Infection Control Research Articles

Experiences with HIV stigma, among other barriers, in oral healthcare settings in Türkiye

ABSTRACT Oral healthcare settings can be a challenging environment for people with HIV. Combined with problematic insurance policies, insufficient health literacy, and higher treatment fees, HIV stigma contributes to barriers when accessing oral healthcare. We conducted a descriptive study via an online survey with open-ended questions to understand the experiences of people with HIV in oral healthcare settings. The survey was administered by non-governmental organizations. Thematic analysis was used to analyze the data via a critical realist approach. Seventy-five participants responded to survey between August and September 2023. Thematic analysis yielded three main themes: occurrences of stigma in healthcare, coping with HIV stigma and anxiety, and barriers beyond stigma. Participants reported a problematic understanding of HIV literature and stigma among dentists, which was manifested as excessive precaution measures, denial of care, unnecessary referrals, gossiping, discriminatory remarks and disclosure of HIV status without consent. This was reflected in people with HIV as self-stigma, fear of healthcare workers and avoidance of healthcare services. Advancements in dental education and post-qualification training are needed in infection control and ethics, while people with HIV need health education to preserve their rights and sustain good health and well-being to prevent adverse outcomes.

A practical approach to investigating nosocomial acquisition of Aspergillus.

Invasive mould disease (IMD) has a high mortality in immunosuppressed patients. Invasive aspergillosis (IA) is the most common IMD. A guideline for preventing IA has been published jointly by the Centers for Diseases Control and Prevention, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Use of high-efficiency particulate air filters, adequate air exchange rates, sealing of patient rooms, and preventing exposure to moulds by nursing patients in areas away from construction sites are recommended by the guideline. However, there is limited information in relation to the actions to be undertaken by infection prevention and control teams in the event of one or more cases of nosocomial aspergillosis. In this review, we describe a systematic approach to aspergillosis by defining possible and probable nosocomial acquisition based on the number of days since hospital admission. We advocate an incremental response to the investigation of nosocomial aspergillosis in patients in protective isolation taking into account the number of cases and the likelihood of nosocomial origin. For single cases of nosocomial IA, we suggest that infection control investigations should focus on case surveillance and walk-through inspection escalating in a step-wise manner to enhanced case surveillance, verification of environmental controls, environmental monitoring, genotyping of clinical and environmental isolates, and review of antifungal prophylaxis for multiple cases and outbreaks. Where applicable, the construction site should be inspected with the aim to reduce the dispersal of conidia. Surveillance systems need to be strengthened to better understand the epidemiology of IA.

Robust mucosal SARS-CoV-2-specific T cells effectively combat COVID-19 and establish polyfunctional resident memory in patient lungs.

Mucosal antigen-specific T cells are pivotal for pathogen clearance and immune modulation in respiratory infections. Dysregulated T cell responses exacerbate coronavirus disease 2019 severity, marked by cytokine storms and respiratory failure. Despite extensive description in peripheral blood, the characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells in the lungs remain elusive. Here we conducted integrated single-cell profiling of SARS-CoV-2-specific T cells in 122 bronchoalveolar lavage fluid (BALF) and 280 blood samples from 159 patients, including 27 paired BALF and blood samples from 24 patients. SARS-CoV-2-specific T cells were robustly elicited in BALF irrespective of prior vaccination, correlating with diminished viral loads, lessened systemic inflammation and improved respiratory function. SARS-CoV-2-specific T cells in BALF exhibited profound activation, along with proliferative and multi-cytokine-producing capabilities and a glycolysis-driven metabolic signature, which were distinct from those observed in peripheral blood mononuclear cells. After viral clearance, these specific T cells maintained a polyfunctional tissue-resident memory phenotype, highlighting their critical roles in infection control and long-term protection.

Knowledge and attitude of nosocomial infection prevention and control precautions among healthcare personnel at Kiruddu Referral Hospital in Kampala, Uganda

BackgroundA key concern for global public health is nosocomial infections. Essential to the fight against nosocomial infection, is healthcare professionals’ knowledge and attitudes. Therefore, this study investigated healthcare professionals’ knowledge and attitudes toward nosocomial infection at the Kiruddu Referral Hospital, Kampala, Uganda.MethodsA facility-based cross-sectional study was carried out at Kiruddu Referral Hospital in Kampala, Uganda. We selected the participants using simple random sampling. Data were collected from a total of 78 healthcare personnel using pretested, structured, self-administered questionnaires. We used SPSS version 20.0 for data analysis and applied descriptive statistics to present the frequencies and percentages. Pearson’s Chi-square test was used to evaluate the association between independent factors and knowledge and attitude (KA) ratings on hospital-acquired infection (HAI) prevention. P-values less than 0.05 were regarded as statistically significant.ResultsAmong the different categories of health workers, doctors exhibited the highest level of knowledge. There was a significant association between knowledge scores and occupation (χ2LR = 25.610; P = 0.000). The mean knowledge scores across different infection prevention aspects were as follows: hand hygiene (82.2 ± 18.9), PPE use (71.8 ± 23.1), sharp disposal and sharp injuries (59.2 ± 25.7), and waste management (57.4 ± 29.9). Notably, 20.5% of participants did not change PPE between patients, and 44.9% indicated that their workload negatively impacted their ability to follow infection prevention standards.ConclusionThe study highlighted gaps in healthcare personnel’s knowledge and attitudes toward infection prevention. It is therefore important to provide regular targeted training programs emphasizing underrepresented areas, PPE availability, strengthen policy enforcement, and integrate infection prevention education into medical and nursing curricula.

Changes in incidence and epidemiology of antimicrobial resistant pathogens before and during the COVID-19 pandemic in Germany, 2015–2022

BackgroundCarbapenem-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are among WHO’s priority pathogens with antimicrobial resistance (AMR). Studies suggest potential impacts of the COVID-19-pandemic on AMR. We described changes in AMR incidence and epidemiology in Germany during the COVID-19-pandemic.MethodsWe used two independent datasets, statutory surveillance and laboratory-based Antibiotic Resistance Surveillance (ARS). We included statutory notifications of infections/colonisations of carbapenem-resistant Acinetobacter spp., Klebsiella pneumoniae, Escherichia coli (CRA/CRKP/CREC) and invasive MRSA. Using Poisson/negative binomial regression and assuming continued pre-pandemic (2015/2017–2020) trends, we projected hypothetical notifications as if the pandemic had not occurred. We quantified annual changes during the pandemic period (2020–2022) by comparing to observed notifications. Additional models considered inpatient reductions, seasonality, infections only, or resistant isolates from ARS.ResultsCRA notified cases were reduced by -30% (95%CI -39%|-20%) in 2020, -23% (-36%|-8%) in 2021, but + 32% (+ 6%|+64%) higher in 2022 relative to hypothetical pre-pandemic projections. Changes were − 35%/-31%/+6% for CRKP, -40%/-61%/-48% for CREC and − 33%/-25%/-20% for MRSA. Statutory-models accounting for fewer inpatients, seasonality and infections only showed similar trends, as did ARS-models for resistant isolates and infections. International mobility for CRA, CRKP and CREC decreased in 2020–2021, then increased in 2022.ConclusionsWe observed significant reductions of AMR notifications and infections during 2020–2021, also when accounting for fewer inpatients. We conclude a genuine reduction of AMR spread occurred during the pandemic. Factors like fewer hospitalisations and reduced international mobility contributed. Rising international mobility may partly explain increases for CRA, CRKP and CREC in 2022. A solid understanding of AMR trends improves infection prevention and control.

Knowledge, attitude, and practice of healthcare workers of primary health facilities of Kathmandu district, Nepal on infection prevention and control

Knowledge, attitude, and practice of healthcare workers of primary health facilities of Kathmandu district, Nepal on infection prevention and control

Genetic diversity and virulence of Bacillus cereus group isolates from bloodstream infections.

Bacillus cereus catheter-related bloodstream infections (CRBSIs) are an increasing concern in Japanese hospitals. Although their clinical characteristics have been explored, the genetic relationships and virulence profiles of B. cereus isolates from CRBSIs remain understudied. Here, using advanced genomic techniques, we investigated the genetic diversity, phylogenetic relationships, and virulence profiles of B. cereus isolates from patients with bloodstream infections. We analyzed 28 B. cereus group strains isolated from blood samples at the University of Tokyo Hospital between 2005 and 2017 using whole-genome sequencing, core-genome single-nucleotide polymorphism (SNP) typing, and virulence gene profiling. Core-genome SNP analysis revealed significant genetic diversity among the isolates, suggesting multiple independent sources of infection. The isolates predominantly belonged to panC clades III and IV, with distinct virulence gene profiles. All panC clade III isolates contained hbl operon genes, whereas four isolates from clade IV harbored cereulide synthetase genes (cesABCD). One isolate possessed a capsule gene operon (capBCADE), a rare finding among clinical B. cereus strains. Biofilm formation ability was observed in 50% of catheter-related isolates, although this ability was not significantly different from that of the noncatheter-related isolates.IMPORTANCEThis study provides novel insights into the genetic diversity and virulence potential of B. cereus strains causing bloodstream infections in a Japanese hospital setting. These findings suggest diverse infection pathways and highlight the importance of continuous molecular epidemiological surveillance for effective infection control.

Establishing robust infection control at a new hospital: the AIIMS Rajkot experience

Establishing robust infection control at a new hospital: the AIIMS Rajkot experience

Prolonged ECMO Support in a Pediatric Patient with Complex Cardiac Conditions During Wartime in Kyiv, Ukraine

Background: Managing complex medical interventions in conflict-affected Kyiv, Ukraine, poses significant challenges, particularly for critically ill pediatric patients. This case report examines the extended use of extracorporeal membrane oxygenation (ECMO) in a 12-year-old girl with severe congenital heart disease, including critical aortic stenosis and myocarditis. With no transplant system and limited resources, alternative solutions were necessary to maintain ECMO support and mitigate complications over a prolonged period. Methods: The patient was on ECMO support for 259 days, utilizing both VV-ECMO and VA-ECMO configurations. Wartime supply issues necessitated the use of polypropylene fiber oxygenators (Quadrox-i and Terumo Fx15), despite their unsuitability for long-term use. Eleven oxygenators were used, with ten replacements due to thrombosis and malfunctions. The oxygenators included EUROSETS Alone, Maquet PLS, Paragon, Terumo Fx15, and Quadrox-i. Care involved frequent ECMO parameter adjustments, infection control, and daily rehabilitation. Cardiac function recovery was consistently negative. Results: Performance of the oxygenators declined over time, necessitating frequent replacements due to clotting, reduced oxygen exchange, and lower CO2 removal efficiency. Usage durations varied: EUROSETS (10, 32, 88, and 26 days), Paragon (78 days), Maquet PLS (14 days), Terumo Fx15 (1-5 days), and Quadrox-i (1 day). EUROSETS nr 3 lasted 88 days, and the Paragon provided 78 days of stable support. The Maquet PLS lasted 14 days, while the Terumo Fx15 and Quadrox-i required replacements within 1 to 5 days. ECMO was discontinued due to irreversible heart failure, with the patient passing away from severe multi-organ dysfunction and complications. Conclusions: This case highlights the extraordinary challenges of prolonged ECMO use in a pediatric patient within a war zone, emphasizing the resilience and adaptability required from healthcare teams in resource-limited settings. The logistical constraints and the necessity to use suboptimal oxygenators underscore the need for international support and mobilization to sustain advanced care in conflict-affected regions.

A single-cell atlas of the Culex tarsalis midgut during West Nile virus infection.

The mosquito midgut functions as a key interface between pathogen and vector. However, studies of midgut physiology and virus infection dynamics are scarce, and in Culex tarsalis-an extremely efficient vector of West Nile virus (WNV)-nonexistent. We performed single-cell RNA sequencing on Cx. tarsalis midguts, defined multiple cell types, and determined whether specific cell types are more permissive to WNV infection. We identified 20 cell states comprising 8 distinct cell types, consistent with existing descriptions of Drosophila and Aedes aegypti midgut physiology. Most midgut cell populations were permissive to WNV infection. However, there were higher levels of WNV RNA (vRNA) in enteroendocrine cells, suggesting enhanced replication in this population. In contrast, proliferating intestinal stem cells (ISC) had the lowest levels of vRNA, a finding consistent with studies suggesting ISC proliferation in the midgut is involved in infection control. ISCs were also found to have a strong transcriptional response to WNV infection; genes involved in ribosome structure and biogenesis, and translation were significantly downregulated in WNV-infected ISC populations. Notably, we did not detect significant WNV-infection induced upregulation of canonical mosquito antiviral immune genes (e.g., AGO2, R2D2, etc.) at the whole-midgut level. Rather, we observed a significant positive correlation between immune gene expression levels and vRNA load in individual cells, suggesting that within midgut cells, high levels of vRNA may trigger antiviral responses. Our findings establish a Cx. tarsalis midgut cell atlas, and provide insight into midgut infection dynamics of WNV by characterizing cell-type specific enhancement/restriction of, and immune response to, infection at the single-cell level.

Effectiveness of room-of-error interventions for healthcare providers: a systematic review

BackgroundPatient safety incidents are recognized as significant contributors to patient mortality, thus demanding immediate attention and strategic interventions in healthcare systems. The room-of-error education program serves as a solution, as it provides a case-based learning platform allowing nursing students to identify and resolve medical errors within a controlled environment systematically. This study aimed to identify the context, mechanisms, and outcomes of room-of-error training programs.MethodsThis study adopted a systematic review methodology aligning with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Comprehensive searches were conducted across key databases, including OvidMEDLINE, Embase, Cochrane, and CINAHL, by utilizing specific terms related to healthcare providers, nursing students, room-of-error education, medical errors, simulation training, and virtual intervention. Included studies focused on healthcare providers or students, error recognition, RFE-related training, and randomized or quasi-experimental trials, while exclusion criteria were non-English/Korean studies, non-original articles, abstracts, and qualitative studies. Risk of bias in the selected studies was assessed using the Risk Of Bias In Non-randomized Studies version 2.0 tool.ResultsThe search strategy yielded 2,447 articles, with eight studies meeting the inclusion criteria. Predominantly quasi-experimental in design, these eight studies primarily focused on nurses as the target population. Simulations were found to be widely integrated into room-of-error programs, emphasizing skill performance and critical thinking. Half of the studies provided preparation time, 37.5% included feedback, and 62.5% covered medication errors, with 87.5% using offline delivery, 62.5% offering individual education, and program durations ranging from 4 to 35 min, with 25% having no time limit for error inspection. Diverse content, including topics such as medication errors and infection control, was found to be delivered through offline or virtual formats and group-based or individual education.ConclusionsThe findings provide valuable insights into the characteristics and outcomes of room-of-error training programs for healthcare professionals and students. This study emphasizes the significance of practical, case-based approaches in nursing education to augment knowledge, confidence, and competencies, thereby enhancing patient safety in clinical practice.

Harnessing from Nature - Evolving Potential of Antimicrobial Peptide.

Antimicrobial peptides (AMPs) are recognized as one of the most ancient components of innate immunity, playing a pivotal role as the first line of host defense systems. These evolutionarily conserved molecules have been identified in various organisms, from prokaryotes to humans. AMPs establish a delicate balanced relationship between host and microbes, by simultaneously regulating the biological activities of pathogens and commensal microbes. Given the escalating global concern over antibiotic resistance, there is an urgent need to explore alternative strategies to combat challenging infectious diseases. AMPs have emerged as promising candidates employed in clinical practice due to their sustainable bactericidal properties. Witnessed by deep understanding of AMPs actions toward host and bacteria, the potential applications of AMPs extend far beyond infection control. Emerging developments harnessed natural capabilities of AMPs to optimize their roles in modulating host signaling, treating diverse diseases, advancing biosensing and bioimaging technologies. In this Concept paper, we provide a comprehensive overview of the diversity and properties of AMPs. Additionally, we elaborate on the mechanisms underlying AMP activity and bacterial responses counteracting AMP'sfunctions. Most importantly, we discuss potential biomedical applications of AMPs and offer perspectives on their future development.

Antibiotic Susceptibility Profile of Gram-Negative Bacteria Isolated From Pond Catfish in Ketu Adie-Owe, Ado-Odo Local Government Area of Ogun State, Nigeria

The increasing number of fish ponds in Nigeria is driven by the demand for fish and fishery products. Catfish, specifically Clarias gariepinus, is popular for cultivation due to its economic significance. However, bacterial infections pose a threat to the health of catfish in these ponds, resulting in the need for antibiotic usage. This study is aimed to assess the antibiotic susceptibility pattern of Gram-negative bacteria isolated from pond catfish. This study involved isolating bacteria from the catfish skin and intestine, analyzing their biochemical characteristics, and conducting antimicrobial susceptibility testing. Fungi present in the catfish samples were also identified. The Gram-negative isolates were subjected to antibiotic susceptibility testing, revealing the prevalence of multidrug-resistant strains. The findings contribute to the understanding of antibiotic resistance in aquaculture and highlight the need for appropriate management strategies. The bacterial load in different catfish samples was examined through total plate counts and dilution effects. The results revealed variations in colony counts and CFU/ml values among the samples, with the highest bacterial load observed in the skin of large catfish. The bacterial load observed in the skin of catfish ranged from 4.7 X 103 CFU/ml to 9.8 X 103 CFU/ml, while the bacterial load observed in the intestine of catfish ranged from 3.1 X 103 CFU/ml to 5.4 X 103 CFU/ml. Biochemical testing identified specific organisms, including Enterobacter cloacae, Aeromonas hydrophila, Klebsiella pneumoniae, Citrobacter brakii, Citrobacter freundii, and Enterobacter aerogenes. Varying resistance patterns emphasize the need for careful antibiotic use and infection control in catfish aquaculture. Therefore, continuous monitoring and preventive measures are recommended.

Microbiological spectrum of pathogens in cardiac surgery patients in the intensive care unit

Background. Intensive care unit (ICU) patients are at high risk of hospital-acquired infections, which is a significant problem in modern medicine. Every year, 140,000 deaths from hospital-acquired infections are reported. For example, studies in the United States show that 30 % of infections occur in the ICUs. The presence of hospital-acquired flora in patients prolongs their stay in the ICU, increases the duration of antibiotic therapy, and treatment costs. The occurrence of such an infection is the result of a complex interaction of pathogenic (virulence, antibiotic resistance), patients’ (comorbidities, acute illnesses, emergency surgery), and treatment factors (invasive devices), and the work of the health care system (staffing, preventive measures). Mortality among individuals with a positive bacteriological blood test reaches 25 % among all patients in the intensive care unit, which emphasizes the importance of timely diagnosis and control of such infection. The analysis of the microbiological spectrum of pathogens in cardiac surgery patients is a complex process, but it is quite possible and necessary to improve the effectiveness of treatment of cardiac surgery patients. Objective: to analyze the microbiological spectrum of pathogens in cardiac surgery patients in the ICU. Materials and methods. The study included retrospective clinical data of 323 patients who were treated in the preoperative or postoperative period at the intensive care unit of the State Institution “Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine” from January 1, 2021, to December 31, 2023. The entire cohort had a positive bacteriological blood test. The microbiological analysis was performed using a Vitek 2 Compact analyzer with a BACT/ALERT 3D60 colometric system for detecting bacterial growth (No. VK2C8748). The microbiological spectrum of pathogens in cardiac surgery patients in the intensive care unit was analyzed. Results. In 2021, 81 patients had a positive microbiological blood test. The incidence of pathogens was as follows: gram-positive infection — 69 (85.1 %), gram-negative infection — 11 (14.6 %), fungi of the genus Candida — 1 (0.3 %) case, respectively. In 2022, 95 patients had a positive microbiological blood test. The frequency of pathogens was as follows: gram-positive infection — 75 (78.9 %) cases, gram-negative infection — 20 (21.1 %). In 2023, 147 patients had a positive microbiological blood test. The incidence of pathogens was as follows: gram-positive infection — 97 (66.0 %) cases, gram-negative infection — 46 (31.3 %) cases, Candida fungi — 4 (2.7 %) cases, respectively. Conclusions. An increase was found in the frequency of Klebsiella spp. microorga-nisms from 60 to 84 % of cases from the total spectrum of gram-negative pathogens in the ICU in 2023. There was a decrease in the frequency of Enterobacter spp. from 22 % of cases in 2021 to 13 % in 2023. The proportion of identified Acinetobacter spp. pathogens decreased from 11 % of cases in 2021 to 3 % in 2023.

Roles of mobile teams in tracing lost to follow–up clients: evidence from the optimization of COVID-19 vaccination uptake and routine immunization in Ekiti State

BackgroundEvidence from literature has established that tracing lost to follow-up clients is an effective strategy for complementing other mechanisms for infectious disease control like human immunodeficiency virus (HIV), tuberculosis, and other diseases such as Ebola. As a long-standing successful public health method of optimizing acceptance and/or adherence to infectious disease treatment tracing lost to follow-up clients is usually carried out by manually investigating individuals who absconded or are absent from treatments designed to manage and/or promote their health status. This study seeks to explore the role of mobile teams in tracing clients lost to follow-up for immunization.MethodsThis study was premised on a qualitative research approach to elicit information from purposively selected populations across 9 local government areas (LGA) in Ekiti state, Nigeria. Focus group discussions, in-depth interviews, and key informant interviews were the selected methods of data collection on the roles of mobile teams in tracing lost to follow–up clients for the optimization of COVID-19 and routine immunization in Ekiti state.ResultsA total of 107 healthcare workers across Ekiti state were selected to participate in this study. Our study found tracing lost to follow-up clients resulted in two major successes for health workers. These are increased awareness of COVID-19 vaccination and routine immunization, and improved vaccination coverage for both categories of vaccinees. Distance between communities, and transportation, were interdependent issues reported by health workers as challenges in the course of their duties.ConclusionOur study emphasizes the importance of onboarding and/or training health workers across all categories that are involved in the implementation of a public health program, irrespective of the existing knowledge that they may have on the concept. This study recommends that health workers across all levels, in collaboration with key players and stakeholders employ human-centered designed approaches to improve the sensitization of caregivers, and community populace on the values, benefits, and significance of the COVID-19 vaccination and routine immunization uptake.

Bacterial Contamination and Antimicrobial Resistance Patterns of Healthcare Workers' Mobile Phones in Hospitals at Khartoum City

Background: Mobile phones used by healthcare workers (HCWs) have emerged as potential reservoirs for pathogens, posing a risk of healthcare-associated infections (HAIs). This study aimed to investigate the prevalence of bacterial contamination on HCWs' mobile phones, determine the antimicrobial susceptibility patterns, and compare findings with global data. Methods: We collected swabs from 94 mobile phones of HCWs across two hospitals in Khartoum. We identified bacterial isolates using standard microbiological techniques and evaluated antimicrobial resistance using the Kirby-Bauer disk diffusion method. Results: Bacterial contamination appeared in 93.6% of mobile phones. Gram-positive bacteria, such as Coagulase-negative staphylococci (36%) and S. aureus (31.8%) were prevalent. Gram-negative organisms were isolated. The predominant organisms were Klebsiella pneumoniae 15 (37%) isolates followed by Pseudomonas aeruginosa 12 (30%) isolates, Proteus mirabilis 5 (12%) isolates, Acintobacter baumannii 4 (10%), Enterobacter spp 3(8%) and Escherichia coli 1 (3%). Antimicrobial susceptibility tests revealed high resistance to penicillin among Gram-positive isolates. The tests revealed no multidrug-resistant (MDR) or extended-spectrum beta-lactamase (ESBL) production. Conclusion: HCWs' mobile phones represent a critical vector for bacterial transmission in hospitals. Stringent infection control measures and regular disinfection should mitigate the associated risks.

A study on hospital acquired infections in paediatric patients admitted in paediatric intensive care unit of a tertiary care hospital of central Gujarat

Background: Nosocomial infections (NIs) are a significant concern in healthcare settings, leading to increased mortality and costs. This study aimed to determine the prevalence of NIs in a paediatric intensive care units (ICU) in India. Methods: A prospective, observational study was conducted over one year in a paediatric ICU. Routine investigations, including blood culture, urine examination, and chest X-ray, were performed. Results: Nosocomial bloodstream infections (BSIs) and urinary tract infections (UTIs) were the most common NIs. Pseudomonas and Klebsiella were the predominant organisms isolated from blood and ET secretion cultures. Severe anemia and severe acute malnutrition were significant co-morbidities contributing to mortality. Conclusions: The study highlights the need for effective infection control measures and antibiotic stewardship in paediatric ICUs. Administering sensitive antibiotics based on geographical bacteriological profiles can improve outcomes and prevent antibiotic resistance.

Tackling Infectious Diseases in the Caribbean and South America: Epidemiological Insights, Antibiotic Resistance, Associated Infectious Diseases in Immunological Disorders, Global Infection Response, and Experimental Anti-Idiotypic Vaccine Candidates Against Microorganisms of Public Health Importance

This paper explores various aspects of microbiology and immunology, with a particular focus on the epidemiology and molecular characterisation of infectious diseases in the Caribbean and South America. Key areas of investigation include tuberculosis (TB), experimental vaccines, and bloodborne pathogens. A retrospective study conducted in Jamaica highlights the significance of early HIV screening, timely diagnosis, and inte-grated care. The paper also examines the challenges posed by nosocomial infections, particularly those caused by antibiotic-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA), emphasising the critical importance of infection control measures. Additionally, it explores the regional microbiome, the global response to infectious diseases, and immune responses in patients with immunodeficiency disorders such as severe combined immunodeficiency (SCID) and chronic granulomatous disease (CGD), underscoring their heightened susceptibility to a wide range of infections.

Genome drafting of nosocomial infection CRE Klebsiella pneumoniae confirming resistance to colistin and eravacycline, carrying blaNDM-1, mcr-1, and blaKPC-2, in neonatology from November to December 2023

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical pathogen in healthcare settings, associated with high mortality due to its extensive antibiotic resistance. In this study, we report an outbreak of CRKP in a neonatal intensive care unit (NICU) within a 200-bed tertiary hospital. The main goal of this study was to characterize the phenotypic and genomic profiles of the CRKP isolates involved in the outbreak and to gain insights into their resistance mechanisms and transmission dynamics within the NICU.MethodsThe study was conducted between November and December 2023 in a 5-bed NICU. Monthly surveillance cultures were performed to monitor colonization and infection with multidrug-resistant organisms. CRKP isolates were obtained from blood and nasal swabs of affected neonates. Identification and antimicrobial susceptibility testing were initially conducted using the Vitek®2 system with an N-395 card and further confirmed by 16S rRNA sequencing. Whole-genome sequencing (WGS) and antimicrobial resistance (AMR) profiling were performed to identify resistance genes and virulence factors. For genetic analysis, both Illumina short-read and Nanopore long-read sequencing were used, followed by hybrid assembly for enhanced genome resolution. Plasmid and resistance gene profiles were determined using AMRFinder and PlasmidFinder databases.ResultsA total of three CRKP isolates (designated Kp1, Kp2, and Kp3) were identified. Kp1 and Kp2 belonged to sequence type (ST) ST23 and were genetically near-identical, differing by a single allele, while Kp3 was of a distinct sequence type, ST2096, with 245 allelic differences from Kp1 and Kp2. All isolates were resistant to colistin and carried resistance genes, including mcr-1 and blaNDM-1,blaKPC2 confirming carbapenem resistance. Efflux pump genes and aminoglycoside resistance genes were also detected, providing a multifaceted defence against antibiotics. Plasmid analysis identified several incompatibility groups (IncFI, IncHI, IncFIB, IncX), indicating the potential for horizontal gene transfer of resistance determinants.ConclusionThis study highlights the complexity of CRKP outbreaks in neonatal care, with isolates exhibiting resistance mechanisms that complicate treatment. The plasmid profiles suggest these strains are reservoirs for multidrug-resistant genes, emphasizing the need for strict infection control and ongoing genomic surveillance. For neonatal care, these resistance challenges increase the risk of treatment failures and mortality, underscoring the importance of enhanced infection prevention and novel therapeutic strategies.

Heterogeneity of Clostridioides difficile asymptomatic colonization prevalence: a systematic review and meta-analysis

BackgroundAsymptomatic carriers significantly influence the transmission dynamics of C. difficile. This study aimed to assess the prevalence of toxigenic C. difficile asymptomatic colonization (tCDAC) and investigate its heterogeneity across different populations. We searched MEDLINE, Web of Science, and Scopus for articles published between 2000 and 2023 on tCDAC. Studies including asymptomatic adults with laboratory-confirmed tCDAC were eligible. We performed a random-effects meta-analysis to estimate the pooled prevalence by clinical characteristics, settings, and geographic areas. In addition, we used outlier analyses and meta-regression to explore sources of prevalence variability.ResultsFifty-one studies involving 39,447 patients were included. The tCDAC prevalence ranged from 0.5 to 51.5%. Among pooled estimates, a high prevalence was observed in patients with cystic fibrosis, outbreak settings, and cancer patients, whereas the lowest rates were found in healthy individuals and healthcare workers. Similar colonization rates were observed between admitted and hospitalized patients. Our meta-regression analysis revealed lower rates in healthy individuals and higher rates in cystic fibrosis patients and studies from North America. Additionally, compared with that among healthy individuals, the prevalence significantly increased by 15–47% among different populations and settings.ConclusionOur study revealed that tCDAC is a common phenomenon. We found high prevalence estimates that showed significant variability across populations. This heterogeneity could be partially explained by population characteristics and settings, supporting their role in the pathogenesis and burden of this disease. This highlights the need to identify high-risk groups to improve infection control strategies, decrease transmission dynamics, and better understand the natural history of this disease.