Journal of Hospital Infection最新文献

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a priority-1 critical pathogen with limited treatment options and high mortality among intensive care unit (ICU) patients. Italy reports hyperendemic levels, whereas France maintains low prevalence. Understanding cross-border differences is essential to inform infection prevention and control (IPC) and antibiotic stewardship strategies.

Aim: We investigated incidence trends of CRAB infections in ICUs across the French-Italian border and assessed structural, organizational, IPC, and stewardship practices to identify factors associated with infection risk.

Methods: We conducted a multicenter observational study involving ICUs of four cross-border regions (Piemonte, Valle d'Aosta, Auvergne Rhône Alpes, Provence Alpes Côte d'Azur). Data on ICU-acquired bloodstream infections (BSI), central-line associated BSI (CLABSI), pneumonia, and ventilator-associated pneumonia (VAP) with CRAB isolates were extracted from the GiViTI and Réa-Rézo surveillance systems (2019-2022). A structured survey explored ICU characteristics, IPC, and stewardship practices. Logistic regression analysis was performed to identify factors associated with CRAB infection episodes.

Results: Overall, 25 ICUs participated in data collection. Among 24,822 ICU admissions, the proportion of A. baumannii isolates that were carbapenem-resistant was 18.75% (95% CI 7.97-34.98) in France and 83.56% (95% CI 80.1-86.63) in Italy. Different approaches to IPC and antibiotic stewardship were highlighted. Structural ICU design, staffing flexibility, and resilient IPC and stewardship practices were associated with lower infection risk.

Conclusion: CRAB incidence was substantially higher in Italy than in France. Cross-border harmonization of surveillance and coordinated preventive strategies are critical to contain cross-border spread.

Background/objectives: Clostridioides difficile infection (CDI) remains a major cause of nosocomial diarrhoea, with intensive care (ICU) and intermediate care (IMC) patients experiencing particularly high morbidity and mortality. Although prognostic models exist, predictive accuracy remains limited. This study aimed to identify determinants of adverse CDI outcomes, recurrence, and prolonged hospitalization in a tertiary care setting.

Methods: We retrospectively analyzed 87 hospitalized CDI cases (2012-2014). Severe CDI was defined by laboratory and clinical criteria. The primary endpoint was major adverse clinical events (MACE-CDI: surgery, in-hospital mortality, or severe-complicated course). Secondary outcomes included recurrence and length of stay. Logistic and linear regression analyses with bootstrap validation (1,000 iterations) were performed.

Results: Among 87 patients (mean age 60.7 ± 15.2 years; 48% ≥65 years; 53% immunosuppressed), 37 (42.5%) required ICU/IMC admission. MACE-CDI occurred in 16.1% and were associated with ICU admission (OR 4.26, 95% CI 1.29-16.76; p=0.017). In-hospital mortality (13.8%) was linked to ICU admission (OR 8.89, 95% CI 2.15-60.65; p=0.0017) and age ≥55 years. Sodium bicarbonate therapy (SBT) predicted poor outcome (OR 2.9, p=0.028). CDI recurrence occurred in 21.8%. Vancomycin-resistant Enterococcus (VRE) colonization conferred a >16-fold increased risk in ICU/IMC patients (OR 16.20, p=0.015). Parenteral nutrition (PN) was consistently associated with severe CDI (OR 2.49, p=0.041) and prolonged hospitalization, alongside ascites (p<0.01). Piperacillin/tazobactam and cephalosporin exposure increased nosocomial/severe CDI risk, whereas trimethoprim/sulphamethoxazole appeared as a lower-risk substitute.

Conclusions: Older age, ICU admission, ascites, VRE colonization, SBT, and PN correlated with adverse CDI outcomes. These factors may inform stewardship/management strategies in high-risk patients.

Background: Rises in the prevalence of multi-drug-resistant organisms threatens patient safety globally. Vancomycin-Resistant Enterococci (VRE) and Carbapenem-Resistant Enterobacteriaceae (CRE) are linked with prolonged hospitalisation, treatment failure, and increased mortality. Decolonisation strategies could reduce transmission and improve outcomes; but their efficacy and safety remain uncertain. This study systematically evaluates decolonisation protocols for VRE and CRE through meta-analysis.

Methods: Following PRISMA guidelines, a systematic review and meta-analysis were performed on studies using PubMed, ScienceDirect, Web of Science, and Scopus. Studies evaluating decolonisation protocols for VRE and CRE were included. Papers were assessed for risk of bias using the Risk of Bias 2, and Newcastle-Ottawa Scale. Meta-analysis were performed using RevMan.

Results: 16 studies with a total of 872 participants were included for meta-analysis. FMT significantly improved clearance of CRE (RR 2.01; 95% CI 1.27-3.18) and VRE (RR 2.96, 95% CI 1.60-5.47) compared to controls, with low to moderate heterogeneity. SDD significantly increased clearance of CRE (RR 2.47, 95% CI 1.32-4.63), but not VRE (RR 1.52, 95% CI 0.70-3.30). Adverse events were generally mild, but SDD was associated with increased antimicrobial resistance in several studies.

Conclusions: FMT and SDD are promising interventions for CRE decolonisation; with FMT also showing benefit in VRE. The durability of SDD effects appears limited, with significant risk of promoting resistance. Future studies should standardise endpoints, evaluate combination approaches, and explore bacteriophage therapy. We suggest implementing uniform terminology with "provisional clearance" as a descriptor for eradication at 1-month post-intervention and "enduring clearance" following continuous eradication for 6 months.

Background: Guidance on the use of fluid-resistant surgical masks (FRSM) and filtering face-piece (FFP3) masks by healthcare staff in England is produced nationally and applied locally by hospital trusts. In April 2022, national infection prevention and control (IPC) guidance was updated with reference to the importance of local risk assessment when considering use of FFP3 masks.

Aim: Our aim was to evaluate local hospital policies for use of face masks and risk assessment for healthcare staff.

Methods: A cross-sectional online survey (February-March 2023) of NHS trusts in England. Responses were analysed using Fisher's Exact tests and the framework approach.

Results: Fifty nine percent (109/186) of eligible hospital trusts responded. All trusts required staff to wear FRSM or FFP3 when providing direct care to patients with suspected respiratory viral infection (RVI); 87% (95/109) and 13% (14/109) respectively. FFP3s were required by 13% of trusts (14/109) when providing direct care to individuals with suspected RVI and by 9% of trusts (10/109) when present in a bay/ward with patients with suspected RVI. Over half of trusts used locally developed risk assessment tools.

Conclusions: There was clear variation in policies for use of face masks and use of workplace and individual risk assessments across hospital trusts. There was also variation in application of mask use, fit testing and audit of adherence. Further work is required to explore whether development of further guidance and national implementation tools could reduce unwarranted variation.

Background: Access to safe drinking water is critical for patient care and infection prevention in healthcare facilities (HCFs). In Sindh, Pakistan, limited monitoring data exist despite widespread reports of contamination.

Objective: To evaluate the physicochemical and microbiological quality of drinking water supplied to HCFs across Sindh and assess associated patient safety risks to inform infection prevention and control (IPC) strategies and guide water quality interventions.

Methods: A total of 280 water samples were collected from 136 HCFs across 26 districts and analysed for key physicochemical parameters and microbial contamination indicators (total coliforms, Escherichia coli) were analyzed following APHA standards. Data were interpreted against WHO drinking water guidelines. Multivariate, facies and hydrochemical interpretation were applied to explain contamination sources and controls.

Results: Contamination patterns were highly variable spatially, with groundwater sources contributing primarily to salinity, hardness and sodium exceedances, whereas surface water sources were associated with turbidity and microbial risks. Filtration plants demonstrated variable performance. District level exceedances identified clear contamination hotspots that require targeted intervention rather than uniform policy responses. TDS exceeded WHO limits in 30% of samples, particularly in NFR, SHK, SNG and UMK. Turbidity exceeded permissible values in 20.7% of samples, mainly in THA, SUJ and SUK. Chloride and hardness exceeded guideline limits in 22.1% and 16.1% samples, respectively, predominantly in groundwater. Sodium exceeded limits in 25% of samples. Fluoride and arsenic contamination remained localized. Microbiological contamination was widespread, with total coliforms detected in 76.3% and E. coli in 18.6% of samples. Multivariate analyses provided further insights; PCA identified mineralization (PC1, 49.45%) and carbonate equilibrium (PC2, 10.63%) as key controls, while hydrochemical facies analysis distinguished precipitation-dominated Ca-Mg-HCO₃ waters, rock-dominated Na⁺ enrichment, and evaporation driven Na⁺-Cl^--SO₄^2- salinization.

Conclusions: A substantial proportion of drinking water in Sindh HCFs does not meet WHO standards, presenting significant microbiological and chemical risks. Strengthened monitoring, effective disinfection, and Water Safety Plans are urgently required to safeguard IPC and patient health in line with global IPC priorities and Sustainable Development Goal 6.

Blood culture contamination (BCC) is a frequent and costly challenge in clinical diagnostics. BCC leads to extended hospital stays, unnecessary antimicrobial therapy, diagnostic delays, and increased healthcare costs, sometimes exceeding $100,000 per case depending on the scope of analysis. It also contributes to environmental waste and reputational harm. Blood culture diversion (BCD), particularly via blood culture diversion devices (BCDDs), has emerged as a promising strategy to reduce BCC. BCDDs divert initial blood flow likely contaminated with skin flora, thereby improving diagnostic accuracy. This scoping review analysed 23 studies, including randomized controlled trials and observational designs. BCD was an effective way to reduce the rate of BCC. BCDDs consistently outperformed open diversion methods in reducing BCC rates. However, findings on their impact on antimicrobial usage, hospital length of stay, and cost-effectiveness varied. Some studies reported significant cost savings and reduced vancomycin use, while others showed minimal change. Barriers to BCDD adoption include financial constraints, inconsistent definitions of BCC, and variable staff compliance. Enablers include positive user feedback, targeted training, and integration into national surveillance frameworks. Evidence gaps remain in comparative effectiveness, sustainability metrics, and behavioural factors influencing implementation. The review recommends broader adoption of BCDDs, particularly in high-risk settings, emphasising the need for local data to identify where implementation will be most effective. It also calls for standardized definitions, improved surveillance, and further research into broader clinical, economic, and environmental outcomes.

Background: Non-ventilator-associated pneumonia (NV-HAP), a subset of healthcare-associated pneumonia (HAP), is common and significantly increases patient mortality and hospital stay. However, no systematic review has been undertaken to synthesise the impact of NV-HAP on these outcomes.

Aim: To undertake a review of the evidence on the impact of NV-HAP on mortality and additional length of stay in adults admitted to an acute care hospital.

Methods: We performed a systematic search to identify research exploring and evaluating the impact of NV-HAP on mortality and additional length of stay in adults admitted to an acute care hospital. The electronic databases MEDLINE and CINAHL were searched, for peer-reviewed articles published between January 2004 and August 2025. An assessment of the study quality and risk of bias of included articles was conducted using the ROBINS-E and ROBINS-I tool.

Findings: 6324 studies were initially identified with 49 articles included in the review following the screening and full-text review. Twenty-six papers identified both mortality and additional length of stay results, 21 papers identified mortality results only and two papers reported additional length of stay results only. Inpatient mortality following NV-HAP ranged from 3.1 - 73.9%. Additional length of stay associated with NV-HAP was extended between 10 - 47.5 days.

Conclusions: This systematic review highlights the impact of NV-HAP on patients admitted to hospital. NV-HAP was associated with patient mortality and additional length of stay. Results of this study will inform a larger planned program of research.