Hospital-Acquired Infections Treatment & Management

  • Author: Ayesha Mirza, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 5, 2012
 

Medical Care

Symptomatic treatment of shock, hypoventilation, and other complications should be provided, along with administration of empiric broad-spectrum antimicrobial therapy.

Bloodstream infections

Line removal should be considered if the line is no longer needed; if the infection is caused by S aureus, Candida species, or mycobacteria; if the patient is critically ill; if the patient fails to clear bacteremia in 48-72 hours; if symptoms of bloodstream infection persist beyond 48-72 hours; and if noninfectious valvular heart disease, endocarditis, metastatic infection, or septic thrombophlebitis is present.[24]

Antibiotics with coverage against gram-positive and gram-negative organisms, including Pseudomonas, should be empirically started and then tailored according to susceptibility pattern of isolated organisms.

Antifungal therapy (eg, fluconazole, caspofungin, voriconazole, amphotericin B) in some cases are added to empiric antibiotic coverage. Antiviral therapy (eg, ganciclovir, acyclovir) can be used in the treatment of suspected disseminated viral infections.

Duration of therapy depends on several factors, including isolated pathogen, retention of catheter, or presence of complications (endocarditis, sepsis). For most bacterial organisms, the duration of therapy is 10-14 days after blood cultures become negative.

Pneumonia

Initial empiric antibiotic therapy should be broad and later on streamlined based on results of examination and cultures of sputum, endotracheal suction material and bronchial lavage wash. The choice of empiric antibiotic coverage should take into consideration the risk for multidrug-resistant (MDR) pathogens. Risk factors for MDR include antimicrobial therapy over the past 90 days, current hospitalization of 5 days or more, high frequency of antibiotic resistance in the community, or hospital and immunosuppression.[26]

No clear consensus has been reached as to the duration of antimicrobial therapy for ventilator-associated pneumonia (VAP). Many experts treat for 14-21 days. However, shorter course of antibiotic therapy (about 1 wk) may be adequate therapy for some cases.[27]

Antiviral medications against influenza have been used to treat symptomatic patients and patients with immunodeficiency or chronic lung diseases to limit morbidity and mortality.

Urinary tract infection

Indwelling catheters should be removed if possible, to avoid persistence and recurrence of infection. In some cases, removal of catheter may result in spontaneous resolution of bacteriuria or asymptomatic cystitis.

Empiric antibiotic and antifungal therapy should be considered to avoid major complications, including pyelonephritis, renal damage, and bloodstream infections. Duration of therapy is controversial. Most experts recommend at least 10-14 days of therapy for children with sepsis, pyelonephritis, or urinary tract abnormalities.

Surgical-site infection

Surgical-site infections (SSIs) should be managed with a combination of surgical care and antibiotic therapy. Antibiotic coverage should be modified once culture results are available.

Severe infections such as streptococcal gangrene and extensive tissue necrosis need aggressive surgical intervention. For these kinds of infections, antibiotics alone may not work.

Other healthcare-associated infections

Rotavirus gastroenteritis is a self-limited disease and only needs supportive care. Medical management should focus on preventing dehydration.

Treatment is not necessary for asymptomatic carriers of Clostridium difficile. For those who have mild symptoms, discontinuance of antibiotics alone may result in resolution of symptoms. For those who have more severe diarrhea, oral metronidazole is the preferred treatment. Oral vancomycin is reserved for treatment failure with metronidazole. Clinical improvement is usually seen within 2 days of initiating therapy, and duration of treatment is usually 10 days.

Next

Surgical Care

Surgical debridement is an integral part of management of surgical-site infections or superinfected decubitus ulcers. Tissue sample should be processed using appropriate stains and cultures to identify the pathogen and its susceptibility.

Previous
Next

Consultations

Infectious disease specialists, burn care specialists, and surgical teams are usually involved in the care of complicated cases. Patients with complicated and severe healthcare-associated infections may require expert care from an ICU team.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Ayesha Mirza, MD  Assistant Professor, Pediatric Infectious Diseases, University of Florida College of Medicine Jacksonville

Ayesha Mirza, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, HIV Medicine Association of America, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Haidee T Custodio, MD  Assistant Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine

Haidee T Custodio, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Coffin SE, Zaoutis TE. Healthcare-Associated Infections. In: Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Churchill Livingstone; 2008:chap 101.

  2. Hospital Infections Program, National Center for Infectious Diseases, CDC. Public Health Focus: surveillance, prevention, and control of nosocomial infections. MMWR. October 1992;41(42):783-787.

  3. Hughes JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34(6):553-61. [Medline].

  4. Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control. Nov 2008;36(9):609-26. [Medline].

  5. Wenzel RP, Edmond MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis. Mar-Apr 2001;7(2):174-7. [Medline].

  6. Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, et al. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr. Apr 2002;140(4):432-8. [Medline].

  7. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA, Levine GL, Stover BH. Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey. J Pediatr. Dec 2001;139(6):821-7. [Medline].

  8. Tikhomirov E. WHO programme for the control of hospital infections. Chemioterapia. June 1987;6(3):148-51.

  9. Rosenthal VD, Maki DG, Mehta A, Alvarez-Moreno C, Leblebicioglu H, Higuera F. International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control. Nov 2008;36(9):627-37. [Medline].

  10. Aiken AM, Mturi N, Njuguna P, Mohammed S, Berkley JA, Mwangi I, et al. Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study. Lancet. Dec 10 2011;378(9808):2021-7. [Medline].

  11. Gastmeier P, Geffers C, Brandt C, Zuschneid I, Sohr D, Schwab F. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect. Sep 2006;64(1):16-22. [Medline].

  12. Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcare-associated infections in US hospitals, 2002. Public Health Rep. Mar 2007;122(2):160-6.

  13. Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2008. CDC. Available at http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf. Accessed 7/1/2009.

  14. Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. Mar 4 2011;60(8):243-8. [Medline].

  15. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. Apr 1999;103(4):e39. [Medline].

  16. Mahieu LM, De Muynck AO, Ieven MM, De Dooy JJ, Goossens HJ, Van Reempts PJ. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect. Jun 2001;48(2):108-16. [Medline].

  17. Newman CD. Catheter-related bloodstream infections in the pediatric intensive care unit. Semin Pediatr Infect Dis. Jan 2006;17(1):20-4. [Medline].

  18. Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. Apr 2000;19(4):319-24. [Medline].

  19. Elward AM, Warren DK, Fraser VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics. May 2002;109(5):758-64. [Medline].

  20. Fayon MJ, Tucci M, Lacroix J, et al. Nosocomial pneumonia and tracheitis in a pediatric intensive care unit: a prospective study. Am J Respir Crit Care Med. Jan 1997;155(1):162-9. [Medline].

  21. Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics. Dec 2003;112(6 Pt 1):1283-9. [Medline].

  22. Moulin F, Quintart A, Sauvestre C, Mensah K, Bergeret M, Raymond J. [Nosocomial urinary tract infections: retrospective study in a pediatric hospital]. Arch Pediatr. 1998;5 Suppl 3:274S-278S. [Medline].

  23. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. Jun 2008;36(5):309-32. [Medline].

  24. Zaoutis TE, Coffin SE. Clinical Syndromes of Device-Associated Infections. In: Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Churchill Livingstone; 2008:chap 102.

  25. Craven DE, Chroneou A, Zias N, Hjalmarson KI. Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest. Feb 2009;135(2):521-8. [Medline].

  26. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. Feb 15 2005;171(4):388-416. [Medline].

  27. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. Nov 19 2003;290(19):2588-98. [Medline].

  28. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. CDC. Available at http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf. Accessed 7/9/2009.

  29. Committee on Infectious Diseases, American Academy of Pediatrics. Pickering LK. Red Book 2006. 27th ed. American Academy of Pediatrics; 2006:153-160.

  30. Guidelines for the prevention of intravascular catheter-related infections. CDC. Available at http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf. Accessed 7/7/2009.

  31. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. Mar 26 2004;53:1-36. [Medline].

  32. Wong ES, Hooton TM. Guideline for prevention of catheter-associated urinary tract infections. CDC. Available at http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html. Accessed 7/7/2009.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.