Antimicrobial Resistance and Infection Control最新文献

Surveillance is essential in the fight against antimicrobial resistance (AMR), to monitor the extent of resistance, inform prevention, control measures, and evaluate intervention progress. Traditional surveillance methods based on phenotypic antimicrobial susceptibility data offer important but limited insights into resistance mechanisms, transmission networks, and spread patterns of resistant bacterial strains. Fortunately, genomic technologies are increasingly accessible and can overcome these limitations. Genomics has the potential to advance traditional bacteriology in routine diagnosis and surveillance, it often relies on the initial isolation of bacterial strains from clinical specimens using conventional culture methods. Culture-based phenotypic characteristics are essential for making inferences about newly recognized genomic patterns. The Africa CDC Pathogen Genomics Initiative (Africa PGI) aims to enhance disease surveillance and public health partnerships through integrated, cross-continent laboratory networks equipped with the tools, human resource capacity and data infrastructure to fully leverage critical genomic sequencing technologies. For genomic surveillance of AMR, it is essential to optimize routine clinical microbiology laboratory services that are weak in many African countries. In this review, we outline shortcomings in clinical microbiology laboratories across Africa that compromise pathogen genomic epidemiology. We emphasize the necessity of investing in bacteriology and enhancing leadership capacity to fully capitalize on the advantages offered by genomic antimicrobial resistance (AMR) surveillance.

In recent years, there has been increased attention on the importance of healthcare environmental cleaning, including the need to professionalize and support the workforce responsible for performing cleaning. Global agendas and strategies on infection prevention and control (IPC) and water, sanitation and hygiene highlight the need for improvements to this sector, particularly in resource-limited healthcare facilities in low- and middle-income countries. Correspondingly, several resources have been developed that aim to (1) improve professional training of cleaners and (2) improve implementation of best practices in resource-limited settings. This commentary seeks to provide insight into the barriers and facilitators to implementing these resources, drawing on the practical experience from two initiatives across four countries from 2018 through 2023. Several common barriers were identified across the diverse settings, including (1) low empowerment and status of the workforce, (2) low pay, inadequate staff time for the high workload needed to achieve best practices and high turnover of staff, and (3) a lack of connection and integration of environmental cleaning with IPC and patient safety efforts at the participating hospitals. Despite barriers, local teams identified effective mitigation measures. While considerable time and effort will be needed to truly overcome these barriers, there are opportunities to build upon attention and momentum on this topic and IPC initiatives in resource-limited settings in low- and middle-income countries. We propose several broader actions, all of which require local leadership and context-specific approaches.

Background: The World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia.

Methods: A retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant.

Results: A total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The "Access" and "Watch" groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062-23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571-6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136-6.584) were significantly associated with antibiotic prescribing.

Conclusion: This study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from "Access" group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases.

Background: Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.

Methods: We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0-100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0-200), basic (201-400), intermediate (401-600), or advanced (601-800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.

Results: Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an "advanced" level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.

Conclusions: Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Background: Surgical site infections (SSIs) are one of the most common healthcare-associated infections and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following Caesarean Section (CS) at Queen Elizabeth Central Hospital (QECH).

Methods: This was a hospital-based quantitative prospective study design involving pregnant women who underwent a CS between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Wound specimens (wound swabs) were collected from all infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata.

Results: The overall cumulative incidence of SSI recorded at QECH during the study period was 9.61% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. All pregnant women who underwent for CS received antibiotic prophylaxis. This study revealed that 138 (66.35%) patients received both preoperative antibiotics (ceftriaxone) and post-CS antibiotics without knowing the specific bacterial organism isolated. This study revealed that ruptured membrane had twice the incidence of SSIs compared to intact membrane (χ² = 2.0922), though not statistically significant. The majority of patients with SSIs (n = 12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni.

Conclusion: The incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.

Study objective: We examined the effectiveness of an antimicrobial surface coating for continual disinfection of high touch-frequency surfaces in the emergency department (ED).

Methods: Following a preliminary observation identifying stretcher rails as the surface with highest touch-frequency in the ED, we conducted a pilot randomized controlled trial involving 96 stretcher rails. The stretchers were randomized to receive an antimicrobial surface coating or placebo coating. Routine cleaning of stretchers subsequently continued as per hospital protocol in both arms. Sampling for total aerobic, gram-positive halophilic, gram-negative and methicillin-resistant Staphylococcus aureus bacteria was performed pre- and post-treatment at 24 h, 7 days and 180 days. Individuals who applied the coating and outcome assessors were blinded to the allocated arms. The primary outcome is contamination of antimicrobial versus placebo rails measured as colony forming units per cm²(CFU/cm²).

Results: Baseline total aerobic bacteria was comparable between placebo and intervention arms (0.84 versus 1.32 CFU/cm², P = 0.235). Total aerobic bacteria contamination was significantly lower on antimicrobial versus placebo rails at 24 h (0.61 versus 1.01 CFU/cm², median difference 0.40 CFU/cm², 95% confidence interval [CI] 0.01 to 1.01 CFU/cm²). There was a non-statistically significant tendency for contamination to be lower on antimicrobial versus placebo rails at 7 days (1.15 versus 1.50 CFU/cm², median difference 0.35 CFU/cm², 95% CI -0.64 to 1.28 CFU/cm²), but higher at 180 days (2.06 versus 1.84 CFU/cm², median difference - 0.22 CFU/cm², 95% CI -1.19 to 0.78 CFU/cm²).

Conclusion: This is the first double-blinded, placebo-controlled, randomized trial to evaluate an antimicrobial surface coating on high touch-frequency surfaces in the emergency department. Total aerobic bacteria found on antimicrobial-coated patient transport stretcher rails was significantly lower than placebo rails at 24 h.

Background: The hospital wastewater system has been reported as a source of nosocomial acquisition of carbapenemase producing Enterobacteriaceae (CPE) in various settings. Cleaning and disinfection protocols or replacement of contaminated equipment often fail to eradicate these environmental reservoirs, which can lead to long-term transmission of CPE. We report a successful multimodal approach to control a New Delhi metallo-beta-lactamase positive Klebsiella pneumoniae (NDM-KP) nosocomial outbreak implicating contamination of sink traps in a low-incidence setting.

Methods: Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated P-traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication.

Results: Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Following the introduction of combined IPC measures, no new case was subsequently detected and sink traps remained negative for NDM-KP within 6 months after the intervention.

Conclusion: The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of P-traps and connecting pieces, was successful in the control of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE).

Background: To prevent cross-contamination between patients, adequate reprocessing is necessary when using flexible endoscopes (FEs) without a working channel. The current reprocessing process using an Endoscope Washer Disinfector (EWD) is time-consuming. Ultraviolet light group C (UV-C) exposition is an alternative and fast disinfection method and has previously been shown to adequately reduce Colony Forming Units (CFUs) on FEs without a working channel. The objective of this study was to examine whether UV-C light is as effective in reducing CFUs on contaminated FEs without a working channel compared to the EWD.

Methods: FEs without a working channel were collected in three different Otorhinolaryngology Departments in the Netherlands. After pharyngolaryngoscopy, a manual pre-cleaning with tap water was performed and a culture was collected by rolling the distal 8-10 cm of the FE over an agar plate. Next, the FE was randomly assigned to be disinfected with UV-C light (D60) or the EWD (gold standard). After disinfection, another culture was taken. The primary outcome was microbiological contamination, defined by Colony Forming Units (CFU).

Results: 600 FEs without a working channel were randomized. After clinical use and manual pre-cleaning, 239/300 (79.7%) FEs in the UV-C group and 262/300 (87.3%) FEs in the EWD group were contaminated (i.e., > 0 CFU). FEs without culture confirmed contamination were excluded from further analysis. After UV-C light disinfection, 195/239 (81.6%) FEs showed 0 CFUs, compared to 187/262 (71.4%) FEs disinfected with the EWD (p < 0.01). A multivariate logistics regression analysis showed an increased odds of 0 CFUs when using UV-C light (OR 1.83, 95% CI 1.19-2.79; p < 0.01), conditional on participating hospitals and types of FE.

Conclusions: UV-C light disinfection of FEs without a working channel appears more effective in reducing CFUs compared to the EWD and might be a good alternative disinfection method.

Trial registration: Not applicable.

An outbreak of OXA-23-producing carbapenem-resistant Acinetobacter baumannii amongst ICU-patients with COVID-19 likely occurred by transmission through inanimate surfaces, potentially facilitated by a contaminated positioning pillow shared between patients. Subsequent rapid spread may have been caused by exposure to respiratory secretions contaminating healthcare worker's gloves and gowns during prone positioning.