The aim of this study was to describe the epidemiology and bacteriological trends of carbapenemase-producing Enterobacteriaceae (CPE) at Nantes University Hospital from 2013 to 2023.
Methods
Potential CPE carriers were prospectively detected, and their contacts were systematically screened for CPE digestive colonization. A retrospective study was conducted from 2013 to 2023 (on patient characteristics) and from 2016 to 2023 (on CPE characteristics). An outbreak was defined as at least one secondary case occurring among contact patients during the same hospitalization, in the same unit, and with the same staff.
Results
All in all, 553 CPE-positive carriers were identified during the study period. Among them, 178 (32 %) were sporadic cases and 100 (18 %) were incidentally detected. Fifty-seven outbreaks were investigated comprising 305 (55 %) secondary cases. The most commonly identified CPE species in outbreaks were Klebsiella pneumonia OXA-48.
Conclusion
CPE detection in the hospital was associated mainly with epidemic spread involving a variable number of secondary cases. CPE patients detected incidentally (without specific infection control measures) several days after hospital admission, repatriates and patients with a history of hospitalization abroad are at high risk of in-hospital CPE spread. The number of outbreaks did not decrease during the study period, and more generally, the number of secondary cases tends in some uncontrolled situations to increase, particular when CPE- positive patients are transferred or rehospitalized.
{"title":"Epidemiological and bacteriological trends from 2013 to 2023 of carbapenemase-producing enterobacterales (CPE) in a French university hospital: A permanent risk of outbreak","authors":"Manon Robert , Stéphane Corvec , Anaïs Andreo , Florence Le Gallou , Géraldine Marquot , Reynald Mangeant , Céline Bourigault , Didier Lepelletier","doi":"10.1016/j.idnow.2024.105021","DOIUrl":"10.1016/j.idnow.2024.105021","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to describe the epidemiology and bacteriological trends of carbapenemase-producing Enterobacteriaceae (CPE) at Nantes University Hospital from 2013 to 2023.</div></div><div><h3>Methods</h3><div>Potential CPE carriers were prospectively detected, and their contacts were systematically screened for CPE digestive colonization. A retrospective study was conducted from 2013 to 2023 (on patient characteristics) and from 2016 to 2023 (on CPE characteristics). An outbreak was defined as at least one secondary case occurring among contact patients during the same hospitalization, in the same unit, and with the same staff.</div></div><div><h3>Results</h3><div>All in all, 553 CPE-positive carriers were identified during the study period. Among them, 178 (32 %) were sporadic cases and 100 (18 %) were incidentally detected. Fifty-seven outbreaks were investigated comprising 305 (55 %) secondary cases. The most commonly identified CPE species in outbreaks were Klebsiella pneumonia OXA-48.</div></div><div><h3>Conclusion</h3><div>CPE detection in the hospital was associated mainly with epidemic spread involving a variable number of secondary cases. CPE patients detected incidentally (without specific infection control measures) several days after hospital admission, repatriates and patients with a history of hospitalization abroad are at high risk of in-hospital CPE spread. The number of outbreaks did not decrease during the study period, and more generally, the number of secondary cases tends in some uncontrolled situations to increase, particular when CPE- positive patients are transferred or rehospitalized.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105021"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.idnow.2024.105013
C. Slekovec , E. Pouly , L. Malinowski , X. Bertrand
Objective
The objective of this study was to evaluate the ability of two macroscopic quality indicators to guide antibiotic stewardship strategies.
Methods
Setting: Bourgogne-Franche-Comté region (eight departments).
Antibiotic reimbursement data, expressed in defined daily doses, were used to calculate two macroscopic quality indicators from 2015 to 2020. Urinary tract infection indicator: (fosfomycin + nitrofurantoin + pivmecillinam) / (ciprofloxacin + ofloxacin + norfloxacin) calculated in women aged 15 to 64. Indicator for ear, nose, throat and respiratory tract infections: (amoxicillin/ (amoxicillin-clavulanate + oral 3GC) calculated in children under 15 years of age.
Results
In 2020, global antibiotic consumption varied from 22.2 to 26.6 defined daily doses per 1000 inhabitants per day, depending on the department. The macroscopic quality indicators were lowest in the departments of Nièvre and Yonne. The scores for the urinary tract infection indicator were 0.55 and 0.74, respectively, while those for the ear, nose and throat and respiratory tract infection indicators were 1.85 and 2.12, respectively. Both scores continuously increased in all departments of the region during the survey, except in 2020 for the urinary tract infection indicator, due to a nitrofurantoin shortage.
Conclusion
Even in departments with low antibiotic consumption, our macroscopic quality indicators help to identify antibiotic stewardship targets for the most common community-based infections,. They are easy to calculate from quantitative data without requiring any information on diagnosis. Complementarily to other indicators, they provide messages specifically addressed to general practitioners regarding population, molecules and diagnostic elements.
{"title":"Proposed macroscopic quality indicators of antimicrobial stewardship in primary care: An observational study","authors":"C. Slekovec , E. Pouly , L. Malinowski , X. Bertrand","doi":"10.1016/j.idnow.2024.105013","DOIUrl":"10.1016/j.idnow.2024.105013","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to evaluate the ability of two macroscopic quality indicators to guide antibiotic stewardship strategies.</div></div><div><h3>Methods</h3><div>Setting: Bourgogne-Franche-Comté region (eight departments).</div><div>Antibiotic reimbursement data, expressed in defined daily doses, were used to calculate two macroscopic quality indicators from 2015 to 2020. Urinary tract infection indicator: (fosfomycin + nitrofurantoin + pivmecillinam) / (ciprofloxacin + ofloxacin + norfloxacin) calculated in women aged 15 to 64. Indicator for ear, nose, throat and respiratory tract infections: (amoxicillin/ (amoxicillin-clavulanate + oral 3GC) calculated in children under 15 years of age.</div></div><div><h3>Results</h3><div>In 2020, global antibiotic consumption varied from 22.2 to 26.6 defined daily doses per 1000 inhabitants per day, depending on the department. The macroscopic quality indicators were lowest in the departments of Nièvre and Yonne. The scores for the urinary tract infection indicator were 0.55 and 0.74, respectively, while those for the ear, nose and throat and respiratory tract infection indicators were 1.85 and 2.12, respectively. Both scores continuously increased in all departments of the region during the survey, except in 2020 for the urinary tract infection indicator, due to a nitrofurantoin shortage.</div></div><div><h3>Conclusion</h3><div>Even in departments with low antibiotic consumption, our macroscopic quality indicators help to identify antibiotic stewardship targets for the most common community-based infections,. They are easy to calculate from quantitative data without requiring any information on diagnosis. Complementarily to other indicators, they provide messages specifically addressed to general practitioners regarding population, molecules and diagnostic elements.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105013"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.idnow.2024.105020
Y. Boué , M. Niang , A. Lapostolle , A. Chamouine , T. Benoit Cattin , M. Favre , C. Rouard , C. Mortier , R. Piarroux , J. Carvelli , for the CHOLEMAY Study Group
Objectives
To describe the presentation and therapeutic management of severe cholera in Mayotte (France).
Patients and methods
We carried out retrospective data collection. All patients treated in the intensive care unit (ICU) with a confirmed diagnosis of cholera by PCR were studied. Only patients treated for hypovolemia were included.
Results
Out of the 215 confirmed cases of cholera in Mayotte on July 12, 2024, 25 required treatment in the ICU (11.6 %). Among these cases, 16 were treated for hypovolemia (7.4 %), while five patients died of cholera before they could be admitted to hospital (lethality rate 2.3 %). No patient died in hospital.
Median patient age was 17 years (4–30) with a sex ratio of 1. Severe diarrhea was the rule with a median of one diarrheal stool every two hours. Clinical severity was characterized by sunken eyes and Glasgow Coma Scale (GCS) < 14 (n = 16/16,100 %). Biological severity was determined by profound metabolic acidosis with venous pH < 7.20 (n = 16/16, 100 %). Intravenous fluid therapy was aggressive with a median of 280 mL/kg (230–300) Ringer’s lactate solution during the first 48 h.
Conclusions
Cholera can be a life-threatening infection, with deaths occurring due to severe diarrhea and hypovolemia. From the onset of symptoms, which are sometimes fulminant, patients must be admitted to a care center as soon as possible. We will continue to collect data to create scores that will enable us to better recognize the most severe forms of the disease.
{"title":"Cholera outbreak in Mayotte (France): A retrospective description of 16 patients treated for hypovolemia in the ICU","authors":"Y. Boué , M. Niang , A. Lapostolle , A. Chamouine , T. Benoit Cattin , M. Favre , C. Rouard , C. Mortier , R. Piarroux , J. Carvelli , for the CHOLEMAY Study Group","doi":"10.1016/j.idnow.2024.105020","DOIUrl":"10.1016/j.idnow.2024.105020","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the presentation and therapeutic management of severe cholera in Mayotte (France).</div></div><div><h3>Patients and methods</h3><div>We carried out retrospective data collection. All patients treated in the intensive care unit (ICU) with a confirmed diagnosis of cholera by PCR were studied. Only patients treated for hypovolemia were included.</div></div><div><h3>Results</h3><div>Out of the 215 confirmed cases of cholera in Mayotte on July 12, 2024, 25 required treatment in the ICU (11.6 %). Among these cases, 16 were treated for hypovolemia (7.4 %), while five patients died of cholera before they could be admitted to hospital (lethality rate 2.3 %). No patient died in hospital.</div><div>Median patient age was 17 years (4–30) with a sex ratio of 1. Severe diarrhea was the rule with a median of one diarrheal stool every two hours. Clinical severity was characterized by sunken eyes and Glasgow Coma Scale (GCS) < 14 (n = 16/16,100 %). Biological severity was determined by profound metabolic acidosis with venous pH < 7.20 (n = 16/16, 100 %). Intravenous fluid therapy was aggressive with a median of 280 mL/kg (230–300) Ringer’s lactate solution during the first 48 h.</div></div><div><h3>Conclusions</h3><div>Cholera can be a life-threatening infection, with deaths occurring due to severe diarrhea and hypovolemia. From the onset of symptoms, which are sometimes fulminant, patients must be admitted to a care center as soon as possible. We will continue to collect data to create scores that will enable us to better recognize the most severe forms of the disease.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105020"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.idnow.2024.105017
Olivia Keita-Perse , Sara Romano-Bertrand , French Guidelines for Respiratory Transmission Prevention of the French Society for Hospital Hygiene
{"title":"Reply to: The new 2024 French guidelines for respiratory transmission prevention: Present-day limitations and the need to implement new standard precautions","authors":"Olivia Keita-Perse , Sara Romano-Bertrand , French Guidelines for Respiratory Transmission Prevention of the French Society for Hospital Hygiene","doi":"10.1016/j.idnow.2024.105017","DOIUrl":"10.1016/j.idnow.2024.105017","url":null,"abstract":"","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105017"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.idnow.2024.105016
Mélanie Colomb-Cotinat , Amélie Jouzeau , Gaëlle Pedrono , Aurélie Chabaud , Christian Martin , Isabelle Poujol , Sylvie Maugat , Lory Dugravot , Catherine Dumartin , Anne Berger-Carbonne , Loïc Simon , Laurent Dortet
Objectives
Even though France faces few severe infections due to carbapenem-producing Enterobacterales (CPE), inter-regional epidemic stages render their dissemination a cause for considerable concern. CPE reporting relies in France on three non-exhaustive monitoring systems (MS): an early-alert system, a nationwide passive surveillance system and the National Reference Centre. We aim to estimate the number and incidence of CPE-related infections in France in 2020 and to identify any overlap between the three systems to determine whether their continued use still serves a purpose.
Methods
Data on clinical CPE isolates in 2020 were extracted from the three MS databases. Screening samples were excluded. Datasets were manually merged, isolate by isolate, so as to identify in which system(s) each isolate was reported. A system-participant was defined as any declarant reporting at least one isolate in an MS. Using our matched dataset, we performed Bayesian model averaging for capture-recapture estimations.
Results
All in all, 1722 CPE isolates were reported through the monitoring systems in 2020. We estimated that the number of CPE infections was almost twice this number, corresponding to incidence of 0.031 CPE/1000 hospital-days [CI95% 0.015–0.057/1,000 hospital-days], with regional disparities taken into account. Among participating the laboratories, 86% were involved in only one of the systems. Among clinical CPE isolates, 56% were isolated from urine.
Conclusion
Regarding this rare infection, surveillance based only on passive surveillance from voluntary hospitals does not reflect actual epidemiology. We recommend maintaining the three monitoring systems and improving the participation of hospitals’ nationwide surveillance, the objective being to more accurately capture the real incidence of CPE infections.
{"title":"Estimating the number and incidence of carbapenemase-producing Enterobacterales infections in France in 2020: A capture-recapture study","authors":"Mélanie Colomb-Cotinat , Amélie Jouzeau , Gaëlle Pedrono , Aurélie Chabaud , Christian Martin , Isabelle Poujol , Sylvie Maugat , Lory Dugravot , Catherine Dumartin , Anne Berger-Carbonne , Loïc Simon , Laurent Dortet","doi":"10.1016/j.idnow.2024.105016","DOIUrl":"10.1016/j.idnow.2024.105016","url":null,"abstract":"<div><h3>Objectives</h3><div>Even though France faces few severe infections due to carbapenem-producing Enterobacterales (CPE), inter-regional epidemic stages render their dissemination a cause for considerable concern. CPE reporting relies in France on three non-exhaustive monitoring systems (MS): an early-alert system, a nationwide passive surveillance system and the National Reference Centre. We aim to estimate the number and incidence of CPE-related infections in France in 2020 and to identify any overlap between the three systems to determine whether their continued use still serves a purpose.</div></div><div><h3>Methods</h3><div>Data on clinical CPE isolates in 2020 were extracted from the three MS databases. Screening samples were excluded. Datasets were manually merged, isolate by isolate, so as to identify in which system(s) each isolate was reported. A system-participant was defined as any declarant reporting at least one isolate in an MS. Using our matched dataset, we performed Bayesian model averaging for capture-recapture estimations.</div></div><div><h3>Results</h3><div>All in all, 1722 CPE isolates were reported through the monitoring systems in 2020. We estimated that the number of CPE infections was almost twice this number, corresponding to incidence of 0.031 CPE/1000 hospital-days [CI95% 0.015–0.057/1,000 hospital-days], with regional disparities taken into account. Among participating the laboratories, 86% were involved in only one of the systems. Among clinical CPE isolates, 56% were isolated from urine.</div></div><div><h3>Conclusion</h3><div>Regarding this rare infection, surveillance based only on passive surveillance from voluntary hospitals does not reflect actual epidemiology. We recommend maintaining the three monitoring systems and improving the participation of hospitals’ nationwide surveillance, the objective being to more accurately capture the real incidence of CPE infections.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105016"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.idnow.2024.105014
Martin Martinot
{"title":"The new 2024 French guidelines for respiratory transmission Prevention: Present-day limitations and the need to implement new standard precautions","authors":"Martin Martinot","doi":"10.1016/j.idnow.2024.105014","DOIUrl":"10.1016/j.idnow.2024.105014","url":null,"abstract":"","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105014"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1016/j.idnow.2025.105033
Tomas Urbina , Martin Bruun Madsen , Camille Hua , Christian Eckmann , Muhammed Elhadi , Mohan Gurjar , Gennaro De Pascale , Farid Zand , Johanna Hästbacka , Ricard Ferrer Rocca , José Artur Paiva , Adam Mikstacki , Richard Layese , Olivier Chosidow , Florence Canoui-Poitrine , Jan De Waele , Nicolas de Prost , SKIN-ICU investigators
Background
Necrotizing soft tissue infections (NSTI) are rare and life-threatening bacterial infections characterized by necrosis of subcutaneous tissue, fascia, or muscle. Few prospective studies have been conducted. The primary objective is to assess the 90-day mortality rate and to identify prognostic factors in patients with NSTI in an international setting. Secondary objectives are i) to characterize the clinical and microbiological presentation and management; ii) to assess the risk of limb amputation and associated factors; and iii) to assess functional and health-related quality of life (HRQoL) outcomes and associated factors.
Methods
We are conducting a multinational, prospective, non-interventional cohort study. We plan to enroll 1,033 consecutive patients admitted to 85 hospitals with surgically proven NSTI between November 2021 and December 2024 in 17 countries over three continents. Data will be collected prospectively on a secure web-based server. The primary outcome measure will be the day-90 mortality. Secondary outcomes include need for limb amputation, the activity of daily living scale and health-related quality of life at day-90 (EQ-5D-5L questionnaire). Baseline characteristics associated with outcomes will be identified by multivariable analyses. Exploratory analyses will be conducted to assess the impact of therapeutic interventions on day-90 mortality and secondary outcomes. The study protocol has been approved by an ethics committee in each participating country.
{"title":"Mortality, functional outcome and health-related quality of life in patients with necrotizing skin- and soft tissue infections in the ICU: Protocol of a multinational prospective cohort study (SKIN-ICU)","authors":"Tomas Urbina , Martin Bruun Madsen , Camille Hua , Christian Eckmann , Muhammed Elhadi , Mohan Gurjar , Gennaro De Pascale , Farid Zand , Johanna Hästbacka , Ricard Ferrer Rocca , José Artur Paiva , Adam Mikstacki , Richard Layese , Olivier Chosidow , Florence Canoui-Poitrine , Jan De Waele , Nicolas de Prost , SKIN-ICU investigators","doi":"10.1016/j.idnow.2025.105033","DOIUrl":"10.1016/j.idnow.2025.105033","url":null,"abstract":"<div><h3>Background</h3><div>Necrotizing soft tissue infections (NSTI) are rare and life-threatening bacterial infections characterized by necrosis of subcutaneous tissue, fascia, or muscle. Few prospective studies have been conducted. The primary objective is to assess the 90-day mortality rate and to identify prognostic factors in patients with NSTI in an international setting. Secondary objectives are <em>i)</em> to characterize the clinical and microbiological presentation and management; <em>ii)</em> to assess the risk of limb amputation and associated factors; and <em>iii)</em> to assess functional and health-related quality of life (HRQoL) outcomes and associated factors.</div></div><div><h3>Methods</h3><div>We are conducting a multinational, prospective, non-interventional cohort study. We plan to enroll 1,033 consecutive patients admitted to 85 hospitals with surgically proven NSTI between November 2021 and December 2024 in 17 countries over three continents. Data will be collected prospectively on a secure web-based server. The primary outcome measure will be the day-90 mortality. Secondary outcomes include need for limb amputation, the activity of daily living scale and health-related quality of life at day-90 (EQ-5D-5L questionnaire). Baseline characteristics associated with outcomes will be identified by multivariable analyses. Exploratory analyses will be conducted to assess the impact of therapeutic interventions on day-90 mortality and secondary outcomes. The study protocol has been approved by an ethics committee in each participating country.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 2","pages":"Article 105033"},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-25DOI: 10.1016/j.idnow.2025.105027
Yusuff Adebayo Adebisi , Adeola Bamisaiye , Don Eliseo-Lucero Prisno III
Antimicrobial resistance (AMR) poses a global health challenge, particularly in maritime environments where unique conditions foster its emergence and spread. Characterized by confined spaces, high population density, and extensive global mobility, ships create a setting ripe for the development and dissemination of resistant pathogens. This review aims to analyse the contributing factors, epidemiological challenges, mitigation strategies specific to AMR on ships and to propose future research directions, bridging a significant gap in the literature. Maritime environments facilitate the propagation of AMR through interconnected factors. The confined and communal nature of ships allows resistant pathogens to spread rapidly among diverse populations. The inappropriate and often empirical use of broad-spectrum antibiotics, compounded by limited access to diagnostic tools, accelerates the selection of resistant strains. Poor infection control practices, including inadequate sanitation and ineffective isolation measures, exacerbate the risks. Environmental contamination through untreated wastewater and ballast water discharge introduces resistant bacteria and genes into marine ecosystems, posing additional public health and ecological threats. Surveillance of AMR on ships is hampered by logistical barriers, including the lack of standardized protocols and reporting systems. Documented outbreaks of resistant pathogens, such as methicillin-resistant Staphylococcus aureus, underline the public health risks associated with AMR in maritime settings, alongside significant operational disruptions and environmental impacts. Despite advancements in portable diagnostic technologies, their adoption on ships remains minimal, leaving critical gaps in detection and management. Effective management of AMR in maritime settings necessitates the integration of stewardship programs tailored to shipboard environments, reinforced infection control measures, and advanced wastewater treatment.
抗菌素耐药性（AMR）对全球健康构成了挑战，尤其是在海洋环境中，其独特的条件更容易导致耐药性的产生和传播。船舶的特点是空间密闭、人口密度高、全球流动性大，为耐药病原体的发展和传播创造了成熟的环境。本综述旨在分析导致船舶上出现抗药性病原体的因素、流行病学挑战、缓解策略，并提出未来的研究方向，弥补文献中的重大空白。海上环境通过相互关联的因素促进了 AMR 的传播。船舶的封闭性和公共性使得耐药病原体在不同人群中迅速传播。广谱抗生素使用不当且往往是经验性的，再加上诊断工具有限，加速了耐药菌株的选择。不良的感染控制措施，包括卫生条件不足和隔离措施不力，加剧了风险。未经处理的废水和压舱水排放造成的环境污染将耐药细菌和基因带入海洋生态系统，对公共卫生和生态环境造成更多威胁。由于缺乏标准化规程和报告系统等后勤障碍，对船上 AMR 的监测工作受到阻碍。耐甲氧西林金黄色葡萄球菌等耐药病原体爆发的记录突显了在海上环境中与 AMR 相关的公共卫生风险，以及严重的运营中断和环境影响。尽管便携式诊断技术取得了进步，但在船舶上的应用仍然很少，因此在检测和管理方面存在重大差距。要在海事环境中有效管理 AMR，就必须整合适合船上环境的管理计划、强化感染控制措施和先进的废水处理技术。
{"title":"Antimicrobial Resistance on Ships: A Narrative Review","authors":"Yusuff Adebayo Adebisi , Adeola Bamisaiye , Don Eliseo-Lucero Prisno III","doi":"10.1016/j.idnow.2025.105027","DOIUrl":"10.1016/j.idnow.2025.105027","url":null,"abstract":"<div><div>Antimicrobial resistance (AMR) poses a global health challenge, particularly in maritime environments where unique conditions foster its emergence and spread. Characterized by confined spaces, high population density, and extensive global mobility, ships create a setting ripe for the development and dissemination of resistant pathogens. This review aims to analyse the contributing factors, epidemiological challenges, mitigation strategies specific to AMR on ships and to propose future research directions, bridging a significant gap in the literature. Maritime environments facilitate the propagation of AMR through interconnected factors. The confined and communal nature of ships allows resistant pathogens to spread rapidly among diverse populations. The inappropriate and often empirical use of broad-spectrum antibiotics, compounded by limited access to diagnostic tools, accelerates the selection of resistant strains. Poor infection control practices, including inadequate sanitation and ineffective isolation measures, exacerbate the risks. Environmental contamination through untreated wastewater and ballast water discharge introduces resistant bacteria and genes into marine ecosystems, posing additional public health and ecological threats. Surveillance of AMR on ships is hampered by logistical barriers, including the lack of standardized protocols and reporting systems. Documented outbreaks of resistant pathogens, such as methicillin-resistant <em>Staphylococcus aureus</em>, underline the public health risks associated with AMR in maritime settings, alongside significant operational disruptions and environmental impacts. Despite advancements in portable diagnostic technologies, their adoption on ships remains minimal, leaving critical gaps in detection and management. Effective management of AMR in maritime settings necessitates the integration of stewardship programs tailored to shipboard environments, reinforced infection control measures, and advanced wastewater treatment.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 2","pages":"Article 105027"},"PeriodicalIF":2.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1016/j.idnow.2025.105026
Jonathan Pehlivan , Pierre Berge , Anne-Laurence Gourdier , Michael Phelippeau , Pierre Danneels , Rafael Mahieu , Vincent Dubée
Background
Computed tomography (CT) is a critical tool for the diagnosis of pneumonia caused by SARS-CoV-2. The Delta and Omicron variants show distinct clinical features, but the radiological differences between pneumonia caused by these variants have not been extensively studied in patients with oxygen-dependent pneumonia.
Objective
To compare the radiological and clinical features of pneumonia in patients hospitalized with oxygen-dependent SARS-CoV-2 infection caused by the Delta and Omicron variants.
Methods
We performed a retrospective single-center study, including patients hospitalized with oxygen-dependent SARS-CoV-2 pneumonia between October 2021 and February 2022. Clinical and radiological data were collected and compared between patients infected with the Delta variant and those with the Omicron variant. CT scans were reviewed by a radiologist and a pulmonologist blinded to clinical and variant information.
Results
A total of 135 patients with the Delta variant and 48 with the Omicron variant were included. Patients infected with Omicron were older (median age 75 years [68–83.2] vs 69 years [62–77.5], p = 0.004), more immunocompromised (52 % vs. 25 %, p < 0.001), and had higher vaccination rates (73 % vs. 51 %, p = 0.009). Radiologically, ground-glass opacities were present in 95 % of patients. There were no significant differences in the degree of lung involvement, type of lesions and their predominance. Unilateral lung involvement was more common in Omicron-infected patients (8.3 % vs 0.74 %, p = 0.02).
Conclusion
While Omicron oxygen-dependent pneumonia occurred in older and more comorbid patients, its clinical and radiological features were largely indistinguishable from those caused by the Delta variant, except for a higher rate of unilateral lung involvement.
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