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Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis

BACKGROUND & AIMS: Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection preven...

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Autores principales: Di Cola, Simone, Gazda, Jakub, Lapenna, Lucia, Ceccarelli, Giancarlo, Merli, Manuela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9938945/
https://www.ncbi.nlm.nih.gov/pubmed/36844944
http://dx.doi.org/10.1016/j.jhepr.2023.100703
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author Di Cola, Simone
Gazda, Jakub
Lapenna, Lucia
Ceccarelli, Giancarlo
Merli, Manuela
author_facet Di Cola, Simone
Gazda, Jakub
Lapenna, Lucia
Ceccarelli, Giancarlo
Merli, Manuela
author_sort Di Cola, Simone
collection PubMed
description BACKGROUND & AIMS: Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis. METHODS: The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient’s exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard. RESULTS: We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 vs. 8.9%, p <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26–0.73, p = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states. CONCLUSIONS: The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes. IMPACT AND IMPLICATIONS: Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections.
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spelling pubmed-99389452023-02-21 Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis Di Cola, Simone Gazda, Jakub Lapenna, Lucia Ceccarelli, Giancarlo Merli, Manuela JHEP Rep Research Article BACKGROUND & AIMS: Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis. METHODS: The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient’s exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard. RESULTS: We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 vs. 8.9%, p <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26–0.73, p = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states. CONCLUSIONS: The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes. IMPACT AND IMPLICATIONS: Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections. Elsevier 2023-02-19 /pmc/articles/PMC9938945/ /pubmed/36844944 http://dx.doi.org/10.1016/j.jhepr.2023.100703 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Di Cola, Simone
Gazda, Jakub
Lapenna, Lucia
Ceccarelli, Giancarlo
Merli, Manuela
Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title_full Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title_fullStr Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title_full_unstemmed Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title_short Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis
title_sort infection prevention and control programme and covid-19 measures: effects on hospital-acquired infections in patients with cirrhosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9938945/
https://www.ncbi.nlm.nih.gov/pubmed/36844944
http://dx.doi.org/10.1016/j.jhepr.2023.100703
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