Hospital-onset bacteremia and fungemia (HOB) has been suggested as a suitable and automatable surveillance target to include in surveillance programs, however differences in definitions across studies limit interpretation and large-scale implementation. We aimed to apply an automated surveillance system for HOB in multiple hospitals using a consensus definition, and describe HOB rates.

Retrospective cohort study in four Dutch hospitals: 1 tertiary hospital and 3 secondary hospitals.

All patients admitted for at least one overnight stay between 2017 and 2021 were included, except patients in psychiatry wards.

Data from the electronic health records and laboratory information system were used to identify HOBs based on the PRAISE consensus definition. HOB rates were calculated at ward and micro-organism-level.

Hospital-wide HOB rates varied from 1.0 to 1.9, and ICU rates varied from of 8.2 to 12.5 episodes per 1000 patient days. The median time between admission and HOB was 8–13 days. HOBs were predominantly caused by Enterobacterales, Enterococci, S. aureus and coagulase-negative staphylococci. Longitudinal HOB surveillance detected differences over time at ward and micro-organism level; for example increased HOB rates were observed during the COVID-19 pandemic. Sensitivity analyses demonstrated the impact of assumptions regarding the collection of confirmatory blood cultures for common commensals.

Applying a fully automated definition for HOB surveillance was feasible in multiple centers with different data infrastructures, and enabled detection of differences over time at ward and micro-organism-level. HOB surveillance may lead to prevention initiatives in the future.

To determine the prevalence and determinants of fecal carriage of vancomycin-resistant enterococci (VRE) in intensive care unit (ICU), hematology-oncology, and hemodialysis patients in The Netherlands.

Descriptive, multicenter study, with yearly 1-week point-prevalence assessments between 1995 and 1998.

All patients hospitalized on the testing days in ICUs and hematology-oncology wards in nine hospitals in The Netherlands were included.

Rectal swabs obtained from 1,112 patients were screened for enterococci in a selective broth and subcultured on selective media with and without 6 mg/L vancomycin. Resistance genotypes were determined by polymerase chain reaction. Further characterization of VRE strains was done by pulsed-field gel electrophoresis (PFGE). We studied possible determinants of VRE colonization with a logistic regression analysis model. Determinants analyzed included gender, age, and log-transformed length of prior hospital stay.

The results showed that 614 (55%) of 1,112 patients were colonized with vancomycin-sensitive enterococci, and 15 (1.4%) of 1,112 carried VRE. No increase in VRE colonization was observed from 1995 to 1998. Eleven strains were identified as Enterococcus faecium and four as Enterococcus faecalis. All E faecium and one E faecalis carried the vanA gene; the other E faecalis strains harbored the vanB gene. PFGE revealed that three vanB VRE isolated from patients hospitalized in one single ICU were related, suggesting nosocomial transmission. Though higher age seemed associated with VRE colonization, exclusion of patients with the nosocomial strain from the regression analysis decreased this relation to nonsignificant. Duration of hospital stay was not associated with VRE colonization.

VRE colonization in Dutch hospitals is an infrequent phenomenon. Although nosocomial spread occurs, most observed cases were unrelated, which suggests the possibility of VRE acquisition from outside the hospital. Prolonged hospital stay, age, and gender proved unrelated to VRE colonization.