Journal of Hospital Infection最新文献

Background: Catheter-associated urinary tract infections (CAUTIs) represent a leading cause of preventable healthcare-associated infections. Despite established risks such as catheter insertion and prolonged dwell time, the consistent implementation of prevention guidelines in clinical practice remains a global challenge.

Aim: The aim of this study was to synthesize available evidence on the effectiveness of multi-modal nursing strategies, compared with single interventions, for reducing CAUTIs in adult inpatients.

Methods: Following the Arksey and O'Malley's framework, a scoping review of literature published between 2019 and 2024 was conducted across nine databases (PubMed, Web of Science, Cochrane Library, Embase, EBSCO-CINAHL, CBM, Wanfang, CNKI and CQVIP). Studies reporting CAUTI-related outcomes in adult inpatients were systematically screened, and interventions were categorized accordingly.

Findings: A total of 26 studies were included. Eight core nurse-driven intervention components were identified: training and education (N = 22), monitoring and feedback (N = 20), daily assessment (N = 17), communication and reminder (N = 10), resource adjustment (N = 10), implementation of a catheter care bundle (N = 7), implementing best practices (N = 7) and setting incentives and disincentives (N = 4). Ten outcome indicators were summarized across 26 articles, with CAUTI-related metrics showing consistent improvement following multi-modal quality improvement initiatives.

Conclusion: Nurse-driven multi-modal strategies, particularly those integrating daily catheter assessment, structured training, care bundles and continuous monitoring, have proven effective in preventing CAUTI risk. This review synthesizes core intervention components into an actionable framework adaptable to diverse clinical settings while underscoring the importance of contextual implementation and the necessity for further rigorous, especially resource-sensitive, evidence.

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.

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.

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.