Antimicrobial Resistance and Infection Control最新文献

Background: Improving healthcare-associated infections, fighting antibiotic resistance, and controlling outbreaks are all made possible by infection prevention and control, a significant global public health concern, particularly in Africa. To pinpoint areas that needed improvement, this study aimed to assess Infection Prevention and Control in Somali Healthcare Facilities using the WHO Infection Prevention and Control Assessment Framework.

Methods: 307 healthcare facilities in Somalia, or 30% of the 1,023 facilities listed by the Federal Ministry of Health, had their IPC practices evaluated by cross-sectional research in October and November 2022. Descriptive statistics were used in the study to examine data categorized by facility type, ownership, and location. The facilities were divided into four IPC levels-inadequate, basic, intermediate, and advanced using the World Health Organization's Infection Prevention and Control Assessment Framework (IPCAF).

Results: The mean overall IPCAF score was 136/800, which indicates inadequate IPC practices. 85% of the institutions were public hospitals, while the majority (68.83%) were primary healthcare centers. CC1 (IPC Program) and CC 5 (Multi-modal Strategies) got the lowest values out of the eight IPC core components, suggesting major improvement. while CC 7 (Workload, Staffing, and Bed Occupancy) and CC 8 (Environments, Materials, and Equipment) had the greatest results. Inadequate IPCAFs were found in all States. The results highlight the urgent need for national and regional policies to give IPC programs and infrastructure funding the Highest priority, mainly in low-performing areas and primary healthcare settings. Regional differences highlight the need for specialized approaches to increase IPC capacity in every state.

Conclusions: The initial IPCAF assessment of Somali healthcare facilities reveals inadequate IPC levels, highlighting the need for urgent intervention to improve practices, ensure patient safety, and support the development of a national IPC policy in Somalia.

Background: The study aimed to assess the effects of vaginal disinfection and sterile draping on the composition and dynamics of the vaginal microbiota during vaginal surgery.

Methods: A prospective cohort study was conducted involving post-menopausal patients undergoing vaginal urogynecological surgery. The vaginal microbiota was assessed by partial 16 S rRNA gene sequencing at three time points: before disinfection (V1); immediately after disinfection and sterile draping (V2); and one-hour post-disinfection (V3).

Findings: In a cohort of 54 postmenopausal women (median age: 69.2 ± 7.6 years), with a mean operative time of 92.89 ± 45.92 min, native tissue prolapse repair was the most common urogynecological vaginal procedure performed (n = 47, 87%). The vaginal microbiota diversity was significantly increased after disinfection associated with reduced abundance of Lactobacillus and Bifidobacterium and increased Pseudomonas (p < 0.0001). Community state type (CST) I prevalence decreased notably from 20% at V1 to 6% at V3, primarily due to the disappearance of CST I-A, while CST IV prevalence rose from 31 to 44%, which was mainly secondary to an increase in CST IV-C (from 20 to 33%).

Conclusions: These findings highlight the impact of povidone-iodine on vaginal microbiota composition during vaginal urogynecological surgery. Disinfection significantly increased vaginal bacterial diversity and reducing Lactobacillus abundance. This observation requires further exploration in the context of development of optimized disinfection protocols aimed at preserving vaginal health during and after surgery.

Background: Hemodialysis-associated bloodstream infections (BSIs) represent a significant burden for patients. Understanding the trends in BSIs among hemodialysis patients is crucial for informing strategies to reduce their incidence and improve patient outcomes. This study aimed to evaluate secular trends, identify causative organisms, assess resistance patterns, and determine the sources of hemodialysis-associated BSIs at Geneva University Hospitals, where Staphylococcus aureus screening and decolonization of hemodialysis patients have been implemented since the year 2000.

Methods: A longitudinal cohort study was conducted using data from 2006 to 23. We included all patients receiving maintenance hemodialysis treatment at our institution. A hemodialysis-associated BSI was defined as BSI occurring during active hemodialysis treatment and diagnosed either during hospital admission or in outpatient hemodialysis unit. Outcomes included incidence rates of hemodialysis-associated BSIs, trends in causative pathogens, sources, and resistant organisms. Poisson regression was used to model trends over time of incidence rate ratios (IRR).

Results: A total of 313 true BSI episodes were identified in 218 hemodialysis patients over 11,413 patient-hemodialysis months. The overall BSI incidence rate was 2.7 episodes per 100 patient-hemodialysis-months, with a consistent decrease over time. Compared to 2006-08, hemodialysis-associated BSI rates decreased by 16% in 2009-11 (IRR 0.84, 95% confidence interval [CI] 0.60-1.18), and by a maximum of 44% in 2021-23 (IRR 0.56, 95% CI 0.36-0.83). The decreasing trend was mainly due to reduced S. aureus BSIs, while Enterobacterales BSIs rates remained stable. Catheter-related BSIs accounted for 41.5% of infections (130/313), with marked reduction following 2014. BSIs caused by resistant bacteria were rare, with decreasing trends of methicillin-resistant S. aureus.

Conclusions: Hemodialysis-associated BSI rates significantly declined, driven largely by reductions in S. aureus BSIs and catheter-related infections. No replacement by Gram-negative BSI was observed. Prevention of hemodialysis-associated BSI is key for reducing infection burden among hemodialysis patients.

Background: A series of transmission of Pseudomonas aeruginosa ST111 bla_VIM-2, previously undetected by standard surveillance, was discovered in a tertiary care hospital in Northern Germany through molecular genetic monitoring. Hence, environmental sampling was initiated to find the source of infection.

Methods: First, routine epidemiological data ruled out patient-to-patient transmission and two initial diagnoses were assessed as externally acquired. After the discovery of the highly related cluster by whole genome sequencing, a more detailed epidemiological analysis was carried out, including previous hospitalizations. An environmental investigation was initiated due to a possible connection of transmissions with an intensive care unit.

Results: Between 2018 and 2023 16 clinical isolates of Pseudomonas aeruginosa ST111 bla_VIM-2 were identified of which 12 isolates belonged to ST111 carrying an In59-like integron. Routine whole-genome sequencing of carbapenem resistant P. aeruginosa identified a highly related cluster (maximum of three allelic differences) of high-risk ST111 isolates in ICU patients over five years, confirming sink-to-patient transmission associated to sink drains in two ICU rooms. In initial routine epidemiological categorization of these highly related isolates four isolates were categorized as possible nosocomial acquisition without direct epidemiological link to other patients, whereas two isolates were categorized as 'externally acquired'.

Conclusions: This finding highlights the ability of high-risk clone ST111 to persist in hospital environments and emphasizes the importance of integrating molecular surveillance with routine epidemiology to uncover hidden transmissions. In this case, the frequent detection of the ST111 high-risk clone led to targeted environmental sampling, uncovering a prolonged outbreak that had gone unnoticed by conventional surveillance. The clone was eliminated from the ward during a reconstruction project.

Background: Infections caused by KPC-producing Klebsiella pneumoniae (KPC-KP) represent a persistent public health challenge. This prospective study examines ten-year trends, clinical features, and genomic epidemiology of hospital-onset (HOI) and non-hospital-onset (non-HOI, including healthcare-associated [HcAI] and community-acquired [CA]) KPC-KP infections following a 2012 outbreak. We evaluated the impacts of a 2014 antimicrobial stewardship program (ASP) and COVID-19-related infection prevention and control (IPC) measures, with emphasis on hospital-to-community dissemination.

Methods: We analysed a prospective, longitudinal cohort of patients (2012-2022) in a tertiary referral hospital. Interrupted time series and ARIMA models assessed ASP and IPC impacts on incidence density (ID). Cross-correlation analysis explored temporal associations between HOI and non-HOI trends. Whole-genome sequencing and PERMANOVA evaluated the genomic structure of ST512/KPC-3 isolates. Multivariable regression analysed the association between infection type and clinical outcomes.

Results: Among 467 patients, 33.2% had non-HOI (ID 0.53/1,000 admissions/month) and 66.8% HOI (ID 0.30, p = 0.39). Urinary tract infections predominated in non-HOI (52.9%), while bloodstream and respiratory infections were more common in HOI. Incidence density of HOI and non-HOI infections declined significantly following ASP implementation, with a 4-month lag suggesting sequential transmission dynamics. These reductions were maintained during the pandemic. Genomic data confirmed ST512/KPC-3 dominance and hospital-to-community spread, with temporal factors-rather than acquisition type-explaining genetic variation. Adjusted analyses showed similar 30-day mortality and treatment responses across HOI and non-HOI.

Conclusions: ASP and COVID-19 IPC measures contributed to maintaining low KPC-KP incidence. Genomic evidence underscores the role of temporal dynamics and clonal expansion in ST512/KPC-3 dissemination. Non-HOI infections are clinically significant and require targeted, system-wide surveillance and control strategies.

Background: Bacterial contamination of the Neonatal Intensive Care Unit (NICU) poses a significant risk for cross-transmission, potentially leading to infections in vulnerable neonates. Key pathogens involved in NICU-acquired infections such as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. are collectively known as ESKAPE pathogens. They are known for their antibiotic resistance, posing challenges for treatment. This study aimed to investigate the prevalence and antibiotic resistance profiles of ESKAPE pathogens in the NICU at the Women and Newborn Hospital (WNH).

Methods: A total of 344 Samples were collected from different medical equipment, inanimate, animate surfaces and indoor air using standard microbiological methods. Antimicrobial susceptibility testing was then performed using the Kirby-Bauer method.

Results: Bacterial contamination rate was 323/344 (93.9%), with 83/323 (25.7%) of samples containing ESKAPE pathogens. Antimicrobial susceptibility varied among ESKAPE pathogens with a total of 75/83 (90%) of the ESKAPE isolates being multi-drug resistant (MDR). Gram-negative isolates exhibited high resistance to β-lactams, carbapenems, and fluoroquinolones, with susceptibility to aminoglycosides, while Gram-positive isolates showed resistance to β-lactams and macrolides but remained largely susceptible to linezolid, clindamycin, and vancomycin.

Conclusion: There was a high level of contamination with MDR ESKAPE pathogens in the NICU. This highlights the need for improved infection prevention and control measures as well as antimicrobial stewardship to prevent further resistance.

Background: Pseudomonas aeruginosa is frequently responsible for hospital-acquired infections. It may be isolated in healthcare environment where it can survive. Between January 2018 and June 2024, a growing number of VIM-producing Pseudomonas aeruginosa (PA-VIM) were isolated from patients hospitalized in our surgical intensive care unit (SICU). The aim of this study was to investigate SICU long-term PA-VIM outbreaks involving a persistent environmental reservoir.

Methods: Investigations included an active case finding, a matched case-control study to identify factors associated with PA-VIM acquisition, the identification of environmental reservoirs, a whole-genome sequencing analysis of patient and environmental strains, and the implementation of control measures.

Results: During these outbreaks, 32 patients were colonized or identified with at least one PA-VIM positive clinical sample during their SICU stay. Factors significantly associated with the PA-VIM acquisition in the conditional univariate analysis included exposure to antibiotics (e.g., carbapenem) and antifungals, and the use of a nasogastric tube and enteral nutrition. Among 342 environmental samples collected in the SICU (including sink drains, syringes and glasses containing syringes used for enteral nutrition), 67 (19.6%) were found positive for PA-VIM. Core-genome Multi-Locus Sequence Typing analysis identified 2 major clones, each including patients and environmental strains.

Conclusions: These long-lasting outbreaks of PA-VIM were associated to a persistent environmental contamination of sink drains. All the strategies aiming at eradicating PA-VIM reservoirs (disinfection, descaling, or replacement of sink drains) failed or only showed a temporary effect.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening by polymerase chain reaction (PCR) is a rapid diagnostic tool with a high negative predictive value for pneumonia caused by MRSA. MRSA remains an important emerging pathogen in China and at present, there is little published data on the effect of rapid MRSA test results on antibiotic utilization for pneumonia.

Methods: A total of 300 inpatients who met the criteria of pneumonia in a tertiary general hospital were randomly assigned to a notification group (NG, n = 150) or a control group (CG, n = 150). Nasal swabs were collected and tested with the Xpert SA Nasal Complete Test (Cepheid, Sunnyvale, CA) to determine MRSA colonization status. Attending clinicians were immediately informed of test results for patients in NG while results were not released to an attending physician in CG. Subsequently, relevant medical records were collected and analyzed.

Results: Patients in the NG received a shorter duration of antimicrobial therapy compared to the CG (5.66 vs. 7.87 days, P < 0.001). Fewer renal injuries (1.33% vs. 8%; P = 0.015), and lower costs of antimicrobial agents ($621.78 vs. $881.70; P = 0.013) were observed in NG patients compared to those in the CG. Further, this intervention did not increase the in-hospital mortality (12.67% vs. 16.67%, P = 0.327).

Conclusions: Rapid and actionable MRSA PCR screening using nasal swabs helped reduce unnecessary anti-MRSA treatment. Early management of antimicrobials not only reduced the duration of anti-MRSA drug exposure but also antimicrobial-related adverse events.