Antimicrobial Resistance and Infection Control最新文献

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.

Background: Two billion vascular access devices (VADs) are used each year worldwide for the administration of intravenous therapy. Among the most serious complications are catheter-related bloodstream infections (CRBSIs), which increase morbidity and mortality and reduce patients' quality of life. The aim of this study was to evaluate the impact of implementing a multimodal intervention through a mobile application (CUIDAVEN, Nursing-led Vascular Access Care) on reducing catheter failure and the healthcare costs associated with CRBSIs, while improving nurses' adherence to best practice recommendations for vascular access care.

Methods: We conducted a quasi-experimental pre-post intervention study without a control group, from April 2019 to August 2022, at the Hospital Regional University of Málaga (Spain). Adult patients requiring VADs (short peripheral intravenous catheters, midlines, peripherally inserted central catheter, and centrally inserted central catheters) for intravenous therapy and capable of using a mobile application were included. Patients with cognitive impairment or in a terminal condition were excluded. The intervention involved the use of the CUIDAVEN mobile application, which provided educational resources, reminders, and monitoring tools. Data were collected during the pre- and post-intervention phases. Variables analysed included sociodemographic characteristics, adherence to good practices, health outcomes, and resource consumption.

Results: A total of 378 patients and 968 VADs were analysed. Catheter failure rate decreased by 19.42% in the post-intervention phase (from 16.95% to 12.24%), with an 80% reduction in CRBSIs (from 2.30% to 0.61%). Mean cost per complication fell from €310.66 to €118.79 (p=0.007). Significant improvements were observed in adherence to best practices. Patients also reported increased knowledge and satisfaction with the use of CUIDAVEN.

Conclusions: The implementation of the CUIDAVEN mobile application was associated with a reduction in both infectious and non-infectious complications and improved adherence to recommended practices. Patients perceived greater knowledge and satisfaction, highlighting the potential of digital health tools to empower individuals and improve health outcomes.

Background: Serratia marcescens (S. marcescens) is a gram-negative opportunistic pathogen causing healthcare-associated infections in neonatal intensive care units (NICUs), with mortality rates of 22.4%-58.0% and multi-drug complicating treatment. Fragmented evidence on risk factors limits infection prevention and control (IPC) strategies.

Methods: Following PRISMA guidelines, we searched PubMed, Web of Science, Wanfang, and CNKI databases from inception to April 25, 2025 for studies in English or Chinese, examining risk factors for S. marcescens infection or colonization in neonates. All reported risk factors were extracted, with those reported in ≥ 3 studies defined as primary outcomes, and those reported in two studies defined as secondary outcomes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models based on I² heterogeneity. Sensitivity and publication bias analyses were conducted.

Results: Twelve studies were included. Prematurity (OR = 2.90, 95%CI: 2.12-3.96) and very low birth weight (VLBW) (OR = 2.34, 95%CI: 1.48-3.72) were key host-related risk factors. Invasive procedures, including oral/nasogastric tube (aOR = 5.10, 95% CI: 3.06-8.52), arterial catheterization, surgery, continuous positive airway pressure(CPAP), mechanical ventilation, and central venous catheterization (CVC), significantly increased risk. Antibiotic exposure (aOR = 2.04, 95% CI: 1.06-3.93) was a modifiable risk factor, while breastfeeding (OR = 0.45, 95% CI: 0.27-0.75) and vaginal delivery (aOR = 0.51, 95% CI: 0.34-0.76) were protective.

Conclusion: This systematic review synthesized evidence on risk factors for S. marcescens in neonates, with outcomes categorized by reporting frequency. Findings advocate for targeted IPC strategies such as antimicrobial stewardship and promotion of protective practices. Limited by case-control designs, future genomic multi-center studies are needed to confirm causality and transmission.

Background: Central-line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI) are associated with increased mortality and healthcare costs. We describe implementing a hospital-wide business intelligence (BI) system coupled with infectious disease (ID) specialist intervention to support proactive CRBSI surveillance.

Methods: We conducted a multicenter, retrospective analysis of a quality improvement initiative from January 2019 to September 2024. A BI system used predefined criteria (leukocytosis, elevated C-reactive protein, prolonged catheter duration, and fever) to identify high-risk patients. Starting in July 2022, ID specialists reviewed these cases and provided advice on catheter reassessment. We employed interrupted time series (ITS) analysis to evaluate quarterly trends in CRBSI incidence and mean central venous catheter (CVC) duration, adjusting for seasonality and conducting a stratified analysis for ICU versus non-ICU settings.

Results: A total of 5090 patients with 6,750 CVC placements were included. While the overall trend for CRBSI incidence was not significantly affected by the intervention, the stratified analysis showed a statistically significant decrease in the CRBSI incidence trend within the ICU setting (slope change Δ = - 0.737/quarter, P = 0.045). No significant change was seen in the non-ICU setting. The intervention's effect on average CVC duration was less evident, with varied and often non-significant changes across different sites.

Conclusion: A hospital-wide BI system, combined with ID specialist expertise, was associated with a significant reduction in CRBSI incidence over time, especially in the high-risk ICU setting. This technology-focused, expert-supported approach offers a promising approach to improving patient safety and infection control outcomes.

Background: Detected first in humans in 1998, Nipah virus (NiV) has produced regular outbreaks with high mortality rates in Southeast Asia. Outbreaks are often driven by human-to-human transmission, posing an infection risk to both the wider community and healthcare workers who care for NiV cases. Infection prevention and control (IPC) practices are key to preventing amplification of disease outbreaks and protecting both healthcare workers and other patients, but significant evidence gaps exist in the identification of specific modes of NiV transmission that occur in outbreaks and the effectiveness of currently recommended IPC practices against NiV.

Methods: A literature search was conducted, retrieving studies from PubMed, Embase, and medRxiv. Following screening, 32 eligible studies were included in the review. Selected studies described the modes of transmission identified in NiV outbreaks, effectiveness of IPC practices against NiV and specific risk factors for NiV transmission. A meta-analysis of NiV transmission exposure risk factors was subsequently conducted.

Results: NiV transmission was identified following various types of contact with cases, including direct contact, touching body fluids and contact with a case after death. A minority of cases were responsible for most transmission events, with 94 cases (67%) with identified transmission routes generated from 6 cases (4%). No comparative studies were found that assessed IPC effectiveness, but several studies described examples of shortcomings in IPC provision in NiV outbreaks. Meta-analysis identified contact with a NiV case as a significant risk factor for transmission.

Conclusions: Identification of multiple modes of human-to-human transmission stresses the importance of adherence to recommended IPC practices when caring for NiV patients. Several nosocomial outbreaks coincided with deficiencies in the wearing of personal protective equipment, hand hygiene, and surface cleanliness. The successful application of updated global IPC recommendations would represent a significant advancement of global preparedness for NiV outbreaks to prevent disease transmission and reduce the risk of a NiV epidemic or pandemic.

Background: Failure to disinfect medical devices properly could lead to hospital-acquired infections. No-touch disinfection with ultraviolet light group C (UV-C) is increasingly used to decontaminate medical devices.

Aim: This scoping review aimed to describe the bacterial reduction on contaminated semicritical medical devices after UV-C light disinfection.

Methods: In December 2023, PubMed, Embase, Cochrane Library, and CINAHL were searched for articles reporting on bacterial reduction after UV-C light disinfection on semicritical medical devices. Characteristics of semicritical devices and disinfection methods were described.

Findings: Our search found 582 articles. Eight met the inclusion criteria. Seven medical devices were identified: endoscopes without a working channel, trans-thoracic, abdominopelvic, and duplex ultrasound probes, and rectal and/or vaginal ultrasound probes. Four UV-C light disinfectors were identified. All studies reported a positive effect on bacterial reduction after UV-C light disinfection.

Conclusions: The bacterial reduction obtained with UV-C light disinfection was not inferior compared to other disinfection methods that are currently being used. Therefore, this indicates that UV-C light disinfection could be used as a disinfection method for semicritical medical devices to reduce microbiological contamination safely. Future research must identify which UV-C light disinfector can be used safely for which medical devices as an alternative to existing disinfection methods.

Acinetobacter baumannii is an opportunistic pathogen causing severe infections in patients residing in intensive care units. The ability of A. baumannii to acquire carbapenem-resistance makes these infections difficult to treat and poses a serious risk for global health. In fact, carbapenem-resistant A. baumannii isolates belonging to eleven international clones (IC1-11), especially IC2, have disseminated globally, generating outbreaks and epidemics. Persistence of A. baumannii in nosocomial settings is favored by its ability to produce biofilm and resist to biocides. However, investigations analyzing the efficacy of biocides by determining the minimum bactericidal concentration (MBC) on field A. baumannii isolates are rare. We determined the MBC of five commonly used biocides (hydrogen peroxide, ethanol, sodium hypochlorite, chlorhexidine digluconate, and benzalkonium chloride) adapting the EN1040 and EN1276 standard methods on 64 A. baumannii isolates collected from human hospital settings and diseased animals (multidrug resistant) and from food (multidrug susceptible). The 64 isolates belonged to diverse sequence types, some of them being part of ICs (IC2, IC7, IC9 and IC11). Efficacy of biocides was evaluated in presence of an interfering substance (bovine serum albumin, BSA) to simulate dirtiness, but also on in vitro formed biofilms. MBC₅₀ and MBC₉₀ values of the five biocides on bacteria in planktonic phase were lower than concentrations used in commercial formulations. Presence of BSA increased the MBC values of sodium hypochlorite and benzalkonium chloride. Isolates presenting the highest MBC values, mostly belonged to IC2 (multidrug resistant) and other expanding clonal complexes (multidrug susceptible). On biofilm matrix, none of the tested biocides could eradicate bacteria neither demonstrated bactericidal activity at the concentrations and exposure time tested. Based on a standardized methodology, our investigation provides data that could contribute to define epidemiological cut offs to interpret bacterial response to biocides. Investigations determining the efficacy of biocides on field isolates both in planktonic phase and in biofilms matrix are necessary to understand if hygienic measure to counteract environmental contamination are adapted and unveil bacterial adaptive strategies to these substances.