Search Results (263)

Background: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally, linked to severe complications such as pelvic inflammatory disease and infertility. In the Brazilian Amazon, socioeconomic vulnerability and the absence of screening policies exacerbate risks, particularly among female sex workers (FSWs). Objective: This study aimed to determine the seroprevalence of anti-C. trachomatis IgG antibodies among FSWs in five municipalities of Pará State, Brazilian Amazon, and identify epidemiological factors associated with infection. Methods: A retrospective cross-sectional study (2005–2007) included 348 FSWs recruited via convenience sampling. Sociodemographic and behavioral data were collected through questionnaires, and blood samples were analyzed by ELISA for anti-C. trachomatis IgG. Statistical analyses included Fisher’s exact tests, odds ratios (ORs), and 95% confidence intervals (CIs), using SPSS 21.0. Results: Overall seroprevalence was 93.9% (327/348; 95% CI: 83.1–90%). Significant associations included a household income of 1–3 minimum wages (98.4%; p = 0.0002), sexual partners from the same region (98.8%; p = 0.0421), and age >42 years (96.3%). Most reported inconsistent condom use (43.7%), multiple monthly partners (54.6%), and illicit drug use (53.4%). Discussion: The extremely high seroprevalence reflects chronic C. trachomatis exposure, driven by socioeconomic deprivation and limited healthcare access. Comparisons with global data underscore the urgent need for screening policies, absent in Brazil for FSWs, and highlight the vulnerability of this population. Conclusions: The findings reveal an alarming burden of C. trachomatis exposure among Amazonian FSWs. Integrated strategies, including routine screening, sexual health education, and inclusion of FSWs in priority health programs, are critical to reduce transmission and associated complications. Full article

The global elimination of hepatitis C virus (HCV) has been prioritized by the World Health Organization (WHO) as a key public health target, with a deadline set for 2030. This initiative aims to significantly reduce both new infection rates and HCV-associated mortality. A major breakthrough in achieving this goal has been the development of direct-acting antiviral agents (DAAs), which offer cure rates exceeding 95%, along with excellent safety and tolerability. Nevertheless, transmission via parenteral routes continues to be the dominant pathway, particularly among high-risk groups, such as individuals who inject drugs, incarcerated populations, those exposed to unsafe medical practices, and healthcare professionals. Identifying, monitoring, and delivering tailored interventions to these groups is crucial to interrupt ongoing transmission and to reduce the burden of chronic liver disease. On a global scale, several nations have demonstrated measurable progress toward HCV elimination, with some nearing the targets set by WHO. These achievements have largely resulted from context-adapted policies that enhanced diagnostic and therapeutic access while emphasizing outreach to vulnerable communities. This review synthesizes current advancements in HCV prevention and control and proposes strategic frameworks to expedite global elimination efforts. Full article

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Acinetobacter baumannii has emerged as a major pathogen responsible for healthcare-associated infections, particularly in intensive care units, contributing to significant morbidity and mortality due to its multidrug resistance and ability to persist in clinical environments. This study aimed to investigate the phenotypic and genomic characteristics of all multidrug-resistant A. baumannii isolates collected between January and June 2022 from two tertiary care hospitals in Thessaloniki, Greece. A total of 40 isolates were included. All isolates exhibited resistance to colistin; however, none harbored the mcr-1 to mcr-9 genes, as confirmed by polymerase chain reaction (PCR). PCR-based screening for virulence-associated genes revealed high prevalence rates of basD (100%), pld (95%), csuE (87.5%), and bap (77.5%). In contrast, ompA and pglC were not detected. Twitching motility ranged from 2 to 50 mm, with 25% of the isolates classified as non-motile and 20% as highly motile. Swarming motility was observed in all strains. Additionally, all isolates demonstrated positive α-hemolysis, suggesting a potential virulence mechanism involving tissue damage and iron acquisition. Pulsed-field gel electrophoresis (PFGE) revealed significant genomic diversity among the isolates, indicating a low likelihood of patient-to-patient or clonal transmission within the hospital setting. These findings highlight the complex relationship between antimicrobial resistance and virulence in clinical A. baumannii isolates and emphasize the urgent need for robust infection control strategies and continued microbiological surveillance. Full article

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

Microbiological contamination of healthcare workers’ gowns represents a critical risk for the transmission of healthcare-associated infections (HAIs). Despite their use as protective equipment, gowns can act as reservoirs of antibiotic-resistant bacteria, favouring the spread of pathogens between healthcare workers and patients. The presence of these resistant bacteria on healthcare workers’ gowns highlights the urgent need to address this risk as part of infection control strategies. The aim of this work was to assess the microbiological risks associated with the contamination of healthcare staff gowns with Gram-negative bacteria, including the ESKAPE group, and their relationship with antimicrobial resistance. An observational, cross-sectional, prospective study was conducted in 321 hospital workers. The imprinting technique was used to quantify the bacterial load on the gowns, followed by bacterial identification by MALDI-TOF mass spectrometry. In addition, antimicrobial resistance profiles were analysed, and tests for carbapenemases and BLEE production were performed. The ERIC-PCR technique was also used for molecular analysis of Pantoea eucrina clones. Several Gram-negative bacteria were identified, including bacteria of the ESKAPE group. The rate of microbiological contamination of the gowns was 61.05% with no association with the sex of the healthcare personnel. It was observed that critical areas of the hospital, such as intensive care units and operating theatres, showed contamination by medically important bacteria. In addition, some strains of P. eucrina showed resistance to carbapenemics and cephalosporins. ERIC-PCR analysis of P. eucrina isolates showed genetic heterogeneity, indicating absence of clonal dissemination. Healthcare personnel gowns are a significant reservoir of pathogenic bacteria, especially in critical areas of Hospital Juárez de México. It is essential to implement infection control strategies that include improving the cleaning and laundering of gowns and ideally eliminating them from clothing to reduce the risk of transmission of nosocomial infections. Full article

Healthcare-associated infections (HAIs), also referred to as nosocomial or hospital-acquired infections, are a significant cause of death worldwide, with hand hygiene being the most powerful means to tackle them. The present study had a twofold aim: first, to assess the level of knowledge and the degree of compliance with hand hygiene practices based on healthcare workers’ self-reports; second, to evaluate whether behavioral economics techniques, specifically a poster combining an image and an informational message, designed according to the published literature, can increase the level of healthcare workers’ compliance with hand hygiene. Factors that potentially affect compliance were also examined. This study involved distributing a questionnaire to healthcare workers in Greek public hospitals, from which 314 completed responses were collected during the last quarter of 2023. Participants were randomly and evenly assigned to an intervention group that received a nudging poster or to a control group, which did not. Self-reported compliance with hand hygiene practices was high, based on two latent variables derived through exploratory factor analysis, although knowledge of germ transmission was moderate, as reflected in the relevant knowledge question scores. However, nudging had no statistically significant effect on hand hygiene behavior. Compliance was associated with several factors, including gender, age, work experience, profession, perceived adequacy of available hygiene-related resources, and perceived consequences of nosocomial infections on patient outcomes. Full article

Background: Enterobacterales are among the most frequent causes of healthcare-associated infections and are increasingly affected by antimicrobial resistance. Antibiotic use disrupts the gut microbiota, facilitating colonization by multidrug-resistant organisms, including carbapenemase-producing Enterobacterales (CPE). While animal studies have suggested that certain antibiotic classes may increase the risk of CPE acquisition, clinical data identifying which classes are most implicated remain limited. Methods: We conducted a single-center, retrospective case-control study (2021–2024) comparing antibiotic prescriptions in patients who acquired CPE with those in controls hospitalized in the same unit and during the same risk period but who did not acquire CPE. The objective of this study was to identify which antibiotic classes or pharmacological properties are associated with the acquisition of carbapenemase-producing Enterobacterales (CPE) in hospitalized patients. Results: During the study period, 35 cases and 70 controls were included. Most cases acquired NDM-type metalloenzymes. Before the risk period, 55 patients had received antibiotic therapy. Univariate analysis identified an association between CPE acquisition and the prescription of fluoroquinolones and antibiotics excreted in bile. During the risk period, only metronidazole prescription was significantly associated with CPE acquisition. Our study has several limitations, including the small sample size, the single-center retrospective design, and the lack of molecular typing (e.g., WGS) to confirm potential clonal transmission. Conclusions: In this preliminary study, metronidazole use was associated with an increased risk of CPE acquisition during risk periods. However, these results should be interpreted cautiously and need to be confirmed in larger, multicenter studies. The high exposure of patients to multiple antibiotic classes highlights the importance of strict antibiotic stewardship policies in the current era of global CPE dissemination. Full article

Background and objective: The approval of mRNA-based vaccines for children and adolescents has contributed to global efforts to control the SARS-CoV-2 pandemic. While hybrid immunity—combining prior SARS-CoV-2 infection and vaccination—may offer enhanced protection, data on its effectiveness versus vaccine-induced immunity in the pediatric population are limited. Methods: This retrospective matched cohort study used linked health data from Norwegian nationwide health registries and the Italian Pedianet network. The study included children and adolescents aged 5–14 years eligible for COVID-19 vaccination at the time of approval (May/September 2021 and November 2021/January 2022, respectively). Mono- and two-dose vaccination schedules were assessed, and hybrid immunity was defined as prior SARS-CoV-2 infection followed by vaccination within 12 months. Conditional Cox regression models were used to estimate hazard ratios (HRs) for SARS-CoV-2 infection risk, adjusting for sociodemographics, comorbidities, and healthcare utilization. Results: The study included 626,537 children and adolescents in Norway and 38,938 in Italy. A single dose of the vaccine did not reduce the risk of infection among SARS-CoV-2–naive individuals in Norway (HR: 1.05; 95% CI: 1.04–1.07), whereas it was associated with an 8% risk reduction in Italy (HR: 0.92; 95% CI: 0.88–0.96). Among individuals with a recent prior infection (within 12 months), vaccination was associated with a reduced risk of reinfection in Norway (HR: 0.10; 95% CI: 0.05–0.13), but not in Italy (HR: 1.22; 95% CI: 0.83–1.80), compared to no vaccination. Among those with prior infection, vaccination was associated with a significantly reduced risk of reinfection in Norway (HR = 0.10; 95% CI: 0.05–0.20), but not in Italy (HR = 0.55; 95% CI: 0.27–1.11). Hybrid immunity provided greater protection against (re-)infection compared to vaccine-induced immunity alone, with a 26% risk reduction observed in Norway (HR = 0.74; 95% CI = 0.47–0.1.16) and an 86% reduction in Italy (HR = 0.14; 95% CI = 0.09–0.21). Conclusions: This analysis supports the effectiveness of SARS-CoV-2 vaccines in children, with hybrid immunity offering enhanced protection against reinfection. Given the waning effectiveness of vaccines over time, continued research and booster strategies are essential to sustain protection and mitigate transmission. Full article

Background: Dental professionals were thought to have the most significant risk of coronavirus infection during the pandemic. Since the first Coronavirus Disease 2019 (COVID-19) patient was detected in Japan in January 2020, Japan has faced several waves of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections. However, no cluster of SARS-CoV-2 infections associated with dental procedures has been reported in Japan. In this study, we aimed to investigate the actual status of SARS-CoV-2 infection during the pandemic through antibody testing for dental professionals. We further investigated saliva and oral management-related aerosol to estimate the risk of virus transmission during dental procedures. Methods: SARS-CoV-2 antibody titer in the blood of dental professionals and their families was determined during the pre-vaccinated period of the SARS-CoV-2 wave to see the history of infection in Japan. Viral loads in saliva and in the aerosol generated during the oral management of COVID-19 patients were detected by RT-qPCR. Results: The antibody testing of dental healthcare providers during the early phases of the pandemic in Japan revealed low antibody positivity, which supported the low incidence of infection clusters among dental clinics. The aerosol generated during dental procedures may contain trace levels of SARS-CoV-2, indicating the risk of transmission through dental procedures is limited. Therefore, SARS-CoV-2 did not spread through dental clinics. Conclusions: Very few SARS-CoV-2 infections were observed in dental professionals who took appropriate infection control measures in the early period of the pandemic. Performing dental procedures using standard precautions seems to be sufficient to prevent SARS-CoV-2 infections. Full article

Coinfection with parasites and viruses can exacerbate disease transmission, outcomes and therapy. This study searched the Web of Science, PubMed, Scopus and JSTOR databases for publications on the prevalence of parasitic coinfection in people living with viruses from 1 January 2005 to 30 April 2022, and 356 studies were included and systematically reviewed. A meta-analysis was performed to assess the global prevalence of and factors potentially associated with parasitic infection (helminths and protozoa) in virus-infected people, and the infection burden was estimated. A variety of parasites (29 families, 39 genera, and 63 species) and viruses (8 kinds) were identified. The prevalence of parasitic coinfection in (all) virus-infected people was estimated to be 21.34% (95% CI 17.58–25.10, 5593 of 29,190 participants) and 34.13% (95% CI 31.32–36.94, 21,243/76,072 participants) for helminths and protozoa, respectively. Specially, in human immunodeficiency virus (HIV)-infected people, the global prevalence was 19.96% (95% CI 16.18–23.74) for helminths and 34.18% (95% CI 31.33–37.03) for protozoa, respectively. The global prevalence of protozoa was 41.79% (95% CI 15.88–67.69) in hepatitis B virus (HBV)-infected people and 17.75% (95% CI 3.54–31.95) in DENV-infected people, respectively. The global burden of parasitic infections in HIV-infected people was 7,664,640 for helminths and 13,125,120 for protozoa, respectively, and that in HBV- and dengue virus (DENV)-infected people was 137,019,428 and 629,952, respectively. The prevalence of parasitic coinfection at the family, genus, and species levels in virus- or HIV-infected people were comprehensively estimated and further analyzed by subgroups. Among the most commonly identified parasites, the five helminth genera with the highest prevalence in HIV-infected people were Schistosoma (12.46%, 95% CI 5.82–19.10), Ascaris (7.82%, 95% CI 6.15–9.49), Strongyloides (5.43%, 95% CI 4.11–6.74), Trichuris (4·82%, 95% CI 2.48–7.17) and Ancylostoma (2.79%, 95% CI 1.32–4.27), whereas the top five protozoan genera were Toxoplasma (48.85%, 95% CI 42.01–55.69), Plasmodium (34.96%, 95% CI 28.11–41.82), Cryptosporidium (14.27%, 95% CI 11.49–17.06), Entamoeba (12.33%, 95% CI 10.09–14.57) and Blastocystis (10.61%, 95% CI 6.26–14.97). The prevalence of parasitic coinfection in virus-infected people was associated with income level. The findings provide valuable global epidemiological information for informing normative guidance, improving surveillance, and developing public healthcare strategies. Full article

Antimicrobial resistance (AMR) has emerged as a critical global public health threat, exacerbating healthcare burdens and imposing substantial economic costs. Currently, AMR contributes to nearly five million deaths annually worldwide, surpassing mortality rates of any single infectious disease. The economic burden associated with AMR-related disease management is estimated at approximately $730 billion per year. This review synthesizes current research on the mechanisms and multifaceted drivers of AMR development and dissemination through the lens of the One Health framework, which integrates human, animal, and environmental health perspectives. Intrinsic factors, including antimicrobial resistance genes (ARGs) and mobile genetic elements (MGEs), enable bacteria to evolve adaptive resistance mechanisms such as enzymatic inactivation, efflux pumps, and biofilm formation. Extrinsic drivers span environmental stressors (e.g., antimicrobials, heavy metals, disinfectants), socioeconomic practices, healthcare policies, and climate change, collectively accelerating AMR proliferation. Horizontal gene transfer and ecological pressures further facilitate the spread of antimicrobial-resistant bacteria across ecosystems. The cascading impacts of AMR threaten human health and agricultural productivity, elevate foodborne infection risks, and impose substantial economic burdens, particularly in low- and middle-income countries. To address this complex issue, the review advocates for interdisciplinary collaboration, robust policy implementation (e.g., antimicrobial stewardship), and innovative technologies (e.g., genomic surveillance, predictive modeling) under the One Health paradigm. Such integrated strategies are essential to mitigate AMR transmission, safeguard global health, and ensure sustainable development. Full article

Background/Objectives: Older adults with frailty are at-risk of worse outcomes following respiratory-viral-infections such as COVID-19. Data on effectiveness of vaccination/boosting in frail older adults during Omicron is lacking. Methods: National healthcare-claims data and COVID-19 registries were utilized to enroll a cohort of older Singaporeans (≥60 years) as of 1 January 2022, divided into low/intermediate/high-risk for frailty; matching weights were utilized to adjust for sociodemographic differences/vaccination uptake at enrolment across frailty categories. Competing-risk-regression (Fine-Gray) taking death as a competing risk, with matching weights applied, was utilized to compare risks of COVID-19-related hospitalizations and severe COVID-19 across frailty levels (low/intermediate/high-risk), with estimates stratified by booster status. Individuals were followed up until study end-date (20 December 2023). Results: 874,160 older adults were included during Omicron-predominant transmission; ~10% had intermediate/high-frailty-risk. Risk of hospitalization/severe COVID-19 was elevated in those with intermediate/high-frailty-risk up to XBB/JN.1 transmission. Boosting was associated with decreased risk of COVID-19-related hospitalization across all frailty categories in infection-naïve individuals. However, in infection-naïve older adults with high-frailty-risk, while receipt of first boosters was associated with lower risk of COVID-19-hospitalization/severe COVID-19, additional booster doses did not reduce risk. In reinfected older adults, first boosters were still associated with lower hospitalization risk (adjusted-hazards-ratio, aHR = 0.55, 95% CI = 0.33–0.92) among the non-frail, but not in the intermediate/high-frailty-risk minority. Conclusions: First boosters were associated with reduced adverse COVID-19 outcomes across all frailty categories in infection-naïve older adults during Omicron. However, in the high-frailty minority, boosting did not additionally reduce risk in reinfected individuals with hybrid immunity, and beyond the first booster for infection-naïve individuals. Full article

Background/Objectives: This narrative review provided a broad synthesis of recent epidemiological trends, priority resistance mechanisms, and public health implications of multidrug-resistant (MDR) bacteria. We focused on the most clinically significant MDR pathogens, regional differences in resistance, and the effectiveness of containment strategies. Our goal was to synthesize current knowledge and propose research directions. Methods: Through comprehensive analysis of epidemiological studies, surveillance reports, clinical trials, and meta-analyses, we present a detailed assessment of the evolving landscape of antimicrobial resistance across both developed and developing nations. The review encompasses data from 187 countries, analyzing over 2500 published studies and reports from major health organizations. Results: Our findings reveal a concerning 43% increase in multidrug-resistant infections globally, with particularly sharp rises in healthcare-associated infections (67% increase) and community-acquired infections (38% increase) in regions with high antibiotic misuse. The analysis specifically focuses on critical pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE), documenting their prevalence, transmission patterns, and treatment outcomes. Economic impact assessments indicate annual global healthcare costs exceeding USD 100 billion due to resistant infections. The review identifies significant gaps in current surveillance systems, particularly in low- and middle-income countries, and proposes standardized approaches for monitoring and containment strategies. We evaluate the effectiveness of various antimicrobial stewardship programs, documenting success rates and implementation challenges across different healthcare settings. Conclusions: The analysis concludes with evidence-based recommendations for policy reforms, research priorities, and international collaboration frameworks necessary to address this growing global health crisis. Our findings highlighted the importance of strengthening stewardship efforts, proposing novel diagnostics and therapeutic interventions, and addressing inequities in access to care and data across different countries. Full article

The COVID-19 pandemic has highlighted the intricate nature of disease dynamics, extending beyond transmission patterns to the complex interplay of intervention strategies. In the post-COVID-19 era, reinfection has emerged as a critical factor, shaping how we model disease progression, evaluate immunity, and assess the effectiveness of public health interventions. This research uniquely explores the varied efficacy of existing vaccines and the pivotal role of vaccination timing in the context of COVID-19. Departing from conventional modeling, we introduce two models that account for the impact of vaccines on infections, reinfections, and deaths. We estimate model parameters under the Bayesian framework, specifically utilizing the Metropolis–Hastings Sampler. We conduct data-driven scenario analyses for the State of Qatar, quantifying the potential duration during which the healthcare system could have been overwhelmed by an influx of new COVID-19 cases surpassing available hospital beds. Additionally, the research explores similarities in predictive probability distributions of cumulative infections, reinfections, and deaths, employing the Hellinger distance metric. Comparative analysis, utilizing the Bayes factor, underscores the plausibility of a model assuming a different susceptibility rate to reinfection, as opposed to assuming the same susceptibility rate for both infections and reinfections. Results highlight the adverse outcomes associated with delayed vaccination, emphasizing the efficacy of early vaccination in reducing infections, reinfections, and deaths. Our research advocates for prioritization of early vaccination as a key strategy in effectively combating future pandemics, thereby providing vital insights for evidence-based public health interventions. Full article