Antimicrobial Resistance and Infection Control最新文献

Background: Healthcare-associated infections (HAIs) are a persistent challenge in intensive care units (ICUs), further aggravated by Antimicrobial Resistance (AMR). Although the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) provides a standardized method to evaluate the Infection Prevention and Control (IPC) capacity, limited data are available on its application in Italy and its association with HAI incidence in ICUs. This study aimed to assess IPC implementation within the Italian Nosocomial Infections Surveillance in Intensive Care Units' network (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva, SPIN-UTI) using the WHO IPCAF tool, analyze its relationship with HAI and process indicators, and identify key barriers to effective IPC practices.

Methods: A cross-sectional analysis was conducted in 43 adult ICUs participating in the 2023 SPIN-UTI surveillance programme. Data on HAIs and IPC-related process indicators were collected alongside IPCAF assessments and a targeted survey on implementation barriers. Descriptive statistics, Spearman's correlation, and Kolmogorov-Smirnov tests were used for analysis.

Results: IPCAF total scores, calculated for each ICU, ranged from 350.0 to 782.5 (median: 610.0), with 51.2% of ICUs achieving an advanced IPC level. The lowest scores were observed in education, monitoring, and multimodal strategies domains. Common barriers included inadequate human and financial resources. A significant inverse correlation was found between IPCAF scores and the number of reported barriers (ρ = - 0.583; p < 0.001). No significant associations were found between IPCAF scores and HAI incidence, except for a positive correlation between HAI surveillance domain scores and central line-associated bloodstream infections rates (CLABSIs) (ρ = 0.424; p = 0.016). Strong positive correlations emerged between IPCAF domains and key process indicators, such as antimicrobial stewardship, oral decontamination, and catheter care.

Conclusions: The study shows substantial variability in IPC implementation across Italian ICUs and identifies key areas for improvement. While higher IPCAF scores correlate with better adherence to preventive practices, they do not directly predict HAI rates, possibly due to differences in surveillance sensitivity, lack of correlation with actual incidence, or the subjective nature of IPCAF responses. Strengthening education, staffing, monitoring and feedback systems is essential to enhance IPC effectiveness and patient safety.

Background: Surgical site infections (SSI) are associated with worse healthcare outcomes and increased costs. Recent evidence suggests dissimilar outcomes for SSI subtypes. Abdominal surgery has the largest SSI incidence compared to other surgeries. However, outcomes are often aggregated, masking potential impact differences. This systematic review is the first to separately summarise outcomes associated with incisional and organ/space SSI in abdominal surgery.

Materials and methods: A systematic search of PubMed, Embase, and CINAHL was conducted for studies published between 1992 and 5th December 2024. Outcomes of interest were excess hospital length of stay (LOS), mortality risk, and proportions of readmitted and repeat surgery patients. Studies reporting at least one outcome for incisional or organ/space SSI in abdominal surgeries for adults were included. Risk of bias was assessed using the Newcastle Ottawa Scale and the Cochrane Risk of Bias tool for observational studies and randomized controlled trials respectively.

Results: Twenty studies were included, pooling 23,567 patients. Five reported outcomes for incisional, one for organ/space and 14 studies for both SSI subtypes. Patients with incisional SSI had an average excess LOS of 5.02 days (3.04-7.01), while organ/space SSI patients had a longer excess LOS of 14.40 days (10.11-18.69). Incisional SSI were associated with weakly increased mortality risk (1.62, 0.74-2.50), while organ/space SSI had increased mortality risk (2.75, 2.56-3.54). Proportions of readmissions were 16% (5-27%) for incisional and 37% (5-69%) for organ/space SSI. Proportions of patients who undergo repeat surgery were 4% (0- 9%) for incisional and 9% (4-14%) for organ/space SSI.

Conclusion: This study revealed a significant burden of SSI, particularly organ/space SSI, which are associated with worse overall outcomes. Infection prevention and control strategies to reduce the impact and cost of SSI might be improved, with a need for targeted efforts against organ/space SSI.

Background: Implementation of rigorous and effective infection prevention and control (IPC) measures is one of the pillars of preventing health care associated infections, reducing inappropriate use of antimicrobials, and combating antimicrobial resistance. Dubai Health Authority has long been implementing IPC programs in Dubai's health facilities. This study aimed to assess the level of IPC implementation in private hospitals in Dubai, United Arab Emirates.

Methods: This was a hospital based cross-sectional study, using primary data collected between May and July 2023. Data were collected using the World Health Organization's Infection Prevention and Control Assessment Framework (IPCAF).

Results: Of the 32 hospitals invited to participate in the study, 25 (78%) completed the survey. The overall IPCAF median score of participating hospitals was 752.5 (IQR: 710-760), which corresponds to an advanced level of IPC implementation. No statistically significant difference was observed either in median scores between hospital levels of care (P value = 0.2) or across hospitals with different bed capacity (P value = 0.6). All IPC components achieved high IPCAF scores, with core component 2 (IPC guidelines) and core component 6 (Monitoring and Feedback) having the highest (100) and the lowest (80) median scores, respectively. Notable variation observed within and between components. Despite high overall scores, several gaps were observed, particularly in implementing multimodal strategy, monitoring and assessing safety culture, institutionalizing leadership-driven staff empowerment in certain hospitals.

Conclusion: The study indicated a strong overall IPC implementation in Dubai's private hospitals. However, targeted interventions such as standardized and continuous training, regular hand hygiene audits with feedback, improved surveillance, and expanded antimicrobial stewardship capacity are needed in specific areas to ensure effective and consistent implementation of the core components across all hospitals.

Background: Preventing surgical site infections (SSI) is crucial and, among preventive measures, preoperative shower is recommended to decrease skin bacterial colonisation. However, there is no recommendation on the use of Chlorhexidine gluconate (CHG) impregnated cloths in this indication. The objective was to assess the microbiological efficacy of 2% CHG cloths for preoperative preparation/shower.

Methods: In this single-centre parallel group trial, patients were randomised (1:1) to receive either 2% CHG cloths (intervention) or 4% CHG soap (standard-of-care) the night before and the morning of the surgery. Samples were taken to assess skin bacterial colonisation in colony forming units (CFU)/cm² at the surgical site: before (T1) and after (T2) the first preparation/shower, before (T3) and after (T4) the second preparation/shower, and before antisepsis in the operating theatre (T5). Side effects were evaluated; patients and healthcare workers (HCW) answered a survey to assess adherence.

Results: From 07/07/2022 to 25/05/2023, 64 patients were included; 32 in each group. There was no significant difference in the median reduction of CFU/cm² between T1 and T5: median reduction of 100% (IQR:100-100) in both groups. There was a greater reduction in the intervention group after the 1st preparation/shower (T1-T2): 100% (IQR:100-100) versus 99.9% (IQR:99.3-100) in the standard-of-care group (p = 0.0001). Side effects were slightly more frequent in the intervention group, but all of them were mild. Satisfaction of patients and HCW was globally high despite ecological concerns.

Conclusions: The use of CHG cloths for preoperative preparation/shower seems to be a good alternative. These results must be confirmed by assessing the impact on SSI.

Trial registration: The trial was approved by the French Ethics Committee (ID-RCB: 2021-A00455-36) and it was registered on ClinicalTrials.gov (NCT05120739).

Background: Healthcare-associated infections (HAIs) are a major problem in healthcare facilities. In Cameroon, maternal and neonatal mortality remain a concern. The underlying determinants include shortcomings in the quality of care, inadequate infrastructure and inconsistent application of infection prevention and control (IPC) measures. The objective of this study was to identify risks that increase the likelihood of HAIs in the obstetrics-gynecology unit of a referral hospital of Yaoundé.

Methods: A descriptive cross-sectional study was conducted in the obstetrics-gynecology department of referral hospital of Yaoundé from April to July 2024. Data were collected using a self-administered questionnaire. A World Health Organization (WHO) tool was used to assess knowledge of hand hygiene, and scores were categorized as good (≥ 75%), average (50-74%), and poor (< 50%). An appropriate WHO tool was also used to assess the level of implementation of the IPC framework.

Results: A total of 41 healthcare workers (HCWs) were enrolled in the study. Participants were predominantly female (78%) and aged 20-57 years (median: 30 years). Hand hygiene knowledge was average, with a median score of 60%. More than two-thirds of respondents (n = 30; 73%) reported that they did not systematically practice hand hygiene before and after patient care. The most common reason for not practicing hand washing was the absence of a hand-washing site near their healthcare post (57%). Face shields were the most frequently reported unavailable equipment (81%). Nearly one-third of HCWs (34%, n = 14) reported having received training in IPC measures, with paramedics being the most represented (52%). In contrast, no medical students reported having received this training. Most HCWs reported having received hand hygiene training, with a particularly high proportion among medical students (80%). Most participants (80%) reported having received training two years ago or more. Less than one-third of respondents (24%) reported the availability of posters on equipment sterilization protocols. The overall score (335.6/800) indicated that the obstetrics-gynecology department had a basic level of implementation of IPC interventions.

Conclusions: Suboptimal IPC implementation was observed in this obstetrics-gynecology setting. Comprehensive interventions are needed, including strengthened IPC adherence, healthcare worker education, and the establishment of regular IPC framework assessment.

Background: Health care-associated infections (HAIs) in long-term care facilities (LTCFs) represent a significant issue within the health care system. With the expected increase in the geriatric population, they will pose an increasing challenge to the health care system. The aim of this study was to analyse and compare the epidemiology of HAIs and the use of antimicrobial agents in Polish LTCFs participating in a longitudinal study based on the European Centre for Disease Control and Prevention (ECDC).

Materials and methods: This study utilized the H4LS: Healthcare-Associated Infections in Long-Term Care Facilities-Longitudinal Study protocol from ECDC. Additionally, data on antibiotic consumption, reflecting the distribution according to specific groups and the WHO AWaRe classification system, were collected. The study was conducted in nursing homes. Patient observation took place from February 1, 2022, to January 31, 2023.

Results: This study included 269 patients residing in three nursing homes. The average age of the residents was 84.06 years (SD 10.2). To varying degrees, cognitive impairments were present in 86.99% of the residents; mobility limitations in 89.96%; urinary or faecal incontinence in 92.19%; urinary catheters in 14.5%; and vascular catheters in 6.69%. Comparison between settings revealed significant differences only for Charlston comorbidity index and urinary/ fecal incontinence. A total of 420 infections were recorded among 183 residents. The cumulative incidence rate was 5.2 per 1000 patient-days. The most prevalent infections were pneumonia (35.24%) and urinary tract infections (20.95%). For pneumonia and conjunctivitis there were also observed differences in incidence between study settings. Among the HAIs, 382 (90.95%) were treated with antimicrobial agents. The most commonly used antibiotics were third-generation cephalosporins (20.83%) and penicillin combinations, including beta-lactamase inhibitors (17.80%) and fluoroquinolones (13.83%). However, significant differences were observed for antibiotic treatment pattersn in study settings. In stratification according to the WHO AWaRe classification, the most commonly used antimicrobials belonged to the Watch group (49%).

Conclusions: These results highlight the urgent need for the effective implementation of infection prevention and control in LTCFs. The implementation should be performed at the regional or country level because only multicentre studies allow us to obtain the most reliable data. Our results revealed a lack of antimicrobial stewardship in the study of LTCFs. This situation also demands quick interventions.

Background: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

Methods: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

Results: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

Conclusions: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.

Background: The transmission of antibiotic-resistant bacteria in intensive care units (ICUs) poses a significant challenge to infection control and patient safety. While direct patient-to-patient transmission is well documented, the relative contributions of endogenous bacterial selection and cross-transmission remain uncertain.

Methods: This retrospective study analyzed microbiological data from two ICUs at St. Anne's University Hospital in Brno, Czech Republic, between 2018 and 2021. Machine learning algorithms and random simulation models were employed to evaluate clustering patterns of resistant bacterial detections and to distinguish between exogenous cross-transmission and endogenous bacterial acquisition. Bacterial findings were compared across three epidemiologically distinct periods-precovid, covid, and intercovid-characterized by differing hygiene protocols and patient populations. The study assumes that the historically unprecedented hygiene measures during the COVID-19 pandemic substantially reduced horizontal cross-transmission, thereby providing a unique opportunity to estimate the relative contributions of exogenous transmission and endogenous acquisition under routine ICU conditions.

Results: The prevalence of Pseudomonas aeruginosa (PSAE) was four times higher during the covid period than precovid and remained elevated in the intercovid period. Stenotrophomonas maltophilia detections tripled during covid, while Klebsiella pneumoniae and Escherichia coli resistant to cefotaxime doubled. The proportion of first bacterial detections occurring after 48 h of ICU admission was significantly higher during covid. Clustering analysis revealed no significant deviation from random distribution for most bacteria, except for PSAE, which exhibited non-random clustering, particularly in the intercovid period. Stenotrophomonas maltophilia showed a highly uneven distribution between the two ICUs, suggesting long-term environmental persistence.

Conclusion: Our findings suggest that antibiotic selection pressure is the primary driver of resistant bacteria acquisition in ICUs, while direct cross-transmission appears to play a limited role. However, environmental persistence may contribute to the recurrent detection of Stenotrophomonas maltophilia, emphasizing the need for enhanced decontamination strategies.