Changes in prevalence of health care-associated infections in U.S. hospitals
Open accessAbstract
BACKGROUND: A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care-associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care-associated infections during a period of national attention to the prevention of such infections. METHODS: At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care-associated infections. We compared the percentages of patients with health care-associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care-associated infections. RESULTS: In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care-associated infections in 2015 (394 patients [3.2%; 95% confidence interval {CI}, 2.9 to 3.5]) than in 2011 (452 [4.0%; 95% CI, 3.7 to 4.4]) (P<0.001), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile [now Clostridioides difficile]), and surgical-site infections were the most common health care-associated infections. Patients' risk of having a health care-associated infection was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 to 0.95; P=0.005), after adjustment for age, presence of devices, days from admission to survey, and status of being in a large hospital. CONCLUSIONS: The prevalence of health care-associated infections was lower in 2015 than in 2011. To continue to make progress in the prevention of such infections, prevention strategies against C. difficile infection and pneumonia should be augmented. (Funded by the Centers for Disease Control and Prevention.).
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Candida species are a leading cause of health care-associated bloodstream infections in the United States and elsewhere.
“In the United States and elsewhere, Candida species are a leading cause of health care–associated bloodstream infections (3–5).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016 (2019) · cites this paper as [3]
Table 5 (Additional information) reports Candida species in 7 of 52 health care-associated bloodstream infections (13%) in the U.S. survey, supporting their description as a leading cause there. The paper does not provide evidence for the claim about countries elsewhere. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCandidemia is the second most common cause of healthcare-associated bloodstream infections nationally.
“Candidemia is also the second most common cause of healthcare-associated bloodstream infections (BSIs) nationally.26”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [26]
Candidemia is a common cause of health care-associated bloodstream infections in the United States.
“Candidemia, a bloodstream infection caused by Candida spp., is a common cause of health care–associated bloodstream infections in the United States.”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [2]
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 [2]
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- Authors
- Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L., Dumyati, G., Nadle, J., Wilson, L. E., Kainer, M. A., Lynfield, R., Greissman, S., Ray, S. M., Beldavs, Z., Gross, C., Bamberg, W., Sievers, M., Concannon, C., Buhr, N., Warnke, L., Maloney, M., Ocampo, V., Brooks, J., Oyewumi, T., Sharmin, S., Richards, K., Rainbow, J., Samper, M., Hancock, E. B., Leaptrot, D., Scalise, E., Badrun, F., Phelps, R., & Edwards, J. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-11
- Volume
- 379
- Issue
- 18
- Pages
- 1732-1744
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7978499
- OpenAlex
- W2898649154
- Semantic Scholar
- c20ae9e33d923c51f0806351b4e37fe88e66bd62
- Cited by
- 1,249
- References
- 20
- Citations by year
- 2026: 123 · 2025: 169 · 2024: 152 · 2023: 175 · 2022: 183 · 2021: 156 · 2020: 155 · 2019: 131 · 2018: 3 · 2015: 1
- FWCI
- 84.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- 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 Center for Emerging and Zoonotic Infectious Diseases (CK17 1701)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- nosocomial infections, infection prevalence, surgical site infection, urinary tract infection, Clostridium difficile infection, nosocomial pneumonia, infection control, hospitalized patients, point prevalence survey, Emerging Infections Program, infection prevention practices, gastrointestinal infections, risk factors
- MeSH terms
- Adult, Aged, Catheterization, Clostridium Infections, Cross Infection, Hospital Bed Capacity, Hospital Units, Hospitalization, Humans, Infant, Newborn, Middle Aged, Pneumonia, Regression Analysis, Respiration, Artificial, Surgical Wound Infection, United States, Urinary Tract Infections, Prevalence, Multivariate Analysis
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