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Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document C(2012) 5538) (Text with EEA relevance) (2012/506/EU), Division 3.1. is up to date with all changes known to be in force on or before 26 July 2024. There are changes that may be brought into force at a future date. Changes that have been made appear in the content and are referenced with annotations.
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A nosocomial infection associated to the current hospital stay is defined as infection that matches one of the case definitions AND
the onset of symptoms was on Day 3 or later (day of admission = Day 1) of the current hospital admission OR
the patient underwent surgery on day 1 or day 2 and develops symptoms of a Surgical Site Infection before day 3 OR
an invasive device was placed on day 1 or day 2 resulting in an HAI before day 3
A nosocomial infection associated to a previous hospital stay is defined as infection that matches one of the case definitions
AND
the patient presents with an infection but has been readmitted less than two days after a previous admission to an acute care hospital
OR
the patient has been admitted with an infection that meets the case definition of a Surgical Site Infection i.e. the SSI occurred within 30 days of the operation (or in the case of surgery involving an implant was a deep or organ/space SSI that developed within a year of the operation) and the patient either has symptoms that meet the case definition and/or is on antimicrobial treatment for that infection
OR
the patient has been admitted (or develops symptoms within two days) with Clostridium difficile infection less than 28 days from a previous discharge from an acute care hospital.
For the purpose of point prevalence surveys, an active nosocomial infection present on the day of the survey is defined as an infection for which signs and symptoms of the infection are present on the survey date or signs and symptoms were present in the past and the patient is (still) receiving treatment for that infection on the survey date. The presence of symptoms and signs should be verified until the start of the treatment in order to determine whether the treated infection matches one of the case definitions of nosocomial infection
Osteomyelitis must meet at least one of the following criteria:
Patient has organisms cultured from bone
Patient has evidence of osteomyelitis on direct examination of the bone 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), localised swelling, tenderness, heat, or drainage at suspected site of bone infection
AND at least one of the following:
organisms cultured from blood
positive blood antigen test (e.g. Haemophilus.influenzae, Streptococcus pneumoniae)
radiographic evidence of infection (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.]).
Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as surgical site infection-organ/space (SSI-O).
Joint or bursa infections must meet at least one of the following criteria:
Patient has organisms cultured from joint fluid or synovial biopsy
Patient has evidence of joint or bursa 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: joint pain, swelling, tenderness, heat, evidence of effusion or limitation of motion
AND at least one of the following:
organisms and white blood cells seen on Gram’s stain of joint fluid
positive antigen test on blood, urine, or joint fluid
cellular profile and chemistries of joint fluid compatible with infection and not explained by an underlying rheumatologic disorder
radiographic evidence of infection (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.])
Vertebral disc space infection must meet at least one of the following criteria:
Patient has organisms cultured from vertebral disc space tissue obtained during a surgical operation or needle aspiration
Patient has evidence of vertebral disc space infection seen during a surgical operation or histopathologic examination
Patient has fever (> 38 °C) with no other recognised cause or pain at the involved vertebral disc space
AND radiographic evidence of infection, (e.g. abnormal findings on x-ray, CT scan, MRI, radiolabel scan [gallium, technetium, etc.]).
Patient has fever (> 38 °C) with no other recognised cause and pain at the involved vertebral disc space
AND positive antigen test on blood or urine (e.g. Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, or Group B Streptococcus).
One positive blood culture for a recognised pathogen
OR
Patient has at least one of the following signs or symptoms: fever (> 38 °C), chills, or hypotension
AND Two positive blood cultures for a common skin contaminant (from two separate blood samples, usually within 48 hours)
Skin contaminants = coagulase-negative staphylococci, Micrococcus spp., Propionibacterium acnes, Bacillus spp., Corynebacterium spp.
Source of bloodstream infection:
:
the same micro-organism was cultured from the catheter or symptoms improve within 48 hours after removal of the catheter (C-PVC: peripheral catheter, C-CVC: central venous catheter (note: report C-CVC or C-PVC BSI as CRI3-CVC or CRI3-PVC respectively if microbiologically confirmed, see CRI3 definition)).
:
the same micro-organism was isolated from another infection site or strong clinical evidence exists that bloodstream infection was secondary to another infection site, invasive diagnostic procedure or foreign body
Pulmonary (S-PUL)
Urinary tract infection (S-UTI)
Digestive tract infection (S-DIG)
SSI (S-SSI): surgical site infection
Skin and soft tissue (S-SST)
Other (S-OTH)
:
None of the above, bloodstream infection of unknown origin (verified during survey and no source found)
:
No information available about the source of the bloodstream infection or information missing
Intracranial infection must meet at least one of the following criteria:
Patient has organisms cultured from brain tissue or dura
Patient has an abscess or evidence of intracranial 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: headache, dizziness, fever (> 38 °C), localising neurologic signs, changing level of consciousness, or confusion
AND at least one of the following:
organisms seen on microscopic examination of brain or abscess tissue obtained by needle aspiration or by biopsy during a surgical operation or autopsy
positive antigen test on blood or urine
radiographic evidence of infection, (e.g. abnormal findings on ultrasound, CT scan, MRI, radionuclide brain scan, or arteriogram)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.
If meningitis and a brain abscess are present together, report the infection as IC
Meningitis or ventriculitis must meet at least one of the following criteria:
Patient has organisms cultured from cerebrospinal fluid (CSF)
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), headache, stiff neck, meningeal signs, cranial nerve signs, or irritability
AND at least one of the following:
increased white cells, elevated protein, and/or decreased glucose in CSF
organisms seen on Gram’s stain of CSF
organisms cultured from blood
positive antigen test of CSF, blood, or urine
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy.
Report CSF shunt infection as SSI if it occurs ≤ 1 year of placement; if later or after manipulation/access of the shunt, report as CNS-MEN
Report meningoencephalitis as MEN
Report spinal abscess with meningitis as MEN
An abscess of the spinal epidural or subdural space, without involvement of the cerebrospinal fluid or adjacent bone structures, must meet at least one of the following criteria:
Patient has organisms cultured from abscess in the spinal epidural or subdural space
Patient has an abscess in the spinal epidural or subdural space seen during a surgical operation or at autopsy or evidence of an abscess seen during a histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), back pain, focal tenderness, radiculitis, paraparesis, or paraplegia
AND at least one of the following:
organisms cultured from blood
radiographic evidence of a spinal abscess (e.g. abnormal findings on myelography, ultrasound, CT scan, MRI, or other scans [gallium, technetium, etc.])
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy
Report spinal abscess with meningitis as meningitis (CNS-MEN)
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
AND pus/inflammation at the insertion site or tunnel
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
AND pus/inflammation at the insertion site or tunnel
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
AND clinical signs improve within 48 hours after catheter removal
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
AND clinical signs improve within 48 hours after catheter removal
BSI occurring 48 hours before or after catheter removal
AND positive culture with the same micro-organism of either:
quantitative CVC culture ≥ 103 CFU/ml or semi-quantitative CVC culture > 15 CFU
quantitative blood culture ratio CVC blood sample/peripheral blood sample > 5
differential delay of positive blood cultures: CVC blood sample culture positive two hours or more before peripheral blood culture (blood samples drawn at the same time)
positive culture with the same micro-organism from pus from insertion site
BSI occurring 48 hours before or after catheter removal
AND positive culture with the same micro-organism of either:
quantitative PVC culture ≥ 103 CFU/ml or semi-quantitative PVC culture > 15 CFU
positive culture with the same micro-organism from pus from insertion site
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 involved vascular site
AND blood culture not done or no organisms cultured from blood
Report infections of an arteriovenous graft, shunt, or fistula or intravascular cannulation site without organisms cultured from blood as CVS-VASC
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 (e.g. 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 valve when culture is negative or not done
valvular vegetation seen during a surgical operation or autopsy
positive antigen test on blood or urine (e.g. Haemophilus influenzae, Streptococcuspneumoniae, Neisseria meningitidis, or Group B Streptococcus)
evidence of new vegetation seen on echocardiogram
AND if diagnosis is made antemortem, physician institutes appropriate antimicrobial therapy
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 EKG consistent with myocarditis or pericarditis
positive antigen test on blood (e.g. Haemophilus influenzae, Streptococcus pneumoniae)
evidence of myocarditis or pericarditis on histologic examination of heart tissue
four-fold 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
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 mediastinal area
organisms cultured from blood or discharge from mediastinal area
mediastinal widening on x-ray
Report mediastinitis following cardiac surgery that is accompanied by osteomyelitis as SSI-O
Conjunctivitis must meet at least one of the following criteria:
Patient has pathogens cultured from purulent exudate obtained from the conjunctiva or contiguous tissues, such as eyelid, cornea, meibomian glands, or lacrimal glands
Patient has pain or redness of conjunctiva or around eye
AND at least one of the following:
WBCs and organisms seen on Gram’s stain of exudates
purulent exudates
positive antigen test (e.g. ELISA or IF for Chlamydia trachomatis, herpes simplex virus, adenovirus) on exudate or conjunctival scraping
multinucleated giant cells seen on microscopic examination of conjunctival exudate or scrapings
positive viral culture
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report other infections of the eye as EYE
Do not report chemical conjunctivitis caused by silver nitrate (AgNO3) as a health care-associated infection
Do not report conjunctivitis that occurs as a part of a more widely disseminated viral illness (such as measles, chickenpox, or a URI)
An infection of the eye, other than conjunctivitis, must meet at least one of the following criteria:
Patient has organisms cultured from anterior or posterior chamber or vitreous fluid
Patient has at least two of the following signs or symptoms with no other recognised cause: eye pain, visual disturbance, or hypopyon
AND at least one of the following:
physician diagnosis of an eye infection
positive antigen test on blood (e.g. Haemophilus influenzae, Streptococcus pneumoniae)
organisms cultured from blood
Ear and mastoid infections must meet at least one of the following criteria:
Otitis externa must meet at least one of the following criteria:
Patient has pathogens cultured from purulent drainage from ear canal
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, redness, or drainage from ear canal
AND organisms seen on Gram’s stain of purulent drainage
Otitis media must meet at least one of the following criteria:
Patient has organisms cultured from fluid from middle ear obtained by tympanocentesis or at surgical operation
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain in the eardrum, inflammation, retraction or decreased mobility of eardrum, or fluid behind eardrum
Otitis interna must meet at least one of the following criteria:
Patient has organisms cultured from fluid from inner ear obtained at surgical operation
Patient has a physician diagnosis of inner ear infection
Mastoiditis must meet at least one of the following criteria:
Patient has organisms cultured from purulent drainage from mastoid
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain, tenderness, erythema, headache, or facial paralysis
AND at least one of the following:
organisms seen on Gram’s stain of purulent material from mastoid
positive antigen test on blood
Oral cavity infections must meet at least one of the following criteria:
Patient has organisms cultured from purulent material from tissues of oral cavity
Patient has an abscess or other evidence of oral cavity infection seen on direct examination, during a surgical operation, or during a histopathologic examination
Patient has at least one of the following signs or symptoms with no other recognised cause: abscess, ulceration, or raised white patches on inflamed mucosa, or plaques on oral mucosa
AND at least one of the following:
organisms seen on Gram’s stain
positive KOH (potassium hydroxide) stain
multinucleated giant cells seen on microscopic examination of mucosal scrapings
positive antigen test on oral secretions
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
physician diagnosis of infection and treatment with topical or oral antifungal therapy
Report health care-associated primary herpes simplex infections of the oral cavity as ORAL; recurrent herpes infections are not healthcare-associated
Sinusitis must meet at least one of the following criteria:
Patient has organisms cultured from purulent material obtained from sinus cavity
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), pain or tenderness over the involved sinus, headache, purulent exudate, or nasal obstruction
AND at least one of the following:
positive transillumination
positive radiographic examination (including CT scan)
Upper respiratory tract infections must meet at least one of the following criteria:
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), erythema of pharynx, sore throat, cough, hoarseness, or purulent exudate in throat
AND at least one of the following:
organisms cultured from the specific site
organisms cultured from blood
positive antigen test on blood or respiratory secretions
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
physician diagnosis of an upper respiratory infection
Patient has an abscess seen on direct examination, during a surgical operation, or during a histopathologic examination
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 Clostridium difficile toxin A and/or B in stools
Pseudomembranous colitis revealed by lower gastro-intestinal endoscopy
Colonic histopathology characteristic of Clostridium difficile infection (with or without diarrhoea) on a specimen obtained during endoscopy, colectomy or autopsy
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 faeces
evidence of an enteric pathogen is detected by cytopathic changes in tissue culture (toxin assay)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
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 spp. esophagitis or proctitis)
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 3 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
Do not report hepatitis or jaundice of non-infectious origin (alpha-1 antitrypsin deficiency, etc.)
Do not report hepatitis or jaundice that results from exposure to hepatotoxins (alcoholic or acetaminophen-induced hepatitis, etc.)
Do not report hepatitis or jaundice that results from biliary obstruction (cholecystitis)
Intraabdominal infections must meet at least one of the following criteria:
Patient has organisms cultured from purulent material from intraabdominal space obtained during a surgical operation or needle aspiration
Patient has abscess or other evidence of intraabdominal 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)
Do not report pancreatitis (an inflammatory syndrome characterised by abdominal pain, nausea, and vomiting associated with high serum levels of pancreatic enzymes) unless it is determined to be infectious in origin
Tracheobronchial infections must meet at least one of the following criteria:
Patient has no clinical or radiographic evidence of pneumonia
AND patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), cough, new or increased sputum production, rhonchi, wheezing
AND at least one of the following:
positive culture obtained by deep tracheal aspirate or bronchoscopy
positive antigen test on respiratory secretions
Do not report chronic bronchitis in a patient with chronic lung disease as an infection unless there is evidence of an acute secondary infection, manifested by change in organism
Other infections of the lower respiratory tract must meet at least one of the following criteria:
Patient has organisms seen on smear or cultured from lung tissue or fluid, including pleural fluid
Patient has a lung abscess or empyema seen during a surgical operation or histopathologic examination
Patient has an abscess cavity seen on radiographic examination of lung
Report lung abscess or empyema without pneumonia as LUNG
ALL of the 3 following criteria:
Supervising physician started appropriate antimicrobial therapy for sepsis for at least five days.
No detection of pathogens in blood culture or not tested
No obvious infection at another site
AND two of the following criteria (without other apparent cause):
Fever (> 38 °C) or temperature instability (frequent post-set of the incubator) or hypothermia (< 36,5 °C)
Tachycardia (> 200/min) or new/increased bradycardia (< 80/min)
Capillary refilling time (CRT) > 2 s
New or increased apnoea (s) (> 20 s)
Unexplained metabolic acidosis
New-onset hyperglycaemia (> 140 mg/dl)
Another sign of sepsis (skin colour (only if the CRT is not used), laboratory signs (CRP, interleukin), increased oxygen requirement (intubation), unstable general condition of the patient, apathy)
at least two of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended capillary refilling time (CRT), metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy
AND
a recognised pathogen other than coagulase-negative staphylococci (CNS) cultured from blood or cerebrospinal fluid (CSF; this is included because meningitis in this age group is usually haematogenous, so positive CSF can be regarded as evidence of BSI even if blood cultures are negative or were not taken)
in order to be consistent with BSI reporting in adults (including secondary BSI), the criterion ‘the organism is not related to an infection at another site’ was removed from the Neo-KISS definition for the purposes of the EU PPS
report the origin of the neonatal BSI in the field BSI origin
if both the case definitions for NEO-LCBI and NEO-CNSB are matched, report NEO-LCBI
at least two of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended recapillarisation time, metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy
AND CNS is cultured from blood or catheter tip
AND patient has one of: C-reactive protein > 2,0 mg/dl, immature/total neutrophil ratio (I/T ratio) > 0,2, leukocytes < 5/nl, platelets < 100/nl
in order to be consistent with BSI reporting in adults (including secondary BSI), the criterion ‘the organism is not related to an infection at another site’ was removed from the Neo-KISS definition for the purposes of the EU PPS
report the origin of the neonatal BSI in the field BSI origin
if both the case definitions for NEO-LCBI and NEO-CNSB are matched, report NEO-LCBI
respiratory compromise
AND new infiltrate, consolidation or pleural effusion on chest X ray
AND at least four of: temperature > 38 °C or < 36,5 °C or temperature instability, tachycardia or bradycardia, tachypnoea or apnoea, dyspnoea, increased respiratory secretions, new onset of purulent sputum, isolation of a pathogen from respiratory secretions, C-reactive protein > 2,0 mg/dl, I/T ratio > 0,2
Histopathological evidence of necrotising enterocolitis
OR
at least one characteristic radiographic abnormality (pneumoperitoneum, pneumatosis intestinalis, unchanging ‘rigid’ loops of small bowel) plus at least two of the following without other explanation: vomiting, abdominal distension, prefeeding residuals, persistent microscopic or gross blood in stools
Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease. In patients without underlying cardiac or pulmonary disease one definitive chest X-ray or CT-scan is sufficient
AND at least one of the following symptoms
Fever > 38 °C with no other cause
Leucopoenia (< 4 000 WBC/mm3) or leucocytosis (≥ 12 000 WBC/mm3)
AND at least one of the following (or at least two if clinical pneumonia only = PN 4 and PN 5)
New onset of purulent sputum, or change in character of sputum (colour, odour, quantity, consistency)
Cough or dyspnoea or tachypnea
Suggestive auscultation (rales or bronchial breath sounds), ronchi, wheezing
Worsening gas exchange (e.g. O2 desaturation or increased oxygen requirements or increased ventilation demand)
and according to the used diagnostic method
Positive quantitative culture from minimally contaminated LRT(2) specimen (PN 1)
Broncho-alveolar lavage (BAL) with a threshold of ≥ 104 CFU/ml(3) or ≥ 5 % of BAL obtained cells contains intracellular bacteria on direct microscopic exam (classified on the diagnostic category BAL)
Protected brush (PB Wimberley) with a threshold of ≥ 103 CFU/ml
Distal protected aspirate (DPA) with a threshold of ≥ 103 CFU/ml
Positive quantitative culture from possibly contaminated LRT specimen (PN 2)
Quantitative culture of LRT specimen (e.g. endotracheal aspirate) with a threshold of 106 CFU/ml
Positive blood culture not related to another source of infection
Positive growth in culture of pleural fluid
Pleural or pulmonary abscess with positive needle aspiration
Histologic pulmonary exam shows evidence of pneumonia
Positive exams for pneumonia with virus or particular germs (e.g. Legionella, Aspergillus, mycobacteria, mycoplasma, Pneumocystis jirovecii)
Positive detection of viral antigen or antibody from respiratory secretions (e.g. EIA, FAMA, shell vial assay, PCR)
Positive direct exam or positive culture from bronchial secretions or tissue
Seroconversion (e.g. influenza viruses, Legionella, Chlamydia)
Detection of antigens in urine (Legionella)
Positive sputum culture or non-quantitative LRT specimen culture (PN 4)
No positive microbiology (PN 5)
A pneumonia is defined as intubation-associated (IAP) if an invasive respiratory device was present (even intermittently) in the 48 hours preceding the onset of infection
Endometritis must meet at least one of the following criteria:
Patient has organisms cultured from fluid or tissue from endometrium obtained during surgical operation, by needle aspiration, or by brush biopsy
Patient has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), abdominal pain, uterine tenderness, or purulent drainage from uterus
Report postpartum endometritis as a health care-associated infection unless the amniotic fluid is infected at the time of admission or the patient was admitted 48 hours after rupture of the membrane
Episiotomy infections must meet at least one of the following criteria:
Postvaginal delivery patient has purulent drainage from the episiotomy
Postvaginal delivery patient has an episiotomy abscess
Vaginal cuff infections must meet at least one of the following criteria:
Posthysterectomy patient has purulent drainage from the vaginal cuff
Posthysterectomy patient has an abscess at the vaginal cuff
Posthysterectomy patient has pathogens cultured from fluid or tissue obtained from the vaginal cuff
Report vaginal cuff infections as SSI-O
Other infections of the male or female reproductive tract must meet at least one of the following criteria:
Patient has organisms cultured from tissue or fluid from affected site
Patient has an abscess or other evidence of infection of affected site seen during a surgical operation or histopathologic examination
Patient has two of the following signs or symptoms with no other recognised cause: fever (> 38 °C), nausea, vomiting, pain, tenderness, or dysuria
AND at least one of the following:
organisms cultured from blood
physician diagnosis
Report endometritis as EMET
Report vaginal cuff infections as VCUF
Infection occurs within 30 days after the operation AND infection involves only skin and subcutaneous tissue of the incision AND at least one of the following:
Purulent drainage with or without laboratory confirmation, from the superficial incision
Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision
At least one of the following signs or symptoms of infection: pain or tenderness, localised swelling, redness, or heat AND superficial incision is deliberately opened by surgeon, unless incision is culture-negative
Diagnosis of superficial incisional SSI made by a surgeon or attending physician
Infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place AND the infection appears to be related to the operation AND infection involves deep soft tissue (e.g. fascia, muscle) of the incision AND at least one of the following:
Purulent drainage from the deep incision but not from the organ/space component of the surgical site
A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms: fever (> 38 °C), localised pain or tenderness, unless incision is culture-negative
An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiological examination
Diagnosis of deep incisional SSI made by a surgeon or attending physician
Infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place AND the infection appears to be related to the operation AND infection involves any part of the anatomy (e.g. organs and spaces) other than the incision which was opened or manipulated during an operation AND at least one of the following:
Purulent drainage from a drain that is placed through a stab wound into the organ/space
Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space
An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiological examination
Diagnosis of organ/space SSI made by a surgeon or attending physician
Skin infections must meet at least one of the following criteria:
Patient has purulent drainage, pustules, vesicles, or boils
Patient has at least two of the following signs or symptoms with no other recognised cause: pain or tenderness, localised swelling, redness, or heat
AND at least one of the following:
organisms cultured from aspirate or drainage from affected site; if organisms are normal skin flora (e.g. diphtheroids [Corynebacterium spp.], Bacillus [not B.anthracis] spp., Propionibacterium spp., coagulase-negative staphylococci [including Staphylococcusepidermidis], viridans group streptococci, Aerococcus spp., Micrococcus spp.), they must be a pure culture
organisms cultured from blood
positive antigen test performed on infected tissue or blood (e.g. herpes simplex, varicella zoster, Haemophilus influenzae, Neisseria meningitidis)
multinucleated giant cells seen on microscopic examination of affected tissue
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report infected decubitus ulcers as DECU
Report infected burns as BURN
Report breast abscesses or mastitis as BRST
Soft tissue infections must meet at least one of the following criteria:
Patient has organisms cultured from tissue or drainage from affected site
Patient has purulent drainage at affected site
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 at the affected site with no other recognised cause: localised pain or tenderness, redness, swelling, or heat
AND at least one of the following:
organisms cultured from blood
positive antigen test performed on blood or urine (e.g. Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, Group B Streptococcus, Candida spp.)
diagnostic single antibody titer (IgM) or four-fold increase in paired sera (IgG) for pathogen
Report infected decubitus ulcers as DECU
Report infection of deep pelvic tissues as OREP
Decubitus ulcer infections must meet the following criterion:
Patient has at least two of the following signs or symptoms with no other recognised cause: redness, tenderness, or swelling of decubitus wound edges
AND at least one of the following:
organisms cultured from properly collected fluid or tissue
organisms cultured from blood
Burn infections must meet at least one of the following criteria:
Patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin
AND histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue
Patient has a change in burn wound appearance or character, such as rapid eschar separation, or dark brown, black, or violaceous discoloration of the eschar, or oedema at wound margin
AND at least one of the following:
organisms cultured from blood in the absence of other identifiable infection
isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings
Patient with a burn has at least two of the following signs or symptoms with no other recognised cause: fever (> 38 °C) or hypothermia (< 36 °C), hypotension, oliguria (< 20 cc/hr), hyperglycaemia at previously tolerated level of dietary carbohydrate, or mental confusion
AND at least one of the following:
histologic examination of burn biopsy shows invasion of organisms into adjacent viable tissue
organisms cultured from blood
isolation of herpes simplex virus, histologic identification of inclusions by light or electron microscopy, or visualisation of viral particles by electron microscopy in biopsies or lesion scrapings
A breast abscess or mastitis must meet at least one of the following criteria:
Patient has a positive culture of affected breast tissue or fluid obtained by incision and drainage or needle aspiration
Patient has a breast abscess or other evidence of infection seen during a surgical operation or histopathologic examination
Patient has fever (> 38 °C) and local inflammation of the breast
AND physician diagnosis of breast abscess
Disseminated infection is infection involving multiple organs or systems, without an apparent single site of infection, usually of viral origin, and with signs or symptoms with no other recognised cause and compatible with infectious involvement of multiple organs or systems
Use this code for viral infections involving multiple organ systems (e.g. measles, mumps, rubella, varicella, erythema infectiosum). These infections often can be identified by clinical criteria alone. Do not use this code for healthcare-associated infections with multiple metastatic sites, such as with bacterial endocarditis; only the primary site of these infections should be reported
Do not report fever of unknown origin (FUO) as DI
Report viral exanthemas or rash illness as DI
Patient has at least one of the following
clinical signs or symptoms with no other recognised cause
fever (> 38 °C)
hypotension (systolic pressure < 90 mm/Hg)
or oliguria (20 cm3(ml)/hr)
And blood culture not done or no organisms or antigen detected in blood
And no apparent infection at another site
And physician institutes treatment for sepsis
Do not use this code unless absolutely needed
For CSEP in neonates, use NEO-CSEP case definition (see below)
Patient has at least one of the following signs or symptoms with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness
AND
patient has a positive urine culture, that is, ≥ 105 microorganisms per ml of urine with no more than two species of microorganisms.
Patient has at least two of the following with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness
AND
at least one of the following:
Positive dipstick for leukocyte esterase and/or nitrate
Pyuria urine specimen with ≥ 104 WBC/ml or ≥ 3 WBC/high-power field of unspun urine
Organisms seen on Gram stain of unspun urine
At least two urine cultures with repeated isolation of the same uropathogen (gram-negative bacteria or Staphylococcus saprophyticus) with ≥ 102 colonies/ml urine in non-voided specimens
≤ 105 colonies/ml of a single uropathogen (gram-negative bacteria or Staphylococcus saprophyticus) in a patient being treated with effective antimicrobial agent for a urinary infection
Physician diagnosis of a urinary tract infection
Physician institutes appropriate therapy for a urinary infection
Asymptomatic bacteriuria should not be reported, but bloodstream infections secondary to asymptomatic bacteriuria are reported as BSI with source (origin) S-UTI
A urinary tract infection (UCA-UTI) is defined as catheter-associated if an indwelling urinary catheter was present (even intermittently) in the seven days preceding the onset of infection
CVC = central vascular catheter, PVC = peripheral vascular catheter
central vascular catheter colonisation should not be reported. A CRI3 (-CVC or -PVC) is also a bloodstream infection with source C-CVC or C-PVC respectively; however when a CRI3 is reported, the BSI should not be reported in the point prevalence survey; microbiologically confirmed catheter-related BSI should be reported as CRI3.
LRT = Lower Respiratory Tract.
CFU = Colony Forming Units.
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