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Surveillance of Bloodstream Infections in Belgian Hospitals - Annual report 2023 , Data up to and including 2022
No full textThese 2022 results of the National Surveillance of Bloodstream Infections (NSIH-SEP) show a hospital-associated bloodstream infection (HABSI) cumulative incidence of 5.4 patients with HABSI per 1,000 hospitalisations, and a HABSI incidence density of 9.2 episodes per 10,000 patient-days (pd). Incidence of Central line-associated bloodstream infection (CLABSI) in 2022 was 2.4 episodes per 10,000 pd. Generally, hospital-wide incidences of HABSI show decreasing trends since 2020, however their 2022 results remain higher as compared to pre-COVID19 levels (2019 and before).
ICU-associated BSI cumulative incidence in 2022 was 18.6 patients with ICU-BSI per 1,000 ICU hospitalisations, and ICU-BSI incidence density in 2022 was 40 episodes per 10,000 ICU pd. ICU-associated CLABSI incidence density in 2022 was 15.5 episodes per 10,000 ICU pd. Generally, incidences of ICU-BSI are multiple times higher as compared to hospital-wide HABSI. As with hospital-wide HABSI, ICU-BSI incidences also show decreasing trends since 2020, but their 2022 incidence also remains higher as compared to 2019 and before.
Forty–three percent of hospital-wide HABSI cases and even 66% of ICU-BSI cases were linked to an invasive device whether directly (central and other catheters) or indirectly (urinary catheter, endotracheal tube). Of these, exposure to central vascular catheter remains the most frequently reported origin of HABSI cases both hospital-wide (26% of HABSI) as well as ICU-only (39% of ICU-BSI). This report also presents for the first time results on the incidence of HABSI cases associated to the use of peripheral line, their 2022 incidence density being 0.23 episodes per 10,000 pd (hospital-wide) and 0,38 episodes per 10,000 ICU pd (ICU-specific). Incidence of these peripheral line-associated HABSI is much lower as compared to CLABSI incidence, however this type of HABSI is possibly underreported in the current version of the NSIH-SEP surveillance protocol.
In 2022, the most commonly micro-organisms (MO) isolated from hospital-wide HABSI cases were E. coli, S. aureus, and S. epidermidis, this last MO also being the most commonly isolated from hospital-wide CLABSI cases. Long-term increasing trends can be observed for hospital-wide HABSI incidences due to E. coli, K. pneumoniae, and E. faecium. The trend of hospital-wide CLABSI due to S epidermidis is also increasing since 2016, while it is decreasing for CLABSI due to S aureus. We also observe a long-term decreasing trend in the prevalence of methicillin-resistant S aureus (MRSA).
While the NSIH-SEP register was the first national Healthcare-associated infection surveillance to migrate to the Healthdata environment in 2017, its actual tools for data collection and centralized data processing and results reporting are now in need of revision. Tools for data collection need to be harmonized with other registers on BSI/AMR such as surveillance of antimicrobial resistance and of ICU-acquired infections, and also need to be adapted towards automated collection of hospital data where possible. Healthdata tools for centralized data processing and reporting of national NSIH-SEP results should also be automated where possible. Next to this, recent and ongoing technical problems of data collection and analysis environments of the Healthdata platform have resulted in unnecessary delays in the reporting of these results; Sciensano and its Healthdata service are therefore recommended to prioritize on the resolution of these issues, and also to elaborate alternative procedures for data collection and reporting such that deadlines for annual publication of national surveillance results remain unaffected.
Another reason for delayed publication of these national results is the late submission of surveillance data for a substantial number of hospitals. A discussion on the (suspension of) the mandatory status of the NSIH-SEP surveillance might be needed, as the delays now observed in collecting and validating surveillance results from many hospitals might as such be avoided.
These results show that central catheter is the most frequently documented HABSI origin in 2022, and that CLABSI incidence in 2022 remains at an increased level as compared to pre-COVID19 years.
We therefore recommend a strong focus on the prevention of this type of HABSI, in the first place by freeing resources for the development of national recommendations on catheter use, and for the follow-up of their compliance on a national level. The NSIH-SEP surveillance should also be adapted such that it allows a more detailed look into catheter infections, for example by adding indicators on catheter use in hospitals in Belgium, and also by additionally documenting exposure to peripheral line exposure for each HABSI episode.</p
Surveillance épidémiologique des infections invasives à pneumocoques - 2019 à 2022
No full textPoints essentiels
• Depuis l’introduction des vaccins antipneumococciques dans les programmes de vaccination des enfants en 2007, l’incidence des infections invasives à pneumocoques (IPD, Invasive Pneumococcal Disease) chez les enfants de moins de 2 ans a diminué. La première vaccination a été effectuée avec le PCV7, suivi du PCV13 à partir de 2011.
• Entre 2011 et 2015, une baisse a été observée surtout chez les enfants.
• Après le remplacement du PCV13 par le PCV10, de 2016 à 2019, l’incidence a augmenté. L’augmentation était plus prononcée chez les jeunes enfants et principalement associée aux sérotypes du PCV13 non contenus dans le vaccin 10-valent (3, 6A, 19A, PCV13pas10). Au cours de l’épidémie COVID-19 (2020-2021), on a observé une diminution générale de la circulation des agents pathogènes respiratoires, qui incluaient donc S pneumoniae.
• Depuis 2019, année de la réintroduction du PCV13 dans la vaccination de référence, on observe une diminution des sérotypes PCV13pas10 chez les jeunes enfants.
• En 2022, l’incidence a augmenté chez les personnes âgées et pour les sérotypes non inclus dans le PCV13, jusqu’au niveau de l’avant COVID-19.</p
Antimicrobial Use in Belgian Acute Care Hospitals : Results of the 2022 ECDC Point Prevalence Survey
No full textBackground: Point prevalence surveys (PPS) organized by the European Centre for Disease Prevention and Control (ECDC) play a crucial role in assessing healthcare-associated infections (HAIs) and antimicrobial use (AU) in European acute care hospitals. In 2017, a crude prevalence of 28.1% (95% CI 27.3-29.0%) of inpatients receiving at least one antimicrobial was recorded in Belgium (patients ≥65 years: 29.6% (95% CI 28.5-30.7%), <65 years : 26.5% (95%CI 25.3-27.6%)) . Following the challenges posed by the COVID-19 pandemic, the 2022 ECDC-PPS aimed to reassess AU levels.
Method: A cross-sectional study was conducted between September and November 2022 in 57 representative acute care Belgian hospital sites (35 mergers), following the ECDC-PPS protocol version 6.0. All patients present in surveyed wards at 8 a.m. on the PPS day and not discharged at that time were included. Infection prevention and control teams collected comprehensive data on hospitals, wards, and AU, including agents and indications.
Results: Among the 10,142 included inpatients, 29.3% (95%CI 28.4-30.2) were receiving at least one antimicrobial (patients ≥65 years: 31.1% (95% CI 29.7-32.4%), <65 years : 27.1% (95%CI 25.6-28.6%)). Intensive care units (56.3%), surgical (38.7%), and medical wards (33.1%) demonstrated the highest AU prevalence, while psychiatric wards exhibited the lowest (3.0%). A total of 3,549 antimicrobials were recorded, commonly prescribed for treating community-acquired infections (48.6%) and HAIs (30.3%, including 4.2% of long-term care facility acquired infections), as well as for surgical and medical prophylaxis (12.4 and 6.6%, respectively). Notably, only 22.7% of surgical prophylaxis courses (n=100/440) lasted more than one day. The top three most used antimicrobial agents consisted of amoxicillin in combination with a beta-lactamase inhibitor (J01CR02, 20.0%), cefazolin (J01DB04, 9.8%) and piperacillin in combination with a beta-lactamase inhibitor (J01CR05, 9.6%). The most frequently reported diagnoses for medical antimicrobial treatment were pneumonia (25.7%) and urinary tract infections (17.1%). The reason for AU was available in 80.0% of the medical notes.
Conclusion: The 2022 PPS reveals an increased AU prevalence (+1.2%) in Belgian acute care hospitals, especially in patients over 65 years of age (+1.5%). This increase was less pronounced in younger patients (<65y) (+0.6%). Future investigations are crucial to delve into prescription attitudes and modifiable practices, emphasizing the urgent</p
Check of APpropriaTeness of Antimicrobial therapy In Nursing homes (CAPTAIN): a point prevalence study in Belgium
No full textObjectives
The overall prevalence of antimicrobial therapy (AMT) in nursing homes is well described. However, less is known about the appropriateness of AMT in nursing home residents. Therefore, the Check of APpropriaTeness of antimicrobial therapy in nursing homes (CAPTAIN) study aimed to assess both prevalence and appropriateness of AMT in Belgian nursing homes.
Methods
In a prospective, observational, point prevalence study, researchers documented prevalence and identified potentially inappropriate prescriptions (PIPs) by evaluating accordance of AMT with national guidelines. The severity of inappropriateness was assessed by a modified Delphi expert panel.
Results
Eleven nursing homes, including 1178 residents, participated in this study. On the survey day, 8.0% of residents took systemic AMT, primarily for urinary tract infections (54.2%), respiratory tract infections (36.5%), and skin and skin-structure infections (6.3%). About half of these prescriptions were used in prophylaxis (52.1%). Registration of indication and stop date was missing in 58.3% and 56.3% of AMTs, respectively. In 89.6% of the systemic AMTs, at least one discordance with national guidelines was identified, resulting in a total of 171 PIPs, with 49 unique PIPs. Of all unique PIPs, 26.5% were assessed with a high severity score (≥4). According to the expert panel, most inappropriate practice was starting AMT for cough without other symptoms. Inappropriate timing of time-dependent AMTs was common, but assessed as ‘moderately severe’. One-third of systemic AMT exceeded the recommended duration.
Conclusions
AMT in nursing homes is often not prescribed according to national guidelines, highlighting the need for future interventions to promote the rational use of AMT in this setting.</p
Epidemiologische surveillance van invasieve meningokokkeninfecties, Neisseria Meningitidis - 2023
No full textBelangrijkste boodschappen
Sinds 2008 tot 2019 (pre-covid-19) schommelt het aantal door het Nationaal Referentiecentrum bevestigde gevallen rond de honderd per jaar. Na een lager aantal gevallen tussen 2020 en 2022, werden 83 gevallen geregistreerd door het NRC meningokokken in 2023. De diensten die verantwoordelijk zijn voor de meldingsplicht registreerden op hun beurt 104 gevallen van invasieve meningokokkeninfecties in België in 2023.
Kinderen jonger dan 5 jaar werden meer getroffen door deze ziekte, met name kinderen jonger dan 1 jaar, in lijn met voorgaande jaren.
In 2023 waren de serogroepen W en Y samen voor het eerst dominant, goed voor 51,8% van de gevallen (4⅜3 gevallen), gevolgd door serogroep B met 43,4% van de gevallen (36/83 gevallen).
Serogroep B overheerste in alle leeftijdsgroepen, behalve in de leeftijdsgroepen 25-49 en 65+ waar de serogroepen W en Y overheersten, en vooral serogroep Y in de leeftijdsgroep 65+.
De verdeling van de serogroepen in Vlaanderen, Wallonië en het Brussels Hoofdstedelijk Gewest kwam sterk overeen met die op nationaal niveau.
In 2023 werden 3 sterfgevallen gemeld (2 in Wallonië en 1 in Vlaanderen). Twee sterfgevallen betroffen serogroep B en één serogroep W.
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Comparative trends of brucellosis serological testing and confirmed brucellosis cases suggest inappropriate prescription habits
No full text
Épidémiologie, facteurs de risque et prévention des chutes chez les personnes âgées en soins primaires au cours de la période 2019-2021 en Belgique.
No full textA One-Health approach to monitoring antimicrobial consumption in Belgium 2012-2021
No full textBackground
Inappropriate antimicrobial consumption (AMC) drives the emergence of antimicrobial resistance (AMR), necessitating a unified “One Health” approach to combat this global threat. Shared metrics enhance intersectoral comparisons and coordination. This study compares AMC in the Belgian human (hospital and community) and veterinary sectors, using a common metric (mg/estimated kg biomass).
Methodology
The JIACRA methodology[1] adapted to the Belgian context and including more recent data (2012-2021) was used. Belgian human AMC for systemic antimicrobials (ATC group J01) stratified by sector (community or hospital) were retrieved from the TESSy database, hosted by European Centre for Disease Prevention and Control. The data were[2] converted to the mass of active compound and aggregated by antimicrobial class. Annual human biomass in Belgium was estimated from Eurostat population demography data alongside estimates of body mass by gender and age[3]. Data on antimicrobial sales in animals expressed in mg/kg biomass from the BelVet-SAC reports were utilized[4]. Pearson and Spearman correlation tests were performed to assess the correlation between AMC and time.
Results
Significant reductions in total AMC (mg/kg estimated biomass) were observed over time in both humans and animals. Notably, in Belgium, consistently higher average human consumption than animal consumption diverged from European trends. Belgian hospitals contributed significantly to human AMC (20.9% in 2021) compared to the European average (10%). Stagnation in hospital AMC and considerable reductions in community AMC, led to a year-on-year increase in the relative contribution of hospitals to total human consumption (15.3% 2012, to 20.9% in 2021). By examining consumption by antimicrobial class, higher overall population-corrected consumption in humans was noted for penicillins, cephalosporins (all generations) and quinolones while other antimicrobial classes showed higher consumption in animals.
Conclusion
This One-Health approach to measure AMC highlight the need to strengthen antimicrobial stewardship interventions, especially in Belgian hospitals
[1] “JIACRA III — Antimicrobial Consumption and Resistance in Bacteria from Humans and Animals.”
[1] “European Surveillance of Antimicrobial Consumption Network (ESAC-Net).”
[1] “Guidance on Selected Default Values to Be Used by the EFSA Scientific Committee, Scientific Panels and Units in the Absence of Actual Measured Data | EFSA.”
[1] “BELVETSAC.”
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