Pub Date : 2024-11-01DOI: 10.1016/j.jhin.2024.08.012
T. Sokolová , P. Paterová , A. Zavřelová , B. Víšek , P. Žák , J. Radocha
Background
Febrile neutropenia (FN) is a common complication of stem cell transplantation.
Aim
To evaluate the frequency of sepsis in patients with FN colonized with resistant Gram-negative bacteria (extended-spectrum β-lactamase (ESBL)-positive, multidrug-resistant (MDR) Pseudomonas aeruginosa) and the choice of primary antibiotic in colonized patients.
Methods
This retrospective study analysed data from patients undergoing haematopoietic stem cell transplantation from January 2018 to September 2022. Data were extracted from the hospital information system.
Findings
Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/–AmpC patients, 31.5% of ESBL+ patients, and 0% of MDR P. aeruginosa patients. Patients with FN and MDR P. aeruginosa colonization had a high prevalence of sepsis (namely 100%, P = 0.0197). The spectrum of sepsis appeared to be different, with Gram-negative bacilli predominating in the ESBL+ group (OR: 5.39; 95% CI: 1.55–18.76; P = 0.0123). Colonizer sepsis was present in 100% of sepsis with MDR P. aeruginosa colonization (P = 0.002), all in allogeneic transplantation (P = 0.0003), with a mortality rate of 33.3% (P = 0.0384). The incidence of sepsis in patients with ESBL+ colonization was 25.9% (P = 0.0197), with colonizer sepsis in 50% of sepsis cases (P = 0.0002), most in allogeneic transplantation (P = 0.0003).
Conclusion
The results show a significant risk of sepsis in FN with MDR P. aeruginosa colonization, a condition almost exclusively caused by the colonizer. At the same time, a higher risk of Gram-negative sepsis has been demonstrated in patients colonized with ESBL+ bacteria.
{"title":"The role of colonization with resistant Gram-negative bacteria in the treatment of febrile neutropenia after stem cell transplantation","authors":"T. Sokolová , P. Paterová , A. Zavřelová , B. Víšek , P. Žák , J. Radocha","doi":"10.1016/j.jhin.2024.08.012","DOIUrl":"10.1016/j.jhin.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Febrile neutropenia (FN) is a common complication of stem cell transplantation.</div></div><div><h3>Aim</h3><div>To evaluate the frequency of sepsis in patients with FN colonized with resistant Gram-negative bacteria (extended-spectrum β-lactamase (ESBL)-positive, multidrug-resistant (MDR) <em>Pseudomonas aeruginosa</em>) and the choice of primary antibiotic in colonized patients.</div></div><div><h3>Methods</h3><div>This retrospective study analysed data from patients undergoing haematopoietic stem cell transplantation from January 2018 to September 2022. Data were extracted from the hospital information system.</div></div><div><h3>Findings</h3><div>Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/–AmpC patients, 31.5% of ESBL<sup>+</sup> patients, and 0% of MDR <em>P. aeruginosa</em> patients. Patients with FN and MDR <em>P. aeruginosa</em> colonization had a high prevalence of sepsis (namely 100%, <em>P</em> = 0.0197). The spectrum of sepsis appeared to be different, with Gram-negative bacilli predominating in the ESBL<sup>+</sup> group (OR: 5.39; 95% CI: 1.55–18.76; <em>P</em> = 0.0123). Colonizer sepsis was present in 100% of sepsis with MDR <em>P. aeruginosa</em> colonization (<em>P</em> = 0.002), all in allogeneic transplantation (<em>P</em> = 0.0003), with a mortality rate of 33.3% (<em>P</em> = 0.0384). The incidence of sepsis in patients with ESBL<sup>+</sup> colonization was 25.9% (<em>P</em> = 0.0197), with colonizer sepsis in 50% of sepsis cases (<em>P</em> = 0.0002), most in allogeneic transplantation (<em>P</em> = 0.0003).</div></div><div><h3>Conclusion</h3><div>The results show a significant risk of sepsis in FN with MDR <em>P. aeruginosa</em> colonization, a condition almost exclusively caused by the colonizer. At the same time, a higher risk of Gram-negative sepsis has been demonstrated in patients colonized with ESBL<sup>+</sup> bacteria.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"153 ","pages":"Pages 73-80"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301271","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 : 2024-10-30DOI: 10.1016/j.jhin.2024.10.009
C. Vicentini , R. Bussolino , M. Perego , D. Silengo , F. D'Ancona , S. Finazzi , C.M. Zotti
Background
Two main approaches are employed to monitor healthcare-associated infections (HAIs): longitudinal surveillance, which allows the measurement of incidence rates, and point prevalence surveys (PPSs). PPSs are less time-consuming; however, they are affected by length-biased sampling, which can be corrected through inverse probability weighting. We assessed the accuracy of this method by analysing data from two Italian national surveillance systems.
Methods
Ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI) incidence measured through a prospective surveillance system (GiViTI) was compared with incidence estimates obtained through conversion of crude and inverse probability weighted prevalence of the same HAIs in intensive care units (ICUs) measured through a PPS. Weighted prevalence rates were obtained after weighting all patients inversely proportional to their time-at-risk. Prevalence rates were converted into incidence per 100 admissions using an adapted version of the Rhame and Sudderth formula.
Findings
Overall, 30,988 patients monitored through GiViTI, and 1435 patients monitored through the PPS were included. A significant difference was found between incidence rates estimated based on crude VAP and CLABSI prevalence and measured through GiViTI (relative risk 2.5 and 3.36; 95% confidence interval 1.42–4.39 and 1.33–8.53, P=0.006 and 0.05, respectively). Conversely, no significant difference was found between incidence rates estimated based on weighted VAP and CLABSI prevalence and measured through GiViTI (P=0.927 and 0.503, respectively).
Conclusions
When prospective surveillance is not feasible, our simple method could be useful to obtain more accurate incidence rates from PPS data.
{"title":"Inverse probability weighting leads to more accurate incidence estimates for healthcare-associated infections in intensive care units – results from two national surveillance systems","authors":"C. Vicentini , R. Bussolino , M. Perego , D. Silengo , F. D'Ancona , S. Finazzi , C.M. Zotti","doi":"10.1016/j.jhin.2024.10.009","DOIUrl":"10.1016/j.jhin.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Two main approaches are employed to monitor healthcare-associated infections (HAIs): longitudinal surveillance, which allows the measurement of incidence rates, and point prevalence surveys (PPSs). PPSs are less time-consuming; however, they are affected by length-biased sampling, which can be corrected through inverse probability weighting. We assessed the accuracy of this method by analysing data from two Italian national surveillance systems.</div></div><div><h3>Methods</h3><div>Ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI) incidence measured through a prospective surveillance system (GiViTI) was compared with incidence estimates obtained through conversion of crude and inverse probability weighted prevalence of the same HAIs in intensive care units (ICUs) measured through a PPS. Weighted prevalence rates were obtained after weighting all patients inversely proportional to their time-at-risk. Prevalence rates were converted into incidence per 100 admissions using an adapted version of the Rhame and Sudderth formula.</div></div><div><h3>Findings</h3><div>Overall, 30,988 patients monitored through GiViTI, and 1435 patients monitored through the PPS were included. A significant difference was found between incidence rates estimated based on crude VAP and CLABSI prevalence and measured through GiViTI (relative risk 2.5 and 3.36; 95% confidence interval 1.42–4.39 and 1.33–8.53, <em>P</em>=0.006 and 0.05, respectively). Conversely, no significant difference was found between incidence rates estimated based on weighted VAP and CLABSI prevalence and measured through GiViTI (<em>P</em>=0.927 and 0.503, respectively).</div></div><div><h3>Conclusions</h3><div>When prospective surveillance is not feasible, our simple method could be useful to obtain more accurate incidence rates from PPS data.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 73-81"},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559480","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 : 2024-10-29DOI: 10.1016/j.jhin.2024.09.028
M. Mulder , K.E.W. Vendrik , S.A.M. van Kessel , D.W. Notermans , A.F. Schoffelen , J. Flipse , A.P.A. Hendrickx , W.C. van der Zwet , C. Schneeberger-van der Linden
Background
Vancomycin-resistant Enterococcus faecium (VREfm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VREfm management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VREfm management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VREfm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures.
Methods
Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VREfm clearance and VREfm outbreaks.
Findings
The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VREfm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VREfm screening versus 50% of the LTCFs. VREfm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VREfm-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities.
Conclusion
This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VREfm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VREfm data on a regional/national level.
{"title":"Management of vancomycin-resistant Enterococcus faecium in Dutch healthcare institutes: a nationwide survey","authors":"M. Mulder , K.E.W. Vendrik , S.A.M. van Kessel , D.W. Notermans , A.F. Schoffelen , J. Flipse , A.P.A. Hendrickx , W.C. van der Zwet , C. Schneeberger-van der Linden","doi":"10.1016/j.jhin.2024.09.028","DOIUrl":"10.1016/j.jhin.2024.09.028","url":null,"abstract":"<div><h3>Background</h3><div>Vancomycin-resistant <em>Enterococcus faecium</em> (VRE<sub>fm</sub>) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VRE<sub>fm</sub> management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VRE<sub>fm</sub> management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VRE<sub>fm</sub> policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures.</div></div><div><h3>Methods</h3><div>Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VRE<sub>fm</sub> clearance and VRE<sub>fm</sub> outbreaks.</div></div><div><h3>Findings</h3><div>The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VRE<sub>fm</sub> outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VRE<sub>fm</sub> screening versus 50% of the LTCFs. VRE<sub>fm</sub>-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VRE<sub>fm</sub>-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities.</div></div><div><h3>Conclusion</h3><div>This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VRE<sub>fm</sub> management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VRE<sub>fm</sub> data on a regional/national level.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 51-59"},"PeriodicalIF":3.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548999","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 : 2024-10-26DOI: 10.1016/j.jhin.2024.10.008
Eung Tae Kim MD , Jae Hwan Lee MD , Dong Jae Shim MD , Yohan Kwon MD , Soo Buem Cho MD , Ki Jun Kim MD , Doyoung Kim MD , Jinoo Kim MD , Eu Suk Kim MD , Hoyong Jun MD , Youn Jeong Kim MD , Jinyeong Kim MD , Eun Jin Kim MD , Chung-Jong Kim MD , Kang-Il Jun MD , Myoung Jin Shin RN , Chang Jin Yoon MD , Seungjae Lee PhD , Soon-Young Song MD , Je Hwan Won MD
Objective
We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).
Methods
We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).
Results
From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (n=662) and cPICC (n=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30–1.38, p=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, p=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, p=0.99) was not different between both groups.
Conclusion
Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.
{"title":"Subcutaneous tunneling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a multicentre, open-label, randomized, controlled trial","authors":"Eung Tae Kim MD , Jae Hwan Lee MD , Dong Jae Shim MD , Yohan Kwon MD , Soo Buem Cho MD , Ki Jun Kim MD , Doyoung Kim MD , Jinoo Kim MD , Eu Suk Kim MD , Hoyong Jun MD , Youn Jeong Kim MD , Jinyeong Kim MD , Eun Jin Kim MD , Chung-Jong Kim MD , Kang-Il Jun MD , Myoung Jin Shin RN , Chang Jin Yoon MD , Seungjae Lee PhD , Soon-Young Song MD , Je Hwan Won MD","doi":"10.1016/j.jhin.2024.10.008","DOIUrl":"10.1016/j.jhin.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).</div></div><div><h3>Methods</h3><div>We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).</div></div><div><h3>Results</h3><div>From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (<em>n</em>=662) and cPICC (<em>n</em>=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30–1.38, <em>p</em>=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, <em>p</em>=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, <em>p</em>=0.99) was not different between both groups.</div></div><div><h3>Conclusion</h3><div>Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570377","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 : 2024-10-25DOI: 10.1016/j.jhin.2024.09.029
Gareth Hughes, Susan Wilkinson, Jean Harker, Itisha Gupta, Elisabeth Holden, Mark Garvey
{"title":"Borderline oxacillin-resistant Staphylococcus aureus: an emerging threat in the hospital environment.","authors":"Gareth Hughes, Susan Wilkinson, Jean Harker, Itisha Gupta, Elisabeth Holden, Mark Garvey","doi":"10.1016/j.jhin.2024.09.029","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.09.029","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570375","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 : 2024-10-23DOI: 10.1016/j.jhin.2024.09.027
V. Boulanger , A. MacLaurin , C. Quach
Although administrative data are not originally intended for surveillance purposes, they are frequently used for monitoring public health and patient safety. This article provides a narrative overview of the barriers and facilitators for the use of administrative data for surveillance, with a focus on healthcare-associated infection (HAI) in Canada. In this case, only articles on administrative data in general or related to HAI were included. Validation study and meta-analyses on administrative data accuracy were excluded. Medline, Embase and Google Scholar were searched as well as references list of all included articles, for a total of 90 articles included. Our analysis identified 78 barriers at the individual, organizational and systemic levels and outlined 75 facilitators and solutions to improve administrative data utilization and quality. This narrative overview will help to understand barriers, facilitators and offer practical recommendations for optimizing the use of administrative data.
尽管行政数据最初并非用于监测目的，但它们经常被用于监测公共卫生和患者安全。本文概述了使用行政数据进行监测的障碍和促进因素，重点关注加拿大的医疗相关感染 (HAI)。在这种情况下，只纳入了一般行政数据或与 HAI 相关的文章。有关行政数据准确性的验证研究和荟萃分析不包括在内。我们检索了 Medline、Embase 和 Google Scholar 以及所有收录文章的参考文献列表，共收录了 90 篇文章。我们的分析确定了个人、组织和系统层面的 78 个障碍，并概述了 75 个促进因素和解决方案，以提高行政数据的利用率和质量。这一叙述性概述将有助于了解障碍和促进因素，并为优化行政数据的使用提供实用建议。
{"title":"Barriers and facilitators for using administrative data for surveillance purpose: a narrative overview","authors":"V. Boulanger , A. MacLaurin , C. Quach","doi":"10.1016/j.jhin.2024.09.027","DOIUrl":"10.1016/j.jhin.2024.09.027","url":null,"abstract":"<div><div>Although administrative data are not originally intended for surveillance purposes, they are frequently used for monitoring public health and patient safety. This article provides a narrative overview of the barriers and facilitators for the use of administrative data for surveillance, with a focus on healthcare-associated infection (HAI) in Canada. In this case, only articles on administrative data in general or related to HAI were included. Validation study and meta-analyses on administrative data accuracy were excluded. Medline, Embase and Google Scholar were searched as well as references list of all included articles, for a total of 90 articles included. Our analysis identified 78 barriers at the individual, organizational and systemic levels and outlined 75 facilitators and solutions to improve administrative data utilization and quality. This narrative overview will help to understand barriers, facilitators and offer practical recommendations for optimizing the use of administrative data.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 25-36"},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513198","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 : 2024-10-22DOI: 10.1016/j.jhin.2024.10.006
S. Ditommaso , J. Garlasco , G. Memoli , A. Curtoni , A. Bondi , A. Ceccarelli , M. Giacomuzzi
Background
Worldwide, the detection of Mycobacterium chimaera in LivaNova heater–cooler units (HCUs) has led to their replacement with other HCUs, although non-tuberculous mycobacteria (NTM) have been reported also for HCUs produced by other manufacturers. In almost all hospitals of our region, LivaNova HCUs have been replaced with Maquet HCU40s, regularly disinfected with chloramine-T.
Aim
To report the results of the surveillance over a 63-month operation period of the Maquet devices, and to provide a trend in NTM positivity over time.
Methods
Twenty-nine Maquet devices (HCU40 and HU35) were monitored by two culture methods and propidium monoazide polymerase chain reaction (PMA-PCR) method. The trend in NTM positivity rate was evaluated through the Locally Estimated Scatterplot Smoothing regression and then modelled over time through segmented logistic regression.
Findings
The data acquired during the study period demonstrate a remarkable increase in the positivity rate, especially after the third year (maximum slope change at 1280 days). Non-tuberculous mycobacteria were isolated in 150 water samples (37.2%); 100% and 62% of HCU40 and HU35 devices, respectively, were colonized with non-tuberculous mycobacteria. The most frequently detected species were Mycobacterium gordonae (73%) followed by Mycobacterium chelonae (41%) and Mycobacterium paragordonae (11%).
Conclusion
Preventive strategies by disinfection with chloramine-T did not effectively reduce non-tuberculous mycobacteria colonization of Maquet devices. Although, to date, no cases of postoperative invasive infections linked to Maquet devices have been reported, our microbiological results emphasize the need for (1) designing changes to increase safety of devices and (2) researching and developing new disinfection protocols including alternative molecules.
{"title":"Emergence of Mycobacterium gordonae in heater–cooler units: a five-year prospective surveillance of devices frequently subjected to chloramine-T booster disinfection","authors":"S. Ditommaso , J. Garlasco , G. Memoli , A. Curtoni , A. Bondi , A. Ceccarelli , M. Giacomuzzi","doi":"10.1016/j.jhin.2024.10.006","DOIUrl":"10.1016/j.jhin.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Worldwide, the detection of <em>Mycobacterium chimaera</em> in LivaNova heater–cooler units (HCUs) has led to their replacement with other HCUs, although non-tuberculous mycobacteria (NTM) have been reported also for HCUs produced by other manufacturers. In almost all hospitals of our region, LivaNova HCUs have been replaced with Maquet HCU40s, regularly disinfected with chloramine-T.</div></div><div><h3>Aim</h3><div>To report the results of the surveillance over a 63-month operation period of the Maquet devices, and to provide a trend in NTM positivity over time.</div></div><div><h3>Methods</h3><div>Twenty-nine Maquet devices (HCU40 and HU35) were monitored by two culture methods and propidium monoazide polymerase chain reaction (PMA-PCR) method. The trend in NTM positivity rate was evaluated through the Locally Estimated Scatterplot Smoothing regression and then modelled over time through segmented logistic regression.</div></div><div><h3>Findings</h3><div>The data acquired during the study period demonstrate a remarkable increase in the positivity rate, especially after the third year (maximum slope change at 1280 days). Non-tuberculous mycobacteria were isolated in 150 water samples (37.2%); 100% and 62% of HCU40 and HU35 devices, respectively, were colonized with non-tuberculous mycobacteria. The most frequently detected species were <em>Mycobacterium gordonae</em> (73%) followed by <em>Mycobacterium chelonae</em> (41%) and <em>Mycobacterium paragordonae</em> (11%).</div></div><div><h3>Conclusion</h3><div>Preventive strategies by disinfection with chloramine-T did not effectively reduce non-tuberculous mycobacteria colonization of Maquet devices. Although, to date, no cases of postoperative invasive infections linked to Maquet devices have been reported, our microbiological results emphasize the need for (1) designing changes to increase safety of devices and (2) researching and developing new disinfection protocols including alternative molecules.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 9-16"},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513199","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 : 2024-10-19DOI: 10.1016/j.jhin.2024.08.013
K. Furuya , T. Yamagishi , K. Suzuki , K. Sugiyama , M. Yamamoto , M. Koyama , A. Yamada , R. Sasaki , J. Kurioka , H. Kurai , K. Tanaka , M. Nakagawa , Y. Kanazawa , S. Onoda , H. Inoue , M. Koshiko , H. Kurosu , T. Shimada , T. Sunagawa , M. Sugai , Y. Hakamata
Background
The target population for active surveillance culture (ASC) of vancomycin-resistant Enterococcus species (VRE) by stool or rectal swabs has not been fully determined during VRE outbreaks in healthcare settings in non-VRE endemic situation.
Aim
To evaluate cumulative incidences of VRE detection during a vancomycin-resistant Enterococcus faecium outbreak to determine reasonable target populations for ASC.
Methods
Cases included inpatients whose first VRE-positive sample was obtained at Shizuoka General Hospital between February 2022 and January 2023, during which we conducted admission screening for possible high-risk patients, bi-weekly screening of all inpatients, admission and discharge screening in the high-care unit, and screening of contacts in each ward using stool or rectal samples. We calculated cumulative incidences of VRE detection for those screened by patient characteristics or possible exposure.
Findings
Among 60 cases identified, 55 (92%) were by ASC. Cumulative incidence was higher for contacts (6.4%, 15/234) than for those identified by other screening methods (0.5%, 40/8565). Among the patients identified through admission screening, those previously hospitalized in areas of reported VRE outbreaks had the highest cumulative incidence (6.6%, 5/78) followed by patients requiring toilet assistance (3.7%, 6/161). A bundle approach including ASC and prompt contact precautions by the hospital infection control team, local public health centre, and local and national infection control experts helped terminate the outbreak in seven months.
Conclusion
Patients with contacts, prior hospitalization in areas with known VRE outbreaks, and who need toilet assistance appear to be high-risk populations for VRE detection and are candidates for ASC.
{"title":"Cumulative incidence of vancomycin-resistant Enterococcus faecium detection by patient characteristics or possible exposures: prioritization of patients for active screening culture","authors":"K. Furuya , T. Yamagishi , K. Suzuki , K. Sugiyama , M. Yamamoto , M. Koyama , A. Yamada , R. Sasaki , J. Kurioka , H. Kurai , K. Tanaka , M. Nakagawa , Y. Kanazawa , S. Onoda , H. Inoue , M. Koshiko , H. Kurosu , T. Shimada , T. Sunagawa , M. Sugai , Y. Hakamata","doi":"10.1016/j.jhin.2024.08.013","DOIUrl":"10.1016/j.jhin.2024.08.013","url":null,"abstract":"<div><h3>Background</h3><div>The target population for active surveillance culture (ASC) of vancomycin-resistant <em>Enterococcus</em> species (VRE) by stool or rectal swabs has not been fully determined during VRE outbreaks in healthcare settings in non-VRE endemic situation.</div></div><div><h3>Aim</h3><div>To evaluate cumulative incidences of VRE detection during a vancomycin-resistant <em>Enterococcus faecium</em> outbreak to determine reasonable target populations for ASC.</div></div><div><h3>Methods</h3><div>Cases included inpatients whose first VRE-positive sample was obtained at Shizuoka General Hospital between February 2022 and January 2023, during which we conducted admission screening for possible high-risk patients, bi-weekly screening of all inpatients, admission and discharge screening in the high-care unit, and screening of contacts in each ward using stool or rectal samples. We calculated cumulative incidences of VRE detection for those screened by patient characteristics or possible exposure.</div></div><div><h3>Findings</h3><div>Among 60 cases identified, 55 (92%) were by ASC. Cumulative incidence was higher for contacts (6.4%, 15/234) than for those identified by other screening methods (0.5%, 40/8565). Among the patients identified through admission screening, those previously hospitalized in areas of reported VRE outbreaks had the highest cumulative incidence (6.6%, 5/78) followed by patients requiring toilet assistance (3.7%, 6/161). A bundle approach including ASC and prompt contact precautions by the hospital infection control team, local public health centre, and local and national infection control experts helped terminate the outbreak in seven months.</div></div><div><h3>Conclusion</h3><div>Patients with contacts, prior hospitalization in areas with known VRE outbreaks, and who need toilet assistance appear to be high-risk populations for VRE detection and are candidates for ASC.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 70-76"},"PeriodicalIF":3.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481259","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 : 2024-10-18DOI: 10.1016/j.jhin.2024.10.004
M. Wang , W. Sun , C. Zhou , S. Wang , Q. Shi , J. Lin , H. Mi , B. Hu , J. Pan , X. Gao
Background
Personnel in clinical microbiology laboratories face heightened risks of occupational infections, due to the potential for pathogenicity in clinical samples.
Aim
To summarize the characteristics of laboratory-acquired infections (LAIs) and review exposure incidents in clinical laboratories, and to conduct a meta-analysis to estimate post-exposure incidence rates and evaluate the efficacy of post-exposure prophylaxis (PEP) following Brucella exposures.
Methods
A systematic search across PubMed, Embase, Web of Science, CNKI, Wanfang, CMB, and the ABSA LAI database extracted relevant literature published from January 1st, 1990, to August 31st, 2023, including case reports and laboratory exposure risk events. Negative-binomial regression was used to estimate the relative increase in reported numbers per year of LAIs. Meta-analysis was performed to estimate the incidence rate (IR) of LAIs among exposed laboratory personnel after Brucella exposure risk events.
Findings
A total of 164 LAIs were reported in hospital laboratories. Negative-binomial regression analysis indicated no significant decline in annual LAIs reports (relative risk and 95% CI: 0.98 (0.97, 1.00); P = 0.052). The leading pathogens were Brucella spp. (55.5%), Neisseria meningitidis (7.3%), and Shigella sonnei (5.5%). The meta-analysis revealed that the incidence rate for Brucella-related LAIs among laboratory personnel was 60 per 100,000 laboratory personnel. Laboratory personnel exposed to high-risk Brucella incidents faced a notably elevated infection risk, estimated at 80 per 100,000 laboratory personnel. Compared with high-risk Brucella exposures with PEP, highrisk Brucella exposures without PEP had a 6.33-fold increase in the risk of Brucella infection.
Conclusions
Clinical laboratory personnel remain at infection risk, with no reduction in reported LAI cases, mainly resulting from Brucella acquisitions. PEP was shown to be effective against high-risk Brucella exposures.
背景：本研究旨在总结实验室获得性感染（LAI）的特点，并回顾临床实验室中的暴露事件。此外，还进行了一项荟萃分析，以估算暴露后的发病率并评估布鲁氏菌暴露后预防（PEP）的疗效：方法：对PubMed、Embase、Web of Science、CNKI、Wanfang、CMB和ABSA LAI数据库等数据库进行了系统检索，以提取1990年1月1日至2023年8月31日期间发表的相关文献。其中包括临床实验室的病例报告和实验室暴露风险事件。采用负二叉回归法估算每年 LAI 报告数量的相对增长。进行了一项荟萃分析，以估算布鲁氏菌暴露风险事件后实验室暴露人员的LAI发病率（IR）：医院实验室共报告了 164 例 LAI。负二项式回归分析表明，每年的LAI报告数量没有显著下降（相对风险和95% CI：0.9834 [0.9667,1.0001]，P值：0.052）。大多数 LAI（68.3%）发生在日常工作中，只有 9.8% 与实验室意外接触有关。主要病原体是布鲁氏菌（55.5%）、脑膜炎奈瑟菌（7.3%）和宋内志贺氏菌（5.5%）。发展中国家由布鲁氏杆菌引起的 LAI 比例高于发达国家（72.4% 对 48.7%）。荟萃分析显示，实验室人员中与布鲁氏菌相关的 LAI 发病率为每 10 万名实验室人员中 60 例。接触高风险布鲁氏菌事件的实验室人员面临的感染风险明显升高，估计为每10万名实验室人员中有80人感染。在较高风险的布鲁氏菌感染事件中，未接受 PEP 的实验室人员的感染风险是接受 PEP 的实验室人员的 6.33 倍。与未接受 PEP 相关的可归因比例为 84.2%：结论：临床实验室人员仍然面临感染风险，报告的 LAI 病例并未减少，主要是由于感染了布鲁氏菌。事实证明，PEP 对高风险的布鲁氏菌暴露有效。
{"title":"Laboratory-acquired infection in clinical laboratories and the incidence rate after Brucella exposure risk events: a systematic review and meta-analysis","authors":"M. Wang , W. Sun , C. Zhou , S. Wang , Q. Shi , J. Lin , H. Mi , B. Hu , J. Pan , X. Gao","doi":"10.1016/j.jhin.2024.10.004","DOIUrl":"10.1016/j.jhin.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Personnel in clinical microbiology laboratories face heightened risks of occupational infections, due to the potential for pathogenicity in clinical samples.</div></div><div><h3>Aim</h3><div>To summarize the characteristics of laboratory-acquired infections (LAIs) and review exposure incidents in clinical laboratories, and to conduct a meta-analysis to estimate post-exposure incidence rates and evaluate the efficacy of post-exposure prophylaxis (PEP) following <em>Brucella</em> exposures.</div></div><div><h3>Methods</h3><div>A systematic search across PubMed, Embase, Web of Science, CNKI, Wanfang, CMB, and the ABSA LAI database extracted relevant literature published from January 1<sup>st</sup>, 1990, to August 31<sup>st</sup>, 2023, including case reports and laboratory exposure risk events. Negative-binomial regression was used to estimate the relative increase in reported numbers per year of LAIs. Meta-analysis was performed to estimate the incidence rate (IR) of LAIs among exposed laboratory personnel after <em>Brucella</em> exposure risk events.</div></div><div><h3>Findings</h3><div>A total of 164 LAIs were reported in hospital laboratories. Negative-binomial regression analysis indicated no significant decline in annual LAIs reports (relative risk and 95% CI: 0.98 (0.97, 1.00); <em>P</em> = 0.052). The leading pathogens were <em>Brucella</em> spp. (55.5%), <em>Neisseria meningitidis</em> (7.3%), and <em>Shigella sonnei</em> (5.5%). The meta-analysis revealed that the incidence rate for <em>Brucella</em>-related LAIs among laboratory personnel was 60 per 100,000 laboratory personnel. Laboratory personnel exposed to high-risk <em>Brucella</em> incidents faced a notably elevated infection risk, estimated at 80 per 100,000 laboratory personnel. Compared with high-risk <em>Brucella</em> exposures with PEP, highrisk <em>Brucella</em> exposures without PEP had a 6.33-fold increase in the risk of <em>Brucella</em> infection.</div></div><div><h3>Conclusions</h3><div>Clinical laboratory personnel remain at infection risk, with no reduction in reported LAI cases, mainly resulting from <em>Brucella</em> acquisitions. PEP was shown to be effective against high-risk <em>Brucella</em> exposures.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 135-144"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481261","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 : 2024-10-18DOI: 10.1016/j.jhin.2024.10.001
R. Sinto , R. Limato , S.P. Radiani , M.N. Huda , H. Surendra , A.W. Praptiwi , Y. Herman , B.A. Musaffa , G. Lazarus , N.P.J. Day , D. Limmathurotsakul , A. Karuniawati , R.L. Hamers
Background
There is an urgent need to understand the implementation barriers of antimicrobial stewardship programmes (ASPs) in low- and middle-income countries.
Methods
We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March–December 2023). We used a self-assessment questionnaire with a scoring system, and multi-level ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGDs) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results.
Results
A total of 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 (interquartile range (IQR) 1–5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9–62.5%), classifying 41 (8.0%) hospitals as inadequate (0–25%), 237 (45.9%) as basic (26–50%), 179 (34.7%) as intermediate (51–75%) and 59 (11.4%) as advanced (76–100%). Scores were highest for hospital leadership support (83.4% (IQR 66.7–100%)), followed by ASP team and infectious disease training (66.7% (IQR 55.6–77.8%)); education (50% (IQR 0.0–75.0%)); ASP interventions (43.8% (IQR 18.7–68.7%)); hospital infrastructure (42.9% (IQR 14.3–71.4%)); and monitoring, reporting and feedback (40.9% (IQR 27.3–54.5%)). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level Public Health Development Index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioural skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation.
Conclusions
Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs.
背景：迫切需要了解抗菌药物管理计划（ASP）在中低收入国家的实施障碍：迫切需要了解抗菌药物管理计划（ASP）在中低收入国家的实施障碍：我们在印度尼西亚各省的公立和私立医院开展了一项混合方法研究（2023 年 3 月至 12 月）。我们使用了带有评分系统的自我评估问卷，并通过多层次序数回归评估了与医院和地区特征之间的关联。与医院利益相关者进行的焦点小组讨论（FGD）探讨了障碍和促进因素。我们采用了患者安全框架来整合结果：3026 家医院中有 575 家（19%）完成了自我评估，其中 516 家（89.7%）拥有正式的 ASP（中位数为 4 [IQR1-5] 年），14 家参与了 FGD。ASP 总体发展得分的中位数为 48.4% (35.9-62.5%)，41 家（8.0%）医院为不足（0-25%），237 家（45.9%）为基本（26-50%），179 家（34.7%）为中等（51-75%），59 家（11.4%）为高级（76-100%）。得分最高的是医院领导支持（83.4%[66.7-100%]），其次是 ASP 团队和传染病培训（66.7%[55.6-77.8%]）；教育（50%[0.0-75.0%]）；ASP 干预（43.8%[18.7-68.7%]）；医院基础设施（42.9%[14.3-71.4%]）；以及监测、报告和反馈（40.9%[27.3-54.5%]）。较高的 ASP 发展得分与较高的医院分级水平、较长的 ASP 持续时间、较高的地区级公共卫生发展指数和人均国内支出有关，但与医院所有权或地理区域无关。专题小组讨论强调了与医院领导支持、员工技术和行为技能、跨学科合作、担心失去处方自主权、微生物学和信息技术支持以及医院认证有关的障碍：已发现的实施障碍可为针对具体情况、可持续改进 ASP 的行动提供参考。
{"title":"A nationwide mixed-methods study of gaps and barriers to implementation of antimicrobial stewardship programmes in hospitals in Indonesia","authors":"R. Sinto , R. Limato , S.P. Radiani , M.N. Huda , H. Surendra , A.W. Praptiwi , Y. Herman , B.A. Musaffa , G. Lazarus , N.P.J. Day , D. Limmathurotsakul , A. Karuniawati , R.L. Hamers","doi":"10.1016/j.jhin.2024.10.001","DOIUrl":"10.1016/j.jhin.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>There is an urgent need to understand the implementation barriers of antimicrobial stewardship programmes (ASPs) in low- and middle-income countries.</div></div><div><h3>Methods</h3><div>We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March–December 2023). We used a self-assessment questionnaire with a scoring system, and multi-level ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGDs) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results.</div></div><div><h3>Results</h3><div>A total of 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 (interquartile range (IQR) 1–5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9–62.5%), classifying 41 (8.0%) hospitals as inadequate (0–25%), 237 (45.9%) as basic (26–50%), 179 (34.7%) as intermediate (51–75%) and 59 (11.4%) as advanced (76–100%). Scores were highest for hospital leadership support (83.4% (IQR 66.7–100%)), followed by ASP team and infectious disease training (66.7% (IQR 55.6–77.8%)); education (50% (IQR 0.0–75.0%)); ASP interventions (43.8% (IQR 18.7–68.7%)); hospital infrastructure (42.9% (IQR 14.3–71.4%)); and monitoring, reporting and feedback (40.9% (IQR 27.3–54.5%)). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level Public Health Development Index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioural skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation.</div></div><div><h3>Conclusions</h3><div>Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 77-87"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481256","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}
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