Epidemiology of MROs in surgical prophylaxis: an analysis of organism, surgical procedures and requirements for alternative surgical antibiotic prophylaxis

Dr Stella  Son1, Ms Jan Roberts2, Dr Kathryn Daveson2

1Australian National University Medical School, Garran, Australia, 2The Canberra Hospital, Garran, Australia

Introduction: The number of patients undergoing surgical procedures with multi-resistant organisms (MRO) is increasing.  Guidelines on surgical antibiotic prophylaxis (SAP) deal poorly with alternative choices for MROs other than MRSA.  The epidemiology of MROs in surgery is not well described.

Methods: A 2-year retrospective clinical audit at a principal referral hospital was performed reviewing the epidemiology of patients undergoing surgical procedures with MRO alerts.  The need for alternative SAP was assessed against guidelines or where no guidelines were available, expert opinion.

Results: 177 patients over 2 years were identified with 304 surgical procedures. 49% (N=149) had known MRO alerts prior to the procedure. Orthopaedics (25%), general surgery (25%) and vascular surgery (17%) were the highest surgical groups with MRO alerts. MRSA was the most common alert (68%, 102/149), followed by VRE (23%, 34/149). The proportion assessed as requiring alternative prophylaxis due to the MRO alert was 72% (106/149) with only 14% (14/106) receiving it. The majority of alternative SAP recommendations were for MRSA (91%, 93/106), followed by multi-resistant Enterobacteriaceae (4%, 4/106).  A recommendation for a change in prophylaxis for VRE colonisation was uncommon.

Conclusion: The need for alternative SSP choices in patients with a known MRO may be high and is currently not being administered routinely. The burden of this requirement will likely increase in coming years with increasing rates of societal antimicrobial resistance.  How we deal with this issue as a multidisciplinary team, particularly where there are no guidelines available, needs addressing. An overview of this is suggested.


Biography:

Kathryn Daveson is employed by both ACT and Queensland Health as a Staff Specialist in Infectious Diseases.  She is currently the acting Director of the Queensland Statewide AMS Program and runs the AMS program at Canberra Hospital & Health Services.

Point Prevalence Surveys of Healthcare-Associated Infection (HAI) in Southwest Finland

Mrs Tiina Kurvinen1, Mrs Kirsi Terho1, Dr Esa Rintala1, Dr Harri Marttila1

1Turku University Hospital, Turku, Finland

Introduction
Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients. Incidence and prevalence surveillance provides tools to prevent and manage the burden of HAIs. Annual point prevalence surveys (PPS) have been performed in the Turku University Hospital from 2007 to 2017 and incidence since 1982.

Methods
PPS was performed in a Finnish tertiary care hospital with 747 beds. The objectives were to assess the magnitude and characteristics of HAIs. A PPS was conducted in each March from 2007 to 2017 to estimate HAI prevalence and associated risk factors.
Results
HAI was found in 936 of 7670 patients (12.2 %). 91% of HAIs started during the current hospital stay. The most frequent HAIs were pneumonia (PPS 26% versus incidence 22%), surgical site infections (PPS 21% versus incidence 21%) and bloodstream infections (PPS 20% versus incidence 20%). The prevalence of HAI was most frequent in the intensivecareunits. On the day of the PPS, 19% of study patients had urinary catheter,11% centralvenous catheter, and 2% received mechanicalventilation as a risk factor for HAI.

Conclusion
The PPS showed that the long-term distribution of HAIs were strikingly similar in PPSs and in incidence surveys, indicating that incidence survey is as reliable method for HAI surveillance as PPS. These two methods are complementary to each other and increase the capturing of all HAIs. More primary prevention efforts are necessary to address HAIs associated to prevent surgical site infections and with the use of invasive devices.


Biography:

Kirsi Terho is a RN, specialized in the nursing in internal diseases and infection prevention. Since 2001 Kirsi has  worked as an ICN in Turku University Hospital. Kirsi Terho made Master degree and she is a post-graduate student in nursing science in the University of Turku. The subject of her thesis is infection prevention. Kirsi Terho has made poster presentations, attended conferences, written articles in Finnish infection prevention textbooks and professional magazines. Kirsi Terho is a one of the founders of the Infection Control Nurses Association in Finland.