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Chapter 21 : Hospital-Associated Infections

Authors: Fann Wu1, Susan Whittier2, Phyllis Della-Latta3
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Affiliations: 1: Clinical Microbiology Services, Columbia University Medical Center, New York-Presbyterian Hospital, 622 West 168th Street, CHC 3-325, New York, NY 10032; 2: Clinical Microbiology Services, Columbia University Medical Center, New York-Presbyterian Hospital, 622 West 168th Street, CHC 3-325, New York, NY 10032; 3: Clinical Microbiology Services, Columbia University Medical Center, New York-Presbyterian Hospital, 622 West 168th Street, CHC 3-325, New York, NY 10032
Content Type: Monograph
Publication Year: 2009

Category: Clinical Microbiology

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Abstract:

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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Tables

Hospital-Associated Infections
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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
/content/10.1128/9781555815455.ch21.ch21tab01
Table 1.
Major pathogen distribution by infection site in immunocompromised patients
Generic image for table
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
/content/10.1128/9781555815455.ch21.ch21tab02
Table 2.
Distribution of major pathogens in bloodstream infections in immunocompromised and immunocompetent patients
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
/content/10.1128/9781555815455.ch21.ch21tab03
Table 3.
toxins
Generic image for table
Table 3.

toxins

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
/content/10.1128/9781555815455.ch21.ch21tab04
Table 4.
Direct laboratory identification of species
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
/content/10.1128/9781555815455.ch21.ch21tab05
Table 5.
Comparison of MRSA real-time PCR assays
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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