AB1281 Incidence and characteristics of healthcare-associated infection (HCAI) in hospitalised patients with rheumatologic disorders at alexandria main university hospital
Authors: A.A. Abdelati, E.A. Sultan
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Healthcare-associated Infection<b> (</b>HCAI) is an important cause of morbidity and mortality in autoimmune diseases<sup>(1)</sup>. The increased susceptibility to infections in such patients is explained by abnormalities of the cellular and humoral immune responses, as well as the use of immunosuppressive drugs. Infection in these patients can present with minimal signs and symptoms or with atypical features in unusual locations that considerably can delay the diagnosis and worsen the outcome. There are few detailed systematic reports on HCAI in rheumatology; most previous reports investigated HCAI in the setting of systemic lupus erythematosus (SLE) but lack other connective tissue diseases<sup>(2)</sup>. <h3>Objectives</h3> To determine the incidence and characteristics of HCAI in patients with rheumatologic diseases admitted to the Rheumatology Unit at the Alexandria Main University Hospital (AMUH) on 2017. <h3>Methods</h3> A One-year duration prospective observational study to elucidate the incidence and characteristics of HCAI in patients with underlying rheumatologic diseases who were admitted to the Rheumatology Unit of the Internal Medicine Department at AMUH between January1st and December 31st 2017. <h3>Results</h3> A total of 516 patients (423 female (82%) and 93 male (18%)) with underlying rheumatologic diseases and disease duration of 6.03±4.18 years were admitted between January1st and December 31st 2017. The mean age was 32.18±9.54 years, and the mean length of hospitalisation was10.04±5.76 days. HCAI occurred in 14.9% (n=77) of patients with a total number of infections of 81 (15.69%) (four cases had more than one episode of infection in more than one site with a different organism during the same admission). Gram -ve bacilli were the most commonly isolated organisms (46.3%; n=38) followed by Gram +ve cocci (25.6%; n=21). The urinary tract was the most commonly documented site of infection (39.5%; n=32) followed by blood stream (18.5%; n=15), and <i>Klebsiella spp</i> (17.9%; n=15) was the most frequently identified infectious agent, followed by <i>Methicillin-resistant Staphylococcus Aureus</i> (MRSA) (14.3%; n=12). Of the total cases with HCAI (n=77), 85.7% (n=66) treated, 7.8% (n=6) deteriorated and shifted to the ICU with multiorgan failure, 5.2% (n=4) died, and 1.3% (n=1) (a case with meningitis) were referred to another specialised hospital. <h3>Conclusions</h3> Despite the improvement in healthcare services, the incidence of HCAI infection in our inpatient population is still high and represents a burden on our resources. Although most cases were treated with appropriate antimicrobials, HCAI is still the cause of deterioration and death in a considerable percentage of patients with rheumatologic diseases. <h3>References</h3> [1] Doria A, Iaccarino L, Ghirardello A, et al. Long-Term prognosis and causes of death in systemic lupus erythematosus. Am J Med2006;119:700–6. [2] Navarro-Zarza JE, lvarez-Herna EA, Casasola-Vargas JC, et al. Prevalence of community-acquired and nosocomial infections in hospitalized patients with systemic lupus erythematosus. Lupus2010; 19:43–8. <h3>Disclosure of Interest</h3> None declared