Healthcare Infection Research Articles

P-1743. Impact of a carbapenem centered antimicrobial stewardship program in the antibiotic consumption patterns and healthcare infections in a tertiary public hospital in Colombia

Abstract Background Antimicrobial stewardship programs (ASP) recommend the control of multiple antibiotics related to bacterial resistance in order to prevent the induction of ESBL, carbapenemases, and vancomycin resistance. Nevertheless, the control of all these antibiotics sometimes is not possible due to the limited workforce in the ASP team. In this study, we decided to limit all ASP interventions to the control of carbapenems, leaving the intervention of other antibiotics as a secondary task Methods A before and after study was conducted from July 2022 to July 2023, with a baseline period (July to December 2022) and an intervention period (January to July 2023). During the intervention, the ASP emphasized carbapenem prescription control while addressing other antibiotics as secondary concerns. Daily monitoring of meropenem and ertapenem prescriptions was prioritized, with other antibiotics monitored as resources allowed only when all carbapenem prescriptions were assessed. Selective reporting eliminated carbapenems from antibiograms in natural resistance patterns, and susceptibility testing for piperacillin-tazobactam was expanded to guide carbapenem-sparing therapies. Educational sessions focused on appropriate carbapenem use Results A decrease in the consumption of carbapenems was observed between the baseline period and the intervention period going from 13.52 (DDD/100 patient days) to 5.84 for meropenem and from 2.70 to 0.59 for ertapenem. Chart1. Additionally, a decrease in the infection rate was observed going from an average of 0.79 (cases/1000 patient days) in the baseline period to an average of 0.47 in the intervention period. Chart 2. The prevalence of carbapenemase producing enterobacterales did not change between the pre and post intervention period but the infection rate did. Chart 3. The non supervised use of other antibiotics was not related to an increase in their consumption. Chart 4. Conclusion ASP strategies can be directed toward a specific antimicrobial group in the pursuing of controlling specific problems such as carbapenem overuse and carbapenemase-producing-enterobacterales. These directed strategies can be implemented without an increase in the consumption of other antimicrobial groups. Disclosures All Authors: No reported disclosures

Healthcare Settings and Infection Prevention: Today’s Procedures in Light of the “Instructions for Disinfection” Issued During the 1817 Typhus Epidemic in the Grand Duchy of Tuscany (Pre-Unification Italy)

Even today, healthcare-associated infections (HCAIs) remain the most frequent and serious complications in healthcare, with a significant clinical and economic impact. The authors of this manuscript address the causes and conditions that determine this situation and describe them in comparison with the situation in the Grand Duchy of Tuscany more than two centuries ago and with the instructions that were issued at the time to contain the typhus epidemic of 1817, increase hospital sanitation, and disinfect houses. Today, we know that a crucial element in the fight against healthcare-associated infections (HCAIs) is the definition and implementation of best care practices and other measures, according to a combined program that must be tailored to each healthcare setting. In the early nineteenth century, these approaches originated from experience and chemical knowledge that were becoming established, opening the way to the ideas and experiments of Ignác Fülöp Semmelweis and later of Joseph Lister, who traced the path for the birth of hygiene. Two centuries later the pioneering vision of the Grand Duchy of Tuscany at the beginning of the 19th century, when preventive measures in the field of public health were still backward and underdeveloped, is still enlightening and surprisingly topical.

A pilot protocol for surveillance of infection and antibiotic prescribing in primary healthcare across the globe: Antibiotic Prescribing in Primary Healthcare Point Prevalence Survey (APC-PPS)

Little data is available from the primary healthcare setting in low- and middle-income countries to describe the burden of clinical infections and antibiotic prescribing proportions for those infections. The AWaRe Antibiotic Book provides a framework for assessing antibiotic prescribing in primary healthcare but requires understanding both frequency of clinical infections and their antibiotic prescribing proportions. The Antibiotic Prescribing in Primary Healthcare Point Prevalence Survey (APC-PPS) project is a series of point prevalence surveys conducted at primary healthcare facilities in LMICs to capture the frequency of consultation for different clinical infections and diagnoses and the frequency and type of antibiotic prescribing associated with these infections in primary healthcare facilities. This study aims to assess the feasibility of using a PPS methodology to collect data on clinical presentation and antibiotic prescribing in primary healthcare settings. The data collected are necessary to be able to summarise relative rates of presentation of different clinical infections and antibiotic prescribing practices to inform global estimates of antibiotic use and inform the development of surveillance methods and representative sampling frames. Each site will conduct 6-8 point prevalence surveys over the course of 12 months. Completely anonymous data on age, sex, relevant comorbidities, infection symptoms and diagnoses and antibiotic prescription are collected for patients of all ages with acute infection symptoms (up to 14 days of symptoms) who present to the facility on the day of the survey. No identifiable data will be collected from individuals. Data is collected via ODK Collect and stored in a secure ODK Cloud server hosted by City St. George’s, University of London. Sites will be active between early 2023- end 2024, with regular interim data analysis scheduled and final data analysis planned by mid 2025. All required local and national ethical and regulatory approvals will be obtained prior to sites starting.

Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort

BackgroundLimited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil.MethodsMulticenter cohort study from September 2019 to December 2023 with prospective individual patient data collection. VAP, CLABSI, and CAUTI were diagnosed by each center in accordance with Brazilian regulatory agency guidance. If a patient fulfilled all diagnostic criteria, he was deemed to have Confirmed HAI. An adjusted disability multistate model was used to evaluate the population attributable in-hospital mortality fraction (PAF) and the absolute in-hospital mortality difference (AMD).ResultsA total of 128,247 patients were included. 4066 (3.2%) distinct patients had at least one diagnosis of HAI (1493 CLABSI, 433 CAUTI, 2742 VAP, and 435 patients with more than one HAI) during the ICU stay. The PAF was 3.89% (95% CI 3.68–4.11%) for HAI, 2.16% (2.05–2.33%) for VAP, 1.2% (1.08–1.32%) for CLABSI, 0.11% (0.07–0.16%) for CAUTI, and 0.33% (0.26–0.4%) for ≥ 2 HAI. The AMD for HAI was 33.69% (95% CI 32.27–35.33%), 29.01% (27.15–30.98%) for VAP, 31.64% (29.3–34.81%) for CLABSI, 9.94% (3.88–15.54%) for CAUTI and 35.6% (28.93–42.99%) for ≥ 2 HAI.ConclusionsDevice-associated HAI significantly contribute to hospital mortality and impose a high excess risk of death for critically ill patients.

Protection against Clostridioides difficile disease by a naturally avirulent strain.

Clostridioides difficile is a leading cause of healthcare infections. Gut dysbiosis promotes C.difficile infection (CDI) and CDIs promote gut dysbiosis, leading to frequent CDI recurrence. Although therapies preventing recurrent CDI have been developed, including live biotherapeutic products, existing therapies are costly and do not prevent primary infections. Here, we show that an avirulent C.difficile isolate, ST1-75, protects mice from developing colitis induced by a virulent R20291 strain when coinfected at a 1:1 ratio. In metabolic analyses, avirulent ST1-75 depletes amino acids more rapidly than virulent R20291 and supplementation with amino acids ablates this competitive advantage, indicating that ST1-75 limits the growth of virulent R20291 through amino acid depletion. Overall, our study identifies inter-strain nutrient depletion as a potentially exploitable mechanism to reduce the incidence of CDI and reveals that the ST1-75 strain may be a biotherapeutic agent that can prevent CDI in high-risk patients.

Innovative Solutions for Multidrug-resistant Organisms Infections in ICU: A Joint Efficacy Evaluation of Multi-disciplinary Team and SHEL Model (Software, Hardware, Environment, Liveware)

The escalating threat of multidrug-resistant organisms (MDROs) in intensive care unit (ICU) demands innovative management strategies to curb the rising infection rates and associated clinical challenges. To assess the effectiveness of integrating the multidisciplinary team (MDT) approach with the SHEL (Software, Hardware, Environment, Liveware) model in reducing MDRO infections within ICU settings. From January 2021 to April 2024, a prospective, randomized controlled study was conducted in the ICU of Nantong Fourth People's Hospital, enrolling 411 patients with MDRO infections. These patients were randomly assigned into 3 groups: the MDT group, the SHEL model group, and a combined group. The intervention lasted for 4 weeks, during which the effects on the MDRO detection rate, infection rate, health care staff's infection control execution scores, and the rationality of antibiotic use were assessed, aiming to determine the efficacy of each approach in managing MDROs in the ICU setting. The overall infection rate of MDROs in the ICU of our hospital from 2021 to 2024 was 60.18%, with sputum infection sources accounting for 68.37% of the total sources, making it the primary source of infection. The detection rate of MDROs in the combined group was significantly higher than that in the MDT and the SHEL groups, with the SHEL group having a higher detection rate than the MDT group (P < 0.05). The infection rate of MDROs in the combined group was significantly lower than that in both the MDT and the SHEL groups, with the SHEL group having a lower detection rate than the MDT group (P < 0.05). The implementation scores of the combination group in standard prevention, hand hygiene, antibiotic management, and isolation measures were significantly higher than those of the MDT and SHEL groups, with the SHEL group scoring higher than the MDT group (P < 0.05). The rational use of antibiotics in the combined group was also higher than in both the MDT and the SHEL groups, with the SHEL group having a higher level than the MDT group (P < 0.05). The integrated MDT and SHEL model significantly reduced MDRO infections in ICU, improved health care workers' infection prevention and nursing quality, and promoted the appropriate use of antibiotics, advocating for its clinical application.

A 4-year outbreak of MRSA ST72-MRSA-IV spa type t1597 in a surgical high dependency unit in Ireland linked to repeated healthcare worker recolonisation

Patients undergoing cardiac surgery are identified as high risk for Staphylococcus aureus infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme. An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where spa typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred. In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit.

Virulence genes and antibiotic susceptibility patterns of Escherichia coli isolated from nosocomial urinary tract infections in the northwest of Iran during 2022-2023: A cross-sectional study.

Urinary tract infections (UTIs) are prevalent among hospitalized patients, constituting the most frequent health-care infections. Uropathogenic Escherichia coli (UPEC) is leading causative agent of UTIs. The present study was aimed to examine the susceptibility of UPEC isolates obtained from nosocomial cases to antibiotics, as well as their biofilm formation capability and frequency of virulence genes. A total of 100 UPEC isolates were collected from nosocomial UTIs at Imam Reza Hospitals in Tabriz, Iran, spanning from April 2022 to January 2023. The antimicrobial susceptibility patterns were evaluated using the disk diffusion method, along with the detection of broad-spectrum β-lactam enzymes (ESBLs) and carbapenemases. The ability of isolates to form biofilms was assessed using the microtiter-plate method, while the PCR method was employed to identify the presence of virulence genes. The highest resistance was observed toward piperacillin (82%), followed by aztreonam and ciprofloxacin (81%), while the lowest resistance was found against piperacillin/tazobactam (12%) and meropenem (9%). ESBLs were detected in 62% of the isolates. The microtiter-plate results revealed strong, moderate, and weak biofilm formation abilities in 32%, 33%, and 24% of the isolates, respectively. The most prevalent virulence gene was fimA (74%) followed by hlyF (68%), papA (44%), papC (32%), iroN (26%), and cnf (20%). The elevated levels of resistance to multiple antimicrobial agents, coupled with the co-presence of virulence genes and biofilm formation abilities, contribute to the persistence of UPEC-related infections, particularly in hospitalized patients. These findings underscore the necessity of implementing an effective program to control nosocomial UTIs caused by UPEC in the healthcare centers.

System infection prevention in hospital networks in the United States-an SHEA research network inquiry into operational characteristics and current challenges.

A 54-question survey about System Healthcare Infection Prevention Programs (SHIPPs) was sent out to SHEA Research Network participants in August 2023. Thirty-eight United States-based institutions responded (38/93, 41%), of which 23 have SHIPPs. We found heterogeneity in the structure, staffing, and resources for system infection prevention (IP) programs.

CRISPR-Cas systems in enterococci.

Enterococci are members of the microbiota of humans and other animals. They can also be found in the environment, associated with food, healthcare infections, and hospital settings. Due to their wide distribution, they are inserted in the One Health context. The selective pressure caused by the extensive use of antimicrobial agents in humans, animals, and agriculture has increased the frequency of resistance to various drugs among enterococcal species. CRISPR-Cas system, an important prokaryotic defense mechanism against the entry of mobile genetic elements, may prevent the acquisition of genes involved in antimicrobial resistance and virulence. This system has been increasingly used as a gene editing tool, which can be used as a way to recognize and inactivate genes of interest. Here, we conduct a review on CRISPR systems found in enterococci, considering their occurrence, structure and organization, mechanisms of action and use as a genetic engineering technology. Type II-A CRISPR-Cas systems were shown to be the most frequent among enterococcal species, and the orphan CRISPR2 was the most commonly found system (54.1%) among enterococcal species, especially in Enterococcus faecalis. Distribution of CRISPR systems varied among species. CRISPR systems had 1 to 20 spacers, with size between 23 and 37bp and direct repeat sequences from 25 to 37bp. Several applications of the CRISPR-Cas biotechnology have been described in enterococci, mostly in vitro, using this editing tool to target resistance- and virulence-related genes.

Impact of early antiviral therapy on SARS-CoV-2 clearance time in high-risk COVID-19 subjects: A propensity score matching study

Effective treatments for COVID-19 are needed to mitigate disease progression and reduce the burden on healthcare systems. This study investigates the impact of early treatments on SARS-CoV-2 viral shedding duration among high-risk individuals with mild symptoms. A single-center, retrospective observational study was conducted at Luigi Sacco Hospital in Milan from December 2021 to March 2023. Hospitalized and nonhospitalized adults with a confirmed SARS-CoV-2 infection and at high-risk of disease progression were enrolled. Unadjusted and adjusted negative binomial regression models and a Random Forest regression model were performed before and after matching subjects based on their propensity of being treated or not. Results from 518 subjects (428 treated and 90 untreated) revealed a significant reduction in SARS-CoV-2 viral shedding duration among those who received early treatment compared to untreated individuals. Propensity score matching and multivariable regression analyses confirmed this finding. Early treatment significantly reduced the risk of COVID-19-related hospitalization and pneumonia development. Subgroup analysis identified COPD as a potential factor influencing effectiveness of early treatments. Early treatments play a crucial role in reducing SARS-CoV-2 viral shedding and preventing disease progression among high-risk individuals. Shorter viral shedding duration also contributes to improved healthcare resource utilization and infection control measures.

Predictors of seropositivity to SARS-CoV-2 among employees at a large urban medical center

BackgroundBefore SARS-CoV-2 vaccination availability, medical center employees were at high risk of COVID-19. However, risk factors for SARS-CoV-2 infection in medical center employees, both healthcare and non-healthcare workers, are poorly understood.MethodsFrom September-December 2020, free IgG antibody testing was offered to all employees at a large urban medical center. Participants were asked to complete a questionnaire on work and non-work related risk factors for COVID-19 infection.ResultsSARS-CoV-2 seropositivity was found in 4.7%. Seropositivity was associated with close contact with COVID-19 cases with or without the use of adequate personal protective equipment (PPE), (OR 3.1 [95% CI 1.4–6.9] and OR 4.7 [95% CI 2.0–11.0] respectively), never wearing a mask outside of work (OR 10.1 [95% CI 1.9–57]), and Native Hawaiian/Pacific Islander race (OR 6.3 95% CI (1.6–25)].ConclusionsAmong workers in a large urban medical center, SARS-CoV-2 seropositivity was associated with work-related COVID-19 close contacts and low mask use outside of work, suggesting that non-workplace close contacts are also relevant routes of COVID-19 spread among healthcare workers.

Disinfectants efficacy in reducing pathogens related to health-care infection associated in universities hospitals of Gorgan, North of Iran

BackgroundDisinfection has a fundamental role in the control of pathogens in the hospital environment. This study was designed to assess the efficacy and functional impact of disinfectants in reducing pathogens related to healthcare associated infections (HAIs) in hospitals.MethodsThis observation study was conducted at three university hospitals in Gorgan, Iran, from May to Oct 2023. The data including used disinfectants and microbiological examination were obtained from the infection control unit of each hospital.ResultsThe results showed that a variety of disinfectants from intermediate to high levels were employed in accordance with the World Health Organization (WHO) protocols. The microbial result revealed that 31.6% (286 out of 906) of the sample had at least one microorganism. Among identified organisms, Bacillus spp. were the predominant species followed by Staphylococcus epidermis, fungus genera, Enterobacter spp., Enterococcus spp., Pseudomonas spp., Escherichia coli, Alcaligenes spp., Staphylococcus aureus, Citrobacter spp., Corynebacterium spp., Klebsiella spp., Acinetobacter spp., Micrococcus spp., Staphylococcus saprophyticus, and Serratias spp. The highest prevalence rates of microorganisms were observed in the wards of ICU, emergency, internal medicine, and women’s ward. The chi-square test revealed a significant relationship between the presence of organisms and hospital wards (P < 0.05).ConclusionThe presence of pathogens indicates a defect in the disinfection process, probably due to both little attention to disinfection protocols and multidrug resistance. It is not yet possible to eliminate pathogens from the hospital environment, but it can be minimized by education intervention, standardizing disinfecting processes, and monitoring by the infection control committee.

Antibiotic susceptibility of uropathogens: a 3-year retrospective study at Ho Teaching Hospital of Ghana

BackgroundUrinary tract infection (UTI) remains one of the most treated infections in primary healthcare over the last two decades. The infection is treated with antibiotics. However, there have been reported cases of increasing antibiotic resistance globally, limiting the available antibiotics for the treatment of the infection. The study aimed to determine the frequency of bacterial urinary tract infections and their antibiotic resistance pattern in Ho Teaching Hospital of Ghana from 2019–2021.MethodologyData on urine culture and susceptibility testing and patient demographics from 2019–2021 were collected from the microbiology unit archives with a designed Microsoft Excel 2019 form and later exported to IBM SPSS (v26) for statistical analysis on the uropathogens and their antibiotic resistance pattern. P-value < 0.05 was considered statistically significant.ResultsOut of 4806 records, 1005 bacterial isolates were found, with a total prevalence of 20.91%. The most prevalent group of organisms was the Enterobacteriaceae, with E. coli 409 (40.70%) being the most frequent isolate. Of the 772 isolates subjected to amikacin, 48(6.22%) and 6(0.78%) of the Gram-negative and Gram-positive bacterial organisms showed resistance to the antibiotic respectively. 58.96% (148/251) and 3.59% (9/251) of Gram-negatives and Gram-positives were resistant to cotrimoxazole. Out of the 1005 bacterial isolates, 165(16.42%), 161(16.02%) and 2(0.20%) showed multidrug resistance (MDR), extensively-drug resistance (XDR), and pandrug resistance (PDR) respectively.ConclusionThere was a high antibiotic-resistant pattern among the uropathogens reported in this current study, hence, the Standard Treatment Guidelines may need to be updated to reflect the high rates of antibiotic resistance exhibited by most prevalent isolates.

SEROPREVALENCE, RISK ASSOCIATIONS, AND TESTING COST OF SCREENING FOR HCV, HBV, AND HIV INFECTIONS AMONG A GROUP OF PRE-OPERATIVE EGYPTIAN PATIENTS

Background: Routine pre-operative testing for Human Immunodeficiency Virus (HIV) and other blood-borne viruses, Hepatitis B Virus, Hepatitis C Virus (HBV, HCV) has been stated as a strategy to reduce the risk of healthcare workers' infection by preventing and reducing their infection. However, the argument that screening is essential or not is strong. Aim: This study aims to determine the incidence of HBV, HCV, and HIV infections identified during pre-operative screening in a cohort of Egyptian individuals, along with the associated risk factors and the subsequent testing costs. Methods: This study comprised 138 patients, with 92 (66.7%) males and 46 (33.3%) females. All patients scheduled for surgical procedures underwent testing for HCV Ab, HBsAg, and HIV Ag/ Ab by chemiluminescent microparticle immunoassay conducted with the ARCHITECT i2000SR Immunoassay (Abbot Japan CO., Ltd, Tokyo, Japan). Among the participants, 23 out of 138 (16.7%) tested positive for HCV, while 5 out of 138 (3.3%) showed equivocal results for HCV, and 110 out of 138 (79.7%) tested negative for HCV. Additionally, 2 out of 138 (1.4%) were positive for HBsAg, while 136 out of 138 (98.6%) tested negative for HBsAg. Furthermore, 1 out of 138 (0.7%) was found to be HIV-positive, while 137 out of 138 (99.3%) tested negative for HIV. Results: The prevalence of each infection detected through pre-operative testing of HCV,HBV and HIV and a questionnaire was compared. Furthermore, we calculated the screening cost per confirmed infection by assessing the incidence of infections linked to different risk factors, ages, genders, and levels of HBV vaccination. Conclusions: Age markedly impacted HCV and HBV rates. There was no link between viral infections and gender. The expenses associated with each affirmative result were 1763 LE for HCV, 5520 LE for HBV, and 22080 LE for HIV. While self-assessment through questionnaires can be partially efficacious, it lacks sufficient screening accuracy.

Strategy against super-resistant bacteria: Curdlan-induced trained immunity combined with multi-epitope subunit vaccine

Methicillin-resistant Staphylococcus aureus (MRSA) is rapidly spreading worldwide, emerging as a leading cause of bacterial infections in healthcare and community settings. This poses serious risks to human health. The shortage of novel antibiotics and the absence of effective vaccines make MRSA particularly challenging to treat. Existing vaccine development strategies often fail to provide early protection against infections, highlighting the urgent need for solutions. Herein, we propose a novel strategy combining trained immunity with a multi-epitope subunit vaccine to combat MRSA infections. We comprehensively evaluated the trained immune phenotypes induced by β-glucan from barley and curdlan. Macrophages trained with curdlan exhibited a more balanced inflammatory response compared to β-glucan from barley, expressing higher levels of IL-1β, IFN-β, TGF-β, and CCL2 upon secondary stimulation. Furthermore, curdlan-induced trained immunity rapidly provided excellent protection against S. aureus infection in mice. RNA-sequencing analysis revealed that curdlan modulates the Wnt signaling pathway in macrophages, resolves inflammation, and promotes tissue repair. When combined with one or two doses of S. aureus multivalent epitope antigen against MRSA infection, curdlan-induced trained immunity enhanced early protection and promoted recovery. Our study demonstrates the feasibility of combining trained immunity with vaccine protection against MRSA, providing a strategy against multi-drug resistant bacteria.

Droplet Digital PCR for Acinetobacter baumannii Diagnosis in Bronchoalveolar Lavage Samples from Patients with Ventilator-Associated Pneumonia.

Advanced diagnostic technologies have made accurate and precise diagnosis of pathogens easy. Herein, we present a new diagnostic method, droplet digital PCR (ddPCR), to detect and quantify Acinetobacter baumannii in mini bronchoalveolar lavage (mini-BAL) samples. A. baumannii causes ventilator-associated pneumonia (VAP), a severe healthcare infection affecting patients' lungs. VAP carries a high risk of morbidity and mortality, making its timely diagnosis crucial for prompt and effective management. Methodology. The assay performance was evaluated by comparing colonization data, quantitative culture results, and different generations of PCR (traditional PCR and Real-Time PCR-qPCR Taqman® and SYBR® Green). The ddPCR and qPCR Taqman® prove to be more sensitive than other molecular techniques. Reasonable analytical specificity was obtained with ddPCR, qPCR TaqMan®, and conventional PCR. However, qPCR SYBR® Green technology presented a low specificity, making the results questionable in clinical samples. DdPCR detected/quantified A. baumanni in more clinical samples than other methods (38.64% of the total samples). This emerging ddPCR technology offers promising advantages such as detection by more patients and direct quantification of pathogens without calibration curves.

Incidence of healthcare-acquired infections among patients with hematopoietic stem cell transplantation

Background Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic modality for the treatment of bone marrow or immune systems that are damaged or defective either because of malignant or nonmalignant causes. Patients receiving HSCT are at high risk for infection for the following reasons: induced suppression of the body’s immune system, administration of massive chemotherapy and immunosuppressive drugs, and use of antibiotic therapy as prophylaxis before and after transplantation. Aim This study aimed to assess the incidence of healthcare-acquired infections among patients with HSCT. Design A descriptive/exploratory research design was used to carry out this study. It is one of the nonexperimental research designs, which are an efficient means of collecting a large amount of data in a relatively short time. The main purpose of a descriptive research design is to describe, observe, and document in detail some processes, events, risk factors, and outcomes. Sample A convenient sample of 62 adult male and female patients after HSCT were recruited to achieve the aim of the study. Setting This study was conducted in the Bone Marrow Transplant Unit at Nasser Institute for Research and Treatment in Cairo, Egypt. Tools: data was collected using three tools: Personal and Medical Background Data Form, The adopted Infection Prevention Checklist, and (c) Healthcare-Acquired Infection Checklists. Results Study findings denoted that the mean age was 35.5±12.9, and more than half of the study sample was males, revealing that 87.8% of the study participants acquired infection during hospitalization, while 12.2% did not acquire infection. However, 50% of study participants acquired bloodstream infection, 19.4% had pneumonia, 12.9% of them had urinary tract infection, and 1.6% had two types of infection perceptively. Conclusion This study concluded that bloodstream infection is the most common and serious healthcare infection among patients with HSCT. Recommendations Nurses should follow the guidelines for aseptic technic during implied central venous line care and drug administration to reduce BSI infection within hospitalization, and patients with HSCT should maintain oral care and self-hygiene regularly to reduce the incidence of healthcare-acquired infections. Also, further studies should be conducted to assess different types of infections.

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.

Expanding the use of mathematical modeling in healthcare epidemiology and infection prevention and control.

During the coronavirus disease 2019 pandemic, mathematical modeling has been widely used to understand epidemiological burden, trends, and transmission dynamics, to facilitate policy decisions, and, to a lesser extent, to evaluate infection prevention and control (IPC) measures. This review highlights the added value of using conventional epidemiology and modeling approaches to address the complexity of healthcare-associated infections (HAI) and antimicrobial resistance. It demonstrates how epidemiological surveillance data and modeling can be used to infer transmission dynamics in healthcare settings and to forecast healthcare impact, how modeling can be used to improve the validity of interpretation of epidemiological surveillance data, how modeling can be used to estimate the impact of IPC interventions, and how modeling can be used to guide IPC and antimicrobial treatment and stewardship decision-making. There are several priority areas for expanding the use of modeling in healthcare epidemiology and IPC. Importantly, modeling should be viewed as complementary to conventional healthcare epidemiological approaches, and this requires collaboration and active coordination between IPC, healthcare epidemiology, and mathematical modeling groups.