Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Environmental Factors and Global Health".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 29134

Special Issue Editors


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Guest Editor
Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
Interests: public health; environmental health; healthcare-associated infections; indoor air quality; infectious diseases; nosocomial infections
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Special Issue Information

Dear Colleagues,

We are organizing a Special Issue entitled “Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination” in Healthcare, which is an interdisciplinary, peer-reviewed, open access journal in the area of health care systems, industry, technology, policy, and regulation, published monthly online by MDPI. More information about the journal can be found at https://www.mdpi.com/journal/healthcare.

According to the World Health Organization (WHO), nosocomial infections are the most frequent adverse event in healthcare delivery worldwide. In particular, hundreds of millions of patients are affected by healthcare-associated infections (HAIs) worldwide each year, leading to significant mortality and financial losses for health systems.
Among the main solutions to contrast nosocomial infection, beyond implementing standard precautions (e.g., best hand hygiene practices), improving staff education and accountability, correctly applying basic precautions during invasive procedures, environmental monitoring, and the appropriate use of antimicrobials play an important role. In this regard, on one hand, environmental monitoring is a useful tool for assessing the effectiveness and efficiency of the measures adopted to control the risk of infection; on the other, antimicrobial resistance (AMR) is considered one of the top 10 global public health threats facing humanity, which is strongly related to drug misuse and overuse both in nosocomial and community environments.

We welcome the submission of reviews, original research articles, short communications, editorial letters, systematic reviews, case studies, and other kinds of articles targeting any of these core research questions and beyond.

Dr. Marco Dettori
Dr. Maria Dolores Masia
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nosocomial infections
  • healthcare-associated infections
  • antimicrobial resistance
  • environmental microbial contamination
  • indoor air quality
  • air monitoring
  • surface monitoring
  • surgical site infections
  • hand hygiene

Published Papers (11 papers)

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Editorial

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3 pages, 198 KiB  
Editorial
Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination
by Maria Dolores Masia and Marco Dettori
Healthcare 2022, 10(2), 242; https://doi.org/10.3390/healthcare10020242 - 27 Jan 2022
Cited by 5 | Viewed by 1869
Abstract
In the context of clinical risks, infectious risk, i [...] Full article

Research

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17 pages, 4454 KiB  
Article
Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach
by Zhi-Yuan Shi, Pei-Hsuan Huang, Ying-Chun Chen, Hui-Mei Huang, Yuh-Feng Chen, I-Chen Chen, Yi-Jing Sheen, Ching-Hui Shen, Jau-Shin Hon and Chin-Yin Huang
Healthcare 2022, 10(11), 2291; https://doi.org/10.3390/healthcare10112291 - 15 Nov 2022
Cited by 2 | Viewed by 3300
Abstract
Background: SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to [...] Read more.
Background: SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety. Full article
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14 pages, 338 KiB  
Article
Microbiology and Clinical Outcome of Hospital-Acquired Respiratory Infections in an Italian Teaching Hospital: A Retrospective Study
by Massimo Maurici, Gian Loreto D’Alò, Carla Fontana, Viviana Santoro, Roberta Gaziano, Marco Ciotti, Domenico Cicciarella Modica, Patrizia De Filippis, Loredana Sarmati, Gerardo De Carolis and Francesca Pica
Healthcare 2022, 10(11), 2271; https://doi.org/10.3390/healthcare10112271 - 12 Nov 2022
Cited by 3 | Viewed by 1392
Abstract
The burden, microbial etiology and clinical impact of hospital-acquired respiratory infections (HARIs) were determined at an Italian teaching hospital over a 12-month period. For this purpose, overall ordinary hospitalizations ≥ 2 days of subjects over 18 years old with discharge from 1 January [...] Read more.
The burden, microbial etiology and clinical impact of hospital-acquired respiratory infections (HARIs) were determined at an Italian teaching hospital over a 12-month period. For this purpose, overall ordinary hospitalizations ≥ 2 days of subjects over 18 years old with discharge from 1 January 2018 to 31 December 2018 were examined by cross-referencing demographic and clinical data from hospital discharge forms with microbiological data from the computer system of the Microbiology Unit. We identified 329 individuals with HARIs (96 females and 233 males; median age 70 years, range 18–93), who represented ¼ of the total hospital-acquired infections (HAIs) in the period. The inpatient setting was medical and surgical in similar proportions (169 vs. 160, respectively) and the mean hospital stay was 38.9 ± 33.6 days. One hundred and forty patients (42.6% of the total sample) were suffering from one or more chronic diseases. A total of 581 microorganisms (82 antibiotic-resistant and 499 non-resistant) were detected in HARI patients. The most common isolated species were Staphylococcus aureus (16.7%), Klebsiella pneumoniae (13.3%), Pseudomonas spp. (12.6%) and Acinetobacter baumannii (10.5%), followed by Enterobacter spp. (5.3%), Escherichia coli (5.2%) and Enterococcus spp. (4.8%). One hundred and sixty-seven individuals (49.0% of the total) had polymicrobial infections. One hundred thirty-one patients (39.8% of the total) underwent endotracheal intubation and mechanical ventilation and 62.6% of them died, compared to 17.7% of the non-intubated patients. Multivariable analysis confirmed a positive correlation between death and increased age (p = 0.05), surgical MDC (p = 0.007), number of microorganisms over the sample mean (p = 0.001), the presence of chronic diseases (p = 0.046), and intubation and mechanical ventilation (p < 0.0001). A positive correlation between intubation and antibiotic-resistant organisms (p = 0.003) was also found. HARIs are still a major public health problem and require constant surveillance due to their severe clinical outcome. Full article
14 pages, 565 KiB  
Article
Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach
by Diane Ashiru-Oredope, Frances Garraghan, Omotayo Olaoye, Eva M. Krockow, Ayodeji Matuluko, Winnie Nambatya, Peter Ahabwe Babigumira, Chloe Tuck, George Amofah, Daniel Ankrah, Scott Barrett, Peter Benedict, Kwame Peprah Boaitey, Kwame Ohene Buabeng, Sarah Cavanagh, Esmita Charani, Enock Chikatula, Sam Ghebrehewet, Jasmin Islam, Yogini H. Jani, Esther Johnston, Mohammed Lamorde, Augustine Malinga, Mariyam Mirfenderesky, Victoria Rutter, Jacqueline Sneddon and Richard Skone-Jamesadd Show full author list remove Hide full author list
Healthcare 2022, 10(9), 1706; https://doi.org/10.3390/healthcare10091706 - 6 Sep 2022
Cited by 7 | Viewed by 2677
Abstract
Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project [...] Read more.
Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project used co-creation and Delphi consensus procedures to adapt and extend the existing published international AMS checklist. The overall objective was to arrive at a contextualised checklist of core AMS elements and key behaviours for use within healthcare settings in Sub-Saharan Africa, as well as to implement the checklist in health institutions in four African countries. The AMS checklist tool was developed using a modified Delphi approach to achieve local expert consensus on the items to be included on the checklist. Fourteen healthcare/public health professionals from Tanzania, Zambia, Uganda, Ghana and the UK were invited to review, score and comment on items from a published global AMS checklist. Following their feedback, 8 items were rephrased, and 25 new items were added to the checklist. The final AMS checklist tool was deployed across 19 healthcare sites and used to assess AMS programmes before and after an AMS intervention in 14 of the 19 sites. The final tool comprised 54 items. Across the 14 sites, the completed checklists consistently showed improvements for all the AMS components following the intervention. The greatest improvements observed were the presence of formal multidisciplinary AMS structures (79%) and the execution of a point-prevalence survey (72%). The elements with the least improvement were access to laboratory/imaging services (7%) and the presence of adequate financial support for AMS (14%). In addition to capturing the quantitative and qualitative changes associated with the AMS intervention, project evaluation suggested that administering the AMS checklist made unique contributions to ongoing AMS activities. Furthermore, 29 additional AMS activities were reported as a direct result of the prompting checklist questions. Contextualised, co-created AMS tools are necessary for managing antimicrobial use across healthcare settings and increasing local AMS ownership and commitment. This study led to the development of a new AMS checklist, which proved successful in capturing AMS improvements in Tanzania, Zambia, Uganda, and Ghana. The tool also made unique contributions to furthering local AMS efforts. This study extends the existing AMS materials for low- and middle-income countries and provides empirical evidence for successful use in practice. Full article
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10 pages, 250 KiB  
Article
Impact of the COVID-19 Pandemic on the Prevalence of HAIs and the Use of Antibiotics in an Italian University Hospital
by Giovanna Deiana, Antonella Arghittu, Davide Gentili, Marco Dettori, Alessandra Palmieri, Maria Dolores Masia, Antonio Azara and Paolo Castiglia
Healthcare 2022, 10(9), 1597; https://doi.org/10.3390/healthcare10091597 - 23 Aug 2022
Cited by 5 | Viewed by 1541
Abstract
The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University [...] Read more.
The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University Hospital and to investigate whether the intensification of hospital infection control measures during the COVID-19 pandemic has affected the prevalence of bacterial HAIs. A point prevalence survey was conducted according to the simplified ECDC protocol. The survey identified a local HAI prevalence of 9.0%, revealing an increase compared to pre-pandemic values (7.3%). The survey also identified an antimicrobial exposure of 40.8%, revealing a decrease in their use compared to the study carried out in the pre-pandemic era (44.6%). Among the organizational challenges experienced during the COVID-19 pandemic, despite the greater attention paid to infection prevention measures aimed at reducing SARS-CoV-2, many healthcare facilities had to contend with the controlled availability of personnel, physical space limitations and a large number of patients. Active surveillance in hospital wards and the consequent reporting by personnel specialized in infection control is fundamental for hospitals to recognize gaps in prevention and report any observed increases in HAIs. Full article
15 pages, 2598 KiB  
Article
Mixed-Method Evaluation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI)
by Catherine V. Hayes, Donna M. Lecky, Fionna Pursey, Amy Thomas, Diane Ashiru-Oredope, Ayoub Saei, Tracey Thornley, Philip Howard, Aimi Dickinson, Clare Ingram, Rosalie Allison and Cliodna A. M. McNulty
Healthcare 2022, 10(7), 1288; https://doi.org/10.3390/healthcare10071288 - 12 Jul 2022
Cited by 2 | Viewed by 2204
Abstract
The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs’ self-reported antimicrobial stewardship (AMS) behaviours. Data [...] Read more.
The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs’ self-reported antimicrobial stewardship (AMS) behaviours. Data collection included staff pre- and post-intervention questionnaires, qualitative interviews, and TARGET Antibiotic Checklists. Quantitative data were analysed by a multivariate ordinal linear mixed effect model; qualitative data were analysed thematically. A total of 101 staff participated from 66 pharmacies, and six completed semi-structured interviews. The statistical model indicated very strong evidence (p < 0.001) that post-intervention, staff increased their antibiotic appropriateness checks and patient advice, covering antibiotic adherence, antibiotic resistance, infection self-care, and safety-netting. Staff reported feeling empowered to query antibiotic appropriateness with prescribing clinicians. The TARGET Antibiotic Checklist was completed with 2043 patients. Topics patients identified as requiring advice from the pharmacy team included symptom duration, alcohol and food consumption guidance, antibiotic side-effects, and returning unused antibiotics to pharmacies. Pharmacy staff acknowledged the need for improved communication across the primary care pathway to optimise antimicrobial use, and PAMSI has potential to support this ambition if implemented nationally. To support patients not attending a pharmacy in person, an online information tool will be developed. Full article
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10 pages, 562 KiB  
Article
Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors
by Antonella Arghittu, Marco Dettori, Grazia Maria Deriu, Serena Soddu, Pietro Carmelo Manca, Anna Angela Carboni, Irene Collu, Alessandra Palmieri, Giovanna Deiana, Antonio Azara, Paolo Castiglia and Maria Dolores Masia
Healthcare 2022, 10(5), 845; https://doi.org/10.3390/healthcare10050845 - 5 May 2022
Cited by 4 | Viewed by 1859
Abstract
Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor’s skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal [...] Read more.
Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor’s skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor’s arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor’s venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety. Full article
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10 pages, 215 KiB  
Article
Hand Hygiene Knowledge and Perception among the Healthcare Workers during the COVID-19 Pandemic in Qassim, Saudi Arabia: A Cross-Sectional Survey
by Adil Abalkhail, Ilias Mahmud, Fahad A. Alhumaydhi, Thamer Alslamah, Ameen S. S. Alwashmi, Divya Vinnakota and Russell Kabir
Healthcare 2021, 9(12), 1627; https://doi.org/10.3390/healthcare9121627 - 24 Nov 2021
Cited by 10 | Viewed by 3461
Abstract
Hand hygiene is among the most important factors of infection control in healthcare settings. Healthcare workers are the primary source of hospital-acquired infection. We assessed the current state of hand hygiene knowledge, perception, and practice among the healthcare workers in Qassim, Saudi Arabia. [...] Read more.
Hand hygiene is among the most important factors of infection control in healthcare settings. Healthcare workers are the primary source of hospital-acquired infection. We assessed the current state of hand hygiene knowledge, perception, and practice among the healthcare workers in Qassim, Saudi Arabia. In this cross-sectional study, we used the hand hygiene knowledge and perception questionnaire developed by the World Health Organization. Knowledge and perceptions were classified into good (80–100%), moderate (60–79%), and poor (<60% score). The majority of the healthcare workers had moderate knowledge (57.8%) and perception (73.4%) of hand hygiene. Males were less likely to have moderate/good knowledge compared to females (OR: 0.52, p < 0.05). Private healthcare workers were less likely (OR: 0.33, p < 0.01) to have moderate/good perceptions compared to the government healthcare workers. Healthcare workers who received training on hand hygiene were more likely to have good/moderate perception (OR: 3.2, p < 0.05) and to routinely use alcohol-based hand rubs (OR: 3.8, p < 0.05) than the ones without such training. Physicians are more likely (OR: 4.9, p < 0.05) to routinely use alcohol-based hand rubs than technicians. Our research highlighted gaps in hand hygiene knowledge, perception and practice among healthcare workers in Qassim, Saudi Arabia and the importance of training in this regard. Full article

Review

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16 pages, 441 KiB  
Review
Medication Errors in Intensive Care Units: An Umbrella Review of Control Measures
by Sara Dionisi, Noemi Giannetta, Gloria Liquori, Aurora De Leo, Victoria D’Inzeo, Giovanni Battista Orsi, Marco Di Muzio, Christian Napoli and Emanuele Di Simone
Healthcare 2022, 10(7), 1221; https://doi.org/10.3390/healthcare10071221 - 29 Jun 2022
Cited by 9 | Viewed by 4706
Abstract
Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent [...] Read more.
Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors. Full article
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18 pages, 295 KiB  
Review
Is Piperacillin-Tazobactam an Appropriate Empirical Agent for Hospital-Acquired Sepsis and Community-Acquired Septic Shock of Unknown Origin in Australia?
by Alice Gage-Brown, Catherine George, Jenna Maleki, Kasha P. Singh and Stephen Muhi
Healthcare 2022, 10(5), 851; https://doi.org/10.3390/healthcare10050851 - 5 May 2022
Cited by 4 | Viewed by 2706
Abstract
Early appropriate empirical antibiotics are critical for reducing mortality in sepsis. For hospital-acquired sepsis of unknown origin in Australia, piperacillin-tazobactam (TZP) is recommended as an empirical therapy. Anecdotally, some institutions also use TZP for community-acquired septic shock. This narrative review aimed to scrutinise [...] Read more.
Early appropriate empirical antibiotics are critical for reducing mortality in sepsis. For hospital-acquired sepsis of unknown origin in Australia, piperacillin-tazobactam (TZP) is recommended as an empirical therapy. Anecdotally, some institutions also use TZP for community-acquired septic shock. This narrative review aimed to scrutinise the appropriateness of TZP as an empirical agent for undifferentiated hospital-acquired sepsis and community-acquired septic shock. An online database (Medline) was searched for relevant studies in adults published in the last 10 years. Studies were included if they addressed separately reported clinical outcomes related to a relevant aspect of TZP therapy in sepsis. Of 290 search results, no studies directly addressed the study aim. This review therefore explores several themes that emerged from the contemporary literature, all of which must be considered to fully interrogate the appropriateness of TZP use in this context. This review reveals the paucity and low quality of evidence available for TZP use in sepsis of unclear origin, while demonstrating the urgent need and equipoise for an Australian audit of TZP use in patients with sepsis of unknown origin. Full article

Other

5 pages, 236 KiB  
Case Report
Transfusion-Transmitted Malaria of Plasmodium malariae in Palermo, Sicily
by Jessica Pulvirenti, Maurizio Musso, Teresa Fasciana, Antonio Cascio, Maria Rita Tricoli, Natascia Oliveri, Maria Favarò, Orazia Diquattro and Anna Giammanco
Healthcare 2021, 9(11), 1558; https://doi.org/10.3390/healthcare9111558 - 16 Nov 2021
Cited by 3 | Viewed by 2318
Abstract
Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. In non-endemic areas, the incidence of transmission of malaria by transfusion is very low. We report a clinical case of transfusion-transmitted malaria due to Plasmodium malariae, which happened in [...] Read more.
Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. In non-endemic areas, the incidence of transmission of malaria by transfusion is very low. We report a clinical case of transfusion-transmitted malaria due to Plasmodium malariae, which happened in a patient with acute hemorrhagic gastropathy. Case presentation: In April 2019, a 70-year-old Italian man with recurrent spiking fever for four days was diagnosed with a P. malariae infection, as confirmed using microscopy and real-time PCR. The patient had never been abroad, but about two months before, he had received a red blood cell transfusion for anemia. Regarding the donor, we revealed that they were a missionary priest who often went to tropical regions. Plasmodium spp. PCR was also used on donor blood to confirm the causal link. Discussion and Conclusions: The donations of asymptomatic blood donors who are predominantly “semi-immune” with very low parasitic loads are an issue. The main problem is related to transfusion-transmitted malaria. Our case suggests that P. malariae infections in semi-immune asymptomatic donors are a threat to transfusion safety. Currently, microscopy is considered the gold standard for the diagnosis of malaria but has limited sensitivity to detect low levels of parasitemia. Screening using serological tests and molecular tests, combined with the donor’s questionnaire, should be used to reduce the cases of TTM. Full article
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