Antimicrobial Resistance and Infection Control最新文献

Background: Reported beta-lactam allergies often lead to avoidance of first-line antibiotics and may increase surgical complications. Cesarean sections (CSs), where prophylactic antibiotics are universally administered, offer a unique setting to assess the clinical impact of these labels on outcomes. The objective of this study was to investigate the impact of beta-lactam allergy labels on surgical site infection (SSI) rates and adherence to CS prophylactic antibiotic guidelines.

Methods: We performed a retrospective cohort study of all women undergoing CS at a secondary medical center between 2018 and 2023. Women with chorioamnionitis or missing antibiotic data were excluded. Patients were grouped by the presence or absence of a beta-lactam allergy label. For each group, we assessed 30-day SSI rates and adherence to prophylaxis guidelines (drug, dose, timing). Multivariable logistic regression identified independent predictors of SSI.

Results: Among 7,060 eligible women, 307 (4.3%) carried a beta-lactam allergy label. Not-per protocol antibiotic administered in 201/307 (65%) of labeled vs. 739/6,753 (11%) of unlabeled patients (p < 0.001), mainly due to clindamycin monotherapy (88% of inadequate regimens). SSI rates were higher among labeled patients, 20/307 (6.5%) vs. 271/6,753 (4.0%) (p = 0.031). Among all patients, SSI occurred in 266/6,733 (3.9%) receiving cefazolin-based prophylaxis, 4/64 (6.3%) with clindamycin plus gentamicin, and 21/256 (8.2%) with inadequate regimens (p = 0.003). Beta-lactam allergy labeling independently increased SSI risk (aOR 1.68, 95% CI 1.05-2.71, P = 0.031).

Conclusions: Beta-lactam allergy labels were associated with an increased risk of SSI after cesarean section, due to suboptimal selection of prophylactic antibiotics. These findings underscore the importance of accurate allergy documentation and evidence-based perioperative antimicrobial stewardship to ensure optimal prophylaxis.

Background: The World Health Organization's Infection Prevention and Control Assessment Framework (IPCAF) is widely used to evaluate infection prevention and control (IPC) quality in hospitals, but IPC standards in long-term care facilities (LTCFs) are less studied and standardized. The IPCAF has not previously been used in LTCFs. This study aimed to pilot an adapted version of the IPCAF in Dutch LTCFs to assess its usability, perceived feasibility and acceptability in this context.

Methods: First, the IPCAF was translated and adapted to the Dutch LTCF context through expert consultation for relevance. In this pilot, the adapted IPCAF was then completed during face-to-face interviews together with a multidisciplinary team in fourteen healthcare groups between May and September 2024. Second, LTCF characteristics were collected in advance through a separate questionnaire on LTCF level. Finally, after receiving feedback reports, LTCFs completed a separate web-based survey about their experiences with the process. Data were summarized descriptively and group differences were tested using the Kruskal-Wallis test.

Results: Most participants found the adapted IPCAF clear and informative, appreciating its ability to highlight areas needing attention and identify priorities for improvement. About a quarter of LTCFs expressed willingness to use the adapted IPCAF in the future, while over half were hesitant. IPC standards were generally high, with the highest scores for 'Workload, staffing and bed occupancy' and 'Environments, materials and equipment for IPC'. The lowest scores were for 'HAI surveillance' and 'IPC education', with only five LTCFs including HAI surveillance in their IPC programs.

Conclusions: This is the first study to adapt the WHO IPCAF as a tool for measuring IPC in LTCFs and to evaluate its usability, perceived feasibility, and acceptability in this context. The adapted IPCAF can be implemented in LTCFs and may help identify IPC priorities and areas for improvement. However, greater familiarity and support may be needed to enable wider adoption. While IPC standards were relatively high in the LTCFs included in this pilot, ongoing attention to surveillance and education remains essential. Further research may be needed to validate our findings in larger and more diverse LTCF populations and to explore its impact on IPC outcomes.

Introduction: Nosocomial infections in Neonatal Intensive Care Units (NICU) are a major concern due to the vulnerability of premature and immunocompromised infants. Serratia marcescens is an opportunistic pathogen often involved in these infections, contributing significantly to morbidity and mortality. Integrating Next-Generation Sequencing (NGS) into infection control programs can enhance detection, surveillance, and prevention efforts. This study aimed to develop a mapping-based pipeline for strain typing and phylogenetic analysis of nosocomial infections, enabling detailed comparison of microbial genomes.

Methods: A retrospective study describing the outbreak was conducted on 18 S. marcescens strains from 14 patients and 2 from environmental swabs collected in the NICU of the University Hospital of Udine between 2023 and 2024. Genomic DNA was extracted and libraries were prepared using the FX DNA Library Preparation Kit (Qiagen). Whole Genome Sequencing (WGS) was performed using an Illumina MiSeq platform (2 × 300 bp paired-end). Data analysis was carried out with CLC Genomic Workbench (Qiagen), using a custom-optimized pipeline for sequence typing (ST). The bioinformatics workflow was developed and validated in-house to ensure accurate SNP-based phylogenetic analysis.

Results: WGS revealed phylogenetic relationships among strains. Six isolates showed close genetic relatedness. Identical genotypes were detected in strains from patient blood samples, rectal swabs, and environmental sources, suggesting potential transmission links.

Conclusions: NGS offers detailed insights into the molecular epidemiology of infections and colonization in the NICU. The genomic data generated can support real-time, evidence-based refinement of infection control strategies, contributing to improved patient safety and outbreak prevention.

Background: To enable proper benchmarking of rates of surgical site infections (SSIs), it is important to consider the variability in case mix and risk factors in the data analysis. SSI risk indices have been used to make the data more comparable. However, different risk indices exist, and studies comparing these indices head-to-head are limited. Thus, the purpose of this study was to compare and externally validate six indices of SSI risk prediction.

Methods: This study was conducted with data from ASPIRE-SSI, a prospective cohort study conducted at 33 sites in ten European countries. The following risk indices were assessed: the National Nosocomial Infections Surveillance System (NNIS) risk index and NNIS index improved for cardiac patients, the Australian clinical risk index, the Infection risk index in cardiac surgery, the risk index A, and risk index B (range of area under the receiver operating characteristic curves in the derivation studies: 0.62-0.67). Comparison was done in two cohorts of patients; an overall cohort, consisting of 9657 patients who underwent 11 different types of surgical procedures, and a sub-cohort, consisting of the 1772 patients who underwent open cardiac surgery. The main endpoint was SSI of any cause up to 90 days after surgery. Model discrimination was assessed with and without accounting for clustering , and model calibration was assessed only in the overall cohort. Furthermore, we attempted to improve the predictive ability of the risk indices by developing a new model consisting of predictor variables from the assessed risk indices.

Results: 5.2% (502/9657) of patients in the overall cohort, and 8.9% (157/1772) of patients in the sub-cohort developed an SSI within 90 days after surgery. When clustering was not accounted for, the risk indices exhibited low discriminative power in both the overall cohort (highest C-statistic 0.60) and sub-cohort (highest C-statistic 0.58), and overestimated the risk of SSI, especially for patients in higher SSI risk categories. The C-statistic estimates were slightly higher in both cohorts (range C-statistic: 0.63-0.65) when clustering was taken into account. The newly developed prediction model (without correction for overfitting) had poor discrimination (C-statistic 0.67, 95% CI 0.64-0.69), but a good agreement between the observed and predicted SSI risks.

Conclusion: The SSI risk indices had comparable discrimination when clustering was taken into account, but suboptimal calibration in our cohorts compared with their derivation cohorts.

Candida auris (Candidozyma auris, C. auris) is a fungal pathogen with multiple drug resistance, belonging to a species of yeast, known for its ability to sustain growth in the host. This organism can colonize human skin and spread through physical contact or contaminated surfaces and equipment. Given the limited reviews on skin load reduction methods of C. auris, this review aims to summarize and evaluate the current load reduction methods involving reducing skin load, and the risk of colonization. The findings will provide healthcare facilities and nursing homes with evidence-based guidance to develop effective prevention and control strategies.

Background and objectives: Maintaining high standards of environmental hygiene in healthcare settings is critical for preventing healthcare-associated infections (HAIs). Traditional cleanliness assessments, including visual inspections and microbial cultures, often lack sensitivity and immediacy. This review aims to evaluate the utility, advantages, and limitations of adenosine triphosphate (ATP) bioluminescence assays as a rapid, objective method for monitoring hospital surface hygiene.

Materials and methods: A comprehensive review of studies published between 2020 and 2025 was conducted using PubMed and Scopus databases. Studies were included if they evaluated ATP bioluminescence as a primary method for assessing hygiene in clinical environments, medical instruments, or healthcare-related settings.

Results: ATP bioluminescence has demonstrated consistent advantages across diverse healthcare settings. It identifies organic residues undetectable by visual inspection and supports real-time corrective actions, particularly in intensive care units, endoscopy suites, and operating rooms. It has also been effectively used in outbreak investigations, veterinary clinics, and pediatric dental settings. Despite its strengths, ATP assays exhibit variability depending on detector type, surface characteristics, and environmental conditions. Moreover, ATP cannot differentiate microbial from non-microbial sources, necessitating complementary methods for pathogen-specific detection.

Conclusions: ATP bioluminescence is a practical, rapid, and increasingly validated tool for improving surface hygiene monitoring and infection control in healthcare environments. While not a replacement for microbial cultures, it serves as a valuable adjunct to existing assessment methods. Standardized protocols, calibrated thresholds, and integration with other diagnostic tools are essential for maximizing its effectiveness and comparability across institutions.

Background: Lower respiratory infections (LRIs) remain a leading cause of death and disability. AMR is considered as a paramount twenty-first century public health threat.

Objectives: To assess the global burden of AMR-associated LRIs using data from Global Burden of Disease (GBD) 2021.

Methods: Mortality data, including absolute counts, age-standardized mortality rates (ASMRs), and AMR-specific metrics, were extracted from the GBD 2021 dataset and stratified by demographic characteristics (age groups, sex), geographic regions, and socioeconomic status (SDI tiers).

Results: From 1990 to 2021, both absolute death counts and ASMRs demonstrated significant declines (EAPC: - 2.09); mortality burden (the death counts and ASMRs) caused by bacteria with AMR are 2 to 3 times that of bacteria with AMS; highest burden was observed in low-SDI regions and increasing trends were noted among older adults (≥ 50 years); S. pneumoniae dominated overall mortality, and S. aureus showed concerning upward trends; the mortality related to carbapenem-resistant A. Baumannii, E. coli, K. pneumoniae, and P. aeruginosa was on the rise.

Conclusions: While overall burden of AMR-associated LRIs mortality shows a declining trajectory, significant disparities persist across SDI strata. The emergence of resistance to last-resort antimicrobials of the leading bacterial pathogens highlights the urgent need for the prevention and control of AMR.

Background: Antimicrobial resistance (AMR) is a major global threat. The World Health Organization (WHO) has identified key organisms that carry the potential for both pathogenicity and AMR, leading to reduced treatment options and worsened outcomes, through the Global Antimicrobial Resistance and Use Surveillance System (GLASS). In Timor-Leste, surveillance is now possible due to significant gains in diagnostic capacity.

Methods: In 2020-2021 a cross-sectional surveillance study was performed on inpatients and outpatients across all hospitals in Timor-Leste. Nose/axilla/groin swabs were selectively cultured for Staphylococcus aureus and methicillin-resistant S. aureus (MRSA); rectal/perianal swabs for extended spectrum beta-lactamase (ESBL) producing organisms and on MacConkey agar with ciprofloxacin and gentamicin discs. S. aureus, Escherichia coli and Klebsiella pneumoniae isolates were assessed for resistance; univariate and multivariable analyses assessed for associations.

Results: 516/517 had Gram-positive bacteria screening. S. aureus was detected in 93 (18.0%), 14 (15.1%) of which were MRSA, representing 2.7% MRSA carriage. 511/517 were screened for Gram-negative organisms; 108 (21.1%) cultured at least one ESBL-producing organism; ciprofloxacin resistance was found in 109 (21.3%) and gentamicin resistance in 77 (15.1%). Only one carbapenem-resistant organism (an Acinetobacter baumannii) was detected. Participants in Dili were more likely to be colonised with resistant Gram-negative bacteria (aOR 5.3 ESBL, aOR 3.5 ciprofloxacin resistance, aOR 2.7 gentamicin resistance). Being an inpatient was associated with gentamicin resistance (aOR 2.9); dog ownership was associated with ESBL carriage (aOR 1.9).

Conclusions: ESBL, ciprofloxacin and gentamicin resistance carriage rates were high, particularly in Dili. MRSA carriage and carbapenem resistance were reassuringly low. Ongoing surveillance is essential to monitor AMR and inform guideline development.

Background: Healthcare-associated infections pose a significant risk to high-risk infants, particularly those with very low birth weight (< 1500 g) and those born very preterm (< 32 weeks gestation). The burden of healthcare-associated infections, contributing risk factors, and efficacy of prevention strategies in the neonatal population remain underinvestigated, with few national and international networks.

Methods: To address this gap, an international team of experts in neonatology, epidemiology, and infection prevention and control from diverse healthcare settings collaborated as consortium partners within the NeoIPC Project to design a surveillance program focused on healthcare-associated infections and multidrug-resistant organisms in neonatal units. Data collection includes the most prevalent neonatal healthcare-associated infections (primary and secondary bloodstream infections, clinical sepsis, pneumonia, necrotizing enterocolitis, and surgical site infections), the presence of multidrug-resistant bacteria and associated risk and protective factors for healthcare-associated infections.

Discussion: By providing standardized methods and reference data for benchmarking, the NeoIPC Surveillance aims to support infection prevention and antibiotic stewardship programs, improve neonatal care outcomes and foster international collaboration. This article outlines the methods of the NeoIPC Surveillance Core Module (Version 1.2), details data collection, management, and analysis, and serves as a comprehensive reference for healthcare professionals and researchers worldwide aiming to implement effective surveillance for healthcare-associated infections in neonatal units.