Vancomycin- Resistant Enterococci (VRE) Infections

Transcription

1 Publié sur INSPQ ( Accueil > Vancomycin-Resistant Enterococci (VRE) Infections - Surveillance results: Vancomycin- Resistant Enterococci (VRE) Infections Surveillance results: From April 1, 2015, to March 31, 2016, 89 healthcare facilities took part in the surveillance of healthcare-associated vancomycin-resistant enterococci (VRE) infections, for a combined total of 4,833,086 patient days (Table 1). In total, 78 VRE infections were reported among patients who contracted strain during a current or previous hospital stay in the reporting facility (categories 1a and 1b). The incidence rate of healthcare-associated VRE infection (cat. 1a and 1b) was 0.16 per 10,000 patient days. This incidence rate was stable since The acquisition rate of healthcare-associated VRE colonization (cat. 1a and 1b) in was 9.76 per 10,000 patient days. For all results, only facilities that participated in at least 11 periods are included in the analyzes. Data was extracted on May 31st, Updated : February 28, 2017 Version française [1]

2 Table 1 Participation of Healthcare Facilities in the Surveillance of VRE Infections, Québec, to * Participating facilities (N) Admissions (N) 356, , , , ,408 Inpatient days (N) 2,811,428 5,011,849 4,844,963 4,701,410 4,833,086 Cases of healthcare-associated VRE infection (cat. 1a and 1b) (N) 30 41** Cases of healthcare-associated VRE colonization (cat. 1a and 1b) (N) 1,958 4,145 5,185 4,675 4,717 Infected patients (cat. 1a and 1b) (N) * The data for are incomplete, as surveillance was initiated on September 11, Categories 1a and 1b refer to the acquisition of the strain, not the infection. ** The origin of acquisition of the strain is unknown in 66 cases involving patients already colonized with VRE. Since , VRE infections included known VRE carriers that developed infection. Note: Colonizations included infections. Open all Incidence rates In , the incidence rate of healthcare-associated VRE infection (cat. 1a and 1b) was 0.16 per 10,000 patient days for healthcare facilities participating to the last year (Table 2) and was 0.16 per 10,000 patient days for healthcare facilities participating to the last five years (Table 3). In the health region of Montreal (06 HR), teaching healthcare facilities have a twofold higher healthcareassociated VRE infection incidence rate than non-teaching facilities (Table 2). Table 2 Incidence Rate and Percentile Distribution of Healthcare-Associated VRE Infection (Cat. 1a and 1b) by Type of Facility and Regional Categories, Québec, (Incidence Rate per 10,000 Patient Days [95% CI]) Type of facility Health Region Min. 25% 50% 75% 90% Max. Incidence Rate Non-teaching (N = 6) 06 HR [0.09 ; 0.38] Teaching (N = 14) 06 HR [0.35 ; 0.59] Non-teaching (N = 57) Other RH [0.02 ; 0.09] Teaching (N = 12) Other RH [0 ; 0.05] Total (N = 89) [0.13 ; 0.20] HR: Health region. [I.C. 95%]: 95% confidence interval. Table 3 Change in Incidence Rate of Healthcare-Associated VRE Infection (Cat. 1a and 1b) by Type of Facility and Regional Category, Québec, to (Incidence Rate per 10,000 Patient Days [95% CI]) Type of facility Health Region Incidence Rate

3 Non-teaching (N = 5) 06 HR 0.31 [0.11 ; 0.61] 0.12 [0.03 ; 0.26] 0.15 [0.05 ; 0.31] 0.17 [0.06 ; 0.34] 0.23 [0.10 ; 0.42] Teaching (N = 11) 06 HR 0.34 [0.21 ; 0.50] 0.29 [0.20 ; 0.40] 0.65 [0.50 ; 0.82] 0.60 [0.46 ; 0.76] 0.51 [0.38 ; 0.66] Non-teaching (N = 55) Other RH 0.03 [0.01 ; 0.07] 0.03 [0.01 ; 0.06] 0.02 [0.01 ; 0.04] 0.06 [0.03 ; 0.10] 0.05 [0.02 ; 0.09] Teaching (N = 12) Other RH [0.01 ; 0.07] 0.03 [0.01 ; 0.07] 0.02 [0 ; 0.05] Total (N = 83) * 0.11 [0.07 ; 0.15] 0.09 [0.06 ; 0.12] 0.17 [0.13 ; 0.21] 0.18 [0.14 ; 0.22] 0.16 [0.13 ; 0.20] HR: Health region * Data are those from facilities that participated in surveillance for at least 11 periods for each year between and Description of cases In total, 89 cases of VRE infection were reported: 82 (92.1%) were identified in patients who acquired VRE infection during a current hospital stay (72 patients), a previous hospital stay (6 patients) or in ambulatory care of the reporting facility (4 patients) (cat. 1a, 1b and 1c). A total of 12 cases were associated to another facility, community or unknown (cat. 2, 3 and 4) (Table 4). A total of 7 cases were associated to another facility, community and unknown (cat. 2, 3 and 4) (Table 4). Among the 89 VRE infections, 48 infections were from known colonized cases. Table 4 Cases of VRE Infection by Presumed Origin of Acquisition, Québec, (N, %) Category Origin of Acquisition Infection 1a Healthcare-associated with a current hospital stay in the reporting facility 72 (80.9%) 1b Healthcare-associated with a previous hospital stay in the reporting facility 6 (6.7%) 1c Healthcare-associated with ambulatory care in the reporting facility 4 (4.5%) 1d Healthcare-associated with long term unit in the reporting facility 0 (0%) 2 Healthcare-associated with another facility 2 (2.2%) 3 Community-associated 5 (5.6%) 4 Unknown origin 0 (0%) Total 89 In , among 89 infections, 15 primary bloodstream infections (BSI) and 13 secondary bloodstream infections have been reported (Table 5). The number of BSI observed in is decreasing as compared to (N = 23). Table 5 Number of Cases of VRE Infection from All Origins by Type of Infection and Number of Complications (Secondary BSIs), Québec, (N = 89)

4 Type of Infection Infections (N) Secondary Bloodstream Infections (N) Primary BSI CRBSI-MBI 1 - CRBSI 2 - Non- CRBSI-MBI 0 - Non-CRBSI 12 - HD 0 - Others Urinary tract 18 1 Abdominal 19 7 Pulmonary 4 0 Surgical site 19 2 Skin and soft tissue 10 2 Bones and joints 0 0 Others 4 1 Total BSI : bloodstream infection CRBSI : catheter-related bloodstream infection MBI : mucosal barrier injury Non-CRBSI : non- catheter-related primary bloodstream infection HD: hemodialysis A total of 16 deaths within 30 days were observed in , yielding a case fatality of 18.0% (Table 6). Since , the case fatality is stable from 18.0% to 19.2%. Table 6 Number of Deaths and 30-days Case Fatality Related to VRE Infections, Québec, to VRE infections (all origins) Number of deaths Case fatality 19.0% 18.8% 18.2% 19.2% 18.0% Colonization Screening Protocol In , the acquisition rate of healthcare-associated VRE colonization (cat. 1a and 1b) was 9.76 per 10,000 patient days in healthcare facilities participating at the least year of surveillance (Table 11) and was 9.60 per 10,000 patient days in those participating at the least five year of surveillance (Table 7). In the health region of Montreal (06 HR) and others, the acquisition rate of healthcare-associated VRE colonization in non-teaching facilities was higher to the one in teaching facilities (Table 7). This trend is

5 similar to Table 7 Change in the Number of Cases and Acquisition Rate of Healthcare-associated VRE Colonization (Cat. 1a and 1b) by Type of Facility and Regional Category, Québec, to (Acquisition rate of Healthcare-Associated VRE colonization per 10,000 patient days) Type of Facility Non-teaching (N = 5) Teaching (N = 11) Non-teaching (N = 55) Teaching (N = 12) Health Region 06 HR HR 894 Other RH 409 Other RH 64 Total (N = 83)* Acquisition Number of Number of Acquisition Number of Acquisition Number of Acquisition Number of Rate of HAcases of cases of Rate of cases of Rate of cases of Rate of cases of VRE colonization colonization HA-VRE colonization HA-VRE colonization HA-VRE colonization Colonization [15.70 ; 19.46] [14.14 ; 16.12] 3.55 [3.21 ; 3.90] 0.94 [0.72 ; 1.18] 6.51 [6.20 ; 6.82] [17.81 ; 20.73] [16.32 ; 17.91] 3.38 [3.13 ; 3.64] 2.48 [2.21 ; 2.77] 7.39 [7.15 ; 7.64] [21.07 ; 24.26] [18.17 ; 19.87] 5.24 [4.93 ; 5.56] 4.12 [3.76 ; 4.49] 9.30 [9.02 ; 9.58] [22.28 ; 25.55] [17.33 ; 19.01] 8.03 [7.65 ; 8.42] 2.17 [1.91 ; 2.45] 9.94 [9.65 ; 10.23] * HR: Health region * Number of healthcare facilities participating in each of the five years of surveillance. Significant statistical difference (p 0.05) between acquisition rate of HA-VRE colonization of and Acquisition Rate of HA-VRE [24.43 ; 27.82] [19.93 ; 21.75] 5.57 [5.25 ; 5.90] 2.32 [2.05 ; 2.61] 9.60 [9.32 ; 9.89] Table 8 shows the number of non-teaching facilities that specified the type of screening used at admission (55 out of 63) and during hospitalization (53 out of 63). The majority of teaching facilities specified the type of screening used at admission (23 out of 26) and during hospitalization (23 out of 26). Only two teaching facilities from the health region of Montreal and one from other health region did not identify the total type of screening. Table 8 Number of Healthcare Facilities that specified the type of Screening Procedure Used at Admission and During Hospitalization by Type of Facility and Regional Category, Québec, Type of Facility Health Region Number of Facilities That specified the Type of Screening Procedure Used At During Not Total Admission Hospitalization Specified Non-teaching (N = 6) 06 HR Teaching (N = 14) 06 HR Non-teaching (N = 57) Other RH Teaching (N = 12) Other RH Total (N = 89) * The number of facilities that reported the type of screening procedures used at admission and during hospitalization is not additive. HR: Health region. Tables 9 and 10 feature the total number of screening tests performed at admission and during hospitalization, as well as the mean number of VRE screening tests. Table 9 Total Number of Screening Tests Performed at Admission and During Hospitalization by Type of Facility and Regional Category, Québec,

6 Type of Facility Health Region Number of screening procedure During At Admission Hospitalization Not Specified Total Non-teaching 06 HR 21,547 23,107 3,439 48,093 Teaching 06 HR 39, ,682 11, ,992 Non-teaching Other RH 139, ,228 53, ,059 Teaching Other RH 67,501 75,171 24, ,657 Total 267, ,188 93, ,801 HR: Health region. Table 10 Mean Number of VRE Screening Score by Type of Healthcare Facility and Regional Categories, Québec, (Mean VRE Screening Tests per Admission) Type of Facility Health Region Mean Number of VRE Screening Score* At Admission During Hospitalization Total Non-teaching 06 HR Teaching 06 HR Non-teaching Other RH Teaching Other RH Total * The mean numbers of VRE screening score at admission and during hospitalization are not additive. HR: Health region. Data per Facility The incidence rate of HA-VRE infection and the percentile rankings by type of facility are shown in Figure 1 and 2. Figures 3 and 4 feature the rate of acquisition and percentile ranking of HA-VRE colonization by type of facility. Figure 1 Incidence Rate and Percentile Ranking of Healthcare-Associated VRE Infection (Cat. 1a and 1b) for Healthcare Facilities from the health region of Montreal, Québec, (Incidence Rate per 10,000 patient days)

7 NB: Facilities 6, 12, 13, 34, 38, 48, 76, 80, 83 and 118 did not report any cases of infection in Figure 2 Incidence Rate and Percentile Ranking of Healthcare-Associated VRE Infection (Cat. 1a and 1b) for Healthcare Facilities outside Heath Region of Montreal, Québec, (Incidence Rate per 10,000 patient days) NB: Facilities 2, 7, 10, 11, 15, 16, 18, 20, 23, 24, 27, 28, 30, 31, 32, 33, 37, 39, 41, 42, 44, 45, 47, 49, 51, 52, 53, 56, 58, 59, 61, 64, 65, 67, 70, 71, 72, 74, 75, 77, 81, 82, 84, 85, 86, 88, 89, 91, 95, 96, 97, 99, 100, 103, 107, 109, 111, 112, 113 and 130 did not report any cases of infection in Figure 3 Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a and 1b) in Healthcare Facilities from the Health Region of Montreal, Québec, (Acquisition Rate of Healthcare-Associated VRE Colonization per 10,000 patient days)

8 NB: Facilities 6 and 12 did not report any cases of infection in Figure 4 Acquisition Rate of Healthcare-Associated VRE Colonization (Cat.1a and 1b) in Healthcare Facilities outside Heath Region of Montreal, Québec, (Acquisition Rate of Healthcare-Associated VRE Colonization per 10,000 patient days) NB: Facilities 16, 20, 32, 49, 59, 61, 64, 67, 70, 71, 72, 74, 75, 84, 86, 88, 89, 91, 97, 100, 107, 109 and 112 did not report any cases of infection in At the local level, in , the incidence rate of HA-VRE infection ranged from 0 to 1.18 per 10,000

9 patient days, whereas the acquisition rate of HA-VRE colonization ranged from 0 to per 10,000 patient days. A total of 25 facilities (28.1%) did not report any HA-VRE infection or colonization in A detailed summary of the surveillance data for HA-VRE infection by healthcare facility can be found in Table 11. Table 11 Incidence Rate of Healthcare-Associated VRE Infection (cat. 1a and 1b), Acquisition Rate of Healthcare-Associated VRE Colonization and Mean VRE Screening Tests by Admission and by Facility, Québec, (Incidence Rate per 10,000 patient days [95% CI]; Acquisition Rate of Colonization per 10,000 patient days) HR Facility Number Name Incidence Rate of HA-VRE Infection (cat. 1a and 1b) [95% CI] Acquisition Rate of HA- VRE Colonization (cat. 1a and 1b) 16 HÔPITAL RÉGIONAL DE RIMOUSKI CENTRE HOSPITALIER RÉGIONAL DU GRAND-PORTAGE HÔPITAL NOTRE-DAME-DE-FATIMA HÔPITAL DE MATANE HÔPITAL D'AMQUI HÔPITAL DE NOTRE-DAME-DU-LAC BAS-SAINT-LAURENT HÔPITAL DE CHICOUTIMI HÔPITAL ET CENTRE DE RÉADAPTATION DE JONQUIÈRE HÔPITAL DE DOLBEAU-MISTASSINI HÔPITAL. CLSC ET CENTRE D'HÉBERGEMENT DE ROBERVAL HÔPITAL DE LA BAIE HÔPITAL D'ALMA SAGUENAY LAC-SAINT-JEAN HÔPITAL DE L'ENFANT-JÉSUS PAVILLON L'HÔTEL-DIEU DE QUÉBEC HÔPITAL DU SAINT-SACREMENT PAVILLON CENTRE HOSPITALIER DE L'UNIVERSITÉ LAVAL PAVILLON SAINT-FRANCOIS D'ASSISE INSTITUT UNIVERSITAIRE DE CARDIOLOGIE ET DE PNEUMOLOGIE DE QUÉBEC HÔPITAL DE BAIE-SAINT-PAUL HÔPITAL DE LA MALBAIE CAPITALE-NATIONALE HÔTEL-DIEU D'ARTHABASKA PAVILLON SAINTE-MARIE HÔPITAL DU CENTRE-DE-LA-MAURICIE HÔPITAL SAINTE-CROIX CENTRE DE SANTÉ ET DE SERVICES SOCIAUX DU HAUT-SAINT-MAURICE MAURICIE ET CENTRE-DU-QUÉBEC Mean VRE Screening Tests per Admission*

10 HR Facility Number Name Incidence Rate of HA-VRE Infection (cat. 1a and 1b) [95% CI] Acquisition Rate of HA- VRE Colonization (cat. 1a and 1b) 15 HÔPITAL FLEURIMONT HOTEL-DIEU DE SHERBROOKE HÔPITAL DE GRANBY 0.21 [0 ; 0.82] CENTRE DE SANTÉ ET DE SERVICES SOCIAUX MEMPHRÉMAGOG CENTRE DE SANTÉ ET DE SERVICES SOCIAUX DU GRANIT HÔPITAL BROME-MISSISQUOI-PERKINS ESTRIE 0.04 [0 ; 0.15] GLEN - ROYAL VICTORIA 1.18 [0.62 ; 1.91] HÔPITAL NOTRE-DAME DU CHUM 0.39 [0.10 ; 0.87] HÔPITAL GÉNÉRAL JUIF 0.54 [0.25 ; 0.95] GLEN - ENFANTS PAVILLON MAISONNEUVE/PAVILLON MARCEL-LAMOUREUX 0.85 [0.48 ; 1.32] CENTRE HOSPITALIER UNIVERSITAIRE SAINTE-JUSTINE INSTITUT DE CARDIOLOGIE DE MONTRÉAL HÔPITAL SAINT-LUC DU CHUM 0.59 [0.21 ; 1.16] HÔTEL-DIEU DU CHUM 0.29 [0.03 ; 0.83] HÔPITAL DU SACRÉ-COEUR DE MONTRÉAL 0.14 [0.01 ; 0.40] HÔPITAL DE VERDUN 0.26 [0.03 ; 0.74] HÔPITAL GÉNÉRAL DE MONTRÉAL 0.69 [0.22 ; 1.43] HÔPITAL SANTA CABRINI HÔPITAL GÉNÉRAL DU LAKESHORE 0.83 [0.30 ; 1.63] HÔPITAL JEAN-TALON CENTRE HOSPITALIER DE ST. MARY HOPITAL DE LACHINE HÔPITAL FLEURY HÔPITAL DE LASALLE HÔPITAL NEUROLOGIQUE DE MONTRÉAL MONTRÉAL 0.40 [0.31 ; 0.50] HÔPITAL DE GATINEAU HÔPITAL DE HULL 0.16 [0 ; 0.63] HÔPITAL DE MANIWAKI HÔPITAL DU PONTIAC HÔPITAL DE PAPINEAU OUTAOUAIS 0.06 [0 ; 0.23] HÔPITAL DE ROUYN-NORANDA HÔPITAL D'AMOS HÔPITAL ET CLSC DE VAL-D'OR CENTRE DE SOINS DE COURTE DURÉE LA SARRE PAVILLON SAINTE-FAMILLE ABITIBI-TÉMISCAMINGUE HÔPITAL LE ROYER HÔPITAL ET CENTRE D'HÉBERGEMENT DE SEPT-ÎLES CÔTE-NORD Mean VRE Screening Tests per Admission*

11 HR Facility Number Name Incidence Rate of HA-VRE Infection (cat. 1a and 1b) [95% CI] Acquisition Rate of HA- VRE Colonization (cat. 1a and 1b) 96 CENTRE DE SANTÉ DE CHIBOUGAMAU NORD-DU-QUÉBEC HÔPITAL DE CHANDLER HÔPITAL HÔTEL-DIEU DE GASPÉ HÔPITAL DE MARIA HÔPITAL DE L'ARCHIPEL HÔPITAL DE SAINTE-ANNE-DES-MONTS GASPÉSIE ÎLES-DE-LA-MADELEINE HÔTEL-DIEU DE LÉVIS HÔPITAL DE SAINT-GEORGES 0.25 [0 ; 0.99] HÔPITAL DE MONTMAGNY HÔPITAL DE THETFORD MINES CHAUDIÈRE-APPALACHES 0.06 [0 ; 0.24] HÔPITAL CITÉ DE LA SANTÉ 0.06 [0 ; 0.23] LAVAL 0.06 [0 ; 0.23] HÔPITAL PIERRE-LE GARDEUR CENTRE HOSPITALIER RÉGIONAL DE LANAUDIÈRE 0.10 [0 ; 0.40] LANAUDIÈRE 0.05 [0 ; 0.19] HÔPITAL DE SAINT-EUSTACHE CENTRE DE SANTÉ ET DE SERVICES SOCIAUX D'ARGENTEUIL HÔPITAL DE MONT-LAURIER HÔPITAL RÉGIONAL DE SAINT-JÉRÔME 0.27 [0.05 ; 0.66] HÔPITAL LAURENTIEN LAURENTIDES 0.12 [0.02 ; 0.29] HÔPITAL CHARLES LEMOYNE 0.16 [0.02 ; 0.45] HÔPITAL DU HAUT-RICHELIEU 0.24 [0.02 ; 0.69] HÔPITAL PIERRE-BOUCHER HÔPITAL HONORÉ-MERCIER 0.15 [0 ; 0.59] HÔTEL-DIEU DE SOREL CENTRE HOSPITALIER ANNA-LABERGE HÔPITAL DU SUROÎT HÔPITAL BARRIE MEMORIAL MONTÉRÉGIE 0.09 [0.03 ; 0.18] Total 0.16 [0.13 ; 0.20] * Number of screening test divided by number of admisions. Mean VRE Screening Tests per Admission* Author Comité de surveillance provinciale des infections nosocomiales (SPIN)

12 Editorial committee Christophe Garenc, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Danielle Moisan, Centre hospitalier régional du Grand-Portage Muleka Ngenda-Muadi, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Mélissa Trudeau, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Isabelle Rocher, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Patrice Vigeant, CISSS de la Montérégie-Ouest - Hôpital du Suroît Jasmin Villeneuve, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec Gouvernement du Québec URL de la page (modifiée le 10/03/ :40) : Liens [1] [2]