Search Results (93)

Background/Objectives: Oral hygiene is an essential component of overall health, but is often neglected during hospital stays, particularly among patients who rely on healthcare providers for daily care. Poor oral hygiene may lead to discomfort, infections, and complications such as hospital-acquired pneumonia. The objective of this study was to assess the oral hygiene practices of hospitalized patients in Al-Ahsa, Saudi Arabia. Methods: A hospital-based cross-sectional study was conducted among patients in public and private hospitals. Since no prior studies existed for this population, a pilot study with 60 participants was used to estimate the population proportion for sample size calculation. Based on the pilot findings, a proportion of 80% was assumed, with a 95% confidence level, 5% margin of error, and 80% power. Patients were recruited through non-probability convenience sampling. Data were collected via structured face-to-face interviews and analyzed using SPSS version 27. Descriptive statistics, chi-square tests, and logistic regression were applied, with significance set at 0.05. Results: Regular toothbrushing declined from 69.6% before admission to 29.8% during hospitalization. Only 29.8% of patients received oral hygiene supplies, and 79.2% received no assistance. In-hospital toothbrushing was significantly associated with being female (AOR = 2.52; 95% CI: 1.17–5.43), non-Saudi (AOR = 3.91; 95% CI: 1.22–12.55), and having a Bachelor’s degree or higher (AOR = 5.66; 95% CI: 1.53–20.88). Conclusions: Oral hygiene among hospitalized patients in Al-Ahsa was inadequate, particularly in public hospitals where essential supplies were lacking. Hospitals should adopt clear oral care policies, ensure supply availability, train staff, and integrate dental professionals to improve patient safety and prevent complications. Full article

Antimicrobial resistance (AMR) is a global health threat, increasing morbidity, mortality, and healthcare costs. Multi-drug resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae) cause most hospital-acquired infections. Local data on their resistance profiles remain limited in low-income settings. This study assessed the prevalence and resistance patterns of ESKAPE pathogens isolated from clinical specimens at Rwanda Military Referral and Teaching Hospital. A descriptive cross-sectional study was conducted from June 2022 to January 2023. ESKAPE isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix M50 System. Data on sample type, ward, and demographics were analyzed. Of 744 bacterial findings, 207 (30%) were ESKAPE isolates. After excluding duplicates and non-recovered isolates, 156 were identified as ESKAPE. K. pneumoniae was most common (41%), followed by S. aureus (27%), A. baumannii (13%), P. aeruginosa (11%), and E. cloacae (8%); no E. faecium was detected. Among Gram-negatives, 63% were resistant to third-generation cephalosporins and 32% to carbapenems, with A. baumannii showing highest resistance (85% and 75%). Methicillin-Resistance in Staphylococcus aureus (MRSA) was 7%. This first hospital-based study in Rwanda shows high cephalosporin and carbapenem resistance, highlighting the need to strengthen diagnostics and stewardship. Full article

Background: Intensive Care Unit (ICU) readmission and in-hospital mortality are critical indicators of patient outcomes following ICU discharge. Patients readmitted to the ICU often face worse prognosis, higher healthcare costs, and prolonged hospital stays. Identifying high-risk patients is essential for optimizing post-ICU care and resource allocation. Methods: This two-phase study included the following: (1) a retrospective analysis of ICU survivors in a mixed medical–surgical ICU to identify risk factors associated with ICU readmission and in-hospital mortality, and (2) a prospective validation of a newly developed predictive model: the Worse Outcome Score (WOScore). Data collected included demographics, ICU admission characteristics, severity scores (SAPS II, SAPS III, APACHE II, SOFA), interventions, complications and discharge parameters. Results: Among 1.190 ICU survivors, 126 (10.6%) were readmitted to the ICU, and 192 (16.1%) died in hospital after ICU discharge. Key risk factors for ICU readmission included Diabetes Mellitus, SAPS III on admission, and ICU-acquired infections (Ventilator-Associated Pneumonia (VAP) and Catheter-Related Bloodstream Infection, (CRBSI)). Predictors of in-hospital mortality were identified: medical admission, high SAPS III score, high lactate level on ICU admission, tracheostomy, reduced GCS at discharge, blood transfusion, CRBSI, and Acute Kidney Injury (AKI) during ICU stay. The WOScore, developed based on the results above, demonstrated strong predictive ability (AUC: 0.845 derivation, 0.886 validation). A cut-off of 20 distinguished high-risk patients (sensitivity: 88.1%, specificity: 73.0%). Conclusions: ICU readmission and in-hospital mortality are influenced by patient severity, underlying comorbidities, and ICU-related complications. The WOScore provides an effective, easy-to-use risk stratification tool that can guide clinicians in identifying high-risk patients at ICU discharge and guide post-ICU interventions, potentially improving patients’ outcomes and optimizing resource allocation. Further multi-center studies are necessary to validate the model in diverse healthcare settings. Full article

Healthcare-associated infections (HAIs) represent one of the most persistent challenges in modern healthcare delivery, affecting millions of patients worldwide and imposing substantial clinical and economic burdens on healthcare systems. The emergence of antimicrobial resistance (AMR) has further complicated infection management, creating an urgent need for innovative therapeutic and preventive strategies. Current strategies for combating AMR in hospital settings encompass comprehensive infection prevention and control measures, antimicrobial stewardship programs, enhanced environmental cleaning protocols and innovative surface modification technologies. Nanotechnology has emerged as a valuable approach to address the limitations of conventional antimicrobial strategies. Various nanomaterial categories offer innovative platforms for developing novel treatment strategies and for providing advantages including reduced toxicity through lower dosage requirements, diminished resistance development potential, and enhanced antibacterial effects through combined action mechanisms. Particularly, metal-based nanoparticles and their oxides demonstrate exceptional antimicrobial properties through multiple mechanisms including membrane damage, protein binding and reactive oxygen species generation. This comprehensive review examines the current landscape of hospital-acquired infections, the growing threat of antimicrobial resistance, and the promising role of nanotechnology-based solutions, with particular emphasis on silver nanoparticles as innovative tool for HAI control in clinical settings. Recent advances in nanotechnology-enabled antimicrobial coatings are assessed along with their clinical translation in hospital settings, identifying key barriers concerning material durability, safety profiles, and regulatory pathways. Full article

Background: The global COVID-19 pandemic has significantly disrupted healthcare systems, inadvertently influencing the epidemiology of antimicrobial resistance (AMR). Among the most critical AMR threats are carbapenem-resistant organisms (CROs), which include carbapenem-resistant Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa. This review explores the pandemic’s impact on carbapenem resistance patterns worldwide. Objectives: This study aimed to assess the effects of the COVID-19 pandemic on carbapenem resistance trends, identify key drivers, and discuss implications for clinical practice and public health policy. Methods: A comprehensive review of peer-reviewed literature, national surveillance reports, and WHO/ECDC data from 2019 to 2025 was conducted, with emphasis on hospital-acquired infections, antimicrobial use, and infection control practices during the pandemic. Results: The pandemic has led to increased use of broad-spectrum antibiotics, including carbapenems, often in the absence of confirmed bacterial co-infections. Overwhelmed healthcare systems and disruptions in infection prevention and control (IPC) measures have facilitated the spread of carbapenem-resistant organisms, particularly in intensive care settings. Surveillance data from multiple countries show a measurable increase in CRO prevalence during the pandemic period, with regional variations depending on healthcare capacity and stewardship infrastructure. Conclusions: COVID-19 has accelerated the emergence and dissemination of carbapenem resistance, underscoring the need for resilient antimicrobial stewardship and IPC programs even during public health emergencies. Integrating pandemic preparedness with AMR mitigation strategies is critical for preventing further escalation of resistance. Full article

Hospital-acquired infections (HAIs) remain a major clinical and economic burden, with pathogens such as Escherichia coli contributing to high rates of morbidity and mortality. Traditional manual disinfection methods are often insufficient, particularly in high-risk hospital environments. In this study, we investigated innovative strategies to enhance surface decontamination and reduce infection risk. First, we assessed the efficacy of the SMEG BPW1260 bedpan washer-disinfector, a thermal disinfection system for human waste containers. Our results demonstrated a reduction in Clostridium difficile and Escherichia coli contamination by >99.9% (>3 log reduction), as measured by colony-forming units (CFU) before and after treatment. Molecular techniques, including spectrophotometry, cell counting, and quantitative PCR (qPCR) for DNA quantification, confirmed reduction in bacterial contamination. Specifically, Clostridium difficile showed a reduction of approximately 89% in both optical density (OD) and cell count (cells/mL). In the case of Escherichia coli, a reduction of around 82% in OD was observed, with an even more pronounced decrease in cell count, reaching approximately 99.3%. For both bacteria, DNA quantification by qPCR was below detectable limits. Furthermore, we optimized the energy efficiency of the disinfection cycle, achieving a 45% reduction in power consumption compared to standard protocols without compromising antimicrobial efficacy. Secondly, we developed a sustainable cleaning solution based on methyl ester sulfonate surfactants derived from waste cooking oil. The detergent’s antibacterial activity was tested on contaminated surfaces and further enhanced through the incorporation of nanoassemblies composed of silver, electrostatically bound either to biomimetic magnetic nanoparticles or to conventional magnetic nanoparticles. Washing with the detergent alone effectively eliminated detectable contamination, while the addition of nanoparticles inhibited bacterial regrowth. Antimicrobial testing against E. coli revealed that the nanoparticle-enriched formulations reduced the average MIC values by approximately 50%, with MIC₅₀ values around 0.03–0.06 mg/mL and MIC₉₀ values between 0.06 and 0.12 mg/mL, indicating improved inhibitory efficacy. Finally, recognizing the infection risks associated with intra-hospital transport, we tested the SAFE-HUG Wheelchair Cover, a disposable non-woven barrier designed to reduce patient exposure to contaminated wheelchair surfaces. Use of the cover resulted in a 3.3 log reduction in surface contamination, based on viable cell counts. Optical density and bacterial DNA were undetectable in all covered samples at both 1 and 24 h, confirming the strong barrier effect. Together, these approaches—thermal no-touch disinfection, eco-friendly detergent boosted with nanoparticles, and protective transport barriers—respond to the urgent need for effective, sustainable infection control methods in healthcare settings. Our findings demonstrate the potential of these systems to counteract microbial contamination while minimizing environmental impact, offering promising solutions for the future of infection prevention in healthcare settings. Full article

This review explores the biofilm architecture and drug resistance of Enterococcus faecalis in clinical and environmental settings. The biofilm in E. faecalis is a heterogeneous, three-dimensional, mushroom-like or multilayered structure, characteristically forming diplococci or short chains interspersed with water channels for nutrient exchange and waste removal. Exopolysaccharides, proteins, lipids, and extracellular DNA create a protective matrix. Persister cells within the biofilm contribute to antibiotic resistance and survival. The heterogeneous architecture of the E. faecalis biofilm contains both dense clusters and loosely packed regions that vary in thickness, ranging from 10 to 100 µm, depending on the environmental conditions. The pathogenicity of the E. faecalis biofilm is mediated through complex interactions between genes and virulence factors such as DNA release, cytolysin, pili, secreted antigen A, and microbial surface components that recognize adhesive matrix molecules, often involving a key protein called enterococcal surface protein (Esp). Clinically, it is implicated in a range of nosocomial infections, including urinary tract infections, endocarditis, and surgical wound infections. The biofilm serves as a nidus for bacterial dissemination and as a reservoir for antimicrobial resistance. The effectiveness of first-line antibiotics (ampicillin, vancomycin, and aminoglycosides) is diminished due to reduced penetration, altered metabolism, increased tolerance, and intrinsic and acquired resistance. Alternative strategies for biofilm disruption, such as combination therapy (ampicillin with aminoglycosides), as well as newer approaches, including antimicrobial peptides, quorum-sensing inhibitors, and biofilm-disrupting agents (DNase or dispersin B), are also being explored to improve treatment outcomes. Environmentally, E. faecalis biofilms contribute to contamination in water systems, food production facilities, and healthcare environments. They persist in harsh conditions, facilitating the spread of multidrug-resistant strains and increasing the risk of transmission to humans and animals. Therefore, understanding the biofilm architecture and drug resistance is essential for developing effective strategies to mitigate their clinical and environmental impact. Full article

Pseudomonas aeruginosa is a highly adaptable opportunistic pathogen with significant clinical relevance in both human and veterinary medicine. Despite its well-documented role in hospital-acquired infections in human healthcare settings, its persistence and transmission within veterinary clinics remain underexplored. This review highlights the overlooked status of veterinary facilities as environmental reservoirs and amplification points for multidrug-resistant (MDR) P. aeruginosa, emphasizing their relevance to One Health surveillance. We examine the bacterium’s environmental survival strategies, including biofilm formation, resistance to disinfectants, and tolerance to nutrient-poor conditions that facilitate the long-term colonization of moist surfaces, drains, medical equipment, and plumbing systems. Common transmission vectors are identified, including asymptomatic animal carriers, contaminated instruments, and the hands of veterinary staff. The review synthesizes current data on antimicrobial resistance in environmental isolates, revealing frequent expression of efflux pumps and mobile resistance genes, and documents the potential for zoonotic transmission to staff and pet owners. Key gaps in environmental monitoring, infection control protocols, and genomic surveillance are identified, with a call for standardized approaches tailored to the veterinary context. Control strategies, including mechanical biofilm disruption, disinfectant cycling, effluent monitoring, and staff hygiene training, are evaluated for feasibility and impact. The article concludes with a One Health framework outlining cross-species and environmental transmission pathways. It advocates for harmonized surveillance, infrastructure improvements, and intersectoral collaboration to reduce the risk posed by MDR P. aeruginosa within veterinary clinical environments and beyond. By addressing these blind spots, veterinary facilities can become proactive partners in antimicrobial stewardship and global resistance mitigation. Full article

Background: Clostridioides difficile infection (CDI) is a major concern in hospital-acquired infections. C. difficile spores can survive on surfaces for months and require sporicidal disinfection for elimination. The use of disinfectants should be based on laboratory-confirmed sporicidal activity, tested according to current standards in suspension and carrier tests. Further evaluation of disinfectant efficacy should occur in clinical settings by analyzing reductions in CDI incidence. This study aims to conduct a retrospective analysis of the impact of a new disinfection protocol and concurrent changes in antibiotic consumption on the incidence of healthcare-acquired CDI (HA-CDI). Methods: This retrospective, single-center study assessed the impact of a chlorine dioxide-based disinfection protocol on HA-CDI across three periods: pre-intervention, intervention, and post-intervention. An interrupted time series analysis (ITS) with a Poisson distribution was used to evaluate the incidence of HA-CDI, while antibiotic consumption data were analyzed to identify any correlation with CDI infection rates. Results: Incidence Rate Ratio (IRR) before the intervention is 1.00, serving as the reference value. During the intervention period, the IRR is 0.79 (95% CI: 0.42–1.36; p = 0.43), indicating a decrease in the incidence of infections compared to the pre-intervention period, although this result is not statistically significant. After the intervention, the IRR is 0.53 (95% CI: 0.26–0.97; p = 0.057), suggesting a further reduction in the incidence of CDI; this result is on the borderline of statistical significance (p = 0.057), indicating a potential effect of the intervention, albeit without full statistical certainty. Conclusions: The absence of a CDI surge despite increased antibiotic consumption highlights the synergistic relationship between antibiotic stewardship and rigorous infection control practices. The combination of the improved disinfection protocol and comprehensive staff training proved remarkably effective in mitigating CDI risk. Cleaning and disinfection in healthcare facilities is crucial for the prevention of healthcare-associated infections. Full article

Background/Objectives: Candidozyma auris (C. auris) is a multidrug-resistant pathogen recognized as a serious global public health threat. Herein, we report a C. auris outbreak that was successfully contained in a general hospital located in Athens, Greece. Methods: This study was conducted between December 2021 and December 2023. Upon identification of the first imported case of C. auris, the following infection control measures were applied in a stepwise approach: the promotion of hand hygiene, contact precautions and isolation, chlorhexidine gluconate bathing of patients, enhanced environmental cleaning, and active surveillance cultures of all high-risk patients upon admission. Active surveillance cultures were performed weekly in non-colonized ICU patients. Results: A total of 1564 screening samples from 890 patients were analyzed. Sixty-three patients were identified to be colonized and three to be infected with C. auris. After implementing screening and enhanced environmental cleaning, the quarterly incidence of hospital-acquired cases decreased from 0.37 to 0.04 cases per 1000 patient-days (slope of linear trend: −0.08; 95% CI: −0.16 to −0.0004; p = 0.05), despite the continuous inflow of already colonized patients. Conclusions: A bundle of infection control measures, including active surveillance cultures upon admission and enhanced environmental cleaning, can contain C. auris dissemination in acute healthcare settings. Full article

Community-acquired infections caused by Klebsiella pneumoniae (K. pneumoniae) have become a significant global health concern, particularly with the emergence of hypervirulent strains (hvKP). These strains are associated with severe infections, such as pyogenic liver abscesses, even in otherwise healthy individuals. Initially reported in Taiwan in the 1980s, hvKP has now spread worldwide. The pathogenicity of hvKP is attributed to an array of virulence factors that enhance its ability to colonize and evade host immune defenses. Additionally, the convergence of hypervirulence with antibiotic resistance has further complicated treatment strategies. As a member of the ESKAPE group of pathogens, K. pneumoniae exhibits high resistance to multiple antibiotics, posing a challenge for healthcare settings. This review provides a comprehensive overview of hvKP, highlighting its structural and pathogenic differences from classical K. pneumoniae strains, key virulence factors, mechanisms of antibiotic resistance, and the increasing threat of multidrug-resistant hvKP. Lastly, we discuss current treatment guidelines and emerging therapeutic strategies to combat this formidable pathogen. Full article

Background: Heart failure (HF) is a leading cause of hospital admissions and in-hospital mortality among the elderly. This study aims to characterize HF patients admitted to Virgen de la Victoria University Hospital (HUVV), identify factors associated with in-hospital mortality and analyze the impact of added morbidity on healthcare costs. Methods: A cross-sectional study was conducted using data from the Minimum Basic Data Set (MBDS) at HUVV. We included all discharges with a primary diagnosis of HF in 2021. Logistic regression analysis was employed to identify factors associated with mortality, and cost analysis was performed to assess the economic impact of added morbidity. Results: A total of 731 hospital discharges for HF were analyzed, with a mortality rate of 14.77%. Mortality was significantly associated with age ≥ 75 years (OR = 4.12; p < 0.001), high or extreme severity (OR = 2.26 and 8.10, respectively; p < 0.001), and more than 10 diagnoses at discharge (OR = 2.95; p < 0.01). Treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) was associated with a reduced risk of death (OR = 0.29; p < 0.001). Hospital-acquired morbidity occurred in 27.22% of patients, resulting in an additional cost of EUR 152,780.61, representing a 3.8% increase over the total hospitalization costs. Conclusions: In-hospital mortality in HF patients at HUVV is strongly associated with advanced age, disease severity, and multiple comorbidities. Treatment with ACEIs or ARBs was associated with a lower likelihood of in-hospital mortality. Preventable added morbidity was associated with increased healthcare costs, highlighting the importance of infection control measures and multidisciplinary management to potentially improve outcomes and reduce costs. Full article

Clostridioides difficile infection (CDI) appears mainly as nosocomial antibiotic-associated diarrhea, and community-acquired infection is increasingly being recognized. The threshold of asymptomatic colonization and the clinical manifestation of CDI need further elucidation. Community-acquired CDI (CA-CDI) should be considered when the disease commences within 48 h of admission to hospital or more than 12 weeks after discharge. Although CDI is not established as a food-borne or zoonotic disease, some data support that direction. The spores’ ability to survive standard cooking procedures and on abiotic surfaces, the formation of biofilms, and their survival within biofilms of other bacteria render even a low number of spores capable of food contamination and spread. Adequate enumeration methods for detecting a low number of spores in food have not been developed. Primary care physicians should take CA-CDI into consideration in the differential diagnosis of diarrhea, as there is a thin line between colonization and infection. In patients diagnosed with inflammatory bowel disease and other comorbidities, C. difficile can be the cause of recurrent disease and should be included in the estimation of diarrhea and worsening colitis symptoms. In the community setting, it is difficult to distinguish asymptomatic carriage from true infection. For asymptomatic carriage, antibiotic therapy is not suggested but contact isolation and hand-washing practices are required. Primary healthcare providers should be vigilant and implement infection control policies for the prevention of C. difficile spread. Full article

Hospital-acquired infections (HAIs) previously focused mainly on multidrug-resistant (MDR) bacteria, with less attention on viruses. The COVID-19 pandemic highlighted the importance of controlling viral infections. Human rhinoviruses (HRVs) are among the viruses responsible for HAIs. HRVs are non-enveloped viruses that infect the upper airways after airborne or direct transmission. Due to their lack of a membrane envelope, HRVs exhibit moderate resistance to commonly applied alcoholic disinfectants. Therefore, there is a significant need to develop alternative disinfection and hand sanitation strategies to control HRV infections in healthcare settings without posing a risk to human health. The antimicrobial activity and safety of rhamnolipids and rhamnolipids nano-micelles (RMN) against MDR-bacteria and several viruses, including SARS-CoV-2, were confirmed recently. Also, we previously demonstrated the superior antimicrobial activity of RMN over rhamnolipids. In the current study, molecular docking demonstrated the weak interactions of rhamnolipids with HRV-1A (minor group) compared to HRV-14 (major group), suggesting a superior antiviral activity of rhamnolipids towards major group rhinoviruses. To biologically validate these data, RMN was prepared and characterized, and then antiviral activity against HRV-16 (major group) and HRV-1B (minor group) infection of HeLa cells was assessed. RMN showed a complete inhibition of HRV-16 infection with recovery of 100% of HeLa cell viability. In contrast, only partial inhibition of HRV-1B infection with approximately 50% protection against infection was observed. Therefore, RMN might be recommended as a disinfectant and/or a hand sanitizer component to control the spread of RVs in hospital care settings or elsewhere to reduce the incidence of respiratory infections. 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