Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101264
Max Alexander Bär PhD , Nadège Akissi Kouamé MSc , Sadikou Touré , Jean Tenena Coulibaly PhD , Pierre Henri Hermann Schneeberger PhD , Prof Jennifer Keiser PhD
<div><h3>Background</h3><div>Trichuriasis is a neglected tropical disease that affects up to 500 million individuals and can cause considerable morbidity. For decades, trichuriasis was thought to be caused by one species of whipworm, <em>Trichuris trichiura</em>. The aim of this study was to investigate the origin of differences in response rates to the best available anthelmintic treatment for trichuriasis—a combination of albendazole and ivermectin—in Côte d’Ivoire by analysing the parasite population.</div></div><div><h3>Methods</h3><div>In this morphological, genomic, and genome-wide association study (GWAS) with drug sensitivity we used long-read and short-read sequencing approaches and assembled a high-quality reference genome of <em>Trichuris incognita</em> n sp isolated in a primary interventional study conducted in the Lagunes district of Côte d’Ivoire. Children aged 6–12 years were screened between July 14, 2022, and July 31, 2022; children positive for <em>T trichiura</em> on duplicate Kato–Katz smears and with infection intensity of 200 eggs per gram or more were eligible and treated first with albendazole (400 mg) and ivermectin (200 μg/kg) then with oxantel pamoate (20 mg/kg). We constructed a species tree of the <em>Trichuris</em> genus using 12 434 orthologous groups. We sequenced individual worms, which were used to confirm the phylogenetic placement and investigate patterns of adaptation through comparative genomic analyses. Finally, we conducted a GWAS to compare albendazole–ivermectin sensitive worms to drug non-sensitive worms.</div></div><div><h3>Findings</h3><div>670 children were screened, of whom 243 were enrolled and from whom 271 worms were isolated after the first treatment and 827 worms after the second treatment. Sufficient DNA was recovered from 747 worms of which 721 were suitable for further bioinformatic analysis; of these, 179 were albendazole–ivermectin sensitive worms and 542 were drug non-sensitive worms. We present and characterise a new, human-infecting <em>Trichuris</em> species named <em>T incognita</em> n sp, which is morphologically indistinguishable from <em>T trichiura</em>, but forms a distinct phylogenetic clade, closer to <em>Trichuris suis</em> than to the canonical human-infective <em>T trichiura</em>. Comparative genomic analysis of genes suspected to confer resistance to either albendazole or ivermectin in helminths revealed a high number of <em>β-tubulin</em> orthologs, present in the whole population of <em>T incognita</em> n sp, compared with the canonical <em>T trichiura</em> species, but these genes were not associated with a resistant phenotype. The GWAS did not provide conclusive evidence of adaptation to drug pressure within the same species.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate that trichuriasis can be caused by multiple whipworm species, and that differences in response rates might result from species responding differently to drug treatment, rather than
背景：鞭虫病是一种被忽视的热带疾病，影响多达5亿人，可引起相当高的发病率。几十年来，人们一直认为鞭虫病是由一种鞭虫引起的。这项研究的目的是通过分析科特迪瓦Côte的寄生虫种群，来调查对血吸虫病的最佳驱虫药治疗（阿苯达唑和伊维菌素的联合治疗）反应率差异的来源。方法：在这项与药物敏感性的形态学、基因组学和全基因组关联研究（GWAS）中，我们使用长读和短读测序方法，组装了在Côte科特迪瓦Lagunes地区进行的初级介入研究中分离到的Trichuris incognita n sp的高质量参考基因组。在2022年7月14日至7月31日期间对6-12岁儿童进行筛查；重复Kato-Katz涂片阳性且感染强度≥200个鸡蛋/克的儿童符合条件，先用阿苯达唑（400 mg）和伊维菌素（200 μg/kg）治疗，然后用帕莫酸牛胺特（20 mg/kg）治疗。我们利用12 434个同源类群构建了一个毛缕属的种树。我们对单个蠕虫进行了测序，用于确认系统发育位置，并通过比较基因组分析研究适应模式。最后，我们进行了GWAS比较阿苯达唑-伊维菌素敏感的蠕虫和药物不敏感的蠕虫。结果：筛选了670名儿童，其中243名入组，在第一次治疗后分离出271条蠕虫，在第二次治疗后分离出827条蠕虫。从747只蠕虫中提取了足够的DNA，其中721只适合进一步的生物信息学分析；其中，阿苯达唑-伊维菌素敏感虫179只，药物不敏感虫542只。我们提出并描述了一种新的，人类感染的毛滴虫物种，命名为incognita n sp，它在形态上与毛滴虫难以区分，但形成了一个独特的系统发育分支，更接近于猪毛滴虫，而不是典型的人类感染的毛滴虫。对蛔虫对阿苯达唑或伊维菌素产生抗性的基因进行了比较基因组分析，结果显示，与典型的毛线虫物种相比，在整个蠕虫种群中存在大量β-微管蛋白同源基因，但这些基因与抗性表型无关。GWAS没有提供在同一物种内适应药物压力的确凿证据。解释：我们的研究结果表明，鞭虫病可以由多种鞭虫引起，反应率的差异可能是由于不同物种对药物治疗的反应不同，而不是由于种内抗性的建立。这一发现，加上对阿苯达唑-伊维菌素的高度耐受性，标志着我们如何理解和处理鞭虫感染的重大转变。资助：欧洲研究委员会。
{"title":"Characterisation of Trichuris incognita n sp in Côte d’Ivoire: a morphological, genomic, and genome-wide association with drug sensitivity study","authors":"Max Alexander Bär PhD , Nadège Akissi Kouamé MSc , Sadikou Touré , Jean Tenena Coulibaly PhD , Pierre Henri Hermann Schneeberger PhD , Prof Jennifer Keiser PhD","doi":"10.1016/j.lanmic.2025.101264","DOIUrl":"10.1016/j.lanmic.2025.101264","url":null,"abstract":"<div><h3>Background</h3><div>Trichuriasis is a neglected tropical disease that affects up to 500 million individuals and can cause considerable morbidity. For decades, trichuriasis was thought to be caused by one species of whipworm, <em>Trichuris trichiura</em>. The aim of this study was to investigate the origin of differences in response rates to the best available anthelmintic treatment for trichuriasis—a combination of albendazole and ivermectin—in Côte d’Ivoire by analysing the parasite population.</div></div><div><h3>Methods</h3><div>In this morphological, genomic, and genome-wide association study (GWAS) with drug sensitivity we used long-read and short-read sequencing approaches and assembled a high-quality reference genome of <em>Trichuris incognita</em> n sp isolated in a primary interventional study conducted in the Lagunes district of Côte d’Ivoire. Children aged 6–12 years were screened between July 14, 2022, and July 31, 2022; children positive for <em>T trichiura</em> on duplicate Kato–Katz smears and with infection intensity of 200 eggs per gram or more were eligible and treated first with albendazole (400 mg) and ivermectin (200 μg/kg) then with oxantel pamoate (20 mg/kg). We constructed a species tree of the <em>Trichuris</em> genus using 12 434 orthologous groups. We sequenced individual worms, which were used to confirm the phylogenetic placement and investigate patterns of adaptation through comparative genomic analyses. Finally, we conducted a GWAS to compare albendazole–ivermectin sensitive worms to drug non-sensitive worms.</div></div><div><h3>Findings</h3><div>670 children were screened, of whom 243 were enrolled and from whom 271 worms were isolated after the first treatment and 827 worms after the second treatment. Sufficient DNA was recovered from 747 worms of which 721 were suitable for further bioinformatic analysis; of these, 179 were albendazole–ivermectin sensitive worms and 542 were drug non-sensitive worms. We present and characterise a new, human-infecting <em>Trichuris</em> species named <em>T incognita</em> n sp, which is morphologically indistinguishable from <em>T trichiura</em>, but forms a distinct phylogenetic clade, closer to <em>Trichuris suis</em> than to the canonical human-infective <em>T trichiura</em>. Comparative genomic analysis of genes suspected to confer resistance to either albendazole or ivermectin in helminths revealed a high number of <em>β-tubulin</em> orthologs, present in the whole population of <em>T incognita</em> n sp, compared with the canonical <em>T trichiura</em> species, but these genes were not associated with a resistant phenotype. The GWAS did not provide conclusive evidence of adaptation to drug pressure within the same species.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate that trichuriasis can be caused by multiple whipworm species, and that differences in response rates might result from species responding differently to drug treatment, rather than","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101264"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101276
Gregory Melocco , Karine Dantas , Herrison Fontana , Caroline L Martini , Elder Sano , Felipe Vasquez-Ponce , Johana Becerra , Bruna Fuga , Fernanda Esposito , Mateus R Ribas , Alessandro C O Silveira , Nilton Lincopan
{"title":"USA300 North American epidemic meticillin-resistant Staphylococcus aureus in South America: new pathogenicity island","authors":"Gregory Melocco , Karine Dantas , Herrison Fontana , Caroline L Martini , Elder Sano , Felipe Vasquez-Ponce , Johana Becerra , Bruna Fuga , Fernanda Esposito , Mateus R Ribas , Alessandro C O Silveira , Nilton Lincopan","doi":"10.1016/j.lanmic.2025.101276","DOIUrl":"10.1016/j.lanmic.2025.101276","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101276"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101284
Munyaradzi Makoni
{"title":"Africa launches plan to eliminate cholera by 2030","authors":"Munyaradzi Makoni","doi":"10.1016/j.lanmic.2025.101284","DOIUrl":"10.1016/j.lanmic.2025.101284","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101284"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101287
Cara Adolph PhD , Simon C Mendelsohn PhD , Laura E Via PhD , Leonardo Martinez PhD , Cecilia S Lindestam Arlehamn PhD , Prof David M Lewinsohn PhD , Jordi B Torrelles PhD , Prof Philip C Hill MD
Progress in tuberculosis vaccine development is hindered by the incomplete understanding of protective immunity and other disease mechanisms. An interconnected network of sample biorepositories from tuberculosis studies could help to address these gaps. To assess the feasibility of such a resource, we conducted a scoping review of tuberculosis observational studies and vaccine clinical trials. The included studies collected at least one biological sample from tuberculosis cases, contacts, or controls and had more than 100 participants. We contacted the corresponding authors of these studies to determine the sample availability and interest in interconnected biorepositories. For the period 2014–24, we identified 104 observational studies and 18 vaccine trials that collected biological samples from 35 075 tuberculosis cases, 39 450 contacts or controls, and 45 628 trial participants across 43 countries. The commonly collected samples were blood, human genomic DNA, RNA, and sputum. Interest among the contacted investigators was high. Interconnected sample biorepositories could facilitate large-scale investigations and accelerate progress towards tuberculosis vaccine development.
{"title":"Global biological sample collections from tuberculosis studies: a scoping review","authors":"Cara Adolph PhD , Simon C Mendelsohn PhD , Laura E Via PhD , Leonardo Martinez PhD , Cecilia S Lindestam Arlehamn PhD , Prof David M Lewinsohn PhD , Jordi B Torrelles PhD , Prof Philip C Hill MD","doi":"10.1016/j.lanmic.2025.101287","DOIUrl":"10.1016/j.lanmic.2025.101287","url":null,"abstract":"<div><div>Progress in tuberculosis vaccine development is hindered by the incomplete understanding of protective immunity and other disease mechanisms. An interconnected network of sample biorepositories from tuberculosis studies could help to address these gaps. To assess the feasibility of such a resource, we conducted a scoping review of tuberculosis observational studies and vaccine clinical trials. The included studies collected at least one biological sample from tuberculosis cases, contacts, or controls and had more than 100 participants. We contacted the corresponding authors of these studies to determine the sample availability and interest in interconnected biorepositories. For the period 2014–24, we identified 104 observational studies and 18 vaccine trials that collected biological samples from 35 075 tuberculosis cases, 39 450 contacts or controls, and 45 628 trial participants across 43 countries. The commonly collected samples were blood, human genomic DNA, RNA, and sputum. Interest among the contacted investigators was high. Interconnected sample biorepositories could facilitate large-scale investigations and accelerate progress towards tuberculosis vaccine development.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101287"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101238
Gilbert Lazarus MD , Benjamin Caddey MSc , Anna Dean DVM MIPH PhD , Florentina Febrina BSc MD , Vincent Kharisma Wangsaputra MD MRes , Shafira Permata Radiani SKM , Yindi Xiong MSc , Prof John M Conly MD FRCPC , Prof Herman W Barkema DVM PhD FCAHS , Lorenzo Pezzoli DVM MSc PhD , Esther van Kleef PhD , Olga Tosas Auguet DVM PhD , Prof Paul Turner MBBS PhD , Kavita U Kothari MSc , Silvia Bertagnolio MD PhD , Diego B Nobrega DVM MSc PhD , Raph L Hamers MD PhD
<div><h3>Background</h3><div>There are fragmented data on the patterns of antimicrobial resistance in the main bacterial pathogens causing meningitis, especially in low-income and middle-income countries (LMICs) where the disease burden is highest. This review aimed to estimate meningitis-specific prevalence of antimicrobial resistance and time trends, globally and for each of the WHO regions, for the main antimicrobials used to treat or prevent meningitis.</div></div><div><h3>Methods</h3><div>In this systematic review and meta-analysis, we systematically searched Embase, Global Health Database, and MEDLINE for original, peer-reviewed articles in any language, published between Jan 1, 2010, and May 16, 2024, describing people diagnosed with a microbiologically confirmed meningitis caused by <em>Streptococcus pneumoniae</em>, <em>Neisseria meningitidis</em>, or <em>Haemophilus influenzae</em>, with antimicrobial susceptibility testing results. We excluded reports that did not describe specimen type, sampling period, geographical setting, denominators, or proportions for single-agent and class resistance. We used multilevel random-effect meta-analysis on summary data to estimate the prevalence and time trends of antimicrobial resistance for relevant pathogen–antimicrobial combinations in each WHO region and globally. To assess article quality, we adopted the Microbiology Investigation Criteria for Reporting Objectively (MICRO) checklist. This review was registered with PROSPERO (CRD42019155379).</div></div><div><h3>Findings</h3><div>The search yielded 1503 studies. After the removal of 606 duplicates, 665 from title and abstract screening, and 140 from full-text screening, 92 reports were eligible for inclusion. A further four were removed due to duplicate datasets. We included 88 reports and extracted data on 16 441 clinical isolates from 37 countries across all WHO regions, mostly LMICs. For <em>S pneumoniae</em> (81 reports, 13 295 isolates), prevalence of antimicrobial resistance was highest in the Western Pacific and Eastern Mediterranean regions, ranging across WHO regions from 14·7% (95% CI 4·5–29·5) to 58·0% (34·9–79·5) for benzylpenicillin (27·4% [19·0–36·6] globally), and from 3·8% (0·0–13·7) to 20·6% (2·2–50·8) for third-generation cephalosporins (3GCs; 8·8% [4·3–14·6] globally). Benzylpenicillin resistance in <em>S pneumoniae</em> meningitis increased over time in LMICs, whereas benzylpenicillin and 3GC resistance decreased over time in high-income countries. For <em>N meningitidis</em> (11 reports, 3001 isolates), prevalence of antimicrobial resistance was highest in the African region, ranging across WHO regions from 9·4% (7·2–11·8) to 44·9% (0·0–100·0) for benzylpenicillin (24·7% [5·3–52·3] globally, increasing over time); from 0·0% (0·0–0·1) to 17·0% (0·0–100·0) for 3GCs (4·6% [0·0–19·4] globally); and from 0·0% (0·0–0·2) to 17·1% (0·0–100·0) for ciprofloxacin (3·7% [0·0-25·9] globally). Among <em>H influenzae</em> isolates (five re
{"title":"Antimicrobial resistance in bacterial meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae (2010–24): a systematic review and meta-analysis","authors":"Gilbert Lazarus MD , Benjamin Caddey MSc , Anna Dean DVM MIPH PhD , Florentina Febrina BSc MD , Vincent Kharisma Wangsaputra MD MRes , Shafira Permata Radiani SKM , Yindi Xiong MSc , Prof John M Conly MD FRCPC , Prof Herman W Barkema DVM PhD FCAHS , Lorenzo Pezzoli DVM MSc PhD , Esther van Kleef PhD , Olga Tosas Auguet DVM PhD , Prof Paul Turner MBBS PhD , Kavita U Kothari MSc , Silvia Bertagnolio MD PhD , Diego B Nobrega DVM MSc PhD , Raph L Hamers MD PhD","doi":"10.1016/j.lanmic.2025.101238","DOIUrl":"10.1016/j.lanmic.2025.101238","url":null,"abstract":"<div><h3>Background</h3><div>There are fragmented data on the patterns of antimicrobial resistance in the main bacterial pathogens causing meningitis, especially in low-income and middle-income countries (LMICs) where the disease burden is highest. This review aimed to estimate meningitis-specific prevalence of antimicrobial resistance and time trends, globally and for each of the WHO regions, for the main antimicrobials used to treat or prevent meningitis.</div></div><div><h3>Methods</h3><div>In this systematic review and meta-analysis, we systematically searched Embase, Global Health Database, and MEDLINE for original, peer-reviewed articles in any language, published between Jan 1, 2010, and May 16, 2024, describing people diagnosed with a microbiologically confirmed meningitis caused by <em>Streptococcus pneumoniae</em>, <em>Neisseria meningitidis</em>, or <em>Haemophilus influenzae</em>, with antimicrobial susceptibility testing results. We excluded reports that did not describe specimen type, sampling period, geographical setting, denominators, or proportions for single-agent and class resistance. We used multilevel random-effect meta-analysis on summary data to estimate the prevalence and time trends of antimicrobial resistance for relevant pathogen–antimicrobial combinations in each WHO region and globally. To assess article quality, we adopted the Microbiology Investigation Criteria for Reporting Objectively (MICRO) checklist. This review was registered with PROSPERO (CRD42019155379).</div></div><div><h3>Findings</h3><div>The search yielded 1503 studies. After the removal of 606 duplicates, 665 from title and abstract screening, and 140 from full-text screening, 92 reports were eligible for inclusion. A further four were removed due to duplicate datasets. We included 88 reports and extracted data on 16 441 clinical isolates from 37 countries across all WHO regions, mostly LMICs. For <em>S pneumoniae</em> (81 reports, 13 295 isolates), prevalence of antimicrobial resistance was highest in the Western Pacific and Eastern Mediterranean regions, ranging across WHO regions from 14·7% (95% CI 4·5–29·5) to 58·0% (34·9–79·5) for benzylpenicillin (27·4% [19·0–36·6] globally), and from 3·8% (0·0–13·7) to 20·6% (2·2–50·8) for third-generation cephalosporins (3GCs; 8·8% [4·3–14·6] globally). Benzylpenicillin resistance in <em>S pneumoniae</em> meningitis increased over time in LMICs, whereas benzylpenicillin and 3GC resistance decreased over time in high-income countries. For <em>N meningitidis</em> (11 reports, 3001 isolates), prevalence of antimicrobial resistance was highest in the African region, ranging across WHO regions from 9·4% (7·2–11·8) to 44·9% (0·0–100·0) for benzylpenicillin (24·7% [5·3–52·3] globally, increasing over time); from 0·0% (0·0–0·1) to 17·0% (0·0–100·0) for 3GCs (4·6% [0·0–19·4] globally); and from 0·0% (0·0–0·2) to 17·1% (0·0–100·0) for ciprofloxacin (3·7% [0·0-25·9] globally). Among <em>H influenzae</em> isolates (five re","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101238"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101250
Ying Fu , Yanfei Wang , Bingyan Yao , Hua Zhou , Jintao He
{"title":"Molecular epidemiology of clinical carbapenem-resistant Citrobacter spp in China (2016–24)","authors":"Ying Fu , Yanfei Wang , Bingyan Yao , Hua Zhou , Jintao He","doi":"10.1016/j.lanmic.2025.101250","DOIUrl":"10.1016/j.lanmic.2025.101250","url":null,"abstract":"","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101250"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.lanmic.2025.101262
Giorgia Gon PhD , Sokvy Ma MSc , Alexander M Aiken PhD , Prof Stephanie J Dancer PhD , Prof Wendy J Graham PhD , Stephen Nash MSc , Vandarith Nov MSc , Sovathiro Mao MSc , Bernice Sarpong MSc , Maxine Pepper MSc , Sreytouch Vong MSc , Vouchnea Tang BA , Jennifer Thompson PhD , Ir Por PhD
Background
Cleanliness of near-patient hospital surfaces is essential for preventing health care-associated infections and the spread of antimicrobial-resistant pathogens. Randomised evaluations of cleaning interventions have not been done in low-resource settings. We assessed the effectiveness of a hospital-based training intervention (Clean Frontline) to improve the microbiological cleanliness of near-patient surfaces.
Methods
In this stepped-wedge, cluster-randomised trial in 13 Cambodian referral hospitals, we defined four steps (timings) that define the transition from control to intervention. All eligible public referral hospitals (district or provincial) in three selected provinces consented to participate. Pre-intervention, environmental cleaning practices remained unchanged. The multicomponent intervention selected, trained, and supervised facility cleaning champions, who in turn trained and supervised hospital cleaners. The primary outcome was microbiological cleanliness of near-patient surfaces, assessed using dipslides (a surface with <2·5 colony-forming units per cm2 was classified as clean). 30 samples per hospital were collected monthly over 10 months. Outcome data collection and analysis teams were masked to treatment allocation. The primary outcome was estimated at surface level (primary analysis, odds ratio) and hospital level (risk difference), using an intention-to-treat approach and adjusted for a-priori confounders: temperature, patient numbers, beds per cleaner, and surface type. This trial is registered with ClinicalTrials.gov, NCT05540886, and is complete.
Findings
Across the 13 participating hospitals, a total of 53 champions and 51 cleaners were trained. Outcomes were measured monthly between May 3, 2022, and March 23, 2023. We collected 3900 samples, 3822 of which were used in the analyses. We observed a positive, although non-significant, effect of the intervention on cleanliness in the surface analysis (odds ratio 1·39 [95% CI 0·95–2·03], p=0·081). The hospital-level analysis indicated a significant improvement of 5·04 percentage points (95% CI 0·76–9·33, p=0·026).
Interpretation
Improving microbiological cleanliness of near-patient surfaces in hospitals in low-resource settings through the delivery of context-appropriate training and support is feasible. Further research should test this intervention with a wider number of clusters. Lessons learnt from the implementation will inform WHO roll-out of the training package.
Funding
Who Gives A Crap and the Reckitt Global Hygiene Institute.
背景：医院近病人表面的清洁对于预防卫生保健相关感染和耐药病原体的传播至关重要。在资源匮乏的环境中，尚未对清洁干预措施进行随机评估。我们评估了以医院为基础的培训干预（清洁前线）的有效性，以提高患者附近表面的微生物清洁度。方法：在13家柬埔寨转诊医院进行的这一楔形分步、聚类随机试验中，我们定义了四个步骤（时间）来定义从控制到干预的过渡。在选定的三个省，所有符合条件的公立转诊医院（区或省）都同意参与。干预前的环境清洁做法保持不变。多组分干预选择，培训和监督设施清洁冠军，他们反过来培训和监督医院清洁工。主要结果是用蘸片评估患者附近表面的微生物清洁度（2级表面为清洁）。每家医院在10个月内每月采集30份样本。结果数据收集和分析小组对治疗分配不知情。主要结局在表面水平（主要分析，优势比）和医院水平（风险差异）进行估计，使用意向治疗方法，并根据先验混杂因素进行调整：温度、患者数量、每个清洁工的床位和表面类型。该试验已在ClinicalTrials.gov注册，编号NCT05540886，并且已经完成。结果：在13家参与医院中，共有53名冠军和51名清洁工接受了培训。结果在2022年5月3日至2023年3月23日期间每月测量一次。我们收集了3900个样本，其中3822个用于分析。在表面分析中，我们观察到干预对清洁度的积极影响，尽管不显著（优势比1.39 [95% CI 0.95 - 2.03], p= 0.081）。医院水平分析显示，显著改善5.04个百分点（95% CI 0.76 - 9.33, p= 0.026）。解释：在资源匮乏的环境中，通过提供适合环境的培训和支持，改善医院近病人表面的微生物清洁度是可行的。进一步的研究应该在更广泛的群体中检验这种干预措施。从实施中吸取的经验教训将为世卫组织推出一揽子培训提供参考。资助：Who Gives A Crap和利洁时全球卫生研究所。
{"title":"Impact of a multicomponent training intervention (Clean FrontLine) on microbiological cleanliness in Cambodian referral hospitals: a multicentre, stepped-wedge, cluster-randomised trial","authors":"Giorgia Gon PhD , Sokvy Ma MSc , Alexander M Aiken PhD , Prof Stephanie J Dancer PhD , Prof Wendy J Graham PhD , Stephen Nash MSc , Vandarith Nov MSc , Sovathiro Mao MSc , Bernice Sarpong MSc , Maxine Pepper MSc , Sreytouch Vong MSc , Vouchnea Tang BA , Jennifer Thompson PhD , Ir Por PhD","doi":"10.1016/j.lanmic.2025.101262","DOIUrl":"10.1016/j.lanmic.2025.101262","url":null,"abstract":"<div><h3>Background</h3><div>Cleanliness of near-patient hospital surfaces is essential for preventing health care-associated infections and the spread of antimicrobial-resistant pathogens. Randomised evaluations of cleaning interventions have not been done in low-resource settings. We assessed the effectiveness of a hospital-based training intervention (Clean Frontline) to improve the microbiological cleanliness of near-patient surfaces.</div></div><div><h3>Methods</h3><div>In this stepped-wedge, cluster-randomised trial in 13 Cambodian referral hospitals, we defined four steps (timings) that define the transition from control to intervention. All eligible public referral hospitals (district or provincial) in three selected provinces consented to participate. Pre-intervention, environmental cleaning practices remained unchanged. The multicomponent intervention selected, trained, and supervised facility cleaning champions, who in turn trained and supervised hospital cleaners. The primary outcome was microbiological cleanliness of near-patient surfaces, assessed using dipslides (a surface with <2·5 colony-forming units per cm<sup>2</sup> was classified as clean). 30 samples per hospital were collected monthly over 10 months. Outcome data collection and analysis teams were masked to treatment allocation. The primary outcome was estimated at surface level (primary analysis, odds ratio) and hospital level (risk difference), using an intention-to-treat approach and adjusted for a-priori confounders: temperature, patient numbers, beds per cleaner, and surface type. This trial is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT05540886</span><svg><path></path></svg></span>, and is complete.</div></div><div><h3>Findings</h3><div>Across the 13 participating hospitals, a total of 53 champions and 51 cleaners were trained. Outcomes were measured monthly between May 3, 2022, and March 23, 2023. We collected 3900 samples, 3822 of which were used in the analyses. We observed a positive, although non-significant, effect of the intervention on cleanliness in the surface analysis (odds ratio 1·39 [95% CI 0·95–2·03], p=0·081). The hospital-level analysis indicated a significant improvement of 5·04 percentage points (95% CI 0·76–9·33, p=0·026).</div></div><div><h3>Interpretation</h3><div>Improving microbiological cleanliness of near-patient surfaces in hospitals in low-resource settings through the delivery of context-appropriate training and support is feasible. Further research should test this intervention with a wider number of clusters. Lessons learnt from the implementation will inform WHO roll-out of the training package.</div></div><div><h3>Funding</h3><div>Who Gives A Crap and the Reckitt Global Hygiene Institute.</div></div>","PeriodicalId":46633,"journal":{"name":"Lancet Microbe","volume":"7 2","pages":"Article 101262"},"PeriodicalIF":20.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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