Cardiovascular System Infection

The “Point prevalence survey of healthcare-associated infections and Antimicrobial use in European acute care hospitals” protocol adopts the following definition of Cardiovascular System Infection (CVS).

CVS-VASC: arterial or venous infection.

Arterial or venous infection must meet at least one of the following criteria

patient has organisms cultured from arteries or veins removed during a surgical operation and blood culture not done or no organisms cultured from blood;

patient has evidence of arterial or venous infection seen during a surgical operation or histopathologic examination;

patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, erythema, or heat at involved vascular site,

and

more than 15 colonies cultured from intravascular cannula tip using semiquantitative culture method,

and

blood culture not done or no organisms cultured from blood.

patient has purulent drainage at the involved vascular site,

and

blood culture not done or no organisms cultured from blood.

infection of an arteriovenous graft, shunt, or fistula, or intravascular cannulation site without organisms cultured from blood must be reported as CVS-VASC.

CVS-ENDO: endocarditis.

Endocarditis of a natural or prosthetic heart valve must meet at least one of the following criteria

patient has organisms cultured from valve or vegetation;

patient has two or more of the following signs or symptoms with no other recognised cause: fever (> 38 °C), new or changing murmur, embolic phenomena, skin manifestations (i.e. petechiae, splinter haemorrhages, painful subcutaneous nodules), congestive heart failure, or cardiac conduction abnormality,

and at least one of the following:

organisms cultured from two or more blood cultures;

organisms seen on Gram’s stain of the valve when culture is negative or not done;

valvular vegetation is seen during a surgical operation or autopsy;

positive antigen test on blood or urine (e.g. H. influenzae, S. pneumoniae, N. meningitidis, or Group B Streptococcus);

evidence of new vegetation seen on echocardiogram;

If the diagnosis is made antemortem, the physician institutes appropriate antimicrobial therapy.

CVS-CARD: myocarditis or pericarditis.

Myocarditis or pericarditis must meet at least one of the following criteria

patient has organisms cultured from pericardial tissue or fluid obtained by needle aspiration or during a surgical operation;

patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), chest pain, paradoxical pulse, or increased heart size;

and at least one of the following:

abnormal ECG/EKG consistent with myocarditis or pericarditis;

positive antigen test on blood (e.g. H. influenzae, S. pneumonia);

evidence of myocarditis or pericarditis on histologic examination of heart tissue;

fourfold rise in type-specific antibody with or without isolation of virus from pharynx or faeces;

pericardial effusion identified by echocardiogram, CT scan, MRI, or angiography.

CVS-MED: mediastinitis.

Mediastinitis must meet at least one of the following criteria

patient has organisms cultured from mediastinal tissue or fluid obtained during a surgical operation or needle aspiration;

patient has evidence of mediastinitis seen during a surgical operation or histopathologic examination;

patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), chest pain, or sternal instability;

and at least one of the following:

purulent discharge from the mediastinal area;

organisms cultured from blood or discharge from the mediastinal area;

mediastinal widening on x-ray.

A mediastinitis that follows a cardiac surgery that is accompanied by osteomyelitis must be reported as SSI-O

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