baveja, Sujata
AU - Fomda, Bashir A.
AU - Sulochana Devi, Khumanthem
AU - Das, Padma
AU - Khandelwal, Neeta
AU - Verma, Prachi
AU - Bhattacharyya, Prithwis
AU - Gaind, Rajni
AU - Kapoor, Lata
AU - Gupta, Neil
AU - Sharma, Aditya
AU - VanderEnde, Daniel
AU - Siromany, Valan
AU - Laserson, Kayla
AU - Guleria, Randeep
AU - Malhotra, Rajesh
AU - Katoch, Omika
AU - Katyal, Sonal
AU - Khurana, Surbhi
AU - Kumar, Subodh
AU - Agrawal, Richa
AU - Dev Soni, Kapil
AU - Sagar, Sushma
AU - Varma, Muralidhar
N1 - Funding Information:
This work was supported by a US CDC cooperative agreement to advance the Global Health Security Agenda in India (cooperative agreement number 1U2GGH001869). We acknowledge the support of the Global Health Security Agenda cell of the Indian Ministry of Health and Family Welfare and the Directorate General of Health Services for this work. We also acknowledge the participation and support of all the staff supporting surveillance and infection prevention and control activities at network hospitals and the network coordination team and microbiology staff at J P Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of US CDC or the US Department of Health and Human Services.
Funding Information:
This work was supported by a US CDC cooperative agreement to advance the Global Health Security Agenda in India (cooperative agreement number 1U2GGH001869). We acknowledge the support of the Global Health Security Agenda cell of the Indian Ministry of Health and Family Welfare and the Directorate General of Health Services for this work. We also acknowledge the participation and support of all the staff supporting surveillance and infection prevention and control activities at network hospitals and the network coordination team and microbiology staff at J P Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of US CDC or the US Department of Health and Human Services.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2022/9
Y1 - 2022/9
N2 - Background: Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. Methods: A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. Findings: 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. Interpretation: The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. Funding: US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. Translation: For the Hindi translation of the abstract see Supplementary Materials section.
AB - Background: Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. Methods: A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. Findings: 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. Interpretation: The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. Funding: US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. Translation: For the Hindi translation of the abstract see Supplementary Materials section.
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U2 - 10.1016/S2214-109X(22)00274-1
DO - 10.1016/S2214-109X(22)00274-1
M3 - Article
AN - SCOPUS:85135712958
SN - 2214-109X
VL - 10
SP - e1317-e1325
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 9
ER -
