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  • Author or Editor: Karolina Böröcz x
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As a result of the age-related changes, more elders live in long-term care facilities (LTCFs). Due to their susceptibility, infections and excess use of antimicrobials are common. The aim was to estimate the burden of infections and antimicrobial use in Hungarian LTCFs in order to increase the attention given to the prevention. European-wide point prevalence survey was conducted between April and May 2013. For each resident who had a signs and symptoms of an infection and/or treated with an antibacterial for systemic use a resident questionnaire was completed. Descriptive statistics were used to present the data. In total, 91 LTCFs with 11,823 residents were selected in this survey. The 252 residents had a sign/symptom of an infection (2.1%) and 156 received antimicrobial (1.3%). Skin and soft tissues (36.5%) was the most frequent infection. However, antimicrobials were mostly prescribed for respiratory tract infections (40.4%). The most common therapeutic antimicrobial agent (97.5%) belonged to the quinolone antibacterials (34.2%). Our results emphasise the need for targeted improvement of antimicrobial use including: reducing the use of quinolone antibacterials in order to prevent the spread of Clostridium difficile and other antimicrobial resistant microorganisms among institutionalized residents.

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Bevezetés: Az egészségügyi ellátással összefüggő fertőzések előfordulása és az antimikrobiális szerek használata gyakori a szociális intézmények ápoltjai között. A standardizált adatok hiányával szembesülve az Európai Betegségmegelőzési és Járványügyi Központ létrehozott egy projektet, hogy az európai szociális intézményekben felmérjék a fertőzések és az antibiotikumhasználat prevalenciáját. Célkitűzés: A szerzők az európai projekt hazai adatainak bemutatását tűzték ki célul. Módszer: Hazánk 91 bentlakásos szociális intézménnyel és 11 823 ápolttal vett részt a 2013. májusban elvégzett pontprevalencia-vizsgálatban. Eredmények: A fertőzések prevalenciája 2,1% volt. A bőr- és lágyrész- (36%), a légúti (30%) és a húgyúti fertőzések (21%) fordultak elő leggyakrabban. Az antibiotikumokat legtöbbször húgyúti (40,3%), légúti (38,4%), illetve bőr- és lágyrész-fertőzésekre (13,2%) írták fel, amelyek 97,5%-a az ATC J01 alcsoportba (szisztémás antibakteriális szerek) tartozott. Következtetések: Az eredmények alapján a szerzők irányelvek és képzési programok kidolgozását tartják szükségesnek az infekció kontroll/prevenció és a helyes antibiotikumhasználat vonatkozásában a szociális intézmények számára. Orv. Hetil., 2014, 155(23), 911–917.

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Transmission of pathogens via healthcare workers’ (HCWs) hands is one of the most frequent means of spreading multi-resistant organisms and occurring healthcare-associated infections (HAIs) in hospitals. The role of contaminated hands in pathogen transmission was recognized by Hungarian physician, Ignác Semmelweis. Hand hygiene prevents cross-infections in hospitals, but numerous epidemiological and microbiology-based studies have documented low compliance of HCWs with this simple procedure. Furthermore, hand hygiene perception of HCWs plays an important role in determining hand hygiene compliance. Our aim was to describe the opinion of HCWs about their perception regarding hand hygiene practice. Our further goal was to strengthen a laboratory basis for bacterial backup control of nosocomial pathogens. A cross-sectional descriptive study was conducted between December 2010 and February 2011 in 13 participating hospitals in Hungary. HCWs know that there is correlation between contaminated hands and HAIs (83%), but neither the frequency (62%) nor the implementation (73%) of their hand hygiene performance are satisfying.We recommend that multimodal interventions — highlighted active microbiological surveillance of HCWs’ hands — are the most suitable strategies to reduce the occurrence of HAIs and to determine their impact on cross-transmission of microorganisms and to overcome barriers of HCWs.

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Fourteen outbreaks in Hungary between 2005 and 2008 caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) were epidemiologically investigated and the isolated pathogens were characterized by molecular techniques. Ten of the fourteen outbreaks occurred in adult wards and four in neonatal units affecting a total number of 73 patients. The 54% [40] of the patients developed bloodstream infections and 21.9%–21.9% [16] pneumonia and surgical site infections, respectively. The overall rate of mortality proved high: 36.9% [27]. Outbreaks in adults affected more patients, had higher attack rates, were more prolonged in duration and had a 6.9-fold higher mortality rate than outbreaks observed in neonates. The outbreaks in neonates were caused by SHV-type ESBL-producing klebsiellae, while in the “adult outbreaks” exclusively CTX-M-type ESBL-KP strains were involved. While the outbreak strains isolated from neonatal units could be assigned to a variety of pulsotypes, the previously described K. pneumoniae epidemic clones, ST15 and ST147, could be identified among the pathogens causing outbreaks in adult units.

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Risk factors for and outcomes of bloodstream infections (BSIs) caused by ESBL-producing and by ESBL-non-producing Klebsiella pneumoniae were compared in a four-year multicenter study in Hungary. One hundred ESBL-positive and one hundred ESBL-negative patients were included as cases and controls. Investigated risk factors were related to demographics, comorbid conditions, treatments, invasive procedures, surgery prior bacteremia, presence of additional nosocomial infections and preceding hospital admission within a year. Measured outcomes were crude mortality, mortality related to infection and delay in introducing appropriate therapy (DAT). Though some risk factors for infection (admission to intensive care units, having central venous and/or urinary catheter, mechanical ventilation) were shared by both groups, in other respects cases and controls were found to differ substantially. The 36 percent of patients with BSIs with ESBL-producing Klebsiella died versus 23 percent of controls (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0–5.4; p = 0.02). The 18 percent of deaths in cases versus 9% in controls could be attributed to infection (OR: 5.0; 95% CI: 1.5–16.2; p = 0.006). Cases more often received previous antibiotic therapy than controls (OR: 2.7; 95% CI: 1.1–6.7; p = 0.02) and delay in the introduction of appropriate antibiotic treatment was observed in 44% of cases versus 19% of controls (OR: 3.4; 95% CI: 1.6–7.3; p = 0.001). The results demonstrate that BSIs caused by ESBL-producing K. pneumoniae are related to previous antibiotic therapy and are associated with a high rate of mortality that is often linked to delay in the introduction of appropriate antibiotic therapy. This confirms that besides infection control measures the early identification and antibiotic resistance profiling of the infecting pathogen is salient in the control of BSIs caused by ESBL-producing K. pneumoniae .

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