From Screening to Outcomes: Fourteen-Year Hospital-Wide Surveillance of Alert Pathogens and Antimicrobial Use in a
Aleksandra Tukendorf1, Julia Burzyńska1, Katarzyna Semczuk1
1Department of Clinical Microbiology and Immunology, Hospital Infection Control Team, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland.
Insights
Increased admission screening and hand hygiene in a paediatric hospital detected more colonisations but kept healthcare-associated infections low. Antimicrobial stewardship shifted antibiotic use without reducing overall consumption.
Area of Science:
- Infection Prevention and Control
- Antimicrobial Stewardship
- Epidemiology
Background:
- Infection prevention and control (IPC) programs integrate pathogen-specific measures like admission screening with universal precautions such as hand hygiene.
- Assessing the interplay between screening, hand hygiene, antimicrobial stewardship (AMS), and hospital-level outcomes is crucial for optimizing patient safety in paediatric settings.
Purpose of the Study:
- To evaluate the temporal associations between admission screening, hand hygiene compliance, antimicrobial stewardship interventions, and hospital-level outcomes, specifically colonisation and healthcare-associated infections (HAIs) caused by alert pathogens.
- To analyze trends in antibiotic consumption patterns in relation to IPC and AMS efforts.
Main Methods:
- Retrospective, hospital-wide ecological time-series study conducted at a tertiary paediatric hospital from 2011-2024.
- Data on screening, colonisation, HAIs, and antibiotic consumption were collected and analyzed using linear regression and Spearman's rank correlation.
- Process indicators included screening tests and alcohol-based hand rub (ABHR) consumption per 1000 patient-days (PD); outcomes included colonisations/HAIs per 1000 PD and antibiotic use (DDD per 1000 PD).
Main Results:
- Screening intensity significantly increased (+8.3/year), correlating with a rise in detected colonisations (slope +0.39/year).
- Multidrug-resistant organism (MDRO)-attributable HAIs remained low and stable (slope -0.014/year).
- Alcohol-based hand rub consumption more than doubled from baseline, while overall antibiotic consumption showed no long-term trend, but a shift in antibiotic class usage was observed.
Conclusions:
- Expansion of admission screening and sustained standard precautions in a paediatric hospital increased colonisation detection but effectively controlled MDRO-attributable HAIs at the hospital level.
- Antimicrobial stewardship interventions were associated with a redistribution of antibiotic classes rather than a reduction in overall consumption.
- These findings highlight the complex interactions between IPC, AMS, and outcomes, providing a basis for hypothesis generation in paediatric settings, though causal inference is limited by the ecological design.
Abstract:
Background/Objectives: Infection prevention and control (IPC) programs combine pathogen-targeted measures (e.g., admission screening) with hospital-wide standard precautions (e.g., hand hygiene, HH). We assessed temporal associations between screening, HH, antimicrobial stewardship (AMS), and hospital-level outcomes in a tertiary paediatric hospital. Methods: This study was a retrospective hospital-wide ecological time-series at the Children's Memorial Health Institute. Annual aggregate data: 2011-2024 for screening, colonisation, and healthcare-associated infections (HAIs) with alert pathogens; 2016-2024 for antibiotic consumption (ATC J01, systemic antibacterials). Process indicators: number of screening tests and alcohol-based hand rub (ABHR) consumption per 1000 patient-days (PD). Outcomes: colonisations/HAIs per 1000 PD and defined daily doses (DDD) per 1000 PD overall and by class. Trends used linear regression and Spearman's rank correlation. Results: Screening intensity increased from 39 to 150/1000 PD (slope +8.3/year; R2 = 0.90; p < 0.001). Detected colonisation rose (2.5 → peak 8.05/1000 PD in 2023; slope +0.39; R2 = 0.81; p < 0.001), while multidrug-resistant-organism (MDRO)-attributable HAIs remained low/stable (0.27-0.62/1000 PD; slope -0.014; p = 0.023). ABHR consumption increased from 26.1 to 78.0 L/1000 PD in 2020 (p < 0.001) and partially normalised to 60.0 in 2024 (>2 × baseline). Overall ATC J01 showed no long-term linear trend (~278-356 DDD/1000 PD; +2.57/year; p = 0.46), but class mix shifted: carbapenems, fluoroquinolones, and amoxicillin-clavulanate decreased; third/fourth-generation cephalosporins, piperacillin/tazobactam, and glycopeptides increased. Conclusions: In this tertiary paediatric setting, expansion of risk-based admission screening and sustained implementation of horizontal IPC measures were accompanied by increased detection of colonisation with alert pathogens, while MDRO-attributable HAIs remained low and stable at the hospital level. Over the same period, AMS activity coincided with a redistribution in antibiotic class use without a clear long-term reduction in total antibiotic consumption. These hospital-level findings are descriptive and hypothesis-generating; causal inference is limited by the ecological study design, and the heterogeneous, multispecialty structure of a tertiary paediatric centre.
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