Hospital Infection Research Articles

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.

Economic burden of healthcare-associated infections (HAI) in a pediatric hospital in Honduras

Abstract Background In numerous reports, the World Health Organization has published that in LMICs approximately 15% of hospitalized patients acquire an HAI. In the Region of the Americas, many countries have made considerable progress in implementing IPC Programs. At Hospital María Especialidades Pediátricas (HMEP), the IPC Program aims to generate a patient safety culture mainly, but also reduce costs for the hospital and the patient. However, in LMICs, non-quality costs, including those associated with HAI, are rarely measured. This abstract aims to demonstrate the economic burden of HAI in hospitalized patients at HMEP between January 2020 and October 2023 and estimate the number of HAIs and associated costs prevented by the IPC Program. Methods At HMEP the IPC Program started in 2017, and the Accounting Department has measured the costs associated with treating and managing every HAI reported since January 2020. Provider costs for every HAI are estimated using a bottom-up (microcosting) approach in which three variables are considered: days of stay, all laboratory tests used for diagnosis and follow-up, and antimicrobials administered to treat the infection. The costs for each variable derive from the hospital’s purchasing system. This process allows us to estimate the annual HAI expenditure. For the estimation of costs avoided, we first calculated the average cost of each HAI using the yearly amount spent and dividing this amount by the number of HAIs registered in the same period. Considering the proportion of patients who suffered an HAI at HMEP compared to the 15% incidence reported by the WHO, we calculated a difference in proportions and were able to estimate the number of HAIs prevented and subsequent costs avoided. We use the NHSN HAI definitions since Honduras does not have a National IPC Program with standardized epidemiological criteria. The results are presented using descriptive statistics. Results During this time, 260 HAIs were identified at HMEP, average 5.6 per month, 57-70 yearly. The proportion of patients who developed an HAI was found to have decreased from 8.6% in 2020 to 5.2% in 2023. The total expenditure attributed to HAIs during the period was USD 913,774.21 (USD 19,865.0 pm). The costliest HAIs were CVC-associated bloodstream infections. HMEP is a public hospital and operates with funds provided by the government, which are deemed insufficient considering the complexity of the patients receiving care at the hospital. The estimated costs represent 2-3% of the hospital’s annual budget. Without the IPC Program, the predicted number of HAIs, according to the WHO, would have been 570 (15% of inpatients). We estimate 310 prevented HAIs, with an associated total cost of USD 1,103,577.99. Conclusion Regardless of the hospital’s methodology, measuring the economic burden related to HAIs is important for decision-making. The main objective of an IPC Program is to guarantee patient safety; however, especially in low-resource settings, it is also important to aim for a cost reduction. Limitations: our methodology does not include other variables (e.g. human resources); therefore, the data underestimates the real expenditure. We aim to improve the costing methodology for more accurate data.

Bloodstream infections in a Brazilian Pediatric Tertiary Oncology Hospital: 30-month analysis regarding the classification of the infection, distribution of microorganisms and their resistance profile

Abstract Background Infections are a major cause of morbidity and mortality in pediatric oncology patients during their treatment. Bloodstream infections are the main site of infection in these patients. Bacteremia in these patients can be secondary to a primary infectious focus, result from central line associated bloodstream infections (CLABSIs) or mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). Methods Descriptive study of bloodstream infections in pediatric patients undergoing oncological treatment and hematopoietic stem cell transplantation in a tertiary pediatric oncology hospital in Brazil from January 1st, 2021 to June 30th, 2023. Infections were classified according to the Centers for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria into CLABSIs, MBI-LCBIs and secondary bloodstream infections. Among the bloodstream infections that met CDC/NHSN criteria for CLABSI, were analyzed separately those who also met the criteria of catheter-related bloodstream infection (CRBSI) according to Infectious Diseases Society of America (IDSA). Results During this period were diagnosed 335 episodes of bloodstream infection (123 episodes in 2021, 150 in 2022 and 62 episodes in the first 6 months of 2023). There were 378 microorganisms isolated. These infections were classified into: 35% CLABSIs, 27% MBI-LCBIs, 23% CRBSIs, and 15% secondary bloodstream infections. Among the CLABSIs, the most common microorganisms were non-fermenting gram negative bacilli (NFGNB) 38%, enterobacteriaceae 35% and coagulase-negative staphylococcus (CoNS) 11%. Between CRBSIs, there were 31% enterobacteriaceae, 22% CoNS and 19% NFGNB. Among the MBI-LCBIs there were 66% enterobacteriaceae and 23% group viridans streptococci (VGS). Streptococcus pneumoniae (33%) was the most common microorganism in secondary infections followed by Staphylococcus aureus (17%). Assessing all infections together, the main enterobacteriaceae were Klebsiella spp. (40%) and only 50% of them were sensitive to cefepime while 10% were carbapenems resistant. Among NFGNB, 13% of Pseudomonas spp. and 5% of Acinetobacter spp. were carbapenems resistant. Between the gram-positive bacteria, 77% of the S. aureus were methicillin sensitive, the same percentage of the VGS were sensitive to cefepime. Conclusion Among bloodstream infections, there were a predominance of CLABSI followed by MBI-LCBIs. Antimicrobial resistance between gram-positive bacteria, is of little concern in our institution. In the case of gram-negative bacteria, resistance to cefepime is becoming worrying among enterobacteriaceae.

Improvement cycle to act against catheter-related bloodstream infections

Abstract Background Catheter-related bloodstream infections (CRBSI) pose significant risks, causing a prolongation of hospital stay, increasing costs and increasing the risk of complications and mortality. It is the first healthcare-associated infection in many hospitals including our institution. Preventing CRBSI is essential for safety in patient’s care. To achieve this, we’ve adopted improvement cycles as a tool, aiming to decrease CRBSI rates by 50%. Methods Over the period of 2012 to 2023, 9036 pediatric patients were monitored throughout their hospitalizations. We utilized improvement cycles through various interventions: first an intervention bundle, secondly avoiding multipuncture, thirdly improving sampling techniques, fourthly optimizing supply management, and lastly restructuring the vascular access clinic. Each cycle involved resource management and process enhancement. Progress was measured through percentage metrics and the primary outcome indicator was CRBSI rates. Results The first cycle achieved a 90% compliance, the achievements were compliance above 85% of the bundle. In the second cycle we attained an 85% compliance, implement a guideline for catheter insertion with only two punctures in practice. The third cycle saw a 70% compliance rate, involving a multidisciplinary team for taking samples, training and monitoring by a skilled supervisor. The fourth cycle reached a 60% compliance through a techno-vigilance process, it was a pity quickly practical solutions didn´t work in practice. The final cycle achieved a 70% compliance, establishing a functional vascular access clinic. Rates CRBSI decreased by 50% overall and in the pediatric intensive care unit, meeting our objective. However this reduction was not observed in other intensive care units. Conclusion Improvement cycles simplify changes. Their implementation is effective but requires close monitoring, support from resources and authorities, a committed and proactive team, and continuous changes according to results. There is a need to consolidate the strategies to sustain and enhance our achievements.

Predicting future hospital antimicrobial resistance prevalence using machine learning

BackgroundPredicting antimicrobial resistance (AMR), a top global health threat, nationwide at an aggregate hospital level could help target interventions. Using machine learning, we exploit historical AMR and antimicrobial usage to predict future AMR.MethodsAntimicrobial use and AMR prevalence in bloodstream infections in hospitals in England were obtained per hospital group (Trust) and financial year (FY, April–March) for 22 pathogen–antibiotic combinations (FY2016-2017 to FY2021-2022). Extreme Gradient Boosting (XGBoost) model predictions were compared to the previous value taken forwards, the difference between the previous two years taken forwards and linear trend forecasting (LTF). XGBoost feature importances were calculated to aid interpretability.ResultsHere we show that XGBoost models achieve the best predictive performance. Relatively limited year-to-year variability in AMR prevalence within Trust–pathogen–antibiotic combinations means previous value taken forwards also achieves a low mean absolute error (MAE), similar to or slightly higher than XGBoost. Using the difference between the previous two years taken forward or LTF performs consistently worse. XGBoost considerably outperforms all other methods in Trusts with a larger change in AMR prevalence from FY2020-2021 (last training year) to FY2021-2022 (held-out test set). Feature importance values indicate that besides historical resistance to the same pathogen–antibiotic combination as the outcome, complex relationships between resistance in different pathogens to the same antibiotic/antibiotic class and usage are exploited for predictions. These are generally among the top ten features ranked according to their mean absolute SHAP values.ConclusionsYear-to-year resistance has generally changed little within Trust–pathogen–antibiotic combinations. In those with larger changes, XGBoost models can improve predictions, enabling informed decisions, efficient resource allocation, and targeted interventions.

Healthcare-associated infections in Japanese hospitals: results from a large-scale multicenter point-prevalence survey in Aichi, 2020.

Healthcare-associated infections (HAIs) pose significant challenges to healthcare systems worldwide. Epidemiological data are essential for effective HAI control; however, comprehensive information on HAIs in Japanese hospitals is limited. This study aimed to provide an overview of HAIs in Japanese hospitals. A multicenter point-prevalence survey (PPS) was conducted in 27 hospitals across the Aichi Prefecture between February and July 2020. This study encompassed diverse hospital types, including community, university, and specialized hospitals. Information on the demographic data of the patients, underlying conditions, devices, HAIs, and causative organisms was collected. A total of 10,199 patients (male: 5,460) were included in this study. The median age of the patients was 73 (interquartile range [IQR]: 56-82) years, and the median length of hospital stay was 10 (IQR: 4-22) days. HAIs were present in 6.6% of patients, with pneumonia (1.83%), urinary tract infection (1.09%), and surgical site infection (SSI) (0.87%) being the most common. The prevalence of device-associated HAIs was 0.91%. Staphylococcus aureus (17.3%), Escherichia coli (17.1%), and Klebsiella pneumoniae (7.2%) were the primary pathogens in 433 organisms; 29.6% of the Enterobacterales identified showed resistance to third-generation cephalosporins. Pneumonia was the most prevalent HAI in small-to-large hospitals (1.69%-2.34%) and SSI, in extra-large hospitals (over 800 beds, 1.37%). This study offers vital insights into the epidemiology of HAIs in hospitals in Japan. These findings underscore the need for national-level PPSs to capture broader epidemiological trends, particularly regarding healthcare challenges post-COVID-19.

Exploring atypical manifestations and multisystem involvement of Epstein-Barr virus infection in hospitalized pediatric patients from Mexico: insights from a tertiary hospital (2012-2022).

Epstein-Barr virus (EBV) infection, with a global prevalence exceeding 95%, typically manifests in children as infectious mononucleosis. However, clinical practice frequently encounters diverse atypical presentations characterized by multisystem involvement, often resulting in an unfavorable clinical course. Our objective is to describe the clinical manifestations and results of EBV infection in a tertiary pediatric hospital in Mexico. An observational, transversal, retrospective, and descriptive study that included a systematic review of medical records (2012-2022) of patients under 18 years of age with detectable EBV particles in peripheral blood. The study included 26 patients with a median age of 5 years and a male predominance of 53.8%. Predominant symptoms were fever (85%) and lymphadenopathy (35%). Sixty-five percent had severe and atypical manifestations, including pneumonia and hepatic, hematologic-oncologic, and autoimmune diseases. Anemia, thrombocytopenia and leukopenia were common, with lymphocytosis in 19% of cases. The median EBV viral load was 2816 copies/mL (range: 555-355,500 copies/mL). Four deaths related to EBV infection were reported. Viral load in these cases also varied widely from 594 to 121,000 copies/mL. Supportive care was administered to 85% of patients, while others received antiviral treatment, steroids, and rituximab. Atypical manifestations were common, especially in children with multisystem involvement. EBV should be considered as a potential contributor to a diverse spectrum of clinical presentations, emphasizing the need for comprehensive evaluation and awareness in clinical diagnosis.

The burden of healthcare-associated infections in New Zealand public hospitals 2021.

There are no contemporary data on the burden of healthcare-associated infections (HAIs) in New Zealand. To estimate the economic burden of HAIs in adults in New Zealand public hospitals by number and monetary value of bed days lost; number of deaths, number of life years lost, and the monetary value (in NZ dollars); Accident Compensation Commission (ACC) HAI treatment injury payments; and disability-adjusted life years (DALYs). The annual incidence rate was calculated from the observed prevalence of HAIs in New Zealand, and length of patient stays. Total HAIs for 2021 were estimated by multiplying adult admissions by incidence rates. The excess length of stay and mortality risk attributed to those with HAI was calculated using a multistate model. Payments for treatment injuries were obtained from the ACC. DALYs for HAIs were estimated from the literature. The incidence rate of HAI was 4.74%, predicting 24,191 HAIs for 2021, resulting in 76,861 lost bed days, 699 deaths, with 9,371 years of life lost (YoLL). The annual economic burden was estimated to be $955m comprised of $121m for lost bed days, $792m for cost of YoLL, and $43m ACC claims. There were 24,165 DALY which is greater than many other measured injuries in New Zealand, eg motor vehicle traffic crashes with 20,328 DALY. HAIs are a significant burden for patients, their families, and the public health system. Preventive guidelines for many HAIs exist and a strategic plan is needed to reduce HAIs in New Zealand.

Molecular Properties of Virulence and Antibiotic Resistance of Pseudomonas aeruginosa Causing Clinically Critical Infections.

The increase in the number of hospital strains of hypervirulent and multidrug resistant (MDR) Pseudomonas aeruginosa is a major health problem that reduces medical treatment options and increases mortality. The molecular profiles of virulence and multidrug resistance of P. aeruginosa-associated hospital and community infections in Mexico have been poorly studied. In this study, we analyzed the different molecular profiles associated with the virulence genotypes related to multidrug resistance and the genotypes of multidrug efflux pumps (mex) in P. aeruginosa causing clinically critical infections isolated from Mexican patients with community- and hospital-acquired infections. Susceptibility to 12 antibiotics was determined using the Kirby-Bauer method. The identification of P. aeruginosa and the detection of virulence and efflux pump system genes were performed using conventional PCR. All strains isolated from patients with hospital-acquired (n = 67) and community-acquired infections (n = 57) were multidrug resistant, mainly to beta-lactams (ampicillin [96.7%], carbenicillin [98.3%], cefalotin [97.5%], and cefotaxime [87%]), quinolones (norfloxacin [78.2%]), phenicols (chloramphenicol [91.9%]), nitrofurans (nitrofurantoin [70.9%]), aminoglycosides (gentamicin [75%]), and sulfonamide/trimethoprim (96.7%). Most strains (95.5%) isolated from patients with hospital- and community-acquired infections carried the adhesion (pilA) and biofilm formation (ndvB) genes. Outer membrane proteins (oprI and oprL) were present in 100% of cases, elastases (lasA and lasB) in 100% and 98.3%, respectively, alkaline protease (apr) and alginate (algD) in 99.1% and 97.5%, respectively, and chaperone (groEL) and epoxide hydrolase (cif) in 100% and 97.5%, respectively. Overall, 99.1% of the strains isolated from patients with hospital- and community-acquired infections carried the efflux pump system genes mexB and mexY, while 98.3% of the strains carried mexF and mexZ. These findings show a wide distribution of the virulome related to the genotypic and phenotypic profiles of antibiotic resistance and the origin of the strains isolated from patients with hospital- and community-acquired infections, demonstrating that these molecular mechanisms may play an important role in high-pathogenicity infections caused by P. aeruginosa.

B-198 Rapid Molecular Detection of Respiratory Infections in Brazilian Hospitals and Outpatient Units: Insights from the Diagnostic Medicine and Health Network

Abstract Background Diagnosing agents causing respiratory infections remains a global challenge due to the numerous coexisting agents and similar symptoms. This study evaluates the epidemiology of viral and bacterial agents responsible for major respiratory infections through molecular detection in patients across various Brazilian hospital units served by a clinical diagnostic and health laboratory. Understanding the distribution and prevalence of these pathogens is crucial for effective diagnosis, treatment, and prevention strategies in the face of evolving epidemiological landscapes. Methods Utilizing an internal database, we conducted a comprehensive analysis of tests performed on the FilmArray® system. This system employs multiplex PCR technology, capable of simultaneously identifying 21 respiratory agents in a single sample obtained from nasopharyngeal and bronchial lavage specimens collected from diverse geographical regions across Brazil. The data for the examination of patient samples with respect to gender, age group, geographical regions, and the prevalence of various agents between January 2021 and April 2023 were retrieved from the database and analyzed. To ensure privacy, sensitive and individual data from all patients were meticulously preserved throughout the study. Results The analysis encompassed a diverse sample of 477 patients, originating from 26 cities across 11 Brazilian states, including Goiás, Minas Gerais, Mato Grosso, Pará, Paraná, Rio de Janeiro, São Paulo, Tocantins, Amazonas, Bahia, and Distrito Federal. The distribution of patients was nearly split between hospital settings (39.8%) and outpatient units, with hospital patients predominantly from departments such as internal medicine, cardiology, and nephrology. In contrast, outpatient samples were primarily requested by specialists in pulmonology and infectious diseases. The demographic profile revealed an average age of 36 years, with a majority male representation (54%). However, a notable shift occurred in the first four months of 2023, where females constituted 60.8% of the sample. The overall test positivity rate stood at 42.3%, with a significant detection of 71% (15 out of 21) of the surveyed respiratory agents at some point during the study period. The most frequently identified pathogens were Rhinovirus, Enterovirus, and SARS-CoV-2, collectively accounting for 55.1% of the positive findings. Additionally, mixed infections were observed in 29 (6%) of the patients, with combinations such as SARS-CoV-2 and Rhinovirus, SARS-CoV-2 and H3N2, and SARS-CoV-2 and RSV, among others, highlighting the complexity of respiratory infections. Conclusions The findings from this study underscore the critical role of advanced molecular diagnostics in the Brazilian clinical-laboratory landscape. The utilization of multiplex PCR technology has proven to be a pivotal tool in accurately identifying a wide array of respiratory pathogens, thereby enhancing the precision of diagnosis and treatment strategies. The detection of a high prevalence of agents such as Rhinovirus, Enterovirus, and SARS-CoV-2, along with the identification of mixed infections, highlights the complexity of respiratory infections and the necessity for robust diagnostic tools. This study not only contributes to the understanding of the epidemiology of respiratory infections in Brazil but also emphasizes the importance of continuous advancements in molecular diagnostics for better patient care and public health management.