Chapter 21 : Hospital-Associated Infections

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The immunocompromised host is at increased risk of acquiring hospital-associated infections (HAIs), resulting in excessive morbidity and mortality, prolonged length of stay (LOS), and considerable cost to medical facilities. Traditionally, infections are classified as either hospital acquired (nosocomial), when symptoms manifest after 72 hours of hospital admission, or community acquired, when infections occur before this time frame. The chapter presents an overview of the prominent emerging pathogens that cause sepsis and respiratory disease-related HAIs in immunocompromised patients. The clinical impact of evolving antimicrobialresistant strains and their financial burden are discussed, along with the critical role of the diagnostic microbiology laboratory in providing tests that detect and identify these pathogens in a clinically relevant time frame. One report that examined early transplant-related mortality after cord blood transplantation from unrelated donors cited a rate close to 50%, mainly due to infectious complications. In this study, infections due to multidrug resistance (MDR) spp. demonstrated a higher mortality rate than those due to cytomegalovirus disease. The majority of patients with ventilator-associated pneumonia (VAP) can be divided into two subgroups according to the time of onset of the disease. Targeted strategies that have been employed with the aim of reduction of selection of MDR gram-negative pathogens include intense monitoring of trends in high-risk units, modifications of formularies, massive education of prescribers, and strict enforcement of infection control practices. The majority of clinical microbiology laboratories still rely on culture-dependent methodologies for the isolation, identification, and antimicrobial susceptibility testing of respiratory tract pathogens.

Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21

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Table 1.

Major pathogen distribution by infection site in immunocompromised patients

Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21
Generic image for table
Table 2.

Distribution of major pathogens in bloodstream infections in immunocompromised and immunocompetent patients

Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21
Generic image for table
Table 3.


Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21
Generic image for table
Table 4.

Direct laboratory identification of species

Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21
Generic image for table
Table 5.

Comparison of MRSA real-time PCR assays

Citation: Wu F, Whittier S, Della-Latta P. 2009. Hospital-Associated Infections, p 429-440. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch21

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