Antimicrobial Resistance and Infection Control最新文献

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.

Introduction: Poor cleaning practices for healthcare workers' mobile phones can promote microbial contamination, posing a latent risk of infections for patients. Despite widespread mobile phone use in healthcare environments, evidence on the effectiveness of disinfection methods in low and middle-income countries remains limited.

Objective: To evaluate the disinfectant capacity of 70% isopropanol on the surface of healthcare workers' smartphones in a Peruvian hospital in 2023.

Methods: We designed a pre-post study to collect demographic, occupational, and phone usage information, along with microbiological culture analysis results before and after cleaning with 70% isopropanol.

Results: We evaluated 178 mobile phones from healthcare workers, 90.5% (95%CI: 85.1-94.0%) of which showed microbiological contamination. The most frequently isolated microorganism was Staphylococcus aureus (41.0%), followed by Enterococcus sp. (14.9%) and Staphylococcus epidermidis (9.9%). Antibiogram analysis revealed high resistance rates to ampicillin. No factors were associated with microbial contamination on phones. A significant reduction in microbiological contamination was observed (90.4% to 14.0%, p < 0.001) after cleaning with 70% isopropanol. Colony counts significantly decreased from 73.4 ± 31.8 CFU/cm² to 3.9 ± 11.0 CFU/cm² (p < 0.001).

Conclusion: The disinfectant capacity of 70% isopropanol on healthcare workers' smartphone surfaces is highly effective, resulting in an approximately fivefold reduction in contamination rates.

Background: Antimicrobial resistance refers to the ability of microorganisms to become resistant to antibiotics, fungicides, and other antimicrobial agents, which are essential for treating illnesses in humans, land and water-based animals, and plants. This issue is quickly emerging as a major danger to health, economic stability, and livelihoods. One notable driver of these resistant microorganisms is the misuse of antimicrobial medications.

Objective: To assess the practices and perspectives on antimicrobial drug misuse in Wolaita Zone, 2024.

Methods: This study employed a community-based cross-sectional mixed-methods design. The study data were collected from 423 community residents for the quantitative phase and 15 participants for the qualitative phase, data collection for the quantitative component was collected using structured interview-administered questionnaires, and the qualitative component involved in-depth interviews with purposively selected participants, guided by a structured interview. Quantitative data management involved the use of EpiData V4.6 and the Statistical Package for the Social Sciences for data entry and analysis, respectively. The qualitative data underwent thematic analysis utilizing OpenCode software, a qualitative data analysis tool.

Results: In this study, the quantitative data found that 67.1% of participants misused antimicrobial drugs. The factors significantly associated with the misuse of antimicrobial drugs included educational status [AOR: 1.91 (95% CI: 0.93-2.11)], drug cost [AOR: 3.22 (95% CI: 1.18-5.3)], knowledge regarding the use of antimicrobial drugs [AOR: 2.23 (95% CI: 1.66-4.01)], and adherence to stewardship guidelines [AOR: 3.37 (95% CI: 2.44-9.24)]. Additionally, the qualitative study identified four key themes from the data analysis namely, factors related to drug providers, patient-driven factors, sociocultural influences, and limitations in regulatory and policy frameworks.

Conclusion: The study reveals a troubling rate of antimicrobial drug misuse among the population. The finding underscores the urgent need to address the gaps and barriers that impede proper use of antimicrobial drugs. It is recommended that government and non-government health sectors, along with relevant stakeholders, implement educational initiatives and health campaigns to combat this problem.

Introduction: We conducted a prospective cohort study of patients with newly acquired extended-spectrum beta-lactamase-producing Enterobacterales (ESBLPE) intestinal colonisation (termed "ESBLPE colonisation") in two public hospitals between January 2013 and October 2016. We evaluated the duration of ESBLPE colonisation and the impact of selected factors on this duration.

Methods: Patient data and faeces samples were collected on enrolment and three monthly for 2 years. Standard laboratory methods were used for ESBLPE identification and susceptibility testing. Whole-genome sequencing of isolates was performed determining sequence type, plasmid replicons, antimicrobial resistance genes, virulence factor genes and phylogenetic relationships.

Results: The median duration of ESBLPE colonisation for the 102 patients was 544 days (range 77-730 days, interquartile range 220-730 days). After one year and at the end of follow up, 61% and 23.4% of patients respectively remained ESBLPE colonised. The same strain of ESBLPE, colonised 70.2% (33/47) patients colonised with Escherichia coli and 70.7% (29/42) patients colonised with Klebsiella pneumoniae. Prolonged ESBLPE colonisation was associated with age ≥ 75 years (HR 0.46, 95% CI 0.23-0.90), an increased intensity of hospitalisation (P = 0.0036), E. coli phylogroup B2 (P = 0.0142), E. coli harbouring bla_CTX-M-15 (P < 0.0001), colonisation with more than one species of ESBLPE (P = 0.0023) and colonisation with more than one E. coli Sequence Type (P = 0.0042).

Conclusions: It is likely that combinations of multiple patient and bacterial factors influence the duration of ESBLPE colonisation. This prolonged duration of ESBLPE colonisation highlights the importance of infection control and public health measures to decrease the acquisition and spread of ESBLPE.

Background: The COVID-19 pandemic underscored the vital role of infection prevention and control (IPC) policies in hospitals to protect patients and healthcare workers. National guidance documents have traditionally provided a framework for local IPC policy development. This study aimed to examine the translation of the Dutch national COVID-19 IPC guidance documents into local Dutch hospital policies, specifically focusing on discontinuing isolation measures for COVID-19 patients.

Methods: This multicentre retrospective study investigated the IPC policies of seven Dutch hospitals, of which three academic hospitals and four non-academic hospitals. IPC practitioners collected data from hospitals' (archived) IPC policy guidelines implemented between March 2020 and December 2021. A composite index based on the criteria for discontinuation of isolation measures for COVID-19 patients was created to capture variation in policy translation within and across hospitals over time, relative to the national guidance document. Using this index, a descriptive analysis was performed to assess the extent to which hospitals adopted the national guidance for discontinuing isolation measures for specific patient groups.

Results: The national COVID-19 IPC guidance document for discontinuing isolation measures established targeted criteria for six patient groups, and included criteria based upon days since symptom onset, symptoms, symptom-free period, and RT-PCR results. Hospitals distinguished 16 patient groups. While the national guidance was updated regularly, the criteria for discontinuing isolation measures changed once; the frequency of local hospital updates ranged from four to 12 times. Policy variation was observed both within and across local hospital policies over time. Local hospital policies tended to be less strict for patients on ventilation and/or with a tracheostomy (78% of the time), while for other patient groups, they were more often stricter.

Conclusions: Compared to the national guidance, local hospital guidelines showed more variety in the number of patient groups described as well as more policy changes throughout the first two years of the pandemic. Furthermore, variation was observed within and between hospitals over time. These variations show the complexity of striving for a uniform and unambiguous policy on a national level, and indicate the need for awareness of the presence of variation in settings regarding patient groups and infrastructure.

Whole-genome sequencing has become a key tool for identifying bacterial cross-transmission in healthcare settings. Among the methods used, core-genome Multi-Locus Sequence Typing (cgMLST) is considered as the reference method owing to its standardization. However, its limitations are often overlooked, particularly for taxonomically complex species such as Enterobacter cloacae. We report a case of false-positive genomic linkage between two E. cloacae isolates recovered from patients hospitalized in different units, four months apart, with no epidemiological overlap. Routine retrospective genomic surveillance using a local cgMLST scheme flagged these isolates as genetically related. However, further analyses based on core-genome Single-Nucleotide Polymorphism (SNPs) calling and molecular phylogeny, including public genomes, revealed that the two isolates belonged to distinct clusters and differed by 99 SNPs. This case illustrates the risk of overinterpreting cgMLST results when applied to species with high genomic heterogeneity and insufficiently robust schemes. These findings highlight the importance of interpreting genomic data within its epidemiological context, and in the case of inconsistency confirming potential links through high-resolution SNP analysis, and developing standardized, species-specific cgMLST schemes.