Table 2

Definitions of infections included in the study

Type of infectionDefinition
Complicated urinary tract infectionFor adults and children >12 years (any of them)
A positive blood culture for CRE or CSE and One of the following:

  • One local symptom (urgency, frequency, dysuria, tenesmus or suprapubic tenderness)

  • or

  • Two systemic symptoms or predisposing conditions (fever (>38°C core or >38.3o C armpit) or hypothermia (<36oC core), new cognitive impairment or change in mental status (in patients over 70 years), flank pain, costovertebral angle tenderness on physical examination, urinary tract abnormalities or presence of a urinary catheter)

  • or

  • A positive urine culture (isolation of CRE or CSE, ≥105 microorganisms per mL of urine)

    and

    No other recognised cause of the bloodstream infection

A positive urine culture for CRE or CSE (c)
and
Two systemic symptoms or predisposing conditions (fever (>38 test-of-cure C core or >38.3°C armpit) or hypothermia (<36oC core), new cognitive impairment or change in mental status (in patients over 70 years), flank pain, costovertebral angle tenderness on physical examination, urinary tract abnormalities or presence of a urinary catheter)
and
No other recognised cause of a UTI
For children >2 years
Abnormal urinary dipstick test (leucocyte esterase >1+, or positive nitrite test) or urinalysis (pyuria with at least 10 WCCs per high power field in centrifuged urine, and bacteriuria with any bacteria per high power field on an unstained specimen of urinary sediment)
and
At least two of the following clinical or biological signs:

  1. Fever with temperature of 38°C or higher

  2. Abdominal or flank pain, urgency, frequency, dysuria, suprapubic tenderness

  3. Elevated C reactive protein or procalcitonin concentrations, according to the local laboratory

and
A positive urine culture with isolation of CRE or CSE only (spontaneously voided urine with≥105 microorganisms per mL of urine or suprapubic aspirate/urinary catheter with ≥104 microorganisms per mL of urine) or a positive blood culture with isolation of CRE with no other recognised cause
For children ≤2 years old
Abnormal urinary dipstick test (leucocyte esterase >1+ or positive nitrite test) or urinalysis (pyuria with at least 10 WCCs per high power field in centrifuged urine, and bacteriuria with any bacteria per high power field on an unstained specimen of urinary sediment)
and
At least two of the following clinical or biological signs:

  1. Fever with temperature of 38°C or higher

  2. General, non-specific signs such as irritability, vomiting, diarrhoea or feeding problems in infants

  3. Elevated C reactive protein or procalcitonin concentrations according to the local laboratory

and
A positive urine culture with isolation of CRE or CSE only (spontaneously voided urine with ≥Ab 105 microorganisms per mL of urine or suprapubic aspirate/urinary catheter with≥104 microorganisms per mL of urine) or positive blood culture with isolation of CRE with no other recognised cause
Intra-abdominal infectionFor all age groups (either of them)
Patient has organisms cultured from purulent material from intra-abdominal space obtained during a surgical operation or needle aspiration.Patient has at least two of the following signs or symptoms with no other recognised cause:

  1. Fever (>38°C)

  2. Nausea

  3. Vomiting

  4. Abdominal pain

  5. Jaundice

and
One of the following:

  1. Organisms cultured from drainage from surgically placed drain (eg, closed suction drainage system, open drain, T-tube drain)

  2. Organisms cultured from blood and radiographic evidence of infection, for example, abnormal findings on ultrasound, CT scan, MRI or radiolabelled scans (gallium, technetium, etc) or on abdominal X-ray

PneumoniaFor all age groups (at least one of the following criteria: radiological, clinical and microbiological)
RadiologyClinical criteriaMicrobiology
Chest X-rays or CT scan with a suggestive image of pneumonia (for patients with underlying cardiac or pulmonary disease, a new infiltrate needs to be demonstrated by comparing with a previous chest X-ray or CT scan)For children ≤12 years oldAt least three of the following:

  1. Fever >38°C with no other cause

  2. Leucocytosis or leucopaenia (see age-specific laboratory variables above)

  3. Worsening gas exchange (eg, O2 desaturations (eg, pulse oximetry reading <94%), increased oxygen requirements or increased ventilator demand)

  4. Apnoea, tachypnoea, nasal flaring with retraction of chest wall or grunting

  5. Wheezing, rales or rhonchi

  6. Cough

  7. Bradycardia or tachycardia (age-specific)

For children ≥12 and adults
At least one each of the following symptoms/signs/laboratory data:

  1. Fever >38°C

  2. Leucocytosis (≥12 000 WCC/mm3)

  3. Leucopaenia (<4000 WCC/mm3)

  4. In patients ≥70 years old, new cognitive impairment or worsening mental status

and
At least one of the following:

  1. New onset of purulent sputum

  2. Change in character of sputum (colour, odour, quantity, consistency)

  3. Cough

  4. Dyspnoea or tachypnoea

  5. Suggestive auscultation signs (rales or bronchial breath sounds), rhonchi, wheezing

  6. Worsening gas exchange (eg, desaturation or increased oxygen requirements or increased ventilation demand)

Isolation of bacteria from any of the following:

  1. Quantitative culture from minimally contaminated lower respiratory tract specimen (bronchoalveolar lavage (BAL) with a threshold of >104 CFU/mL or ≥5% of BAL-obtained cells containing intracellular bacteria on direct microscopic examination; protected specimen brush with a threshold of >103 CFU/mL; distal protected aspirate with a threshold of >103 CFU/mL)

  2. Quantitative culture of endotracheal aspirate or unprotected specimen brush with a threshold of 106 CFU/mL

  3. Blood cultures, not related to any other source of infection

  4. Pleural fluid or needle aspiration of pleural or pulmonary abscess

  5. Sputum culture with quality criteria (>25 leucocytes/field 100X and <10 squamous epithelial cells/field 100X)

Bloodstream infectionFor all age groups
Positive blood culture with isolation of CRE or CSE in patients with sepsis criteria

  • CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; UTI, urinary tract infection; WCC, white cell count.