Antimicrobial Resistance and Infection Control最新文献

Background: We investigated a KPC-2-producing Enterobacterales (KPC-2 CPE) outbreak in a Korean hospital from July to September 2019, which subsided following enhanced surveillance and strict infection control. The study aimed to elucidate transmission dynamics using epidemiological and genomic methods.

Methods: The study period covered the outbreak and a 9-month post-outbreak observation. Investigations included a matched case-control study and whole-genome sequencing (WGS) of isolates, including long-read sequencing for two isolates. Single nucleotide polymorphism (SNP) analysis (≤ 6 SNPs for clonality, ≤ 15 for relatedness) was used to construct transmission networks.

Results: A total of 42 KPC-2 CPE cases were identified: 34 Klebsiella pneumoniae, 4 Escherichia coli, 1 Enterobacter asburiae, and 3 cases co-colonized with K. pneumoniae and E. coli. Among these, 33 were hospital-linked and 9 were imported. Retrospective tracing indicated that covert transmission began a month before the outbreak, and 13 hospital wards were identified as potential acquisition sites. Genomic analysis revealed all but one K. pneumoniae belonged to ST307, cgMLST 439, which grouped into three clades. Clade 1 was linked to a specific hospital ward, supported by the case-control study (adjusted odds ratio, 3.63; 95% confidence interval, 1.36-9.63); Clade 2 was spread between wards via a haemodialysis unit and shared healthcare personnel. Imported cases had the same clones as early hospital-linked cases, suggesting undetected introduction before enhanced surveillance. Additionally, an IncX3 plasmid carrying bla_KPC-2 was found in both K. pneumoniae and E. coli, indicating horizontal gene transfer.

Conclusion: This study demonstrates that clonal spread of KPC-2 CPE can remain undetected without enhanced active surveillance, underscoring the need for early detection. Genomic analysis clarified ST307 K. pneumoniae transmission through unrecognised epidemiological links and horizontal bla_KPC-2 transfer to E. coli.

Background: Hospital-onset bacteraemia and fungaemia (HOB) has emerged as a novel surveillance metric in recent years and a prime target for automation of surveillance of healthcare-associated infections. However, real-life HOB data from European institutions remain scarce. This study explores the epidemiology of HOB at a German university hospital and describes characteristics of HOB cases.

Methods: A retrospective single-centre study was conducted by applying an extended version of the Providing a Roadmap for Infection Surveillance in Europe (PRAISE) automated HOB algorithm to data from the electronic health records of all in-hospital patients admitted to Charité university hospital between 2018 and 2022. HOB rates per 1,000 patient days were calculated for different groups of wards. Furthermore, the distribution of microorganisms, share of antimicrobial resistance, and source of possible secondary HOB (defined as HOB-causing pathogens detected in relevant clinical samples other than blood) were analysed. Additionally, patient characteristics and outcomes were investigated.

Results: A total of 3,648,254 patient days and 7,256 HOB with 8,357 microorganisms were included. The pooled HOB rate was 6.0 per 1,000 patient days in intensive care units, and between 0.9 and 2.0 in the various groups of non-intensive care units. Around 34.5% (n = 2,505) of HOB were deemed potentially secondary, with respiratory tract (37.6%, n = 943) being the most common source. A total of 1,106 of 8,357 (13.2%) microorganisms were classified as multidrug-resistant, including 60.5% (23 of 38) of Acinetobacter baumannii with resistance to carbapenems. Case fatality within 14 days of HOB onset was 16.2% (990 of 6,093 patients).

Conclusions: Analysis of electronic health record data provides important insights into the epidemiology and characteristics of HOB cases. Substantial rates of antimicrobial resistance and case fatality underscore the relevance of HOB as an IPC metric. Results from this study may inform refinement of algorithms for automated HOB surveillance.

Background: Central-line-associated bloodstream infections (CLABSI) impart substantial morbidity and mortality worldwide Neonates and other pediatric patients with chronic conditions that require long-term central access are at the highest risk and often develop CLABSIs despite high compliance with evidence-based prevention bundles. One potential adjunctive prevention strategy is the use of antimicrobial locks; however, data concerning the effectiveness of locks in preventing pediatric CLABSIs are mixed.

Methods: We conducted a systematic review of randomized controlled trials and, separately, observational studies of pediatric patients who received antimicrobial locks for primary and secondary CLABSI prevention since antimicrobial locks were described in 1990. We conducted meta-analyses for both study designs to evaluate the effectiveness of antimicrobial locks in reducing CLABSIs.

Results: Thirty-five studies were included in the systematic review; twenty-six studies were included in the meta-analyses. Among the 11 randomized controlled trials eligible for inclusion in the meta-analysis, there was a 48% lower rate of CLABSIs in those with antimicrobial locks than in those with standard locks (pooled IRR: 0.52 (p = 0.016, [95% CI 0.317, 0.86], I²: 52%). This reduction in CLABSIs varied among patient populations and lock types. Among 15 observational studies eligible for inclusion in the meta-analysis, there was a 70% reduction in the rate of CLABSIs with antimicrobial locks compared with standard locks (pooled IRR: 0.31, p = 0.001, [95% CI 0.17, 0.57], I²: 92%); however, this reduction was not significant among all subgroups or between lock types. Significant bias was noted in the observational studies.

Conclusions: This review highlights the need for well-designed studies to determine the clinical effectiveness of antimicrobial locks for primary and secondary CLABSI prevention in specific pediatric populations and to determine whether there is differential impact by lock type.

Background: Surgical site infections (SSIs) account for up to 20% of healthcare-associated infections and significantly increase morbidity, mortality, and healthcare costs. Preoperative decolonization strategies-targeting nasal and/or skin colonization-are variably recommended across surgical disciplines. While benefits have been reported in elective arthroplasty, their efficacy in trauma surgery remains unclear.

Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for systematic reviews and Meta-Analyses. The study protocol was registered in PROSPERO (CRD420250642382). MEDLINE, Cochrane Library, ClinicalTrials.gov, and Google Deep Research were searched up to 26 February 2025. Eligible studies reported on patients undergoing elective lower extremity joint arthroplasty or fracture surgery and compared nasal, skin, or combined decolonization protocols to standard care. Primary outcome was the incidence of SSIs. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.

Results: Nineteen studies (n = 64,796 patients) met inclusion criteria. Of those, five were RCTs and 14 were observational, retrospective or pre-post studies. 17 focused on elective arthroplasty; two addressed fracture surgery. Among orthopedic patients, nasal decolonization reduced SSIs with an OR of 0.65 (95% CI, 0.34-1.22), skin decolonization with an OR of 0.43 (95% CI, 0.29-0.64), and combined strategies with an OR of 0.48 (95% CI, 0.33-0.69). Trauma surgery data were limited and heterogeneous (I² = 81%); the pooled OR for combined decolonization was 0.59 (95% CI, 0.08-4.32), but with conflicting individual study results.

Conclusion: Nasal and skin decolonization protocols seem to reduce the incidence of SSIs in elective hip and knee arthroplasty. Thereby, skin, nasal and combined decolonization strategies may be used. However, current evidence in fracture surgery remains insufficient and inconsistent. High-quality randomized trials are urgently needed to evaluate decolonization efficacy in lower extremity trauma surgery.

Background: Post-ERCP biliary tract infection (PEBTI) is a critical complication influenced by multiple factors, yet the role of preoperative antibiotic prophylaxis remains unclear. This study investigated the relationship between intestinal colonization and PEBTI, and whether antibiotic prophylaxis mediates this association.

Methods: A multi-center, prospective cohort of 2110 patients undergoing ERCP for biliary obstruction was analyzed. Preoperative rectal swabs screened for common intestinal colonizers. Directed acyclic graphs (DAGs), Cox regression models, inverse probability of treatment weighting (IPTW), and mediation analysis were employed to assess confounders, effect estimates, and mechanistic pathways.

Results: PEBTI occurred in 100 (4.7%) enrolled patients, and intestinal colonization was detected in 343 (16.2%), predominantly ESBL-producing Escherichia coli (73.2%). Initial unadjusted analysis showed a significant association between intestinal colonization and PEBTI (HR = 2.18, 95% CI 1.41-3.36). However, after adjusting for DAG-suggested confounders, the association attenuated to non-significance (adjusted HR = 1.53, 95% CI 0.89-2.66). Mediation analysis revealed no significant indirect effect via antibiotic prophylaxis (HR = 0.93, P = 0.132), accounting for 21% of the observed attenuation. Sensitivity analyses by trimmed-IPTW and stratified center confirmed robustness of findings.

Conclusions: Our analysis did not find significant evidence that intestinal colonization independently increases PEBTI risk. The observed associations appear to be largely confounded by patient vulnerability factors, with no significant evidence of mediation by antibiotic prophylaxis. These findings suggest prioritizing host-directed prevention strategies over pathogen-directed interventions in clinical practice.

Carbapenem-resistant Acinetobacter baumannii (CRAB) are rare in France and are usually reported in intensive care units (ICU). In 2021/2022, an unexpected increase in the incidence of CRAB isolates co-producing OXA-23 and NDM carbapenemases (OXA-23/NDM-CRAB) in several hospitals in the north of Paris prompted a common retrospective investigation. These strains were extremely resistant to both first- and second-line antibiotics, resulting in difficult-to-treat infections. We collected all cases of OXA-23/NDM-CRABs infection/colonisation between January 2020 and December 2022 in five northern Paris hospitals. Demographic and clinical data were collected for each patient. Isolates were sequenced using Illumina and representative isolates were sequenced using Nanopore. An OXA-23/NDM-CRAB was detected in 42 patients (mean age 61 years, M/F: 1.3), 58% of whom were hospitalised in a medical ward and 42% in an ICU, within three hospitals. Of these patients, 26% (11/42) were infected with CRAB, while 74% (31/42) were colonised. Two clonal strains spread over one year: ST^Ox231^/Pas1 in hospital 1 (n = 12) and hospital 3 (n = 13) differing by 0-16 SNPs and ST^Ox1632^/Pas600 in hospital 2 (n = 13) differing by 0-17 SNPs. WGS and epidemiological investigation identified the likely index patient for hospitals 1 and 3 outbreaks as a patient repatriated from hospitalisation in Cape Verde. This patient was not screened for multidrug resistant bacteria carriage during hospitalisation in hospital 1 and was detected positive 5 days after admission to the ICU in hospital 3. All outbreaks were stopped after infection control teams' intervention. This is the first description of OXA-23/NDM-CRAB outbreaks in metropolitan France. The simultaneous dissemination of two clonal OXA-23/NDM-CRAB strains in Parisian hospitals is unusual, particularly in non-ICU settings. Medical and nursing staffs must be sensitized to the importance of screening patients returning from abroad, including for CRAB, to prevent future outbreaks.

Background: Vancomycin-resistant Enterococcus (VRE) and carbapenemase-producing Enterobacterales (CPE) cause outbreaks in hospitals and the community. There is limited literature on the clearance time of VRE and CPE colonization. We reported the natural clearance time of VRE and CPE among residents of the Residential Care Home for the Elderly (RCHE) and the factors associated with prolonged colonization.

Methods: This retrospective study reviewed cases of VRE and CPE colonization reported to the Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region from 1 January, 2012 to 31 December, 2024. We reviewed the demographic characteristics and outcomes of the VRE and CPE cases when they were cleared of the bacteria or died during the follow-up period, up to 31 December 2024. Clearance of VRE and CPE was defined as negative culture results for at least two and three consecutive specimens collected at least 48 h apart at the RCHE respectively. We compared the clearance time of VRE and CPE using the Kaplan-Meier method and determined the factors influencing the duration of clearance by univariate and multiple Cox regression.

Results: A total of 3626 VRE cases and 4434 CPE cases were followed up. CPE cases tended to be older and had a higher proportion of females compared to VRE cases. There was no statistical difference in the types of homes between the two groups. The mortality rate of VRE (25.7%) was similar to that of CPE (25.1%). It was found that the carriage duration of CPE was significantly longer than that of VRE, as tested by the log-rank test (p < 0.01). Half of the VRE and CPE cases will clear the bacteria by 85 days and 131 days, respectively. The carriage duration for the majority (90%) of VRE and CPE cases was 400 and 818 days, respectively. After adjusting for all associated factors, a longer length of stay for readmission to hospitals and lower occupancy rates in RCHEs were significantly associated with prolonged carriage status.

Conclusions: The natural clearance duration of VRE and CPE provides useful information to improve guidelines of screening of previously colonized patients, and duration of contact precautions to prevent transmission of these resistant organisms among the vulnerable groups.

Background: Hand hygiene compliance among healthcare workers (HCWs) remains a critical challenge in infection prevention. Traditional audit methods have limitations, including observation bias and Hawthorne effect. This study used eye-tracking technology to as an objective behavioural tool to assess and compare of HCWs compliance with infection control measures in two teaching hospital in Malaysia.

Methods: A prospective observational study was conducted across two hospitals (Hospital I and II). Participants performed standardized patient care scenarios incorporating the "5 Moments for Hand Hygiene" technique while wearing eye-tracking glasses to monitor the compliance of HCWs. Handrub duration, scrub-the-hub duration and gaze behavior including dwell time, fixation time and saccade on selected areas of interest were recorded.

Results: 75 HCWs (doctors and nurses) were recruited. Hospital I showed higher overall compliance (56.9%) than Hospital II (42.6%). Lowest adherence occurred at the moment "before patient contact". The average handrub duration of 13.63 s fell substantially below the WHO-recommended standard. Similarly, scrub-the-hub durations of 7.6 s in Hospital I and 4.13 s in Hospital II failed to meet the 10-15 s guideline, potentially compromising the effectiveness of these critical infection control measures. Medical station alcohol-based handrub (ABHR) dispensers received more visual attention than bedside ABHR, but did not consistently translate to compliance. Scrub-the-hub required the longest visual engagement, indicating procedural complexity.

Conclusions: The use of eye-tracking technology in hand hygiene audits identified critical gaps in both compliance and technique quality. This study suggests the need for targeted training on proper durations, optimized ABHR placement, and technology-enhanced monitoring. This approach provides behavioral insights that could improve hand hygiene interventions and reduce infection risks.

Background: Antimicrobial resistance (AMR) poses a growing threat to global public health and is a key concern for infection control teams in hospitals. However, AMR surveillance is time-consuming and limited in most countries, resulting in incomplete findings. In high-income countries, infection control teams ensure the contact tracing of every patient carrying an emerging extensively drug-resistant bacterium which is very time-consuming. Wastewater surveillance (WWS) has been proposed as an alternative approach for the surveillance of infectious diseases. This study aims to test the feasibility of AMR WWS under real-world conditions in hospital. It investigates the dynamics of endemic (bla_CTX-M) and emerging AMR genes (bla_OXA-48, bla_NDM, bla_KPC and vanA) in wastewater from two hospital buildings where patients with contrasting risk for carrying resistant bacteria were cared for and compares results with clinical data.

Methods: The sampling programmes were adapted according to the sampling sites and patient flow for each hospital building. Genes were quantified in the effluent using qPCR and dPCR. Cultivable carbapenemase-producing Gram-negative bacteria were characterised using MALDI-TOF MS and PCR.

Results: The feasibility of AMR monitoring in wastewater in real hospital conditions was demonstrated by dPCR and qPCR, which produced correlated results. The presence of peaks and the low load of the vanA and bla_NDM genes in wastewater (compared to bla_CTX-M) were consistent with their known emerging status, as indicated by national and local clinical data. However, the high concentration of bla_OXA-48 and bla_KPC in wastewater was unexpected because it did not reflect the known clinical involvement of these emerging resistances, particularly in the case of bla_KPC. Bacterial culture also revealed discrepancies between the species isolated in wastewater and those isolated in patients in the hospital, with a majority of Citrobacter spp. carrying bla_KPC and bla_OXA-48 in wastewater, whereas Escherichia coli and bla_OXA-48 dominated in patients. Quantifying carbapenemase genes in wastewater was able to differentiate between buildings housing patients contrasting risks of emerging AMR.

Conclusion: This study shows the WWS feasibility in real hospital conditions and preliminary findings regarding patient populations but identified obstacles that need to be overcome prior to use WWS for routine surveillance in an infection control hospital context.

In low- and middle-income countries (LMICs), gram-negative bacteria cause over half of intensive care unit (ICU) infections, with up to 50% mortality associated with multidrug-resistant (MDR) strains. Hospital sink drains are increasingly recognized as reservoirs for MDR organisms and are well-documented sources for nosocomial infections, yet effective and sustainable decontamination strategies-particularly for resource-limited facilities-remain elusive. This narrative review synthesizes evidence on sinks as pathogen reservoirs, evaluates limitations of existing remediation approaches, presents pilot data from our tertiary hospital in Botswana, and outlines research priorities for LMICs. We identify five dimensions that complicate control of gram-negative pathogens in sink drains: (1) poor visibility of drain interiors limiting awareness of biofilm growth extent; (2) nutrient inputs from non-hand-hygiene uses that can encourage microbial growth; (3) design barriers to cleaning and disinfection; (4) inconsistent pathogen detection methods; and (5) uncertainty about optimal regimens for cleaning and disinfection. We share data from pilot studies assessing treatment interventions for neonatal ICU sinks with high baseline contamination-including periodic addition of boiling water, sodium hypochlorite, and a commercial probiotic cleaner. Carbapenem-resistant Enterobacterales growth was suppressed by treatment with boiling water and sodium hypochlorite, but the highest prevalence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and Acinetobacter spp. was observed for sinks treated with sodium hypochlorite; probiotic cleaning was associated with the lowest ESBL-E prevalence. Findings from our literature review and pilot studies collectively support the need for a framework for hospital sink-drain stewardship that shifts away from routine chemical disinfectants and toward effective thermal or microbial strategies (e.g., probiotics, bacteriophages) that could reduce pathogen burden without selecting for more virulent or drug-resistant strains. Future work should define concentrations/regimens, safety precautions, and pathogen monitoring strategies for these approaches and embed them within sink-drain stewardship frameworks suitable to LMIC settings.