Table 1.

Summary of abstracts presented at the 2013 World Healthcare-Associated Infections Forum

I. Antimicrobial use and resistance
Author	Short title	Study design	Setting	Key findings
Balkhy et al.	Susceptibility of isolates from patients with VAP in Saudi Arabia	Retrospective susceptibility study	Single adult ICU, Saudi Arabia, 2004 – 2009	• Acinetobacter spp. was highly resistant (70 – 90%) to all tested antimicrobials including carbapenems (78% had four-class MDR)
				• Klebsiella spp. had low (0 – 14%) resistance with no detected MDR
Carrel et al.	MRSA and proximity to concentrated animal feeding operations	Retrospective unmatched case-control study	Veterans Affairs Hospital, Iowa, USA, 2009 – 2011	• High swine exposure (residential proximity to CAFOs) was associated with an increased risk of MRSA colonization
Dantes et al.	National burden of invasive MRSA infections, USA 2011	Prospective, population-based surveillance study	USA, 2011	• Compared to 2005, hospital-onset MRSA infections decreased by 54%, but community-associated infections remain stable
				• Invasive MRSA infections are now more common among persons in the community than hospitalized patients
Datta et al.	Quantifying MDRO exposure from patients in a single hospital to all California facilities	Retrospective case-cohort study	California hospitals and long-term-care facilities, 2005 – 2009	• Within a 5-year period, 1,198 patients with MRSA in a single hospital later exposed 137 hospitals and 103 LTCF
Gastmeier et al.	Dramatic increase of vancomycin-resistant enterococci in Germany with a belt of high proportions	Prospective surveillance study	> 600 ICUs and > 300 surgical wards throughout Germany, 2007 – 2012	• Healthcare-associated VRE colonization and infections are increasing dramatically in Germany, particularly SSI and primary BSI
				• There is a belt of significantly higher VRE proportions running through the middle of Germany
Gikas et al.	Antimicrobial use and HAI prevalence in Greek hospitals	Antimicrobial and HAI point prevalence study	37 hospitals, Greece, 2012	• 54.7% of hospitalized patients were receiving an antimicrobial (a slight increase from 51.4% ten years before)
				• ICU and surgery patients received the highest proportion of antimicrobials
				• 9% of patients had documentation of a HAI
Gniadkowski et al.	Obstacles in controlling KPC spread in Poland	Retrospective surveillance study	Poland, 2008 – June 2013	• KPC-producing enterobacteriaceae have spread rapidly throughout Poland since their emergence in 2008
				• Most common infection type is UTI; infections are most commonly reported by ICUs
Hsueh PR	Antimicrobial drug resistance in Asia Pacific	Prospective and retrospective surveillance studies	Taiwan, 2002 – 2011	• VRE infections in Taiwanese ICUs are increasing dramatically
				• ESBL-producing Escherischia coli infections have been increasing in Asia Pacific
				• Resistance to colistin (polymyxin B) is emerging in A. baumannii and Pseudomonas aeruginosa
Kaku et al.	Trends of antimicrobial resistance in a Japanese hospital	Retrospective surveillance study	Tertiary care hospital, Japan, 2012 – April 2013	• ESBL-producing bacteria are increasing in prevalence
				• Trends in MRSA and multi-resistant Pseudomonas are stable
Mushtaq et al.	Prevalence of carbapenemase carriage among inpatients in Karachi	Prospective surveillance study	Tertiary care hospital, Pakistan, 2012	• Of 469 patients sampled on admission by rectal swab, 36% were positive for blaNDM and 92% for blaCTX-M-15
Reuland et al.	Risk factors for carriage of ESBL-producing enterobacteriaceae in the community	Prospective cohort study with nested, unmatched case-control study	Adult, community-dwelling volunteers, Netherlands, 2012	• Of 1713 stool samples from community-dwelling volunteers, 8% were positive for ESBL-producing enterobacteriaceae
				• Significant risk factors were hospital admission in a foreign country, antimicrobial use, and antacid use
				• ESBL-encoding genes CTX-M-15 and -14 were significantly associated with travel to Africa and the Middle and Far East, while CTX-M-1 had no association with travel
Thu le et al.	Antimicrobial use and resistance in surgical patients in Vietnam	Literature review	Vietnamese hospitals, 2010 – 2012	• Antimicrobials are prescribed inappropriately in Vietnamese surgical patients
				• The chief reason for prolonging antimicrobial therapy was the perception of a “poor environment”
II. Emergence and control of endemic resistance
Author	Short title	Study design	Setting	Key findings
Adler et al.	Characteristics of an outbreak caused by OXA-48-producing CRE in a neonatal ICU in Jerusalem	Combined retrospective and prospective before-after cohort study	Neonatal ICU, Israel, 2012	• At the peak of the outbreak, one third of ICU patients acquired OPE
				• After the implementation of a bundled intervention, which included cohorting colonized patients, frequent rectal surveillance, and improving the implementation of infection control practices, no new cases were detected over the following three months
Baltieri et al.	Prevention of Staphylococcus aureus infection in the NICU: routine surveillance and decolonization	Combined retrospective and prospective before-after cohort study	Brazilian NICU, 2010 – 2012	• In response to increasing MRSA prevalence, universal NICU screening and decolonization (nasal mupirocin and oral hygiene with chlorhexidine for one week) were implemented
				• The fraction of MRSA infections decreased from 2% to 0.4% after bundle implementation; there was no significant impact on MSSA infections
				• There was no microorganism replacement phenomenon
Cheung et al.	Overcoming hand hygiene fatigue by involving the link nurses	Before-after study	Tertiary care hospital, Hong Kong, 2008 – 2012	• The activities of link nurses helped to increase compliance with hand hygiene practices from 50% to 83%
Fournier et al.	Emerging MDRO: same risk of outbreaks?	Prospective surveillance study	38 hospitals, France, 2010 – March 2013	• Incidence of secondary cases of VRE and CRE was significantly lower if cohorting and dedicated nursing staff and/or barrier precautions were employed within two days of detection of the index case
				• If these measures were delayed beyond two days, VRE spread was more significant than that of CRE
Grall et al.	Can the medical device DAV132 decrease the impact of antibiotics on fecal microbiota?	Experimental animal models (porcine, canine, murine)	France, 2013	• DAV132 is an oral medical device designed to deliver an adsorbent to the distal ileum that interferes with antibiotic absorption distal to the ileocecal junction
				• DAV132 captured gut antibiotic residues in dogs treated with intravenous levofloxacin without impacting blood pharmacokinetics and, in mice, significantly reduced the impact of cefotaxime on resistance to colonization by beta-lactam resistant enterobacteriaceae
III. Antimicrobial conservation
Author	Short title	Study design	Setting	Key findings
Awang Jalil et al.	Infection prevention and control strategies of MDR infections in a neonatal ICU	Before-after study	Neonatal ICU, Malaysia, 2012 – April 2013	• An antimicrobial conservation program with dedicated staff was implemented, with resultant improvement in hand hygiene practices (95% compliance) and a sharp decline in HAI sepsis rates
Bailin et al.	Antimicrobial treatment for UTI among patients with total hip or knee arthroplasty	Two-stage combined retrospective and prospective cohort study	Tertiary care hospital, USA, 2011 – 2012	• Pre-operative screening for UTI was conducted in 95% of patients undergoing total hip or knee arthroplasty, regardless of symptoms; post-operative removal of the urinary catheter was also followed by urinalysis in 99% of patients regardless of symptoms
				• Nearly half (45.5%) of patients received antimicrobials pre- or post-operatively
				• In the prospective study, receipt of antimicrobials was not associated with signs and symptoms of UTI
Bavestrello et al.	Impact of intervention on antimicrobial consumption in aquaculture in Chile	Before-after economic analysis	Chile, 2008 – 2009	• After regulations on antimicrobial use in the salmon industry were introduced in late 2008, importation of fluoroquinolones decreased dramatically
Edmunds et al.	Assessing the need for antimicrobial use guidelines among staff of a Saudi Arabian hospital	Voluntary survey	Tertiary care hospital, Saudi Arabia, 2013	• Physicians’ responses to clinical vignettes in this survey showed good awareness of appropriate antibiotic options for various infections
				• Correct answers were not associated with age group, gender, or training status
Glass-Kaastra et al.	Variation in antimicrobial use patterns in Canadian Provinces	Retrospective population-level surveillance study	Canadian provinces, 2000 – 2010	• Although overall antimicrobial use is declining, patterns of use vary by province
				• Quebec had the lowest overall antimicrobial use, Newfoundland the highest
Guzman-Blanco et al.	Pan-American Health Organization guideline for treatment of infectious diseases in Latin America	International guideline	Latin America, 2013	• This guideline was recently updated to include recent surveillance data from Central and South America
Koo et al.	Appropriateness of continued use of empirical vancomycin	Retrospective cohort study	Tertiary care hospital, South Korea 2012	• Only 37.8% of systemic vancomycin prescriptions for 339 hospitalized patients over the year were deemed appropriate
Ling et al.	Case-control study to determine risk factors for CRE carriage	Retrospective matched (1:2) case-control study	Tertiary care hospital, Singapore, 2011 – 2013	• Significant risk factors were overseas hospitalizations in the past year, ICU admission, and exposure to carbapenems and fluoroquinolones
Mehtar and Hara	Antimicrobial stewardship in Africa-humble beginnings	Descriptive epidemiologic study	African hospitals, 2011 – 2012	• Only 14% of hospitals responding to a ESCMID survey reported having an ACP in place
				• The new Infection Control Africa Network is implementing ACP education programs in some African countries; long-distance learning and communication will employ mobile phone technology
Moro et al.	Impact of a regional intervention program to control carbapenemase-producing Klebsiella pneumonia (CPKP)	Before-after study	17 hospitals, Italy (Emilia-Romagna), 2011 – 2013	• Given the rapid spread of CRE in Italy, a bundled intervention targeting patients at increased risk for CRE was implemented in mid-2011 in the county of Emilia-Romagna
				• A significant deceleration in the spread of CRE was observed overall; in 5 hospitals the incidence rate of CPKP decreased from 32 to 15 cases/100,000 hospital patient-days
Ndoye	Antibiotic control in Senegal	Before-after study	Community hospitals, Senegal, 2008 – 2012	• Despite a national initiative issued in 2008 to establish site-based antibiotic conservation, regular assessments through 2012 reveal that nearly 60% of facilities have not begun any preparatory activity, and no facility has implemented recommended interventions fully
				• The chief reason appears to be a shortage of dedicated human resources
Nicolle	Antimicrobial stewardship in long-term-care facilities: what is effective?	Systematic literature review	Published studies retrieved through Medline & Embase, 1998 – 2013	• Engagement of internists and promoting infectious diseases consultations were very effective; strategies incorporating education, local guidelines, and feedback were less so
				• Specific programs to decrease UTI prophylaxis and treatment of asymptomatic bacteriuria were successful
Nussenblatt et al.	Inappropriate diagnosis and treatment of VAP is common in ICUs	Prospective observational study	ICUs in a single tertiary care center, USA, 2009 – 2010	• Antibiotics were continued for more than 3 days in patients without VAP (77%)
				• Those patients with inappropriately long antibiotic courses trended toward more symptomatic CDI and longer hospital stays
Pulcini and Carlet for WAAAR	A multidisciplinary initiative to save antibiotics: the World Alliance Against Antibiotic Resistance	Cross-disciplinary alliance	42 countries represented, 2011 –	• This alliance of nearly 500 individuals from 42 countries was formed in 2011
				• Non-profit organization composed of antimicrobial prescribers (physicians, veterinarians) and consumers, including politicians and environmentalists) open to all people worldwide
				• Goal is to decrease AMR’s prevalence
Skov et al.	Reducing antibiotic usage in Denmark: a campaign launch	Ongoing campaign	Danish general practitioners and general public, 2012 –	• In response to increasing AMR prevalence, a campaign to reduce unnecessary antimicrobial consumption has been launched
				• The campaign targets prescribers (physicians) and consumers (general public)

ACP: antimicrobial conservation program; AMR: antimicrobial resistance; BSI: bloodstream infections; CAFO: concentrated animal feeding operation; CDI: Clostridium difficile infection; CRE: carbapenem-resistant enterobacteriaceae; ESBL: extended-spectrum beta-lactamase; ESCMID: European Society of Clinical Microbiology and Infectious Diseases; HAI: healthcare-associated infection; ICU: intensive care unit; KPC: Klebsiella pneumoniae carbapenemase; LTCF: long-term-care facility; MDR: multi-drug resistant; MDRO: multidrug-resistant organism; MRSA: methicillin-resistant Staphylococcus aureus; MSSA: methicillin-susceptible S. aureus; NICU: neonatal intensive care unit; OPE: OXA-48-producing enterobacteriacae; SSI: surgical site infections; UTI: urinary tract infection; VAP: ventilator-associated pneumonia; VRE: vancomycin-resistant enterococci.