Infections Surveillance System Research Articles

Spatiotemporal, Demographic, and Climatic Drivers of Malaria Transmission in the Endemic Setting of Jazan, Saudi Arabia: A Retrospective Study.

Despite progress, malaria remains endemic in Jazan, Saudi Arabia necessitating updated epidemiological research to guide elimination strategies. This study analyzed recent surveillance data to elucidate drivers of sustained transmission. A retrospective, epidemiological study was conducted using malaria surveillance data from the Jazan region of Saudi Arabia over a 3-year period from January 2018 to December 2020. Deidentified records of all confirmed malaria cases reported across Jazan during the study period were obtained from the Jazan Department of Health infectious disease surveillance system. Additional meteorological data was acquired to assess climatic correlates. The final analysis included 5255 confirmed cases meeting completeness criteria for key variables. Descriptive statistics characterized cases across demographic factors and spatial and temporal distributions. Correlations and linear regression modeling identified associations between monthly cases and weather parameters. Mapping visualized geographic patterns. Of 5255 confirmed cases, most were concentrated in Baish sector (50.8-72.0% annually), affected adult male foreigners (93.8-97.0%), peaked inconsistently across seasons, and were imported (85.4-94.9%). Non-Saudi nationality had 6-fold higher incidence versus Saudi citizens in 2020 (677.6 vs 23.1 per 100,000). Monthly cases associated negatively with temperature (p=0.015) and positively with windspeed (p=0.005). Malaria persistence in Jazan involves geographic and demographic hotspots driven by imported infections and climate effects on vectors. Tailored programming aligned with evolving local dynamics will be essential to sustain elimination gains. Surveillance, optimized interventions, and flexible adaptation to high-risk locations/populations and meteorological influences are key priorities.

Risk assessment and prediction of nosocomial infections based on surveillance data using machine learning methods

BackgroundNosocomial infections with heavy disease burden are becoming a major threat to the health care system around the world. Through long-term, systematic, continuous data collection and analysis, Nosocomial infection surveillance (NIS) systems are constructed in each hospital; while these data are only used as real-time surveillance but fail to realize the prediction and early warning function. Study is to screen effective predictors from the routine NIS data, through integrating the multiple risk factors and Machine learning (ML) methods, and eventually realize the trend prediction and risk threshold of Incidence of Nosocomial infection (INI).MethodsWe selected two representative hospitals in southern and northern China, and collected NIS data from 2014 to 2021. Thirty-nine factors including hospital operation volume, nosocomial infection, antibacterial drug use and outdoor temperature data, etc. Five ML methods were used to fit the INI prediction model respectively, and to evaluate and compare their performance.ResultsCompared with other models, Random Forest showed the best performance (5-fold AUC = 0.983) in both hospitals, followed by Support Vector Machine. Among all the factors, 12 indicators were significantly different between high-risk and low-risk groups for INI (P < 0.05). After screening the effective predictors through importance analysis, prediction model of the time trend was successfully constructed (R2 = 0.473 and 0.780, BIC = -1.537 and -0.731).ConclusionsThe number of surgeries, antibiotics use density, critical disease rate and unreasonable prescription rate and other key indicators could be fitted to be the threshold predictions of INI and quantitative early warning.

Implementation and evaluation of a SARI surveillance system in a tertiary hospital in Scotland in 2021/2022

ObjectiveTo set up and evaluate a new surveillance system for severe acute respiratory infection (SARI) in Scotland. Study designCross-sectional study and evaluation of surveillance system. MethodsThe SARI case definition comprised patients aged 16 years or over with an acute respiratory illness presentation requiring testing for influenza and SARS-CoV-2 and hospital admission. Data were collected from SARI cases by research nurses in one tertiary teaching hospital using a bespoke data collection tool from November 2021 to May 2022. Descriptive analyses of SARI cases were carried out. The following attributes of the surveillance system were evaluated according to Centers for Disease Control and Prevention (CDC) guidelines: stability, data quality, timeliness, positive predictive value, representativeness, simplicity, acceptability and flexibility. ResultsThe final surveillance dataset comprised 1163 records, with cases peaking in ISO week 50 (week ending 19/12/2021). The system produced a stable stream of surveillance data, with the proportion of SARI records with sufficient information for effective surveillance increasing from 65.4% during the first month to 87.0% over time. Similarly, the proportion where data collection was completed promptly was low initially, but increased to 50%–65% during later periods. ConclusionSARI surveillance was successfully established in one hospital, but for a national system, additional sentinel hospital sites across Scotland, with flexibility to ensure consistently high data completeness and timeliness are needed. Data collection should be automated where possible, and demands on clinicians minimised. SARI surveillance should be embedded and resourced as part of a national respiratory surveillance strategy.

COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application-Based Prospective Observational Cohort Study.

The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. We enrolled 10,077 participants (aged ≥16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2% (95% CI 70.4%-97.4%) at week 4 to 37.2% (95% CI 23.5%-48.5%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6% (95% CI 50.3%-78.8%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools.

The Incidence and Risk Factors of Early Periprosthetic Joint Infections.

Periprosthetic joint infections (PJI) represent major complications in arthroplasty, contributing to increased patient morbidity and imposing substantial financial burdens. Meticulous surveillance of PJI occurrences and identification of associated risk factors is imperative for accurately gauging the incidence rates and implementing proactive infection control measures. This study aimed to ascertain the early incidence of PJI and elucidate the key risk factors involved in its occurrence. This monocentric, prospective descriptive study conducted between June 2018 and June 2019, including all patients aged 18 years and above who underwent hip and knee arthroplasty. The research documented and evaluated patient demographic characteristics, clinical findings, laboratory results, treatment practices, and potential risk factors associated with the surgical process. After the 90-day postoperative period, patients were categorized into PJI and non-PJI groups, allowing for a comprehensive comparison of identified risk factors. This study identified a cohort of 590 patients, of whom 185 underwent hip arthroplasties (31.4%) and 405 underwent knee arthroplasties (68.6%). The average age of the patients was 65.2 years, with females constituting 80.2% of the population. The overall incidence of early PJI was found to be 2.88% (n=17). Following hip arthroplasties, the PJI incidence was 4.86%, while knee arthroplasties exhibited a lower incidence of 1.9%. Several potential risk factors associated with PJI were identified, including comorbid diseases (adjusted odds ratio [aOR]=3.35, 95% confidence interval [CI]=1.18-9.47), preoperative length of stay (aOR=0.89, 95% CI=0.79-1.01), postoperative erythrocyte suspension replacement (aOR=1.96, 95% CI=0.71-5.44), and a National Nosocomial Infections Surveillance System (NNIS) score of 1 or higher (aOR=3.10, 95% CI=1.10-8.71). These factors were identified as potential contributors to the risk of PJI in patients undergoing hip and knee arthroplasties. Compared to other reported outcomes in the literature, this study observed a higher incidence of early-stage PJI. The higher incidence may be due to PJI surveillance deficiencies such as difficulty in post-discharge surgical site infection (SSI) follow-up, reporting, and bacterial sampling. This discrepancy underscores the importance of actively monitoring patients with risk factors for PJI development, including medical comorbidities and a high NNIS score. Implementing prospective active surveillance in such cases is deemed crucial for the timely identification and management of PJI.

Infectious diseases in Poland in 2021.

OBJECTIVE OF THE WORK. As 2021 was the second year of COVID-19 pandemic we expect the continuous impact of the pandemic on other infectious diseases. We aimed at reviewing the national infectious surveillance data based on available surveillance reports (Epidemiological Chronicle) to summarize the infectious disease situation in 2021. MATERIAL AND METHODS. National infectious disease surveillance system collects mandatory notifications from physicians and laboratories as well as epidemiological investigation reports prepared by State Sanitary Inspection, where relevant. We also include mortality data based on the reports of Statistics Poland office. RESULTS AND DISCUSSION. In 2021, there were 2,852,789 cases of COVID-19 reported, corresponding to the incidence of 7475.4 per 100,000 and 90,126 deaths related to COVID-19. For most of diseases the incidence remained lower than before the pandemic. This included influenzea and influenzea-like illness incidence (- 5.4% vs 2020 and - 37.6% vs median 2015-2019) and tuberculosis incidence (+9.3% vs 2020 and -35.9% vs median 2015-2019). The incidence was lower than in 2020 for: pertussis (-75.7%), measles (-54.9%), rubella (48.7%), mumps (-16.4%), chickenpox (-19.0%) or H. influenzea invasive disease (-33.0%). A notable exception to these trends was Clostridium difficile intestinal infections incidence, which was higher by 88.2% from the 2015-2019 median with 21,157 case and 1,120 fatalities reported in 2021. There was also an almost 4-fold increase in norovirus infections incidence. The number of chronic hepatitis infections diagnoses were substantially lower than median for 2015-2019 (-53.7% for HBV and - 68.8% for HCV). The COVID-19 pandemic still played the crucial role as a public health problem, but its impact on other infectious diseases was less clear than in 2020. The reduction in the number of registered cases was with likely attributable to non-pharmaceutic interventions and to delays in registration due to reduced public health resources.

Persistence and Variation of the Indirect Effects of COVID-19 Restrictions on the Spectrum of Notifiable Infectious Diseases in China: Analysis of National Surveillance Among Children and Adolescents From 2018 to 2021.

Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6% during 2020 but rebounded by 56.9% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95% CI 0.53-0.87), but rebounded in 2021. The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections.

Genomic surveillance strategy. Problems and perspectives

The topic of epidemiologic surveillance is one of the basic concepts in the theory and practice of epidemiologic science. In Russia, generalization of the accumulated factual material and theoretical developments have allowed us to formulate a number of provisions on the nature of the epidemic process. The pandemic of a new coronavirus infection has forced adjustments in all spheres of society, including the activities of the infectious disease epidemiological surveillance system, requiring the development and implementation of innovative solutions. Based on the experience of prompt response to the tasks set by the COVID-19 pandemic, the authors raised the problem of development and implementation of a system of molecular genetic monitoring for pathogens of emerging and re-emerging infections as a priority vector of epidemiological surveillance development. The introduction of modern molecular biological technologies for the identification of pathogens with epidemic potential, taking into account their genetic diversity, into the system of epidemiologic surveillance has been substantiated based on the experience of using platform solutions created by the Central Research Institute of Epidemiology of Rospotrebnadzor. The strategy of genomic epidemiologic surveillance as a powerful tool to ensure readiness for response measures and management of the epidemic process by implementing and adjusting preventive and anti-epidemic measures was developed. The Russian platform for aggregation of information on virus genomes (VGARus) developed at the Central Research Institute of Epidemiology of Rospotrebnadzor as a technological, scientific, organizational and infrastructural base of genomic epidemiological surveillance, acting as an interdepartmental consortium, has been introduced into practice. The efficiency of VGARus was shown to assess the mutational variability of SARS-CoV-2, the influence of evolutionary development of circulating pathogens on the characteristics of the epidemic process, the implementation of operational and retrospective analysis of morbidity and prediction of the spread of genetic variants of pathogens.

Estimated Impact of Nirsevimab on the Incidence of Respiratory Syncytial Virus Infections Requiring Hospital Admission in Children < 1 Year, Weeks 40, 2023, to 8, 2024, Spain.

Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.

West Nile Virus Emergence in Germany 2019: Looking for Hidden Human West Nile Virus Infections.

Background: Autochthonous human West Nile virus (WNV) infections were notified in the infectious disease surveillance system in Germany in 2018 for the first time and every year since then. Since clinically apparent infections are infrequent, we conducted two studies to investigate subclinical infections of this emerging disease in Germany in 2019 to detect infections not visible to surveillance based on symptomatic infections: limited-scope blood donor testing and a serosurvey among employees at two Berlin zoos with a history of demonstrated WNV infections in animals. Methods: For the zoo study, employees of the two zoos in Berlin were invited to participate in the study in late 2019. Blood samples were drawn and tested for the presence of antibodies (immunoglobulin M [IgM] and immunoglobulin G [IgG]) against WNV, and two other flaviviruses present in Germany: Usutu virus and Tick-borne encephalitis virus (TBEV). For the study in blood donors, four blood establishments with collection sites in regions with documented WNV-infected animals in 2018 and 2019 participated in the study. All donations in these regions were tested for WNV genome from July to November 2019. Results: In the enzyme-linked immunosorbent assay, none of the 70 tested zoo employees were WNV IgM-positive, 8 were WNV IgG-positive, additional 2 participants had equivocal results. All 10 were negative in the virus neutralization test (VNT) for WNV, but positive in the VNT for TBEV. None of the 4273 samples from blood donors tested in areas with WNV-infected animals was positive for WNV-RNA. Conclusion: Our results indicate that WNV circulation in Germany, though clearly documented in animals in 2019, apparently affected very few humans. Still areas with WNV-positive animals remain risk areas for human infection as well.

Evaluation of a surveillance system for Clostridioides difficile infections for Swiss hospitals.

This study evaluated an approach to establishing a comprehensive nationwide surveillance system forClostridioides difficileinfection in Switzerland. We report the results of patient-related surveillance and calculate the incidence rate ofC. difficileinfection in Switzerland in 2022. Initiated in 2017 by the National Centre for Infection Prevention (Swissnoso), in collaboration with the Swiss Centre for Antibiotic Resistance (ANRESIS), laboratory surveillance enables the automatic import ofC. difficileinfection laboratory data and is fully operational. However, the very limited number of participating laboratories impedes the generation of representative results. To address this gap, Swissnoso introduced patient-related surveillance, with a questionnaire-based survey used across Swiss acute care hospitals. This survey revealed an incidence of 3.8 (Poisson 95% CI: 3.2-4.5)C. difficileinfection episodes per 10,000 patient-days, just above the mean rate reported by the European Centre for Disease Prevention and Control (ECDC). Additionally, we report substantial heterogeneity in laboratory tests, diagnostic criteria and infection control practices among Swiss hospitals. This study underscores the importance of a joint effort towards standardized surveillance practices in providing comprehensive insights intoC. difficileinfection epidemiology and effective prevention strategies in Swiss healthcare settings. The patient-related approach remains the gold standard forC. difficileinfection surveillance, although it demands substantial resources and provides results only annually. The proposed implementation of nationwide automated laboratory-based surveillance would be pragmatic and efficient, empowering authorities and hospitals to detect outbreaks promptly and to correlate infection rates with antibiotic consumption.

Effectiveness of HealthTracker for post-caesarean section surgical site infection surveillance: An intervention study.

This intervention study aimed to implement and evaluate the effectiveness of HealthTracker, a post-discharge surgical site infection surveillance system. Participants were 730 women birthing by caesarean section at a large hospital over a 6-month period. Data were downloaded from clinical data systems and HealthTracker. Receiver operating characteristics were used to assess HealthTracker. Over a 6-month period, 382 women completed HealthTracker, with 83 scoring ≥6, indicating signs and symptoms of surgical site infection. Of this 83, 58 sought advice from health professionals, 29 returned to hospital, and 45 received antibiotics. A total of 20 infections from a total population of 730 were confirmed, with 14 out of 382 respondents confirmed via HealthTracker. Receiver operating characteristics identified HealthTracker as an excellent indicator of surgical site infection. HealthTracker is a feasible mHealth option for monitoring post-discharge surgical site infection post-caesarean section. In addition, by providing alerts, advising women to monitor their symptoms and seek treatment if necessary, HealthTracker has the potential to enhance self-efficacy for surgical wound monitoring at home.

Data quality review of the Brazilian nosocomial infections surveillance system

BackgroundSurveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. MethodsData Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. ResultsThroughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. ConclusionsWhile adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.

A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study

BackgroundSurgical site infection (SSI) is a common and serious complication of elective clean orthopedic surgery that can lead to severe adverse outcomes. However, the prognostic efficacy of the current staging systems remains uncertain for patients undergoing elective aseptic orthopedic procedures. This study aimed to identify high-risk factors independently associated with SSI and develop a nomogram prediction model to accurately predict the occurrence of SSI.MethodsA total of 20,960 patients underwent elective clean orthopedic surgery in our hospital between January 2020 and December 2021, of whom 39 developed SSI; we selected all 39 patients with a postoperative diagnosis of SSI and 305 patients who did not develop postoperative SSI for the final analysis. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted in the training cohort to screen for independent risk factors of SSI, and a nomogram prediction model was developed. The predictive performance of the nomogram was compared with that of the National Nosocomial Infections Surveillance (NNIS) system. Decision curve analysis (DCA) was used to assess the clinical decision-making value of the nomogram.ResultsThe SSI incidence was 0.186%. Univariate and multivariate logistic regression analysis identified the American Society of Anesthesiology (ASA) class (odds ratio [OR] 1.564 [95% confidence interval (CI) 1.029–5.99, P = 0.046]), operative time (OR 1.003 [95% CI 1.006–1.019, P < 0.001]), and D-dimer level (OR 1.055 [95% CI 1.022–1.29, P = 0.046]) as risk factors for postoperative SSI. We constructed a nomogram prediction model based on these independent risk factors. In the training and validation cohorts, our predictive model had concordance indices (C-indices) of 0.777 (95% CI 0.672–0.882) and 0.732 (95% CI 0.603–0.861), respectively, both of which were superior to the C-indices of the NNIS system (0.668 and 0.543, respectively). Calibration curves and DCA confirmed that our nomogram model had good consistency and clinical predictive value, respectively.ConclusionsOperative time, ASA class, and D-dimer levels are important clinical predictive indicators of postoperative SSI in patients undergoing elective clean orthopedic surgery. The nomogram predictive model based on the three clinical features demonstrated strong predictive performance, calibration capabilities, and clinical decision-making abilities for SSI.

Suppressed pediatric asthma hospitalizations during the COVID-19 pandemic in Japan, from a national survey.

Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID-19 pandemic in Japan. Thirty-three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID-19 pandemic and whether or not COVID-19 caused acute asthma exacerbation were investigated. From fiscal years 2010-2019, the median number of acute asthma hospitalizations per year was 3524 (2462-4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3- to 6-year group. SARS-CoV-2 was evaluated in 2094 patients from fiscal years 2020-2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS-CoV-2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long-term control medications before admission despite the severity of bronchial asthma. SARS-CoV-2 was hardly detected in children with acute asthma hospitalization during the COVID-19 pandemic. This result indicated that SARS-CoV-2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long-term control medications is a major problem that should be addressed.

THE IMPACT OF HOSPITAL-ACQUIRED INFECTIONS ON PATIENT OUTCOMES

Hospital-acquired infections (HAIs), also known as healthcare-associated infections, are infections that patients acquire while they are in the hospital. They are typically not present or might be incubating at the time of admission. HAIs usually manifest 48 hours after admission to the hospital. The National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention (CDC) closely monitors HAIs to prevent them and improve patient safety. HAIs include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and Hospital-acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP), and Clostridium difficile infections (CDI). For the last few decades, hospitals have taken HAIs seriously. Several hospitals have established infection tracking and surveillance systems in place, along with robust prevention strategies to reduce the rate of HAIs. HAIs can have a significant impact on patients, both at an individual level and at the community level. They can lead to longer hospital stays, increased costs of care, and even death. HAIs can also be linked to the spread of multidrug-resistant infections. In recent years, the definitions of pneumonia have been changed to better identify patients at risk for multidrug-resistant (MDR) pathogens. This change was made to avoid the overuse of antibiotics. The term Healthcare-acquired Pneumonia (HCAP) has been made obsolete, and the term Hospital-acquired Pneumonia (HAP) has replaced it. HAP is defined as pneumonia that occurs 48 hours or more after admission to the hospital and did not appear to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops more than 48 to 72 hours after endo-tracheal intubation. Both HAP and VAP are associated with poorer outcomes and significant morbidity and mortality worldwide.

Nosocomial infections in patients admitted in medical intensive care units in a tertiary health center in Western part of India and their hematological correlation

Background and Aim: Acquired infections (AIs) in medical intensive care units (MICUs) have become serious threats with increasing mortality and morbidity more so in the developing countries. The most common reason is lack of efficient infection control protocols. The national nosocomial infections surveillance system defines a nosocomial infection as a localized or systemic condition that results from adverse reaction to the presence of infectious agents or their toxins that were not present or incubating at the time of admission to the hospital. Critically ill patients are at increased risk of acquiring nosocomial infections because of their lower immune status. These infections being opportunistic, microbes of low virulence cause also cause disease in hospital patients whose immune systems are impaired. This study was conducted to study the association of leukocytosis in relation to nosocomial infections in MICU. Methods: A retrospective study was conducted at the MICU under the Department of Anesthesiology in collaboration with the Department of Microbiology and Department of Pathology of Mahatma Gandhi Medical College and Hospital, Navi Mumbai over six months. All the patients who were admitted in MICU and stayed for more than 48 hours were included in the present study. Results: A total of 805 patients were admitted in the MICU from January 1st to June 30th, 2017, for a period of 6 months. Out of 805 cases, 27 patients developed nosocomial infections amounting to 3.3% with male-to-female ratio of 2.8:1. The age of the patient ranged from 15 to 85 years with the mean age of 50 years. Male predominance was seen with 74% cases with mean age of 48.5 years. Maximum cases were seen in the geriatric age group mainly 6th to 7th decade comprising of 40.7% of all cases. In our study, bloodstream infection was the most common finding constituting 100% of the cases, followed by urinary tract infections. All the cases of nosocomial infections showed polymorphonuclear leukocytosis with shift to left. In our study, diabetes mellitus followed by hypertension and chronic kidney disease was the major contributory comorbidities comprising of 29.6%, 29.6%, and 22.2%, respectively. In our study, the invasive devices contributed to the overall outcome of the patients. Urinary catheters (all cases) were the most prevalent invasive device followed closely by Ryle’s tube (90%) and endotracheal tube (60%). Conclusions: Intensive care units (ICUs) comprise of less than 10% of the total hospital beds but contribute &gt;20% of all the nosocomial infections acquired in the hospital. World Health Organization (WHO) estimates the burden of nosocomial infections in hospitalized patients to be 7–12% globally, in contrast to the figures from India being alarmingly high varying from 11–83%.

Comparative Analysis of Clinical Outcomes Using Propensity Score Matching: Coronavirus Disease 2019 vs. Seasonal Influenza in Korea.

The advent of the omicron variant and the formulation of diverse therapeutic strategies marked a new epoch in the realm of coronavirus disease 2019 (COVID-19). Studies have compared the clinical outcomes between COVID-19 and seasonal influenza, but such studies were conducted during the early stages of the pandemic when effective treatment strategies had not yet been developed, which limits the generalizability of the findings. Therefore, an updated evaluation of the comparative analysis of clinical outcomes between COVID-19 and seasonal influenza is requisite. This study used data from the severe acute respiratory infection surveillance system of South Korea. We extracted data for influenza patients who were infected between 2018 and 2019 and COVID-19 patients who were infected in 2021 (pre-omicron period) and 2022 (omicron period). Comparisons of outcomes were conducted among the pre-omicron, omicron, and influenza cohorts utilizing propensity score matching. The adjusted covariates in the propensity score matching included age, sex, smoking, and comorbidities. The study incorporated 1,227 patients in the pre-omicron cohort, 1,948 patients in the omicron cohort, and 920 patients in the influenza cohort. Following propensity score matching, 491 patients were included in each respective group. Clinical presentations exhibited similarities between the pre-omicron and omicron cohorts; however, COVID-19 patients demonstrated a higher prevalence of dyspnea and pulmonary infiltrates compared to their influenza counterparts. Both COVID-19 groups exhibited higher in-hospital mortality and longer hospital length of stay than the influenza group. The omicron group showed no significant improvement in clinical outcomes compared to the pre-omicron group. The omicron group did not demonstrate better clinical outcomes than the pre-omicron group, and exhibited significant disease severity compared to the influenza group. Considering the likely persistence of COVID-19 infections, it is imperative to sustain comprehensive studies and ongoing policy support for the virus to enhance the prognosis for individuals affected by COVID-19.

Current Status and Recent Changes in Nationwide Surveillance System for Surgical Site Infections

Current Status and Recent Changes in Nationwide Surveillance System for Surgical Site Infections