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Microbiology

The growing incidence of HAIs demonstrates the need for reliable testing

Hospital costs directly related to management of healthcare-associated infections (HAIs) are on the rise and the subject of intense focus for managing quality of care and institutional efficiency.

Additionally, the US acute care costs associated with Clostridioides difficile (C. difficile), formerly Clostridium difficile, infection are up to $5.9 billion.1 On top of these financial costs, HAIs can result in2:

  • Prolonged hospital stays
  • Increased resistance of microorganisms to antimicrobials
  • Emotional burden for patients and their families
  • Increased number of deaths
  • Decreased hospital reputation3
Discharge rate for C. difficile Infections from US short-stay hospitals by age4
microbiology-chart-1
Urgent need for healthcare facilities to establish effective surveillance
 

Of all HAIs, Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile (C. difficile) represent the most common HAIs11, with MRSA/MSSA5, 12, 13 and C. difficile1 infections affecting millions of patients and causing millions of extra days of hospital stay each year. The substantial human suffering and financial burden of these endemic HAIs prompt an urgent need for healthcare facilities to establish effective MRSA/MSSA surveillance and timely C. difficile testing for effective infection control and prevention.

Microbiology labs are the first lines of defense for detection of HAIs, unexpected pandemics, and outbreaks. For example, by implementing a reliable MRSA/MSSA surveillance program that rapidly and accurately detects colonized patients, clinical microbiology and infection control can help reduce the worldwide burden and spread of these costly infections.

 

 

The most expensive program you 
can have is one that fails.

 

alt
 
 
 
Lance R. Peterson, MD

Director of Microbiology and
Infectious Disease Research
NorthShore University HealthSystem

 

 
The burden of MRSA Infections
 
  • Responsible for an estimated 80,461 invasive infections and 11,285 deaths in the US in 20115
  • Compared to patients with MSSA infection:
    • Patients with MRSA infections have 3.4 times higher risk of death6
    • Patients infected with MRSA spent more days in ICU and other wards7
    • Medical cost associated with MRSA infection can be more than 2 times greater median hospital cost7
microbiology-doctor-1

CO-HCA: community onset health care–associated infection,
NHO: nursing home onset.
HO: hospital onset

The rising burden of Clostridioides difficile
 

CDI, which is known to cause severe diarrhea, pseudomembranous colitis, or toxic megacolon, not only imposes a monetary burden on both healthcare facilities and patients, but also results in prolonged patient suffering. Patients infected with C. difficile may require extended hospital stays, possible re-hospitalization, and additional medications. 

Complicating efforts to manage these costly infections, CDI is changing as evidenced by: increasing virulence, rising incidence, unresponsiveness to metronidazole therapy, and worse outcomes, including death.8 In fact, deaths in the US related to C. difficile increased 400% between 2000 and 2007, in part because of the emergence of hypervirulent strains.9 Additionally, US hospital stays related to CDI tripled in the last decade, further illustrating the growing public health threat of the infection.10

The increased severity and incidence of CDI make accurate and rapid identification of the infection imperative, highlighting the need for reliable diagnostic methods to help prevent outbreaks, and identify and treat patients quickly.4,8

According to the CDC, hospitals that followed infection control recommendations lowered CDI rates by 20% in less than 2 years.10 Microbiology labs are an essential part of timely and accurate reporting of CDI, enabling clinicians to provide appropriate therapy and improve patient management.

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References

 

  1. Kwon et al. Infect Dis Clin North Am. (1):123-134.
  2. World Health Organization. Report on the burden of endemic health care-associated infection worldwide. http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf?ua=1. Published 2011. Accessed April 15, 2014.
  3. Mazor KM, Dodd KS, Kunches L. Am J Med Qual. 2008;24(2):108–115.
  4. Lessa FC, Gould CV, McDonald LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis. 2012;55(Suppl 2):S65-S70. doi:10.1093/cid/cis319.
  5. Dantes, R. et al. JAMA Intern Med. 2013;173(21):1970-8.
  6. Calfee, DP et al. Infect Control Hosp Epidemiol 2014;35(7):772-796.
  7. Filice, GA. Et al. Infect Control Hosp Epidemiol. 2010;31(4):365-733.
  8. Peterson LR, Mehta MS, Patel PA, et al. Laboratory testing for Clostridium difficile infection: light at the end of the tunnel. Am J Clin Pathol.2011;136(3):372-380. doi:10/1309/AJCPTP5XKRSNXVIL.
  9. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Published September 2013. Accessed April 15, 2014.
  10. Centers for Disease Control and Prevention. Stopping C. difficile infections. http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/. Published March 2012.
  11. Magill SS et al. N Engl J Med 2014;370:1198-208
  12. Reed SD, et al. Infect Control Hosp Epidemiol. 2005 Feb; 26(2):175-83.
  13. Engemann JJ, et al. Clin Infect Dis. 2003 Mar 1; 36(5):592-8.
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