Effective Infection Control Research Articles

Infection prevention and control in 2030: a first qualitative survey by the Crystal Ball Initiative

BackgroundHealthcare delivery is undergoing radical changes that influence effective infection prevention and control (IPC). Futures research (short: Futures), the science of deliberating on multiple potential future states, is increasingly employed in many core societal fields. Futures might also be helpful in IPC to facilitate current education and organisational decisions. Hence, we conducted an initial survey as part of the IPC Crystal Ball Initiative.MethodsIn 2019, international IPC experts were invited to answer a 10-item online questionnaire, including demographics, housekeeping, and open-ended core questions (Q) on the “status of IPC in 2030” (Q1), “people in charge of IPC” (Q2), “necessary skills in IPC” (Q3), and “burning research questions” (Q4). The four core questions were submitted to a three-step inductive and deductive qualitative content analysis. A subsequent cross-case matrix produced overarching leitmotifs. Q1 statements were additionally coded for sentiment analysis (positive, neutral, or negative).ResultsOverall, 18 of 44 (41%) invited experts responded (from 11 countries; 12 physicians, four nurses, one manager, one microbiologist; all of them in senior positions). The emerging leitmotifs were “System integration”, “Beyond the hospital”, “Behaviour change and implementation”, “Automation and digitalisation”, and “Anticipated scientific progress and innovation”. The statements reflected an optimistic outlook in 66% of all codes of Q1.ConclusionsThe first exercise of the IPC Crystal Ball Initiative reflected an optimistic outlook on IPC in 2030, and participants envisioned leveraging technological and medical progress to increase IPC effectiveness, freeing IPC personnel from administrative tasks to be more present at the point of care and increasing IPC integration and expansion through the application of a broad range of skills. Enhancing participant immersion in future Crystal Ball Initiative exercises through simulation would likely further increase the authenticity and comprehensiveness of the envisioned futures.

Microbiological Landscape of Intensive Care Unit: A Retrospective Analysis of Bacterial Pathogens and Their Implications

Introduction: The intensive care unit (ICU) is a high-risk environment for hospital-acquired infections (HAIs) due to the complex interplay of patient vulnerability, invasive procedures, and the selective pressure of antimicrobial use. Understanding the local epidemiology of bacterial pathogens is crucial for effective infection prevention and control strategies. This study aimed to characterize the bacterial profile in an ICU setting, providing insights into the prevalent pathogens and their potential implications for patient care. Methods: A retrospective cross-sectional study was conducted, encompassing patients admitted to the ICU of Bangli Hospital Bali in 2023 and 2024. Data on patient demographics, sample sources, and microbiological findings were collected from medical records. Samples included blood cultures, sputum cultures (from both endotracheal tubes and spontaneous expectoration), wound swabs, and other sterile site cultures. Microbiological identification was performed using standard laboratory techniques. Results: A total of 219 patients were included in the study. The most common sample source was blood culture (42.9%), followed by sputum culture from endotracheal tubes (39.3%). A significant proportion of cultures showed no growth (34.7%), highlighting the challenges in identifying causative pathogens in the ICU. Among the identified pathogens, Staphylococcus spp. was predominant (15.5%), followed by Stenotrophomonas maltophilia (9.6%) and coagulase-negative staphylococci (8.7%). The distribution of pathogens varied across sample sources, with Staphylococcus spp. being prevalent in sputum cultures from endotracheal tubes and Klebsiella pneumoniae in sputum cultures. Conclusion: This study underscores the dynamic nature of the microbiological landscape in the ICU. The predominance of Staphylococcus spp., Stenotrophomonas maltophilia, and other opportunistic pathogens emphasizes the need for robust infection prevention and control measures. Further research is warranted to explore the impact of these pathogens on patient outcomes and to optimize antimicrobial stewardship in this critical care setting.

Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model.

Staphylococcus aureus [S. aureus] is a leading cause of sepsis and septic arthritis, conditions that pose significant medical challenges due to their high mortality and morbidity. No studies have used an in vivo imaging system [IVIS] to monitor S. aureus sepsis and septic arthritis. Here, we employed a bioluminescent reporter strain of S. aureus, Newman AH5016, administered intravenously to induce sepsis and intra-articularly to induce local septic arthritis in mice. Disease progression was monitored using IVIS to capture bioluminescent signals from kidneys, joints, and whole mice. Cytokines in the blood and joints were measured. The efficacy of cloxacillin treatment was evaluated. In the sepsis model, bioluminescent signals from kidneys, but not from whole mice, were correlated with kidney bacterial load and abscess formation. Ex vivo kidney imaging detected increased bacterial load and abscess formation from day 3 to day 10. Antibiotic treatment significantly reduced kidney signals, correlating with decreased bacterial counts and IL-6 levels, indicating effective infection control. In the local infection model, early-phase bioluminescent signals from joints were correlated with macroscopic arthritis and bacterial burden. Thus, signal detection from kidneys using IVIS is useful for monitoring S. aureus sepsis and assessing antibiotic efficacy, though it may only be effective for early-phase monitoring of local septic arthritis.

Molecular detection of extended-spectrum β-lactamase- and carbapenemase-producing Klebsiella pneumoniae isolates in southwest Iran.

The global emergence of carbapenem-resistant Klebsiella pneumoniae is considered a significant contemporary concern., as carbapenems are the last resort for treating infections caused by multidrug-resistant Gram-negative bacteria. This study aimed to investigate the carbapenem-resistance genes in extended-spectrum β-lactamase producing K. pneumoniae isolates. Seventy-five non-duplicate clinical K. pneumoniae strains were isolated from urine, blood, sputum, and wound samples. Antimicrobial susceptibility tests for 12 different antibiotics were performed using the disk diffusion method, followed by determining minimum inhibitory concentrations of imipenem and meropenem. Phenotypic detection of extended-spectrum β-lactamase and carbapenemase enzymes was performed by double-disc synergy test and modified Hodge test, respectively. PCR assay further investigated resistant isolates for extended-spectrum β-lactamase and carbapenemase-encoding genes. The highest and lowest resistance rates were observed against ampicillin (93.3%) and tigecycline (9.3%). According to phenotypic tests, 46.7% of isolates were positive for extended-spectrum β-lactamase enzymes and 52.8% for carbapenemase. A total of 11 isolates contained carbapenemase genes, with blaOXA-48 (19.4%; 7/36) being the predominant gene, followed by blaNDM (8.3%; 3/36). The study's findings reveal the alarming prevalence of beta-lactamase enzymes in K. pneumoniae strains. Early detection of carbapenem-resistant isolates and effective infection control measures are necessary to minimise further spread, as carbapenem resistance has become a public health concern.

Modification of carbapenemase inhibition test and comparison of its performance with NG-Test CARBA 5 for detection of carbapenemase-producing enterobacterales.

Adequately and accurately identifying carbapenemase-producing Enterobacterales (CPE) is vital for selecting appropriate antimicrobial therapy and implementing effective infection control measures. This study aims to optimize the phenotypic detection method of carbapenemase for routine diagnostics in clinical microbiology laboratories. Carbapenemase genes in 2665 non-duplicate carbapenem-resistant Enterobacterales (CRE) clinical strains collected from various regions of China were confirmed through whole-genome sequencing (WGS). The carbapenemase inhibition test (CIT) was conducted and interpreted using different methods and breakpoints, then compared with the NG-Test CARBA 5 for carbapenemase detection. The diagnostic performance of the CIT method was optimal when the carbapenemase types were determined by comparing the inhibition zone diameters of the imipenem disc with 3-aminophenylboronic acid (APB) plus ethylenediaminetetraacetic acid (EDTA) to those of the imipenem disc with either APB or EDTA alone, with a breakpoint of 4mm. The overall sensitivities of the current CIT, the modified CIT and NG-Test CARBA 5 were 91.4%, 94.9% and 99.9%, respectively. For detecting isolates co-producing Klebsiella pneumoniae carbapenemase (KPC) and metallo-β-lactamases (MBLs), the modified CIT method had higher sensitivity than the current method (70.0%vs. 53.3%), though this difference was not statistically significant (p=0.063). The NG-Test CARBA 5 showed excellent performance for multi-carbapenemases diagnosis, with sensitivity and specificity of 97.1% and 100%, respectively. Optimizing and standardizing the CIT method for clinical use is necessary. It has certain advantages in diagnosing multi-carbapenemase and rare carbapenemase production. However, for identifying common carbapenemase types, the NG-Test CARBA 5 demonstrated superior performance.

Respiratory microbiome and clinical course of carbapenem-resistant Acinetobacter baumannii pneumonia in critically Ill patients.

Carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia has been a serious problem in the intensive care unit (ICU). However, defined characteristics of respiratory microbiome in CRAB pneumonia are lacking nowadays. This study aimed to analyze respiratory microbiome of CRAB pneumonia compared to non-CRAB pneumonia and reveal the clinical significance of respiratory microbiome data in these patients. Patients diagnosed with severe pneumonia with mechanical ventilation were enrolled in the ICU of a tertiary care hospital. Respiratory specimens were collected on days 1, 4, 7, and 14 in each participant via tracheal aspiration. Clinical data and outcomes of each enrolled patient were collected via electronic medical records. Microbiome analysis was conducted with collected respiratory specimens undergone by next-generation sequencing of microbial 16S ribosomal DNA. Six CRAB pneumonia, 4 non-CRAB pneumonia and 5 healthy controls were enrolled. In CRAB pneumonia, CRAB was detected in 3 patients by sputum culture at day 1, while it was negative at day 1 and detected later in the others by follow-up sputum culture. Beta diversity plot analysis showed differences between each group. Shannon index was decreased markedly at day 4 in CRAB pneumonia compared to the others. Among CRAB pneumonia cases, 3 respiratory specimens were culture-negative, but positive by microbiome analysis. Lower respiratory microbiome in CRAB pneumonia had distinct characteristics and early loss of diversity compared to non-CRAB pneumonia, which might be related to poor clinical course. Moreover, CRAB acquisition and colonization would be predicted by preemptive microbiome analysis, which will contribute to effective infection control in the ICU.

Central Nervous System Infection with Hypervirulent Klebsiella pneumoniae

Hypervirulent Klebsiella pneumoniae (hvKp) infections are being increasingly reported globally, and cause severe central nervous system (CNS) and multiorgan infections even in immunocompetent individuals. The recent emergence of hvKp antibiotic resistance has generated escalating concern about effective infection control for this potentially neuroinvasive pathogen. Herein, we report two cases of Klebsiella pneumoniae-related CNS infection, including one patient with antimicrobial-resistant hvKp, confirmed by string test that demonstrated a hypermucoviscous phenotype.

Early Candida colonisation impact on patients and healthcare professionals in an intensive care unit.

Candida spp. is an opportunistic pathogen that causes superficial and invasive infections with nosocomial outbreaks without strict hygiene protocols. Herein, we assessed oral colonisation by Candida spp. in 209 Intensive Care Unit (ICU) patients between July 2021 and April 2022, conducting clinical, epidemiological, and microbiological characterisation of those developing oral or invasive candidiasis. Initial oral swabs were collected within 24 h of admission in the ICU, followed by collections on Days 2, 4, 6 and 8. Swabs from denture-wearing patients, abiotic surfaces, healthcare professionals' hands, and retroauricular regions were also obtained. Recovered yeasts and filamentous fungi were identified using MALDI-TOF MS and morphological characteristics, respectively. Genetic similarity of Candida spp. isolates was evaluated using Amplified fragment length polymorphism (AFLP), and the antifungal susceptibility profile was determined by broth microdilution. In the study, 64.11% of patients were orally colonised by Candida spp. Of these, 80.59% were colonised within the first 24 h. Oral colonisation also occurred on subsequent days: 50%/Day 2, 26.92%/Day 4, and 11.53%/Days 6 and 8. Of the patients, 8.61% had oral candidiasis, mainly pseudomembranous. Among orally colonised patients, 2.23% developed invasive candidiasis. Besides, 89.47% of healthcare professionals evaluated were colonised. MALDI-TOF MS identified different yeast species, and C. albicans (45.34%), C. tropicalis (15.7%), and C. parapsilosis sensu stricto (9.88%) were the most prevalent. AFLP analysis indicated a high genetic correlation (≥97%) between C. parapsilosis sensu stricto isolates from patients and professionals. Three resistant C. albicans isolates were also found. This study reported a diversity of yeast and filamentous fungi species in ICU patients and highlighted early Candida spp. colonisation risks for invasive candidiasis, as well as the potential horizontal transmission in the nosocomial setting, emphasising the need for effective infection control measures.

Cilostazol is a promising anti-pseudomonal virulence drug by disruption of quorum sensing

Resistance to antibiotics is a critical growing public health problem that desires urgent action to combat. To avoid the stress on bacterial growth that evokes the resistance development, anti-virulence agents can be an attractive strategy as they do not target bacterial growth. Quorum sensing (QS) systems play main roles in controlling the production of diverse virulence factors and biofilm formation in bacteria. Thus, interfering with QS systems could result in mitigation of the bacterial virulence. Cilostazol is an antiplatelet and a vasodilator FDA approved drug. This study aimed to evaluate the anti-virulence activities of cilostazol in the light of its possible interference with QS systems in Pseudomonas aeruginosa. Additionally, the study examines cilostazol’s impact on the bacterium’s ability to induce infection in vivo, using sub-inhibitory concentrations to minimize the risk of resistance development. In this context, the biofilm formation, the production of virulence factors and influence on the in vivo ability to induce infection were assessed in the presence of cilostazol at sub-inhibitory concentration. Furthermore, the outcome of combination with antibiotics was evaluated. Cilostazol interfered with biofilm formation in P. aeruginosa. Moreover, swarming motility, biofilm formation and production of virulence factors were significantly diminished. Histopathological investigation revealed that liver, spleen and kidney tissues damage was abolished in mice injected with cilostazol-treated bacteria. Cilostazol exhibited a synergistic outcome when used in combination with antibiotics. At the molecular level, cilostazol downregulated the QS genes and showed considerable affinity to QS receptors. In conclusion, Cilostazol could be used as adjunct therapy with antibiotics for treating Pseudomonal infections. This research highlights cilostazol’s potential to combat bacterial infections by targeting virulence mechanisms, reducing the risk of antibiotic resistance, and enhancing treatment efficacy against P. aeruginosa. These findings open avenues for repurposing existing drugs, offering new, safer, and more effective infection control strategies.

Burden of Multidrug-Resistant Gram-Negative Bacterial Infections in a Tertiary Care Hospital

Multidrug-resistant (MDR) Gram-negative bacterial infections have emerged as a major public health concern. The aim of the present study was to detect the rate of infections due to MDR Gram-negative bacteria (GNB) in a tertiary care hospital, the rate of Carbapenemases and AmpC-β-lactamases production and the Antimicrobial susceptibility test pattern (AST) among MDR GNB. The rate of MDR GNB during the study period was 25.70%. Urine samples showed the highest contribution to the total MDR GNB. Among the total MDR GNB isolates, 166 were randomly selected and included in the present study. A higher rate of MDR GNB was reported among male patients (61.5%) compared to the females (38.5%) and most of them were from the patients aged between 61-70 years (30.7%). The most prevalent MDR GNB was Klebsiella pneumoniae 80 (48.12%), followed by Escherichia coli 43 (25.9%). AST of MDR GNB revealed their significant resistance to β-lactamases/β-lactamases inhibitors, cephalosporins, fluoroquinolones and carbapenem drugs (98%). Of 123 MDR Enterobacterales, 83% of them were found to be Metallo β-lactamase (MBLs) producers by mCIM and eCIM methods. Of 43 MDR non-fermenters, 29 (67.4%) of them were found to be carbapenemase producers by MHT. About 29.51% of MDR GNB isolates were found to be AmpC producers by AmpC disk test. A reliable and rapid phenotypic method to detect carbapenemases and AmpC β-lactamases among MDR GNB in a routine microbiology laboratory method is clinically important to guide antibiotic therapy and implementation of effective infection control practices.

Investigating the pro-inflammatory differentiation of macrophages with bacterial ghosts in potential infection control.

In the complex realm of bacterial infections, particularly those caused by Staphylococcus aureus (S. aureus), macrophages play a pivotal role in orchestrating the immune response. During the initial stages of infection, the monocytes give rise to macrophages with a pro-inflammatory (M1 type) behaviour, engulfing and neutralizing the invading pathogens. However, under the sustained influence of S. aureus infection, monocytes can undergo a transition into an anti-inflammatory M2 state (pro-infection) rather than the M1 state (anti-infection), thereby compromising effective infection control. Therefore, it is necessary to develop a strategy that would preserve the pro-inflammatory functions of macrophages, in a safe and controlled manner. For this, we focused on harnessing the potential of S. aureus-derived ghost cells (GCs) which are non-live empty envelopes of bacterial cells, but with the antigenic determinants intact. Through a unique Lugol's-iodine treatment, we generated GCs and characterization of these GCs using gel electrophoresis, FTIR, flow cytometry, TEM, and SEM confirmed their structural integrity. Following this, we assessed the extend of cellular association of the GCs with RAW267.4 macrophages, and observed an immediate interaction between the two, as evident from the flowcytometry and microscopy studies. We then performed macrophage polarisation on a human monocyte-macrophage model cell line, THP-1. Our findings revealed that GCs effectively activated macrophages, and promoted a pro-inflammatory polarisation with the expression of M1 differentiation markers (CD86, TNFα, IL-1β, IL-6, IL-12) evaluated through both qPCR and ELISA. Interestingly an intermediary expression of M2 markers viz., CD206 and IL-10 was also observed, but was overruled by the enhanced expression of M1 markers at a later time point. Overall, our study introduces a novel approach utilizing GCs to guide naïve macrophages towards M1 subtypes, thereby potentiating immune responses during microbial infections. This innovative strategy can modulate macrophage function, ultimately improving outcomes in S. aureus infections and beyond.

Late-onset sepsis in newborns caused by Bacillus Cereus: a case report and literature review

Bacillus cereus is a bacterium capable of causing late-onset neonatal sepsis. By analyzing 11 cases, this study investigates the diagnosis, treatment, and prognosis of Bacillus cereus infections, aiming to provide insights into clinical diagnosis and therapy. The study scrutinized 11 instances of late-onset neonatal sepsis, including two fatalities attributable to Bacillus cereus, one accompanied by cerebral hemorrhage. An examination and analysis of these cases’ symptoms, signs, laboratory tests, and treatment processes, along with a review of related literature from 2010 to 2020, revealed a high mortality rate of 41.38% in non-gastrointestinal infections caused by Bacillus cereus. Our findings underscore the critical importance of rapid diagnosis and effective antimicrobial therapy in reducing mortality rates. Once the source of infection is identified, implementing effective infection control measures is essential.

A reaction–diffusion model of major emerging infectious diseases in a spatially heterogeneous environment and case study

During the outbreak of major emerging infectious diseases, virus droplets can survive in the environment as aerosols for hours to days, and their impact on human infectious diseases is often overlooked. In addition, the speed of transmission of infectious diseases is often closely related to transportation. Therefore, studying the impact of environmental viruses and transportation on disease development is significant for effective infectious disease prevention and control. We proposed a degenerate reaction–diffusion infectious disease model ([Formula: see text]) considering environmental virus interference and established a well-posedness and threshold system for this model. We have obtained the system solution approaches the disease-free equilibrium ([Formula: see text]) when the basic reproduction number [Formula: see text]. The system has at least one positive steady state solution (PSS) when [Formula: see text]. This paper used a non-standard finite difference method discretization model while data fitting and parameter estimation were performed based on data provided by the Health Commission. Further sensitivity analysis was conducted on [Formula: see text]. At the same time, we also discussed the impact of various parameters in the early stages of the outbreak of major emerging infectious diseases on the development of the disease. Research found that even if the contact rate between people is controlled at a shallow level, the disease may persist. In the early stages of major emerging outbreak of infectious diseases, immediately reducing the use of transportation can effectively reduce the speed of disease spread.

Biofilm Formation and Antibiotic Resistance Profiles in Carbapenemase-Producing Gram-Negative Rods-A Comparative Analysis between Screening and Pathological Isolates.

(1) Background: Carbapenem-resistant (CR) bacteria pose a significant global public health challenge due to their ability to evade treatment with beta-lactam antibiotics, including carbapenems. This study investigates the biofilm-forming capabilities of CR clinical bacterial isolates and examines the impact of serum on biofilm formation. Additionally, the study evaluates the resistance profiles and genetic markers for carbapenemase production. (2) Methods: Bacterial isolates were collected from the microbiology laboratory of Mures County Clinical Hospital between October 2022 and September 2023. Pharyngeal and rectal swabs were screened for carbapenem-resistant bacteria using selective media. Lower respiratory tract samples were also analyzed for CR Gram-negative bacteria. The isolates were tested for their ability to form biofilms in the presence and absence of fetal bovine serum at 24 and 48 h. Carbapenemase production was detected phenotypically and confirmed via PCR for relevant genes. (3) Results: Out of 846 screened samples, 4.25% from pharyngeal swabs and 6.38% from rectal swabs tested positive for CR bacteria. Acinetobacter baumannii and Klebsiella pneumoniae were the most common species isolated. Biofilm formation varied significantly between clinical isolates and standard strains, with clinical isolates generally showing higher biofilm production. The presence of serum had no significant effect on biofilm formation in Klebsiella spp., but stimulated biofilm formation for Acinetobacter spp. Carbapenemase genes blaKPC, blaOXA-48-like, and blaNDM were detected in various isolates, predominantly in Klebsiella spp., but were not the main determinants of carbapenem resistance, at least in screening isolates. (4) Conclusions: This study highlights the variability in biofilm formation among CR clinical isolates and underscores the differences between the bacteria found as carriage versus infection. Both bacterial species and environmental factors variably influence biofilm formation. These insights are crucial for the development of effective treatment and infection control strategies in clinical settings.

Combinational therapy of mesenchymal stem cell-derived extracellular vesicles and azithromycin improves clinical and histopathological recovery in CLP sepsis model

BackgroundSepsis is a syndrome that occurs following an infection and marked by severe inflammatory responses, and if not treated in time, it can lead to multi-organ failure syndrome and death. This study examines the effects of a novel combination therapy using azithromycin and mesenchymal stem cell-derived extracellular vesicles (EVs) on a cecal ligation and puncture (CLP) model of sepsis. MethodsHuman Wharton’s jelly-mesenchymal stem cells were cultured, characterized, and used to extract EVs. The CLP sepsis model was induced in mice, followed by treatments: saline, AZM, EVs, and combination therapy (A+E). Clinical sepsis scores were recorded 24 h post-treatment. Serum, peritoneal fluid, and organ tissues (kidney, liver, lung) were collected and analyzed for biochemical parameters (AST ALT, and creatinine), inflammatory markers, bacterial load, and histopathological changes. ResultsThe A+E combined treatment improved the clinical scores of septic mice. The administration of A+E reduced bacterial loads in the peritoneum of septic mice, contributing to effective control of infection. Inflammatory markers of neutrophils-to-lymphocytes ratio (NLR) and TNF-α serum levels were significantly lower in the combinational therapy group, indicating significant anti-inflammatory effect of this combination. Additionally, combination of AZM and EVs alleviated organ damage mainly within liver, kidneys and lungs. Based on histopathological assessments and biochemical parameters, there was diminished tissue damage as well as reduced inflammation, which is correlated with improved functions of these vital organs. ConclusionThe combined use of azithromycin and EVs offers a promising therapeutic approach for sepsis by effectively controlling infection and modulating the inflammatory response.

Staphylococcus aureus: changes in antimicrobial sensitivity profile and its relationship with SCCmec among clinical isolates

Background and Objectives: Staphylococcus aureus is a pathogen of great clinical relevance, especially those resistant to methicillin, called MRSA. Over the years, S. aureus antimicrobial resistance patterns have changed. Understanding such changes is essential to update protocols and propose efficient therapeutic approaches. This study aimed to characterize the temporal distribution of S. aureus antimicrobial resistance in patients admitted to the hospital as well as to assess its relationship with SCCmec typing. Methods: a total of 9,949 cultures of clinical materials were analyzed, between January 2000 and October 2019, from patients admitted to a university hospital in southern Brazil. All isolates had their identification and antimicrobial sensitivity profile analyzed using manual and automated techniques. Furthermore, 86 isolates were selected for mecA gene research and SCCmec typing using conventional and multiplex PCR techniques, respectively. Results: when assessing the temporal distribution of S. aureus over 20 years, it was possible to observe a drop in the proportion of MRSA compared to methicillin-sensitive S. aureus (MSSA). Between 2000 and 2002, the frequency of MRSA was 58.5%, whereas that of MSSA was 36.7%. However, from 2003 onwards, there was a reversal of these percentages. At the end of the analyzed period, 55.2% of infections were caused by MSSA, whereas 36.2% contained MRSA isolates. Furthermore, in the period analyzed, the highest prevalence was of SCCmectype II. Conclusion: these data suggest an epidemiological change in S. aureus from clinical materials, with a change in the prevalent type of SCCmec and changes in the antimicrobial sensitivity profile exhibited by the isolates. Such facts must be considered by the clinical staff with a focus on effective patient management, the choice of appropriate antimicrobial therapy so that effective infection control measures are implemented.

Radiation to Chemicals Unpacking Occupational Safety Hazards in Educational Hospital through the HOSHRA Lens

Objective: The current study evaluates occupational safety and health risks in educational hospitals using the Hoshra index by concentrating on the detection and control of frequent hazards.Methods: Using a structured approach, the HOSHRA index classifies risks in to physical, chemical, biological, ergonomic and psychological domains. The framework supports targeted risk scoring, improving the efficiency with which hospitals can allocate resourcesFindings: The analysis uncovers important types of healthcare worker hazards. Biological and psychological risks appear to be particularly suboptimal, emphasizing the importance of effective infection control interventions, as well as psychological care. The study underscores the need to have a culture of safety that supports hazard reporting and management.Novelty: This is one of the first to use the HOSHRA index in many educational hospital, introducing new methods for risk analysis and assessment beyond traditional classic styles.Research Implications: The results highlight the need for adapted and risk based strategies in healthcare settings. Healthcare organizations can improve the well-being of staff and, by extension, patient care outcomes, by aligning safety protocols with the unique features of wards.

Clinical and microbiological characteristics of a hospital outbreak of Candida auris in a referral hospital in Lima, Peru.

Candida auris, a multidrug-resistant fungal pathogen, has received considerable attention owing to its recent surge, especially in South America, which coincides with the ongoing global COVID-19 pandemic. Understanding the clinical and microbiological characteristics of outbreaks is crucial for their effective management and control. This retrospective observational study aimed to characterize a C. auris outbreak at a Peruvian referral hospital between January 2021 and July 2023. Data were collected from hospitalized patients with positive C. auris culture results. Microbiological data and antifungal susceptibility test results were analysed. Additionally, infection prevention and control measures have been described. Statistical analysis was used to compare the characteristics between the infected and colonized patients. Thirty-three patients were identified, mostly male (66.7%), with a median age of 53 years. Among them, 18 (54.5%) were colonized, and 15 (45.5%) were infected. Fungemia was the predominant presentation (80%), with notable cases of fungemia in tuberculosis patients with long-stay devices for parenteral anti-tuberculosis therapy. Seventy-five percent of the isolates exhibited fluconazole resistance. Echinocandins were the primary treatment, preventing fungemia recurrence within 30 days. Infected patients had significantly longer hospital stays than colonized patients (100 vs. 45 days; p = .023). Hospital mortality rates were 46.7% and 25% in the infected and fungemia patients, respectively. Simultaneous outbreaks of multidrug-resistant bacteria were documented. This study underscores the severity of a C. auris outbreak at a referral hospital in Peru, highlighting its significant impact on patient outcomes and healthcare resources. The high prevalence of fluconazole-resistant isolates, leading to prolonged hospital stay and high mortality rates, particularly in cases of fungemia, underscores the critical need for effective infection prevention and control strategies.

Distribution of Carbapenemase Genes among Carbapenem-Resistant Klebsiella pneumoniae Isolates from the Patients in Najaf, Iraq

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global threat, causing serious community- and hospital-acquired infections with limited treatment options. Understanding the local epidemiology of CRKP is crucial for guiding antimicrobial stewardship and infection control measures. This study aimed to investigate the phenotypic characteristics, antimicrobial resistance profiles, and carbapenemase genes among CRKP isolates from the patients in Najaf, Iraq. Methods: This cross-sectional research was performed at diverse hospitals and centers in Najaf, Iraq, from September 2023 to March 2024. The study was approved by the Ethics Committee of Kufa University. CRKP isolates were collected from various health-care facilities and tested for hypermucoviscosity, antimicrobial susceptibility, and carbapenemase production using phenotypic methods. The presence of carbapenemase genes (blaNDM, blaVIM, blaKPC, blaOXA-48, blaOXA-23, and blaOXA-51) was examined by polymerase chain reaction. Results: Of the 27 CRKP isolates, 9 (33.3%) exhibited a hypermucoviscous phenotype. Regarding antimicrobial resistance, 12 (44.4%) were multidrug resistant, 14 (51.9%) were extensively drug resistant, and 1 (3.7%) was pandrug resistant. Phenotypic carbapenemase production was detected in 5 (18.5%) and 11 (40.7%) isolates by the modified Hodge test and E-test metallo-β-lactamase strips, respectively. Molecular analysis revealed that all CRKP harbored the blaOXA-51 gene, whereas blaNDM, blaOXA-23, and blaVIM were detected in 70.4%, 40.7%, and 11.1% of the isolates, respectively. Neither blaKPC nor blaOXA-48 genes were found. In addition, 22 (81.5%) isolates carried multiple carbapenemase genes. Conclusions: The high prevalence of blaOXA-51 and blaNDM carbapenemases, along with the high rates of multidrug resistance among CRKP isolates in Najaf, Iraq, are alarming. This necessitates the immediate implementation of effective antimicrobial stewardship and infection control measures to prevent the further spread of these difficult-to-treat pathogens.

Genomic Study of High-Risk Clones of Enterobacter hormaechei Collected from Tertiary Hospitals in the United Arab Emirates.

Enterobacter hormaechei has emerged as a significant pathogen within healthcare settings due to its ability to develop multidrug resistance (MDR) and survive in hospital environments. This study presents a genome-based analysis of carbapenem-resistant Enterobacter hormaechei isolates from two major hospitals in the United Arab Emirates. Eight isolates were subjected to whole-genome sequencing (WGS), revealing extensive resistance profiles including the blaNDM-1, blaOXA-48, and blaVIM-4 genes. Notably, one isolate belonging to ST171 harbored dual carbapenemase genes, while five isolates exhibited colistin resistance without mcr genes. The presence of the type VI secretion system (T6SS), various adhesins, and virulence genes contributes to the virulence and competitive advantage of the pathogen. Additionally, our isolates (87.5%) possessed ampC β-lactamase genes, predominantly blaACT genes. The genomic context of blaNDM-1, surrounded by other resistance genes and mobile genetic elements, highlights the role of horizontal gene transfer (HGT) in the spread of resistance. Our findings highlight the need for rigorous surveillance, strategic antibiotic stewardship, and hospital-based WGS to manage and mitigate the spread of these highly resistant and virulent pathogens. Accurate identification and monitoring of Enterobacter cloacae complex (ECC) species and their resistance mechanisms are crucial for effective infection control and treatment strategies.