Pub Date : 2026-01-14DOI: 10.1016/j.jhin.2025.12.011
A C Büchler, C P Haanappel, I de Goeij, C H W Klaassen, M C Vos, A F Voor In 't Holt, J A Severin
Background: Follow-up strategies to determine the loss of carbapenemase-producing Pseudomonas aeruginosa (CPPA) carriage vary considerably, with a lack of evidence-based guidance to direct discontinuation of infection prevention measures.
Aim: The aim of this study was to determine the duration of carriage (DOC), risk factors for longer carriage, positive follow-up screenings and the number and timing of negative screenings needed to identify loss of CPPA carriage.
Methods: This retrospective cohort study included adult CPPA carriers under active follow-up from 2010 to 2023. Active follow-up entailed a minimum of six bi-monthly screenings, with six consecutive negative screenings indicating loss of CPPA carriage. Cox regression models were used to estimate the median DOC and to identify risk factors for longer carriage; a logistic mixed-effect regression model was used to identify risk factors associated with positive follow-up screenings.
Findings: Sixty-eight patients were included, with 52 achieving loss of CPPA carriage. Analysis of maximum DOC results generated a median value of 606 days (95% confidence interval: 529-813 days) and a recurrence rate of 11.5%. Risk factors for longer carriage were first detection in a clinical sample and a positive first follow-up screening. A policy of five or six consecutive negative screenings generated false-negative rates of 13.5% and 11.5%, respectively.
Conclusions: Postponement of the start of follow-up, for up to one year, should be considered for patients presenting with risk factors for longer CPPA carriage. This would facilitate a more economical approach to CPPA screening while minimizing the burden for patients. Follow-up may begin immediately for patients without any risk factors, and five consecutive negative screenings might be sufficient.
{"title":"Retrospective evaluation of carbapenemase-producing Pseudomonas aeruginosa carriage and a proposed follow-up strategy: insights from a bla<sub>VIM</sub>-dominant setting.","authors":"A C Büchler, C P Haanappel, I de Goeij, C H W Klaassen, M C Vos, A F Voor In 't Holt, J A Severin","doi":"10.1016/j.jhin.2025.12.011","DOIUrl":"10.1016/j.jhin.2025.12.011","url":null,"abstract":"<p><strong>Background: </strong>Follow-up strategies to determine the loss of carbapenemase-producing Pseudomonas aeruginosa (CPPA) carriage vary considerably, with a lack of evidence-based guidance to direct discontinuation of infection prevention measures.</p><p><strong>Aim: </strong>The aim of this study was to determine the duration of carriage (DOC), risk factors for longer carriage, positive follow-up screenings and the number and timing of negative screenings needed to identify loss of CPPA carriage.</p><p><strong>Methods: </strong>This retrospective cohort study included adult CPPA carriers under active follow-up from 2010 to 2023. Active follow-up entailed a minimum of six bi-monthly screenings, with six consecutive negative screenings indicating loss of CPPA carriage. Cox regression models were used to estimate the median DOC and to identify risk factors for longer carriage; a logistic mixed-effect regression model was used to identify risk factors associated with positive follow-up screenings.</p><p><strong>Findings: </strong>Sixty-eight patients were included, with 52 achieving loss of CPPA carriage. Analysis of maximum DOC results generated a median value of 606 days (95% confidence interval: 529-813 days) and a recurrence rate of 11.5%. Risk factors for longer carriage were first detection in a clinical sample and a positive first follow-up screening. A policy of five or six consecutive negative screenings generated false-negative rates of 13.5% and 11.5%, respectively.</p><p><strong>Conclusions: </strong>Postponement of the start of follow-up, for up to one year, should be considered for patients presenting with risk factors for longer CPPA carriage. This would facilitate a more economical approach to CPPA screening while minimizing the burden for patients. Follow-up may begin immediately for patients without any risk factors, and five consecutive negative screenings might be sufficient.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":"34-43"},"PeriodicalIF":3.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991880","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 : 2026-01-12DOI: 10.1016/j.jhin.2025.12.009
N. Ablakimova , S. Rachina , D. Strelkova , A. Suvorov , G. Smagulova
Background
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality and antimicrobial resistance rates.
Aim
The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP.
Methods
A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package).
Findings
Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = –1.02; 95% confidence interval [CI]: –1.76 to –0.28; P = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26–27.67; P = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51–1.05; P = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73–1.76; P = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs.
Conclusion
Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.
背景：医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）是最严重的卫生保健相关感染（HAIs）之一，其特点是高发病率、死亡率和抗微生物药物耐药性（AMR）率。目的：系统评估抗菌药物管理和诊断干预对成年HAP/VAP患者临床、微生物学和治疗结果的影响。方法：根据PRISMA 2020指南（PROSPERO: CRD42023492494）进行系统评价和荟萃分析。检索了PubMed、Scopus和Web of Science数据库，检索了2000年至2025年5月期间发表的研究。符合条件的设计包括随机试验、准实验和涉及HAP或VAP成人的前后研究。使用R （meta package）中的随机效应模型估计合并优势比（OR）和标准化平均差（SMD）。结果：纳入了19项研究，其中11项进行了meta分析。ASP干预显著缩短了抗生素治疗的持续时间（SMD = -1.02; 95% CI: -1.76至-0.28;p = 0.007）。方案依从性也有显著改善（OR = 5.91; 95% CI: 1.26-27.67; p = 0.024）。住院死亡率（OR = 0.73; 95% CI: 0.51-1.05; p = 0.088）、住院30天死亡率（OR = 1.13; 95% CI: 0.73-1.76; p = 0.58）、ICU住院时间或无呼吸机天数均无统计学差异。各设计的异质性很高。结论：HAP/VAP的管理干预安全缩短了抗生素疗程，提高了临床方案的依从性，同时不影响患者的安全。为了获得更有意义的临床影响，未来的ASP模型应该在多学科ICU框架内整合诊断、PK/ pd指导给药和呼吸机护理包。
{"title":"Antimicrobial stewardship interventions in adults with hospital-acquired pneumonia: a systematic review and meta-analysis","authors":"N. Ablakimova , S. Rachina , D. Strelkova , A. Suvorov , G. Smagulova","doi":"10.1016/j.jhin.2025.12.009","DOIUrl":"10.1016/j.jhin.2025.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent the most severe healthcare-associated infections (HAIs), characterized by high morbidity, mortality and antimicrobial resistance rates.</div></div><div><h3>Aim</h3><div>The aim of this study was to systematically assess the impact of antimicrobial stewardship and diagnostic interventions on clinical, microbiological and process outcomes in adult patients with HAP/VAP.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (International Prospective Register of Systematic Reviews registration number: CRD42023492494). PubMed, Scopus and Web of Science databases were searched for studies published from 2000 to May 2025. Eligible designs included randomized trials, quasi-experimental and before-and-after studies involving adults with HAP or VAP. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were estimated using random-effect models in R (meta package).</div></div><div><h3>Findings</h3><div>Nineteen studies were included, of which 11 were meta-analysed. Antimicrobial stewardship programme (ASP) interventions significantly reduced the duration of antibiotic therapy (SMD = –1.02; 95% confidence interval [CI]: –1.76 to –0.28; <em>P</em> = 0.007). A significant improvement was also observed for protocol adherence (OR = 5.91; 95% CI: 1.26–27.67; <em>P</em> = 0.024). No statistically significant differences were found for hospital mortality (OR = 0.73; 95% CI: 0.51–1.05; <em>P</em> = 0.088), 30-day in-hospital mortality (OR = 1.13; 95% CI: 0.73–1.76; <em>P</em> = 0.58), length of intensive care unit (ICU) stay or ventilator-free days. Heterogeneity was high across designs.</div></div><div><h3>Conclusion</h3><div>Stewardship interventions for HAP/VAP safely shorten antibiotic duration and improve adherence to clinical protocols without compromising patient safety. To achieve more meaningful clinical impact, future ASP models should integrate diagnostics, pharmacokinetic/pharmacodynamic-guided dosing and ventilator-care bundles within multi-disciplinary ICU frameworks.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"169 ","pages":"Pages 176-192"},"PeriodicalIF":3.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985828","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 : 2026-01-12DOI: 10.1016/j.jhin.2025.12.008
A Rath, L J Klages, B Kieninger, A Eichner, A Keller-Wackerbauer, S M Wellmann, A Ambrosch, J Fritsch, M Kabesch, C Rückert-Reed, T Busche, J Kalinowski, W Schneider-Brachert
Aim: Non-pigmented Serratia marcescens - bacteria otherwise known for occasional reddish pigmentation and frequent outbreaks in neonatal intensive care units (NICUs) - were recently reclassified to novel species: S. sarumanii and S. bockelmannii. This raised questions about possible differences regarding clinical significance. Here, we report the first detected concurrent transmission of these novel species in a neonatal department.
Methods: Between March and October 2023, non-pigmented S. marcescens (according to mass spectrometry) were repeatedly found in 40 patients of a neonatology department. Proactive short-read (N = 42, including two environmental) and for three large clusters additional long-read (nanopore sequencing, N = 23) whole-genome sequencing (WGS) was performed, followed by ad-hoc core-genome multi-locus sequence typing (cgMLST, SeqSphere+ software), taxonomic analysis with Type Strain Genome Server (TYGS), and virulence factor/resistance prediction with Abricate.
Results: WGS revealed a polyclonal Serratia spp. population comprising 14 genotypes, including three large clusters (N = 6, 8, and 9, respectively) alongside two pairs of twins and a small cluster of three isolates. In contrast to initial MALDI-ToF classification as S. marcescens, WGS-driven taxonomic analysis reclassified isolates within the largest cluster as S. bockelmannii (including one environmental isolate), whereas the remaining two large clusters were assigned to S. sarumanii.
Conclusion: WGS-based analysis revealed a prolonged outbreak involving newly classified non-pigmented Serratia spp. - S. bockelmannii and S. sarumanii - through conventional mass spectrometry. This highlights the importance of routinely implementing WGS to accurately track transmission and implement effective infection control measures.
{"title":"Genome-oriented outbreak management reveals the first detection of concurrent transmissions of Serratia sarumanii and Serratia bockelmannii in a neonatal department.","authors":"A Rath, L J Klages, B Kieninger, A Eichner, A Keller-Wackerbauer, S M Wellmann, A Ambrosch, J Fritsch, M Kabesch, C Rückert-Reed, T Busche, J Kalinowski, W Schneider-Brachert","doi":"10.1016/j.jhin.2025.12.008","DOIUrl":"10.1016/j.jhin.2025.12.008","url":null,"abstract":"<p><strong>Aim: </strong>Non-pigmented Serratia marcescens - bacteria otherwise known for occasional reddish pigmentation and frequent outbreaks in neonatal intensive care units (NICUs) - were recently reclassified to novel species: S. sarumanii and S. bockelmannii. This raised questions about possible differences regarding clinical significance. Here, we report the first detected concurrent transmission of these novel species in a neonatal department.</p><p><strong>Methods: </strong>Between March and October 2023, non-pigmented S. marcescens (according to mass spectrometry) were repeatedly found in 40 patients of a neonatology department. Proactive short-read (N = 42, including two environmental) and for three large clusters additional long-read (nanopore sequencing, N = 23) whole-genome sequencing (WGS) was performed, followed by ad-hoc core-genome multi-locus sequence typing (cgMLST, SeqSphere+ software), taxonomic analysis with Type Strain Genome Server (TYGS), and virulence factor/resistance prediction with Abricate.</p><p><strong>Results: </strong>WGS revealed a polyclonal Serratia spp. population comprising 14 genotypes, including three large clusters (N = 6, 8, and 9, respectively) alongside two pairs of twins and a small cluster of three isolates. In contrast to initial MALDI-ToF classification as S. marcescens, WGS-driven taxonomic analysis reclassified isolates within the largest cluster as S. bockelmannii (including one environmental isolate), whereas the remaining two large clusters were assigned to S. sarumanii.</p><p><strong>Conclusion: </strong>WGS-based analysis revealed a prolonged outbreak involving newly classified non-pigmented Serratia spp. - S. bockelmannii and S. sarumanii - through conventional mass spectrometry. This highlights the importance of routinely implementing WGS to accurately track transmission and implement effective infection control measures.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":"60-68"},"PeriodicalIF":3.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985818","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 : 2026-01-12DOI: 10.1016/j.jhin.2025.12.010
Yuki Kono, Takahiro Niimura, Yumiko Hosaka, Koji Yahara, Aki Hirabayashi, Toshiki Kajihara, Mitsuhiro Goda, Koji Miyata, Kei Kawada, Fuka Aizawa, Kenta Yagi, Yuki Izumi, Yuki Izawa-Ishizawa, Keisuke Ishizawa
Background: Excessive antibiotic use contributes to the emergence of antimicrobial resistance (AMR). The Japanese government implemented an antimicrobial stewardship incentive program for the pediatric population in 2018. However, its effect on prescription patterns and the AMR rates remains unclear.
Objectives: To investigate the impact of the implementation of the antimicrobial stewardship incentive program on AMR rates through changes in antimicrobial prescribing patterns.
Methods: We retrospectively analyzed prescription patterns using data from a nationwide claims database and extracted pediatric patient data from healthcare facilities with ≥20 beds from January 2014 to July 2021. The antibiotic prescription amounts were calculated per 1,000 patient-days. The AMR rates of urinary E. coli were analyzed using data from the comprehensive national AMR surveillance database. Changes were evaluated using interrupted time-series analysis.
Results: After the intervention, antibiotic prescription patterns in 8,292 healthcare facilities of both broad- and narrow-spectrum antimicrobials, but not of first-generation cephalosporin, showed a decreasing trend. Prescriptions of fluoroquinolone and broad-spectrum penicillin prescriptions changed from increasing to decreasing trends, whereas those of third-generation cephalosporins continued to decline. The AMR patterns of urinary E. coli to both broad- and narrow-spectrum antibiotics showed decreasing trends in over 800 healthcare facilities.
Conclusions: After the introduction of the antimicrobial stewardship incentive program, prescriptions for broad-spectrum antibiotics and a part of narrow-spectrum antibiotics declined and the AMR rates of urinary E. coli to both broad- and narrow-spectrum antibiotics decreased. These findings suggest the effectiveness of policy-driven interventions for containing AMR in the pediatric population.
{"title":"Impact of antimicrobial stewardship interventions in pediatric populations on antimicrobial resistance: analysis of national claim and antimicrobial resistance surveillance data in Japan.","authors":"Yuki Kono, Takahiro Niimura, Yumiko Hosaka, Koji Yahara, Aki Hirabayashi, Toshiki Kajihara, Mitsuhiro Goda, Koji Miyata, Kei Kawada, Fuka Aizawa, Kenta Yagi, Yuki Izumi, Yuki Izawa-Ishizawa, Keisuke Ishizawa","doi":"10.1016/j.jhin.2025.12.010","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.12.010","url":null,"abstract":"<p><strong>Background: </strong>Excessive antibiotic use contributes to the emergence of antimicrobial resistance (AMR). The Japanese government implemented an antimicrobial stewardship incentive program for the pediatric population in 2018. However, its effect on prescription patterns and the AMR rates remains unclear.</p><p><strong>Objectives: </strong>To investigate the impact of the implementation of the antimicrobial stewardship incentive program on AMR rates through changes in antimicrobial prescribing patterns.</p><p><strong>Methods: </strong>We retrospectively analyzed prescription patterns using data from a nationwide claims database and extracted pediatric patient data from healthcare facilities with ≥20 beds from January 2014 to July 2021. The antibiotic prescription amounts were calculated per 1,000 patient-days. The AMR rates of urinary E. coli were analyzed using data from the comprehensive national AMR surveillance database. Changes were evaluated using interrupted time-series analysis.</p><p><strong>Results: </strong>After the intervention, antibiotic prescription patterns in 8,292 healthcare facilities of both broad- and narrow-spectrum antimicrobials, but not of first-generation cephalosporin, showed a decreasing trend. Prescriptions of fluoroquinolone and broad-spectrum penicillin prescriptions changed from increasing to decreasing trends, whereas those of third-generation cephalosporins continued to decline. The AMR patterns of urinary E. coli to both broad- and narrow-spectrum antibiotics showed decreasing trends in over 800 healthcare facilities.</p><p><strong>Conclusions: </strong>After the introduction of the antimicrobial stewardship incentive program, prescriptions for broad-spectrum antibiotics and a part of narrow-spectrum antibiotics declined and the AMR rates of urinary E. coli to both broad- and narrow-spectrum antibiotics decreased. These findings suggest the effectiveness of policy-driven interventions for containing AMR in the pediatric population.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985825","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 : 2026-01-09DOI: 10.1016/j.jhin.2025.10.022
I. Amirav , H. Ben Yosef , N. Zelniker , M. Be'er , L. Dennett , O. Besor , M. Lavie , J. Pillay
Background
Nebulized aerosol therapy is widely used for treating respiratory diseases, including those caused by severe acute respiratory syndrome coronavirus-2. During pandemics, some guidelines recommend avoiding nebulizers, yet supporting evidence is limited.
Objective
To undertake a systematic review of evidence on the risk of cross-infection linked to nebulizer use in healthcare settings.
Data sources
Databases including Medline and Embase were searched from June 2020 to February 2024. Two independent reviewers conducted study selection and data extraction; discrepancies were resolved by a third reviewer.
Data extraction
Risk of bias was assessed using the Newcastle–Ottawa Scale for case–control and cohort studies, an adapted version for cross-sectional studies, and a custom tool for experimental/simulation studies. Meta-analysis was performed on comparative clinical data. Certainty of evidence was rated using the Grading of Recommendation, Assessment, Development and Evaluation approach.
Synthesis
Twenty-six studies met the inclusion criteria (six case–control, three cohort, one cross-sectional, four case series, 12 experimental/simulation). None of them reported that nebulizer use is free from risk of cross-infection. Meta-analysis of 10 comparative clinical studies (N=8536) found an association between nebulizer use and increased risk of infection (odds ratio 3.20, 95% confidence interval 1.59–6.44; P=0.0001), although certainty was low. Nine of 12 experimental/simulation studies demonstrated aerosol dispersion of particles or pathogens.
Conclusions
Nebulizer exposure may elevate the risk of infection compared with non-exposure. Nebulizer use in hospital settings should be limited during pandemics or when cross-infection is a concern. When necessary, additional precautions are warranted.
{"title":"Risk of small-volume nebulizer treatments in the transmission of bacteria and viruses: a systematic review","authors":"I. Amirav , H. Ben Yosef , N. Zelniker , M. Be'er , L. Dennett , O. Besor , M. Lavie , J. Pillay","doi":"10.1016/j.jhin.2025.10.022","DOIUrl":"10.1016/j.jhin.2025.10.022","url":null,"abstract":"<div><h3>Background</h3><div>Nebulized aerosol therapy is widely used for treating respiratory diseases, including those caused by severe acute respiratory syndrome coronavirus-2. During pandemics, some guidelines recommend avoiding nebulizers, yet supporting evidence is limited.</div></div><div><h3>Objective</h3><div>To undertake a systematic review of evidence on the risk of cross-infection linked to nebulizer use in healthcare settings.</div></div><div><h3>Data sources</h3><div>Databases including Medline and Embase were searched from June 2020 to February 2024. Two independent reviewers conducted study selection and data extraction; discrepancies were resolved by a third reviewer.</div></div><div><h3>Data extraction</h3><div>Risk of bias was assessed using the Newcastle–Ottawa Scale for case–control and cohort studies, an adapted version for cross-sectional studies, and a custom tool for experimental/simulation studies. Meta-analysis was performed on comparative clinical data. Certainty of evidence was rated using the Grading of Recommendation, Assessment, Development and Evaluation approach.</div></div><div><h3>Synthesis</h3><div>Twenty-six studies met the inclusion criteria (six case–control, three cohort, one cross-sectional, four case series, 12 experimental/simulation). None of them reported that nebulizer use is free from risk of cross-infection. Meta-analysis of 10 comparative clinical studies (<em>N</em>=8536) found an association between nebulizer use and increased risk of infection (odds ratio 3.20, 95% confidence interval 1.59–6.44; <em>P</em>=0.0001), although certainty was low. Nine of 12 experimental/simulation studies demonstrated aerosol dispersion of particles or pathogens.</div></div><div><h3>Conclusions</h3><div>Nebulizer exposure may elevate the risk of infection compared with non-exposure. Nebulizer use in hospital settings should be limited during pandemics or when cross-infection is a concern. When necessary, additional precautions are warranted.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"168 ","pages":"Pages 144-160"},"PeriodicalIF":3.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939155","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 : 2026-01-09DOI: 10.1016/j.jhin.2025.12.006
M. Gallouche , B. Rubens Duval , S. Boisset , F. Cazzorla , P. Astagneau , C. Landelle
Background
The risk factors for Staphylococcus aureus nasal colonisation have been well described, but studies focusing on orthopaedic surgery patients are scarce.
Aim
The objective was to analyse the risk factors for S. aureus nasal colonisation in patients undergoing elective orthopaedic surgery.
Methods
A retrospective study was conducted in one orthopaedics department, including adult patients who benefited from a nasal screening from February 8th, 2017 to June 30th, 2021 before elective orthopaedic surgery. The predictive factors were assessed with a logistic regression model.
Findings
A total of 4354 patients were included. Among them, 29.4% (1282/4354) had a positive screening test, of which 2.1% were positive for meticillin-resistant S. aureus (27/1282). In multivariate analysis, having a history of S. aureus colonisation was significantly and strongly associated with preoperative S. aureus nasal colonisation (adjusted odds ratio: 58.34; 95% confidence interval: 13.21–257.78). Having no history of S. aureus screening (4.17; 1.49–11.69) compared to negative screenings only, age between 50 and 59 years (1.62; 1.10–2.38) or age <50 years (1.87; 1.28–2.74) compared to age ≥80 years, male gender (1.64; 1.41–1.91), and BMI ≥35 kg/m2 (2.03; 1.08–3.79) compared to BMI <18.5 were also risk factors.
Conclusion
In our cohort, having a history of positive S. aureus nasal screening or no history of nasal screening (compared with a history of negative screenings), male gender, younger age, and high BMI were independent risk factors for preoperative S. aureus nasal colonisation. The relative weight of risk factors highlights the importance of knowing colonisation history to accurately assess the risk.
{"title":"Staphylococcus aureus nasal colonisation: prevalence and risk factors in a cohort of patients undergoing elective orthopaedic surgery","authors":"M. Gallouche , B. Rubens Duval , S. Boisset , F. Cazzorla , P. Astagneau , C. Landelle","doi":"10.1016/j.jhin.2025.12.006","DOIUrl":"10.1016/j.jhin.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>The risk factors for <em>Staphylococcus aureus</em> nasal colonisation have been well described, but studies focusing on orthopaedic surgery patients are scarce.</div></div><div><h3>Aim</h3><div>The objective was to analyse the risk factors for <em>S. aureus</em> nasal colonisation in patients undergoing elective orthopaedic surgery.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted in one orthopaedics department, including adult patients who benefited from a nasal screening from February 8<sup>th</sup>, 2017 to June 30<sup>th</sup>, 2021 before elective orthopaedic surgery. The predictive factors were assessed with a logistic regression model.</div></div><div><h3>Findings</h3><div>A total of 4354 patients were included. Among them, 29.4% (1282/4354) had a positive screening test, of which 2.1% were positive for meticillin-resistant <em>S. aureus</em> (27/1282). In multivariate analysis, having a history of <em>S. aureus</em> colonisation was significantly and strongly associated with preoperative <em>S. aureus</em> nasal colonisation (adjusted odds ratio: 58.34; 95% confidence interval: 13.21–257.78). Having no history of <em>S. aureus</em> screening (4.17; 1.49–11.69) compared to negative screenings only, age between 50 and 59 years (1.62; 1.10–2.38) or age <50 years (1.87; 1.28–2.74) compared to age ≥80 years, male gender (1.64; 1.41–1.91), and BMI ≥35 kg/m<sup>2</sup> (2.03; 1.08–3.79) compared to BMI <18.5 were also risk factors.</div></div><div><h3>Conclusion</h3><div>In our cohort, having a history of positive <em>S. aureus</em> nasal screening or no history of nasal screening (compared with a history of negative screenings), male gender, younger age, and high BMI were independent risk factors for preoperative <em>S. aureus</em> nasal colonisation. The relative weight of risk factors highlights the importance of knowing colonisation history to accurately assess the risk.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"169 ","pages":"Pages 151-158"},"PeriodicalIF":3.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953989","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 : 2026-01-09DOI: 10.1016/j.jhin.2025.12.007
L. Heireman , B.B. Xavier , S. De Feyter , T. De Grauwe , J. De Munck , L. De Smedt , A. Dewaele , K. De Wilde , F. Dumez , T. Monteyne , R. Naesens , J.W.A. Rossen , W. Temmerman , J. Van Laere , P. Van Lint , P. Van Puyvelde , I. Verschraegen , W. Verstrepen , A. Vonck , W. Swinnen
Introduction
Klebsiella pneumoniae rapidly disseminates in clinical environments and is frequently responsible for hospital outbreaks. The present study highlights an under-recognized and concerning nosocomial transmission route involving intravenous contrast dye, after a cluster of seven patients became acutely ill after undergoing contrast-enhanced computed tomography (CT).
Methods
All applied consumables, administration sets and the environment of the CT scanner were sampled and cultured. Whole-genome sequencing and phylogenetic analyses were performed on outbreak isolates, with a hypervirulent strain and a quality control strain serving as references.
Results
A microbiological analysis of the residual contrast dye vials and associated administration set identified contamination with K. pneumoniae. Whole-genome sequencing confirmed a genetic link between these strains and the K. pneumoniae strain isolated from the patient’s blood culture. Molecular characterization suggested that the detected strain represented a contaminant rather than a nosocomial outbreak clone belonging to ST45 with K62 serotype.
Conclusion
The exact source of contamination remains unknown as contamination in the pharmaceutical supply chain or hospital practices cannot be excluded. However, storing the opened contrast dye bottle at body temperature for 8 h before administration undoubtedly contributed to an increase in the bacterial load. This incident underscores the potential risk associated with storing an opened contrast dye bottle at body temperature—a common practice in the radiology department.
{"title":"From imaging to infection: contrast dye contaminated with Klebsiella pneumoniae as a source of nosocomial infections","authors":"L. Heireman , B.B. Xavier , S. De Feyter , T. De Grauwe , J. De Munck , L. De Smedt , A. Dewaele , K. De Wilde , F. Dumez , T. Monteyne , R. Naesens , J.W.A. Rossen , W. Temmerman , J. Van Laere , P. Van Lint , P. Van Puyvelde , I. Verschraegen , W. Verstrepen , A. Vonck , W. Swinnen","doi":"10.1016/j.jhin.2025.12.007","DOIUrl":"10.1016/j.jhin.2025.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Klebsiella pneumoniae</em> rapidly disseminates in clinical environments and is frequently responsible for hospital outbreaks. The present study highlights an under-recognized and concerning nosocomial transmission route involving intravenous contrast dye, after a cluster of seven patients became acutely ill after undergoing contrast-enhanced computed tomography (CT).</div></div><div><h3>Methods</h3><div>All applied consumables, administration sets and the environment of the CT scanner were sampled and cultured. Whole-genome sequencing and phylogenetic analyses were performed on outbreak isolates, with a hypervirulent strain and a quality control strain serving as references.</div></div><div><h3>Results</h3><div>A microbiological analysis of the residual contrast dye vials and associated administration set identified contamination with <em>K. pneumoniae</em>. Whole-genome sequencing confirmed a genetic link between these strains and the <em>K. pneumoniae</em> strain isolated from the patient’s blood culture. Molecular characterization suggested that the detected strain represented a contaminant rather than a nosocomial outbreak clone belonging to ST45 with K62 serotype.</div></div><div><h3>Conclusion</h3><div>The exact source of contamination remains unknown as contamination in the pharmaceutical supply chain or hospital practices cannot be excluded. However, storing the opened contrast dye bottle at body temperature for 8 h before administration undoubtedly contributed to an increase in the bacterial load. This incident underscores the potential risk associated with storing an opened contrast dye bottle at body temperature—a common practice in the radiology department.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"169 ","pages":"Pages 159-166"},"PeriodicalIF":3.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953940","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 : 2026-01-01DOI: 10.1016/j.jhin.2025.08.005
E.S. Tanriverdi , Y. Yakupogullari , F. Memisoglu , B. Otlu
{"title":"Transmission of Staphylococcus aureus from an outpatient to an inpatient: implications for infection control","authors":"E.S. Tanriverdi , Y. Yakupogullari , F. Memisoglu , B. Otlu","doi":"10.1016/j.jhin.2025.08.005","DOIUrl":"10.1016/j.jhin.2025.08.005","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"167 ","pages":"Pages 256-257"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024734","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 : 2026-01-01DOI: 10.1016/j.jhin.2025.09.021
S.J. Dancer
{"title":"Carbapenemase genes in the healthcare environment: does it matter?","authors":"S.J. Dancer","doi":"10.1016/j.jhin.2025.09.021","DOIUrl":"10.1016/j.jhin.2025.09.021","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"167 ","pages":"Pages 261-262"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775466","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}
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