Journal of Hospital Infection最新文献

Background: Following the recent observation of bacterial deposits on dry surfaces referred to as Dry surface biofilms (DSB), a number of studies were conducted in vitro on bacterial culturability, sensitivity to cleaning and disinfection protocols, and bacterial transfer via gloves or wipes to culture media or inert surfaces. Our study aimed to reproduce in vitro the cross-transmission of bacteria from dry surfaces to invasive medical devices via healthcare professional's gloves.

Methods: Monobacterial DSBs were produced using an automated model with five different bacterial isolates involved in healthcare-associated infections. Bacteria from dried or rehydrated DSBs were first transferred to sterile gloves, then to central venous catheters, urinary catheters or endotracheal tubes. The presence of culturable bacteria and the formation of traditional hydrated biofilms inside the devices were investigated.

Findings: Methicillin-resistant Staphylococcus aureus was the only species to be transferred from both dry and rehydrated DSBs to each invasive device, while the other isolates were only transferred from rehydrated DSBs on mainly central catheters and endotracheal tubes. Despite the non-culturability of Pseudomonas aeruginosa in all the DSBs produced, rehydration enabled its transfer to endotracheal tubes and urinary catheters, suggesting residual viability as evidenced by Live/Dead staining.

Conclusions: A possible link appears to emerge between DSB rehydration, bacterial culturability and transferability. Rehydration may promote bacterial adhesion to gloved fingers and/or the "resuscitation" of non-culturable bacteria. This viable but non-culturable state of bacteria in DSBs needs to be studied in depth and considered in infection prevention strategies.

Candidozyma auris (formerly Candida auris) is an emerging fungal pathogen which is highly transmissible in clinical settings, likely due to its ability to persist on skin and hard surfaces. We investigated the biofilm-forming ability of three C. auris isolates on non-porous plastic surfaces and developed a relevant and repeatable laboratory model for evaluating decontamination interventions. The isolate from clade I (South Asian) developed a robust biofilm under realistic environmental conditions, driving persistence of viable cells on dry surfaces up to 28 days, with reduced susceptibility to oxidising disinfectants. Nonetheless, all clades displayed initial attachment to surfaces within 15 minutes. Results highlight the importance of robust environmental decontamination strategies, including frequency of cleaning during C. auris outbreaks, and the importance of evaluating disinfectants under realistic conditions regarding application and organism state (biofilm).

Background: Carbapenem-resistant Enterobacterales (CRE) pose a substantial burden in healthcare settings, where delayed detection increases transmission risk and prolongs unnecessary isolation. Rapid screening methods are essential for effective infection prevention and control (IPC). Immunochromatographic tests (ICTs) offer a faster and more affordable alternative to culture and PCR.

Aim: To assess the impact of implementing ICT rapid carbapenemase-screening on CRE acquisition and IPC measures.

Methods: We conducted a quasi-experimental study in two ICUs of a tertiary hospital in Brazil, comparing a baseline period with an intervention period. During baseline, CRE screening consisted of rectal swab culture with weekly follow-up. During intervention, units additionally implemented either GeneXpert Carba-R PCR or broth-enriched ICT. Outcomes evaluated were CRE admission prevalence, ICU acquisition rate, time to initiation or discontinuation of Contact Precautions, test performance compared with culture and cost. Analyses included descriptive statistics, segmented regression, and survival methods.

Findings: 1128 patients were admitted during baseline and 385 during intervention; 5% and 12%, respectively, were colonized with CRE on admission. ICT demonstrated 91% sensitivity, 99% specificity, 86% positive predictive value, and 99% negative predictive value for detecting carbapenemase-producing CRE. ICT and PCR reduced time to diagnosis from 181 to 108 hours and from 155 to 77 hours, respectively (both p<0.001). Time to discontinue empirical isolation from 47 to 23 hours with ICT and from 52 to 17 hours with PCR (both p<0.001). Despite these operational gains, CRE acquisition during ICU stay did not significantly change.

Conclusion: ICT offers a practical and cost-effective screening option, particularly for high-burden or resource-limited settings.

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.