Hospital Infection Research Articles

Results of surgical treatment of infective endocarditis complicated by acute heart failure

Objective. To evaluate the results of surgical treatment of infective endocarditis complicated by acute heart failure. Materials and methods. The clinical data of 72 patients with infective endocarditis complicated by preoperative acute heart failure who underwent cardiac surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2019 to 30.12.2022 were studied. All patients were assigned to functional class IV according to the functional classification of the New York Heart Association. Results. The average duration of infective endocarditis from its first signs (hyperthermia above 38 °C) to diagnosis was 2 months (2; 4 months). Among the causes of infective endocarditis, bronchopulmonary diseases dominated – 24 (33.3%) observations, general surgical interventions – 7 (9.7%) and hospital infection – 7 (9.7%). Urologic surgical interventions caused the development of infective endocarditis in 6 (8.3%) patients, hypothermia in 4 (5.6%), drug addiction in 4 (5.6%), and dental procedures in 1 (1.4%) patient. In 19 (26.4%) patients, the causes of infective endocarditis were not established. In 62 (86.1%) patients, a multi–valve correction was performed, and in 10 (13.9%) – a single–valve correction. The most common were two main options: aortic valve prosthetics in combination with mitral and tricuspid valve surgery in 13 (18.1%) patients and mitral and tricuspid valve surgery in 14 (19.4%) patients. Surgical intervention for combined lesions of the valvular apparatus of the left and right heart was performed in 51 (70.8%) patients with infective endocarditis complicated by acute heart failure. Frequent intracardiac abscessing – in 20 (27.8%) patients with aortic valve lesions and in 9 (12.5%) patients with mitral valve lesions – indicated a high rate of extensive infection spread. Hospital mortality in the surgical treatment of infective endocarditis complicated by acute heart failure was 13.9%. 10 patients died. Conclusions. In 96.1% of patients with infective endocarditis complicated by preoperative acute heart failure, multivalve surgical correction was performed. In the initial acute heart failure in the setting of infective endocarditis, intracardiac abscessing was often recorded: 27.8% in aortic valve lesions and 12.5% in mitral valve lesions. Hospital mortality in the surgical treatment of infective endocarditis complicated by preoperative acute heart failure was 13.9%.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p<0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Prevalence of surgical site infections in a tertiary care teaching hospital in Goa, India: a cross-sectional study

Background: Surgical site infections (SSIs) are a major category of healthcare-associated infections (HAIs), particularly in surgical settings. They lead to extended hospital stays, increased morbidity, and financial burden. The study was conducted in the surgical wards of Goa medical college, a tertiary care hospital, to assess the prevalence of SSIs and identify the key bacterial pathogens and associated risk factors. Methods: A cross-sectional, prospective study design was employed, involving 378 patients aged over 18 years admitted for surgical procedures. Data collection included daily follow-up for signs of infection, identification of bacterial pathogens, and analysis of potential risk factors such as age, type of surgery, duration of postoperative drain, length of hospital stays, and wound classification. Statistical analyses were conducted using SPSS software, with significance set at p<0.05. Results: The study identified an SSI prevalence of 12.69% among the participants, with Pseudomonas being the most common causative agent. Significant risk factors included extended postoperative drain duration, longer hospital stays, emergency surgical procedures, and surgeries involving contaminated or clean-contaminated wounds. Patients with prolonged postoperative drains had a markedly higher incidence of SSIs (63.63%). Conclusions: The findings reveal a considerable burden of SSIs in the studied setting, with high infection rates in patients undergoing prolonged drain usage, emergency surgeries, and surgeries on contaminated wounds. Strengthening infection prevention measures, particularly in high-risk cases, and enforcing strict adherence to hygiene and sterilization practices are critical. Enhanced infection surveillance programs and targeted interventions could help reduce SSI rates, improve patient outcomes, and minimize healthcare costs.

Assessment of the disease course, diagnosis, and treatment of the new coronavirus infection in a Stavropol multidisciplinary hospital during the COVID-19 pandemic

Aim. To evaluate the disease course, laboratory diagnosis, and treatment results of COVID-19 patients. Materials and methods. In the period from January to December 2021, the moderate and severe COVID-19 forms complicated by polysegmental community-acquired pneumonia were monitored in 861 patients admitted to Stavropol Clinical City Hospital No. 3. Patients were assessed according to laboratory data, body mass index, concomitant diseases, gender, age, duration of inpatient treatment, and disease outcome. Results. More than half of the COVID-19 patients were overweight and had concomitant diseases at the time of admission, which significantly worsened the course and prognosis of the disease. The inflammation predictors (C-reactive protein, procalcitonin, fibrinogen, D-dimer, lactate dehydrogenase) were found to have an important role, with their indicators correlating significantly with the severity of the patient’s condition. Dynamic monitoring of these laboratory parameters served as a marker of the adequacy of the therapy; however, these were not always a criterion for prescribing antibacterial therapy. Bacteriological diagnostics was applied only in 9.4% of cases. Conclusion. Although the COVID-19 severity was not associated with gender, it correlated significantly with age and the presence of comorbid cardiovascular, bronchopulmonary, and endocrine diseases. A retrospective analysis revealed characteristic laboratory markers of the severity of COVID-19 infection. It was revealed that the initial empirical ABT was initiated in 94% of cases in the absence of reliable objective signs of bacterial infection.

Fractional-Order Mathematical Modeling of Methicillin- Resistant Staphylococcus aureus Transmission in Hospitals

This article investigates the environmental contamination and antibiotic exposure effect on the transmission dynamics of the Methicillin-Resistant Staphylococcus aureus (MRSA) model in hospitals using the fractional Adams–Bashforth–Moulton Method (ABMM). This epidemic model simulates the dynamics of patient populations, bacterial contamination, and healthcare worker safety under varying conditions. This model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, demonstrating the importance of symmetry in balancing hospital admission and discharge rates to manage infection spread effectively. The analysis extends to the impact of environmental bacterial density and hospital admission rates on patient colonization. Increasing admission rates introduce more susceptible patients, exacerbating infection spread when bacterial density is high. Conversely, lower admission rates and bacterial density result in a more controlled infection environment. The model further investigates how varying discharge rates influence colonization dynamics, highlighting that effective discharge practices can mitigate infection spread, especially in high-bacterial density scenarios. It must be noted that this model is studied fractionally for the first time. Overall, this model provides critical insights into the interactions between hospital practices, environmental factors, and infection dynamics, offering valuable guidance for infection control strategies and hospital policy formulation. By adjusting fractional order constant (σ) values and analyzing different scenarios, this research aids in understanding and managing bacterial infections in healthcare settings. The proposed method is able to provide the results presented in the figures within this study considering the influence of many factors.

Clinico-bacteriological profile of lower respiratory tract infections in a tertiary care hospital in Kolkata – A cross-sectional and observational study

Clinico-bacteriological profile of lower respiratory tract infections in a tertiary care hospital in Kolkata – A cross-sectional and observational study

PP385 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: RELATIONSHIP BETWEEN HOSPITAL STAY AND INFECTIONS ASSOCIATED WITH HEALTH CARE WITH THE USE OF MECHANICAL VENTILATION IN PEDIATRIC CRITICAL PATIENTS IN A REFERENCE HOSPITAL

PP385 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: RELATIONSHIP BETWEEN HOSPITAL STAY AND INFECTIONS ASSOCIATED WITH HEALTH CARE WITH THE USE OF MECHANICAL VENTILATION IN PEDIATRIC CRITICAL PATIENTS IN A REFERENCE HOSPITAL

Lumbar Fusion Surgical Prophylaxis Using Cefazolin vs. Vancomycin in the Penicillin-Allergic Patient.

Retrospective cohort study. To compare peri- and postoperative infection rates among patients with mild to moderate penicillin allergies who receive cefazolin vs vancomycin as prophylaxis for lumbar fusion. Additionally, we sought to determine if patients receiving cefazolin exhibited any clinical symptoms suggestive of drug-induced hypersensitivity reactions, and to compare those rates to patients who received vancomycin. Cefazolin has been historically linked to hypersensitivity reactions in penicillin-allergic patients due to cross-reactivity. As a result, vancomycin is often given to these patients instead. To our knowledge, no studies have directly compared these two antibiotics in penicillin-allergic patients undergoing lumbar fusion. Patients with mild to moderate documented penicillin allergies who underwent lumbar fusion from 2017-2022 and received prophylactic cefazolin or vancomycin were studied. Demographic, surgical information, and hospital length of stay (LOS) were recorded. We identified drug sensitivity reactions, in hospital infections, 90-day readmissions related to infectious etiologies and need for irrigation and debridement (I&D) to treat a surgical site infection. 222 patients received cefazolin, while 180 received vancomycin. Patients receiving vancomycin had more medical comorbidities, while patients receiving cefazolin had slightly more levels fused. No significant differences existed between cohorts in postoperative infection rate. One patient given cefazolin developed a mild drug-induced skin reaction that was treated with topical steroids. No significant differences existed between cohorts in 90-day readmissions or need for I&D surgery. On bivariate analysis, patients given cefazolin had a longer LOS but this was attributed to confounding variables on multivariate analysis. Cefazolin and vancomycin are comparable at preventing postoperative infections among patients with mild to moderate documented reactions to penicillin. Our findings also suggest that penicillin-allergic patients are not at higher risk of developing drug-related hypersensitivity reactions in response to cefazolin exposure when compared to those who received vancomycin.

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.

Sustainability in the Next Generation Hospital. Needs and Requirements collection from healthcare infrastructures supply chain stakeholders with One Health approach

Abstract Technological, demographic, epidemiological, environmental and social changes require investment in new sustainable hospital infrastructure; there is a lack of guidelines and interaction between Stakeholders. In February 2022, the Joint Research Platform Healthcare Infrastructures (JRP HI) was established consisting of Hospital Strategic Directions and Industrial Partners in Italy. Starting from the WHO Techincal Brief “Hospitals of the Future”, a national survey was carried out via web-survey and semi-structured interviews with a sample of 30 stakeholders to collect the main drivers and constraints for innovation and the framework from a One Health perspective and in terms of sustainability. The main needs to be addressed through the guidelines refer to digitalization (27%), flexibility (32%), environmental sustainability (36%) and economic sustainability (27%) as well as flow management (18%) and hospital infection (14%). The participants consider SDG-3 ‘Good Health and Wellbeing’ to be the most relevant for development activities. Hospital managers prioritize SDG-8 ‘Decent Work and Economic Growth’ (23%); vice-versa the industrial partners suggest SDG-11 ‘Sustainable Cities and Communities’ and SDG- 13 ‘Climate Actions’ (32%) as topics to be addressed. Furthermore, 57% of the respondents state that they lack adequate training, budget or leadership to apply innovative strategies in the day-to-day management of the healthcare organization. The survey highlighted a lack of initiatives, budget, and standardization for enhancing environmental sustainability in healthcare infrastructures. The sustainability of building systems depends on factors such as energy consumption, alternative energy sources, thermal comfort, water usage, waste management, ventilation, lighting efficiency, air quality, and construction materials. Ensuring the adoption of monitoring systems and harmonized standards of performance measurement is crucial for increasing the environmental sustainability.

Risk perception survey for healthcare-associated infections in a large teaching hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are the main complications of hospitalization. The goal of the study was to enhance awareness, improve risk perception, and facilitate measures to reduce the outcomes of HAIs. A bottom-up approach, in which the healthcare workers involved play a key role, can be adopted to decrease the spread of HAIs. Therefore, a survey was conducted in a large teaching hospital in Rome from 2019 to 2023, excluding 2020 due to COVID-19. Methods A longitudinal study was conducted in all integrated care departments with beds. The data was collected using a standardized, anonymous, self-administered questionnaire for healthcare workers. The questionnaire consisted of 61 items assessing socio-professional features, knowledge of HAIs, attitudes and barriers to hygiene compliance, self-analysis of professional behavior and advice for new interventions. The study lasted 21 days between November and December, which is considered a period of normal care activity. A multivariable logistic regression model was built. Statistical analyses were performed with STATA 18.0. Results There were 384 health workers respondents: female (67.7%) and nurses (56.5%). The most represented areas were internal medicine (37.9%) and surgery (27.3%). The correct frequency of perception of HAIs increased from 33.3% in 2019 to 36.3% in 2023. From 2022 to 2023, the multivariable model showed that physicians (OR 0.48, CI 95% 0.24-0.93, p-value 0.03) and elder staff (OR 1.02, CI 95%, 1.0-1.1, p-value 0.04) seemed to be more aware of the prevalence of HAIs in their ward. Conclusions Targeted training days were organized after the study to discuss the data collected. Staff awareness of the prevalence of HAIs in their ward is improving, even if it is complicated to quantify it by attending HAIs training events. The survey has been included as a corporate goal for 2024 as a useful tool to improve awareness of HAIs and to evaluate the effectiveness of ongoing training. Key messages • A bottom-up approach, in which healthcare workers assume a pivotal role, can be employed to reduce the spread of HAIs as it serves as a valuable tool to evaluate the efficacy of targeted training. • The results indicate that the education of healthcare workers is a crucial factor in enhancing awareness of HAIs. Therefore, there is a need to improve the education of younger and non-medical staff.

Respiratory tract and bloodstream infections: microbiological profile in an intensive care unit for COVID-19

This is a retrospective cross-sectional study aimed at identifying the profile of lower respiratory tract (RTI) and bloodstream infections (BSI) in patients in the Intensive Care Unit (ICU) of a Reference Hospital for COVID-19 in Recife, Pernambuco. Data were collected on the age and sex of patients, material used in cultures, microorganisms detected, and resistance and sensitivity to the antimicrobials used. The most frequent species was Acinetobacter baumannii in RTI and Staphylococcus haemolyticus in BSI, being more resistant to levofloxacin and more sensitive to linezolid. Knowing the pathogens and their respective susceptibility patterns facilitates the choice of initial therapy, as well as the establishment of action protocols for health professionals and hospital infection control committees.

Molecular characterization of human adenovirus associated with pediatric severe acute respiratory infections in a tertiary care hospital in North East India

PurposeThe present study explored the molecular characterization of human Adenovirus (HAdV) and its strains among hospitalized SARI cases in the pediatric unit of a tertiary care hospital in North-East India.MethodsNasal and throat swabs were collected from 70 patients of Pediatric Unit, of a tertiary hospital in NE India from April 2023-October 2023. The samples were screened for the presence of HAdV using an adenovirus-specific Real-Time PCR Kit. For molecular characterization, Next Generation Sequencing (NGS) was performed by targeting the hexon gene of HAdV followed by post-sequencing analysis.ResultsOverall, 18.57% (13/70) of samples were positive for HAdV. In context of the severity of illness, 3/13 adenovirus-positive patients (23.07%) died after hospitalization, had severe pneumonia among which two were of less than one year of age. Molecular characterization using NGS indicated that 4/13 individuals were infected with HAdV-B type 3 and 5/13 patients were infected with HAdV type 7. Notably, 4/7 cases of severe pneumonia were under five years of age and associated with HAdV type 7 infection. The ratio of non-synonymous to synonymous mutation (dN/dS) was comparatively low in HAdV type 7 positive samples (dN/dS=0.31). No non-synonymous mutation was observed in HAdV-B type 3 positive samples. The higher neutrophil percentage among the death cases suggested an acute immune response.ConclusionThe study demonstrated HAdV type 7 and HAdV-B type 3 as strains associated with pediatric SARI cases from April 2023-October 2023. Further, HAdV type 7 infection was primarily linked with lower respiratory tract infections mainly severe pneumonia.

Clinico-microbiological profile of Burkholderia pseudomallei infections in a tertiary care hospital in South India

Melioidosis, caused by Burkholderia pseudomallei, is known for its diverse clinical presentations and high mortality rate. This brief communication reports the clinico-microbiological profile of twenty cases of melioidosis in a tertiary care hospital over three years. We have analyzed demographic data, clinical presentations, microbiological findings, and treatment outcomes to enhance the understanding and management of this under-recognized infection.

The Incidence and Characteristics of Oral Candidiasis in Patients Hospitalized for SARS-CoV-2 Infection During the Circulation of Alpha, Beta, and Delta Variants

Background: Oral candidiasis has been documented in patients with SARS-CoV-2 infection, with varying prevalence rates across geographic regions and patient demographics. This study aimed to ascertain the incidence, characteristics, and risk factors associated with the development of oral candidiasis in patients hospitalized for SARS-CoV-2 infection in a tertiary infectious diseases hospital in Romania. Methods: A retrospective analysis was conducted on adult patients hospitalized between March 2020 and December 2022 with moderate or severe forms of SARS-CoV-2 infection, for whom a culture of lingual scrapings for Candida spp. was performed. Results: A total of 294 patients were deemed eligible for inclusion in the analysis, with an incidence rate of oral candidiasis of 17.0%. The incidence of oral candidiasis was 4.2 times higher in patients with severe forms of SARS-CoV-2 infection compared to those with moderate forms. Patients with a diagnosis of COVID-19 and oral candidiasis were more likely to receive antibiotics (98.0% vs. 86.1%, p = 0.017) and corticosteroids (100% vs. 83.6%, p = 0.003) than those without oral candidiasis. These findings were associated with a 19% higher relative risk of developing oral candidiasis for patients who received corticosteroid therapy compared to those who did not, and a 13% higher relative risk for those who were administered antibiotics compared to those who were not. The presence of respiratory insufficiency increased the odds of oral candidiasis association 4.7-fold (88.0% vs. 61.1%, p < 0.001). Conclusions: Although the data have been analyzed retrospectively, we have shown that individuals with severe forms of COVID-19 exhibited an elevated risk of developing oral candidiasis. The administration of antibiotics and corticosteroids was identified as a positive predictor for the development of oral candidiasis. The data presented here suggest that a key aspect of the therapeutic management of patients with SARS-CoV-2 infection should include the implementation of preventive measures to minimize the risk of secondary fungal infections.

Abnormal spirometric patterns and respiratory symptoms in HIV patients with no recent pulmonary infection in a periurban hospital in Ghana.

Human immunodeficiency virus (HIV) infection is associated with chronic airway obstruction, even in patients who have achieved viral suppression from combination antiretroviral treatment (cART). Spirometry is a supplementary test that aids in diagnosing pulmonary dysfunction in people living with HIV. To compare the prevalence of spirometric abnormalities among cART-treated HIV patients and cART-naïve HIV patients with non-HIV controls with no recent history of pulmonary infection in a peri-urban hospital in Ghana. In a case-control design, spirometry was performed in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls. Clinical, sociodemographic data and respiratory symptoms were collected using a structured questionnaire. Spirometric abnormalities were categorised as obstructive (OSP) or restrictive (RSP) spirometric patterns based on the Cameroonian reference equation. The prevalence of OSP was higher in the cART-treated and cART-naïve HIV patients compared to non-HIV controls (13.9% vs 10.7% vs 5.1% respectively, p = 0.026), whereas that of RSP was similar among the study groups. Respiratory symptoms were common among cART-treated and cART-naïve HIV patients compared to non-HIV controls (48.1% vs 40% vs 19.2% respectively, p < 0.001). The major factors associated with OSP were female gender [OR (95% CI) = 2.46 (1.09-5.13), p = 0.031], former cigarette smoking [1.92 (1.04-3.89), p < 0.001], exposure to medium-to-high levels of biomass [3.07 (1.16-8.73), p = 0.019], presence of a respiratory symptom [1.89 (1.11-5.08), p = 0.029] and unemployment [3.26 (1.19-8.95), p = 0.042]. The major determinants of RSP were age, female gender [1.74 (1.05-4.29), p = 0.041], former cigarette smoking [2.31 (1.27-6.77), p < 0.001] and medium-to-high biomass exposure [1.58 (1.06-5.37), p = 0.043]. In HIV patients without any recent pulmonary infection in a peri-urban area of Ghana, there was a higher prevalence of OSP among cART-treated and cART naïve HIV patients compared to the non-HIV control. However, the prevalence of RSP was similar among HIV patients and non-HIV controls.

CUIDADOS DE ENFERMAGEM NA PREVENÇÃO DE INFECÇÕES HOSPITALARES: ESTRATÉGIAS E PROTOCOLOS

Objective: The study aimed to analyze the strategies and protocols adopted by nursing professionals in order to evaluate their effectiveness and propose improvements. Method: A bibliographic methodology was used, reviewing the current literature on hand hygiene protocols, use of Personal Protective Equipment (PPE), and prevention of infections associated with invasive devices. Results: The results indicated that the fundamental protocols are effective in reducing infections, but highlighted the need for continuous training and the potential use of monitoring technologies to improve adherence and evaluation of practices. The study objectives were achieved, recommending regular updating of protocols, intensification of training, and the integration of new technologies to improve strategies for preventing hospital infections. Conclusion: This article investigated nursing care in the prevention of hospital infections. The justification for the study lies in the importance of optimizing infection prevention, a continuous challenge in hospital settings that impacts patient safety and health costs. Keywords: Hospital infections. Nursing care. Prevention. Control strategies.

CUIDADOS DE ENFERMAGEM NA PREVENÇÃO DE INFECÇÕES HOSPITALARES: ESTRATÉGIAS E PROTOCOLOS

Objective: The study aimed to analyze the strategies and protocols adopted by nursing professionals in order to evaluate their effectiveness and propose improvements. Method: A bibliographic methodology was used, reviewing the current literature on hand hygiene protocols, use of Personal Protective Equipment (PPE), and prevention of infections associated with invasive devices. Results: The results indicated that the fundamental protocols are effective in reducing infections, but highlighted the need for continuous training and the potential use of monitoring technologies to improve adherence and evaluation of practices. The study objectives were achieved, recommending regular updating of protocols, intensification of training, and the integration of new technologies to improve strategies for preventing hospital infections. Conclusion: This article investigated nursing care in the prevention of hospital infections. The justification for the study lies in the importance of optimizing infection prevention, a continuous challenge in hospital settings that impacts patient safety and health costs. Keywords: Hospital infections. Nursing care. Prevention. Control strategies.

Direct Klebsiella pneumoniae Carbapenem Resistance and Carbapenemases Genotype Prediction by Al-MOF/TiO2@Au Cubic Heterostructures-Assisted Intact Bacterial Cells Metabolic Analysis.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections pose a significant threat to human health. Fast and accurate prediction of K. pneumoniae carbapenem resistance and carbapenemase genotype is critical for guiding antibiotic treatment and reducing mortality rates. In this study, we present a novel method using Al-MOF/TiO2@Au cubic heterostructures for the metabolic analysis of intact bacterial cells, enabling rapid diagnosis of CRKP and its carbapenemases genotype. The Al-MOF/TiO2@Au cubic composites display strong light absorption and high surface area, facilitating the in situ effective extraction of metabolic fingerprints from intact bacterial cells. Utilizing this method, we rapidly and sensitively extracted metabolic fingerprints from 169 clinical isolates of K. pneumoniae obtained from patients. Machine learning analysis of the metabolic fingerprint changes successfully distinguishes CRKP from the sensitive strains, achieving the high area under the curve (AUC) values of 1.00 in both training and testing sets based on the 254 m/z features, respectively. Additionally, this platform enables rapid carbapenemase genotype discrimination of CRKP for precision antibiotic therapy. Our strategy holds great potential for swift diagnosis of CRKP and carbapenemase genotype discrimination, guiding effective management of CRKP bacterial infections in both hospital and community settings.

Clinical Evaluation of Blood Culture Identification Gram-Positive Panel on Methicillin Resistant Gene Testing in a Large Metropolitan Teaching Hospital

Abstract Introduction The ePlex blood culture identification (BCID) gram-positive panel is a PCR-based approach used for the detection of common pathogens associated with bloodstream infections and corresponding antibiotic-resistance genes. One of the genes, mecA, is associated with methicillin, penicillin, and other penicillin-like-antibiotic-resistant gram-positive bacteria (GPB). It is unclear whether the BCID panel has predictive utility and accuracy in treating hospital infections due to GPB. This retrospective study attempts to determine the consistency and accuracy of BCID gene testing compared to more traditional susceptibility methods at a large public hospital. Method A search query was performed for all BCID results at one teaching hospital in a large metropolitan area for one year (2022). The query included demographic information, BCID results, culture results, and combined susceptibility data. The results were filtered to include only cases in which the mecA gene was detected. The filtered results were then analyzed to determine if the susceptibility results from the susceptibility platform (VITEK) were consistent with the expected susceptibility of the target gene, specifically for oxacillin and vancomycin. The susceptibility cutoff was set as &amp;gt;0.5 mcg/mL and &amp;lt;1 mcg/mL respectively, the standard threshold used at the institution. Results A total of 1211 culture results were obtained, of which the mecA gene was identified by BCID in 321 cases, along with the following GPB: Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus sp. (not aureus). The corresponding cultures grew the following isolates: S. aureus, S. epidermidis, S. hominis, and S. haemolyticus. Of the 321 BCID results, 75 were identified as S. aureus. The isolates grew methicillin-resistant Staph aureus (MRSA) (69/75) 92%, while the typical S. aureus grew (6/75) in 8% of the isolates. In these cases, we compared susceptibility testing for both isolates as either sensitive or resistant, with a MIC of &amp;gt;0.5 mcg/mL for oxacillin to be designated as resistant, and &amp;lt;1 mcg/mL to be designated as sensitive to vancomycin. Of the 75 specimens, the concordance rate was 97% (73/75) for oxacillin and 100% (75/75) for vancomycin. The average receipt to verification turnaround time (TAT) was 36 hours for BCID results and 121 hours (about 5 days) for culture sensitivity results. Conclusion The results show that oxacillin resistance can be predicted by detecting S. aureus and the mecA gene using the BCID panel. However, the mecA gene can be identified in other GPB such as S. epidermidis, in which it should not be used to infer oxacillin or vancomycin susceptibilities. In the case of mecA and S. aureus detection by BCID, treating the patient as a MRSA infection may be appropriate before the susceptibilities have been performed. This approach can reduce the turnaround time for antimicrobial resistance reporting and improve antimicrobial stewardship efforts.