Antimicrobial Resistance and Infection Control最新文献

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.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern, particularly in resource-limited settings such as Africa. This meta-analysis aimed to determine the proportion of MRSA among S. aureus isolates from patients with confirmed infections and to assess associated antibiotic resistance profiles across the continent.

Methods: A comprehensive literature search was conducted in African Journals Online, African Index Medicus, PubMed, Scopus, Google Scholar, and Web of Science for studies published between January 1, 2013, and June 5, 2024. Primary studies were included if they reported MRSA proportion or resistance profiles in Africa, employed reliable detection techniques, and analyzed clinical specimens from infected patients. Statistical analyses were performed using the meta package in R software, applying a random-effects model. A p-value of < 0.05 was considered statistically significant.

Results: This meta-analysis included 191 studies, encompassing 40,979 S. aureus isolates. Nigeria contributed the highest number of studies (n = 29), followed by Egypt (n = 26). The vast majority of studies (n = 186) were based on hospital settings. The pooled proportion of MRSA in Africa was 42.2% (95% CI 38.7-45.6). By detection method, proportion was 41.4% for mecA, 42.8% for the cefoxitin disc method, and 39.1% for the oxacillin disc method, with no significant differences observed (p = 0.8). Regionally, Northern Africa had a significantly higher proportion of 56.2% (95% CI 49.3-62.9) compared with 36.7% (95% CI 33.2-40.4) in Sub-Saharan Africa (p < 0.001). At the country level, Eritrea reported the highest proportion (71.8%), followed by Egypt (61.8%), while the lowest rates were observed in Malawi (7.0%) and Gabon (8.2%). Regarding MRSA resistance profiles, linezolid (3.4%) and vancomycin (4.7%) showed the lowest resistance rates, whereas higher rates were noted for fusidic acid (11.6%), rifampin (28.4%), clindamycin (40.4%), trimethoprim-sulfamethoxazole (54.5%), and tetracycline (60.2%). Limited data were available for telavancin, dalbavancin, oritavancin, tedizolid, ceftaroline, mupirocin, and daptomycin.

Conclusion: The proportion of MRSA in Africa remains high at 42.2%, with marked regional disparities. Although resistance rates for linezolid and vancomycin are relatively low, they surpass global averages, raising concerns about emerging resistance. Alarmingly high resistance rates to several other antibiotics further underscore the urgent need for targeted interventions and continuous surveillance.

Introduction: Bloodstream infections (BSIs) are a leading cause of healthcare-associated morbidity and mortality, with a significant portion being preventable. Despite this, BSIs remain common, particularly in Australian hospitals. Princess Alexandra Hospital (PAH) in Queensland has implemented a surveillance program that focuses on the preventability of BSIs, with continuous loop, real-time audit-feedback to teach clinicians about preventable factors and possible actions. This study evaluated the program's implementation and impact on reducing infections.

Methods: A Type I hybrid implementation-effectiveness design was used, combining interrupted time series analysis of BSI data from 2002 to 2023 and focus group discussions with the Infection Management Service team members and ward-based clinicians. Interrupted time series analysis was used to assess the impact of the Staphylococcus aureus bacteraemia (SAB) prevention initiative introduced in November 2011. Statistical analysis employed segmented regression using negative binomial regression with robust standard errors. Focus group data were analysed via the Consolidated Framework for Implementation Research (CFIR).

Results: The intervention resulted in an immediate, but non-significant, reduction in SAB monthly rates (incidence rate ratio, IRR = 0.839, 95% CI: 0.653-1.078), and a declining trend in monthly rates was also noted postintervention (IRR = 0.998, 95% CI: 0.996-1.000). Focus group feedback identified enablers, including effective collaboration and challenges such as needing to address inconsistent documentation and differing perceptions of the program's intent.

Discussion: The program's focus on preventability was associated with a reduction in SAB rates and a sustained downward trend over time. While these changes did not reach conventional thresholds for statistical significance, the magnitude and direction of effects, together with qualitative feedback on improved collaboration and targeted prevention strategies, indicate potential for broader application.

Background: Healthcare-associated infections pose a major challenge in developing countries, with hand hygiene (HH) compliance being the most critical preventive measure. Despite WHO recommendations, HH compliance in Pakistani healthcare settings remains suboptimal. This study aimed to evaluate the effectiveness of a WHO-based multimodal HH improvement intervention in enhancing compliance among healthcare workers at Tabba Heart Institute, Karachi, from 2022 to 2024.

Methods: A quasi-experimental before-and-after study was conducted in three phases: baseline assessment (Jan-Dec 2022), intervention implementation (Jan-Dec 2023), and post-intervention evaluation (Jan-Jun 2024). The multimodal intervention included system changes, educational training, monitoring with feedback, workplace reminders, and institutional safety climate enhancement. Trained observers used the WHO HH observation tool to record 9460 HH opportunities across physicians, nurses, and allied healthcare staff.

Results: HH compliance improved significantly from 68.0 in 2022 to 71.0% in 2023, with sustained improvement reaching 85.5% in 2024. Compliant HH actions increased from 3082/4532 opportunities in 2022 to 1150/1344 in 2024. Monthly compliance rates showed consistent upward trends, peaking in early 2024. Nurses demonstrated the highest compliance, followed by physicians and allied staff.

Conclusion: The WHO multimodal HH strategy effectively and sustainably improved HH compliance at our institution, achieving a 17.5% increase over three years. This demonstrates the feasibility and impact of systematic quality improvement interventions in resource-limited healthcare settings.

Background: Healthcare-associated infections (HAIs) are a global public health issue and a major threat to patient safety. This study aimed to estimate the prevalence of HAIs and antimicrobial use in a tertiary hospital in Shanghai, China.

Methods: Point-prevalence surveys were conducted annually from 2012 to 2023. All inpatients present on the survey day were included. Data were analyzed to identify trends and patterns in the prevalence of HAIs and antimicrobial use.

Results: The overall prevalence of HAIs was 3.97%, with significant variations observed across departments, age groups and patient populations, whether undergoing surgery or not. There was a significant upward trend in surgical wards from 3.97% in 2012 to 4.82% in 2023 (β = 0.135, P = 0.003). The prevalence of catheter-associated urinary tract infection showed a significant decreasing trend (β = - 0.032, P < 0.001). There was an increasing trend in the proportion of patients receiving single-agent antimicrobial use for prophylactic and therapeutic purposes. The most frequently isolated pathogens were Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli, which exhibited high rates of resistance to carbapenems.

Conclusion: Despite some progress, challenges regarding HAIs and antimicrobial resistance persist in a tertiary care setting. The findings highlight the necessity for targeted infection control measures and robust antimicrobial stewardship programs to mitigate the burden of HAIs and optimize antimicrobial use.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a pivotal pathogen contributing to healthcare-associated infections. Identifying environmental risk factors associated with CRAB contamination is critical.

Objectives: To assess the associations of ward microclimate and procedure duration with CRAB contamination risks.

Methods: High-touch environment and exposure surface, and air samples were repeatedly measured. A total of 2330 high-touch environment surfaces, 345 exposure surfaces, and 366 air samples were collected. The generalized linear mixed-effects model and additive interaction analysis were employed to examine the associations of ward microclimate and procedural factors with environmental CRAB contamination risks.

Results: We found that compared to procedures lasting ≤15min, those lasting >15min were related to higher risks of CRAB contamination (OR: 1.435, 95% CI: 1.052, 1.954). Compared to the standard environmental conditions (22.5-25.5 °C for temperature and 30-60% for humidity), lower temperature (<22.5 °C) and lower humidity (<30%) were associated with increased CRAB contamination risks (ORs:1.568 and 1.602). However, there was no significant association between high temperature (>25.5°C) or high humidity (>60%) and CRAB contamination risks. The combination of lower temperature or humidity with prolonged procedures showed synergistical interaction on increased risks of CRAB contamination. Additionally, CRAB was consistently detected in air across all sampling scenarios (static conditions, real-time nursing care procedures, and real-time sanitation), with the nursing care procedures group showing the highest detection rate (29.66% vs. 13.95% for static conditions and 8.33% for real-time sanitation).

Conclusions: Temperature and humidity below standard thresholds, combined with prolonged procedures were associated with an increased risk of environmental CRAB contamination in ICUs.