Antimicrobial Resistance and Infection Control最新文献

Background: Hand hygiene is vital for infection prevention, yet compliance among medical staff remains low. This study assessed whether training medical students using a multimodal educational intervention, including their roles as 'hand hygiene covert observers' (HHCOs) in their pre-internship phase, could improve hand hygiene compliance during their internship.

Methods: A retrospective study was conducted at Queen Mary Hospital, Hong Kong, comparing two consecutive cohorts of medical interns: cohort A (historical control, starting July 1, 2024) and cohort B (intervention group, starting July 1, 2025). Cohort B participated in a half-day training workshop and covertly observed hand hygiene compliance as HHCOs during a 19-day pre-internship clinical attachment in June 2025. Hand hygiene compliance observed by HHCOs was compared with infection control nurses (ICNs) observations collected concurrently. Additionally, hand hygiene compliance among cohorts A and B was monitored by ICNs using World Health Organization audit tools. Baseline knowledge and attitudes of cohort B regarding hand hygiene were assessed by questionnaire.

Results: Seventy-four pre-interns in cohort B completed the baseline questionnaire; 38 (51.4%) identified alcohol-based hand rub (ABHR) as the most effective hand hygiene method, while 36 (48.6%) selected soap and water. Positive attitudes were evident, with 54 (73.0%) strongly agreeing on hand hygiene's role in preventing healthcare-associated infections and 52 (70.3%) strongly agreeing that compliance impacts patient safety. During the pre-internship clinical attachment, hand hygiene compliance observed by HHCOs among cohort A was significantly higher than that observed by ICNs (96%, 682/713 vs. 59%, 144/244; p < 0.001). Comparison of ICN-observed compliance showed a non-significant increase for cohort B versus cohort A (66%, 230/348 vs. 58%, 156/267; p = 0.051). However, cohort B demonstrated a significantly higher proportion of hand hygiene episodes using ABHR compared to cohort A (90%, 208/230 vs. 79%, 123/156; p = 0.001).

Conclusions: Engaging pre-interns in a multimodal educational intervention, including their roles as covert observers, did not significantly increase overall hand hygiene compliance compared to historical controls. However, there was a notable rise in ABHR use among the intervention group. This approach may promote awareness and foster a culture of patient safety.

Background: Single use devices (SUDs) are designed for single use. However, in low-income countries, they are often reprocessed and reused. Because these devices are intended for single use, no standardized protocol for reprocessing these devices currently exists. We developed a protocol for reprocessing SUDs in low-income settings and assessed the efficacy of this protocol in eliminating bacterial burden from a subset of used respiratory SUDs.

Methods: Reprocessing of these devices was conducted in accordance with the National IPC reference manual with minor modifications. The surfaces of used SUDs were swabbed for bacterial culture before and after reprocessing. Serial dilutions of the swab samples were inoculated on plate count agar media and incubated. Bacterial burden was determined by colony forming unit (CFU) counts. Bacterial isolates were identified and characterized using standard microbiology techniques, antimicrobial susceptibility testing, and modified carbapenem inactivation method in accordance with Clinical and Laboratory Standards Institute guidelines.

Results: Prior to reprocessing, twenty-seven (77.1%) of 35 devices tested were culture-positive for one or more bacterial species. The average bacterial count before reprocessing ranged from 1.98 × 10⁴ to 1.92 × 10⁵ CFU/cm². Nineteen (54.3%) tested devices were positive for coagulase-negative Staphylococcus, and 19 (54.3%) for Gram-negative organisms: Acinetobacter spp. (n = 7; 36.8%), Klebsiella pneumoniae (n = 6; 31.6%), Pseudomonas aeruginosa (n = 3; 15.8%), Escherichia coli (n = 2; 10.5%), and K. oxytoca (n = 1; 5.3%). Ten (52%) of the Gram-negative organisms were multidrug-resistant. Following reprocessing, no bacterial growth was demonstrated on any of the devices.

Conclusion: The reprocessing protocol employed in this study demonstrated absence of culturable bacteria from used SUDs. However, since the assessment was limited to surface swabbing of a small number of devices collected from a single facility and targeted only selected bacterial pathogens, the presence of other potential pathogens could not be completely ruled out. There is a need to assess the impact of the reprocessing procedure on the structural integrity and functionality of these devices. If SUDs are being reused, the efficacy of the decontamination method should be ascertained to mitigate the risk of transmission of pathogens between patients.

Background: Audit and feedback (A&F) of performance is a common strategy to improve antibiotic prescribing, yet it is variably successful. Little is known about the impact of social relationships on the implementation of A&F interventions in antibiotic stewardship. Our objective was to identify how social context influences primary care clinicians' perceptions of A&F received as part of a stewardship intervention.

Methods: We conducted semi-structured interviews with primary care clinicians who participated in a stewardship intervention in the Eastern United States. Interviews were conducted in the year following the intervention and respondents were purposively sampled by their performance: (1) sustained high performance, (2) improved performance, and (3) no improvement. Snowball sampling was used to deepen our understanding of practice context. Interviews were analyzed using the framework method.

Results: Interviews were conducted with 32 clinicians from 15 practices. Two clinicians were recruited via snowball. Thirty respondents were exposed to the intervention (of 183 clinicians in the intervention). Of these 30 respondents, 13 sustained high performance, 7 improved, and 10 did not improve. The content of responses by group varied in descriptions of the influence of social relationships on clinician understanding of feedback. Three relationships were identified as important: 1) with the health system, 2) with the practice, and 3) with patients. Clinicians with consistently high or improved performance described being understanding of and responsive to the demands of the health system and having a unified approach to judicious prescribing in their practice. They also expressed confidence in navigating patient demand for antibiotics. Clinicians whose performance did not improve were either annoyed by, anxious about, or dismissive of the health system's expectations, had low levels of interactions with colleagues in their practice surrounding antibiotics and prescribing norms at the practice that catered to patient expectations for antibiotics. They also reported difficulty in negotiating patient demand for antibiotics.

Conclusions: This study examines clinician reactions to the implementation of a feedback intervention to improve antibiotic prescribing in primary care. Our study demonstrates that clinicians use social relationships to make sense of performance feedback, which may influence the formation and execution of behavioral intentions in response to feedback.

Over a 14-day period, four patients developed sepsis within hours of undergoing endoscopic procedures at a gastroenterology outpatient clinic in Geneva (Switzerland), triggering an urgent epidemiological investigation upon notification to authorities. The case clustering raised concerns about a iatrogenic source, prompting a coordinated public health response. This report outlines the investigation led by the Geneva Health Authorities in collaboration with the medical team, emergency care providers, infection prevention specialists, and the bacteriology laboratory at Geneva University Hospitals. A multidisciplinary team, including an epidemiologist, a pharmacist and an infection prevention specialist, conducted an on-site investigation the day after the outbreak was identified, highlighting a probable extrinsic contamination of propofol by Escherichia coli.

Background: There is a paucity of studies investigating the prevalence of healthcare-associated infections and antimicrobial use at a national level in Kazakhstan. Therefore, this study aims to address this gap by reporting the results of the first nationwide investigation into healthcare-associated infections and antimicrobial use in acute care hospitals.

Methods: A point-prevalence survey was conducted in 26 acute care hospitals across Kazakhstan in June 2023. The methodology strictly adhered to Protocol 5.3 of the European Centre for Disease Prevention and Control. The sample consisted of 8,076 patients.

Results: The overall rate of healthcare-associated infections was 2.4%, with 42.9% occurring in surgical wards. Pneumonia was the most common type of healthcare-associated infection (25.0%), followed by surgical site infections (13.2%), and gastrointestinal tract infections (11.8%). Antimicrobial use was reported in 40.2% of patients, with cephalosporins being the most frequently prescribed pharmacological group (59.7%). Resistance to third-generation cephalosporins was the most commonly observed resistance in microorganisms isolated from HAI cases (47.6%).

Conclusions: Kazakhstan needs to continue implementing infection prevention and control measures and foster the development of antimicrobial stewardship programs tailored to the specific needs of its hospitals.

Background: Traditional typing methods, such as pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and Whole genome sequencing (WGS) have limitations in terms of labor intensity, cost, and delayed results. This study evaluates Fourier transform infrared spectroscopy (FTIR), particularly IR Biotyper^® system (IRBT), as an alternative typing method for E. cloacae complex.

Methods: The research involves retrospective analysis of 72 carbapenem-resistant strains of E. cloacae complex, assessing the IR Biotyper's efficacy, discriminatory power, and concordance with PFGE and WGS. Clustering concordance was evaluated using Simpson's index of diversity (SID) and adjusted Rand index (ARI). Methodology was tested in a real-world outbreak investigation compared with WGS.

Results: The results underscore the benefits of IRBT, which include rapid turnaround times under 3 h, cost-effectiveness, and operational simplicity. IR Biotyper^® had greater discriminatory power (SID: 0.709) than PFGE (SID: 0.694) and nearly the same as WGS (SID: 0.704). The concordance of IRBT with the other two methods was assessed by the adjusted Rand index (ARI), showing values close to unity in both cases, indicating near-perfect agreement. Moreover, the methodology proves effective in real-world outbreak investigations, demonstrating its potential integration into routine clinical microbiology practices.

Conclusions: Our study proposes FTIR as a powerful tool for typing of E. cloacae complex, specifically IR Biotyper^®, offering high discriminatory power and providing results in a shorter time, compared to conventional methods. However, there is urgent need for standardization of cutoff values, which is a fundamental challenge to address in order to facilitate its use and extrapolation of results between laboratories.

Background: Assessing the quality of antimicrobial prescribing is critical to combating antimicrobial resistance. The Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) assists in the assessment of antimicrobial prescribing appropriateness using consensus definitions, extending beyond guidelines compliance. Applying the Hospital NAPS in Portugal can address a knowledge gap.

Objectives: To assess the quality of antibiotic prescribing in a sample of Portuguese hospitals and evaluate Hospital NAPS implementability.

Methods: A point prevalence audit using the translated and culturally validated Hospital NAPS definitions for Portugal and Hospital NAPS methodology was conducted across eight Portuguese hospitals from October 2023 to February 2024. Antimicrobial stewardship teams were surveyed to explore implementability.

Results: Among 2178 non-critical adult inpatients, 719 (33%) received antibiotics, resulting in 881 prescriptions (1.2 per patient). Most were male (68%), with a median age of 74 years, admitted to medical wards (46%) and managed by internal medicine (39%). Treatment indications accounted for 86% of prescriptions. High documentation rates were observed for indication (95%) and review/stop dates (91%). Guideline compliance was 68% Unnecessary prescribing occurred in 7%. Overall prescriptions inappropriateness was 42%. Spectrum too broad (41%) or incorrect dose or frequency (29%) were the main reasons for prescriptions being deemed inappropriate. Surgical prophylaxis > 24 h occurred in 26% of surgeries. Participants reported that Hospital NAPS has potential for implementation in Portugal.

Conclusions: The First Portugal Hospital NAPS increased knowledge about antibiotic prescribing, identified areas for improvement and demonstrated the potential for Hospital NAPS implementation in Portugal, contributing to global antimicrobial stewardship efforts.

Background: The growing threat of antimicrobial resistance has led to efforts to improve the responsible use of antimicrobials (antimicrobial stewardship - AMS). AMS education and training is essential for providing healthcare professionals with the knowledge and skills required to change prescribing behaviours, but the design and delivery of education and training varies, and it is unclear what content, and methods make for more effective education and training. The aim of this systematic review was to apply behavioural science frameworks to specify the content of AMS education and training interventions in hospital settings to determine 'what works' and to evaluate their effectiveness and cost-effectiveness.

Methods: We searched MEDLINE, EMBASE, and CENTRAL and hand searched studies included in a previous Cochrane review for studies published from January 2015 to February 2025. We applied behavioural science frameworks (Action, Actor, Context, Target and Time framework, Behaviour Change Wheel and Behaviour Change Technique Taxonomy) to code intervention descriptions and supplementary materials from published papers into target behaviours, modes of delivery and behaviour change strategies used. Meta-regressions were used to explore the (cost-)effectiveness of different target behaviours, modalities, and behaviour change strategies on reducing antibiotic consumption.

Results: Of the 1845 studies identified, 64 were included in the review and 26 included in the meta-regression. Education/training was more effective in reducing antibiotic consumption when delivered face-to-face (β= - 2.65, 95% CI: - 5.23 to - 0.07, k = 21). In total, 29 behaviour change techniques were identified across interventions, with no individual behaviour change technique associated with reduced antibiotic consumption. Interventions using the broad intervention types of modelling (Providing an example for people to aspire to or imitate) (β= - 2.23 (95% CI: - 4.27 to - 0.18) and restriction (Using rules to reduce the opportunity to engage in the target behaviour or to increase the target behaviour by reducing the opportunity to engage in competing behaviours) (β = 2.95 (95% CI: 1.10 to 4.79) had significant effects on antibiotic consumption.

Conclusion: Our results suggest that AMS education and training interventions may be more effective when they focus on modelling and appropriate restriction, and when delivered in-person. However, more evidence is needed from well-designed studies that explicitly report intervention content, to enable firmer conclusions about the specific elements involved in effective AMS education and training.

Background: Vascular access devices (VADs) are essential in healthcare but carry risks, including bloodstream infections and increased mortality. This study aimed to identify risk factors for in-hospital all-cause mortality in non-ICU patients with CVADs and midlines and for infection-related mortality in patients with catheter-related/associated bloodstream infections (CRBSI/CABSI).

Methods: We conducted a retrospective, single-center study at an Italian tertiary hospital, enrolling hospitalized non-ICU patients with VADs (CVADs and midlines in particular) between July 2021 and March 2024. We analyzed demographic, clinical, VAD, and microbiological data. Risk factors for mortality were assessed using competing risk models.

Results: Among 2062 patients with CVADs or midlines, in-hospital all-cause mortality was 13.9% (4.41 deaths/1000 patient-days). Independent risk factors included advanced age (HR: 1.05 per year), > 4 comorbidities (HR: 1.55), COVID-19-related pneumonia (HR: 2.58), and cachexia (HR: 2.59). Female sex (HR: 0.71) and multiple VAD placements (HR: 0.54) were protective. Among 159 CRBSI/CABSI patients, infection-related mortality was 12.6% (5.24 deaths/1000 patient-days). Prompt catheter removal (HR: 0.09) and appropriate antibiotic therapy (HR: 0.37) were independently protective. Coagulase-negative Staphylococci were less frequent in CRBSI/CABSI deaths (25% vs. 53.7%).

Conclusion: Mortality in non-ICU patients with CVAD or midlines is significantly influenced by age, comorbidity burden, and COVID-19 related pneumonia. For CRBSI/CABSI, timely catheter removal and appropriate antibiotics are crucial for improving survival. These findings underscore the importance of targeted risk assessment and aggressive management strategies in this vulnerable population.

Background: Eradication treatment of methicillin-resistant Staphylococcus aureus (MRSA) carriers is an effective strategy to reduce transmission and infection rates. However, throat carriage is associated with treatment failure, and the optimal treatment for these patients remains uncertain. This study evaluated the effectiveness of topical eradication treatment in a cohort of patients with throat carriage and identified risk factors for treatment failure.

Methods: This population-based cohort study included residents of the North Denmark Region with first-time MRSA throat carriage between January 1, 2017, and December 31, 2020. Exclusions included patients under two years of age, those with occupational livestock exposure, and patients receiving systemic antimicrobial treatment. Successful eradication was defined as being MRSA-free six months after one or two topical treatment courses. Multivariable analysis assessed risk factors for treatment failure, including selected patient, environmental, and strain-related factors.

Results: Of 319 MRSA throat carriers, 258 completed the follow-up test six month after treatment. Among patients who completed follow-up, the overall eradication success rate was 43.4%. Throat carriers without additional risk factors for treatment failure achieved a 54.7% success rate, while those with additional risk factors had success rates ranging from 28.6% to 55.6%, depending on specific risk factors. Throat carriage combined with younger age, colonization by non-CC398 MRSA strains, and having MRSA-positive household members were associated with treatment failure.

Conclusions: Initial topical treatment may be appropriate for MRSA throat carriers without additional risk factors, with over half achieving long-term eradication. This approach is especially relevant given the potential adverse effects of systemic antibiotics.