Nosocomial Research Articles

Same-day discharge coronary interventions: How to succeed?

Percutaneous coronary interventions (PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvements in PCI technique, stent technology, and antiplatelet therapy led to a complication rate of <5%, a success rate of >95%, and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits of inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease, and chronic total occlusions were also shown to be feasible and safe in the OP setting. Currently, available data show that OP PCI leads to cost optimization, increased capacity of PCI centers, decrease in the nosocomial infections rate, and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalization and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI, and propose a periprocedural patient management checklist to facilitate the implementation of OP PCI in interventional cardiology centers.

EVALUATION OF THE ROLE OF SELECTIVE DIGESTIVE TRACT DECONTAMINATION IN PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT PATIENTS

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in critically ill patients, contributing to increased morbidity, mortality, and healthcare costs. The incidence of VAP in intensive care units (ICUs) ranges from 7% to 40%, with mortality rates potentially exceeding 50%1. Recent studies highlight that VAP affects approximately 27% of all critically ill patients, with 86% of these infections associated with mechanical ventilation. The attributable mortality of VAP varies, with some studies reporting an increase in mortality of up to 27%3. Pathogens such as Pseudomonas aeruginosa, Acinetobacter, and Stenotrophomonas maltophilia are linked to higher mortality rates4. Beyond mortality, VAP significantly extends ICU length of stay and increases healthcare costs5. The gastrointestinal tract plays a crucial role in VAP pathogenesis, as it often becomes colonized with Gram-negative bacteria during critical illness6. Interventions such as selective decontamination of the digestive tract (SDD), stress ulcer prophylaxis with sucralfate, and enteral feeding strategies are employed to reduce VAP incidence. While SDD has been shown to decrease VAP incidence and may positively impact mortality, it also poses a risk of promoting Gram-positive bacterial infections. SDD involves the use of non-absorbable antibiotics applied topically to the oropharynx and through a nasogastric tube, often supplemented with systemic antibiotics during the initial days of ICU admission. Recent guidelines and systematic reviews continue to emphasize the importance of accurate VAP diagnosis and effective antimicrobial therapy to improve patient outcomes and reduce healthcare burdens.

MRSA Inhibitory Activity of Some New Pyrazolo[1,5-a]pyrimidines Linked to Arene and/or Furan or Thiophene Units.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major contributor to hospital-acquired infections and is highly resistant to treatment. Ongoing research focuses on developing new antimicrobial medications to prevent the spread of resistance. A facile method was employed to efficiently synthesize new pyrazolo[1,5-a]pyrimidines in 84-93 % yields by reacting 4-benzyl-1H-pyrazole-3,5-diamine with the respective α,β-unsaturated ketones. The reaction was carried out in ethanol containing 1.2 equivalents of potassium hydroxide at reflux for 5-6 h. The new products are attached to a para-substituted aryl group with variable electronic properties at pyrazolopyrimidine-C5, in addition to one of three units at C7, namely phenyl, thiophen-2-yl, or furan-2-yl units. A wide spectrum of antibacterial activity was displayed by the new pyrimidines against six different bacterial strains. In general, pyrimidines attached to furan-2-yl units at C7, in addition to another aryl unit at C5, attached to 4-Me or 4-OMe groups, demonstrate significant antibacterial activity, particularly against S. aureus strain. They had MIC/MBC of 2.5/5.1 and 2.4/4.9 μM, respectively, which exceeded that of ciprofloxacin. Moreover, they demonstrate more effective MRSA inhibitory activity than linezolid, with MIC/MBC values up to 4.9/19.7 and 2.4/19.7 μM against MRSA ATCC:33591 and ATCC:43300 strains, respectively.

Antimicrobial Performance of Different Metals

Health care associated infections or nosocomial infections (NI) is the fourth leading cause of disease and the most common complication affecting hospitalised patients in addition to a minimum of 175,000 deaths every year in industrialised countries. The Center for Disease Control and Prevention (CDC) states that influenza is transmitted from person to person primarily via large virus-laden droplets or through direct or indirect contact with respiratory secretions when touching surfaces contaminated with influenza virus and approximately 80% of the infections are transmitted via touch surfaces. In the year 2020 the Coronavirus (Covid 19) spread has affected the global community and also caused a great concern for the people and health care workers with a global infected population of more than five million. With the ongoing population rise in the cities growing drug resistant bacteria, increasing infection rate in hospitals and communities, ageing world population strongly indicates the need to minimise the spread of infections via touch surfaces. Metals (and products manufactured from them) such as copper and silver are known to exhibit antimicrobial properties. These metals, or composites containing them, can be used as additives and incorporated into other materials such as paints, plastics and powder coatings to imbue these materials with antimicrobial properties. In this paper we present the inherent antimicrobial properties of a copper containing alloy, two alloys of hospital grade steel (304 and 316), extruded aluminium (606013), anodized aluminium (606013) and zinc clad aluminium (3003-7072). Additionally, these materials were coated in epoxy resin powder coating with and without silver based antimicrobial additive. The ability of these metal alloys to reduce the population of inoculated microorganism numbers was assessed via the international standard (ISO) 22196:2011 Measurement of antimicrobial activity on plastics and other non-porous surfaces.

The role of tranexamic acid for infection prevention after fracture fixation

Despite the measures employed, fracture-related infections remain a concern after fracture fixation worldwide. Recently, the role of tranexamic acid as a protective drug against postsurgical infections in joint replacement and orthopedic trauma surgery has been proposed, where tranexamic acid has been associated with less surgical wounds complications and infectious complications including periprosthetic joint infection. The mechanism through which tranexamic acid exerts a protective effect against peri-implant infection is still the subject of debate. Although some authors hypothesize an indirect effect inhibiting the formation of postoperative hematoma, there are several studies that show a direct antibacterial effect of the drug against the capacity of bacterial aggregation, even avoiding biofilm formation, favoring the immune response of the host and the action of antibiotics. The purpose of this narrative review is to show the current role of tranexamic acid in orthopedic trauma, specifically its relationship with the prevention of infections related to implants.

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.

Genomic epidemiology and resistant genes of Acinetobacter baumannii clinical strains in Vietnamese hospitals.

Introduction. Acinetobacter baumannii is a common cause of multidrug-resistant (MDR) nosocomial infections worldwide, including Vietnam.Hypothesis. Analysis of crucial genetic factors may link to epidemiological characteristics and antibiotic resistance of A. baumannii clinical strains in Vietnamese hospitals.Methodology. Fifty-one A. baumannii clinical strains from six different tertiary hospitals in Vietnam were analysed using whole genome sequencing (WGS), between 2017 and 2019.Results. Eleven sequence types (STs) were identified, including four STs reported for the first time in Vietnam based on the PubMLST database and three new STs not previously documented. ST1336, ST1260 and ST575 were found exclusively in Vietnam. These STs were widely distributed in all hospitals in Vietnam, with ST2 and ST571 being the most dominant. Resistant rates to eight antibiotics, belonging to four antibiotic groups, were very high (72.5-94.1 %) with high MIC values, while resistance to colistin was 29.4%. Fifty-one isolates were identified as MDR, with 100% (51/51) isolates carrying antimicrobial-resistant (AMR) genes, and 52 antibiotic-resistant genes were detected among these strains, including β-lactam (22 genes), chloramphenicol (5 genes), lincosamide (2 genes), aminoglycoside (11 genes), rifampicin (1 gene), quinolone (2 genes), sulfonamide and trimethoprim (4 genes) and tetracycline (5 genes) resistance. The most commonly found mobile structures carried partial or complete transposons: ISaba24/ISEc29/ISEc35 contains a series of antibiotic-resistant genes.Conclusion. The WGS results of the 51 strains of A. baumannii provided important information regarding the distribution of STs and associated antibiotic-resistant genes among A. baumannii strains.

Detection of Efflux pump MexX and MexY genes in Multidrug Resistant Pseudomonas aeruginosa

High antibiotic resistance among Pseudomonas aeruginosa could be viewed as the primary cause of nosocomial infections. In this study, 60 isolates of Pseudomonas aeruginosa were isolated from urine, sputum, burn, ear and wounds swab. The major goal was to determine the relationship between MexX and MexY and the resistance of MDR P. aeruginosa to many drugs. Prevalence of multidrug resistant (MDR) Pseudomonas aeruginosa was 22 isolates (36.66%) and 38 isolates (63.34%) were found to be non-MDR isolates. Moreover, molecular detection of MexX and MexY genes was done for MDR isolates.MexY gene was found in all MDR isolates and MexX gene was detected in 20 (90.9%) MDR isolates. Susceptibility test showed highly significant differences p≤0.01. Highest resistance was found against piperacillin/sulbactam (45%), followed by ceftazidime/avibactam with 33.33%, and by ceftolozane/tazobactam and levofloxacin which shared same percentage at 31.67%. Almost 23.33% were less resistant to both doripenem and colistin, and 25% to tobramycin. All these findings confirmed a positive correlation between the presence of MexX and MexY genes and an increase in the resistance for all antibiotics used in this study the results of which were highly significant at p≤0.01 for all antibiotics. The study found that some antibiotics that had not been studied previously, also had a relationship with the presence of these genes and the resistance of bacteria to antibiotics such as penicillin, unlike it was previously believed that they do not have relation with the efflux pump mechanism in P. aeruginosa and that this bacterium use other mechanisms to resist them.

Selective Digestive Decontamination: A Comprehensive Approach to Reducing Nosocomial Infections and Antimicrobial Resistance in the ICU.

Background/Objective: Multidrug-resistant (MDR) bacteria pose a significant threat to global health, especially in intensive care units (ICUs), where high antibiotic consumption drives antimicrobial resistance. Selective digestive decontamination (SDD) is a strategy designed to prevent nosocomial infections and colonization by MDR pathogens. This study aimed to evaluate the impact of implementing an SDD protocol on antibiotic consumption and colonization by carbapenemase-producing Enterobacterale (CPE) in a specific ICU setting. Methods: This quasi-experimental study was conducted in the ICU of a university hospital from June 2021 to June 2023. Patients were divided into two groups: pre-intervention (before SDD) and post-intervention (after SDD implementation). Data on antibiotic consumption (expressed as defined daily doses (DDDs) per 100 stays), nosocomial infections, colonization rates, and the incidence of MDR bacteria were collected. A statistical analysis was conducted to compare the pre- and post-intervention groups. Results: A total of 3266 patients were included, with 1532 in the pre-intervention group and 1734 in the post-intervention group. The implementation of the SDD protocol resulted in a significant reduction in total antibiotic consumption (p = 0.028), with notable decreases in carbapenem use (p < 0.01) and colonization by CPE (p = 0.0099). The incidence of nosocomial infections also decreased in the post-SDD group, although this reduction was not statistically significant. Conclusions: The implementation of the SDD protocol in this ICU setting significantly reduced antibiotic consumption and colonization by CPE. These findings suggest that SDD may be a valuable tool in managing antimicrobial resistance in critical care settings, without contributing to the development of MDR bacteria.

Molecular Characterization of Enterococcus faecium Clinical Isolates Harbouring erm (T) from an Italian Hospital.

The presence of erm(T) gene conferring resistance to macrolides, lincosamides and streptogramin B (MLSB), was screened in 296 enterococci collected from clinical samples in a central Italy hospital and seven Enterococcus faecium isolates resulted positive to erm(T) by PCR. All isolates were resistant to erythromycin, tetracycline, ciprofloxacin and ampicillin but susceptible to vancomycin and chloramphenicol. Whole Genome Sequencing analysis revealed that in five E. faecium isolates, all belonging to the sequence type ST80 included in the clonal complex CC17 responsible of nosocomial infections, erm (T) gene was chromosome-located, in different genetic contexts. In E. faecium 735,236, erm (T) was on a 4,159-bp region flanked by two IS1216 and inserted at the 3' end of the mp gene. In E. faecium 711,448 and 739,437, erm (T) was found in a 4,463-bp region identical to that detected in E. faecium 735,236 except for 319bp. In E. faecium 713,729 and 757,415, erm (T) was on a 7,038-bp region flanked by IS1251 and ISEfm2 transposases and encompassed between the genes encoding a recombinase and three hypothetical proteins. erm(T)-carrying minicircles were detected in all isolates by inverse PCR assays demonstrating that erm(T) was included in mobile elements. However, in conjugation assays by filter mating, the erm(T) transferability was unsuccessful. Although macrolides are not used to treat enterococcal infections, the resistance is nonetheless widespread. These antibiotics are critically important in human medicine, but only few studies focused on erm (T)-harbouring clinical enterococci. The emergence of erm (T)-mediated erythromycin resistance among enterococci, potentially transferable to other nosocomial pathogens, should be constantly monitored.

The Ventriculoperitoneal Shunt Complication Rate in Baghdad Medical City from 2019 to 2022

Background and aimsDue to the substantial lack of data from Iraq on ventriculoperitoneal shunt (VPS) complications, this study aims to examine the various types of complications after VPS surgery in Baghdad Medical City. MethodsThe retrospective cohort study analyzed VP shunt procedures at Baghdad Medical City from 2019 to 2022. The overall complication rate, including infection and shunt malfunction, was determined from patient records. Data were analyzed using descriptive statistics and Kaplan-Meier survival analysis. Ethical approval was obtained from the IRB, with consent waived due to the study's retrospective nature. The findings highlight the need for improved management to reduce complication rates in VP shunt procedures. ResultsThe study involved 113 participants with an average age of 2.62 years (±3.4). The most common indications for VPS placement are congenital hydrocephalus (40%) and post-infectious hydrocephalus (30%). The most common complications of post-VPS surgery are VP obstruction (54%) and post-surgical infections (44%). There were no significant differences in the incidence of post-operative complications across different age groups. ConclusionOur study showed the significant complication rate associated with VPS surgeries for hydrocephalus, particularly VPS infections and obstruction. There were no significant age-related differences in VPS complication rates across age groups.

Prevalence of Drug Resistance and Pathogenic Factors of Pseudomonas aeruginosa Isolates Recovered from Hospitalized Patients

Background: Humans can develop both acute and chronic infections from Pseudomonas aeruginosa, a bacterium that is a prominent cause of nosocomial infections, as well as respiratory, urinary tract, burn, wound, ear, eye, and bloodstream infections. Objectives: This study aimed to identify antibiotic resistance in P. aeruginosa strains obtained from hospitalized patients and assess the frequency of virulence genes. Methods: In this cross-sectional study, 86 strains of P. aeruginosa were isolated from patients in various hospital wards in Shiraz and Yasuj in 2021. Antibiotic susceptibility was tested using the disk diffusion method, while the frequency of virulence genes (aprA, phzM, phzS) and antibiotic resistance genes (blaGES, blaSPM, blaVIM) was evaluated using PCR and specific primers. Results: The P. aeruginosa isolates showed the highest antibiotic resistance to imipenem and the lowest resistance to piperacillin-tazobactam. PCR amplification of aprA, phzM, and phzS genes indicated that aprA had the highest frequency among the isolates, with a prevalence of 98.8%. The frequencies of phzM and phzS were 96.5% and 91.9%, respectively. Conclusions: This study revealed a high prevalence of the virulence genes aprA, phzM, and phzS in P. aeruginosa isolates. Given the bacterium’s resistance to many antibiotics, clinicians should exercise caution when prescribing antibiotics, particularly for infections caused by P.aeruginosa.

New Antimicrobial Materials Based on Plasticized Polyvinyl Chloride for Urinary Catheters: Preparation and Testing.

Given the constant increased number of nosocomial infections in hospitals, especially associated with prolonged usage of inserted medical devices, our work aims to ameliorate clinical experience and promote faster healing of patients undergoing urinary catheterization by improving the properties of medical devices materials. Within this research, nine different composites were prepared based on polyvinyl chloride, using three different plasticizers (di-(2-ethylhexyl) phthalate, Proviplast 2646, and Proviplast 2755), and two different antimicrobial additives containing silver nanoparticles. The prepared materials were analyzed, and their physicochemical properties were determined: water absorption, relative density, plasticizer migration, hydrophobicity/hydrophilicity by contact angle measurement, Shore A hardness, tensile strength, and elongation at break. Structure and morphology were also investigated by means of FTIR, SEM, and EDX analyses, and thermal (TG-DSC) and biological properties were evaluated. The most important aspects of obtained results are showing that plasticizer migration was significantly reduced (to almost zero) and that the usage of antimicrobial additives improved the materials' biocompatibility. Thus, based on the concluded favorable properties, the obtained materials can be further used for catheter development. Pressure-flow studies for different sizes and configurations are the next steps toward advanced in vivo and clinical trials.

Targeting virulence of resistant Escherichia coli by the FDA-approved drugs sitagliptin and nitazoxanide as an alternative antimicrobial approach.

The spread of multidrug-resistant Escherichia coli in healthcare facilities is a global challenge. Hospital-acquired infections produced by Escherichia coli include gastrointestinal, blood-borne, urinary tract, surgical sites, and neonatal infections. Therefore, novel approaches are needed to deal with this pathogen and its rising resistance. The concept of attenuating virulence factors is an alternative strategy that might lead to low levels of resistance and combat this pathogen. A sub-inhibitory concentration (¼ MIC) of sitagliptin and nitazoxanide was used for phenotypic assessments of Escherichia coli virulence factors such as biofilm production, swimming motility, serum resistance, and protease production. Moreover, qRT-PCR was used to determine the impact of sub-MIC of the tested drugs on the relative expression levels of papC, fimH, fliC, kpsMTII, ompT_m, and stcE genes encoding virulence factors in Escherichia coli. Also, an in vivo model was conducted as a confirmatory test. Phenotypically, our findings demonstrated that the tested strains showed a significant decrease in all the tested virulence factors. Moreover, the genotypic results showed a significant downregulation in the relative expression levels of all the tested genes. Besides, the examined drugs were found to be effective in protecting mice against Escherichia coli pathogenesis. Sitagliptin and nitazoxanide exhibited strong anti-virulence activities against Escherichia coli. In addition, it is recommended that they might function as adjuvant in the management of Escherichia coli infections with either conventional antimicrobial agents or alone as alternative treatment measures.

Increased frailty is associated with risk of hospital-acquired infections and death during heart failure hospital admissions

Abstract Background Frailty is common in patients admitted with acute decompensation of heart failure (ADHF) and it is unclear how the frailty syndrome affects heart failure (HF) patients during their acute hospital admission. Understanding the interplay between frailty, impaired renal function, hospital-acquired infections (HAI), and death may be useful in optimising patient care and prognosis. Purpose The aim of this analysis was to explore the relationship between admission frailty levels and the incidence of HAI, acute kidney injury (AKI), and mortality in acute HF hospital admissions. Methods This is a retrospective analysis of data submitted from a single centre to the National HF audit between January and June 2023. Additional frailty and baseline renal function data was retrospectively collected from electronic patient health records. Patients were categorised into three groups according to their Rockwood Clinical Frailty Scale (CSF) (1): no/mild frailty (CFS 1-3), moderate frailty (CFS 4-6) and severe frailty (CFS 7-9). AKI was defined based on baseline and admission creatinine, as per KDIGO guidelines (2). Chi-squared and t-tests were used to compare baseline characteristics between frailty groups. Chi-squared tests were used to compare frailty groups in terms of: HAI, AKI, mortality. Results Between 1st January and 22nd June 2023, there were 344 acute HF hospital admissions in our centre. Most patients had moderate frailty on admission (n=256, 74.4%). Frail patients were significantly older, had a lower admission mean haemoglobin and more were female, compared to non-frail patients (Figure 1A). Patients who were more frail were more likely to experience HAI during their admission; p=0.035 (figure 1B). Furthermore, patients with HAI had a greater risk of mortality, at a median follow-up of 171 (IQR 100.25) days after admission, compared to those without HAI (p&amp;gt;0.001). 41.9% of acute HF admissions were associated with an AKI, and although numerically more frail patients had an AKI, this did not achieve statistical significance (p=0.084). Patients who were more frail were more likely to die, both during hospital admission and at 3 months following discharge; p&amp;lt;0.001 (Figure 1B). Furthermore, this trend persisted after follow-up; p&amp;lt;0.001 (Figure 2). Conclusions Patients with moderate or severe frailty are at greater risk of adverse events (HAI, death) during an acute HF hospital admission, than patients with no or mild frailty. It is imperative to consider the frailty status of all patients with ADHF, to be aware of the frailty-associated risks, and act proactively with targeted interventions (screen for infections, daily bloods, early conversations with patients and their families about treatment escalation plans and patient priorities) to improve outcomes and enhance the quality of care for this vulnerable patient population. Further research is warranted to explore potential interventions to address frailty-related risks in HF management.

Distribution and Molecular Characterization of Antibiotic-Resistant Pseudomonas aeruginosa in Hospital Settings of Sulaymaniyah, Iraq.

Pseudomonas aeruginosa is a significant pathogen in hospital settings, notorious for its role in hospital-acquired infections and its ability to develop resistance to multiple antibiotics. This study investigates the prevalence, distribution, and antibiotic resistance gene profiles of P. aeruginosa in seven hospitals in Sulaymaniyah City. A total of 300 samples were collected from various hospital surfaces including mops, sinks, medical equipment, beds, desks, and floors. Using bacteriological, biochemical, and molecular methods, 66 isolates were confirmed as Pseudomonas species, with 26 identified as P. aeruginosa. Antibiotic susceptibility testing revealed resistance rates of 23.3% to streptomycin, 13.6% to tobramycin, 22.7% to moxifloxacin, 21.2% to levofloxacin, and 22.7% to norfloxacin. Furthermore, the antibiotic resistance gene detection showed the presence of the bla CTX-M, bla SHV, qnrB, and bla ACC-1 genes among the isolates. The study highlights a 22% contamination rate of hospital surfaces with Pseudomonas species, emphasizing the urgent need for enhanced infection control measures and targeted antimicrobial stewardship to manage and reduce the spread of multidrug-resistant P. aeruginosa.

Proteomic approach to identify host cell attachment proteins provides protective Pseudomonas aeruginosa vaccine antigen FtsZ

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that causes severe nosocomial infections in susceptible individuals due to the emergence of multidrug-resistant strains. There are no approved vaccines against P. aeruginosa infections nor candidates in active clinical development, highlighting the need for novel candidates and strategies. Using a cell-blot proteomic approach, we reproducibly identified 49 proteins involved in interactions with human lung epithelial cells across four P. aeruginosa strains. Among these were cell division protein FtsZ and outer membrane protein OpmH. Escherichia coli BL21 cells overexpressing recombinant FtsZ or rOpmH showed a 66- and 15-fold increased ability to attach to 16HBE14o− cells, further supporting their involvement in host cell attachment. Both antigens led to proliferation of NK and CD8+ cytotoxic T cells, significant increases in the production of IFN-γ, IL-17A, TNF and IL-4 in immunised mice and elicited strong antigen-specific serological IgG1 and IgG2c responses. Immunisation with FtsZ significantly reduced bacterial burden in the lungs by 1.9-log CFU and dissemination to spleen by 1.8-log CFU. The protective antigen candidate, FtsZ, would not have been identified by traditional approaches relying on either virulence mechanisms or sequence-based predictions, opening new avenues in the development of an anti-P. aeruginosa vaccine.

Pattern of Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital of Bangladesh

Background: Surgical Site Infection (SSI) is a common form of hospital-acquired infection and major cause of postoperative illness accounting for approximately a quarter of all nosocomial infections. As a result, surgical antibiotic prophylaxis is now considered essential to conventional surgical procedure in order to reduce surgical site infections and improve postoperative recovery. The misuse and overuse of antibiotics has led to an increase in treatment costs and the emergence of antimicrobial resistance. The goal of the study is to identify the pattern of prophylactic antibiotic prescriptions for different surgical operations. Materials and methods: A retrospective observational study was conducted among 600 patients undergoing different surgeries in a tertiary care hospital of private setting in Dhaka, Bangladesh from July 2023 to December 2023. The demographic data, types of surgery, types of therapy, choice of antibiotic along with dosage formulations were collected. Results: Out of 600 patients, 245 (41%) were male and 355 (59%) were female. Highest bulk of patients were from Department of General Surgery (47.5%), followed by Department of Obstetrics &amp; Gynecology (24.16%) and Department of Otolaryngology (16.7%). Surgical prophylactic antibiotic was used in all 600 patients, and all antibiotics were given in intravenous route (100%). Almost 505 patients (84.2%) had received ceftriaxone as antimicrobial agent. Ceftriaxone with metronidazole or gentamicin and Cefuroxime with metronidazole or amikacin drugs combination were given to 75 (12.5%) and Cefuroxime, Amikacin, Metronidazole drugs combination were given to 20 patients (3.3%). 3rd generation cephalosporin, Ceftriaxone, was the most commonly prescribed antibiotic as monotherapy (94.3%), followed by 2nd generation cephalosporin, cefuroxime (4%). Conclusion: Ceftriaxone was the preferred antibiotic for surgical prophylaxis. Existence of an antimicrobial guideline along with antibiotic stewardship program in every hospital could be helpful for prescribers to play role in containment of antimicrobial resistance. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 70-74

Leveraging digital platforms to improve Public Health in hospital smart buildings

Abstract The integration of digital platforms into hospital infrastructure represents a significant leap forward in public health management. This session explores how smart hospital buildings, equipped with advanced digital technologies, can enhance public health outcomes through more effective disease surveillance, improved environmental controls and enhanced patient care management. Smart hospital buildings utilize a range of new technologies such as IoT sensors, AI-driven analytics and big data solutions to monitor and optimize various aspects of hospital operations and care. These technologies enable real-time data collection on environmental conditions, patient health metrics and resource utilization, creating an ecosystem that not only supports the immediate health needs of patients but also contributes to broader public health goals. The session will address four key areas where digital platforms can make an impact: -Disease Surveillance and Management: Digital tools can track health data trends and patterns within hospital settings, enabling early detection of infectious outbreaks and more precise tracking of patient outcomes. -Environmental Monitoring: IoT sensors can continuously assess conditions such as air quality, temperature and humidity, which are critical for preventing hospital-acquired infections and ensuring a safe environment for patients and staff. -Resource Optimization: AI algorithms can analyse data to optimize resource allocation, ensuring that medical supplies and human resources are used efficiently, which is crucial in health emergencies. -Patient-Centred Care: Digital platforms can facilitate personalized patient care through real-time health monitoring and data analysis, ensuring timely medical interventions and better health management. This session will highlight case studies demonstrating successful implementation of digital technologies in smart hospital buildings and discuss the challenges and lessons learned from these initiatives.

Effect of the implementation of infection prevention measures by an infection prevention link physician in trauma/orthopaedics surgery a onto hygiene-relevant processes and nosocomial infections

BackgroundThe German Infection Protection Act and KRINKO recommend nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). Detailed evidence on the contribution of PLPs to reducing infection rates is not available in Germany. AimThe "HygArzt"-study investigated whether , and to what extent, a PLP in orthopaedics/trauma surgery is able to improve hand hygiene adherence (HHA), process steps of dressing change, nosocomial infection (NI) and surgical site infection (SSI) rates by implementing an infection prevention bundle (IPB). MethodsIn consideration of a literature review on infection prevention measures in orthopaedics/trauma surgery and existing departmental hygiene standards, supported by the responsible infection control specialist, an IPB was developed by an interdisciplinary team and implemented by a PLP. The effects of IPB on NI, SSI, and HHA were determined in a pre-post study design on three trauma surgery/orthopaedic wards of a university hospital. FindingsIn pre-post comparison HHA was significantly increased, and NI rates were reduced significantly. The greatest increase in adherence occurred in the pre-indications "Before touching a patient" (pre: 37.3%; post: 73.0%), "Before clean/aseptic procedure" (pre: 34.2%; post: 75.5%) and "Before surgery" (pre: 9.7%; post: 57.0%). The analysis of NI and SSI rates (NI: p=0.03; SSI: p=0.01; relative risk (RR) of 0.53 in each case) revealed rate reductions. ConclusionThe implementation of an IPB by a PLP led to an optimisation of processes and to a reduction of SSIs and NIs. PLPs seem to have the potential for targeted, group-specific implementation of complex IPBs.