Antimicrobial Resistance and Infection Control最新文献

Background: Bacillus cereus is an emerging cause of fulminant nosocomial bacteremia in premature infants. Here we aimed to report the successful management of two successive waves of contamination, colonization and infections caused by this pathogen in one neonatal intensive care unit (NICU).

Methods: This study reports all investigative, preventive, and management measures taken during these episodes (in 2023 and 2024) in a 3rd level NICU. A case was defined as an infection with B. cereus confirmed by at least one positive blood culture. Contamination was monitored by surface samples from the NICU and colonization by stool or skin samples from patients. The bacterial genomes were compared via multilocus sequence typing, core genome typing, and distance matrix.

Results: Between January 2021 and May 2025, B. cereus were detected in 156 surface samples within the NICU, mainly in 2023 and 2024. Three patients developed a sepsis caused by B. cereus, including 2 fatal cases. Thirty-three others patients were colonized with B. cereus during this period but none developed B. cereus sepsis. A set of structural, logistical, hygiene, and air quality optimization measures were implemented in September 2023. The environmental contamination was considered as under control in February 2024, but a resurgence was observed in April 2024. Measures to control and prevent environmental contamination in the NICU were intensified, controlling the situation by August 2024. Residual circulation persists at low levels. Analyses revealed widespread contamination including NICU equipment, air, air treatment infrastructure, linen and maintenance equipment. A pluriclonal population was described, with more than 20 different clones circulating simultaneously. The three strains isolated from blood cultures were different but each one was also identified in the NICU environment.

Conclusion: The detection of B. cereus, whether in carriers or in the environment, should trigger rapid investigations to identify entry points and the immediate implementation of barrier measures to protect the most vulnerable newborns. Care must be taken with respect to air treatment, laundry, and hand hygiene.

Background: Hospital indoor air is contaminated with multidrug-resistant bacteria, and this contributes to their spread. However, there is limited information linking environmental and atmospheric factors to the levels of these resistant bacteria in indoor hospital air. Hence, this study assessed the levels of multi-drug resistant bacteria in the indoor air of a tertiary hospital and the contributing environmental and atmospheric factors.

Methods: This cross-sectional study observed hygiene practices, sanitary conditions, occupancy ratio, activity rates, temperature and humidity levels in selected indoor areas of University College Hospital, Ibadan. Airborne bacteria were sampled with their loads via a volumetric sampler, and they were tested for susceptibility against 13 antibiotics via the disk diffusion method. Data was collected twice daily, thrice weekly for two weeks, and analyzed using SPSS version 26.

Results: The hygiene practices observed varied across the sampled areas with the office area (10.00 ± 0.00) and psychiatry (9.17 ± 0.41) wards showing best practices, and the laundry area (6.00 ± 0.00) with the worst, sanitary conditions also followed a similar pattern. The study identified 93 bacterial isolates from the MacConkey agar, Staphylococcus aureus (33.3%), Bacillus species (31.18%), Klebsiella pneumoniae (15.05%), Escherichia coli (10.75%), and Coagulase-negative Staphylococcus (9.68%). The mean bacterial load (CFU/m³) varied significantly across sampled areas (p < 0.01): Laundry (2962.96 ± 547.59) > Children Emergency Ward (2537.03 ± 551.67) > Neurosurgery (2310.19 ± 560.31) > Psychiatry (1828.70 ± 431.93) > Office (421.30 ± 311.09), with the exception of office area, the loads were above the WHO acceptable limit of 1000 CFU/m³. Bacterial load correlated negatively with hygiene practices and sanitary conditions, but positively with occupancy ratio, activity levels, humidity and temperature, all p < 0.01. The identified bacteria exhibited a high multidrug resistance, this includes the identification of Methicillin Resistant Staphylococcus aureus and extended spectrum beta lactamases producing Escherichia coli and Klebsiella pneumoniae.

Conclusion: Healthcare environments, particularly indoor air remains highly contaminated with multidrug-resistant bacteria, with environmental factors like hygiene, sanitation, occupancy, activity, and atmospheric factors like temperature and humidity contributing to their spread. Therefore, improved environmental practices, routine indoor air surveillance and antimicrobial stewardship is advocated.

Background: Critically ill patients in intensive care units (ICUs) are at risk for colonization and infection by carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant pathogen with high mortality. Despite the use of infection control bundles, CRAB often persists on environmental surfaces, posing ongoing challenges for containment. The potential impact of managing soft environmental reservoirs-such as pillow covers-remains underexplored. This study evaluated whether daily pillow cover replacement can reduce CRAB acquisition in a medical ICU (MICU).

Methods: A prospective intervention study was conducted in a 23-bed MICU at a tertiary hospital in Korea between August 2023 and July, 2024. Standard infection prevention and control (IPC) practices, including hand hygiene, cohort isolation, chlorhexidine bathing, and routine cleaning, were consistent throughout the study. Starting February 1, 2024, pillow covers were replaced regularly as an additional intervention. CRAB acquisition was defined as positive clinical cultures obtained > 48 h after admission. Incidence rates were compared between the pre- and post-intervention periods using Poisson regression and interrupted time series analyses.

Results: A total of 152 patients met the inclusion criteria (108 pre- and 44 post-intervention). In this study, 224 CRAB-positive clinical specimens were identified from 152 patients, and only the first isolate per patient was included in the incidence analysis. The mean age was 76 years; 59.9% were male, and the average MICU stay was 26 days. Sputum accounted for 76.8% of CRAB-positive specimens. Compliance with daily pillow cover replacement was 100%. Poisson regression revealed a significant reduction in CRAB incidence following the intervention, with a 3.92% weekly decrease (95% CI 0.10-7.69%; p = 0.045).

Conclusions: When integrated into existing IPC bundles, daily pillow-cover replacement may reduce CRAB cross-transmission in the MICU. This simple, low-cost intervention with high compliance offers a promising strategy for improving environmental hygiene and infection control in high-risk settings.

Objective: To assess the implementation of infection prevention and control (IPC) measures in municipal and higher-level tuberculosis (TB)-designated medical institutions and to identify areas for improvement by comparing data from 2014 and 2022.

Methods: This study compared infection control measures using data from 47 TB-designated medical institutions that participated in both the 2014 and 2022 national surveys. Implementation rates of administrative, environmental and respiratory protection measure were compared.

Results: A total of 47 institutions were analyzed, including 20 provincial institutions (42.6%) and 27 municipal institutions (57.4%). Overall infection control performance in 2022 was high and consistent across regions, levels, and grades. Significant improvements from 2014 to 2022 were observed in: dedicated pathways for patients/staff (80.9% vs. 97.9%, 17.0% increase), separate wards for smear-positive/smear-negative patients (63.8% vs. 87.2%, 23.4% increase), separate wards for drug-resistant/non-resistant patients (74.5% vs. 95.7%, 21.2% increase), and use of medical protective mask by staff (70.2% vs. 95.7%, 25.5% increase) (all P < 0.05). The use of air purification/filtration also increased significantly (14.9% vs. 57.4%, 42.5% increase, P < 0.001), with over 90% of institutions adopting natural ventilation and ultraviolet germicidal irradiation.

Conclusion: Significant improvements in IPC measures were achieved between 2014 and 2022, particularly in administrative controls. However, further efforts are needed to standardize ward zoning management and ensure more equitable resource allocation across regions and institution levels.

Background: Antimicrobial resistance is a major public health challenge, particularly in low- and middle-income countries, where antimicrobial stewardship is often lacking. This study assessed the knowledge, attitudes, and practices of healthcare professionals in pediatric settings regarding antimicrobial resistance and antimicrobial stewardship at Maputo Central Hospital, Mozambique.

Methods: A cross-sectional study was conducted among pediatric healthcare professionals using a self-administered questionnaire. Descriptive and inferential statistical analyses were performed to assess knowledge, attitudes, and practices, and their associated factors for inappropriate prescribing.

Results: Of 108 eligible participants, 82 (76%) responded to the questionnaire. Overall, 53 (66%) correctly identified that antibiotics do not treat viral infections, and 79 (99%) recognized factors contributing to antimicrobial resistance. However, only 28 (34%) were familiar with the concept of antimicrobial stewardship programs, and participant knowledge related to empiric antibiotic selection was suboptimal. Physicians had significantly higher knowledge scores than laboratory technicians (p = 0.036). Prior antimicrobial stewardship training was strongly associated with improved knowledge (p < 0.001) and better prescribing practices (p = 0.005). A majority, 77 (94%), expressed interest in further antimicrobial stewardship training.

Conclusion: Pediatric healthcare professionals at Maputo Central Hospital are generally aware of antimicrobial resistance and exhibit positive attitudes toward antimicrobial stewardship. However, notable gaps exist in their knowledge and practices. Strengthening antimicrobial stewardship education, increasing access to treatment guidelines, and integrating antimicrobial stewardship training into routine professional development are recommended to improve appropriate antimicrobial prescribing.

Background: Antimicrobial resistance is a leading cause of death worldwide, with the highest burdens in low-resource settings. Antimicrobial stewardship programs (ASP) are coordinated interventions designed to improve and measure the appropriate use of antimicrobials. In December 2020, the Ministry of Health of Chile mandated that all hospitals in the country implement an ASP, but there has been little rigorous, comparable information on the prevalence and types of ASP activities currently occurring in Chilean hospitals, which is critical for infection control officials and health decision-makers.

Objectives: We aimed to assess the current degree of implementation of ASPs in Chilean public hospitals using a web-based survey.

Results: Of 66 responses, 57 hospitals (86.4%) reported having an ASP and were used as the denominator in the analyses. Among them, 39 (68.4%) reported having a written institutional protocol. On average, the hospitals performed seven antimicrobial optimization activities (range 1-9). For hospitals that have WHO Reserve group antibiotics, use authorization was almost universally required (90.9% to 100%). Prospective audit and feedback was performed in 64.9% of the institutions. Seventeen hospitals (29.8%) did not measure their antibiotic consumption. The median ASP implementation survey score was 68.4 points (ranging from 30.7 to 96.5).

Conclusion: These findings show a variable implementation of ASP activities in Chilean hospitals and provide the necessary information to establish the baseline for the implementation of ASPs in hospitals in Chile.

Background: In resource-constrained healthcare settings such as in India, effective infection prevention and control (IPC) practices are essential for reducing healthcare-associated infections (HAIs) and enhancing patient outcomes. This study aimed to evaluate a customized IPC model implemented in Indian hospitals to address these challenges and improve patient safety. The model was designed to be replicable by other hospitals with similar objectives.

Methods: The multicenter pre-post quality improvement study was conducted across 11 Indian private tertiary hospitals from January 2022 to June 2023, with a 6 months preintervention phase (January-June 2022) and a 12 months intervention phase (July 2022-June 2023). Following the World Health Organization (WHO) guidelines, the study employed a stepwise methodology, including induction, HAI data collection, baseline assessments using WHO's Infection Prevention and Control (IPC) Assessment Framework (IPCAF) tool to evaluate IPC level, team formation, training, surveillance, and audit protocols. The intervention phase focused on comprehensive IPC training, virtual courses, and IPC surveillance. The project utilized the IPC model to enhance the methodology of implementing IPC, enabling transition over an 18-month duration.

Results: Significant improvements were observed in IPC assessment scores, hand hygiene compliance, and adherence to IPC care bundles during the intervention phase. IPC assessment scores remarkably improved from a median of 78-97% (p = 0.004), with hospitals remaining in the advanced IPC level both pre and post intervention. Compliance toward hand hygiene improved from a median of 65% in the preintervention phase to 88% in the postintervention phase (p = 0.004). Significant improvement in compliance with IPC care bundles were observed for CAUTI (p = 0.016), CLABSI (p = 0.004), SSI (p = 0.010), and VAP (p = 0.037).Overall, HAI incidence rates remained consistently low during the study period with no statistically significant difference (p > 0.05) between preintervention and postintervention rates; however, variability across individual hospitals highlights differences in settings and indicates further strengthening and standardization of IPC practices.

Conclusions: This quality improvement initiative highlights that a structured, WHO-aligned IPC approach can be practically adopted across Indian hospitals and can strengthen key IPC practices such as hand hygiene and care bundle compliance. With HAI rates already low at baseline and remaining stable over the study period, the findings primarily highlight the feasibility and scalability of such IPC programs across diverse healthcare settings.

Background In 2022, a study in the maternity and neonatology units of Franceville Hospital revealed high risk of carbapenemase-producing Enterobacterales (CPE) acquisition in parturients and newborns potentially linked to suboptimal hand hygiene (HH) compliance, environmental contamination, and extensive use of broad-spectrum antibiotics in newborns. To address this, a three-pronged intervention-HH promotion via hand rubbing, sink trap replacement, and restricted antibiotic use-was implemented.Methods We conducted a prospective post-intervention study. HH compliance was assessed in February 2023, before the intervention. From July to September 2023, HH compliance, CPE carriage in parturients and newborns, neonatal infections, environmental contamination, and antibiotic use were evaluated post-intervention. The impact on asymptomatic CPE carriage in parturients and newborns, neonatal CPE infections, and environmental contamination was assessed by comparing post-intervention results with pre-intervention data from 2022.Results HH compliance improved significantly (2.9% vs. 70.6%; p < 0.001), and neonatal antibiotic use declined (74.9% vs. 15.3%, p < 0.001). ESBLE carriage rates decreased among parturients, (15.8% vs. 40.1%; p < 0.001), and among newborns (0.5% vs. 5.4%; p = 0.007). CPE carriage rates decreased among parturients (4.6% vs. 1.0%; p = 0.059). No neonatal CPE infections occurred post-intervention. Despite sink trap replacement, contamination persisted. Genomic analysis of CPE strains suggested reduced parturient-to-parturient transmission and CPE acquisition from the environment.Conclusions Our findings suggest a reduction in the risk of CPE acquisition among parturients and neonates after implementing the intervention. Our findings strongly support the need for sustained HCW training, ensuring the availability of hand rub solutions, and campaigns promoting proper HH practices and rational antibiotic use to prevent nosocomial infections caused by hypervirulent CPE clones circulating in Gabon.

Background: Occupational exposure to blood and body fluids (BBFE) remains a significant risk for healthcare workers (HCWs), yet underreporting persists despite the implementation of institutional policies. This study aimed to compare BBFE prevalence, reporting practices, and HCWs' knowledge, perceptions, attitudes, and behaviors, and identify predictors of BBFE and failure to report incidents over a ten-year period at a tertiary medical center.

Methods: Two cross-sectional surveys were conducted at the American University of Beirut Medical Center (AUBMC) in 2013-2014 and 2023-2024. In 2013-2014, all participants completed paper-based questionnaires, whereas in 2023-2024, medical students, residents, and nurses completed online surveys, and housekeeping/laundry staff completed paper-based surveys. Descriptive comparisons and logistic regression were performed to assess BBFE prevalence, reporting behaviors, and predictors of exposure and reporting using logistic regression.

Results: A total of 299 HCWs participated (157 in 2013-2014; 142 in 2023-2024). Overall, 31.3% reported experiencing a BBFE, with housekeeping/laundry staff (48.6%) and nurses (44.6%) showing the highest prevalence (p < 0.001). The overall reporting rate was 82.6%, exceeding regional and global estimates. Lower attitude/behavior scores independently predicted BBFE occurrence (aOR = 0.665, p = 0.013), while lower perception scores predicted failure to report (aOR = 0.206, p < 0.001). No significant differences were observed in BBFE or reporting rates between cohorts, though knowledge and perception scores were higher in the 2023-2024 cohort.

Conclusion: Despite modest improvements in awareness and perception, BBFE remains a persistent occupational hazard across professional categories. High reporting rates reflect institutional progress, yet behavioral and cultural barriers to full compliance persist. Sustained efforts targeting safety culture, reporting accessibility, and psychosocial barriers are needed to achieve lasting reductions in occupational exposure.

Background: There is an urgent need to optimize antimicrobial prescribing in the hospitalized setting, driven by the complexity of infection types, the high risk of antimicrobial resistance, and the potentially severe clinical consequences. However, the key determinants of physician prescribing behavior remain inconsistent, and the evidence regarding the effectiveness of interventions is still subject to debate.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science up to July 5, 2025, to identify evidence on determinants of and interventions for antibiotic prescribing practices in the inpatient environment. Through a single-arm 3-level model, we quantified the influence of these determinants on prescription behavior. We employed a random-effects model to analyze the effect of interventions on prescription outcomes. Interventions were categorized by behavior change techniques, with the effectiveness rate calculated.

Results: A total of 59 studies were included, comprising 20 qualitative and 39 quantitative investigations. The findings indicated that 77.6%, 71.4%, and 64.2% of participants acknowledged the influence of environmental, prescriber, and patient factors, respectively. Interventions were associated with a 21% (RR = 1.21, 95% CI: 1.03-1.42) improvement in rational antimicrobial prescribing. Analysis of behavior change techniques identified "behavior feedback" as the most effective strategy (effectiveness rate = 3.5).

Conclusion: Our study shows that hospitalized physicians' antibiotic prescribing is shaped by multiple determinants, with contextual and environmental factors most frequently studied. Interventions generally improved prescribing in hospital settings. However, evidence from resource-limited settings remains sparse; rigorous, context-specific studies are needed to optimize prescribing in low- and middle-income countries.