Journal of Hospital Infection最新文献

英文中文

Outbreak simulation on the neonatal ward using silica nanoparticles with encapsulated DNA: unmasking of key spread areas 使用包裹 DNA 的二氧化硅纳米粒子模拟新生儿病房的疫情--揭示关键传播区域。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-09-14 DOI: 10.1016/j.jhin.2024.09.002

M. Wallner , L. Pfuderer , L. Bašková , K. Dollischel , R.N. Grass , A. Kücher , A.M. Luescher , J.M. Kern

Background

Nosocomial infections pose a serious threat. In neonatal intensive care units (NICUs) especially, there are repeated outbreaks caused by micro-organisms without the sources or dynamics being conclusively determined.

Aim

To use amorphous silica nanoparticles with encapsulated DNA (SPED) to simulate outbreak events and to visualize dissemination patterns in a NICU to gain a better understanding of these dynamics.

Methods

Three types of SPED were strategically placed on the ward to mimic three different dissemination dynamics among real-life conditions and employee activities. SPED DNA, resistant to disinfectants, was sampled at 22 predefined points across the ward for four days and quantitative polymerase chain reaction analysis was conducted.

Findings

Starting from staff areas, a rapid ward-wide SPED dissemination including numerous patient rooms was demonstrated. In contrast, a primary deployment in a patient room only led to the spread in the staff area, with no distribution in the patient area.

Conclusion

This study pioneers SPED utilization in simulating outbreak dynamics. By unmasking staff areas as potential key trigger spots for ward-wide dissemination the revealed patterns could contribute to a more comprehensive view of outbreak events leading to rethinking of hygiene measures and training to reduce the rate of nosocomial infections in hospitals.

目的：非医院感染构成严重威胁。特别是在新生儿重症监护室（NICU），微生物导致的爆发事件屡屡发生，但其来源或动态却无法确定。本研究旨在使用封装了 DNA 的无定形二氧化硅纳米粒子（SPED）来模拟疫情爆发事件，并对新生儿重症监护室中的传播模式进行可视化，从而更好地了解这些动态：在病房中战略性地放置了三种类型的 SPED，以模拟真实环境和员工活动中三种不同的传播动态。在整个病房的 22 个预定点进行了为期四天的 SPED DNA（对消毒剂有抗药性）采样，并进行了 qPCR 分析：结果：从员工区开始，SPED 迅速扩散到整个病房，包括许多病房。与此形成对比的是，在病房中的主要部署只导致了在员工区的传播，而没有在病人区传播：这项研究开创了利用 SPED 模拟疫情动态的先河。所揭示的模式揭示了员工区作为全院传播的潜在关键触发点，有助于更全面地了解疫情爆发事件，从而重新思考卫生措施和培训，降低医院的非医院感染率。

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引用次数: 0

Persistence of plasmid-borne carbapenemase genes in environmental Gram-negative bacilli plays a role in hospital acquisition of carbapenemase-producing organisms. 环境革兰氏阴性杆菌中质粒携带的碳青霉烯酶基因在医院感染产碳青霉烯酶生物（CPO）的过程中发挥了作用。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-09-13 DOI: 10.1016/j.jhin.2024.09.003

T Y Tan, J Li, L C Eng, Y Y Leong, R An, F B Abu Bakar, N M Thevasagayam, D S Q Loy, P S Rama Sridatta, J J Y Chua, K Marimuthu, O T Ng

引用次数: 0

Epidemiologic characteristics and risk factors of Clostridioides difficile infection in patients with active tuberculosis in the Republic of Korea: a nationwide population-based study 大韩民国活动性肺结核患者中艰难梭菌感染的流行病学特征和风险因素：一项基于全国人口的研究。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-09-13 DOI: 10.1016/j.jhin.2024.07.019

J.W. Suh , Y.J. Jeong , H.G. Ahn , J.Y. Kim , J.W. Sohn , Y.K. Yoon

Background

The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB.

Methods

This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service-National Health Information Database. The risk factors for CDI in patients with TB were identified through multi-variate logistic regression analysis using a 1:4 greedy matching method based on age and sex.

Results

During the study period, CDI developed in 2901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and TB was 9.9%, compared with 6.9% in those with TB alone (P<0.0001). Multi-variate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotic exposure, standard regimen, multi-drug-resistant TB and extrapulmonary TB to be significant risk factors for development of CDI in patients with TB.

Conclusion

CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be monitored carefully for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

背景：抗结核（TB）药物与艰难梭菌感染（CDI）之间的关系仍不清楚。本研究旨在调查结核病患者 CDI 的流行病学特征和风险因素：这项基于人群的全国性队列研究于 2018 年 1 月至 2022 年 12 月在大韩民国（ROK）进行。数据来自国民健康保险服务（NHIS）国家健康信息数据库。通过基于年龄和性别的1:4贪婪匹配法进行多变量逻辑回归分析，确定了肺结核患者发生CDI的风险因素：在研究期间，131 950 名服用抗结核药物的肺结核患者中有 2 901 人发生了 CDI。韩国结核病患者的 CDI 发病率逐年上升，从 2018 年的 12.31/1000 增至 2022 年的 33.51/1000。口服甲硝唑（81.94%）是治疗 CDI 最常见的一线疗法。同时患有 CDI 和结核病的患者的院内死亡率为 9.9%，而仅患有结核病的患者的院内死亡率为 6.9%（PC结论：CDI 在肺结核患者中并不常见，但会导致死亡率显著增加。接受结核病治疗的患者应仔细监测是否发生 CDI。需要进一步开展临床研究，以确定在结核病治疗期间预防和控制 CDI 的有效干预措施。

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引用次数: 0

Longitudinal two-year comparative genomic analysis of respiratory Staphylococcus aureus isolates from intensive care unit mechanically ventilated patients 对来自重症监护室机械通气患者的呼吸道金黄色葡萄球菌分离物进行为期两年的纵向比较基因组分析。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-09-13 DOI: 10.1016/j.jhin.2024.09.004

S. Meyer , A.C. Hernandez-Padilla , A-L. Fedou , T. Daix , D. Chainier , M-C. Ploy , P. Vignon , B. François , O. Barraud

Background

Ventilator-associated pneumonia (VAP) is the main healthcare-associated infection in intensive care units with Staphylococcus aureus as the first pathogen in early VAP.

Aim

To compare, using whole-genome sequencing (WGS), consecutive S. aureus isolates from lower respiratory samples of mechanically ventilated patients for identification of potential cross-transmissions; and to determine a potential link between S. aureus WGS data and patients with S. aureus early VAP.

Methods

All mechanically ventilated patients with a documentation of respiratory S. aureus isolates were included over a two-year period. WGS allowed typing, comparative genomic and phylogenic analyses, as well as analyses of antibiotic resistance genes and virulence genes. Virulence genes were compared between patients who developed respiratory infectious event and those who did not.

Findings

A total of 172 S. aureus isolates from 167 patients were sequenced. WGS revealed that the S. aureus population was polyclonal with only two potential healthcare cross-transmissions, each involving two isolates (2.3%). A very low resistance rate was observed with a strong genotypic/phenotypic association, and with a virulence profile highly dependent on the sequence type. No significant correlation was observed between VAP and virulence profile.

Conclusion

This study on consecutive respiratory S. aureus isolates of mechanically ventilated patients revealed a very low level of cross-transmission. No association was observed between S. aureus WGS data and VAP occurrence.

背景：呼吸机相关性肺炎（VAP）是重症监护病房的主要医源性感染，金黄色葡萄球菌是早期 VAP 的首要病原体：主要目的是利用全基因组测序技术（WGS）对机械通气患者下呼吸道样本中连续分离出的金黄色葡萄球菌进行比较，以确定潜在的交叉传播。次要目的是确定金黄色葡萄球菌 WGS 数据与金黄色葡萄球菌早期 VAP 患者之间的潜在联系：研究设计：和方法：纳入两年内所有有呼吸道金黄色葡萄球菌分离记录的 MV 患者。WGS 可进行分型、比较基因组和系统发育分析，以及抗生素耐药基因和毒力基因分析。对发生呼吸道感染事件和未发生呼吸道感染事件的患者的毒力基因进行了比较：共对来自 167 名患者的 172 株金葡菌分离物进行了测序。WGS显示，金黄色葡萄球菌群体是多克隆的，只有两个潜在的医疗保健交叉传播，每个涉及两个分离株（2.3%）。耐药率很低，基因型/表型关联性很强，毒力特征高度依赖于序列类型。在 VAP 与毒力特征之间没有观察到明显的相关性：这项对 MV 患者连续呼吸道金黄色葡萄球菌分离物的研究显示，交叉传播的程度很低。金黄色葡萄球菌 WGS 数据与 VAP 发生率之间没有关联。

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引用次数: 0

Collateral damage of a waterless intensive care unit. 无水重症监护室的附带损害。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-09-12 DOI: 10.1016/j.jhin.2024.07.018

P Ross, D Perréard, E Genevois, F Boroli, J Pugin, M-C Zanella, N Buetti

引用次数: 0

Acanthamoebae as a protective reservoir for Pseudomonas aeruginosa in a clinical environment 在临床环境中，棘阿米巴是铜绿假单胞菌的保护库。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-30 DOI: 10.1016/j.jhin.2024.08.010

R. Mooney , K. Richardson , K. Rodgers , E. Giammarini , R. Williams , S. Kelly , N. Amaeze , T. Inkster , F.L. Henriquez , W. Mackay

Background

Pseudomonas aeruginosa is a growing concern in healthcare-associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as Acanthamoeba play in the detection, disinfection and transmission of P. aeruginosa. P. aeruginosa can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas.

Methods/findings

We screened for the presence of Acanthamoeba spp. and P. aeruginosa within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a four-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed that amoebae harbour a unique microbial community comprised primarily of Pseudomonas spp. that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between acanthamoeba and P. aeruginosa in the laboratory, showing that (i) acanthamoeba growth rate is increased in the presence of pseudomonas biofilms and viable pseudomonas persist within the amoebae and (ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of P. aeruginosa in the presence of acanthamoeba than when the bacteria are incubated alone.

Conclusions

These findings suggest that amoebae, and other protists, can influence the detection and persistence of P. aeruginosa in high-risk areas and should be considered when implementing mitigation strategies.

铜绿假单胞菌在与医疗相关的感染中日益受到关注，并对那些有严重潜在健康问题的人构成重大风险。病原体的抗菌特性和形成生物膜的能力使有效的缓解和消毒策略变得困难。此外，阿卡阿米巴等自由生活的阿米巴虫在铜绿假单胞菌的检测、消毒和传播中也扮演着重要角色。铜绿假单胞菌可在阿米巴原虫细胞内存活，这有可能限制其可检测性，并允许其传播到高风险地区。在此，我们采用培养和分子方法筛查了苏格兰一家正常运行的综合医院中是否存在阿卡阿米巴和铜绿假单胞菌，在 4 个月的时间里，我们在多个地点发现了它们的存在，尤其是在连接病房的地漏中。此外，微生物组分析表明，变形虫蕴藏着一个独特的微生物群落，主要由假单胞菌组成，使用微生物组测序技术在环境拭子上不易检测到假单胞菌。在证明这两种生物在医院环境中持续存在之后，我们在实验室中研究了棘阿米巴和铜绿假单胞菌之间的关系，结果表明：i）棘阿米巴的生长速度在假单胞菌生物膜存在的情况下会增加，并且有活力的假单胞菌会在阿米巴内持续存在；ii）过氧化氢类消毒剂在棘阿米巴存在的情况下对铜绿假单胞菌分离株的杀灭效果明显低于细菌单独培养的情况。这些发现表明，阿米巴原虫和其他原生动物会影响高风险地区铜绿假单胞菌的检测和持续存在，因此在实施缓解策略时应加以考虑。

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引用次数: 0

Determinants of compliance with infection prevention measures by physicians: a scoping review 医生遵守感染预防措施的决定因素：范围界定审查。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-28 DOI: 10.1016/j.jhin.2024.08.011

M. Schutte , R. van Mansfeld , R. de Vries , M. Dekker

Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking. The aim of this review was to identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models, and frameworks from implementation science have been used in these studies. A literature search was performed in PubMed, Embase, APA PsycInfo and Web of Science up to June 2^nd, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF). Fifty-six articles were included. The TDF domains ‘environmental context and resources’, ‘social influences’, ‘beliefs about consequences’, ‘memory, attention and decision-making’, ‘knowledge’, and ‘skills’ were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education, and a champion. Theories, models, and frameworks have rarely been used to guide implementation strategy development. In conclusion, it was found that intervention studies rarely specify the determinants that they aim to address and they lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.

背景：尽管有证据表明，采取预防感染措施可以减少医护人员相关感染，但这些措施的依从性却很低，尤其是医生。干预效果往往无法持续。目的：确定影响医生感染预防行为的决定因素，探讨提高依从性的策略，以及在这些研究中是否使用了实施科学的理论、模型和框架：范围界定审查方法。我们与一位医学信息专家合作，在 PubMed、Embase、APA PsycInfo 和 Web of Science 中进行了文献检索，时间截至 2023 年 6 月 2 日。所有关注高收入国家医生感染预防行为的研究类型均被纳入。提取了有关决定因素和策略的数据；决定因素按理论领域框架（TDF）进行了分类：我们共纳入了 56 篇文章。发现与 TDF 领域最相关的是 "环境背景和资源"、"社会影响"、"对后果的信念"、"记忆、注意力和决策"、"知识 "和 "技能"。最主要的决定因素涉及到 TDF 之外的一个主题：社会人口因素。可持续的干预措施是多模式方法，至少包括反馈、教育和倡导者。理论、模型和框架很少被用于指导实施战略的制定：本综述概述了医生预防感染行为的决定因素。干预研究很少明确指出其旨在解决的决定因素，也缺乏理论支撑。未来的倡议应将决定因素的知识与实施科学相结合，针对决定因素制定基于理论的干预措施。

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引用次数: 0

Simulation as a tool for promoting infection control measures during a carbapenemase-producing Enterobacterales outbreak: lessons learned 将模拟作为一种工具，在产卡巴培南酶肠杆菌爆发期间推广感染控制措施：经验教训。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-28 DOI: 10.1016/j.jhin.2024.08.008

A. Otu , A. Richards , N. Buckle , A. Blackmore , K. Adams , D. Wearmouth

引用次数: 0

Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data 新型冠状病毒大流行前后日本医院使用酒精擦手液进行手部卫生的趋势：一项利用国家监测数据进行的观察性研究。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-28 DOI: 10.1016/j.jhin.2024.08.007

T. Higashionna , H. Hagiya , Y. Fujita , T. Kiguchi

Background

Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear.

Methods

This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019–2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC).

Results

Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations.

Conclusion

This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.

背景：医疗保健相关感染（HAIs）是全球医疗保健机构关注的问题，而使用酒精擦手液（ABHR）进行手部卫生（HH）是预防 HAIs 的关键。尽管之前的研究报告称，在 COVID-19 大流行期间，手卫生的依从性有所改善，但日本医疗机构的实际情况仍不清楚：本观察性研究从日本国家监测中获取数据，重点关注 COVID-19 大流行前后医院中 ABHR 的使用情况。研究时间跨度为五年（2019-2023 年），按季度划分，并采用联点回归分析法评估年度百分比变化（APC）：结果：总体而言，在大流行期间，重症监护病房和普通病房中每位患者每天的 ABHR 使用量均显著增加。然而，从2021年第四季度到2023年第一季度，重症监护病房的APC呈下降趋势，而普通病房的ABHR使用量仍低于世卫组织的建议量：该趋势分析通过比较COVID-19前后两个时期，强调了日本医院最近的ABHR使用模式。尽管随着时间的推移，ABHR 的使用量有所增加，但仍需持续努力促进 HH 合规性，尤其是在普通病房。

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引用次数: 0

Is Clostridioides difficile diarrhoea associated with greater social deprivation in England? 难辨梭状芽孢杆菌腹泻是否与英格兰社会贫困程度加剧有关？

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-27 DOI: 10.1016/j.jhin.2024.08.009

S Oggiano, A J Plant

引用次数: 0

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