Incidence and pathogen distribution of healthcare-associated infections in pilot hospitals in Egypt.
OBJECTIVE
To report type and rates of healthcare-associated infections (HAIs) as well as pathogen distribution and antimicrobial resistance patterns from a pilot HAI surveillance system in Egypt.


METHODS
Prospective surveillance was conducted from April 2011 through March 2012 in 46 intensive care units (ICUs) in Egypt. Definitions were adapted from the Centers for Disease Control and Prevention's National Healthcare Safety Network. Trained healthcare workers identified HAIs and recorded data on clinical symptoms and up to 4 pathogens. A convenience sample of clinical isolates was tested for antimicrobial resistance at a central reference laboratory. Multidrug resistance was defined by international consensus criteria.


RESULTS
ICUs from 11 hospitals collected 90,515 patient-days of surveillance data. Of 472 HAIs identified, 47% were pneumonia, 22% were bloodstream infections, and 15% were urinary tract infections; case fatality among HAI case patients was 43%. The highest rate of device-associated infections was reported for ventilator-associated pneumonia (pooled mean rate, 7.47 cases per 1,000 ventilator-days). The most common pathogens reported were Acinetobacter species (21.8%) and Klebsiella species (18.4%). All Acinetobacter isolates tested (31/31) were multidrug resistant, and 71% (17/24) of Klebsiella pneumoniae isolates were extended-spectrum β-lactamase producers.


CONCLUSIONS
Infection control priorities in Egypt should include preventing pneumonia and preventing infections due to antimicrobial-resistant pathogens.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Isaac
I
See
Fernanda C
FC
Lessa
Omar Abo
OA
ElAta
Soad
S
Hafez
Karim
K
Samy
Amani
A
El-Kholy
Mervat Gaber
MG
El Anani
Ghada
G
Ismail
Amr
A
Kandeel
Ramy
R
Galal
Katherine
K
Ellingson
Maha
M
Talaat
D000293:Adolescent; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology; D011159:Population Surveillance; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D062885:Urinary Catheters / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult