Infection Prevention Strategies Research Articles

Prevalence and factors associated with multidrug resistant Escherichia coli carriage on chicken farms in west Nile region in Uganda: A cross-sectional survey.

Infections with multi-drug-resistant (MDR) pathogens in food-animals threaten public health and food security. However, the epidemiology and factors associated with MDR Escherichia coli (MDR E. coli) on Ugandan farms are not well known. This study investigated the prevalence, resistance patterns and factors associated with MDR E. coli carriage on chicken farms. Escherichia coli was isolated from each of the 158 chicken farms sampled. The disc diffusion method for susceptibility testing was performed. Clinical breakpoints were interpreted according to Clinical and Laboratory Standards Institute guidelines. MDR was defined as resistance to three or more classes of antibiotics. MDR E. coli prevalence on chicken farms was 62.7% (95% CI: 55.0-70.3). High resistance was observed against ampicillin 79.8% (95% CI: 72.7-85.4), tetracycline 72.8% (95% CI: 65.2-79.2), cotrimoxazole 55.7% (95% CI: 47.8-63.3), and ciprofloxacin 38% (95% CI: 30.7-45.9). Male farm managers (Adjusted prevalence ratio [APR] = 0.72, CI: 0.55-0.93), attainence of at least secondary education (APR = 0.64, CI: 0.46-0.88) and administration of recommended antibiotic doses (APR = 0.76, CI: 0.59-0.96) posed a lower risk of MDR E. coli carriage while farms without footbaths posed a heighten risk (APR = 1.48, CI: 1.16-1.88). MDR E. coli carriage was highly prevalent on chicken farms in Uganda. This study underscores the urgent need for antimicrobial stewardship and improved infection prevention strategies on chicken farms.

Mpox: Changing epidemiology, evolving epidemic, new vaccine production, and way out in a resource-limited economy

Mpox was declared public health emergency of continental security and public health emergency of international concern by the Africa CDC and the WHO in 2024 due to devastating global outbreak caused by newly emerged Mpox virus clades. The divergent virulent new clades are genetically and phylogenetically different from the previous ones that were endemic in Democratic Republic of the Congo, spreading to neighboring countries and other parts of the globe, with considerable morbidity and mortality. The emerged new circulating clades responsible for current epidemics are associated with changing epidemiology and new disease outcomes. Sexual transmission plays a key role in sustaining transmission, spread beyond Africa and affected mainly the sexually active young adults. To curb the menace of these epidemics, there is need to develop a polyvalent vaccine incorporating the various circulating clades. Mass vaccination with the proposed vaccine will achieve herd immunity in addition to effective infection prevention and control strategies.

Risk Factors for Shunt Failure in Pediatric Patients with Hydrocephalus: A Systematic Literature Review

Background: Hydrocephalus in pediatric patients is a severe neurological condition requiring timely and effective treatment to prevent life-threatening complications. Shunt placement is the primary intervention to manage cerebrospinal fluid buildup, but shunt failure remains a persistent and critical challenge in clinical practice. This study aimed to evaluate the risk factors influencing shunt success and explore infection prevention strategies to enhance treatment outcomes for pediatric patients. Methods: Using a systematic review of relevant literature accessed through PubMed, we analyzed studies selected based on strict inclusion criteria, including research type and publication year. Key findings from this analysis underscore several critical aspects: risk factors for shunt failure, the efficacy of innovative technologies, and infection prevention strategies. Results: Advanced devices like the Sophy valve and El-Shafei shunt system demonstrate promising potential in improving treatment outcomes, particularly in adult patients. However, their applicability in pediatric cases requires further exploration. Infection prevention strategies are vital to reducing complications, with approaches such as postoperative antibiotics and the use of antibiotic-impregnated cerebrospinal fluid shunt catheters proving effective in lowering postoperative infection rates. A cost-benefit analysis further highlights the economic viability of AISC utilization in standard practice. A comprehensive understanding of shunt failure risk factors and infection control measures is essential for optimizing pediatric hydrocephalus treatment. While new technologies and preventive strategies show significant promise, additional research comparing these innovations with conventional methods is necessary to fully establish their safety and efficacy. Conclusion: This study provides a foundation for advancing more effective, efficient, and economically viable treatment approaches for pediatric hydrocephalus patients.

Retrospective review of the development and implementation of a bedside tunneled dialysis catheter program.

The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements. In this retrospective case series, we present data from a quality improvement initiative aimed at integrating available evidence for bedside tunneled dialysis catheter placement with electrocardiograph (ECG) tip positioning, to expedite care, improve patient safety outcomes, and reduce healthcare costs associated with the procedure. Most patients in the study had end-stage renal disease (59%) or acute kidney injury (37%) and were receiving placement for the first time (91%). The right jugular vein was cannulated in 84% of the placements and rates of post-insertion complications were <1%, regardless of the vessel cannulated. Performing bedside tunneled dialysis catheter placement resulted in a cost savings of $385,938.76 over a 2-year period. The placement of ultrasound guided tunneled dialysis catheters at the bedside following a pre-procedural evaluation of the right jugular, brachiocephalic, and femoral veins is a safe option resulting in expedited patient care, decreased resource utilization, and significant cost savings. Non-bedside techniques performed in interventional radiology, or the operating room should remain a consideration for patients requiring left sided venous access, signs of central stenosis, a history of multiple tunneled catheters, or patients requiring moderate sedation outside of the ICU.

The impact of antimicrobial stewardship interventions on appropriate use of surgical antimicrobial prophylaxis in low- and middle-income countries: a systematic review

BackgroundSurgical antimicrobial prophylaxis (SAP) is an effective infection prevention strategy used to reduce postoperative surgical site infection. Inappropriate use of SAP is a concern in low-middle-income countries (LMICs) due to increased mortality risks, adverse reactions, re-admission rates and length of hospital stay. Antimicrobial Stewardship Programs (ASP) have been shown to be effective in improving the appropriate use of antibiotics including the use of SAP. The aim of this review was to evaluate the impact of ASP on the appropriate use of SAP and its implication on patient outcomes in LMICs.MethodThe protocol for this review was registered in PROSPERO. Studies published between 1st January 2010 and 31st December 2023 were searched electronically from Medline, Central Cochrane Library, web of science, CINAHL and APA PsychInfo databases. Studies were included if they assessed the impact of ASP interventions on SAP use in low- and middle-income countries (LMICs). Studies were evaluated using the Risk of Bias in Non-Randomized Studies–of Interventions (ROBINS-I) tool for non-randomized and before and after studies as well as the Cochrane Risk of Bias 2 (ROB 2) tool for randomized studies. Findings were summarized in tables.ResultsTwenty studies comprising of seventeen before-after studies, two interrupted time series, and one randomized controlled trial were included. Penicillins and cephalosporins were the most commonly used antibiotics for SAP. Most (50%) of the studies were conducted in Asia followed by Africa (45%). While 80% of the studies showed the impact of ASP on compliance to SAP guidelines, only 45% showed an impact on antibiotic utilization. Again, 50% and 60% showed an impact on reducing antibiotic costs and patient length of stay at hospitals respectively. Patient outcomes including rates of surgical site infections and mortality showed no significant change. The studies showed a high risk of bias mainly due to the choice of study designs.ConclusionASP interventions in LMICs are effective in improving SAP guideline adherence, antibiotic utilization and their cost. Deliberate effort must be made to improve on the quality of future interventional studies in these settings to guide practice and encourage other LMICs to conduct such studies to assess the influence of different geographical contexts on SAP use.

How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment".

SUMMARYIn healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of contamination, infectious dose (ID), virulence, hygiene practices, and patient vulnerability. This review attempts to close a gap in previous reviews on persistence/tenacity by only including articles (n = 171) providing quantitative data on re-cultivable pathogens from fomites for a better translation into clinical settings. We have therefore introduced the new term "replication capacity" (RC). The RC is affected by the degree of contamination, surface material, temperature, relative humidity, protein load, organic soil, UV-light (sunlight) exposure, and pH value. In general, investigations into surface RC are mainly performed in vitro using reference strains with high inocula. In vitro data from studies on 14 Gram-positive, 26 Gram-negative bacteria, 18 fungi, 4 protozoa, and 37 viruses. It should be regarded as a worst-case scenario indicating the upper bounds of risks when using such data for clinical decision-making. Information on RC after surface contamination could be seen as an opportunity to choose the most appropriate infection prevention and control (IPC) strategies. To help with decision-making, pathogens characterized by an increased nosocomial risk for transmission from inanimate surfaces ("fomite-borne") are presented and discussed in this systematic review. Thus, the review offers a theoretical basis to support local risk assessments and IPC recommendations.

Genomic Characterizations of Klebsiella variicola: Emerging Pathogens Identified from Sepsis Patients in Ethiopian Referral Hospitals

Healthcare in low- and middle-income countries is becoming problematic due to the emergence of multidrug-resistant bacteria causing serious morbidity and mortality. Klebsiella variicola carrying multiple antimicrobial resistance (AMR) genes was found significantly among sepsis patients in a study done between October 2019 and September 2020 at four Ethiopian hospitals located in the central (Tikur Anbessa and Yekatit 12), southern (Hawassa), and northern (Dessie) parts. Among 1416 sepsis patients, 74 K. variicola isolates were identified using MALDI-TOF, most of them at Dessie (n=44) and Hawassa (n=28) hospitals. Whole genome sequencing showed that K. variicola strains identified at Dessie Hospital displayed phylogenetic clonality, carried an IncM1 plasmid and the majority were ST3924. Many K. variicola identified at Hawassa Hospital were clonally clustered and the majority belonged to novel STs and carried IncFIB(K) and IncFII(K) plasmids concurrently. Fifty K. variicola carried ESBL genes while 2 isolates harbored AmpC. Other frequently found genes were aac(3)-lla, bla CTX-M-15, bla TEM-1B, bla LEN2, bla OXA-1, bla SCO-1, catB3, dfrA14, QnrB1, aac(6')-lb-cr and sul2. Virulence genes detected at both sites were mrk operons for biofilm formation and siderophore ABC transporter operons for iron uptake. Capsular alleles varied, with wzi 269 at Dessie and wzi 582 at Hawassa. The isolation of multidrug-resistant K. variicola as an emerging sepsis pathogen calls for strong infection prevention strategies and antimicrobial stewardship supported by advanced bacterial identification techniques.

First Identification of Emerging Pathogenic Yeast in Clogmia albipunctata (Diptera: Psychodidae) at a Brazilian Hospital.

Psychodinae (Diptera: Psychodidae), commonly known as "drain flies", are a subfamily of insects adapted to environments modified by humans. While often regarded as harmless, it has been reported that they may carry pathogenic microorganisms, contributing to hospital environmental contamination and potentially playing a role in healthcare-associated infections. This study aimed to investigate drain flies in a hospital setting to assess their role in carrying microbial pathogens. Twenty-six drain flies were collected from a tertiary hospital using sterile tubes and processed within two hours. The insects were identified as Clogmia albipunctata (Williston, 1893). Whole-body macerates were cultured on EMB media, and fungal isolates were identified using MALDI-TOF MS and ITS region sequencing. The emergent pathogen Trichosporon asahii was isolated, highlighting the potential role of C. albipunctata as a mechanical vector of fungal pathogens associated with HAIs. These findings underscore the importance of monitoring drain flies as part of infection prevention and control strategies in healthcare settings.

Management of Surgical Wound Care Using the Bundles Principle as an Infection Control Strategy in Post-operative Patients

Background: Infection prevention strategies, such as applying the bundle's principle, play a vital role in surgical wound care. However, limited studies assess nurse compliance with these standards. Investigating compliance is crucial to understanding its impact on post-operative wound infection. This study examines how nurse adherence to the bundle's principle influences wound infection during the healing process. Methods: A before-and-after study was conducted at a second-level hospital in Indonesia over three months. Using total sampling, 100 nurses meeting inclusion criteria (adults with over one year of experience and training in bundle strategies) participated. Patients were selected through accidental sampling and included adults with non-infectious surgical wounds and no complications. The bundle's principle was implemented from the third to the sixth postoperative day, with infection signs assessed afterward. Instruments included demographic data, compliance checklists, and wound infection assessments. Data were analyzed using logistic regression. Results: Gender did not significantly affect wound infection occurrence (OR 0.39, *P* = 0.092). Nurse compliance and work length showed a significant association with infection prevention (OR 4.47, *P* = 0.006). Educational background was not significantly associated with compliance (OR 2.11, *P* = 0.409). Conclusion: Nurses' compliance with the bundle's principle significantly reduces post-operative wound infections, promoting effective healing. Factors like gender, work length, and educational background contribute equally to post-operative wound care outcomes.

Whole genome-based characterization of extended-spectrum β-lactamase-producing Enterobacter cloacae from orthopedic patients and environment of a tertiary referral hospital in Tanzania

ObjectivesWe investigated the genomic epidemiology of extended-spectrum β-lactamase-producing Enterobacter cloacae (ESBL-Ec) isolates from patients and hospital environment to better understand their distribution to help devising effective strategies for infection prevention and control. MethodsWe screened ESBL-Ec at Bugando Medical Center (BMC) in Mwanza, Tanzania. Rectal swabs from orthopedic patients on admission and swabs from the neighboring inanimate environment were collected. Following microbial culture, DNA was extracted from pure ESBL-Ec, and whole-genome sequencing was done. Sequence typing (ST), plasmid replicons, drug resistance, and virulence genes were deciphered using the Rapid Microbial Analysis Pipeline (rMAP). ResultsWe obtained 209 ESBL isolates, of which 15 (7.2%) were ESBL-Ec [8 (53.30%) from patients and 7 (46.7%) from the environment]. Seven isolates were novel and eight were diverse each with a unique ST. All isolates harbored two to five β-lactamase genes, with the predominance of blaCTX-M-15(15/15), blaOXA-1(14/15), blaTEM(14/15) and blaACT(12/15). The most common non β-lactam drug resistance genes were aac(3)-IIa (14/15), aac(6’)-Ib-cr (14/15), fosA (14/15), and qnrB1 (12/15), aph(3’’)-Ib (10/15) and aph(6)-Id (10/15). Eleven different types of plasmid replicons were identified in 14/15 of the isolates, harboring one to five plasmids, with the most common plasmids being IncFII (11/15) and IncFIB (10/15). All isolates harbored the outer membrane protein (ompA), and curli protein (csg) was in 14/15 isolates. ConclusionAdmitted orthopedic patients and the hospital environment act as a reservoir of ESBL-Ec with diverse STs and endowed with drug resistance and arsenals of virulence genes, calling for their routine screening on admission for mitigation of potential subsequent infections.

Potential role of bacterial extracellular vesicles in the pathophysiology of systemic lupus erythematosus

Systemic Lupus Erythematosus (SLE) is a rare autoimmune disorder influenced by various factors, including infections. Following bacterial or viral infections, there is an increase in IFN-I production, primarily by plasmacytoid dendritic cells (pDCs). Overproduction of IFN-I has been shown to drive the progression of SLE. Recent findings indicate that the gene expression signature of IFN-I in lupus nephritis patients does not co-occur with pDCs as expected; instead, it is localized in glomerular regions with anastomosing capillaries, suggesting a potential source from the blood. T cells, natural killer cells, and myeloid lineage cells may also secrete IFN in the bloodstream. Bacterial presence in the bloodstream challenges the concept of blood sterility, raising the possibility that cell-free microbial components, such as bacterial extracellular vesicles (BEVs), could trigger excessive IFN production through systemic circulation. While existing studies suggest a role for BEVs in human SLE, experimental evidence has yet to establish a direct association between the entire BEV nanoparticle and the disease. Research has primarily focused on (1) mammalian EVs and (2) purified eDNA and other specific cargoes as contributors to SLE progression. It remains unproven whether these bacterial molecules exert their effects while associated with vesicular membranes, i.e., BEVs. We hypothesize that BEVs, which carry diverse cargoes including nucleic acids, may enter systemic circulation, induce cellular responses leading to IFN overproduction, and exacerbate SLE severity. Clinical studies could investigate the association of BEVs with SLE progression by monitoring their presence and quantity in blood samples and correlating these factors with disease outcomes. Furthermore, understanding the involvement of BEVs may aid in identifying SLE biomarkers, inform infection prevention strategies, and inspire the development of BEV-neutralizing agents.

Exploring facilitators and barriers to daily chlorhexidine gluconate bathing in adult patients undergoing hematopoietic stem cell transplantation.

This study explored patients' perceived facilitators, barriers, and education/knowledge related to CHG bathing and thus addresses the gap in implementation for immunocompromised HCT patients. This study used a qualitative description approach to explore patients' perceived facilitators, barriers, and knowledge of CHG bathing. Fourteen HCT recipients (mean 51 ± 16years) completed semi-structured interviews. Data were analyzed using a rapid qualitative analysis approach to identify themes. Participants identified facilitators to using CHG wipes including ease of use, comfort, and staff assistance, along with barriers including wait time, discomfort, and physical challenges. Patient education themes encompassed patient understanding of CHG purpose, perceived ease in learning/application, inconsistent instruction, and inconsistent procedures. CHG bathing is a valuable infection prevention strategy for HCT patients. Participants' perspectives highlight the importance of addressing practical challenges and improving education to enhance adherence. This study contributes insights from HCT recipients, emphasizing the need for patient-centered interventions to reduce HAI and improve overall patient care.

Emerging Challenges and Innovations in the Management of Carbapenem-resistant Enterobacteriaceae Infections in Hospital Settings”

Carbapenem-resistant Enterobacteriaceae represent a crucial global public health issue. The challenges associated with carbapenem-resistant Enterobacteriaceae are multifac-eted. This review article aims to explore and comprehend the emerging challenges and the latest developments in the management of carbapenem-resistant Enterobacteriaceae infec-tions. A comprehensive literature search was conducted using databases such as PubMed, Cochrane Library, and Embase. Studies published from database inception until May 2024 were included. Articles were selected based on relevance, study design, and quality. Data from clinical trials, observational studies, and reviews were synthesized to provide a detailed over-view of the current state of knowledge on carbapenem-resistant Enterobacteriaceae. The re-view identifies key epidemiological trends, including geographic variations and risk factors associated with carbapenem-resistant Enterobacteriaceae. Mechanisms of resistance are elu-cidated, focusing on carbapenemase production and other related factors. Current treatment options are assessed, with an emphasis on newer antibiotic combinations such as ceftazidime/avibactam, meropenem/vaborbactam, ceftolozane/tazobactam, and cefepime/en-metazobactam. The review also highlights emerging therapeutic approaches, including novel antibiotics and non-traditional approaches like phage therapy, fecal microbiota transplanta-tion, probiotics, antimicrobial peptides, vaccines, and herbal drugs. Additionally, the review also reflects on effective infection prevention and control strategies. While research efforts to explore newer combinations and alternate approaches to treat carbapenem-resistant Entero-bacteriaceae infections are crucial, the importance of stringent infection prevention and con-trol strategies cannot be overstated. This dual focus is essential to address both the immediate and long-term challenges posed by carbapenem-resistant Enterobacteriaceae

Combating infections under siege: Healthcare challenges amidst the military assault in Gaza

AbstractThe ongoing Israeli military assault on Gaza has caused a devastating collapse of healthcare infrastructure, resulting in an unprecedented surge in infectious diseases. The destruction of sanitation systems, restrictions on medical supplies, and displacement of civilians have created an environment conducive to the rapid spread of waterborne, vector‐borne, and antibiotic‐resistant infections. This paper draws from the insights of local Palestinian healthcare workers and recent medical missions conducted by FAJR Scientific, the Palestine American Medical Association, and Doctors Without Borders, examining infection control efforts under extreme constraints. The missions encountered major challenges, such as the absence of sterile equipment, inadequate access to clean water, and disrupted healthcare services. These conditions have exacerbated the spread of diseases such as hepatitis, meningitis, and polio, with severe impacts on Gaza's pediatric population. Efforts to implement infection control measures, such as telemedicine consultations, wound care protocols, and antibiotic stewardship, were heavily impeded by the ongoing blockade. The paper underscores the critical importance of lifting the siege to allow humanitarian access and to address the root causes of the infectious disease crisis in Gaza. It also highlights the resilience of Palestinian healthcare workers who continue to provide care under these dire circumstances. The recommendations outlined aim to support future medical teams working in conflict zones by providing practical strategies for infection prevention and control amidst such sustained violence. These efforts are contingent on international intervention and an end to the systematic blockade that has weaponized healthcare access.

Vancomycin-Resistant Enterococci: Current Understandings of Resistance in Relation to Transmission and Preventive Strategies.

Due to the limited treatment options and increased mortality rates, infection prevention and control strategies have been implemented for many years to mitigate dissemination of vancomycin-resistant enterococci (VRE) within healthcare settings. The overview provides an insight into the most recent research, particularly the pathogen's resilience in the healthcare environment, and the critical need for infection control strategies, which are currently being scrutinized by some researchers. The notable resilience of enterococci to various environmental conditions highlights the necessity for investigations into innovative technologies capable of effectively targeting the biofilm produced by enterococci on hospital surfaces. A critical approach to traditional infection control strategies is becoming more accepted worldwide, taking into account the epidemiological situation in the given healthcare setting as well as specific characteristics of a patient. For certain high-risk patient populations, traditional infection control strategies including CP and screening should not be omitted. Additionally, further investigation into the resistance mechanisms of available antimicrobial agents is essential, as is research into their potential association with specific successful clones through WGS genotyping, to pre-emptively mitigate their spread before it escalates.

The Role of Interdisciplinary Collaboration in Combating Infection in Health Facilities: A Systematic Review

Infection control in health facilities is critical for patient safety, with interdisciplinary collaboration emerging as a significant factor in reducing infection rates. This systematic review examines the role of collaborative efforts among healthcare professionals, including doctors, nurses, pharmacists, and laboratory technicians, in combating infections within healthcare settings. Utilizing databases such as PubMed, Scopus, and Cochrane Library, 32 studies published between 2014 and 2024 were analyzed, focusing on collaboration models, infection control outcomes, and the barriers and facilitators of teamwork. The findings reveal that interdisciplinary collaboration enhances adherence to infection control protocols, fosters clear communication, and improves overall compliance with hygiene practices. Key benefits include reduced healthcare-associated infections, faster response to infection outbreaks, and improved patient outcomes. However, challenges such as communication gaps, unclear role definitions, and limited resources hinder effective collaboration. The review suggests that structured interdisciplinary practices, supported by training, leadership engagement, and integrated technology, are essential for effective infection control. These insights can guide healthcare administrators and policymakers in strengthening infection prevention strategies. Future research should focus on evaluating the long-term impact of collaboration on infection rates and examining the roles of specific professionals in infection control.

Veteran Patient Perceptions of a Universal Gloving Intervention for Healthcare-Associated Infection Prevention: A Qualitative Study

BackgroundUniversal gloving by healthcare workers (HCW) for all patient care activities (beyond isolation and standard precautions) has been proposed to reduce healthcare-associated infection transmission, but patient perceptions of this approach are unclear. We interviewed patients who experienced a universal gloving intervention by HCW within Veterans Affairs inpatient acute care units to understand their perceptions of universal gloving. MethodsWe conducted interviews with 15 across five Veterans Affairs (VA) hospitals. We used a rapid qualitative inquiry approach to analyze interview transcripts and identified patient perceptions of universal gloving regarding patient knowledge, patient experience, and HCW practice. ResultsPatients were highly supportive of healthcare workers’ use of universal gloving, noting potential benefits for infection prevention, patient and healthcare worker safety, and patient feelings of well-being and care. Patients also communicated support of universal gloving in the context of the COVID-19 pandemic. DiscussionUniversal gloving by healthcare workers may support patients’ feelings of safe and positive healthcare delivery. ConclusionsPatients’ positive perception of gloving may facilitate universal gloving as an infection prevention and control strategy.

A propensity-matched cohort study examining the impact of gentamycin-collagen sponge on the prevention of infections in patients with implantable cardioverter defibrillator undergoing revision surgery

Abstract Introduction Despite the obvious benefits, the use of implantable cardioverter defibrillators (ICDs) is associated with serious complications, including infections. In particular, device replacement or revision procedures are associated with an increased risk of infection. Aim of the study was to compare the cardiac device infection rate with and without the use of the gentamycin-collagen sponge (GCS) in patients undergoing device replacement or revision procedures of implanted ICDs. Methods This cohort study analyzed ICD patients from a prospective single-centre ICD-registry who underwent elective device replacement, system upgrade or lead revision between 2014 and 6/2023. From September 2020 onwards, a GCS was inserted into the device pocket (GCS group, n = 204). Each patient of the GCS group was matched to a control without GCS. Results The baseline characteristics and the PADIT score were well matched except for the rate of submuscular device pockets which was lower in the GCS group (Table 1). The GCS was well tolerated and there were no complications associated with the GCS. The Kaplan-Meier estimated infection rate after one year was 1.0% in the GCS group and 6.5% in the control group (p &amp;lt; 0.001, Figure 1). Time from revision to infection was 144 + 134 days in the GCS group vs. 334 + 261 days in the control group. Conclusion Adjunctive use of a GCS was associated with a lower incidence of device infections than standard-of-care infection-prevention strategies alone.Table 1Figure 1

Transmission Routes and Prevention Strategies of Multidrug-Resistant Organism Infections in Hospitals

With the spread of multidrug-resistant organisms (MDROs) in hospitals, infection control faces significant challenges. MDROs refer to microorganisms resistant to three or more antimicrobial agents, commonly including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase-producing bacteria (ESBL). These resistant organisms primarily transmit through direct contact, indirect contact, and airborne routes within hospitals. Effective prevention and control of these infections require a comprehensive approach, including strict hand hygiene and personal protection, implementation of infection control standards, environmental cleaning and disinfection, management of medical device sterilization, and rational use of antimicrobial agents along with resistance monitoring. This paper summarizes the transmission routes and prevention strategies for MDRO infections, providing references for hospital management and clinical practice. Future research should focus on optimizing prevention measures and resistance monitoring to address the changing patterns of resistant organisms and enhance infection control effectiveness.

Occurrence and characterization of ESKAPE organisms on the hands of veterinary students before patient contact at a veterinary academic hospital, South Africa

ObjectiveThis study aimed to investigate the presence of ESKAPE organisms on the hands of students working in the intensive care unit (ICU) at a veterinary academic hospital.MethodsA cross-sectional study was conducted among students working in an ICU at a veterinary academic hospital in South Africa. Students were sampled before the start of the ICU shift using a modified glove-juice method. Standard microbiological techniques and a series of polymerase chain reaction (PCR) assays were used to identify and characterize the bacteria. All the isolates were tested for resistance against a specific panel of antibiotics using the disk diffusion method. Proportions of bacterial species and their antimicrobial-susceptibility profiles were calculated.ResultsAt screening, all the veterinary students (n = 62) carried at least one of the ESKAPE organisms on their hands. Escherichia coli was the most isolated organism (76%, 47/62), followed by P. aeruginosa (48%, 30/62), A. baumannii (47%, 29/62), E. faecium (35%, 22/62), K. pneumoniae (27%, 17/62), and S. aureus (24%, 15/62). A reduced proportion of isolates were recovered from the samples, E. coli (26%, 12/47), E. faecium (23%, 5/22), P. aeruginosa (43%, 13/30), A. baumannii (24%,7/29), K. pneumoniae (41%, 7/17), and S. aureus (20%, 3/15). Most of the organisms showed a high proportion of resistance to at least one antibiotic. Multidrug resistance was reported among just over half (56%, 5/9) of E. coli, 40% (2/5) of E. faecium, 100% (13/13) of P. aeruginosa, and 33% (1/3) of S. aureus isolates.ConclusionStudents working in the ICU carry several organisms belonging to the ESKAPE group of organisms before contact with patients. Moreover, MDR resistance was common among this group of organisms. The findings of the present study underscore the importance of infection prevention and control (IPC) strategies to help reduce the likelihood of the spread of these organisms to personnel, owners, family members, and patients.