Antimicrobial Resistance and Infection Control最新文献

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.

We report the long-term impact of a multifaceted intervention bundle containing nine measures to reduce the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients admitted to the intensive care division at Geneva University Hospitals over a prolonged follow-up period of more than seven years, including the COVID-19 pandemic. The original study included a follow-up of 11 months and showed a marked decrease in VAP incidence. We compared the five pre-defined time periods (pre-intervention, intervention, post-intervention, prolonged follow-up, and COVID-19 pandemic period) using a Poisson model. The incidence of VAP per 1000 ventilator days reduced from 24.3 (95% confidence interval [CI] 18.8-30.9) in the pre-intervention period to 3.9 (95%CI 2.0-6.8) in the post-intervention period. During the prolonged follow-up and the COVID-19 pandemic periods, VAP incidence per 1000 ventilator-days remained similar as in the initial post-intervention period with 4.0 (95%CI 2.9-5.4) and 3.7 (95%CI 2.8-4.7), respectively. Adherence to the bundle measures was assessed using the monthly percentage of correct observations and shown overall for each of the five time periods. Adherence to all but two bundle measures (oral care and hand hygiene) remained high or even improved during the prolonged follow-up period. In conclusion, after implementing a VAP prevention bundle in 2014, there was a sustained effect on VAP incidence during a 7-year follow-up, including the COVID-19 pandemic period.

In July 2025, Nigeria announced it would host the 5th Global High-Level Ministerial Conference on Antimicrobial Resistance (AMR) in Abuja in June 2026, the first such meeting in Africa. This comes at a critical moment, as AMR causes 1.27 million deaths annually and contributes to 5 million associated deaths worldwide. In Nigeria, AMR accounted for 64,500 direct deaths in 2021 and substantial economic losses. Previous commitments, including the Muscat Manifesto (2022) and Jeddah Commitments (2024), set ambitious targets, but implementation remains limited. The Abuja meeting offers an opportunity to reposition global AMR governance toward actionable, equitable outcomes. Key priorities include adopting an Abuja Outcome Document with measurable targets, securing sustainable financing, integrating stewardship into health and agricultural programmes, and advancing One Health surveillance. To ensure accountability, an annual AMR scorecard with comparable indicators and financing mechanisms is proposed. Centering African leadership and representation will be essential for translating rhetoric into results.

Background: Surgical Site Infection (SSI) surveillance efforts in sub-Saharan Africa have largely been documented in research settings. Such programs need to be institutionalized within routine healthcare settings for sustainability. We evaluate the feasibility of setting up an SSI surveillance and prevention program within public settings in Kenya.

Methods: Facility infection prevention and control (IPC) committees were established, trained, and resourced on SSI surveillance and prevention in two large hospitals in Kenya. A surgical checklist and monitoring form assessing surgical care bundle implementation and wound status before discharge was included in the medical charts of women who had cesarean section (CS) deliveries. Post-discharge wound assessment interviews were targeted for completion 14-30 days after surgery. Data were analyzed using descriptive statistics and chi-square tests (χ²) for differences.

Results: The program enrolled 1,039 women undergoing CS. Only 65% (675/1039) were reached for any post-discharge wound assessment, with 28% (186/675) reached within the targeted 30 days. Of these, 7% (12/186) had an SSI. Six of these women (6/37 = 16%) were identified within 14 days post-operatively while the remaining six (6/149 = 4%) were identified 15-30 days post-operatively. Surgical care bundle implementation differed by site, with pre-operative antibiotic use at 100% in Thika vs. 66% in Kitale, with variation in the antibiotics used. Blood glucose monitoring at 23 vs. 32% respectively. Hair removal was low overall at 2%.

Conclusion: While setting up an SSI surveillance and prevention program is feasible, efforts and resources targeting post-discharge follow-up and case finding should be prioritized. National guidelines standardizing surgical antibiotic prophylaxis are needed as part of antimicrobial stewardship programs.

Background: Antimicrobial resistance (AMR) is a critical global health challenge, linked to 4·71 million deaths in 2021 and affecting human health, animals, food, plants, and the environment. This scoping review aims to map out published interventions addressing AMR in the Latin America and Caribbean (LAC) region.

Methods: We searched PubMed, Web of Science, LILACS, and grey literature for articles reporting the implementation of AMR programs, interventions, or policies aimed at tackling AMR published between January 2018 and December 2024.

Results: A total of 82 studies were included, comprising 64 peer-reviewed articles and 18 from grey literature. The majority (n = 75) focused on human health, while a smaller subset (n = 7) addressed animal health. Geographically, most studies were conducted in Brazil (n = 32) and Colombia (n = 22) with only one study in the Caribbean. Antimicrobial stewardship interventions were the primary focus in 50 studies. Only 53 out of 74 studies included an evaluation of the intervention.

Conclusion: Significant gaps remain in AMR research in LAC, particularly in animal and environmental health. Rigorous intervention evaluations are needed to generate high-quality evidence for policy and practice. Increased funding for intervention and implementation research across all sectors is crucial to tackling AMR regionally and globally.

Background: Antimicrobial resistance (AMR) is increasing worldwide, undermining strides in public health and the economy, particularly in low- and middle-income countries. Africa is the continent with the highest death rate attributed to antimicrobial-resistant infections. There is a lack of information on AMR mitigation strategies and their implementation in the region. The aim of this study was to analyze national strategies to tackle AMR with focus on AMR surveillance in the East African Community (EAC) and their implementation status including the analysis of strengths, weaknesses, opportunities, and threats.

Methods: Within our expert group (composed of representatives from the National Public Health Laboratories (NPHL), Ministries of Health of Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda) we used a qualitative approach to analyze AMR National Action Plans (NAPs), AMR surveillance programs, publications and reports on the AMR situation and strategies in the EAC.

Results: We found varying levels of implementation of antimicrobial resistance (AMR) strategies among East African Community (EAC) Partner States. For example, progress in key steps for the sustainable implementation of National Action Plans on AMR (AMR-NAPs) ranged from 7% in Burundi to 94% in Kenya. The overall accomplishment of the WHO checklist for AMR surveillance also varied: 44% in South Sudan, 61% in Burundi, 89% in Rwanda, 94% in Tanzania, and 100% in both Uganda and Kenya. Within EAC Partner States, the detection of bacterial pathogens and their antimicrobial susceptibility profiles is coordinated by national reference laboratories. Most EAC countries have established AMR surveillance systems. However, challenges such as limited laboratory testing capacity, low representativeness of surveillance data, lack of integration among existing systems, and financial constraints undermine efforts to curb AMR.

Conclusions: Regional collaboration among EAC Partner States is essential for an effective and sustainable response to antimicrobial resistance. Strengthening joint efforts will enable countries to share resources, harmonize surveillance systems, and address common challenges more efficiently. The EAC Regional Network of Reference Laboratories is one example of a regional mechanism that can support such collaboration. The findings of this study will inform the development of a regional AMR strategy focused on laboratory-based surveillance and help guide the prioritization of technical and financial support across the EAC region.

The emergence of multidrug-resistant organisms (MDROs) represents a significant challenge for global healthcare systems. The Netherlands maintains one of the lowest antimicrobial resistance rates in the world, attributed to prudent antibiotic use and effective infection prevention and control policies in healthcare settings. This report presents an updated national guideline for the infection prevention and control of MDROs in hospitals, developed by the Dutch Collaborative Partnership for Infection Prevention Guidelines (SRI). Using a multidisciplinary approach and evidence-based frameworks such as AGREE-II and GRADE, the guideline addresses the definition of MDRO, risk assessment and recommendations for MDRO screening, isolation and infection prevention measures, source and contact tracing, discontinuation of isolation measures, and organization of care. It incorporates new evidence, and other aspects such as patient perspectives, sustainability, costs, and organizational factors, providing practical recommendations to mitigate MDRO transmission. This update aims to strengthen national infection control practices and sustain the Dutch low antimicrobial resistance levels.

Background: Antimicrobial resistance (AMR) is a global health crisis, but its burden is magnified in conflict-affected, resource-limited settings. We present the first national-scale assessment of AMR in Palestinian hospitals, characterizing prevalence patterns and identifying demographic and clinical predictors of multidrug resistance (MDR).

Methods: This cross-sectional study examined 10,007 unique bacterial isolates from thirteen West Bank governmental hospitals (January-December 2023). Bacterial identification and antimicrobial susceptibility testing adhered to Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Multidrug-resistant (MDR) organisms were defined as resistant to ≥ 3 antimicrobial classes. Binary logistic regression identified demographic and clinical predictors of MDR.

Results: Of 10,007 bacterial isolates, 36.7% were MDR, with the highest rates observed in Acinetobacter baumannii (76.4%), ESBL-producing Klebsiella pneumoniae (69.2%), and ESBL-producing Escherichia coli (58.3%). Staphylococcus aureus had a 29.5% MDR rate. Elderly patients (≥ 65 years) had the highest MDR (48.4%; adjusted OR 1.85, 95% CI 1.61-2.13, p < 0.001). Hospital-specific MDR rates ranged from 24.0 to 64.4%.

Conclusions: Palestine faces a critical MDR burden, necessitating urgent antibiotic regulation, enhanced stewardship, and standardized diagnostics to mitigate AMR in this and similar conflict-affected settings.

Background: Colistin-carbapenem combination therapy is frequently used for carbapenem-resistant Gram-negative infections, but its impact on subsequent acquisition of carbapenem-resistant Enterobacterales (CRE) requires further investigation. We evaluated the incidence of CRE acquisition and performed molecular characterization of recovered isolates following treatment with colistin-meropenem versus colistin monotherapy.

Methods: This analysis addressed a pre-specified secondary aim of the AIDA multicenter randomized controlled trial, which compared colistin monotherapy to colistin-meropenem combination therapy for carbapenem-resistant Gram-negative infections at six hospitals in Israel, Greece, and Italy. Rectal swabs were obtained at enrollment and weekly until day 28 or discharge. Swabs were processed centrally by plating onto MacConkey agar supplemented with imipenem to selectively isolate CRE. Recovered colonies were identified using MALDI-TOF mass spectrometry, and meropenem minimum inhibitory concentrations (MICs) were determined by broth microdilution. Clinical cultures were obtained as indicated and processed locally, and CRE isolates were sent to the central laboratory for confirmation and characterization. Whole-genome sequencing was used to determine sequence types and resistance genes. Patients were excluded if they had CRE detected at baseline, either by rectal culture or as the index clinical isolate, or if no follow-up rectal cultures were available.

Results: Among 197 eligible patients (99 colistin; 98 colistin-meropenem), CRE acquisition occurred in 6 (3.0%): 1/99 (1.0%, 95% CI 0.03-5.5%) in the monotherapy arm and 5/98 (5.1%, 95% CI 1.7-11.5%) in the combination arm (p = 0.12). Two patients in the combination arm developed clinical infections caused by CRE (bacteremia and pneumonia); none occurred in the monotherapy arm. Carbapenemase genes were detected in four of the six acquired CRE isolates: one in the monotherapy arm (bla_VIM) and three in the combination arm (all bla_KPC). Identified species included Klebsiella pneumoniae and Escherichia coli belonging to established and emerging high-risk, multidrug-resistant clones.

Conclusions: Patients treated with colistin-meropenem had a higher, though not statistically significant, rate of CRE acquisition. Early detection of high-risk CRE clones highlights the need to weigh potential unintended consequences when selecting combination regimens for multidrug-resistant infections.

Trial registration: AIDA trial was registered with ClinicalTrials.gov, number NCT01732250 (submitted 19-11-2012).

Objective: The aim was to develop a comprehensive system of hand hygiene (HH) indicators for environmental services (EVS) staff in medical institutions, thereby providing clear guidelines on the appropriate moments for EVS staff to perform HH, offering monitoring and feedback metrics for their HH practices, and utilizing the collected monitoring data to evaluate the effectiveness of these practices and serve as a basis for implementing improvement measures.

Methods: We conducted non-participant observations to document the workflows of EVS staff across 38 clinical departments within a single tertiary hospital in China, creating a textual corpus. Utilizing the Latent Dirichlet Allocation (LDA) modeling, we identified thematic work tasks for EVS staff in medical settings. We analyzed HH protocols based on standard operating procedures for each task and synthesized these with literature insights to derive HH guidelines for EVS staff. The Delphi method was employed to refine these guidelines and establish their relative importance through hierarchical analysis.

Results: Our research identified and labeled twelve themes of janitorial tasks. Through a meticulous examination and extraction process based on detailed standard operating procedures for each task, we delineated seven HH moments for EVS staff: before handling clean items, before cleaning or disinfection, before donning personal protective equipment (PPE), before doffing PPE, after cleaning or disinfection, after touching highly contaminated surfaces or items, and after doffing PPE. Following two rounds of Delphi consultation, experts reached a consensus and five indicators were retained based on importance, feasibility, and coefficient of variation. The final HH indicators for healthcare EVS staff, ranked by importance, included: after touching highly contaminated surfaces or items, before handling clean items, after cleaning or disinfection, before cleaning or disinfection, and after doffing PPE.

Conclusion: The formulation of HH indicators for cleaning personnel not only clarifies when and under what circumstances HH should be performed but also fosters further advancements in HH management for EVS staff.