Pub Date : 2025-02-01DOI: 10.1016/j.jhin.2024.11.017
E. Pouly , A. Biguenet , P. Cholley , D. Hocquet , X. Bertrand
Background
Staphylococcus haemolyticus is a clinically relevant coagulase-negative staphylococcus frequently responsible for hospital-acquired infections, especially in premature newborns.
Aim
To describe an outbreak of multidrug-resistant S. haemolyticus in a neonatal department.
Methods
The outbreak was investigated using classical methods, including screening of the patients, genotyping of the isolates and environmental survey. Numerous infection control measures were implemented.
Findings
In 2022 and 2023, a clonal outbreak of multidrug-resistant S. haemolyticus ST29 (40 infections and 71 carriages) occurred in the neonatology department of a University Hospital in France. The infection control measures implemented only partially controlled the outbreak. Although our investigation did not clearly identify the source and mode of transmission, a reservoir constituted by patients and transmission by healthcare workers are the most likely. This episode occurred in a context of countrywide outbreaks of S. haemolyticus ST29 in several French neonatology departments.
Conclusion
This prolonged outbreak of S. haemolyticus ST29 accounted for the increase in the incidence of S. haemolyticus-related infections in French neonatology departments. Implementation of proactive measures is crucial to limit the spread of such pathogens in neonatal ICUs.
{"title":"Outbreak of multidrug-resistant Staphylococcus haemolyticus ST29 in a French neonatal unit","authors":"E. Pouly , A. Biguenet , P. Cholley , D. Hocquet , X. Bertrand","doi":"10.1016/j.jhin.2024.11.017","DOIUrl":"10.1016/j.jhin.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div><em>Staphylococcus haemolyticus</em> is a clinically relevant coagulase-negative staphylococcus frequently responsible for hospital-acquired infections, especially in premature newborns.</div></div><div><h3>Aim</h3><div>To describe an outbreak of multidrug-resistant <em>S</em>. <em>haemolyticus</em> in a neonatal department.</div></div><div><h3>Methods</h3><div>The outbreak was investigated using classical methods, including screening of the patients, genotyping of the isolates and environmental survey. Numerous infection control measures were implemented.</div></div><div><h3>Findings</h3><div>In 2022 and 2023, a clonal outbreak of multidrug-resistant <em>S. haemolyticus</em> ST29 (40 infections and 71 carriages) occurred in the neonatology department of a University Hospital in France. The infection control measures implemented only partially controlled the outbreak. Although our investigation did not clearly identify the source and mode of transmission, a reservoir constituted by patients and transmission by healthcare workers are the most likely. This episode occurred in a context of countrywide outbreaks of <em>S. haemolyticus</em> ST29 in several French neonatology departments.</div></div><div><h3>Conclusion</h3><div>This prolonged outbreak of <em>S. haemolyticus</em> ST29 accounted for the increase in the incidence of <em>S. haemolyticus</em>-related infections in French neonatology departments. Implementation of proactive measures is crucial to limit the spread of such pathogens in neonatal ICUs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 17-20"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.11.009
M. Virieux-Petit , J. Ferreira , A. Masnou , C. Bormes , M-P. Paquis , M. Toubiana , L. Bonzon , S. Godreuil , S. Romano-Bertrand
Background
Deciphering precise sources and patterns of healthcare-associated Pseudomonas aeruginosa colonization/infection is crucial in defining strategies of prevention and control.
Aim
To prospectively investigate the role of hospital environment in P. aeruginosa nosocomial bloodstream infections (Pa-BSIs) during one year in a tertiary-care hospital.
Methods
Clinical records of patients presenting Pa-BSIs after >48 h of hospitalization were investigated to confirm the nosocomial character of BSIs and identify the routes of entry and risk factors. Environmental investigations were performed to track P. aeruginosa source/reservoir along the care pathway. Clinical and environmental strains were compared by whole-genome sequencing to identify the route of contamination from hospital environment to patients.
Findings
Fifty-three BSIs episodes in 49 patients were considered as nosocomial, mostly involving men (73%), with an average age of 62.4 years, immunosuppressed in >40% of cases, and after previous antibiotic therapy in almost 92% of cases. BSIs occurred after 27 days of hospitalization on average. The main routes of entry were urinary (30%, on indwelling catheters for two-thirds of cases) and cutaneous (17%, catheter-related in almost 80% of cases). P. aeruginosa was found in 16 out of 49 investigations, representing 34 positive samples, including 54% of sink traps, 23% of water, and 20% of tap aerators. An epidemiological link was established between environmental and clinical strains only for eight patients, representing 15% of nosocomial BSIs.
Conclusion
The hospital environment usually considered as the main source of P. aeruginosa healthcare-associated infections was identified as responsible for nosocomial BSIs in only 15% of patients. Since the implementation of water and hospital environment management, one may hypothesize that P. aeruginosa has become a community-acquired pathogen with a nosocomial expression in infection.
{"title":"Assessing the role of environment in Pseudomonas aeruginosa healthcare-associated bloodstream infections: a one-year prospective survey","authors":"M. Virieux-Petit , J. Ferreira , A. Masnou , C. Bormes , M-P. Paquis , M. Toubiana , L. Bonzon , S. Godreuil , S. Romano-Bertrand","doi":"10.1016/j.jhin.2024.11.009","DOIUrl":"10.1016/j.jhin.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Deciphering precise sources and patterns of healthcare-associated <em>Pseudomonas aeruginosa</em> colonization/infection is crucial in defining strategies of prevention and control.</div></div><div><h3>Aim</h3><div>To prospectively investigate the role of hospital environment in <em>P</em>. <em>aeruginosa</em> nosocomial bloodstream infections (Pa-BSIs) during one year in a tertiary-care hospital.</div></div><div><h3>Methods</h3><div>Clinical records of patients presenting Pa-BSIs after >48 h of hospitalization were investigated to confirm the nosocomial character of BSIs and identify the routes of entry and risk factors. Environmental investigations were performed to track <em>P</em>. <em>aeruginosa</em> source/reservoir along the care pathway. Clinical and environmental strains were compared by whole-genome sequencing to identify the route of contamination from hospital environment to patients.</div></div><div><h3>Findings</h3><div>Fifty-three BSIs episodes in 49 patients were considered as nosocomial, mostly involving men (73%), with an average age of 62.4 years, immunosuppressed in >40% of cases, and after previous antibiotic therapy in almost 92% of cases. BSIs occurred after 27 days of hospitalization on average. The main routes of entry were urinary (30%, on indwelling catheters for two-thirds of cases) and cutaneous (17%, catheter-related in almost 80% of cases). <em>P</em>. <em>aeruginosa</em> was found in 16 out of 49 investigations, representing 34 positive samples, including 54% of sink traps, 23% of water, and 20% of tap aerators. An epidemiological link was established between environmental and clinical strains only for eight patients, representing 15% of nosocomial BSIs.</div></div><div><h3>Conclusion</h3><div>The hospital environment usually considered as the main source of <em>P</em>. <em>aeruginosa</em> healthcare-associated infections was identified as responsible for nosocomial BSIs in only 15% of patients. Since the implementation of water and hospital environment management, one may hypothesize that <em>P</em>. <em>aeruginosa</em> has become a community-acquired pathogen with a nosocomial expression in infection.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 26-33"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.11.011
J.F. Navarro-Gracia , F.J. Gómez-Romero , F.J. Lozano-García , R. Ortí-Lucas , J.A. Delgado-De los Reyes , M. Fernández-Prada , R. Herruzo-Cabrera
Background
The Zero Surgical Infection Project (ZSIP) in Spain is a nationwide programme to prevent surgical site infections (SSIs), sponsored by the Ministry of Health. The programme includes the application of a bundle of five key preventive measures (5PM): peri-operative antibiotic prophylaxis (PAP), skin antisepsis (SA), hair removal (HR), normothermia and normoglycaemia.
Aim
To assess the effectiveness of the 5PM, applied in a set of Spanish public hospitals between 2017 and 2021, under standard conditions of surgical health care in Spain.
Methods
This prospective cohort study of 33,240 patients from the ZSIP Registry (National Database Network) included surveillance of SSI data of selected surgical interventions, compliance data and other risk factors. Compliance with the 5PM bundle was verified through a specific checklist. The intervention and comparison groups were patients who were compliant with the 5PM bundle and patients who were not compliant with the 5PM bundle, respectively. Adjusted odds ratios (OR) and preventive fractions (PF) were calculated using logistic regression.
Findings
The overall SSI rates for patients in the compliant group and non-compliant group were 4.77% and 6.90%, respectively. Overall compliance with the 5PM bundle was 35.9%, and the compliance rates were highest for PAP (87.2%), SA (82.2%) and HR (78.7%). Compliance with the 5PM bundle had a PF of 32% and adjusted OR of 0.68 (95% confidence interval 0.60–0.76).
Conclusion
The ZSIP, implemented between 2017 and 2021 in Spain, had a significant level of effectiveness against SSIs.
{"title":"Effectiveness of the Zero Surgical Infection Project (ZSIP) in Spanish hospitals 2017–2021: a prospective cohort study","authors":"J.F. Navarro-Gracia , F.J. Gómez-Romero , F.J. Lozano-García , R. Ortí-Lucas , J.A. Delgado-De los Reyes , M. Fernández-Prada , R. Herruzo-Cabrera","doi":"10.1016/j.jhin.2024.11.011","DOIUrl":"10.1016/j.jhin.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>The Zero Surgical Infection Project (ZSIP) in Spain is a nationwide programme to prevent surgical site infections (SSIs), sponsored by the Ministry of Health. The programme includes the application of a bundle of five key preventive measures (5PM): peri-operative antibiotic prophylaxis (PAP), skin antisepsis (SA), hair removal (HR), normothermia and normoglycaemia.</div></div><div><h3>Aim</h3><div>To assess the effectiveness of the 5PM, applied in a set of Spanish public hospitals between 2017 and 2021, under standard conditions of surgical health care in Spain.</div></div><div><h3>Methods</h3><div>This prospective cohort study of 33,240 patients from the ZSIP Registry (National Database Network) included surveillance of SSI data of selected surgical interventions, compliance data and other risk factors. Compliance with the 5PM bundle was verified through a specific checklist. The intervention and comparison groups were patients who were compliant with the 5PM bundle and patients who were not compliant with the 5PM bundle, respectively. Adjusted odds ratios (OR) and preventive fractions (PF) were calculated using logistic regression.</div></div><div><h3>Findings</h3><div>The overall SSI rates for patients in the compliant group and non-compliant group were 4.77% and 6.90%, respectively. Overall compliance with the 5PM bundle was 35.9%, and the compliance rates were highest for PAP (87.2%), SA (82.2%) and HR (78.7%). Compliance with the 5PM bundle had a PF of 32% and adjusted OR of 0.68 (95% confidence interval 0.60–0.76).</div></div><div><h3>Conclusion</h3><div>The ZSIP, implemented between 2017 and 2021 in Spain, had a significant level of effectiveness against SSIs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 78-86"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.12.005
Y. Zhu , H. Hu , X. Guo , H. Zhang , D. Li , C.S. Dela Cruz , W. Xie , L. Xie , L. Sharma , D. Chang
Background
The purpose of this study was to evaluate the treatment strategies that dictate the host susceptibility to secondary bacterial infections during coronavirus disease 2019 (COVID-19).
Methods
This nested, case–control study was conducted in three general hospitals in China between 1st December 2022 and 1st March 2023. A total of 456 confirmed COVID-19 patients matched 1:2 (152 cases and 304 controls) based on age, sex, disease severity and age-adjusted Charlson Comorbidity Index (aCCI) using propensity-score matching (PSM) were included. Association of secondary bacterial infections with treatment strategies including the supportive measures, antiviral, and antibacterial therapies were the main outcome measures.
Findings
Conditional logistic regression analyses demonstrated that among categorical variables, use of antibiotics, antivirals, intravenous injection of human immunoglobulin, glucocorticoids or anticoagulants were not associated with the risk of secondary bacterial infections in the COVID-19 patients. The use of supplemental oxygen by either low (odds ratio (OR): 0.18, P<0.001) or high flow (OR: 0.06, P<0.001), but not through ventilators were associated with significant protection against secondary bacterial infection. In contrast, feeding through gastric tube (OR: 10.97, P<0.001) or parenteral nutrition (OR: 3.97, P=0.002) was associated with significant increase in the risk of secondary bacterial infections. Similar data were obtained when data were analysed using continuous variables. Further, the early (<5 days post symptom onset, OR: 0.09, P<0.001), but not the late use of antivirals was associated with protection against secondary bacterial infections.
Conclusions
Oxygen supplementation in non-ventilator settings and early use of antivirals were associated with decreased incidences of secondary bacterial infections, while parenteral nutrition or tube feedings were associated with increased incidences of secondary bacterial infections.
{"title":"Early antiviral use and supplemental oxygen decrease the risk of secondary bacterial infections: a multi-centre, nested, case–control study","authors":"Y. Zhu , H. Hu , X. Guo , H. Zhang , D. Li , C.S. Dela Cruz , W. Xie , L. Xie , L. Sharma , D. Chang","doi":"10.1016/j.jhin.2024.12.005","DOIUrl":"10.1016/j.jhin.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate the treatment strategies that dictate the host susceptibility to secondary bacterial infections during coronavirus disease 2019 (COVID-19).</div></div><div><h3>Methods</h3><div>This nested, case–control study was conducted in three general hospitals in China between 1<sup>st</sup> December 2022 and 1<sup>st</sup> March 2023. A total of 456 confirmed COVID-19 patients matched 1:2 (152 cases and 304 controls) based on age, sex, disease severity and age-adjusted Charlson Comorbidity Index (aCCI) using propensity-score matching (PSM) were included. Association of secondary bacterial infections with treatment strategies including the supportive measures, antiviral, and antibacterial therapies were the main outcome measures.</div></div><div><h3>Findings</h3><div>Conditional logistic regression analyses demonstrated that among categorical variables, use of antibiotics, antivirals, intravenous injection of human immunoglobulin, glucocorticoids or anticoagulants were not associated with the risk of secondary bacterial infections in the COVID-19 patients. The use of supplemental oxygen by either low (odds ratio (OR): 0.18, <em>P</em><0.001) or high flow (OR: 0.06, <em>P</em><0.001), but not through ventilators were associated with significant protection against secondary bacterial infection. In contrast, feeding through gastric tube (OR: 10.97, <em>P</em><0.001) or parenteral nutrition (OR: 3.97, <em>P</em>=0.002) was associated with significant increase in the risk of secondary bacterial infections. Similar data were obtained when data were analysed using continuous variables. Further, the early (<5 days post symptom onset, OR: 0.09, <em>P</em><0.001), but not the late use of antivirals was associated with protection against secondary bacterial infections.</div></div><div><h3>Conclusions</h3><div>Oxygen supplementation in non-ventilator settings and early use of antivirals were associated with decreased incidences of secondary bacterial infections, while parenteral nutrition or tube feedings were associated with increased incidences of secondary bacterial infections.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 87-95"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.10.018
J.W. Decousser , O. Keita-Perse , L.S. Aho Glele , R. Baron , Y. Carre , P. Cassier , P. Chaize , M. Coppry , C. Dananche , A. Florentin , S. Fournier , J. Racaud , A.M. Rogues , V. Souyri , C. Tamames , T. Lavigne , P. Parneix , S. Romano-Bertrand , the Scientific Committee of the French Society for Hospital Hygiene
{"title":"Transmission pathways and personal protective equipment requirement for mpox clade Ib lineage: nothing new on this front","authors":"J.W. Decousser , O. Keita-Perse , L.S. Aho Glele , R. Baron , Y. Carre , P. Cassier , P. Chaize , M. Coppry , C. Dananche , A. Florentin , S. Fournier , J. Racaud , A.M. Rogues , V. Souyri , C. Tamames , T. Lavigne , P. Parneix , S. Romano-Bertrand , the Scientific Committee of the French Society for Hospital Hygiene","doi":"10.1016/j.jhin.2024.10.018","DOIUrl":"10.1016/j.jhin.2024.10.018","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 125-127"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.11.013
J. Wu , T.P. Thompson , N.H. O'Connell , K. McCracken , J. Powell , B.F. Gilmore , C.P. Dunne , S.A. Kelly
Background
Hospital wastewater systems have been identified as reservoirs for antibiotic-resistant bacteria, with biofilms harbouring extended-spectrum β-lactamase (ESBL)-producing micro-organisms posing significant infection risk.
Aim
To study the antimicrobial susceptibility and biofilm control of ESBL-producing bacteria from wastewater pipes from a tertiary care teaching hospital in Ireland, which had experienced endemic infection outbreaks caused by ESBL-producing bacteria.
Methods
Following isolation of ESBL producers on selective agar, antibiotic susceptibility profiles were determined for a number of antibiotics assessed for their ability to form biofilms. Biofilm eradication studies using the commercially available disinfectants bleach, Optizan™, Virkon™ and Clinell™ were performed on selected isolates.
Findings
ESBL-producing bacteria (N = 39 isolates) showed a high degree of resistance to β-lactams. Biofilm-forming ability ranged from non-adherent to strongly adherent and appeared to be source dependent, suggesting that the characteristics of the pipe environment played an important role in biofilm formation. All disinfectants showed effective biofilm eradication under suggested working conditions. Effectiveness was significantly reduced following reductions in concentration and contact time, with only Clinell™ showing significant biofilm reduction against all isolates at all concentrations and contact times tested. Of the chlorine-based formulations, Optizan™ frequently outperformed bleach at lower concentrations and treatment times. Biofilm eradication was strain dependent, with varying disinfectant response profiles observed from biofilms from different Stenotrophomonas maltophilia isolates.
Conclusions
This study highlights the high degree of ESBL-producing bacteria recovery from patient-facing hospital wastewater apparatus. Their ability to form resident biofilms and act as potential reservoirs of infection emphasizes the need for rigorous and effective infection control practices.
{"title":"Extended-spectrum β-lactamase-producing bacteria from hospital wastewater pipes: isolation, characterization and biofilm control using common disinfectants","authors":"J. Wu , T.P. Thompson , N.H. O'Connell , K. McCracken , J. Powell , B.F. Gilmore , C.P. Dunne , S.A. Kelly","doi":"10.1016/j.jhin.2024.11.013","DOIUrl":"10.1016/j.jhin.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Hospital wastewater systems have been identified as reservoirs for antibiotic-resistant bacteria, with biofilms harbouring extended-spectrum β-lactamase (ESBL)-producing micro-organisms posing significant infection risk.</div></div><div><h3>Aim</h3><div>To study the antimicrobial susceptibility and biofilm control of ESBL-producing bacteria from wastewater pipes from a tertiary care teaching hospital in Ireland, which had experienced endemic infection outbreaks caused by ESBL-producing bacteria.</div></div><div><h3>Methods</h3><div>Following isolation of ESBL producers on selective agar, antibiotic susceptibility profiles were determined for a number of antibiotics assessed for their ability to form biofilms. Biofilm eradication studies using the commercially available disinfectants bleach, Optizan™, Virkon™ and Clinell™ were performed on selected isolates.</div></div><div><h3>Findings</h3><div>ESBL-producing bacteria (<em>N</em> = 39 isolates) showed a high degree of resistance to β-lactams. Biofilm-forming ability ranged from non-adherent to strongly adherent and appeared to be source dependent, suggesting that the characteristics of the pipe environment played an important role in biofilm formation. All disinfectants showed effective biofilm eradication under suggested working conditions. Effectiveness was significantly reduced following reductions in concentration and contact time, with only Clinell™ showing significant biofilm reduction against all isolates at all concentrations and contact times tested. Of the chlorine-based formulations, Optizan™ frequently outperformed bleach at lower concentrations and treatment times. Biofilm eradication was strain dependent, with varying disinfectant response profiles observed from biofilms from different <em>Stenotrophomonas maltophilia</em> isolates.</div></div><div><h3>Conclusions</h3><div>This study highlights the high degree of ESBL-producing bacteria recovery from patient-facing hospital wastewater apparatus. Their ability to form resident biofilms and act as potential reservoirs of infection emphasizes the need for rigorous and effective infection control practices.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 34-49"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.11.014
R. Magboo , J. Cooper , A. Shipolini , G. Krasopoulos , B.H. Kirmani , E. Akowuah , H. Byers , J. Sanders
Objective
Further to previous development and internal validation of the Barts Surgical Infection Risk (B-SIR) tool, this study sought to explore the external validity of the B-SIR tool and compare it with the Australian Clinical Risk Index (ACRI), and the Brompton and Harefield Infection Score (BHIS).
Study design and setting
This multi-centre retrospective analysis of prospectively collected local data included adult (age ≥18 years) patients undergoing cardiac surgery between January 2018 and December 2019. Pre-pandemic data were used as a reflection of standard practice. Area under the curve (AUC) was used to validate and compare the predictive power of the scores, and calibration was assessed using the Hosmer–Lemeshow test and calibration plots.
Results
In total, 6022 patients from three centres were included in the complete case analysis. The mean age was 66 years, 75% were men and 3.19% developed a surgical site infection (SSI). The B-SIR tool had an area under the curve (AUC) of 0.686 [95% confidence interval (CI) 0.649–0.723], similar to the developmental study (AUC=0.682, 95% CI 0.652–0.713). This was significantly higher than the BHIS AUC of 0.610 (95% CI 0.045–0.109; P<0.001) and the ACRI AUC of 0.614 (95% CI 0.041–0.103; P<0.001). After recalibration using a correction factor, the B-SIR tool gave accurate risk predictions (Hosmer–Lemeshow test P=0.423). The multiple imputation result (AUC=0.676, 95% CI 0.639–0.712) was similar to development data, and higher than the ACRI and BHIS.
Conclusion
External validation indicated that the B-SIR tool predicted SSI after cardiac surgery better than the ACRI and BHIS. This suggests that the B-SIR tool could be useful for use in routine practice.
{"title":"The Barts Surgical Infection Risk (B-SIR) tool: external validation and comparison with existing tools to predict surgical site infection after cardiac surgery","authors":"R. Magboo , J. Cooper , A. Shipolini , G. Krasopoulos , B.H. Kirmani , E. Akowuah , H. Byers , J. Sanders","doi":"10.1016/j.jhin.2024.11.014","DOIUrl":"10.1016/j.jhin.2024.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>Further to previous development and internal validation of the Barts Surgical Infection Risk (B-SIR) tool, this study sought to explore the external validity of the B-SIR tool and compare it with the Australian Clinical Risk Index (ACRI), and the Brompton and Harefield Infection Score (BHIS).</div></div><div><h3>Study design and setting</h3><div>This multi-centre retrospective analysis of prospectively collected local data included adult (age ≥18 years) patients undergoing cardiac surgery between January 2018 and December 2019. Pre-pandemic data were used as a reflection of standard practice. Area under the curve (AUC) was used to validate and compare the predictive power of the scores, and calibration was assessed using the Hosmer–Lemeshow test and calibration plots.</div></div><div><h3>Results</h3><div>In total, 6022 patients from three centres were included in the complete case analysis. The mean age was 66 years, 75% were men and 3.19% developed a surgical site infection (SSI). The B-SIR tool had an area under the curve (AUC) of 0.686 [95% confidence interval (CI) 0.649–0.723], similar to the developmental study (AUC=0.682, 95% CI 0.652–0.713). This was significantly higher than the BHIS AUC of 0.610 (95% CI 0.045–0.109; <em>P</em><0.001) and the ACRI AUC of 0.614 (95% CI 0.041–0.103; <em>P</em><0.001). After recalibration using a correction factor, the B-SIR tool gave accurate risk predictions (Hosmer–Lemeshow test <em>P</em>=0.423). The multiple imputation result (AUC=0.676, 95% CI 0.639–0.712) was similar to development data, and higher than the ACRI and BHIS.</div></div><div><h3>Conclusion</h3><div>External validation indicated that the B-SIR tool predicted SSI after cardiac surgery better than the ACRI and BHIS. This suggests that the B-SIR tool could be useful for use in routine practice.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"156 ","pages":"Pages 113-120"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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.jhin.2024.09.030
L. Moshkanbaryans , V. Shah , L.Y. Tan , M.P. Jones , K. Vickery , M. Alfa , J. Burdach
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Pub Date : 2025-02-01DOI: 10.1016/j.jhin.2024.11.016
M. Meda , M. Weinbren , C. Nagy , V. Gentry , M. Gormley
Background
Carbapenemase-producing Enterobacterales (CPE) are antimicrobial resistant (AMR) bacteria which are increasing in incidence globally. Hospitals act as powerhouses for transmission of such bacteria with some regions experiencing prolonged outbreaks and high prevalence for several years. Current screening strategies are based on admission and risk-based screening only. Growing evidence supports hospital wastewater as playing a key role in transmission. We describe how changes to the CPE screening policy at Wexham Park Hospital (WPH) identified a hospital-based outbreak which, in turn, led to identification and mitigation of risks from the hospital wastewater system.
Methods
Enhanced CPE patient screening (using a molecular methodology) was introduced to include admission and discharge screening of all patients admitted to the hospital over a 34-week period. The wastewater drainage infrastructure was surveyed, and likely interventions identified.
Findings
The screening strategy detected a polymicrobial hospital-wide CPE outbreak involving different enzymes, predominantly New Delhi metallo-β-lactamase (NDM) and OXA-48 with the hospital wastewater system acting as the reservoir. During the 34-week period of enhanced screening, 1.2% of patients screened CPE positive, of which 14% of patients developed infection. Of the 65 CPE-positive patients detected, healthcare acquisition at WPH was likely in 47 (73%) patients. Mitigations to the risk from the hospital wastewater system combined with universal admission and discharge screening produced a long-standing reduction in transmission.
Conclusion
Universal admission and discharge screening along with introduction of water-safe concepts are effective in improving detection of CPE outbreaks and followed by a reduction of acquisition in healthcare settings where prevalence of such bacteria is increasing.
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