Special Issue "Healthcare-Associated Infections"

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: closed (1 August 2021) | Viewed by 8477

Special Issue Editors

Prof. Elisabetta Caselli
E-Mail Website
Guest Editor
Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
Interests: medical microbiology; human, animal, and built-environments microbiome; healthcare-associated infections; antimicrobial resistance; infection prevention and control
Special Issues, Collections and Topics in MDPI journals
Dr. Luca Arnoldo
E-Mail Website
Guest Editor
Azienda Sanitaria Universitaria Integrata di Udine; University of Udine, Udine
Interests: infection prevention and control; healthcare-associated infections; antimicrobial resistance; patient safety; HAIs surveillance

Special Issue Information

Dear Colleagues,

Healthcare-associated infections (HAIs) are a growing global health concern. According to WHO definition, HAIs (also referred to as nosocomial or hospital infections) are infections occurring in a patient during the process of care in a hospital or other healthcare facility that were not present or incubating at the time of admission.

Up to 15% of all hospitalized patients in acute care settings acquire one or more HAIs as a direct consequence of hospitalization in the western world, and the rate is even higher in low-income countries and, in particular, wards, including pediatric and intensive care units.

Over 3 million patients in the EU and 2 million patients in the USA are estimated to acquire a HAI each year. Approximately 37,000 patients die every year in EU and 90,000 in the USA as a direct consequence of HAI, ranking HAIs as the fifth leading cause of death in US hospitals.

The substantial impairment of patient outcome and the financial burden of HAIs is staggering.

The overall direct costs associated with HAI management are over 1 billion Euro in Europe and up to 45 billion US$. However, most HAIs are thought to be preventable, and their prevention and control depend on multiple factors, including the adoption of standard and transmission-based precautions, appropriate environmental hygiene, pertinent diagnostics, and prudent antibiotic use. Concern about HAIs is in accompanied and worsened by concern about anti-microbial resistance (AMR), as most HAI-associated pathogens are drug-resistant and cause infections that are difficult to treat. Particularly in the hospital environment, due to the selective pressure exerted by the widespread use of antibiotics, in recent decades HAI-associated pathogens have been observed to be increasingly resistant to drugs; thus, HAIs tend to exhibit higher resistance rates to antibiotics compared with community-acquired infections, further threatening the outcome of infections in hospitalized patients. Consequently, AMR in HAIs is a recognized threat to global public health. However, although HAIs represent the most frequent adverse event in health care, their true global burden is still unclear, due to the difficulty in obtaining reliable data and the lack of uniformity of diagnostic criteria.

Studies in the past years have described HAI epidemiology and prevalence, trying to define the risk factors as well as the factor bundle associated with the prevention and control of HAIs. However, further effort is needed to increase our knowledge of HAI transmission routes and HAI-associated agents evolution and circulation between different healthcare facilities, as well as in identifying local determinants of the HAI burden; implementing hygiene precautions, staff education, and accountability; and conducting research to validate surveillance.

For this Special Issue of Pathogens, we invite you to submit research articles, review articles, short notes, as well as communications related to all aspects concerning HAI research and management. We look forward to your contribution.

Prof. Elisabetta Caselli
Dr. Luca Arnoldo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. Pathogens is an international peer-reviewed open access monthly 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 2200 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

  • healthcare-associated infections
  • epidemiology
  • diagnostics
  • antimicrobial resistance
  • HAI-associated pathogens
  • antimicrobial therapy
  • pathogenicity factors
  • risk assessment
  • infection prevention and control strategies

Published Papers (5 papers)

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Research

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Article
Microbial Contamination in Hospital Environment Has the Potential to Colonize Preterm Newborns’ Nasal Cavities
Pathogens 2021, 10(5), 615; https://doi.org/10.3390/pathogens10050615 - 17 May 2021
Cited by 4 | Viewed by 1163
Abstract
Infants born before 28 weeks are at risk of contracting healthcare-associated infections (HAIs), which could be caused by pathogens residing on contaminated hospital surfaces. In this longitudinal study, we characterized by NGS the bacterial composition of nasal swabs of preterm newborns, at the [...] Read more.
Infants born before 28 weeks are at risk of contracting healthcare-associated infections (HAIs), which could be caused by pathogens residing on contaminated hospital surfaces. In this longitudinal study, we characterized by NGS the bacterial composition of nasal swabs of preterm newborns, at the time of birth and after admission to the Neonatal Intensive Care Unit (NICU), comparing it with that of the environmental wards at the time of delivery and during the hospitalization. We characterized the resistome on the samples too. The results showed that environmental microorganisms responsible for HAIs, in particular Staphylococcus spp., Streptococcus spp., Escherichia-Shigella spp., and K. pneumoniae, were detected in higher percentages in the noses of the babies after 13 days of hospitalization, in terms of the number of colonized patients, microorganism amount, and relative abundance. The analysis of nasal bacteria resistome evidenced the absence of resistance genes at the time of birth, some of which appeared and increased after the admission in the NICU. These data suggest that hospital surface microbiota might be transported to respiratory mucosae or other profound tissues. Our study highlights the importance of a screening that allows characterizing the microbial profile of the environment to assess the risk of colonization of the newborn. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections)
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Article
A Probiotic-Based Sanitation System for the Reduction of Healthcare Associated Infections and Antimicrobial Resistances: A Budget Impact Analysis
Pathogens 2020, 9(6), 502; https://doi.org/10.3390/pathogens9060502 - 23 Jun 2020
Cited by 4 | Viewed by 2689
Abstract
Healthcare associated infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) has been shown to decrease hospital surface pathogens up to 90% vs. conventional [...] Read more.
Healthcare associated infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) has been shown to decrease hospital surface pathogens up to 90% vs. conventional chemical cleaning (CCC). This study compares PCHS to CCC as to reduction of HAIs and their severity, related antibiotic resistances, and costs. Incidence rates of HAIs/antibiotic resistances were estimated from a previously conducted multicenter pre-post (6 months CCC + 6 months PCHS) intervention study, after applying the propensity score matching technique. A budget impact analysis compared the current scenario of use of CCC with future scenarios considering increasing utilization of PCHS, from 5% to 50% in the next five years, from a hospital perspective in Italy. The cumulative incidence of HAI was 4.6% and 2.4% (p < 0.0001) for CCC (N = 4160) and PCHS (N = 4160) (OR = 0.47, CI 95% 0.37–0.60), with severe HAIs of 1.57% vs. 1% and antibiotic resistances of 1.13% vs. 0.53%, respectively. Increased use of PCHS over CCC in Italian internal medicine/geriatrics and neurology departments in the next 5 years is expected to avert at least about 31,000 HAIs and 8500 antibiotic resistances, and save at least 14 million euros, of which 11.6 for the treatment of resistant HAIs. Innovative, environmentally sustainable sanitation systems, like PCHS, might substantially reduce antibiotic resistance and increase protection of health worldwide. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections)
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Article
Efflux MexAB-Mediated Resistance in P. aeruginosa Isolated from Patients with Healthcare Associated Infections
Pathogens 2020, 9(6), 471; https://doi.org/10.3390/pathogens9060471 - 15 Jun 2020
Cited by 6 | Viewed by 1482
Abstract
Today, one of the most important challenges for physicians is the adequate treatment of infections due to multidrug resistant organism (MDR). Pseudomonas aeruginosa is considered an opportunistic organism causing different types of healthcare associated infections (HAIs). We aimed to investigate the MDR and [...] Read more.
Today, one of the most important challenges for physicians is the adequate treatment of infections due to multidrug resistant organism (MDR). Pseudomonas aeruginosa is considered an opportunistic organism causing different types of healthcare associated infections (HAIs). We aimed to investigate the MDR and pandrug resistance (PDR) rate in P. aeruginosa in our region and detect efflux-pump mexAB genes and the proposed binding interactions of five different categories of antimicrobial agents with the mexB pump. A total of 180 non-duplicated P. aeruginosa strains were isolated from patients with HAIs in the Suez Canal University Hospital. Phenotypically, minimum inhibitory concentration (MIC) was done for all MDR and PDR strains before and after addition of efflux pump inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP). Molecular detection of mexA and mexB genes was done by using polymerase chain reaction (PCR). Most of the isolated strains (126 strains) were MDR (70%); only 10 samples (5.5%) were PDR. MexA and mexB genes were detected in 88.2% (120 strains) and 70.5% (96 strains) of stains, respectively. All PDR strains (10 stains) carried both mexA and mexB genes. Efflux mexAB genes were detected in all MDR and PDR strains (136 strains). Molecular modeling studies were performed to investigate the modes of intermolecular binding interactions between the antimicrobial agents and mexB key amino acids that resulted in MDR and PDR. The current study reported high prevalence of MDR and PDR P. aeruginosa in patients with HAIs in the Suez Canal University Hospitals. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections)
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Review

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Review
Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis
Pathogens 2021, 10(9), 1149; https://doi.org/10.3390/pathogens10091149 - 07 Sep 2021
Cited by 1 | Viewed by 1039
Abstract
Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), [...] Read more.
Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections)
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Review
Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review
Pathogens 2020, 9(8), 651; https://doi.org/10.3390/pathogens9080651 - 13 Aug 2020
Cited by 10 | Viewed by 1412
Abstract
Several studies have revealed that dental unit waterlines (DUWLs) are often contaminated by large numbers of various micro-organisms (bacteria, fungi, protozoa, viruses). Microbial contamination in DUWLs may originate from the mains water piped into the dental unit, the suck-back of patients’ saliva into [...] Read more.
Several studies have revealed that dental unit waterlines (DUWLs) are often contaminated by large numbers of various micro-organisms (bacteria, fungi, protozoa, viruses). Microbial contamination in DUWLs may originate from the mains water piped into the dental unit, the suck-back of patients’ saliva into the line due to the lack of adequate valves, and contamination from bottled water systems. Some of the main determinants of microbial contamination in DUWLs are: a very small lumen size (0.5–2 mm) of the tubing used, high surface-to-volume ratio (6:1), low throughput and the materials of which the tubing is made, water stagnation outside of working hours. The environmental conditions present inside the conduits of the dental unit may facilitate the proliferation of micro-organisms and the consequent formation of biofilm on the interior surface of the pipes of DUWLs. During the use of handpieces, particularly high-speed rotating instruments, a spray is thrown up in the form of aerosols or spatters containing biological material (saliva, blood and dental plaque) and micro-organisms. This means that the health of both dental staff and patients could be at risk of infection. The risk of cross-infections in dental settings can be tackled by implementing combined interventions to prevent the contamination of DUWLs. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections)
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