Infection Control Research Articles

Aptamer-Based Activatable Tyramide Signal Amplification for Low-Background Detection of SARS-CoV-2 Nucleocapsid Protein.

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection posed a significant threat to public health and the global economy, in vitro diagnosis of the SARS-CoV-2 nucleocapsid protein proved to be an effective way for SARS-CoV-2 infection control in the past years. Tyramide signal amplification (TSA) has been extensively utilized in tissue imaging and pathological diagnosis owing to the powerful signal enhancement. However, the elevated "ALWAYS ON" fluorescence background limited the accuracy and sensitivity of the conventional TSA assay. To achieve an activated "TURN ON" signal, herein, a small molecule, termed dichlorodihydrofluorescein tyramide (T-DCFH), was synthesized for activatable TSA. Under the catalysis of horseradish peroxidase (HRP) with hydrogen peroxide (H2O2), this T-DCFH facilitates the "TURN ON" fluorescence signal. Additionally, as a recognition tool, DNA aptamer has been used for developing in vitro diagnostic approaches. Hence, based on HRP-labeled aptamers binding with SARS-CoV-2 nucleocapsid protein, we achieved aptamers-based activatable TSA detection with a higher signal-to-noise ratio than that of fluorescent dye (FITC)-labeled aptamers, while showing lower background than traditional fluorescein tyramide with "ALWAYS ON". The results demonstrated that the activated T-DCFH significantly enhances the fluorescence signal while diminishing the background noise. By employing multiple aptamers targeting, we offered a timely and accurate in vitro diagnostic approach for future emergent infectious diseases.

Antimicrobial resistance profile of bacteria from hospital wastewater at two specialized hospitals in Bahir Dar city, Ethiopia

BackgroundThe high levels of antimicrobial consumption in hospitals contribute to the occurrence of antimicrobial resistant bacteria. Antimicrobial resistant bacteria and sub-lethal concentrations of antimicrobial metabolites can end up in hospital wastewater which can spread to the environment and to the community. However, information on the resistance profile of bacteria isolated from environments is not well studied. Thus, the main aim of this study was to determine the antibiotic resistance profile of bacteria from hospital wastewater in Bahir Dar City, Northwest Ethiopia.MethodA total of 70 hospital wastewater samples were collected from two comprehensive specialized hospitals using a grab-sampling technique. Bacteria were identified using colony morphology, Gram staining, and biochemical tests. The drug susceptibility test was performed using the Kirby-Bauer disc diffusion method on Muller-Hinton agar.ResultThe most dominant bacterial isolates from hospital wastewater were Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Citrobacter spp., Acinetobacter spp., Enterobacter spp., Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa). All K. pneumoniae and 52.4% (11/21) E. coli were resistant to ceftazidime (third-generation cephalosporin), while Citrobacter spp., Acinetobacter spp., and Enterobacter spp., were susceptible to ceftazidime. Likewise, S. aureus revealed 64% (16/25) resistance to erythromycin. Overall, 22.2% of bacterial isolates were multidrug resistant bacteria to the commonly prescribed antimicrobials.ConclusionHospital waste waters contain high prevalence of multiple drug-resistant bacteria, particularly the third-generation cephalosporin resistant K. pneumoniae and E. coli would be a big concern. Infection prevention and control practices with proper treatment of hospital wastewater before discharging should be in practice to contain the spread of drug-resistant bacteria from hospital to external environment.

Best practices for disinfection in dental settings: insights from Italian and European regulations.

Disinfection practices in dental settings are fundamental to clinical safety, playing a pivotal role in preventing cross-infections and protecting the health of patients and healthcare professionals. This article examines the key components of effective disinfection, based on evidence-based protocols developed by international organizations such as the WHO and the U.S. CDC, alongside European and Italian regulatory standards. Dental instruments require stringent sterilization by autoclave or chemical methods, while high-level disinfection is essential for non-sterilizable items. Clinical surfaces require routine biocidal treatment tailored to microbial hazards and material compatibility. The European Biocidal Products Regulation and the Medical Devices Regulation provide critical oversight, ensuring product safety and effectiveness while preventing resistance. Antiseptics also play a vital role in oral care, with applications ranging from infection prevention to the treatment of periodontal disease, and are governed by strict regulatory frameworks. Disinfection effectiveness is significantly affected by factors such as microbial load, presence of biofilm, pH, temperature and biocide exposure time. Preventing bacterial resistance requires appropriate germicide selection, adherence to manufacturer protocols, robust sterilization and cleaning procedures. In addition, the increased use of disinfection during public health emergencies highlights the need for adaptability to mitigate evolving risks. Regular audits, biological tests, and training for healthcare personnel ensure the consistent application of these rigorous protocols. By integrating international and national standards, dental facilities achieve a uniform approach to hygiene and safety, advancing public trust and compliance. This article highlights the imperative for ongoing research and dissemination of best practices to enhance infection control in dental care environments.

Transgenic poplar for resistance against pest and pathogen attack in forests: an overview

Forests are potential habitats for immense terrestrial ecosystems and aquatic biodiversity, performing an essential role in ecological preservation and regulation of climate. The anthropogenic pressures on the forests lead to forest loss, fragmentation and degradation. Requirements for sustainable methodologies for forest protection are of utmost priority under the climate change regime. Among forest trees, poplar trees (Populus L.) have attracted attention in global forestry as a promising material for improving the quality and quantity of urban landscapes. These plants provide wood, which can be utilized as raw resources for the paper industry and as a potential source of biofuel. However, several biotic stresses, such as attacks by pests and pathogens, severely affect poplar production and productivity. The improvement of Populus trees through conventional tree breeding methods is restricted due to their long-life cycles and the lack of suitable donors with resistance genes. Populus has been utilized as a model plant for studying gene functions due to its highly efficient genetic transformation capabilities. The present review will provide a comprehensive overview of pest and pathogen attacks on poplar, focusing on their infection mechanisms, transmission routes, and control strategies. Additionally, it will examine the most widely used genetic transformation methods (gene gun-mediated, Agrobacterium tumefaciens-mediated, protoplast transformation, micro-RNA mediated and micro-RNA clustered regularly interspaced short palindromic repeats (CRISPR)-associated (CRISPR-Cas) systems methods and RNA interference) for improving tolerance in poplar trees against pest and pathogens attack. Furthermore, it will delve into prospects, challenges, and recent advances in molecular biology tools and their safe application for genetic transformation to improve insect and pest resistance in poplar trees. Finally, the regeneration of transgenic poplar trees with enhanced resistance, developed through various genetic engineering techniques, is discussed.

Clinical Application Study of External Fixation Treatment Using Removed Locking Plates in Patients with Failed Debridement and Antimicrobial Therapy for Infection after Internal Fixation of Fractures.

Purpose: The main focus of this study is to investigate the clinical efficacy of external fixation treatment using removed locking plates in patients with failed debridement and antimicrobial therapy of infection after internal fixation of fractures. Patients and Methods: From January 2019 to January 2023, our medical institution treated 13 patients who had failed debridement and antimicrobial therapy for infection after internal fixation of fractures. All patients had their internal fixation devices removed, underwent thorough debridement, and then the removed locking plates were repurposed for external fixation treatment. Post-operatively, we observed the infection control status, fracture healing, and complications following locking plate external fixation. Results: Among all patients, there were seven males and six females, with an average age of 45.92 ± 13.19 years. The time interval from fracture internal fixation surgical procedure to the onset of infection was 7.08 ± 1.89 weeks, and the average debridement frequency was 1.62 ± 0.51 times. After treatment with external fixation using a removed locking plate, infection was controlled in 12 patients, ultimately achieving clinical bone healing. These 12 patients achieved clinical bone healing at a time of 7.50 ± 1.00 months, and the locking plate external fixation time was 9.83 ± 1.11 months. Conclusions: External fixation using removed locking plates appears to be an effective treatment option for patients who have failed debridement and antimicrobial therapy for infection after internal fixation of fractures. This approach effectively controls infection symptoms while not interfering with the fracture healing process. Additionally, this treatment option using a removed locked plate may potentially contribute to reducing patients' medical expenses.

Antibiotics versus Non-Antibiotic in the treatment of Aspiration Pneumonia: analysis of the MIMIC-IV database

BackgroundAspiration pneumonia (AP) is a common complication in the intensive care unit (ICU), which is associated with significantly increased morbidity and mortality and has a significant impact on patient prognosis. Antibiotics are commonly used in the clinical treatment of AP. However, the prognostic impact of antibiotics on patients with AP has not been adequately characterized. The purpose of this study is to illustrate the relationship between the use of antibiotics and in-hospital mortality of AP patients, as well as to analyze the effects of different antibiotic treatment regimens on the prognosis of the patients, and to further understand the distribution of pathogens and drug resistance in AP patients, so as to provide guidance information for the rational use of medication for patients in the clinic.MethodsClinical data of AP patients were extracted from the MIMIC-IV database. Statistical methods included multivariate logistic regression, propensity score matching (PSM), and inverse probability weighting (IPW) based on propensity scores to ensure the robustness of the findings. In addition, the characteristics of the medications used by patients with AP were described using statistical graphs and tables.ResultsA total of 4132 patients with AP were included. In-hospital mortality was significantly lower in the group using antibiotics compared to the group not using antibiotics (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.27- 0.71, P = 0.001). Furthermore, in the group using mechanical ventilation (MV), antibiotics use significantly reduced in-hospital mortality (OR = 0.30, 95% CI 0.15–0.57, P < 0.001).Vancomycin and cephalosporins are the most commonly used antibiotics to treat AP. Specifically, vancomycin in combination with piperacillin-tazobactam was used most frequently with 396 cases. The highest survival rate (97.6\\%) was observed in patients treated with levofloxacin combined with metronidazole. Additionally, vancomycin combined with piperacillin-tazobactam had many inflammation related features that differed significantly from those in patients who did not receive medication.ConclusionsAntibiotics use is closely associated with lower in-hospital mortality in ICU patients with AP. Moreover, understanding antibiotics use, the composition of pathogenic bacteria, and the rates of drug resistance in patients with AP can aid in disease prevention and prompt infection control.

Identifying multidrug-resistant organisms in diabetic foot ulcers: a study of risk factors and antimicrobial resistance genes.

This study aims to evaluate the antibiotic susceptibility profiles of bacterial isolates from DFU patients, identify the prevalence of MDROs, and identify specific risk factors contributing to these infections to inform effective antibiotic treatment strategies. This prospective cohort study included 187 DFU patients from March 2023 to February 2024 at King Khalid Hospital, Saudi Arabia. The exclusion criteria were nondiabetic ulcers, specific infections, tumours, or recent antibiotic use. Data on demographics, diabetes duration, DFU characteristics, and antibiotic history were collected. Ethical approval and informed consent were obtained. During the 1-year study, 187 DFU patients were included, with 72.7% males and 27.3% females. The mean age of the study participants was 54.9 ± 11.8 years. The average duration of diabetes was 6.3 ± 3.7 years, and themean HbA1c was 8.0 ± 1.0%. Over half (54.5%) of the patients had Wagner ulcer grade III, and neuropathy (67%) and retinopathy (73%) were the most common complications. Polymicrobial infections were identified in 54% of the cases, with 61.5% of the isolates producing biofilms. The key risk factors for MDR infections included amputation (OR: 5.92), polymicrobial infections (OR: 7.49), biofilm production (OR: 5.00), recent antibiotic use (OR: 3.97), and an ulcer duration > 30 days (OR: 2.23). Sex, age, and weight were not significantly associated with MDR infections. Among the 27 MRSA isolates, 81.5% carried the mecA gene, and 98.8% of the ESBL-producing organisms harboured at least one ESBL gene, with blaCTX-M being the most common (27.2%). Carbapenem resistance was confirmed in 25.6% of the isolates, with blaNDM being the predominant carbapenemase gene (69.3%). Coresistance with ESBL genes was detected in 66.7% of the blaNDM-producing isolates. This study demonstrates a high prevalence of MDROs in DFUs, primarily driven by biofilm-producing polymicrobial infections and resistance genes like blaNDM and blaCTX-M. The findings accentuate the clinical importance of integrating molecular diagnostics for early detection of resistance determinants, enabling precise, targeted therapy. Tailored antibiotic stewardship and enhanced infection control measures are critical to optimizing treatment outcomes, reducing complications, and mitigating the burden of chronic DFUs in healthcare settings.

Innovative public strategies in response to COVID‐19: A review of practices from China

AbstractThe COVID‐19 pandemic presented unparalleled challenges to prompt and adaptive responses from nations worldwide. This review examines China's multifaceted approach to the crisis, focusing on five key areas of response: infrastructure and system design, medical care and treatment, disease prevention and control, economic and social resilience, and China's engagement in global health. This review demonstrates the effectiveness of a top‐down command system at the national level, intersectoral coordination, a legal framework, and public social governance. This study also examines medical care and treatment strategies, highlighting the importance of rapid emergency response, evidence‐based treatment, and well‐planned vaccination rollout. Further discussion on disease prevention and control measures emphasizes the importance of adaptive measures, timely infection control, transmission interruption, population herd immunity, and technology applications. Socioeconomic impact was also assessed, detailing strategies for disease prevention, material supply, livelihood preservation, and social economy revival. Lastly, we examine China's contributions to the global health community, with a focus on knowledge‐sharing, information exchange, and multilateral assistance. While it is true that each nation's response must be tailored to its own context, there are universal lessons to be drawn from China's approach. These insights are pivotal for enhancing global health security, especially as the world navigates evolving health crises.

Pressure Difference Measuring System for Clean Rooms

This article presents the development and implementation of a pressure difference measuring system tailored for clean rooms, essential in medical facilities to control airflow and reduce nosocomial infections. The study evaluates various pressure sensors, leading to the selection of intelligent sensors that meet specific performance criteria. Key features and operating principles of the system are outlined, including sensor types, measurement techniques, and system architecture. A detailed comparison of sensors such as BMP180 and BMP280 highlights their suitability based on parameters like resolution, power consumption, and communication interfaces. The system’s structure includes dual pressure sensor units connected to a main control unit, enabling real- time pressure monitoring across different room zones. The sensors, equipped with a microcontroller for initial data processing, relay information to the control unit for further analysis and display. Designed with a calibration feature, the system ensures measurement accuracy by allowing recalibration under identical atmospheric conditions. Operating on low voltage, the system provides safe and reliable performance with applications extending to isolation rooms and environments requiring precise pressure regulation. Integrating the measuring system with ventilation systems significantly mitigates the risk of airborne disease transmission, contributing to the maintenance of sterile environments. The article concludes that this cost-effective, intelligent pressure monitoring solution not only enhances safety in healthcare settings but also supports regulatory compliance and improves overall infection control measures in high-risk areas.

Can a diet rich in Brassicaceae help control Helicobacter pylori infection? A systematic review

IntroductionHelicobacter pylori (Hp) infection is highly prevalent globally and poses a significant public health challenge due to its link with chronic gastritis, peptic ulcers, and gastric malignancies. Hp’s persistence within the gastric environment, particularly in case of infection with virulent strains, triggers chronic inflammatory responses and mucosal damage. Antibiotic therapy is the primary approach for Hp eradication, but antibiotic resistance and adverse effects hinder treatment efficacy. Emerging evidence suggests that Brassicaceae-derived metabolites could serve as adjunctive therapy for Hp infection, offering potential antimicrobial and anti-inflammatory benefits.MethodsA systematic literature review was conducted following PRISMA guidelines to assess the impact of Brassicaceae-rich diets on Hp infection control. Searches were performed in MEDLINE PubMed, Web of Science, and the Cochrane Library until 18 October 2023, without language or date restrictions. Eligible studies meeting PICOS criteria were included, encompassing populations infected with Hp or Hp-infected human cell cultures, interventions involving Brassicaceae consumption or its bioactive molecules, and outcomes related to Hp infection control, antibiotic therapy interactions, reduction of antibiotic side effects, and inflammation mitigation. Animal studies, cell line experiments, reviews unrelated to the research objectives, and studies on Hp-related gastric cancer were excluded.ResultsAvailable evidence indicates that Brassicaceae consumption exhibits the potential to reduce Hp colonization but achieving complete eradication of the pathogen remains challenging. Conflicting results regarding the efficacy of broccoli in Hp treatment emerge, with certain investigations suggesting limited effectiveness. Other studies point to a potential for heightened eradication rates when combined with standard triple therapy. Furthermore, promising outcomes are observed with broccoli extract supplements, indicating their role in mitigating Hp-induced gastric mucosal damage. In fact, it is noteworthy that sulforaphane and its derivatives manifest notable reductions in pro-inflammatory markers, indicative of their anti-inflammatory properties. Adverse events associated with antibiotic therapy seem unaffected by sulforaphane derivatives or probiotics. However, individual responses to these treatments vary, underscoring the unpredictability of their efficacy in ameliorating antibiotic therapy-related side effects.ConclusionOur systematic review highlights the potential of Brassicaceae-rich diets as adjunctive therapy for Hp infection, offering synergistic interactions with antibiotics and possibly mitigating antibiotic side effects and inflammation. Further research, particularly well-designed randomized trials, is warranted to elucidate the therapeutic efficacy and optimal utilization of Brassicaceae-derived metabolites in managing human Hp-related diseases.

An Overview of Recent Clinical Trials for Diabetic Foot Ulcer Therapies

Diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to high mortality, reduced quality of life, neuropathy, ischemia, infection, and amputation risks. The prevalence of these ulcers is only on the rise as more people suffer from type 2 diabetes and obesity. The current wound management involves wound dressings, offloading, debridement, and infection control, but more must be done to keep up with the rising prevalence of DFUs and the strain they put on patients and the healthcare system. To find recent therapeutic advances in DFU treatment, we searched PubMed for novel therapeutics from the past 5 years. We found a diversity of promising interventions, including advanced wound dressings and topicals, physical energy-based therapies, regenerative scaffolds, and growth factor- and cell-based therapies. Recent therapies hold significant promise in healing more DFUs faster and more effectively. Providers should consider employing safe, novel therapeutics when standard dressings are not effective.

Novel travel time aware metapopulation models and multi-layer waning immunity for late-phase epidemic and endemic scenarios.

In the realm of infectious disease control, accurate modeling of the transmission dynamics is pivotal. As human mobility and commuting patterns are key components of communicable disease spread, we introduce a novel travel time aware metapopulation model. Our model aims to enhance estimations of disease transmission. By providing more reliable assessments on the efficacy of interventions, curtailing personal rights or human mobility behavior through interventions can be minimized. The proposed model is an advancement over traditional compartmental models, integrating explicit transmission on travel and commute, a factor available in agent-based models but often neglected with metapopulation models. Our approach employs a multi-edge graph ODE-based (Graph-ODE) model, which represents the intricate interplay between mobility and disease spread. This granular modeling is particularly important when assessing the dynamics in densely connected urban areas or when heterogeneous structures across entire countries have to be assessed. The given approach can be coupled with any kind of ODE-based model. In addition, we propose a novel multi-layer waning immunity model that integrates waning of different paces for protection against mild and severe courses of the disease. As this is of particular interest for late-phase epidemic or endemic scenarios, we consider the late-phase of SARS-CoV-2 in Germany. The results of this work show that accounting for resolved mobility significantly influences the pattern of outbreaks. The improved model provides a refined tool for predicting outbreak trajectories and evaluating intervention strategies in relation to mobility by allowing us to assess the transmission that result on traveling. The insights derived from this model can serve as a basis for decisions on the implementation or suspension of interventions, such as mandatory masks on public transportation. Eventually, our model contributes to maintaining mobility as a social good while reducing exuberant disease dynamics potentially driven by travel activities.

Surge of healthcare associated infections in COVID intensive care units

: Healthcare-associated infection played a vital role in determining the patient’s outcome during the COVID pandemic. However, the data on HAI rates is largely unavailable in COVID locations. This is because conducting HAI surveillance inside COVID ICUs is a big challenge. Therefore, we conducted this unique quality improvement study which aims at comparing the trends of HAI rates in COVID and non-COVID ICUs during the ongoing pandemic.: The aim of the study was to compare the HAI rates in COVID and non COVID ICUs with the baseline HAI rates in pre COVID era.: The HAI surveillance was carried out during April 2020-December 2020 in the COVID ICUs (test group) and non-COVID ICUs (control group) and compared with ICUs from January 2019 to March 2020 (pre COVID baseline group). Then HAI data was analysed and the HAI rates were calculated based on national healthcare safety network guidelines. Overall, the HAI rates were higher in COVID time in comparison to pre COVID time. During the COVID period, higher HAI rates were seen in the COVID ICUs than in the non COVID ICUs. CLABSI rate had the highest occurrence followed by VAE, CAUTI, and SSI.: Higher HAI rates in COVID time indicates that there is need of serious infection control intervention thereby reducing the HAIs associated in COVID patients. Strict compliance to hand hygiene and other transmission-based precautions are to be followed in order to enhance the overall safety of patients.

Specialty-specific hand hygiene compliance: 5-year study from a large public sector teaching hospital, South India

: Hand hygiene (HH) is essential for preventing healthcare-associated infections (HAIs), especially in ICUs and cancer care centers. These settings often involve immunocompromised patients and invasive devices, making HH critical for patient safety. Despite its recognized importance, consistent adherence to HH practices by healthcare workers (HCWs) remains a significant challenge. This study aimed to evaluate HH compliance in a tertiary care hospital in South India using a customized Android application aligned with WHO guidelines. : This observational study was conducted across high-risk areas of a tertiary care hospital from June 2019 to May 2024. The hospital's high-risk units, under medical, surgical, and pediatric alliances, were included. An Android application based on the Ibhar platform and WHO hand hygiene audit guidelines was used for data collection. The study recorded HH opportunities, Complete HH Adherence (HHCAR), Partial HH Adherence (HHPAR), and Total HH Adherence (HHTAR). The data were analyzed for location-specific, profession-specific, and moment-specific compliance rates. : A total of 196,252 HH opportunities were recorded, with the surgical alliance accounting for the highest number. Pediatric units had the highest compliance, with an HHTAR of 89% and an HHCAR of 66%. Nurses demonstrated the highest compliance among professions, with an HHTAR of 82.8%. Compliance was higher after patient care moments compared to before. Statistically significant differences were noted across different specialties and moments. : This large-scale study highlights the variation in HH compliance across different specialties and the need for targeted training sessions. Given the resource constraints in many tertiary care centers, focusing audits on high-risk areas is practical. The use of software-based applications like Ibhar enhances data collection and analysis, making the audit process more efficient. Regular HH audits and behavioral changes are essential to improve and sustain high standards of HH compliance, ultimately contributing to better infection control practices.

Infection in nicu setting pose serious health risks to neonates - A meta-analysis

Infections in Neonatal Intensive Care Units (NICUs) pose significant health risks to neonates, particularly due to their underdeveloped immune systems and the invasive procedures often necessary for treatment. These infections can lead to severe complications, prolonged hospital stays, and increased mortality rates. This meta-analysis aims to assess the prevalence, risk factors, outcomes, and preventive strategies associated with infections in NICU settings to better understand the scope of the problem and provide insights for improved healthcare practices. A systematic search was conducted across multiple databases, including PubMed, CINAHL, and Medline, for peer-reviewed studies published in the last two decades. Studies were selected based on criteria that included focus on NICU-acquired infections, study design, and outcomes reported on neonatal health. Data on infection prevalence, types, risk factors, treatment efficacy, and preventive interventions were extracted and analyzed using meta-analytic techniques to calculate pooled estimates and examine statistical associations. Findings indicate a high prevalence of infections in NICUs, with bloodstream infections, pneumonia, and urinary tract infections as the most common types. Risk factors such as prematurity, low birth weight, invasive procedures, and prolonged NICU stay significantly increase infection rates. Neonates with infections demonstrated higher morbidity, longer hospital stays, and a higher risk of long-term health complications. Preventive measures, particularly hand hygiene protocols, sterilization practices, and early identification strategies, were associated with reduced infection rates. Infections in NICUs remain a critical issue, impacting neonatal outcomes and healthcare costs. Strengthening preventive measures and developing standardized protocols for infection control are essential to reduce infection rates and improve neonatal health outcomes. Further research is needed to identify the most effective interventions and foster a culture of infection prevention within NICU settings.

Prevalence of multidrug-resistant gram-negative bacilli (MDR-GNB) in hospital-acquired and ventilator-associated pneumonia: A comparative study from a tertiary care center, Gujarat

Antibiotic resistance poses a formidable challenge to global healthcare, with Gram-negative bacteria emerging as a primary concern. Multidrug-resistant Gram-negative bacilli (MDR-GNB) have become a significant cause of nosocomial infections, particularly pneumonia, complicate therapy, and have a detrimental impact on patients’ outcomes. This study aims to investigate the etiology, risk factors, and antibiotic resistance patterns associated with Gram-negative bacilli (GNB) isolated from nosocomial pneumonia cases.This prospective cross-sectional study was conducted at the Microbiology laboratory of a tertiary care Hospital in Gujarat. Patients hospitalized for &amp;#62;48 hours with new lung infiltrates and at least two of the following clinical features: fever, leukocytosis/leukopenia, purulent secretions, or decreased oxygenation were included. The study was initiated after the ethical approval. Patient demographic and clinical details were noted in the preformed questionnaire. A total of 64 specimens [Sputum (n= 28) and Endotracheal aspirate (ET, n=36)] were cultured on MacConkey’s agar and Blood agar and further species identification with Antimicrobial Susceptibility Pattern was done by automated Vitek-2 compact system. Ventilator-associated Pneumonia (VAP) was found in 14.6% of infected patients, with male predominance and common in the 30-50 years age group. Out of them, 72% were mainly associated with late-onset. Overall, the major isolates were (20/64, 31%), followed by (19/64, 29.6%) and (17/64, 26.5%) both as solitary and mixed infections.76% strains of and 85% of strains were resistant to carbapenems and 93.3% of were resistant to cephalosporins and carbapenems. strains were 100% resistant to carbapenems. The study recommends effective Infection control practices and strong antibiotic stewardship programs to reduce the morbidity and mortality of nosocomial pneumonia.

Students’ perspectives and expectations on the planning phase of elective postings in phase III of the MBBS program

Background: The National Medical Council (NMC) in its new Curriculum Based Medical Education (CBME) has mandated four weeks of elective postings for phase III part II MBBS students of 2019 batch. Each student will undergo two weeks of training in block-1 subjects including pathology, microbiology, virology, biochemistry, genetics, molecular biology, immunology, infection control, research, community outreach experience and others. Block-2 electives include psychiatry, neonatology, dermatology, rehabilitation and palliative care, hematology, oncology and others. Since the 2019 batch of students were the first batch of students who have undergone electives postings, this study was conducted to understand their perspectives and expectations about the planning phase of the elective postings, so that appropriate changes could be made in the future to make the learning experience more fruitful. Methods: This was a questionnaire-based study done among 198 phase III, part II MBBS students in various Government and self-financing medical colleges across South-India (mainly Tamilnadu). The google form questionnaire was shared to the students through social media platforms. Results: Among the study participants 25% were from Government medical colleges and the 75% are from self-financing medical colleges. Majority of the students chose the block-2 elective subject based on their interest whereas only half of the students chose their elective subject in block-1 based on interest. A significantly higher number of students in private medical colleges were given information about the expected learning experience in each elective posting before choosing one in block-1. A significantly higher number of students in block-1 were given a schedule and logbook when compared to block-2. All the students were given a logbook in Government medical colleges in both block-1 and block-2 postings. Conclusion: Providing a proper learning environment and appropriate planning by the stakeholders for elective postings, as recommended by the NMC will motivate the students to perform better academically and will guide them to choose their specialization based on their interests and the needs of the country.

Profilaxia pós-exposição ocupacional contra o vírus da imunodeficiência humana para trabalhadores da área de saúde vítimas de acidentes com material biológico

Introduction: Postexposure prophylaxis (PEP) reduces the risk of human immunodeficiencyvirus (HIV) transmission after workplace exposure of health care workers. Objectives: Toevaluate adherence to postexposure prophylaxis for HIV, incident characteristics, post-incidentinitiation of therapy, and reported adverse effects among treated health care workers. Methods: Epidemiologic, descriptive, retrospective study based on analysis of workplace incident reports involving exposure to biological materials from 2011 to 2020 at a university hospital. Data were analyzed using descriptive statistics, odds ratio using simple logistic regression, and comparison of variables using Fisher’s exact test (p&lt;0.05). Results: A total of 516 cases eligible for prophylaxis were analyzed and divided into three risk groups: 168 (32.6%) involving HIV-positive source patients, 263 (50.9%) involving source patients with unknown infection status, and 85 (16.4%) involving source patients in the window period. Most cases involved females (74.80%), injuries from percutaneous exposure (80.42%), contact with blood (56.59%), and nursing technicians (30.46%). Full compliance and adherence with drug therapy (28 days) was reported in 77.45% of the workers, and the time between the incident and the start of prophylaxis was within 24 hours of the incident in 94.27% of the workers. In total, 205 (39.73%) of the workers discontinued outpatient follow-up, which was associated with education, risk group, and occupation. Conclusions: Incidents involving contaminated sharp instruments pose an increased risk of infection by pathogens transmitted primarily by blood. Workplace HIV infection can be prevented by providing mandatory training programs for workers on proper work practices, use of devices with retractable needles and needle protection systems, safe and proper disposal of materials,use of personal protective equipment, and appropriate workplace postexposure interventions, including PEP. None of the workers who completed outpatient follow-up seroconverted to HIV, thus demonstrating the protective effect of PEP. Regular training is recommended, with an emphasis on incident prevention, infection control, and health education, combined with case reporting strategies.

Characterization of a carbapenemase-producing Klebsiella pneumoniae isolate of a patient in an intensive care unit in Greece: A study of resistome, virulome, and mobilome.

Klebsiella pneumoniae is a major pathogen associated with hospital-acquired infections, particularly those involving multidrug-resistant strains. Carbapenem resistance, often driven by carbapenemases such as KPC, VIM, OXA-48, and NDM, poses a significant challenge in clinical settings. This study reports on K. pneumoniae strain A165, isolated from a blood culture of a 51-year-old female patient hospitalized for respiratory distress post-SARS-CoV-2 infection. This K. pneumoniae strain exhibited resistance to several antibiotics, including carbapenems, cephalosporins, aminoglycosides, and fluoroquinolones, but remained susceptible to gentamicin, colistin, and trimethoprim-sulfamethoxazole. Next-generation sequencing was performed on Ion torrent platform, that revealed a genome size of 5,676,404 bp, including a chromosome and six plasmids. The strain was classified as sequence type 11 (ST11), a high-risk lineage associated with carbapenem resistance. The resistome of A165 included multiple β-lactamase genes, such as blaNDM-1 and blaOXA-48, as well as genes conferring resistance to other antibiotic classes. The virulome analysis identified genes involved in iron acquisition (yersiniabactin operon genes: ybtE, ybtT, irp1, irp2; aerobactin receptor: iutA), adhesion (mrkA-J, fimA-K), capsule and biofilm formation (rcsA, rcsB, ompA) and resistance to complement (traT) contributing to its pathogenic potential. The mobilome analysis revealed nine insertion sequences, including ISKpn1, ISKpn18, ISKpn43, ISKpn28, ISKpn14, ISEcp1, and IS6100. The strain also harbored six replicons: Col440II, ColRNAI, IncFIA(HI1), IncFIB(K), IncFII(K), and IncR, which are associated with the horizontal transfer of resistance and virulence genes. Comparative analysis with global isolates demonstrated the widespread dissemination of carbapenemase-producing K. pneumoniae, with notable occurrences in Europe, Asia, and the Americas. This study highlights the growing concern of multidrug-resistant K. pneumoniae in hospital settings and emphasizes the need for robust surveillance and infection control measures.

Analysis Alternative Priority Problem-Solving Infection Prevention and Control in Guido Valadares National Hospital Dili Timor-Leste

Introduction: Infection prevention and control in hospitals is a practical approach based on real evidence to prevent patients, families and visitors as well as health workers from the risk of infection. Purpose: Purpose of this study was to determine alternative priorities for solving infection prevention and control problems at Hospital Nacional Guido Valadares Dili, Timor Leste. Methods: The method used in this research is qualitative research using interviews and focus group discussions involving 3 key informants consisting of the Executive Director, Clinical Director and Director of nursing and midwifery and 16 informants consisting 1 head of the Quality Control department, 13 head of rooms and 2 educators. Data analysis through several stages, namely problem identification, problem prioritization with the non-scoring Delphi, root cause of the problem with the Fishbone diagram and determining alternative priority problem-solving using the Capability, Accessibility, readiness and leverage (CARL) method. Results: The results of the analysis show that the prevention and control of infections that are not running optimally have obstacles from the Human Aspects, Methods, Budget, Material and Machine or tools, based on the results of the analysis of alternative problem-solving priorities using the CARL method from the first and second rank are Conducting training for surveillance personnel, monitoring and evaluating infection prevention and control activities regularly. Conclusion: Based on the analysis of alternative priority problem solving using the CARL Method is to organize training for surveillance personnel, conduct regular monitoring and evaluation of prevention activities. Monitoring and evaluation should be carried out regularly to monitor the implementation of intervention activities and evaluate infection prevention and control activities, surveillance activities so as to ensure targeted achievements.