Bifurcation analysis and global dynamics of a mathematical model of antibiotic resistance in hospitals.

Effects of the COVID-19 pandemic on antibiotic use and resistance in French hospitals, 2019-22: a retrospective ecological analysis of national surveillance data.

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

Complex patterns in a space–time discrete mathematical model of antibiotic resistance in hospitals with self-diffusion

Time To Get Serious About Infection Prevention in the ICU

From February 1984 to October 1986, a total of 4369 blood cultures were obtained from patients at Basrah University Teaching Hospital. Among these, 227 (5.2%) were bacteriologically positive, givin...

BackgroundUsing mathematical deterministic models of the epidemiology of hospital-acquired infections and antibiotic resistance, it has been shown that the rates of hospital-acquired bacterial infection and frequency of antibiotic infections can be reduced by (i) restricting the admission of patients colonized with resistant bacteria, (ii) increasing the rate of turnover of patients, (iii) reducing transmission by infection control measures, and (iv) the use of second-line drugs for which there is no resistance. In an effort to explore the generality and robustness of the predictions of these deterministic models to the real world of hospitals, where there is variation in all of the factors contributing to the incidence of infection, we developed and used a stochastic model of the epidemiology of hospital-acquired infections and resistance. In our analysis of the properties of this model we give particular consideration different regimes of using second-line drugs in this process.MethodsWe developed a simple model that describes the transmission of drug-sensitive and drug-resistant bacteria in a small hospital. Colonized patients may be treated with a standard drug, for which there is some resistance, and with a second-line drug, for which there is no resistance. We then ran deterministic and stochastic simulation programs, based on this model, to predict the effectiveness of various treatment strategies.ResultsThe results of the analysis using our stochastic model support the predictions of the deterministic models; not only will the implementation of any of the above listed measures substantially reduce the incidences of hospital-acquired infections and the frequency of resistance, the effects of their implementation should be seen in months rather than the years or decades anticipated to control resistance in open communities. How effectively and how rapidly the application of second-line drugs will contribute to the decline in the frequency of resistance to the first-line drugs depends on how these drugs are administered. The earlier the switch to second-line drugs, the more effective this protocol will be. Switching to second-line drugs at random is more effective than switching after a defined period or only after there is direct evidence that the patient is colonized with bacteria resistant to the first antibiotic.ConclusionsThe incidence of hospital-acquired bacterial infections and frequencies of antibiotic resistant bacteria can be markedly and rapidly reduced by different readily implemented procedures. The efficacy using second line drugs to achieve these ends depends on the protocol used for their administration.

* Hospitals, and particularly intensive care units, are an important breeding ground for the development and spread of antibiotic resistant bacteria. This is the consequence of exposing to heavy antibiotic...

Abundant evidence suggests a relationship between antibiotic resistance and use, including animal models, consistent associations between resistance and antibiotic use in hospitals, concomitant variation in resistance as antibiotic use varies, and a dose-response relationship for many pathogen/antibiotic combinations. Much of the evidence has come from studies performed in single hospitals. Most multicentre studies on resistance have not included data on antibiotic usage. Despite this substantial body of evidence, some studies have failed to demonstrate an association between antibiotic resistance and use, suggesting other contributing factors such as cross-transmission, inter-hospital transfer of resistance, a community contribution to resistance, or a complex relationship between resistance and the use of a variety of antibiotics. A multicentre study, project ICARE (Intensive Care Antimicrobial Resistance Epidemiology), implemented in 1994 by Centers for Disease Control and Prevention and Rollins School of Public Health, Emory University, has found dramatic differences in the patterns of antibiotic usage and resistance in US hospitals. The findings suggest that antibiotic usage is the major risk factor in development of antibiotic resistance in hospitals but the relationship can be complex with additional factors involved. Understanding the problem of antibiotic resistance in a hospital cannot be achieved without knowledge of the hospital's pattern of antibiotic use.

ObjectiveHospitals serve as hotspots of antibiotic resistance. Despite several studies exploring antibiotic resistance in hospitals, none have explored the resistance profile of soil bacteria from a hospital precinct. This study examined and compared the antibiogram of the soil isolates from a hospital and its affiliated university precinct, to determine if antibiotic resistant bacteria were present closer to the hospital.Results120 soil samples were collected from JSS Hospital and JSS University in Mysore, India across three consecutive seasons (monsoon, winter and summer). 366 isolates were randomly selected from culture. Antibiotic susceptibility testing was performed on 128 isolates of Pseudomonas (n = 73), Acinetobacter (n = 30), Klebsiella species (n = 15) and Escherichia coli (n = 10). Pseudomonas species exhibited the highest antibiotic resistance. Ticarcillin-clavulanic acid, an extended-spectrum carboxypenicillin antibiotic used to treat moderate-to-severe infections, ranked highest amongst the antibiotics to whom these isolates were resistant (n = 51 out of 73, 69.9%). Moreover, 56.8% (n = 29) were from the hospital and 43.1% (n = 22) were from the university precinct, indicating antibiotic resistant bacteria were closer to the hospital setting. This study highlights the effect of antibiotic usage in hospitals and the influence of anthropogenic activities in the hospital on the dissemination of antibiotic resistance into hospital precinct soil.

Hospital infection prevention and control: A global perspective

Section 1 Perspectives: the control of infections in hospitals - 1750-1950 cost-effectiveness and cost-benefit analysis in infection control the modern infection control practitioner heath care reform and the hospital epidemiologist in the US. Section 2 Management: regulatory, accreditation, and professional agencies influencing infection control programs controversies in isolation policies and practices organizing for infection control with limited resources microbiology: the role of the clinical laboratory health psychology. Section 3 Epidemiology methods: surveillance, reporting and use of computers what to do about high endemic rates of infection epidemics: identification and management design and analytical issues in studies of infectious diseases statistics in infection control studies. Section 4 Special locations: outpatient/out of hospital care issues infection contra issues in same-day surgery extended care facilities. Section 5 Special problems: the threat of antibiotic resistance optimal use of antibiotics multidrug resistant enterococci and the threat of vancomycin-resistant staphylococcus aurous epidemiology of nosocomial tuberculosis. Section 6 Protecting employees: protecting employees from injury and infection management of exposures to infections. Section 7 Environmental issues: hospital environment for high-risk patients environment issues and nosocomial infections the operating theatre: a special environment area disinfection, sterilization and waste disposal the hospital and pollution: role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support. Section 8 Preventing specific infections: handwashing, hand disinfestation, and skin disinfestation nosocomial blood stream infections IV-related infections nosocomial pneumonia urinary tract infections surgical infections including burns perioperative antibiotic prophylaxis infection in implantable prosthetic devices nosocomial gastrointestinal infections uncommon infections of the eye prevention and control of nosocomial infections in obstetrics and gynaecology. Section 9 Special patients: infection in the newborn the paediatric patient the elderly solid-organ transplant patients bone marrow transplant patients the AIDS patient protecting recipients from blood and blood products.

Relevance. The COVID-19 pandemic has led to significant overloads in the work of health systems in many countries, a shortage of beds and staff, which contributes to a decrease in adherence to measures to prevent and control nosocomial infections, which can significantly worsen the course of viral pneumonia. Aim. To assess the possibility of the formation of hospital strains of multidrugresistant microorganisms in hospitals repurposed to provide medical care to patients with COVID-19. Materials and methods. The study included patients with severe and moderate forms of COVID-19 (ICD codes U07.1, U07.2), who were admitted to two large hospitals repurposed for the treatment of this infection. The data of microbiological studies of the biomaterial associated with the respiratory tract (sputum, bronchoalveolar lavage, tracheal aspirates) obtained from 1101 patients from May to January 2021 were analyzed using a combination of molecular genetic methods (RAPD-PCR, detection of integrons and the carbapenemase gene bla NDM.), and molecular typing of carbapenem-resistant strains of Klebsiella pneumoniae and Acinetobacter baumannii was carried out. Results. It was found that carbapenem resistant gram-negative bacteria predominate in the structure of the nosocomial microbiota of the respiratory tract of patients with COVID-19 in both hospitals. Based on molecular typing made the wide distribution of several genetic lines of integron-positive carbapenem resistant Klebsiella pneumoniae and Acinetobacter baumannii was detected. Conclusions. The COVID-19 pandemic has exacerbated the spread and circulation of bacteria with multiple antibiotic resistance in hospitals. This study has demonstrated the possibility of the formation of hospital strains of nosocomial infections in COVID-19 hospitals, which justifies the need to improve infection control measures in the context of a new coronavirus infection pandemic.

Understaffing, overcrowding, inappropriate nurse:ventilated patient ratio and nosocomial infections: which parameter is the best reflection of deficits?

A unified inter-host and in-host model of antibiotic resistance and infection spread in a hospital ward

Bacterial resistance to antibiotics is a well‐known phenomenon and the mechanisms of resistance are generally well described in the literature. In comparison, bacterial resistance to biocides (i.e. formulations with disinfectant, antiseptic and/or preservative properties) has been described more recently and has been overall little studied, although several mechanisms have been put forward in recent years. The possible linkage of biocide and antibiotic resistance in bacteria has been reported by several authors and has fuelled recent debates as to whether the use of biocides selects for antibiotic resistance. The increased number of commercially available products containing biocides for hospital and especially domiciliary uses has invigorated this debate. There is a need to reassess our understanding of the mechanism(s) of action of, and bacterial resistance to, biocides and antibiotics and to review the laboratory and field evidence on possible linkage between antibiotic and biocide resistance in non‐sporulating bacteria. This supplement contains almost all the papers presented in Swansea at the Society for Applied Microbiology summer conference entitled “Antibiotic and Biocide resistance in bacteria: perceptions and realities for the prevention and treatment of infection”. It is entirely dedicated to biocides and antibiotics and more particularly to the mechanisms of resistance associated with their use.