The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Gastrointestinal System Infections (GI):

 

GI-CDI :Clostridium difficile infection.

A Clostridium difficile infection (previously also referred to as Clostridium difficile associated diarrhoea, or CDAD) must meet at least one of the following criteria:

  • Diarrhoeal stools or toxic megacolon, and a positive laboratory assay for C. difficile toxin A and/or B in stools;
  • pseudomembranous colitis revealed by lower gastro-intestinal endoscopy;
  • colonic histopathology characteristic of C. difficile infection (with or without diarrhoea) on a specimen obtained during endoscopy, colectomy or autopsy.

Note:

if clinical signs of Clostridium difficile infection appear in 28 days after hospital discharge period, GI-CDI must be defined as healthcare-associated infection.

 

GI-GE: gastroenteritis (excluding CDI).

Gastroenteritis must meet at least one of the following criteria:

  • patient has an acute onset of diarrhoea (liquid stools for more than 12 hours) with or without vomiting or fever (> 38 °C) and no likely non-infectious cause (e.g. diagnostic tests, therapeutic regimen other than antimicrobial agents, acute exacerbation of a chronic condition, or psychological stress).
  • patient has at least two of the following signs or symptoms with no other recognised cause: nausea, vomiting, abdominal pain, fever (> 38 °C), or headache;

and at least one of the following:

    • an enteric pathogen is cultured from stool or rectal swab;
    • an enteric pathogen is detected by routine or electron microscopy;
    • an enteric pathogen is detected by antigen or antibody assay on blood or feces;
    • evidence of an enteric pathogen is detected by cytopathic changes in tissue culture (toxin assay);
    • diagnostic single antibody titre (IgM) or fourfold increase in paired sera (IgG) for pathogen.

 

GI-GIT: gastrointestinal tract (oesophagus, stomach, small and large bowel, and rectum) excluding gastroenteritis and appendicitis.

Gastrointestinal tract infections, excluding gastroenteritis and appendicitis, must meet at least one of the following criteria:

  • patient has an abscess or other evidence of infection seen during a surgical operation or histopathologic examination;
  • patient has at least two of the following signs or symptoms with no other recognised cause and compatible with infection of the organ or tissue involved: fever (> 38 °C), nausea, vomiting, abdominal pain, or tenderness;

and at least one of the following:

    • organisms cultured from drainage or tissue obtained during a surgical operation or endoscopy or from a surgically placed drain;
    • organisms seen on Gram’s or KOH stain or multinucleated giant cells seen on microscopic examination of drainage or tissue obtained during a surgical operation or endoscopy or from a surgically placed drain;
    • organisms cultured from blood;
    • evidence of pathologic findings on radiographic examination;
    • evidence of pathologic findings on endoscopic examination (e.g. Candida esophagitis or proctitis).

 

GI-HEP: hepatitis.

Hepatitis must meet the following criterion:

  • patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), anorexia, nausea, vomiting, abdominal pain, jaundice, or history of transfusion within the previous three months;

and at least one of the following:

    • positive antigen or antibody test for hepatitis A, hepatitis B, hepatitis C, or delta hepatitis;
    • abnormal liver function tests (e.g. elevated ALT/AST, bilirubin);
    • cytomegalovirus (CMV) detected in urine or oropharyngeal secretions.

Further instructions for reporting:

  • hepatitis or jaundice of non-infectious origin (alpha-1 antitrypsin deficiency, etc) must not be  reported;
  • hepatitis or jaundice that result from exposure to hepatotoxins (alcoholic or acetaminopheninduced hepatitis, etc) must not be  reported;
  • hepatitis or jaundice that result from biliary obstruction (cholecystitis) must not be reported.

 

GI-I AB: intra-abdominal, not specified elsewhere including gallbladder, bile ducts, liver (excluding viral epatitis), spleen, pancreas, peritoneum, subphrenic or subdiaphragmatic space, or other intra-abdominal tissue or area not specified elsewhere

Intra-abdominal infections must meet at least one of the following criteria:

  • patient has organisms cultured from purulent material from intra-abdominal space obtained during a surgical operation or needle aspiration;
  • patient has abscess or other evidence of intra-abdominal infection seen during a surgical operation or histopathologic examination;
  • patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), nausea, vomiting, abdominal pain, or jaundice;

and at least one of the following:

    • organisms cultured from drainage from surgically placed drain (e.g. closed suction drainage system, open drain, T-tube drain);
    • organisms seen on Gram’s stain of drainage or tissue obtained during surgical operation or needle aspiration;
    • organisms cultured from blood and radiographic evidence of infection, e.g. abnormal findings on ultrasound, CT scan, MRI, or radiolabel scans (gallium, technetium, etc.) or on abdominal x-ray.

A pancreatitis (an inflammatory syndrome characterised by abdominal pain, nausea, and vomiting associated with high serum levels of pancreatic enzymes) must not be reported, unless it is determined to be infectious origin.

_____ 

Link to European IC/HH Core Competencies

Area 3. Surveillance and investigation of healthcare associated infection (HAI)

 

References

http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf