Search Results (205)

Background/Objectives: Infection prevention and control (IPC) programs combine pathogen-targeted measures (e.g., admission screening) with hospital-wide standard precautions (e.g., hand hygiene, HH). We assessed temporal associations between screening, HH, antimicrobial stewardship (AMS), and hospital-level outcomes in a tertiary paediatric hospital. Methods: This study was a retrospective hospital-wide ecological time-series at the Children’s Memorial Health Institute. Annual aggregate data: 2011–2024 for screening, colonisation, and healthcare-associated infections (HAIs) with alert pathogens; 2016–2024 for antibiotic consumption (ATC J01, systemic antibacterials). Process indicators: number of screening tests and alcohol-based hand rub (ABHR) consumption per 1000 patient-days (PD). Outcomes: colonisations/HAIs per 1000 PD and defined daily doses (DDD) per 1000 PD overall and by class. Trends used linear regression and Spearman’s rank correlation. Results: Screening intensity increased from 39 to 150/1000 PD (slope +8.3/year; R² = 0.90; p < 0.001). Detected colonisation rose (2.5 → peak 8.05/1000 PD in 2023; slope +0.39; R² = 0.81; p < 0.001), while multidrug-resistant-organism (MDRO)-attributable HAIs remained low/stable (0.27–0.62/1000 PD; slope −0.014; p = 0.023). ABHR consumption increased from 26.1 to 78.0 L/1000 PD in 2020 (p < 0.001) and partially normalised to 60.0 in 2024 (>2 × baseline). Overall ATC J01 showed no long-term linear trend (~278–356 DDD/1000 PD; +2.57/year; p = 0.46), but class mix shifted: carbapenems, fluoroquinolones, and amoxicillin–clavulanate decreased; third/fourth-generation cephalosporins, piperacillin/tazobactam, and glycopeptides increased. Conclusions: In this tertiary paediatric setting, expansion of risk-based admission screening and sustained implementation of horizontal IPC measures were accompanied by increased detection of colonisation with alert pathogens, while MDRO-attributable HAIs remained low and stable at the hospital level. Over the same period, AMS activity coincided with a redistribution in antibiotic class use without a clear long-term reduction in total antibiotic consumption. These hospital-level findings are descriptive and hypothesis-generating; causal inference is limited by the ecological study design, and the heterogeneous, multispecialty structure of a tertiary paediatric centre. Full article

Background: Pseudomonas aeruginosa is one of the leading agents causing healthcare-associated infections (HAIs) due to its intrinsic resistance, its capacity to acquire resistance mechanisms, and its persistence in hospital environments. In Mexico, it ranks among the most frequently reported pathogens in national surveillance systems. The aim of this study was to characterize antimicrobial resistance profiles and the genetic determinants associated with MDR/XDR phenotypes in P. aeruginosa strains from HAIs at Hospital Juárez de México (HJM). Methods: Sixty-three strains from patients with HAIs were analyzed. Identification was confirmed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing followed CLSI guidelines. MDR/XDR phenotypes were classified according to the Latin American consensus for categorizing MDR, XDR, and PDR pathogens. Screening for resistance mechanisms was carried out by PCR for the main β-lactamases circulating at HJM. Finally, mutations in the oprD gene were detected in imipenem-resistant isolates through amino acid sequence alignment. Results: Resistant phenotypes allowed the identification of MDR and XDR profiles. Only the metallo-β-lactamase bla_VIM was detected. Analysis of oprD porin sequences revealed recurrent mutations (S103T, T115K, L170F, G186P, and T189V) associated with imipenem resistance. Conclusions: In P. aeruginosa, the presence of bla_VIM and structural alterations in OprD confirms the multifactorial nature of carbapenem resistance. These findings underscore the need to strengthen microbiological surveillance programs and antimicrobial stewardship strategies to mitigate the impact and spread of MDR/XDR isolates. Full article

Background/Objectives: Healthcare-associated infections (HAIs), particularly those caused by multidrug-resistant (MDR) bacteria, remain a major challenge for Romanian hospitals. This study aimed to evaluate the epidemiological burden of MDR-related HAIs and to characterize the distribution of MDR bacterial isolates and their antimicrobial resistance patterns over four consecutive semesters in a Romanian tertiary care hospital. Methods: A retrospective study was conducted using data from the Electronic Registry of HAIs, clinical observation sheets, and microbiology laboratory records. An epidemiological analysis was performed on patients diagnosed with MDR-related HAIs, while a separate microbiological analysis included all MDR bacterial isolates identified during the study period. Descriptive and comparative statistical analyses were applied to assess temporal trends, pathogen distribution, and resistance profiles. Results: Of the 327 HAIs identified, 56 cases (17.13%) were caused by MDR bacteria. Most MDR-HAIs originated from the Intensive Care Unit (≈60%), with Acinetobacter baumannii and Klebsiella spp. as the predominant pathogens. Overall mortality among patients with MDR-HAIs was high (51.79%), particularly in infections caused by A. baumannii and K. pneumoniae. Microbiological analysis of MDR isolates (n = 406) revealed consistently high resistance rates to ciprofloxacin, cefepime, and ceftazidime, exceeding 95% in 2023–2024, while resistance to carbapenems surpassed 90% by the end of the study period. Temporal variability in MDR burden was observed across semesters, suggesting an influence of clinical and institutional factors. Conclusions: MDR-related HAIs represent a significant and persistent problem in Romanian acute-care hospitals, particularly in Intensive Care Units. The dominance of carbapenem-resistant A. baumannii and extended-spectrum beta-lactamase-producing and carbapenem-resistant Klebsiella spp. highlights the urgent need for strengthened antimicrobial stewardship, enhanced microbiological surveillance, and reinforced infection prevention strategies. Full article

Background/Objectives: Healthcare-associated infections (HAIs) require specific skills in nursing education, yet their curricular integration often remains fragmented, limiting the consolidation of knowledge and safe clinical practice. This study aimed to explore the perceptions of nursing students from Brazil and Peru regarding the use of clinical simulation as a strategy to develop skills in HAIs prevention and control. Methods: A qualitative approach was employed, involving 12 focus groups (n = 297 students) across four universities. The discussions were conducted following simulation activities based on standardized scenarios structured into four phases: pre-reading, briefing, execution, and debriefing. Data were collected using a semi-structured interview guide flowed by content analysis, through which saturation was achieved. The study adhered to COREQ guidelines. Results: Three main themes emerged: (i) clinical simulation as a student-centered teaching–learning strategy, where pre-reading and briefing materials enhanced students’ confidence and clarity in performing tasks, with checklists suggested to avoid omissions; (ii) simulation as a facilitator of autonomy and safety in HAI prevention, offering a protected environment for making mistakes and learning, with formative feedback during debriefing increasing risk awareness, although debriefing time was noted as an area for improvement; and (iii) meaningful learning and integration with traditional education, as students reported increased engagement, better knowledge retention, and greater perceived transfer of skills to real clinical settings. Conclusions: Clinical simulation demonstrated strong potential to support the development of HAI prevention skills in undergraduate nursing students. Longitudinal implementation with standardized scenarios and further evaluation of educational effectiveness and debriefing strategies is recommended. Full article

Background and Objectives: Healthcare-associated infections (HAIs) significantly increase morbidity and mortality in critically ill patients, and their burden became more pronounced during the COVID-19 pandemic. However, data describing the temporal evolution of HAIs, pathogen distribution, and associated risk factors across consecutive pandemic waves remain limited. This study aimed to characterize the epidemiology, microbiology, and outcomes of HAIs in COVID-19 intensive care units (ICU) patients and to identify clinical and laboratory predictors of mortality. Materials and Methods: This retrospective observational study included adult patients with RT-PCR–confirmed COVID-19 who developed at least one HAI ≥ 48 h after ICU admission between March 2020 and December 2020, encompassing the first three pandemic waves in Türkiye, in a tertiary-care ICU. Demographic, clinical, laboratory, and microbiological data were collected. Inflammatory markers and severity scores (SAPS-II, MCCI, and NLR) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for mortality prediction. Results: Among the 1656 ICU admissions, 145 patients (8.7%) developed HAIs; after exclusions, 136 patients were included in the final analysis. Bloodstream infections were the most frequent HAI (57%), followed by urinary tract infections (31%), ventilator-associated pneumonia (9%), and surgical site infections (1%). Klebsiella pneumoniae was the predominant pathogen, followed by Candida albicans and Acinetobacter baumannii. Multidrug-resistant organisms, including MRSA and VRE, showed variable distribution across pandemic periods. Overall in-hospital mortality was 74.3%. Non-survivors had significantly higher SAPS-II, MCCI, and NLR values. ROC analysis identified NLR > 38.8 and SAPS-II > 35.5 as mortality-predictive thresholds. Dynamic inflammatory marker patterns correlated with infection timing, and early peaks of CRP, WBC, and IL-6 were associated with worse outcomes. Conclusions: HAIs imposed a substantial clinical burden on critically ill COVID-19 patients, with high mortality driven predominantly by multidrug-resistant bloodstream infections. Severity indices and inflammation-based biomarkers demonstrated strong prognostic value. Temporal shifts in pathogen ecology across pandemic waves underscore the need for adaptive infection-prevention strategies, continuous microbiological surveillance, and strengthened antimicrobial stewardship in critical care settings. Full article

Background and Objectives: Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality and can lead to serious long-term consequences, increased hospital length stay, higher rates of antibiotic resistance, and additional financial costs. The study aim was to highlight important aspects related to the level of knowledge of HAIs, risk factors for HAI and methods of preventing HAIs among nurses from urban hospitals in the North-East of Romania. Materials and Methods: We conducted a cross-sectional study on the level of knowledge of HAI problems among medical personnel (nurses). The study group consisted of 288 nurses who responded online to a questionnaire. Results: Multivariate analysis suggested that 45.5% of the value of the knowledge score of prevention and limitation of HAIs could be determined by the answers to the questions regarding the importance of the nurse role, professional experience, and training. Moreover 84.6% of the knowledge score could be determined by the answers to the questions regarding the assessment of the importance of factors related to lack of medical personnel, professional burnout, insufficient knowledge and staff training, inefficient team, poor collaboration within departments, stressful work environment, staff health status, multiple tasks at work (p = 0.038). While 50% of the knowledge score could be explained by responses regarding personal problems related to daily activity; physical and mental health status; and physical, psychological, and social components (p = 0.038). Conclusions: Our study highlighted aspects of the level of knowledge regarding HAIs among nurses, an issue that plays a key role in hospital management. Overall, the knowledge score for the prevention and limitation of HAIs was higher in nurses/females aged over 40 and in nurses with more than 15 years of experience. Full article

Background: Evidence on HAIs in Africa is fairly common. Objectives: The main objective was to identify the surveillance tools used for healthcare–associated infections (HAIs) in countries in the WHO African Region. Secondary objectives focused on the organization of surveillance, the pathogens involved, and the frequency of multidrug–resistant species. Inclusion and exclusion criteria: Observational or interventional studies on healthcare–associated infections in humans, published between January 2011 and December 2024, in French or English, were included. However, the following publications were not included: animal studies, healthcare–associated infections not related to healthcare, literature reviews, studies outside the period or geographical area, and studies in languages other than French or English. Sources of information and search date: The databases consulted were PubMed, Web of Science, EMBASE, Cochrane, African Index Medicus, Google Scholar, and AJOL. The search was conducted between January and March 2025. Risk of bias assessment: The risk of bias was assessed using a specific grid (eleven criteria), scored from one (low) to three (high). The studies were classified into three levels of methodological quality. The results of the bias assessment showed that the publications were excellent (strong and moderate) with a cumulative rate of 99.9%. Methods of synthesizing results: Data were extracted using a standardized grid and synthesized narratively. No meta–analysis was performed. Number of studies and characteristics: 95 studies were included, mostly cross–sectional studies (82.1%), cohorts (10.4%), and a few case reports. Most were from West Africa (60.0%), particularly Nigeria (16.8%) and South Africa (14.7%). Main results: • Most common pathogens: Staphylococcus aureus (53.7%), Escherichia coli (43.2%), Klebsiella pneumoniae (32.6%). • Resistance profile: ESBL (27.4%), MRSA (21.1%), multidrug resistance (13.7%). • Sources of HAIs: mainly exogenous (83.2%). • Laboratory methods: phenotypic (70.5%), genotypic or genomic rare (3.1%). • Scope of studies: local (96.8%), national (3.2%). Limitations of evidence: Risk of bias due to underreporting of HAIs, methodological heterogeneity, predominance of cross–sectional studies, low use of molecular methods, lack of modeling, and uneven geographical coverage. Overall interpretation and implications: surveillance of HAIs in Africa remains fragmented and poorly standardized. There is a need to strengthen national systems, integrate molecular methods, train professionals, and promote interventional research. The WHO GLASS program can serve as a framework for harmonizing surveillance. Full article

Background: Acinetobacter baumannii is classified within the ESKAPE-E group of pathogens, recognized for its role in causing severe infections, and is often associated with various healthcare-related infection (HAIs) types, particularly in intensive care units. This opportunistic pathogen is distinguished by its considerable antibiotic resistance and is associated with prolonged hospital stays, high medical costs, and increased mortality rates. Objective: This study investigated factors associated with HAIs caused by A. baumannii, versus other ESKAPE-E pathogens, to identify distinguishing intrinsic and extrinsic factors that guide the control and prevention of HAIs within our hospital. Methods: This study included patients from a Third-Level IMSS Hospital in Mérida, Mexico, between 2018 and 2022, with 54 cases (HAIs caused by A. baumannii) and 108 matched controls (HAIs caused by other ESKAPE-E pathogens). Results: Ventilator-associated pneumonia was the most frequent HAI in both groups, followed by catheter-related bloodstream infections. Comorbidities were more common in patients with HAIs caused by A. baumannii than in those with other ESKAPE-E pathogens. Most patients received antimicrobial treatment before HAIs development. Bivariate analysis showed that comorbidities and prior meropenem and linezolid treatment were significant risk factors, whereas multivariate analysis identified comorbidities and prior meropenem use as risk factors for A. baumannii HAIs versus other ESKAPE-E pathogens. Most A. baumannii isolates were extensively drug-resistant (90.7%), with 84% showing carbapenem resistance. Conclusions: This study highlights the importance of optimizing antimicrobial use and measures to mitigate A. baumannii HAIs. These findings have significant implications for infection control and antimicrobial stewardship in healthcare settings. Full article

Antibiotic-resistant microbes represent a growing problem for modern medicine and public health. Projections indicate that deaths from such infections could reach 10 million per year by 2050. Healthcare associated infections (HAI) are among the most significant causes of mortality and morbidity in hospitals, impacting millions of patients globally. The emergence of HAI is associated with resistance to antimicrobials, rapidly worsening the patient’s condition. Antimicrobial resistance determines unresponsiveness to treatment, which can ultimately lead to severe complications such as sepsis and shock. It is estimated that one in every ten patients are susceptible to infection during their stay in hospital, with the microorganism responsible for the infection frequently proving resistant to antibiotics. Among the latter, CRE (carbapenem-resistant Enterobacteriaceae), CRAB (carbapenem-resistant Acinetobacter baumannii), CRPA (carbapenem-resistant Pseudomonas aeruginosa), vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus (MRSA), commonly referred to as ‘superbugs’, are a major cause of HAIs. The aim of the present study is to provide a comprehensive overview of the global epidemiology of healthcare-associated infections, with particular emphasis on their incidence, distribution over time, and correlation with the socioeconomic status of different countries. Furthermore, the review aims to evaluate the effectiveness of current preventive strategies in reducing the incidence and mortality associated with HAIs. Full article

Background: Healthcare-associated infections (HAIs) are a significant public health problem, having a decisive impact on the prognosis of patients hospitalized with COVID-19. In Romania, the absence of a uniform reporting system and the lack of epidemiological data comparable to European standards limit the real assessment of their incidence and consequences. Methods: In this context, the present study aimed to conduct an integrated analysis of the clinical, epidemiological, and microbiological factors involved in the mortality of patients with COVID-19 and HAIs in a county located in southeastern Romania. This research was based on a retrospective observational study that included 295 patients with a confirmed diagnosis of COVID-19 and at least one documented HAI between January 2020 and December 2022. Data were extracted from standardized reporting forms, and statistical analyses included tests (Fisher’s exact test, Mann–Whitney U), ROC curves, Kaplan–Meier survival analysis, and Cox proportional hazard regression. Results: The analysis revealed a mortality rate of 32.5%, significantly associated with advanced age, gastrointestinal surgery, and respiratory infections. Clostridioides difficile was the predominant pathogen (84.1%), and the threshold of ≥63.5 years demonstrated predictive value for mortality. In multivariate models, age greater than 63 years and gastrointestinal surgery were confirmed as independent predictors of death. Conclusions: The findings highlight the substantial impact of HAIs on the clinical progression of COVID-19 patients, underscoring the need for comprehensive systemic interventions, including enhanced prevention and control strategies, prudent antimicrobial therapy, and standardized epidemiological monitoring. Implementing these measures is crucial to mitigating HAIs’ effects and improving patient outcomes in similar situations. Full article

Stenotrophomonas maltophilia is considered one of the emerging bacterial agents causing healthcare-associated infections (HAIs) in hospital environments. This microorganism has been identified as multidrug-resistant, capable of forming mature biofilms—an ability that promotes adherence to surfaces and invasive medical devices, favoring persistence in hospital environments and the potential to generate outbreaks. The aim of this study was to characterize S. maltophilia strains isolated from HAI cases at the Hospital Juárez de México and to determine the presence of hidden outbreaks. Antibiotic resistance profiles were determined, along with the typing of 20 genes associated with virulence factors and the assessment of the ability to form mature biofilms on inert surfaces. Finally, sequence type (ST) was obtained through multilocus sequence typing (MLST) analysis, and a phylogenetic tree was constructed to determine the clonal diversity of the isolates. All strains showed uniform resistance to β-lactam antibiotics tested while remaining sensitive to fluoroquinolones, phenicols, tetracyclines, and trimethoprim/sulfamethoxazole. Some isolates exhibited adherent activity, with the “strong biofilm-former” phenotype predominating. Sixteen virulence-related genes were heterogeneously detected, revealing broad genetic diversity. MLST analysis grouped the isolates into nine ST related to infection cases reported in others countries. Phylogenetic analyses demonstrated the presence of three potential clones distributed across Internal Medicine and the Pediatric Intensive Care Unit. These results highlight the importance of investigating S. maltophilia as an HAI-associated pathogen that remains understudied. Full article

Background: Healthcare-associated infections (HAIs), antimicrobial resistance (AMR), and antibiotic use (AU) remain critical challenges in intensive care units (ICUs). Reliable long-term surveillance is essential to inform stewardship programs and infection prevention. Methods: We conducted a seven-year ecological study (2018–2024) of adult patients admitted to the surgical ICU of a Serbian tertiary university hospital. Patients with ICU stays >48 h were included. Data on demographics, HAIs, AU expressed as ‘days of therapy’ (DOT) per 100 patient-days, and resistance profiles of key pathogens were collected. AU was classified by WHO Access, Watch and Reserve categories. Trends were analyzed, and correlations between AU and healthcare-associated Clostridioides difficile infection (HA-CDI) incidence density as well as changes in AMR rates were assessed. Direct expenditures for antibiotic therapy were also calculated. Results: Among 2055 patients, 511 (24.9%) developed at least one HAI. HA-CDI showed a marked upward trend. Overall, AU was stable, but Reserve antibiotics increased significantly (R² = 0.456), particularly linezolid, colistin, and ceftazidime–avibactam. Resistance to carbapenems and colistin in Klebsiella pneumoniae (K. pneumonia) demonstrated alarming trends. A strong correlation was observed between colistin use and colistin resistance in K. pneumoniae. Antibiotic expenditures peaked in 2023 at more than double pre-COVID levels, mainly driven by Reserve agents. Conclusions: This study reveals a concerning rise in multidrug-resistant pathogens, escalating Reserve antibiotic use, and substantial financial burden. Strengthened antimicrobial stewardship, optimization of Access, restriction of Reserve agents, and investment in infection prevention and surveillance are urgently needed. Full article

Background and Objectives: Changes in the incidence of healthcare-associated infections (HAIs) during the coronavirus disease 2019 (COVID-19) pandemic and during periods with fewer or more COVID-19 cases have been inconclusively studied. Compared with 2015, in 2019, the abundances of the microorganisms Klebsiella pneumoniae and Enterococcus faecium increased in intensive care units (ICUs) in Taiwan. The trend in the incidence of HAIs in ICUs in Taiwan during the emergence of new infectious diseases is worth studying. Materials and Methods: We surveyed the incidence densities of different types of HAIs, device-associated HAIs, pathogens, and antimicrobial resistance in a dataset from the Taiwan Healthcare-associated Infection and Antimicrobial Resistance Surveillance System from 2015 to 2022. The change in incidence density trends was evaluated via Poisson regression, and the change in proportion trends was checked via the Mantel–Haenszel chi-square test. Results: The incidence of HAIs decreased from 5.7 to 5.17 episodes per 1000 person-days from the pre-COVID-19 period to the post-COVID-19 period. The incidences of healthcare-acquired pneumonia (HAP), device-associated HAIs decreased. However, the incidences of bloodstream infections (BSIs) increased. The percentages of patients with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii infections significantly decreased. The percentage of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection decreased, but that of patients with carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus faecium infections increased. The antimicrobial consumption related to CRKP increased and MRSA decreased. Conclusions: Overall, HAIs, HAP, and VAP decreased in incidence after the COVID-19 pandemic. These results revealed decreases in MRSA infection incidence under infection control protocols with more antimicrobial use. However, the proportion of CRKP among HAIs increased with broad-spectrum antimicrobial agent use. Based on the recent incidence of HAIs in ICUs, the quality of infection control in medical units can be enhanced to decrease HAI incidence. Full article

Background/Objectives: Epidemiological surveillance of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) bacteria is a key responsibility of hospital infection control committees (HICC). Active surveillance swabs facilitate the early detection of colonized patients; helping to prevent MDR pathogen transmission in intensive care units. This study aimed to describe antimicrobial resistance profiles of bacterial isolates from clinical samples in neonatal and pediatric intensive care units. Methods: A retrospective cross-sectional study was conducted at a maternal and child hospital in Rio de Janeiro, Brazil including patients aged 0–18 years admitted to neonatal (NICU), surgical (SICU), and pediatric (PICU) intensive care units between January and December 2023. A total of 286 positive cultures were analyzed from different sample types including blood, urine, tracheal aspirates, cerebrospinal fluid (CSF), and catheter tips as well as screening swabs (nasal and rectal) for colonization surveillance. Bacterial isolates were identified and tested for antimicrobial susceptibility following BrCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines. Results: Of the 286 cultures, 146 (51%) originated from the NICU, 70 (24%) from the SICU, and 70 (24%) from the PICU. Coagulase-negative staphylococci (CoNS) predominated in blood cultures, especially among neonates, while MRSA was found in all nasal swabs. Among the Gram-negative bacteria; Klebsiella pneumoniae and Pseudomonas aeruginosa were the most frequent isolates, with 30–50% resistant to third-generation cephalosporins or carbapenems. ESBL-producing organisms were found in 40% of rectal swabs. Conclusions: The predominance of CoNS in neonatal ICUs and high resistance rates among Gram-negative bacteria highlight the urgent need for continuous microbiological surveillance and antimicrobial stewardship in vulnerable pediatric populations. Full article