Multistate point-prevalence survey of health care-associated infections
Open accessAbstract
BACKGROUND: Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. METHODS: We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. RESULTS: Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011. CONCLUSIONS: Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections.
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Candidemia is a common healthcare-associated bloodstream infection in the United States with significant morbidity and 25%-40% all-cause in-hospital mortality.
“Candidemia is one of the most common healthcare-associated bloodstream infections in the United States (US) [1,2].It is associated with significant morbidity and 25%-40% all-cause in-hospital mortality [3].”
From Burden of Candidemia in the United States, 2017 (2020) · cites this paper as [1]
Potential harms of unnecessary antimicrobials include allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance.
“These include a range of adverse events such as allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance (101-106).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [106]
The Training and Data Collection section (p. 4) uses antimicrobial therapy to identify patients whose records should be reviewed; it does not assess harms from unnecessary treatment. The Discussion (p. 8) reports the prevalence of C. difficile infection, but does not link it to unnecessary antimicrobials. Searches for the listed adverse reactions and antimicrobial resistance found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredE. coli, S. aureus, Enterococcus spp., P. aeruginosa, Klebsiella spp., coagulase-negative Staphylococci, and Candida spp. are among the most frequently isolated microbes in healthcare-associated infections.
“E. coli, S. aureus, Enterococcus spp., P. aeruginosa, Kleibsiella spp., coagulasenegative Staphylococci, and Candida spp.are among the most frequently isolated microbes in health care-associated infections [3].”
From Antimicrobial Properties of Antidepressants and Antipsychotics—Possibilities and Implications (2021) · cites this paper as [3]
Sepsis and septic shock due to fungi are most commonly observed in ICUs and are associated with poor outcomes.
“Sepsis and septic shock due to fungi are most commonly observed in ICUs and are associated with poor outcomes [166–170].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [168]
Candida species account for about 1 in 5 nosocomial bloodstream infections.
“In point prevalence studies, Candida species account for about 1 in 5 nosocomial bloodstream infections [1,3].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [1]
Candida species are frequent colonizers of the human alimentary tract and skin that have emerged as important nosocomial pathogens.
“Candida species are frequent colonizers of the human alimentary tract and skin that have emerged as important nosocomial pathogens, in tandem with advances in modern medical therapeutics [1,2].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [1]
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- Authors
- Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J., Ray, S. M., Thompson, D. L., Wilson, L. E., & Fridkin, S. K.
- Affiliations
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-03-27
- Volume
- 370
- Issue
- 13
- Pages
- 1198-1208
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4648343
- OpenAlex
- W2155800098
- Semantic Scholar
- e10c71ecc2944c86b1e4bcbe19c6138cac14245a
- Cited by
- 3,931
- References
- 40
- Citations by year
- 2026: 183 · 2025: 234 · 2024: 288 · 2023: 347 · 2022: 312 · 2021: 352 · 2020: 350 · 2019: 401 · 2018: 436 · 2017: 359 · 2016: 360 · 2015: 237 · 2014: 63 · 2013: 1 · 2012: 1
- FWCI
- 238.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- New England Journal of Medicine (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Maryland Shared Open Access Repository (USMAI Consortium) (submittedVersion, public-domain)
- Digital Repository at the University of Maryland (University of Maryland College Park) (public-domain)
- Funders
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention
- Agency for Toxic Substances and Disease Registry
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- nosocomial infections, point prevalence, acute care hospitals, Clostridium difficile infection, device-related infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, surgical site infection, nosocomial pneumonia, gastrointestinal infections, National Healthcare Safety Network, infection surveillance
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Centers for Disease Control and Prevention, U.S., Child, Child, Preschool, Cross Infection, Data Collection, Delivery of Health Care, Female, Hospitals, Special, Humans, Infant, Male, Middle Aged, Risk Factors, United States, Prevalence, Pneumonia, Ventilator-Associated, Catheter-Related Infections, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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