Infection Control and Hospital Epidemiology最新文献

Background: The clinical impact of carbapenem-resistant Acinetobacter baumannii (CRAB) remains controversial, with uncertainty about whether it directly contributes to mortality or merely reflects underlying patient's morbidity. This study aimed to evaluate the impact of CRAB colonization and infection on patient outcomes.

Methods: A retrospective cohort study was conducted in an Israeli tertiary hospital between January 2023 and December 2024. Patients were categorized into CRAB-negative (A group), CRAB-present on admission (POA, B group), and hospital-acquired CRAB (C group). Time-varying Cox proportional hazards models were used to estimate 30- and 90-day mortality risks while adjusting for immortal time bias. Kaplan-Meier and cumulative hazard curves were generated, and univariable Firth logistic regressions were performed as exploratory analyses.

Results: Of 3,080 patients, 149 had CRAB-POA and 108 acquired CRAB. Risk factors for CRAB-POA included long-term care facility residence (odds ratio (OR) = 4.1) and mechanical ventilation (OR = 2.3). Hospital-acquired CRAB was associated with longer length of stay and ventilation. Time-varying Cox models adjusting for immortal time bias showed that both CRAB colonization and infection were associated with increased 30-day mortality (hazard ratio (HR) range: 1.95-2.88) and 90-day mortality (HR range: 2.11-2.93), compared with CRAB-negative patients. Implementation of enhanced screening and cohorting in the late study period was associated with reduced CRAB acquisition (OR = 0.13, 95% confidence interval (CI): 0.07-0.24) and mortality (OR = 0.62, 95% CI: 0.41-0.94).

Conclusions: Both CRAB colonization and infection are associated with twofold increase in mortality after adjusting for disease severity. Enhanced infection control measures reduced acquisition and mortality.

Objective: We assessed the impact of an oral care initiative on non-ventilator-associated hospital-acquired pneumonia (NV-HAP) risk using two different measurement strategies.

Methods: We evaluated changes in NV-HAP events among all patients admitted to 17 VA Medical Centers (1) across the period 10/01/2015-12/31/2019, and (2) one-year pre- vs post- each hospital's oral care initiative start date. We modeled and compared observed versus predicted NV-HAP events per hospitalization using (1) an electronic clinical definition and (2) diagnosis codes, adjusting for patients' demographics, vital signs, and laboratory results at presentation.

Results: Among 333,257 hospitalizations, 1,922 (0.58%) met NV-HAP electronic clinical criteria and 2,386 (0.72%) diagnostic coding criteria. The risk of NV-HAP defined by electronic clinical criteria was 0.62% in October 2015 and 0.54% in December 2019 (estimated difference -0.084% [95% CI: -0.17%, 0.0056%]; the risk of NV-HAP defined by diagnostic coding decreased from 1.0% to 0.48% (estimated difference -0.53% [-0.63%, -0.43%]). In the one-year pre- vs post-analysis, there was no evidence of effect of the implementation on NV-HAP using either electronic clinical criteria (adjusted risk difference -0.078% (95% CI: -0.25%, 0.091%) or diagnostic coding criteria (adjusted risk difference -0.021% (95% CI: -0.18%, 0.14%).

Conclusions: In a large multi-center study of hospitalized patients, we were unable to identify a clear effect of an oral care initiative on NV-HAP using electronic clinical criteria or diagnostic coding criteria.

Objective: The study aimed to summarize estimates of key epidemiological parameters to improve the effectiveness of Clostridioides difficile infection (CDI) mathematical models and quantitatively characterize high-touch surfaces (HTSs) and mutual-touch surfaces in healthcare settings.

Methods: We systematically searched four databases and applied predefined eligibility criteria to screen, select, and include peer-reviewed studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study is registered in the International Prospective Register of Systematic Reviews (CRD42023408483).

Results: Among the 21 C. difficile infection modeling studies, 76.2% used compartmental model approaches that group patients into infection disease categories such as susceptible, infected, or recovered, while 23.8% applied agent-based model approaches that simulate individual patients, staff, or surfaces. Key epidemiological parameters varied widely: estimates of how many new cases one patient could cause-the basic reproduction number (R₀)-ranged from 0.28, suggesting limited hospital spread, to as high as 2.6, which implies sustained in-hospital transmission. Incubation periods were reported between 4 and 18 days. Recovery and recurrence rates also differed across studies. Quantitative HTSs ranking revealed that bed rails, bedside tables, and supply carts were the top three most frequently touched surfaces.

Conclusions: Our findings highlight that modeling studies used different assumptions and estimates, creating variations in results. Clinicians should interpret modeling outputs, such as predicted spread or effectiveness of an intervention carefully, as differences may reflect real-world variation between hospitals or methodological variation. Developing infection models that reflect real-world conditions will enable healthcare teams better simulate and prioritize interventions, optimize cleaning protocols, and improve CDI transmission models for more targeted prevention.

We surveyed SHEA Research Network institutions in the U.S. to characterize penicillin allergy delabeling practices. Although most institutions reported active delabeling programs, we found substantial variability in these initiatives. Reported barriers included minimal electronic health record (EHR) integration and time constraints. Expanding non-allergist-led programs and EHR integration are critical to optimizing and advancing delabeling.

Background: Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.

Methods: We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.

Results: A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.

Conclusion: Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.

Background: Surgical site infections (SSIs) are among the most common postoperative complications in colorectal surgery, and associate with increased morbidity, prolonged recovery, and higher healthcare costs. Most studies combine all SSI categories, potentially overestimating economic burden due to higher severity of organ/space infections. The specific cost impact of incisional SSIs-superficial and deep infections-remains underexplored, despite its prevention potential. This study aimed to evaluate hospital costs associated with incisional SSIs following colorectal resection.

Methods: A retrospective cohort study was conducted at a tertiary oncologic center, including patients who underwent surgical resection for primary neoplasms of the colon, rectum, or anal canal between 2018 and 2023. Patients with incisional SSIs were matched 1:1 to controls without SSI using propensity scores based on demographic and surgical variables. Total hospital costs within 60 days postoperatively were analyzed using real-world, institution-specific cost data. Multivariate regression was used to identify independent cost predictors.

Results: Among 985 eligible patients, 176 (17.9%) developed an incisional SSI. After matching, 346 patients (173 pairs) were included in the cost analysis. Mean hospital costs were significantly higher in the SSI group (€6,065.93 vs €5,089.97; P < 0.001), primarily due to prolonged hospitalization and increased outpatient care use (medical and nursing consultations). Incisional SSI was an independent predictor of higher costs, along with open surgery, comorbidities and stoma presence.

Conclusions: Incisional SSIs associated with higher hospital costs after colorectal surgery. These findings support the implementation of targeted SSI prevention strategies to reduce complications and optimize healthcare resource use.

Objective: This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge.

Methods: Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire.

Results: IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16-985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing.

Conclusion: The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.

In a retrospective cohort of 6363 neonates admitted to three NICUs, there was no reduction in Staphylococcus aureus acquisition when comparing pre- and post-pandemic incidence rates. While additional infection prevention practices introduced during the pandemic helped prevent SARS-CoV-2 transmission, these practices may not have reduced S. aureus transmission to infants.

This single-center retrospective analysis evaluated the yield of blood cultures in patients with febrile neutropenia during a supply shortage. The detection rate of true bacteremia was observed to increase with the number of sets obtained, although this increase was not statistically significant. Findings support limiting repeat cultures within 48 hours.

Objective: To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults.

Design: Pre-post quasi-experimental study.

Setting: Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers.

Patients: Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023.

Methods: A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods.

Results: The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups.

Conclusions: A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.