Healthcare-related Infections Research Articles

Anti-Inflammatory Benefits of Vitamin D and Its Analogues against Glomerulosclerosis and Kidney Diseases

Apart from the significant progress the scientific community has made during the last few decades, inflammation-mediated kidney-related diseases like chronic and diabetic kidney diseases (CKD and DKD) and glomerulosclerosis still continue to raise mortality rates. Recently, conventional therapeutic interventions have been put aside, since natural vitamin D-derived treatment has gained attention and offered several promising outcomes. Within this article, the utilization of vitamin D and its analogues as potential treatment toward kidney-related diseases, due to their anti-inflammatory, antioxidant and anti-fibrotic activity, is outlined. Vitamin D analogues including calcitriol, paricalcitol and 22-oxacalcitriol have been previously explored for such applications, but their hidden potential has yet to be further elucidated. Several clinical trials have demonstrated that vitamin D analogues’ supplementation is correlated with inflammatory signaling and oxidative stress regulation, immunity/metabolism augmentation and subsequently, kidney diseases and healthcare-related infections’ prevention, and the results of these trials are thoroughly evaluated. The highlighted research outcomes urge further study on a plethora of vitamin D analogues with a view to fully clarify their potential as substantial anti-inflammatory constituents of renal diseases-related treatment and their health-promoting properties in many kidney-associated healthcare complications and infections.

Determination of Nasal and Endotracheal (ETT) Microorganisms in Pediatric Patients with Intubated VAP Admitted to the Pediatric Intensive Care Unit (PICU)

Background: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-related infections in pediatric and neonatal intensive care units. In the present study, due to the importance of prevention, early identification, and treatment of VAP, nasal and endotracheal microorganisms were determined in intubated patients admitted to the pediatric intensive care unit. Objectives: The present study aims to determine the nasal and endotracheal (ETT) microorganisms in pediatric patients with intubated VAP admitted to the pediatric intensive care unit (PICU). Methods: This cross-sectional two-group case-control study was conducted on 90 intubated patients: Sixty patients with VAP (30 nasal, 30 tracheal tubes) and 30 patients without VAP, hospitalized in the PICU department of Amir al Mominin Ali (AS) Hospital in Zabol, Iran, from March 2018 to December 2018. The criteria for diagnosing VAP was the clinical pulmonary infection score (CPIS). In both case and control groups, samples were collected from nasal tubes using nasal swabs and from tracheal tubes (ETT) as tracheal aspirates from intubated patients, and sent to the laboratory for culture. The collected samples were interpreted in the microbiology laboratory to identify microorganisms. Data collection was done using a demographic information questionnaire and the clinical pulmonary infection score CPIS. The data was entered into SPSS 20 statistical software and analyzed. Results: The results of the present study showed that gender and age of patients do not affect the incidence of VAP, but children with VAP have a significantly longer stay in the PICU. Microbiological examination showed that Klebsiella and Escherichia coli (13.3%) were the most frequent among the positive nasal samples, and Klebsiella and E. coli (36.7%) were the most frequent among the positive tracheal samples. The diversity of microbes observed in ETT samples was also higher. Conclusions: The present study showed that the duration of hospitalization in the pediatric intensive care unit, as well as the age of hospitalized patients, can increase the risk of VAP. Additionally, nasal sampling is effective in identifying and differentiating VAP patients. It is suggested to reduce the duration of hospitalization in these departments as much as possible and to pay more attention to older children to prevent the increase of VAP. The results indicate that nasal bacteria play a role in the more severe occurrence of ventilator-induced pneumonia. Therefore, it is recommended to use broad-spectrum antibiotics and implement preventive nursing measures. If possible, starting feeding earlier through a gastric tube is also suggested.

Potentially pathogenic culturable bacteria in hemodialysis waters

BackgroundHemodialysis patients are at risk of acquiring healthcare-related infections due to using non-sterile water to prepare hemodialysis fluid. Therefore, microbiological control and monitoring of used water are of crucial importance.Materials and methodsIn this work, we identified bacterial populations occupying a hemodialysis water distribution system for almost a 6-month period in Ahvaz city, southwest of Iran. A total of 18 samples from three points were collected. We found high colony counts of bacteria on R2A agar. 31 bacteria with different morphological and biochemical characteristics were identified by molecular-genetic methods based on 16 S rRNA gene sequencing. Endotoxin concentrations were measured, using Endosafe® Rapid LAL Single-Test Vials.ResultsA diverse bacterial community was identified, containing predominantly Gram-negative bacilli. The most frequently isolated genus was Sphingomonas. Five species including M. fortuitum, M. lentiflavum, M.szulgai, M. barrassiae, and M. gordonae was identified .Despite the presence of Gram-negative bacteria the endotoxin analysis of all samples revealed that their endotoxin values were below the detection limit.ConclusionThe members of Sphingomonas genus along with Bosea and mycobacteria could be regarded as pioneers in surface colonization and biofilm creation. These bacteria with others like Pelomonas, Bradyrhizobium, staphylococcus, and Microbacterium may represent a potential health risk to patients under hemodialysis treatment.

Phenotypic and Genotypic Characterization of AmpC Beta-Lactamase in Clinical Isolates of Pseudomonas aeruginosa Findings From a Tertiary Care Hospital.

Background and aim Pseudomonas aeruginosa is an opportunistic pathogen responsible for various healthcare-related infections, which are difficult to treat due to intrinsic and acquired resistance. This study aimed to investigate AmpC β-lactamase production using phenotypic and genotypic methods in Pseudomonas aeruginosa strains isolated from a tertiary care hospital in Karad, Maharashtra, India. Material and methods Over one year, a descriptive cross-sectional study was conducted at the Department of Microbiology, Krishna Institute Medical Sciences, Krishna Vishwa Vidyapeeth, Karad. Phenotypic detection of AmpC beta-lactamase was performed using the Cefoxitin-Cloxacillin Double-Disc Synergy Test method, and genotypic detection was conducted using conventional polymerase chain reaction (PCR) targeting the bla Pseudomonas-derived cephalosporinases (PDC) and bla cephamycinase (CMY) genes. Results Out of 205 clinical isolates of Pseudomonas aeruginosa, 110 (53.66%) showed AmpC production phenotypically, while 86 (41.95%) were positive genotypically. The blaPDC gene was detected in 36.10% of isolates, and the blaCMY gene in 10.73% ofisolates. Conclusions The study findings indicate that AmpC-β-lactamase stands out as the primary resistance mechanism in strains of Pseudomonas aeruginosaisolated from the hospital. PCR study concluded that blaPDC (36.10 %) was the leading gene responsible for AmpC synthesis among study isolates. Early detection of AmpC beta-lactamase production by employing phenotypic and genotypic methods is crucial for detecting antibiotic resistance. This dual approach enables healthcare professionals to decide on the most effective antibiotics and mitigate the development of resistance.

Antimicrobial susceptibilities, resistance mechanisms and molecular characteristics of toxigenic Clostridioides difficile isolates in a large teaching hospital in Chongqing, China

ObjectivesClostridioides difficile ranks among the primary sources of healthcare-related infections and diarrhoea in numerous nations. We evaluated the drug susceptibility and resistance mechanisms of C. difficile isolates from a hospital in Chongqing, China, and identified resistance rates and resistance mechanisms that differed from previous findings. MethodsThe toxin genes and drug resistance genes of clinical strains were detected using Polymerase Chain Reaction (PCR), and these strains were subjected to Multilocus Sequence Typing (MLST). The agar dilution technique was employed for assessing susceptibility of antibiotics. Clinical data collection was completed through a review of electronic medical records. ResultsA total of 67 strains of toxin-producing C. difficile were detected. All C. difficile isolates demonstrated susceptibility to both metronidazole and vancomycin. However, resistance was observed in 8.95%, 16.42%, 56.72%, 56.72%, 31.34% and 5.97% of the isolates for tigecycline, tetracycline, clindamycin, erythromycin, moxifloxacin and rifampin, respectively. Among the strains with toxin genotypes A + B + CDT - and belonging to the ST3, six strains exhibited reduced susceptibility to tigecycline (MIC=0.5mg/L) and tetracycline (MIC=8mg/L). The tetA(P) and tetB(P) genes were present in these six strains, but were absent in tetracycline-resistant strains. Resistance genes (ermB, tetM, tetA(P) and tetB(P)) and mutations (in gyrA, gyrB, and rpoB) were identified in resistant strains. ConclusionsIn contrast to prior studies, we found higher proportions of ST3 isolates with decreased tigecycline sensitivity, sharing similar resistance patterns and resistance genes. In the resistance process of tigecycline and tetracycline, the tetA(P) and tetB(P) genes may play a weak role.

UM FILME DE POLIURETANO DE BASE AQUOSA CONTENDO ÓLEO DE MAMONA E NANOPARTÍCULAS DE PRATA INDUZIU A INIBIÇÃO DE BIOFILME BACTERIANO IN VITRO

Healthcare-related infections (HAIs) are a huge global issue. In 2020, about 11,124 patients (12.7%) with an ICU (intensive care unit) stay of over two days developed at least one ICU-acquired healthcare-associated infection (European Centre for Disease Prevention and Control, 2024). Hospital-acquired infections are mainly caused by contamination of these facilities, which often involves the transmission of microorganisms through contact with contaminated surfaces. In this context, the advancement of novel strategies to mitigate the contamination of medical devices, biomaterials, and hospital equipment is crucial and drives the demand for advancements in materials sciences. The application of antimicrobial polymers to coat medical devices and other hospital equipment has emerged as a promising approach, reducing the risk of healthcare-related contamination. The main goal of this research was to incorporate silver nanoparticles (Ag-NPs) into a waterborne castor oil-based polyurethane (PU) suspension to produce a film coating and evaluate its effectiveness in preventing bacterial adhesion. The films of pristine polyurethane (WBPU) and polyurethane containing Ag-NPs were subjected to physicochemical characterization and antimicrobial assays. Thermogravimetric analysis showed that no decomposition occurs below 200 oC, and the PU can be used in materials at the body temperature range. The WBPU film with 0.4% (w/w) Ag-NPs exhibited 36.4% inhibition of Staphylococcus aureus adhesion and 20.5% inhibition of biofilm formation. This castor oil-based polyurethane antimicrobial film is a promising alternative for coating the surfaces of equipment and devices used in the healthcare sector.

A Randomized Control Trial to Compare the Efficacy of Routine Soap Water V/S Alcohol Based Hand Sanitizer in Pre-Operative Scrubbing at Tertiary Health Centre in Western India

Introduction: Hand Hygiene is important for preventing healthcare related infections. Effective hand scrubbing is important for the success of surgical procedure. Pre operative scrubbing using soap and water is routinely used, however, there are many benefits of using alcohol-based hand sanitizer in preoperative scrubbing. Objective: The objective was to compare the efficacy of Routine soap water scrubbing versus Alcohol based hand sanitizer in pre-operative scrubbing by comparing the microbiological profile of swab samples of scrubbed participants. Materials and Methods: Total 200 participants who got scrubbed in the Surgery Department of an Ahmedabad based medical college, were enrolled for the study. Study design chosen was randomized trial where out of 200 participants, 100 each were randomly allocated into two groups of (1) Routine soap water scrubbing and (2) Alcohol-based hand sanitizer scrubbing. After hand scrubbing in either of the group, every participant was sampled from different areas of hand immediately before the operation. The samples were sent for culture and sensitivity (C & S) testing and results obtained were documented. Results: No growth of organism was observed in C & S reports from the swabs of all 200 participants. Conclusions: Alcohol based hand sanitizer is equally efficacious to Routine soap water scrubbing in preoperative scrubbing. Keywords: Soap water scrub, Alcohol-based hand sanitizer, pre-operative scrubbing,

A culture-independent nucleic acid diagnostics method for use in the detection and quantification of Burkholderia cepacia complex contamination in aqueous finished pharmaceutical products.

The Burkholderia cepacia complex (Bcc) is the number one bacterial complex associated with contaminated Finished Pharmaceutical Products (FPPs). This has resulted in multiple healthcare related infection morbidity and mortality events in conjunction with significant FPP recalls globally. Current microbiological quality control of FPPs before release for distribution depends on lengthy, laborious, non-specific, traditional culture-dependent methods which lack sensitivity. Here, we present the development of a culture-independent Bcc Nucleic Acid Diagnostic (NAD) method for detecting Bcc contaminants associated with Over-The-Counter aqueous FPPs. The culture-independent Bcc NAD method was validated to be specific for detecting Bcc at different contamination levels from spiked aqueous FPPs. The accuracy in Bcc quantitative measurements was achieved by the high degree of Bcc recovery from aqueous FPPs. The low variation observed between several repeated Bcc quantitative measurements further demonstrated the precision of Bcc quantification in FPPs. The robustness of the culture-independent Bcc NAD method was determined when its accuracy and precision were not significantly affected during testing of numerous aqueous FPP types with different ingredient matrices, antimicrobial preservative components and routes of administration. The culture-independent Bcc NAD method showed an ability to detect Bcc in spiked aqueous FPPs at a concentration of 20 Bcc CFU/mL. The rapid (≤ 4 hours from sample in to result out), robust, culture-independent Bcc NAD method presented provides rigorous test specificity, accuracy, precision, and sensitivity. This method, validated with equivalence to ISO standard ISO/TS 12869:2019, can be a valuable diagnostic tool in supporting microbiological quality control procedures to aid the pharmaceutical industry in preventing Bcc contamination of aqueous FPPs for consumer safety.

Multidrug-resistant Stenotrophomonas maltophilia in residential aged care facilities: An emerging threat.

Stenotrophomonas maltophilia is a multidrug-resistant (MDR), Gram-negative bacterium intrinsically resistant to beta-lactams, including last-resort carbapenems. As an opportunistic pathogen, it can cause serious healthcare-related infections. This study assesses the prevalence, resistance profiles, and genetic diversity of S. maltophilia isolated from residential aged care facilities (RACFs). RACFs are known for their overuse and often inappropriate use of antibiotics, creating a strong selective environment that favors the development of bacterial resistance. The study was conducted on 73 S. maltophilia isolates recovered from wastewater and facility swab samples obtained from three RACFs and a retirement village. Phenotypic and genotypic assessments of the isolates revealed high carbapenem resistance, exemplifying their intrinsic beta-lactam resistance. Alarmingly, 49.3% (36/73) of the isolates were non-wild type for colistin, with minimum inhibitory concentration values of > 4 mg/L, and 11.0% (8/73) were resistant to trimethoprim-sulfamethoxazole. No resistance mechanisms were detected for either antimicrobial. Genotypic assessment of known lineages revealed isolates clustering with Sm17 and Sm18, lineages not previously reported in Australia, suggesting the potential ongoing spread of MDR S. maltophilia. Lastly, although only a few isolates were biocide tolerant (2.7%, 2/73), their ability to grow in high concentrations (64 mg/L) of triclosan is concerning, as it may be selecting for their survival and continued dissemination.

Overview of Healthcare-Related Infections in Intensive Care Units of a public hospital

Introduction: Healthcare-Associated Infections are illnesses acquired after the patient's admission to the hospital unit and which manifest themselves during hospitalization or after discharge. Aim: To analyze the panorama of health-related infections in patients admitted to intensive care units. Outlining: Cross-sectional, retrospective study, collected from the Hospital Infection Control Commission database in a public hospital from July to December 2022. Crude and adjusted odds ratios were calculated using logistic regressions. The study followed the ethical and legal precepts of resolution 466/2012. Results: There was a predominance of males and those aged over 60 years. The main clinical problems were co infection with COVID-19 and co-infection with HIV. Regarding previous conditions, Systemic Arterial Hypertension stood out. When analyzing the etiological agents, the presence of Klebsiella pneumoniae showed a marginally significant association with an increase in the chances of death. Implications: The use of invasive devices, prolonged hospital stay and other factors such as age, associated comorbidities, were predictors of mortality among patients, as well as risk factors for the development of Klebsiella Pneumoniae Carbapenemase infection.

Susceptibility Patterns in Staphylococcus and Klebsiella Causing Nosocomial Infections upon Treatment with E-Anethole-Rich Essential Oil from Clausena anisata

High rates of resistance to antibiotics are associated with healthcare-related infections, thus demonstrating the urgent need for effective antimicrobials against these maladies. The present study aims to determine the chemical composition of essential oil (EO) from Clausena anisata leaves and evaluate their antibacterial activity against selected nosocomial bacteria. To this end, one kilogram (1 kg) of fresh leaves of C. anisata was washed and boiled with 500 mL of distilled water for 2−4 h using a Clevenger apparatus. The oil was then collected in an Erlenmeyer, dried using anhydrous sodium sulfate, bottled in a tinted glass bottle and refrigerated at 4 °C before analysis. Next, the as-prepared oil was analyzed using gas chromatography-mass spectrometry (GC-MS). The essential oil was further tested against a panel of selected nosocomial bacteria, including Staphylococcus and Klebsiella species, among others, by microdilution using a resazurin assay to determine the minimum inhibitory and minimum bactericidal concentrations (MICs and MBCs, respectively). As a result, 0.77% of EO was extracted from fresh leaves of C. anisata. The GC-MS analysis revealed that the as-prepared essential oil contained E-anethole (70.77%), methyl isoeugenol (13.85%), estragole (4.10%), γ-terpinene (3.33%), myrcene (2.82%) and sabinene (0.77%), with E-anethole being the major constituent. Twenty-two compounds were identified in the EO of C. anisata leaves through gas chromatography. Upon antibacterial testing against selected nosocomial pathogens, the E-anethole-rich essential oil exhibited MIC and MBC values ranging from 3.91 to 125 µg/mL and 7.81 to 125 µg/mL, respectively, indicative of a bactericidal orientation of the plant’s essential oil (MIC/MBC ratio < 4). This novel contribution highlights the scientific validation of the use of C. anisata leaves in the traditional treatment of various infectious diseases. However, toxicity and pharmacokinetic studies, mechanistic bases of the antibacterial action, and in vivo antibacterial experiments of the E-anethole-rich EO of C. anisata should be investigated to successfully use this plant in the treatment of infectious diseases.

PREVENTIVE NURSE ACTIONS AND RISK FACTORS ASSOCIATED WITH HEALTH CARE RELATED INFECTIONS: A NARRATIVE REVIEW

PREVENTIVE NURSE ACTIONS AND RISK FACTORS ASSOCIATED WITH HEALTH CARE RELATED INFECTIONS: A NARRATIVE REVIEW

Healthcare-related infections before and during the Covid-19 pandemic with Carbapenem-resistant Acinetobacter baumannii

Objective: to compare profile of healthcare-related infections (HRI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAb) and to describe the incidence before and after COVID-19 pandemic. Methods: this is a cross-sectional, retrospective study, carried out in a hospital located in Southern Brazil. Data were collected between march, 2019 to December, 2021 from 105 medical records and entries in the local infection control service. Information gathered included sex, age, inpatients diagnosis, site of infection, length of stay until infection, outcome, APACHE II, number of comorbidities, number days with invasive devices, hospitalization days until positive culture, Hospital stays days, colonization, infection treatment and used antibiotic. Results: There were 121 HRI caused by Acinetobacter baumannii. Before the COVID-19 pandemic, the incidence density was 5.73/1000 for ventilator-associated pneumonia and 0.73/1000 for urinary tract infection, while the cumulative incidence was 2.63/100. In the COVID-19 period, the incidence density of ventilator-associated pneumonia was 9.24/1000, 2.04 for urinary tract infection, 0.7/1000 for primary bloodstream infection and the cumulative incidence was 7.64/100. Overall mortality of 57.1% (n=60: 95% CI: 29.5%-62.5%). All isolates were sensitive to Polymyxin. The best outcomes occurred with combination therapy with amikacin Regarding Acinetobacter baumannii infection, the variable days of hospitalization until positive culture (p=0.034) and days of hospitalization (p=0.034) were statistically significant and antibiotics used about the outcome (p=0.069). Conclusion: During the COVID period, there was an increase in the resistance to bacterial infections, in the morbidity and mortality of patients, and the incidence rates of Acinetobacter baumannii infections.

Healthcare-Associated Infections and Prevention Programs in General Nursing versus Residential Homes-Results of the Point Prevalence Survey in Polish Long-Term Care Facilities.

Background and Objectives: The number of residents of long-term care facilities (LTCFs) is expected to increase. Determining the epidemiological situation in the context of organizational conditions is therefore extremely important for planning the necessary future activities in the field of infection prevention. The aim of this study was to analyze the prevalence rates in Polish nursing vs. residential homes, in the context of the medical and functional burdens of residents and the organizational conditions of both types of units. Material and Methods: the data that were analyzed came from a point prevalence survey of infections and antibiotic consumption in LTCFs, conducted in accordance with the HALT-3 protocol in Poland in 2017, between April and June. Results: This study included a total of 2313 residents in 24 LTCFs. The most common risk factors for infections in the study population were urinary and fecal incontinence (77.0%), impaired mobility (the patient was in a wheelchair or lying down) (68.7%), and impaired spatial and temporal orientation (52.5%). The median prevalence in nursing homes (NHs) was 3.2% and that in residential homes (RHs) was 0.7%, but without statistical significance. The median for the entire group was 2.6%. A total of 93 healthcare-related infections were detected in 91 residents. The most frequently reported forms of infections were urinary tract infections, lower respiratory tract infections, and skin infections. A statistically significant positive correlation was found only between the percentage of residents with pressure ulcers and other wounds and the incidence of gastrointestinal infections (correlation coefficient = 0.413, p < 0.05). Infection prevention and control measures were implemented mainly in nursing homes, and in residential homes, only hand hygiene procedures were commonly available. Conclusions: For the two types of LTCFs, the epidemiological situation in terms of nosocomial infections is diverse. Consequently, both types of facilities require different approaches to infection control and prevention and outcomes analysis.

Application of Global Trigger Tools in University Hospital and Comparison to Volunteer Adverse Events Reporting System.

A voluntary reporting system (VRS) is still used to detect adverse events (AEs) in health-care services in many countries. We attempted to apply the Global Trigger Tool (GTT) for the first time in our country and searched for an answer to the question of whether there could be new triggers. Two hundred and forty inpatient records were selected from total of 1,807 inpatient files in the university obstetrics and gynecology clinic between 2018 and 2020. Twenty files per month were reviewed retrospectively using GTT, an approach developed by the American Institute for Health Development. VRS records of the same period were examined. The data were evaluated according to the National Coordinating Council for Medication Error Reporting and Prevention scale and those in the E, F, G, H, I categories were included. The number of AEs per 1,000 patient days was 47.81, AEs per 1,000 patient hospitalizations was 95.83, and hospitalizations with AEs was 9.58%. In the VRS data, 10 of 85 reporting cases were listed in the E category (Damage is temporary and requires intervention), 6 of them were related to fall of the patient, and 4 of them were related to medical device and material safety. By applying GTT, 45 cases in category E and 35 cases in category F (Damage is temporary and requires hospitalization or prolonged hospitalization) AEs were detected in 23 patients (9.58%). The number of AEs reported was 8.3 times higher in the GTT than with VRS. Healthcare related infection, development of complications from any procedure, APTT>100 Seconds, INR>6, Organ Injury - Repair or Removal, All Kinds of Operative Complications were found to be the most sensitive triggers (PPV = 100). There was no difference between the patients with and without AEs in terms of age and number of hospitalization days (p: 0.707, p: 0.618). The sensitivity rate of vaginal dinoprostone use and CRP elevation (30% and 22%, respectively) was higher than the mean sensitivity rate of GTT triggers (15.6%). The GTT is more effective than VRS in detecting AEs. Using vaginal dinoprostone (propess) and high CRP levels could be used as a trigger. The GTT is a credible and fruitful instrument for determining AEs when adapted to the departmental practices.

Neonatal innate immunity response in invasive candidiasis.

Infections caused by Candida spp. are frequent in critically hospitalized patients, especially among premature neonates, representing one of the most common healthcare-related infections. Although there is considerable production of current knowledge about the mechanisms of immune response, aspects involved in the newborn's innate defense are not fully understood. The aim of this study was to describe the innate immune mechanisms involved in the defense of neonates against invasive candidiasis. This is an integrative literature review from the Scopus, Scifinder, Medline, Web of Science databases and the electronic libraries ScienceDirect and Scielo, in the period between 2002 and 2020, with rescue based on primary descriptor Immunity Innate plus secondary descriptors Candidiasis Invasive AND Infant Newborn. We have observed the involvement of various mechanisms in the neonatal response against invasive candidiasis, including the recognition, signaling, recruitment, and initiation of an effective immune response. These mechanisms encompass the presence of antimicrobial peptides, phagocytosis, synthesis of reactive oxygen species, inflammatory mediators, and complex cell signaling systems mediated by Pattern Recognition Receptors (PRRs). With this study, it is expected to contribute to the expansion of knowledge about the immunological mechanisms involved in the innate immune response of the newborn against disseminated infections caused by Candida species, and in the same sense, highlight the importance of this knowledge as a reflex in the decrease in mortality in the neonatal period.

Bacterial ecology related to healthcare in a Moroccan intensive care unit: A prospective analysis of 53 cases

Introduction: This study aims to determine the incidence of healthcare-related infections in our structure, identify the different types of healthcare-related infections in order of frequency, and understand the bacterial ecology. Materials and methods: We conducted a prospective observational, descriptive study, which included all patients over 16 years of age who were hospitalized in the Intensive Care Unit (ICU) A4 of the Hassan II University Hospital of Fez. The study was performed over a period of 12 months, from May 2021 to May 2022. Patients hospitalized in the ward during this period were all monitored throughout their stay. The study included those who developed a healthcare-related infection, regardless of the site of the infection. We excluded all patients who did not present with a healthcare-related infection and those who were discharged from intensive care or died within the first 48 hours. Results: Seven hundred and sixty-four patients were admitted to ICU A4 during the study period from May 2021 to May 2022. Out of these, 53 patients developed healthcare-related infections, resulting in an incidence rate of 6.9%. The average age of our patients was 47.42 years, with a significant male predominance. A total of 120 healthcare-related infections were documented during this study period. Bacteremia accounted for the highest percentage at 64.2%, followed by infections related to catheters and pneumopathies acquired under mechanical ventilation, both at 60.4%. Additionally, surgical site infections comprised 22.6%, while urinary tract infections accounted for 18.9%. The average time of infection onset associated with care, compared to hospitalization, was 5.85 days. The evolution was favorable in 13 (24.5%) cases, and unfortunately, there was a significant mortality rate of 40 (75.5%) patients. The isolated germs were mainly Acinetobacter baumannii, with a rate of 88 (61.11%) cases, followed by enterobacteria, which made up 44 (30.55%) cases. In third place comes Pseudomonas aeruginosa with a rate of 13 (9.02%), followed by enterococci with a rate of 10 (6.94%), and Staphylococcus with a rate of eight (5.55%). four (2.77%). Conclusion: Healthcare-related infections are frequent in ICUs and can be serious. The severity of these infections is due to both the infection itself and the compromised immune defense mechanisms of the patient, which reflect their overall health condition. Moreover, prevention is still the best weapon.

Determination of ertapenem in plasma and ascitic fluid by UHPLC-MS/MS in cirrhotic patients with spontaneous bacterial peritonitis

Abstract Objectives Spontaneous bacterial peritonitis is a frequent severe complication in cirrhotic patients with ascites. Carbapenem antibiotics are currently the treatment of choice for patients with hospital-acquired or healthcare-related infections. However, there is limited evidence available on the efficacy of ertapenem in cirrhotic patients with spontaneous bacterial peritonitis. As a result, the pharmacokynetics and pharmacodynamics of this antibiotic are still unknown. The objective of this study was to develop and validate measurement procedures based on liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) to determine ertapenem concentrations in plasma and ascitic fluid. Methods Samples were pretreated by acetronile protein-precipitation. Chromatographic separation is performed on a C18 reversed-phase Acquity®-UPLC®-BEHTM column (2.1 × 100 mm id, 1.7 µm) using a non-linear gradient of water/acetonitrile containing 0.1 % of formic acid at a flow rate of 0.4 mL/min. Ertapenem and its internal standard (ertapenem-D4) are detected by tandem mass spectrometry using positive electrospray ionization and multiple reaction monitoring, and using 476.2 → 346.0/432.2 as mass transition for ertapenem and 480.2 → 350.0 for its internal standard. Results No significant interferences or carry-over contamination were observed. Imprecisions, absolute relative bias, matrix effects and normalized recoveries were ≤14.5 %, ≤9.3 % (92.8–104.5) % and (98.8–105.8) %, respectively. Chromatographic measurement procedures were linear from (0.50–100) mg/L. Conclusions The measurement procedures based on UHPLC-MS/MS developed and validated in this study could be useful in pharmacokynetic and pharmacodynamic studies in subjects with liver cirrhosis who develop spontaneous bacterial peritonitis treated with ertapenem.

Severe Covid-19 in pregnant and postpartum women admitted to an intensive care unit: A retrospective cohort study

Background SARS-CoV-2 infection is associated with worse maternal and fetal outcomes. This study aims to describe the characteristics of pregnant and postpartum women with severe Covid-19 admitted to ICU. Methods and findings It’s a retrospective cohort study evaluating pregnant and postpartum women referenced to a specialized ICU between May 2020 and June 2022. Covid-19 was confirmed with RT-PCR or rapid antigen test on a nasopharyngeal swab. Variables were described by median and IQR when numerical, and by frequency and percentage when categorical. OR with 95% CI were calculated for the evaluation of factors related to death. P-values were calculated using Pearson’s ꭓ2-test, Fisher’s exact test, Wilcoxon rank sum test, and Kruskall-Wallis test, and statistical significance was established as &lt; 0·05. Missing data were excluded. All statistical analysis were performed using R software version 4.2.2. Of the 101 admissions, 85 (84·2%) were of pregnant women. Obesity (23·0%) and systemic arterial hypertension (13·0%) were the most prevalent medical conditions. Sixty-six (65·3%) were admitted using some type of oxygen support. Forty-seven (46·5%) evolved to mechanical ventilation. There were 61 events considered obstetric complications, with 8 stillbirths/fetal losses. The overall lethality was 15·8%. Pregnancy interruption, need for non-invasive mechanical ventilation, level of oxygen support at admission, prone maneuver, hemodialysis, and healthcare-related infections were factors associated with death. Evaluating the WHO 7-category ordinary scale, there was a trend of increase in the risk of death with higher punctuation, with a statistically significant difference of women with 5 (OR = 7·27; 95% IC = 1·17–194; p = 0·031) or 6 points (OR = 12·0; 95% IC = 1·15–391; p = 0·038) when compared to the ones with 3 points, i.e., of women admitted with a high-flow non-rebreathing mask or invasive mechanical ventilation, compared with the ones admitted at room air, respectively. The main limitations of this study are the relatively small number of participants, and the use of data derived of medical records—which are susceptible to misclassification and variable amounts of missing data. Conclusions Pregnant and postpartum women with severe Covid-19 have high lethality and a high incidence of clinical and obstetric complications. These findings support that this population should be prioritized in public health strategies that address Covid-19.

A single plain ring is not associated with increased bacterial load on hands: An experimental study among healthcare worker students undertaking mock surgery

BackgroundAdequate hand hygiene is considered as one of the most effective strategies in healthcare-related infection prevention. The potential negative effect of rings in hand disinfection and thus, in increased nosocomial infections rates is still controversial. Therefore, the present study was designed with the purpose of examining if rings frequently exposed to surgical scrubbing were associated or not with increased bacterial counts. Methods32 volunteers were randomized into 4 groups: A (no rings), B (participants wore a ring), C (no rings and performed surgical scrubbing with chlorhexidine every 48 h) and D (participants wore a ring and performed surgical scrubbing every 48 h). Glove juice samples were obtained at day 0 (T0) and after a 90-min mock-surgery on day 14 (T1). Quantitative (number of UFC/mL) and qualitative data (microorganism type) were collected as study variables. ResultsAll groups were comparable at T0. All ring carriers obtained negative cultures at T1. Ring presence was not associated with higher bacterial counts; comparisons between A vs B groups and C vs D groups showed no statistically significant differences (p = 0.076 and 1.000). T1 negative cultures were more frequent in participants performing surgical scrubbing every second day (93.8 % vs 75 %), although this difference did not reach statistical significance (p = 0.332). ConclusionsThe presence of single plain ring does not seem to be associated with an increased hand bacterial load. Regular surgical scrubbing with chlorhexidine impregnated sponges reduces bacterial contamination of hands, even in the presence of plain rings.