Definition of Nosocomial Infections Causes of Nosocomial Infections Most common sites for Nosocomial Infections Nosocomial Infectious Diseases and antibiotic-resistant during The Covid-19 pandemic

1. Nosocomial infections
In the name of God

2. Learning objectives
Definition of Nosocomial Infections
Causes of Nosocomial Infections
Most common sites for Nosocomial Infections
Nosocomial Infectious Diseases and antibiotic-resistant during The Covid-19
pandemic
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3. Introduction
Nosocomial infections comes from Greek words “ nosus ” meaning
disease and “ komeion ” meaning to take care of
Also called as:
 Hospital acquired infections
 Hospital associated infections
Hospital infections
Healthcare-Associated Infections (HAI)
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4. Key Definitions
• Nosocomial Infection: an infection that occurring within 48 hours of
hospital admission, 3 days of discharge, or 30 days of an operation
• In the 19th century, even when an operation or treatment had been successful,
the patient often died from a patient of infection-related conditions like
sepsis and gangrene.
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5. Healthcare-Associated Infections (HAI)
• About 1 in 10 of the people admitted to a hospital will contract a HAI
• The actual rate of NIs varies from 5-10% among modern health centers in
developed countries and up to 25% in developing countries
• This rate has been reported to be 1.9 to 25 percent in Iran.
• They’re also associated with significant:
• Morbidity
• Mortality
• Hospital costs
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6. Nosocomial infections
 One of the most common wards where HAIs occur is the intensive care unit
(ICU)
The high incidence of nosocomial infections, which has a significant impact
on hospital mortality, represents the main cause of death in 33% of the
patients who died in the ICU.
 Some data show that patients who require ICU and advanced organ support
tend to develop super-infection frequently and are at a significantly increased
risk of death. 6

7. Algorithm for the registry of nosocomial infections
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8. Factors of rising nosocomial infection
Crowded hospital conditions
New microorganism
Increasing number of people with compromised immune system
Increasing Bacterial resistance
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9. Modes of transmission
• There are five main modes of transmission
Contact
Vector borne
Air borne
Droplet
Common vehicle
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10. What causes nosocomial infections?
• Bacteria, fungus, and viruses can
cause HAIs
• Bacteria alone cause about 90
percent of these cases
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11. Common microorganisms (Bacteria)
Aerobic gram-positive cocci
• Staphylococcus aureas [MRSA]
• Enterococci [VRE]
 Aerobic gram-negative bacilli
• Escherichia coli
• P. aeruginosa
• Acinetobacter baumannii
• Klebsiella pneumoniae
• Enterobacter spp 11

12. Common microorganisms
Bacteria Infection type
Staphylococcus aureus (S. aureus) blood
Escherichia coli (E. coli) UTI
Enterococci blood, UTI, wound
Pseudomonas aeruginosa (P.
aeruginosa)
kidney, UTI, respiratory
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13. Common microorganisms (Fungi)
Fungal pathogens are usually associated with opportunistic infections in
immunocompromised patients
• Candidiasis (C. albicans, C. glabrata and … )…… most commonly
• Aspergillosis (Aspergillus fumigatus )
• Mucor mycosis (Covid-19 pandemic)
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14. Common microorganisms(Viruses)
• Infections due to viral pathogens are the least reported, making up 1-5% of all
HAIs pathogens
• hepatitis B and C , human deficiency virus (HIV), rhinovirus,
cytomegalovirus, herpes simplex virus, rotavirus, and influenza
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15. Escherichia coli
E. coli isolatse are responsible for:
80% of community-acquired UTI
30% of nosocomial-acquired UTI (associated with urinary catheters)
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16. Acinetobacter baumannii
ICU is known as the main center for infections caused by A. baumannii
This pathogen is responsible for about 2-10% of infections caused by all
gram-negative
Therapeutic options are very limited and in some cases not exist
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17. Pseudomonas aeruginosa
P. aeruginosa is known to be one of the leading causes of nosocomial
infections, accounting for 10% of all nosocomial infections
Resistance rates to imipenem, quinolones, and third-generation
cephalosporins have increased among P. aeruginosa
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18. Klebsiella pneumoniae
Klebsiella pneumoniae found in a variety of environments, including the human body,
gastrointestinal tract, skin, and nasopharynx
Klebsiella pneumoniae is one of the most important bacterial isolated from NICU in Iran
Due to capsule production, antibiotic resistance, and biofilm formation, the nosocomial
infections caused by this species are typically chronic and difficult to treat
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19. Staphylococcus aureas [MRSA]
MRSA infections are important clinically and socioeconomically due to their
antibiotic resistance and high mortality rates which has prompted WHO to
refer to them as "superbugs"
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20. Enterococci [VRE]
VRE now accounts for about 30% of enterococcal infections, with most VRE
isolates being E.faecium (>90%).
The hands of health care workers appear to be the most common source of
transmission of VRE.
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21. Most common sites for nosocomial infections
 Urinary Tract Infection (i.e., catheter-related)
Surgical/Traumatic Wound Infection
Lower respiratory tract (Ventilator Associated Pneumonia)
 Bloodstream (i.e., catheter-related)
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22. Hospital-acquired infection rates in Iran 2017
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23. Healthcare-Associated Urinary Tract
Infection
Urinary tract infection (UTI) causes ~ 40% of hospital-acquired infections
Most infections due to urinary catheters
25% of inpatients are catheterized
Leads to increased morbidity and costs
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24. Drug Resistant Organism Infections &
Colonizations
• Methicillin-Resistant Staphylocuccus aureus (MRSA)
• Vancomycin-Resistant Enterococcus (VRE)
• Extended-Spectrum Beta Lactamase (ESBL)
• Multi-drug Resistant Bacteria
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25. Frequency of microorganisms detected in positive blood
cultures in hospitalized patients during the pre-COVID-19
period & COVID-19 period
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26. Nosocomial infections in Covid-19 patients admitted to the
ICU of Imam Khomeini complex hospital in Tehran(2021)
• In this study, 289 (23.3%) out of 1320 patients experienced NIs.
• 200 patients (69%) died
• The most common type of nosocomial infection (66%) was ventilator-
associated pneumonia (VAP)
• The most common microorganisms that cause pneumonia were A. baumannii,
K. pneumoniae and P. aeruginosa respectively.
•
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27. COVID-19 & Antibiotic Resistance
 Antibiotic resistance is still a public health threat during the COVID-19
pandemic.
 About 70% of hospitalized COVID-19 patients receive antibiotics
 COVID-19 patients often receive empiric broad-spectrum antibiotic therapy.
 16% of hospitalized COVID-19 patients develop a secondary bacterial
infection, which will necessitate antibiotic therapy.
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European Centre for Disease Prevention and Control (ECDC 2021).

28. Antibiotic-resistant Pathogens in Hospitalized Patients
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