Yiying Cai1,2, Indumathi Venkatachalam3, Nancy W Tee4, Thean Yen Tan5, Asok Kurup6, Sin Yew Wong7, Chian Yong Low8, Yang Wang9, Winnie Lee1, Yi Xin Liew1, Brenda Ang10, David C Lye10, Angela Chow11,12, Moi Lin Ling13, Helen M Oh14, Cassandra A Cuvin9, Say Tat Ooi15, Surinder K Pada16, Chong Hee Lim17, Jack Wei Chieh Tan18, Kean Lee Chew19, Van Hai Nguyen20, Dale A Fisher21,22, Herman Goossens23, Andrea L Kwa1,2,24, Paul A Tambyah21,22, Li Yang Hsu10,12, Kalisvar Marimuthu10,22. 1. Department of Pharmacy, Singapore General Hospital. 2. Department of Pharmacy, National University of Singapore. 3. Department of Infectious Diseases, Singapore General Hospital. 4. Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital. 5. Department of Laboratory Medicine, Changi General Hospital. 6. Infectious Diseases Care, Mount Elizabeth (Orchard) Hospital. 7. Infectious Disease Specialists, Gleneagles Hospital. 8. Novena Medical Specialists, Mount Elizabeth (Novena) Hospital. 9. Division of Nursing, Raffles Hospital, Departments of. 10. Infectious Diseases and. 11. Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital. 12. Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital. 13. Infection Control, Singapore General Hospital. 14. Division of Infectious Diseases, Changi General Hospital. 15. Department of General Medicine, Khoo Teck Puat Hospital. 16. Department of Infectious Diseases, Ng Teng Fong General Hospital. 17. Department of Cardiothoracic Surgery, National Heart Center. 18. Department of Cardiology, National Heart Center. 19. Department of Laboratory Medicine, National University Hospital, Singapore. 20. School of Pharmacy, Memorial University, St John's, NL, Canada. 21. Division of Infectious Disease, National University Hospital, and. 22. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 23. Laboratory of Medical Microbiology, University of Antwerp, Belgium; and. 24. Emerging Infectious Diseases, Duke-NUS Medical School, Singapore.
Abstract
BACKGROUND: We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. METHODS: Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. RESULTS: Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. CONCLUSIONS: This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.
BACKGROUND: We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. METHODS: Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. RESULTS: Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. CONCLUSIONS: This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.
Authors: Alvin Qijia Chua; Andrea Lay-Hoon Kwa; Thean Yen Tan; Helena Legido-Quigley; Li Yang Hsu Journal: Singapore Med J Date: 2019-08 Impact factor: 1.858
Authors: Hoe Nam Leong; Asok Kurup; Mak Yong Tan; Andrea Lay Hoon Kwa; Kui Hin Liau; Mark H Wilcox Journal: Infect Drug Resist Date: 2018-10-25 Impact factor: 4.003