Antimicrobial Resistance and Infection Control最新文献

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.

Background: Personal protective equipment (PPE) should effectively protect health care workers (HCWs) when treating infectious patients. However, during doffing contamination from outside of the PPE could be transferred and might cause serious infection. Therefore, complex doffing procedures have been developed, which include disinfection steps and would thereby protect the HCWs even if a contamination event occurred during doffing. However, assessing these complex multi-step procedures regarding risk of contamination and infection is challenging. The use of harmless surrogates with pathogen mimicking properties such as lipid nanoparticles encapsulating DNA (LNPs) could provide valuable insights into the effectiveness of doffing and disinfection procedures. Compared to the state-of-the-art method of contamination monitoring using fluorescent lotions LNPs promise to be more sensitive and give additional insights into the value of the disinfection steps.

Methods: After pre-testing the suitability of LNPs as viral surrogates in terms of detection limit and susceptibility to ethanolic disinfection, LNPs with different barcodes were used to evaluate the PPE doffing procedure in place at the Cantonal Hospital Baden (Switzerland). During the biannual HCWs' PPE training, several sites of the PPE were deliberately contaminated with LNPs after donning. After completion of the doffing procedure, the hands and faces of the HCWs and several environmental sites were analysed for LNP contamination via qPCR.

Results: The analysis showed that no contamination of HCWs' hands and faces was detectable, indicating the effective protection of HCWs. But some environmental sites were contaminated during the doffing procedure. Owing to the disinfection sensitivity of the LNPs it could be shown that the LNPs detected were disintegrated during one of the disinfection steps of the procedure.

Conclusions: This study demonstrates that LNPs can be used as viral surrogates during the evaluation of PPE doffing procedures. LNPs can lead to insightful results due to their low detection limit and the susceptibility towards disinfection, making this method superior to fluorescent lotions. Consequently, indications for the procedures' effectivity in inhibiting pathogen transfer to HCWs were found using LNPs. At the same time, blind spots in environmental contamination were uncovered, and the necessity of the disinfection steps in the protocol was displayed.

Antimicrobial resistance (AMR) is a major public health issue that, combined with healthcare-associated infections (HAIs) threaten the quality and safety of hospital care. Monitoring AMR and HAIs is one of the cornerstones of preventing these phenomena with the use of indicators. Various monitoring networks and indicators exist for this type of surveillance, yet the landscape is cluttered with a confusing array of them, making it unclear why so many are used or how they were chosen. We provide a comprehensive overview of the diversity indicators employed in monitoring AMR and HAI from local to international networks. One challenge is the variation in case definitions between networks, which complicates direct comparisons. Standardized infection rates help adjust for confounding factors such as demographics (age, sex) and other infection-related risks, but obtaining such detailed data remains complex. Benchmarking hospital indicators involves comparing performance metrics with those of peer institutions, offering valuable insights to improve care quality, patient safety, and overall healthcare efficiency. However, to drive meaningful improvements, comprehensive feedback must be shared to guide targeted corrective actions.The emergence of health data warehouses (HDWs) and artificial intelligence (AI) provides new opportunities to refine and develop indicators, better addressing the challenges of contemporary healthcare monitoring.