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[Nosocomial infection: clinical aspects]
1Service des Maladies infectieuses Hôpital Saint-Antoine, Paris.
Abstract:
Nosocomial infections develop within a hospital or are produced by microorganisms acquired during hospitalization. They may involve not only patients (2 to 10 percent) but also hospital personnel. They arise from complex interactions of multiple causal factors. Patients risk factors are these that reduce the patient's capacity for resisting the injurious effects of the microorganisms and impair natural host defense mechanisms: patients with malignant disorders or immunosuppressive therapy, poor nutritional status, extensive burn wounds ... The young and the elderly are generally more susceptible to infection. Other infections are preventable. Disease causation is often multifactorial. Nosocomial urinary tract infections had the highest rate, followed by lower respiratory tract infections, surgical infections and bacteremias. The emergence of other nosocomial infections, caused by bacteria (tuberculosis), virus (HIV, hepatitis B and C virus, cytomegalovirus...), Aspergillus species or Pneumocystis carinii appears to be recent in origin and is of importance to immunocompromised hosts, other patients and hospital personnel. Nosocomial infections and their social and economic impacts require for their prevention vigorous organized hospital-wide surveillance and control programs.
Insights
Nosocomial infections, acquired during hospitalization, affect patients and staff. Prevention requires organized hospital-wide surveillance and control programs to mitigate complex causal factors.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Context:
- Nosocomial infections are acquired during hospitalization, impacting both patients (2-10%) and healthcare personnel.
- These infections arise from complex interactions of multiple causal factors, including patient-specific risks and environmental influences.
Purpose:
- To summarize the epidemiology, risk factors, and emerging pathogens associated with nosocomial infections.
- To highlight the importance of surveillance and control programs in preventing hospital-acquired infections.
Summary:
- Nosocomial infections encompass a range of hospital-acquired conditions, with urinary tract infections being the most prevalent, followed by respiratory, surgical, and bloodstream infections.
- Risk factors include patient conditions (immunosuppression, malnutrition, age) and iatrogenic causes, while emerging pathogens like tuberculosis, HIV, and opportunistic fungi pose increasing threats, particularly to immunocompromised individuals.
- The emergence of novel pathogens like HIV, hepatitis B and C virus, cytomegalovirus, Aspergillus, and Pneumocystis carinii is a significant concern for vulnerable populations and hospital staff.
Impact:
- Nosocomial infections present substantial social and economic burdens.
- Effective prevention necessitates robust, organized, hospital-wide surveillance and control programs.
- Understanding multifactorial disease causation is crucial for targeted intervention strategies.