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Infection control is a growing problem in places where hygiene is required particularly in hospitals. Most of the clothing and garments used to protect cross infections from patient to patient and patient to medical personnel possess barrier properties that resist not only the entry of blood and liquids but also microorganisms. The present study developed a novel sustainable antimicrobial polyurethane foam castor oil-based method using ZnO as a reactive filler with different amounts (0, 10, 20, and 30 wt%). To evaluate how the addition of ZnO affects the specific properties of polyurethane foam were used techniques by optical microscopy (OM), scanning electron microscopy (SEM), density, contact angle, Fourier transform infrared spectroscopy (FTIR), Thermogravimetry (TGA), X-Ray diffraction analysis (XRD), and Compressive strength test, respectively. The antibacterial activity of the optimal composites was investigated against Pseudomonas aeruginosa bacteria. Incorporating ZnO in the PU matrix caused an increase in the density of composites, which affected directly morphology exhibiting a higher number of cells with a small pore size as the amount of ZnO content was increased. FTIR results indicated that ZnO was hydrogen bonded to the PU foam chains, confirming that they act as nucleating agents. Also, the addition of ZnO improved the hydrophobicity, crystallinity, and thermal and mechanical properties of PU foams. PU/ZnO30% has ideal conditions and efficient antimicrobial activity, making it suitable as an antimicrobial hospital mattress to control hospital infections. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) are considered to be one of the biggest health problems as they continue to be an important cause of morbidity and mortality worldwide. They cannot be completely prevented, but their incidence can be significantly limited. Preventive action is the most important measure in this case. Due to the frequent interaction between healthcare professionals and patients, the crucial importance of hand hygiene is therefore emphasised. Adherence to good disinfection and hand washing practices remains around 40%, which can be improved by using a variety of nudge tools to promote desired hygienic behaviour. We conducted an open observation of employees and visitors with participation. The aim of this study was to determine the actual status of hand disinfection in a selected healthcare facility amongst doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children; then, we selected and introduced three nudge tools of desired hygiene behaviour and analysed their effectiveness; finally, we provided suggestions for the use of nudge tools of desired hygiene behaviour with the aim of influencing doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children so that they disinfect their hands properly. The actual state of hand disinfection was determined on the basis of observation without introducing any changes; then, we separately introduced three nudge tools, posters with an inscription and picture, the scent of citrus, and flashing lights. The obtained results were analysed with the help of the SpeedyAudit Lite application, and the effectiveness of each nudge tool and the adequacy of hand disinfection by categories of people were compared. In general, posters with a picture and an inscription contributed the most to more consistent disinfection of employees' hands, while the scent of citrus and flashing lights contributed slightly less. [ABSTRACT FROM AUTHOR]

Ralstonia spp. are low-virulent environmental Gram-negative bacteria that can cause serious nosocomial infections in immunocompromised patients. We report the characteristics of a cluster of R. insidiosa bacteremia cases occurring in our oncology day ward in Milan, Italy, between January and March 2022. A case was defined as a cancer patient attending our day ward and whose blood culture (performed because of bacteremia symptoms) led to the isolation of Ralstonia insidiosa. An epidemiological investigation was conducted in order to seek the possible source of infection. Seven adult patients received curative or palliative treatment via infusion through a Port-a-Cath (PAC). All developed symptoms within 24 h of the infusion (three during the infusion itself). Ralstonia insidiosa was isolated in the blood drawn from the PAC in all patients. All of the isolates were susceptible to carbapenems, fluoroquinolones, and piperacillin/tazobactam but resistant to aminoglycosides and cephalosporins. Systemic and/or lock antibiotic therapy led to stable symptom resolution and negative blood cultures in five patients, whereas bacteremia recurred in two patients. An epidemiological investigation suggested that extrinsic contamination of antiseptic solutions was the possible cause of the R. insidiosa infections. Although R. insidiosa is not considered a virulent pathogen, clinicians, microbiologists, and infection control teams should be aware about its potential to cause outbreaks of nosocomial bloodstream infections, especially in immunocompromised patients bearing central venous catheters. [ABSTRACT FROM AUTHOR]

Purpose: Acinetobacter baumannii (Ab) is a Gram-negative opportunistic bacterium responsible for nosocomial infections or colonizations. It is considered one of the most alarming pathogens due to its multi-drug resistance and due to its mortality rate, ranging from 34 to 44,5% of hospitalized patients. The aim of the work is to create a predictive mortality model for hospitalized patient with Ab infection or colonization. Methods: A cohort of 140 sequentially hospitalized patients were randomized into a training cohort (TC) (100 patients) and a validation cohort (VC) (40 patients). Statistical bivariate analysis was performed to identify variables discriminating surviving patients from deceased ones in the TC, considering both admission time (T0) and infection detection time (T1) parameters. A custom logistic regression model was created and compared with models obtained from the "status" variable alone (Ab colonization/infection), SAPS II, and APACHE II scores. ROC curves were built to identify the best cut-off for each model. Results: Ab infection status, use of penicillin within 90 days prior to ward admission, acidosis, Glasgow Coma Scale, blood pressure, hemoglobin and use of NIV entered the logistic regression model. Our model was confirmed to have a better sensitivity (63%), specificity (85%) and accuracy (80%) than the other models. Conclusion: Our predictive mortality model demonstrated to be a reliable and feasible model to predict mortality in Ab infected/colonized hospitalized patients. [ABSTRACT FROM AUTHOR]

Cefepime/enmetazobactam (EXBLIFEP®), an intravenous (IV) antibacterial fixed-dose combination of a 4th generation cephalosporin and an extended-spectrum β-lactamase (ESBL) inhibitor, is being developed by Allecra Therapeutics and ADVANZ PHARMA for the treatment of infections caused by multi-drug-resistant (MDR) Gram-negative bacteria. In February 2024, cefepime/enmetazobactam was approved in the USA for use in adults with complicated urinary tract infections (cUTI) including pyelonephritis, caused by susceptible strains of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Enterobacter cloacae complex. In March 2024, cefepime/enmetazobactam was approved in the EU for use in adults for the treatment of cUTI, including pyelonephritis, and hospital-acquired pneumonia, including ventilator associated pneumonia, and the treatment of patients with bacteraemia occurring in association with or suspected to be associated with any of these infections. This article summarizes the milestones in the development of cefepime/enmetazobactam leading to this first approval for the treatment of adults with infections caused by MDR Gram-negative bacteria. [ABSTRACT FROM AUTHOR]

Novel antifungal drugs are urgently needed to treat candidiasis caused by the emerging fungal multidrug-resistant pathogen Candida auris. In this study, the most cost-effective drug repurposing technology was adopted to identify an appropriate option among the 1615 clinically approved drugs with anti-C. auris activity. High-throughput virtual screening of 1,3-beta-glucanosyltransferase inhibitors was conducted, followed by an analysis of the stability of 1,3-beta-glucanosyltransferase drug complexes and 1,3-beta-glucanosyltransferase–dutasteride metabolite interactions and the confirmation of their activity in biofilm formation and planktonic growth. The analysis identified dutasteride, a drug with no prior antifungal indications, as a potential medication for anti-auris activity in seven clinical C. auris isolates from Saudi Arabian patients. Dutasteride was effective at inhibiting biofilm formation by C. auris while also causing a significant reduction in planktonic growth. Dutasteride treatment resulted in disruption of the cell membrane, the lysis of cells, and crushed surfaces on C. auris, and significant (p-value = 0.0057) shrinkage in the length of C. auris was noted at 100,000×. In conclusion, the use of repurposed dutasteride with anti-C. auris potential can enable rapid recovery in patients with difficult-to-treat candidiasis caused by C. auris and reduce the transmission of nosocomial infection. [ABSTRACT FROM AUTHOR]

Chryseobacteria consists of important human pathogens that can cause a myriad of nosocomial infections. We isolated four multidrug‐resistant Chryseobacterium bacteria from activated sludge collected at domestic wastewater treatment facilities in the New York Metropolitan area. Their genomes were sequenced with Nanopore technology and used for a comprehensive resistomics comparison with 211 Chryseobacterium genomes available in the public databases. A majority of Chryseobacteria harbor 3 or more antibiotic resistance genes (ARGs) with the potential to confer resistance to at least two types of commonly prescribed antimicrobials. The most abundant ARGs, including β‐lactam class A (blaCGA‐1 and blaCIA) and class B (blaCGB‐1 and blaIND) and aminoglycoside (ranA and ranB), are considered potentially intrinsic in Chryseobacteria. Notably, we reported a new resistance cluster consisting of a chloramphenicol acetyltransferase gene catB11, a tetracycline resistance gene tetX, and two mobile genetic elements (MGEs), IS91 family transposase and XerD recombinase. Both catB11 and tetX are statistically enriched in clinical isolates as compared to those with environmental origins. In addition, two other ARGs encoding aminoglycoside adenylyltransferase (aadS) and the small multidrug resistance pump (abeS), respectively, are found co‐located with MGEs encoding recombinases (e.g., RecA and XerD) or transposases, suggesting their high transmissibility among Chryseobacteria and across the Bacteroidota phylum, particularly those with high pathogenicity. High resistance to different classes of β‐lactam, as well as other commonly used antimicrobials (i.e., kanamycin, gentamicin, and chloramphenicol), was confirmed and assessed using our isolates to determine their minimum inhibitory concentrations. Collectively, though the majority of ARGs in Chryseobacteria are intrinsic, the discovery of a new resistance cluster and the co‐existence of several ARGs and MGEs corroborate interspecies and intergenera transfer, which may accelerate their dissemination in clinical environments and complicate efforts to combat bacterial infections. [ABSTRACT FROM AUTHOR]

Introduction: Invasive device-associated nosocomial infections commonly occur in intensive care units (ICUs). These infections include intravascular catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). This study aimed to evaluate the factors associated with invasive device-associated nosocomial infections based on the underlying diseases of the patients and antibiotic resistance profiles of the pathogens causing the infections detected in the ICU in our hospital over a five-year period. Methodology: Invasive device-associated infections (CRBSI, VAP, and CAUTI) were detected retrospectively by the laboratory- and clinicbased active surveillance system according to the criteria of the US Centers for Disease Control and Prevention (CDC) in patients hospitalized in the ICU of the tertiary hospital between 1 January 2018 and 30 June 2023. Results: A total of 425 invasive device-associated nosocomial infections and 441 culture results were detected (179 CRBSI, 176 VAP, 70 CAUTI). Out of them, 57 (13.4%) patients had hematological malignancy, 145 (34.1%) had solid organ malignancy, and 223 (52.5%) had no histopathologic diagnosis of any malignancy. An increase in extended-spectrum beta lactamase (ESBL) and carbapenem resistance in pathogens was detected during the study period. Conclusions: Antibiotic resistance of the Gram-negative bacteria associated with invasive device-associated infections increased during the study period. Antimicrobial stewardship will reduce rates of nosocomial infections, reduce mortality, and shorten hospital stay. Long-term catheterization and unnecessary antibiotic use should be avoided. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa, a Gram-negative bacterium, presents a substantial challenge in healthcare due to its adaptability and resistance. This study delves into its genotypic characteristics, focusing on ESBL and MBL genes. The prevalence of P. aeruginosa in nosocomial infections, the research aims to decipher resistance mechanisms crucial for tailored interventions. The study includes 170 nonrepetitive clinical samples with protocols. Antibiotic susceptibility testing reveals diverse resistance patterns. Molecular detection of ESBL and MBL genes involves DNA isolation, PCR amplification, and gel electrophoresis. The study examined 170 P. aeruginosa samples, revealing gender-specific variations with 65.91% male and 34.09% female isolates. Antimicrobial testing displayed resistance in Ceftazidime (59%) and Ciprofloxacin (48%), while Ticarcillin-clavulanic acid showed promising sensitivity (58%). Molecular identification unveiled diverse resistance genes across sample types, emphasizing genetic complexity. The study underscores the urgency for targeted therapeutic interventions and novel antimicrobial strategies against P. aeruginosa infections. As antimicrobial resistance complexities persist, this research guides efforts toward a profound understanding of clinical interventions and strategic antimicrobial management. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFU) in patients with uncontrolled diabetes mellitus are considered a global public health menace that is highly associated with morbidity and mortality. Pathogenic microorganisms entrenched deep into diabetic foot wounds are the causative agents for delayed healing and escalation of diabetic foot wound severity. Pseudomonas aeruginosa is a common opportunistic pathogen associated with several nosocomial infections, cystic fibrosis, and one of the most critical pathogens often isolated from acute and chronic diabetic foot ulcers. The organism can exhibit resistance to a wide range of antibiotics like ciprofloxacin, cefotaxime, and meropenem, thereby causing severe damage to the host tissues, followed by amputation of the affected foot region. Due to their ability to synthesize biofilms, the wound becomes more chronic and incurable, posing a serious threat to immunocompromised diabetic patients. This review highlights on the insights of pathophysiology and microbiological profile of Diabetic foot ulcers, the resistance mechanisms, and the therapeutics available for dealing with drug-resistant Pseudomonas, which could help clinicians in treating DFUs. [ABSTRACT FROM AUTHOR]

Multidrug resistance patterns of Acinetobacter spp. have led to their emergence as an important source of nosocomial infections. This study investigated the prevalence and clinical characteristics of Acinetobacter spp. in hospital-acquired wound and urinary tract infections. A total of 432 samples [wound swabs (210) and urine samples (222)] were analyzed for the presence of Acinetobacter spp. through selective culturing on MacConkey and Leeds Acinetobacter medium followed by identification with API 20E strips and VITEK 2 compact system. Antimicrobial susceptibility was assessed by adopting the disk diffusion method on Muller-Hinton agar, whereas the minimum inhibitory concentration procedure was carried out by using a ComASP™ Colistin test kit. Biofilm formation was examined using microtiter plates and following the crystal violet staining method. PCR was performed to amplify virulence (lasB, bap, and plcN) and antimicrobial resistance (blaOXA-51like) genes. The results revealed a low prevalence of Acinetobacter spp. (1.85 %) where Acinetobacter baumannii was the predominant species. Acinetobacter baumannii isolates harbored blaOXA-51-like gene to exert extensive or pan-drug resistance. Most Acinetobacter baumannii isolates demonstrated weaker to moderate biofilm-forming capabilities and carried the bap gene. Acinetobacter baumannii isolates lacked the combination of virulence factors encoding lasB and plcN genes. Acinetobacter baumannii infections are rising in Saudi Arabia. The results of this study highlight the epidemiology of virulent and antibiotic-resistant Acinetobacter spp., particularly A. baumannii, in Saudi Arabia. The detailed elaboration on the diversity, virulence, and antimicrobial susceptibility patterns of Acinetobacter spp. in Saudi Arabia requires further in-depth molecular investigations. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa can quickly develop antibiotic resistance mainly through chromosomal mutations, and its carbapenem-resistant resulting from metallo-β-lactamases (MBL) has been reported to be a significant cause of nosocomial infection. Objectives: To characterize the antibiotic resistance profiles, detect carbapenemase production, and identify MBL encoding genes in P. aeruginosa isolates. Materials and Methods: P. aeruginosa was isolated (n=59) from patients at Hiwa Hematology/Oncology (n=31) Hospital and High-Quality Hospital (n=28) from June 2022 to January 2023. An antimicrobial susceptibility test, a CarbaNp test, and a combination detection test (CDT) were used to identify MBL producer isolates. Additionally, PCR targeting MBL-encoding genes for blaVIM, blaVIM, blaIMP, blaSPM, blaSIM and blaGIM was performed to provide additional confirmation. Results: Approximately 37% of the isolates exhibited multi-drug resistance (MDR), while 22% showed extensive drug resistance (XDR). About 30% of the isolates were resistant to carbapenem. Among carbapenem-resistant P. aeruginosa (CRPA), 61% and 56% had positive results for imp/EDTA combined disc and RAPIDEC® CARBA NPs, respectively, while 67% harbored MBL-encoding genes. blaVIM-2 was identified as the most prevalent gene (66.6%), followed by blaIMP-1 (16.6%), and then blaSIM-1 (11.1%). Conclusions: Multiplex PCR is a rapid and accurate technique to detect MBL-encoding genes. The blaVIM gene has been identified as the primary genetic determinant associated with carbapenemase production. [ABSTRACT FROM AUTHOR]

Introduction: The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. Method: This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. Result: A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). Conclusion: Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Critically ill patients with tuberculosis carry high mortality. Identification of factors associated with mortality in critically ill tuberculosis patients may enable focused treatment. DATA SOURCES: An extensive literature search of PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar was performed using Medical Subject Headings terms "tuberculosis," "critical care," "critical care outcome," and "ICU." We aimed to identify factors affecting mortality in critically ill tuberculosis patients. STUDY SELECTION: All the studies comparing factors affecting mortality between survivors and nonsurvivors in critically ill tuberculosis patients were included. The database search yielded a total of 3017 records, of which 17 studies were included in the meta-analysis. DATA EXTRACTION: Data were collected including the name of the author, year and country of publication, duration of the study, number of patients studied, type of tuberculosis, patient demography, smoking history, laboratory parameters, comorbidities, the requirement for mechanical ventilation, duration of ventilation, ICU and hospital length of stay (LOS), type of lung involvement, complications, and outcomes. DATA SYNTHESIS: The major factors that contributed to mortality in critically ill tuberculosis patients were age, platelet count, albumin, C-reactive protein (CRP), the requirement and duration of invasive mechanical ventilation, Pao2/Fio2 ratio, presence of acute respiratory distress syndrome, shock, hospital-acquired infections, renal replacement therapy, and ICU and hospital LOS. CONCLUSIONS: Patient age, platelet count, albumin and CRP levels, the requirement and duration of invasive mechanical ventilation, Pao2/Fio2 ratio, hospitalacquired infections, renal replacement therapy, and ICU LOS were variables associated with mortality. [ABSTRACT FROM AUTHOR]

The emergence of nosocomial infections (NCI) in Intensive care units (ICUs) that caused by antimicrobial Drug Resistance (AMR) Gram-Negative bacilli (GNB) has become a major public health threat since there is a limited effective treatment. This study is aimed to determine the Prevalence Rate of NCI, and the antibiotic susceptibility pattern of isolates. A cross-sectional study was conducted in six adult ICUs at Al Thawra General hospital, Sana'a, Yemen. A total of 117 admitted patients were included in the study from the period of 1st August to 31st October 2021. A pre-designed questionnaire was used for the collection of socio-demographic and clinical data, various clinical specimens were collected from NCI patients and processed using Vitek 2 automated system to identify the isolates and its susceptibility pattern. Carbapenemase producing was tested by Imipenem-EDTA synergy disc diffusion test according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using Epi-info version 7.2 statistical software packages (CDC, USA), and the results were presented as descriptive statistics: rates & frequency for categorical variables while, mean ±SD or\medium (minimum --maximum) for quantitative variables. The prevalence of NCI in ICUs was 46%. The most isolates were GNB (88%, 52/59). K pneumoniae was the most prevalent (37%, 19/52) while, P aeruginosa and A baumannii were the most resistant. The resistance for tested antibiotics was 98% (51/52) of isolates; 75% of them showed Extensive Drug Resistance (XDR), and 47% were Carbapenemase producers. However, most AMR-GNB is still susceptible to Polymyxin B and Colistin, the resistance has found to be 10% and 12 % respectively. The high prevalence of AMR-NCI in ICUs calls for an urgent establishment of a stewardship program with strict measures of Infection Prevention Control and regular monitoring of the resistant strains. [ABSTRACT FROM AUTHOR]

Objective: To establish the frequency of emerging pathogens and their susceptibility profiles amongst various healthcareassociated infections. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2020. Methodology: One hundred and ninety-six samples with a history of hospital-acquired infections were received and processed folowing standard microbiological techniques. Antibiotic susceptibility testing was done by the Kirby-Bauer Disk Diffusion technique for the commonly used antibiotics. For colistin susceptibility, the Clinical and Laboratory Standards Institute recommends broth microdilution, colistin broth disk elution, or colistin agar testing MIC methods, however, colistin susceptibility was performed by the E-strip method. Results: One hundred and ninety-six clinical samples with bacterial isolates causing healthcare-associated infections were processed. Specimens were from patients with surgical site infections (59,30.1%), Catheter-associated bloodstream infection (52, 26.5%); Ventilator-associated pneumonia (48, 24.5%) and Urinary tract infection (37,18.9%). Klebsiela pneumoniae (64, 32.7%), E.coli (51, 26%) and Acinetobacter baumani (45,23%) were the leading bacterial pathogens. A total of 72(36.7%) isolates showed multidrug resistance whereas extensively drug-resistant isolates were calculated to be 124(63.3%). Conclusion: High level of bacterial resistance amongst common health-care-associated infections is an eye-opener and impacts applying strict infection control measures along with antimicrobial stewardship. It wil also help clinicians modify empiric treatment regimes in affected patients. [ABSTRACT FROM AUTHOR]

Background: The human microbiota, K.oxytoca, is resistant to multiple drugs, endangering the lives of patients. Hypervirulent strains evolved into multidrug-resistant strains due to the acquisition of mobile genetic elements. Objectives: To detect the antibiotic-resistant profile and the related virulence genes in the hypervirulent and non-hypervirulent strains isolated from clinical specimens. Materials and methods: A total of 136 clinical samples were collected from patients at Baghdad City Hospitals, Iraq. The isolates were identified, and an antibiotics sensitivity test was carried out. The polymerase chain reaction typing method was used to detect the virulence genes. Results: The most frequent source of K. oxytoca was urine samples (36.03%), then blood samples (15.44%), particularly inpatient samples. About 12.5% of isolates were positive for the hypervirulent test (the string test). Isolates showed variable levels of resistance towards antibiotic groups. The blaCTX-M and aac(6’)-Ib-cr genes were revealed in 88% of isolates, and the blaOXA-48 gene was in 44%. All the tested isolates were negative for the rmpA gene. Conclusion: K. oxytoca is recognized as one of the leading causes of hospital-acquired infections. The rapid identification of antibiotics-resistant, hypervirulent isolates that present a considerable threat to human health is highly recommended in the local hospitals. [ABSTRACT FROM AUTHOR]

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) are a public health concern, causing infections with a high mortality rate, limited therapeutic options and challenging infection control strategies. In Portugal, the CR-KP rate has increased sharply, but the factors associated with this increase are poorly explored. In order to address this question, phylogenetic and resistome analysis were used to compare the draft genomes of 200 CR-KP isolates collected in 2017–2019 from five hospitals in the Lisbon region, Portugal. Most CR-KP belonged to sequence type (ST) 13 (29%), ST17 (15%), ST348 (13%), ST231 (12%) and ST147 (7%). Carbapenem resistance was conferred mostly by the presence of KPC-3 (74%) or OXA-181 (18%), which were associated with IncF/IncN and IncX plasmids, respectively. Almost all isolates were multi-drug resistant, harbouring resistance determinants to aminoglycosides, beta-lactams, trimethoprim, fosfomycin, quinolones and sulphonamides. In addition, 11% of isolates were resistant to colistin. Colonizing and infecting isolates were highly related, and most colonized patients (89%) reported a previous hospitalization. Moreover, among the 171 events of cross-dissemination identified by core genome multi-locus sequence typing data analysis (fewer than five allelic differences), 41 occurred between different hospitals and 130 occurred within the same hospital. The results suggest that CR-KP dissemination in the Lisbon region results from acquisition of carbapenemases in mobile genetic elements, influx of CR-KP into the hospitals by colonized ambulatory patients, and transmission of CR-KP within and between hospitals. Prudent use of carbapenems, patient screening at hospital entry, and improvement of infection control are needed to decrease the burden of CR-KP infection in Portugal. [ABSTRACT FROM AUTHOR]

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Background: Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. Objective: This article describes device and surgical procedure-related HAI epidemiology in Canada from 2018 to 2022. Methods: Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt (CSF) SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Results: Between 2018 and 2022, 2,258 device-related infections and 987 surgical procedurerelated infections were reported. A significant rate increase was observed in adult mixed intensive care unit CLABSIs (1.07-1.93 infections per 1,000 line days, p=0.05) and a nonsignificant rate increase was observed in SSIs following knee arthroplasty (0.31-0.42 infections per 100 surgeries, p=0.45). A fluctuating rate trend was observed in CSF shunt SSIs over the time period and a significant rate decrease in paediatric cardiac SSIs was observed (68%, from 7.5-2.4 infections per 100 surgeries, p=0.01). The most commonly identified pathogens were coagulase-negative staphylococci (22.8%) among CLABSIs and Staphylococcus aureus (42%) among SSIs. Conclusion: Epidemiological and microbiological trends among selected device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii is a non-fermentative Gram-negative bacterium that can cause nosocomial infections in critically ill patients. Carbapenem-resistant A. baumannii (CRAB) has spread rapidly in clinical settings and has become a key concern. The main objective of this study was to identify the distribution of integrons and biofilm-formation-related virulence genes in CRAB isolates. A total of 269 A. baumannii isolates (219 isolates of CRAB and 50 isolates of carbapenem-sensitive A. baumannii (CSAB)) were collected. Carbapenemase genes (blaKPC, blaVIM, blaIMP, blaNDM, and blaOXA-23-like) and biofilm-formation-related virulence genes (abal, bfms, bap, and cusE) were screened with PCR. Class 1 integron was screened with PCR, and common promoters and gene cassette arrays were determined with restriction pattern analysis combined with primer walking sequencing. Whole-genome sequencing was conducted, and data were analyzed for a blaOXA-23-like-negative isolate. All 219 CRAB isolates were negative for blaKPC, blaVIM, blaIMP, and blaNDM, while blaOXA-23-like was detected in 218 isolates. The detection rates for abal, bfms, bap, and cusE in 219 CRAB were 93.15%, 63.93%, 88.13%, and 77.63%, respectively. Class 1 integron was detected in 75 CRAB (34.25%) and in 3 CSAB. The single gene cassette array aacA4-catB8-aadA1 with relatively strong PcH2 promoter was detected in class 1 integrons. The blaOXA-23-like-negative CRAB isolate was revealed to be a new sequence type (Oxford 3272, Pasteur 2520) carrying blaOXA-72, blaOXA-259, and blaADC-26. In conclusion, blaOXA-23-like was the main reason for CRAB's resistance to carbapenems. A new (Oxford 3272, Pasteur 2520) CRAB sequence type carrying the blaOXA-72, blaOXA-259, and blaADC-26 was reported. [ABSTRACT FROM AUTHOR]

The issue of bacterial infections in COVID-19 patients has received increasing attention. Scant data are available on the impact of bacterial superinfection and antibiotic administration on the outcome of hospitalized COVID-19 patients. We conducted a literature review from 1 January 2022 to 31 March 2024 to assess the current burden of bacterial infection and the evidence for antibiotic use in hospitalized COVID-19 patients. Published articles providing data on antibiotic use in COVID-19 patients were identified through computerized literature searches with the search terms [(antibiotic) AND (COVID-19)] or [(antibiotic treatment) AND (COVID-19)]. PubMed and SCOPUS databases were searched from 1 January 2022 to 31 March 2024. No attempt was made to obtain information about unpublished studies. English language restriction was applied. The quality of the included studies was evaluated by the tool recommended by the Joanna Briggs Institute. Both quantitative and qualitative information were summarized by means of textual descriptions. Five hundred fifty-one studies were identified, and twenty-nine studies were included in this systematic review. Of the 29 included studies, 18 studies were on the prevalence of bacterial infection and antibiotic use in hospitalized COVID-19 patients; 4 studies reported on the efficacy of early antibiotic use in COVID-19; 4 studies were on the use of sepsis biomarkers to improve antibiotic use; 3 studies were on the efficacy of antimicrobial stewardship programs and predictive models among COVID-19-hospitalized patients. The quality of included studies was high in 35% and medium in 62%. High rates of hospital-acquired infections were reported among COVID-19 patients, ranging between 7.5 and 37.7%. A high antibiotic resistance rate was reported among COVID-19 patients developing hospital-acquired infections, with a high in-hospital mortality rate. The studies evaluating multi-faceted antimicrobial stewardship interventions reported efficacy in decreasing antibiotic consumption and lower in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Enterobacter cloacae, E. hormaechei and related subspecies remain the most clinically relevant among the Enterobacter cloacae complex (ECC). Carbapenemase-producing ECC strains are increasingly identified in hospital-acquired infections and usually belong to four main multilocus sequence types (MLST STs) named ST114, ST93, ST90 and ST78. Instead, ST182 has been sporadically reported among E. hormaechei strains, and recently, outbreaks of blaNDM-producing ST182 clonal strains have emerged. Herein, we aimed to investigate the presence of ST182 and explore its evolution and modes of blaNDM acquisition. Methods: A phylogenetic analysis of 646 MLST STs identified among 4685 E. hormaechei whole-genome sequencing (WGS) assemblies deposited in public repositories was performed, as well as an in silico comparative and phylogenomic analyses for 55 WGS assemblies of ST182. blaNDM-harboring contigs were also compared to published plasmid sequences. Results: ST182 E. hormaechei strains were recovered from patients on five continents during 2011–2021. They were divided into three major genomic clusters, comprising a separate clonal complex with six other STs. In 30 out of 55 ST182 WGS assemblies, blaNDM-harboring structures were identified that were similar to the plasmids predominant in Gram-negative bacteria, harboring resistance genes to multiple antibiotic classes and virulence genes. No associations between the genomic clusters and the country/continent of isolation or the presence and the plasmid types of the blaNDM-harboring contigs were observed. Conclusions: Our findings show that ST182 E. hormaechei strains have been identified in the past decade worldwide; 54.5% of them carried diverse blaNDM genetic structures, suggesting recent acquisition of the blaNDM alleles. Thus, blaNDM-harboring ST182 is an emerging multidrug-resistant and virulent lineage in ECC strains that requires close monitoring. [ABSTRACT FROM AUTHOR]

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Nosocomial pneumonia (NP) represents a leading nosocomial infection and results in substantial morbidity and cost. Over the last several years, the evidence has evolved which directs our approach to NP. Specifically, the definition of NP and classification of its various subtypes has expanded to capture nuances among various phenotypes of this syndrome. For example, segregating those with hospital-acquired pneumonia (HAP) based on whether they subsequently require mechanical ventilation has been shown to be important. Likewise, newer data indicate the true economic cost of NP and underscore the diverse range of pathogens that can cause NP. Moreover, multidrug-resistant (MDR) bacteria have become a major threat in NP. Fortunately, newer simple preventive strategies have been tested and found to be effective at reducing the incidence of NP. Should prevention fail, a range of new antibiotics have been formally studied in NP and found to be effective. Some of these novel agents have relatively broad ranges of activity and are in vitro active against select MDR organisms. Others, however, are narrower in spectrum and directed against specific problem bacteria. In short, the literature in the field of NP has progressed rapidly, and clinicians require a clear appreciation of these changes so as to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Pancreatic stone protein (PSP) exhibits potential as a plasma biomarker for infection diagnosis and risk stratification in critically ill patients, but its significance in nosocomial infection and intensive care unit (ICU)-acquired bloodstream infection (BSI) remains unclear. This study explores the temporal responses of PSP in ICU-acquired BSI caused by different pathogens. Methods: From a large cohort of ICU patients, we selected episodes of ICU-acquired BSI caused by Gram-negative rods (GNRs), enterococci, or Candida species. Events were matched on length of ICU stay at infection onset, Severe Organ Failure Assessment (SOFA) score, presence of immune deficiency, and use of renal replacement therapy. PSP concentrations were measured at infection onset (T0) and at 24, 48 and 72 h prior to infection onset as defined by the first occurrence of a positive blood culture. Absolute and trend differences in PSP levels between pathogen groups were analysed using one-way analysis of variance. Sensitivity analyses were performed in events with a new or worsening systematic inflammatory response based on C-reactive protein, white cell count and fever. Results: We analysed 30 BSI cases per pathogen group. Median (IQR) BSI onset was on day 9 (6–12). Overall, PSP levels were high (381 (237–539) ng/ml), with 18% of values exceeding the assay's measurement range. Across all 90 BSI cases, there was no clear trend over time (median change 34 (− 75–189) ng/ml from T-72 to T0). PSP concentrations at infection onset were 406 (229–497), 350 (223–608), and 480 (327–965) ng/ml, for GNR, enterococci, and Candida species, respectively (p = 0.32). At every time point, absolute PSP levels and trends did not differ significantly between pathogens. PSP values at T0 correlated with SOFA scores. Eighteen (20%) of 90 BSI events did not exhibit a systemic inflammatory response, primarily in Candida species. No clear change in PSP concentration before BSI onset or between-group differences were found in sensitivity analyses of 72 cases. Conclusions: Against a background of overall (very) high plasma PSP levels in critically ill patients, we did not find clear temporal patterns or any pathogen-specific differences in PSP response in the days preceding onset of ICU-acquired BSI. [ABSTRACT FROM AUTHOR]

Introduction: Carbapenemase-Producing Escherichia coli (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure. Methods: Ninety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and wholegenome sequencing was performed. Antibiotic resistance and virulenceassociated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed. Results and discussion: The 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were blaOXA-48 (45.6%), blaVIM-1 (23.3%), blaNDM-1 (7.8%), blaKPC-3 (6.7%), and blaNDM-5 (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored blaNDM. Five of the plazomicin-resistant isolates harbored rmt. IncL plasmids were the most frequent (45.7%) and eight of these harbored blaVIM-1. blaOXA-48 was found in IncF plasmids in eight isolates. Metallo-β-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with sat and pap virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections. [ABSTRACT FROM AUTHOR]

There are few studies comparing proportion, frequency, mortality and mortality rate following antimicrobial-resistant (AMR) infections between tertiary-care hospitals (TCHs) and secondary-care hospitals (SCHs) in low and middle-income countries (LMICs) to inform intervention strategies. The aim of this study is to demonstrate the utility of an offline tool to generate AMR reports and data for a secondary data analysis. We conducted a secondary-data analysis on a retrospective, multicentre data of hospitalised patients in Thailand. Routinely collected microbiology and hospital admission data of 2012 to 2015, from 15 TCHs and 34 SCHs were analysed using the AMASS v2.0 (www.amass.website). We then compared the burden of AMR bloodstream infections (BSI) between those TCHs and SCHs. Of 19,665 patients with AMR BSI caused by pathogens under evaluation, 10,858 (55.2%) and 8,807 (44.8%) were classified as community-origin and hospital-origin BSI, respectively. The burden of AMR BSI was considerably different between TCHs and SCHs, particularly of hospital-origin AMR BSI. The frequencies of hospital-origin AMR BSI per 100,000 patient-days at risk in TCHs were about twice that in SCHs for most pathogens under evaluation (for carbapenem-resistant Acinetobacter baumannii [CRAB]: 18.6 vs. 7.0, incidence rate ratio 2.77; 95%CI 1.72–4.43, p<0.001; for carbapenem-resistant Pseudomonas aeruginosa [CRPA]: 3.8 vs. 2.0, p = 0.0073; third-generation cephalosporin resistant Escherichia coli [3GCREC]: 12.1 vs. 7.0, p<0.001; third-generation cephalosporin resistant Klebsiella pneumoniae [3GCRKP]: 12.2 vs. 5.4, p<0.001; carbapenem-resistant K. pneumoniae [CRKP]: 1.6 vs. 0.7, p = 0.045; and methicillin-resistant Staphylococcus aureus [MRSA]: 5.1 vs. 2.5, p = 0.0091). All-cause in-hospital mortality (%) following hospital-origin AMR BSI was not significantly different between TCHs and SCHs (all p>0.20). Due to the higher frequencies, all-cause in-hospital mortality rates following hospital-origin AMR BSI per 100,000 patient-days at risk were considerably higher in TCHs for most pathogens (for CRAB: 10.2 vs. 3.6,mortality rate ratio 2.77; 95%CI 1.71 to 4.48, p<0.001; CRPA: 1.6 vs. 0.8; p = 0.020; 3GCREC: 4.0 vs. 2.4, p = 0.009; 3GCRKP, 4.0 vs. 1.8, p<0.001; CRKP: 0.8 vs. 0.3, p = 0.042; and MRSA: 2.3 vs. 1.1, p = 0.023). In conclusion, the burden of AMR infections in some LMICs might differ by hospital type and size. In those countries, activities and resources for antimicrobial stewardship and infection control programs might need to be tailored based on hospital setting. The frequency and in-hospital mortality rate of hospital-origin AMR BSI are important indicators and should be routinely measured to monitor the burden of AMR in every hospital with microbiology laboratories in LMICs. [ABSTRACT FROM AUTHOR]

Background: Avoiding excessive antibiotic treatment duration is a fundamental goal in antimicrobial stewardship. Manual collection of data is a time-consuming process, but a semi-automated approach for data extraction has been shown feasible for community-acquired infections (CAI). Extraction of data however may be more challenging in hospital-acquired infections (HAI). The aim of this study is to explore whether semi-automated data extraction of treatment duration is also feasible and accurate for HAI. Methods: Data from a university-affiliated hospital over the period 1-6-2020 until 1-6-2022 was used for this study. From the Electronic Health Record, raw data on prescriptions, registered indications and admissions was extracted and processed to define treatment courses. In addition, clinical notes including prescription instructions were obtained for the purpose of validation. The derived treatment course was compared to the registered indication and the actual length of treatment (LOT) in the clinical notes in a random sample of 5.7% of treatment courses, to assess the accuracy of the data for both CAI and HAI. Results: Included were 10.564 treatment courses of which 73.1% were CAI and 26.8% HAI. The registered indication matched the diagnosis as recorded in the clinical notes in 79% of treatment courses (79.2% CAI, 78.5% HAI). Higher error rates were seen in urinary tract infections (UTIs) (29.0%) and respiratory tract infections (RTIs) (20.5%) compared to intra-abdominal infections (7.4%), or skin or soft tissue infections (11.1%), mainly due to incorrect specification of the type of UTI or RTI. The LOT was accurately extracted in 98.5% of courses (CAI 98.2%, HAI 99.3%) when compared to prescriptions in the EHR. In 21% of cases however the LOT did not match with the clinical notes, mainly if patients received treatment from other health care providers preceding or following the present course. Conclusion: Semi-automatic data extraction can yield reliable information about the indication and LOT in treatment courses of hospitalized patients, for both HAI and CAI. This can provide stewardship programs with a surveillance tool for all in-hospital treated infections, which can be used to achieve stewardship goals. [ABSTRACT FROM AUTHOR]

Background: Extended illness-death models (a specific class of multistate models) are a useful tool to analyse situations like hospital-acquired infections, ventilation-associated pneumonia, and transfers between hospitals. The main components of these models are hazard rates and transition probabilities. Calculation of different measures and their interpretation can be challenging due to their complexity. Methods: By assuming time-constant hazards, the complexity of these models becomes manageable and closed mathematical forms for transition probabilities can be derived. Using these forms, we created a tool in R to visualize transition probabilities via stacked probability plots. Results: In this article, we present this tool and give some insights into its theoretical background. Using published examples, we give guidelines on how this tool can be used. Our goal is to provide an instrument that helps obtain a deeper understanding of a complex multistate setting. Conclusion: While multistate models (in particular extended illness-death models), can be highly complex, this tool can be used in studies to both understand assumptions, which have been made during planning and as a first step in analysing complex data structures. An online version of this tool can be found at https://eidm.imbi.uni-freiburg.de/. [ABSTRACT FROM AUTHOR]

Nosocomial infections represent a major threat within healthcare systems worldwide, underscoring the critical need for materials with antimicrobial properties. This study presents the development of polyurethane foam embedded with silver nanoparticles (PUF/AgNPs) using a rapid, eco-friendly, in situ radiochemical synthesis method. The nanocomposites were characterized by UV–vis and FTIR spectroscopy, scanning electron microscopy coupled with energy dispersive X-ray technique (SEM/EDX), differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), tensile and compression strengths, antimicrobial activity, and foam toxicity tests. The resulting PUF/AgNPs demonstrated prolonged stability (over 12 months) and good dispersion of AgNPs. Also, the samples presented higher levels of hardness compared to samples without AgNPs (deformation of 1682 µm for V1 vs. 4307 µm for V0, under a 5 N force), tensile and compression strength of 1.80 MPa and 0.34 Mpa, respectively. Importantly, they exhibited potent antimicrobial activity against a broad range of bacteria (including Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis) and a fungal mixture (no fungal growth on the sample surface was observed after 28 days of exposure). Furthermore, these materials were non-toxic to human keratinocytes, which kept their specific morphology after 24 h of incubation, highlighting their potential for safe use in biomedical applications. We envision promising applications for PUF/AgNPs in hospital bed mattresses and antimicrobial mats, offering a practical strategy to reduce nosocomial infections and enhance patient safety within healthcare facilities. [ABSTRACT FROM AUTHOR]

Successful microbial colonization of the gastrointestinal (GI) tract hinges on an organism's ability to overcome the intense competition for nutrients in the gut between the host and the resident gut microbiome. Enteric pathogens can exploit ethanolamine (EA) in the gut to bypass nutrient competition. However, Klebsiella pneumoniae (K. pneumoniae) is an asymptomatic gut colonizer and, unlike well-studied enteric pathogens, harbors two genetically distinct ethanolamine utilization (eut) loci. Our investigation uncovered unique roles for each eut locus depending on EA utilization as a carbon or nitrogen source. Murine gut colonization studies demonstrated the necessity of both eut loci in the presence of intact gut microbiota for robust GI colonization by K. pneumoniae. Additionally, while some Escherichia coli gut isolates could metabolize EA, other commensals were incapable, suggesting that EA metabolism likely provides K. pneumoniae a selective advantage in gut colonization. Molecular and bioinformatic analyses unveiled the conservation of two eut loci among K. pneumoniae and a subset of the related taxa in the K. pneumoniae species complex, with the NtrC-RpoN regulatory cascade playing a pivotal role in regulation. These findings identify EA metabolism as a critical driver of K. pneumoniae niche establishment in the gut and propose microbial metabolism as a potential therapeutic avenue to combat K. pneumoniae infections. Author summary: Klebsiella pneumoniae (K. pneumoniae) is a leading cause of nosocomial infections but is considered a silent gut colonizer. A molecular understanding of how K. pneumoniae colonizes the GI tract and overcomes host- and resident gut microbiota-mediated colonization resistance requires further investigation. A direct mechanism of colonization resistance is through competition for the same nutrient resources. K. pneumoniae can sidestep nutrient competition by metabolizing ethanolamine as an alternative nutrient source, thus overcoming microbiota-mediated colonization resistance. The unique ethanolamine utilization loci of K. pneumoniae are both required for robust gut colonization and are conserved among K. pneumoniae, suggesting that ethanolamine metabolism is an important mediator of gut colonization. [ABSTRACT FROM AUTHOR]

Background: Infections caused by multidrug-resistant gram-negative bacteria present a severe threat to global public health. The WHO defines drug-resistant Klebsiella pneumoniae as a priority pathogen for which alternative treatments are needed given the limited treatment options and the rapid acquisition of novel resistance mechanisms by this species. Longitudinal descriptions of genomic epidemiology of Klebsiella pneumoniae can inform management strategies but data from sub-Saharan Africa are lacking. Methods: We present a longitudinal analysis of all invasive K. pneumoniae isolates from a single hospital in Blantyre, Malawi, southern Africa, from 1998 to 2020, combining clinical data with genome sequence analysis of the isolates. Results: We show that after a dramatic increase in the number of infections from 2016 K. pneumoniae becomes hyperendemic, driven by an increase in neonatal infections. Genomic data show repeated waves of clonal expansion of different, often ward-restricted, lineages, suggestive of hospital-associated transmission. We describe temporal trends in resistance and surface antigens, of relevance for vaccine development. Conclusions: Our data highlight a clear need for new interventions to prevent rather than treat K. pneumoniae infections in our setting. Whilst one option may be a vaccine, the majority of cases could be avoided by an increased focus on and investment in infection prevention and control measures, which would reduce all healthcare-associated infections and not just one. [ABSTRACT FROM AUTHOR]

A convenient synthetic strategy has been developed for the synthesis of a pentasaccharide related to the cell wall O‐polysaccharide of Acinetobacter baumannii (A. baumannii) 90 in very good yield applying a stereoselective [3+2] block glycosylation reaction. The synthesis of the target pentasaccharide was challenging due to the presence of a rare sugar, 4‐amino‐4‐deoxy‐D‐fucose and several α‐glycosidic linkages in it. The construction of 1,2‐cis glycosyl linkages were achieved using a combination of copper(II) bromide and tetra‐n‐butylammonium bromide (TBAB) or a combination of N‐iodosuccinimide (NIS) and trimethylsilyl trifluoromethanesulfonate (TMSOTf) as thiophilic glycosylation activator. Perchloric acid supported over silica (HClO4‐SiO2) mediated orthogonal glycosylation reaction has been carried out using glycosyl trichloroacetimidate derivative as donor and thioglycoside as acceptor. [ABSTRACT FROM AUTHOR]

Background: Packed red blood cell (PRBC) transfusion has been shown to increase nosocomial infection risk in the injured population; however, the post-traumatic infectious risk profiles of non-PRBC blood products are less clear. We hypothesized that plasma (fresh frozen plasma [FFP]), platelet (PLT), and cryoprecipitate administration would not be associated with increased rates of nosocomial infections. Patients and Methods: We performed a retrospective, matched, case-control study utilizing the American College of Surgeons National Trauma Data Bank data for 2019. We included all patients who received any volume of PRBC within four hours of presentation. Our outcome of interest was any infection. Controls were matched to cases using individual matching with a desired 1:3 case:control ratio. Bivariable analysis according to infection status, and multivariable logistic regression modeling the development of infection were then performed upon the matched data. Results: A total of 1,563 infectious cases were matched to 3,920 non-infectious controls. First four-hour transfusion volumes for FFP, PLT, and cryoprecipitate in the infection group exceeded those in the control group. The first four-hour FFP transfusion volume (per unit odds ratio [OR], 1.02; 95% confidence interval [CI], 0.99–1.04; p = 0.28) and cryoprecipitate transfusion volume (per unit OR, 1.01; 95% CI, 0.99–1.02; p = 0.43) were similar in cases and controls whereas PLT transfusion volume (per unit OR, 0.92; 95% CI, 0.86–0.98; p = 0.01) was lower in cases of infection than in controls. Conclusions: Fresh frozen plasma, PLT, and cryoprecipitate transfusion volumes were not independent risk factors for the development of nosocomial infection in a trauma population. PLT transfusion volume was associated with less infection. [ABSTRACT FROM AUTHOR]

The genus Acinetobacter comprises both environmental and clinically relevant species associated with hospital-acquired infections. Among them, Acinetobacter baumannii is a critical priority bacterial pathogen, for which the research and development of new strategies for antimicrobial treatment are urgently needed. Acinetobacter spp. produce a variety of structurally diverse capsular polysaccharides (CPSs), which surround the bacterial cells with a thick protective layer. These surface structures are primary receptors for capsule-specific bacteriophages, that is, phages carrying tailspikes with CPS-depolymerizing/modifying activities. Phage tailspike proteins (TSPs) exhibit hydrolase, lyase, or esterase activities toward the corresponding CPSs of a certain structure. In this study, the data on all lytic capsule-specific phages infecting Acinetobacter spp. with genomes deposited in the NCBI GenBank database by January 2024 were summarized. Among the 149 identified TSPs encoded in the genomes of 143 phages, the capsular specificity (K specificity) of 46 proteins has been experimentally determined or predicted previously. The specificity of 63 TSPs toward CPSs, produced by various Acinetobacter K types, was predicted in this study using a bioinformatic analysis. A comprehensive phylogenetic analysis confirmed the prediction and revealed the possibility of the genetic exchange of gene regions corresponding to the CPS-recognizing/degrading parts of different TSPs between morphologically and taxonomically distant groups of capsule-specific Acinetobacter phages. [ABSTRACT FROM AUTHOR]

Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like herpes simplex and varicella zoster, and fungi-like Candida species appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result. Key Words: burn wound infections; biofilm; epidermis; hospital; opportunistic infection [ABSTRACT FROM AUTHOR]

The purpose of this review is both to evaluate the impact of the association of nosocomial infections, dental and somatic pathology in patients with depression, because the presence of comorbidities leads to an increase in health care costs, as well as to evaluate the importance of multidisciplinary care of these patients. Chronic depression correlated, independently, more frequently with the state of somatic health compared to episodic depression thus emphasizing the need for prompt treatment of depression. Nosocomial infections associated with depression are a constant concern in the medical field, despite significant advances in patient care. These infections, occurring within medical institutions, constitute a major problem in the health system, generating significant morbidity and mortality, and involving substantial socio-economic costs. There is a higher prevalence of cardiovascular diseases and strokes in patients suffering from recurrent depressive disorder. It is possible that anxiety through serotonergic dysfunction represents the physio-pathological link that establishes the depressionanxiety-somatic pathology connection. The physical health of patients with depression must also include prevention of oral pathology through oral hygiene advice, management of iatrogenic dry mouth and early dental visits. Osteo-articular diseases increase the risk of suicide, while cardiovascular diseases lead to an increase in the frequency of episodes and hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa is a common cause of nosocomial infections. However, the emergence of multidrug-resistant strains has complicated the treatment of P. aeruginosa infections. While polymyxins have been the mainstay for treatment, there is a global increase in resistance to these antibiotics. Therefore, our study aimed to determine the prevalence and molecular details of colistin resistance in P. aeruginosa clinical isolates collected between June 2019 and May 2023, as well as the genetic linkage of colistin-resistant P. aeruginosa isolates. Results: The resistance rate to colistin was 9% (n = 18) among P. aeruginosa isolates. All 18 colistin-resistant isolates were biofilm producers and carried genes associated with biofilm formation. Furthermore, the presence of genes encoding efflux pumps, TCSs, and outer membrane porin was observed in all colistin-resistant P. aeruginosa strains, while the mcr-1 gene was not detected. Amino acid substitutions were identified only in the PmrB protein of multidrug- and colistin-resistant strains. The expression levels of mexA, mexC, mexE, mexY, phoP, and pmrA genes in the 18 colistin-resistant P. aeruginosa strains were as follows: 88.8%, 94.4%, 11.1%, 83.3%, 83.3%, and 38.8%, respectively. Additionally, down-regulation of the oprD gene was observed in 44.4% of colistin-resistant P. aeruginosa strains. Conclusion: This study reports the emergence of colistin resistance with various mechanisms among P. aeruginosa strains in Ardabil hospitals. We recommend avoiding unnecessary use of colistin to prevent potential future increases in colistin resistance. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired influenza (HAI) is under-recognized despite its high morbidity and poor health outcomes. The early detection of HAI is crucial for curbing its transmission in hospital settings. Aim: This study aimed to investigate factors related to HAI, develop predictive models, and subsequently compare them to identify the best performing machine learning algorithm for predicting the occurrence of HAI. Methods: This retrospective observational study was conducted in 2022 and included 111 HAI and 73,748 non-HAI patients from the 2011–2012 and 2019–2020 influenza seasons. General characteristics, comorbidities, vital signs, laboratory and chest X-ray results, and room information within the electronic medical record were analysed. Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGB), and Artificial Neural Network (ANN) techniques were used to construct the predictive models. Employing randomized allocation, 80% of the dataset constituted the training set, and the remaining 20% comprised the test set. The performance of the developed models was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), the count of false negatives (FN), and the determination of feature importance. Results: Patients with HAI demonstrated notable differences in general characteristics, comorbidities, vital signs, laboratory findings, chest X-ray result, and room status compared to non-HAI patients. Among the developed models, the RF model demonstrated the best performance taking into account both the AUC (83.3%) and the occurrence of FN (four). The most influential factors for prediction were staying in double rooms, followed by vital signs and laboratory results. Conclusion: This study revealed the characteristics of patients with HAI and emphasized the role of ventilation in reducing influenza incidence. These findings can aid hospitals in devising infection prevention strategies, and the application of machine learning-based predictive models especially RF can enable early intervention to mitigate the spread of influenza in healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia (VAP) is defined as infection of lung parenchyma in patients exposed to invasive mechanical ventilation for at least 48 h. VAP is the second most common hospital-acquired infection with a mortality rate up to 40%. Aims and Objectives: To determine the microbiological profile of VAP-related samples, the demographic profile of patients, and associated risk factors. Materials and Methods: VAPrelated samples including endotracheal tube tip, tracheal secretions, and bronchoalveolar lavage (BAL) fluid were collected from 73 patients during the study period from January 2023 to November 2023. Their blood samples were also collected for automated blood culture. Samples were processed as per standard protocol. Results: Out of the total patients, 60.31% were male and 39.68% were female. 61-80 years was the most commonly affected age group. The most commonly isolated micro-organism was Acinetobacter baumannii with the highest sensitivity to polymixin B and tigecycline. Associated blood culture positivity was maximum in patients whose samples of ET tube tip, tracheal secretions, and BAL fluid had isolated A. baumannii and Klebsiella pneumoniae. Two Candida albicans were isolated with sensitivities to voriconazole and amphotericin B. Many patients had associated septicemia. Endotracheal intubation and tracheal suction were the most common risk factors associated. Conclusion: As associated septicemia may increase the mortality rate manifold blood samples should also be collected in suspected VAP patients along with VAP-related samples for early detection of sepsis leading to better patient management. [ABSTRACT FROM AUTHOR]

Pneumonia is a global health concern, causing significant morbidity and mortality, particularly among vulnerable populations. This study, conducted at Dr. Soetomo Regional Public Hospital (RSUD Dr. Soetomo), Surabaya, Indonesia, aimed to assess the causative pathogens, antibiotic sensitivity patterns, and the impact of empiric therapy on the clinical outcomes of pneumonia patients. The present study analyzed 324 cases from January to March 2023, categorizing pneumonia as communityacquired (CAP), hospital-acquired (HAP), and ventilator-associated (VAP). Gram-negative bacteria, predominantly Klebsiella pneumoniae, were the primary pathogens, with 44% being multidrug-resistant. Antibiotic sensitivity patterns highlighted the efficacy of amikacin, cefoperazone sulbactam, and meropenem against Gram-negative bacteria. Empiric therapy, mainly monotherapy, showed varied outcomes across pneumonia types. Clinical improvement was observed in 72.5% of CAP patients, while HAP and VAP patients faced challenges, with high mortality rates of 47.2% and 89.1%, respectively. Clinical stability in CAP correlated with age, culture results, multidrug resistance, pneumonia severity, and antibiotic class. In HAP, appropriate empiric therapy and pneumonia severity influenced clinical outcomes. Notably, VAP patients experienced poor outcomes irrespective of the variables studied. This study underscores the importance of local pathogen prevalence awareness and tailored empiric therapy to enhance pneumonia management, especially in HAP and VAP cases. Further research is warranted to refine treatment strategies and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas (P. aeruginosa) is a worrisome multidrug (MDR) or even extensively drug-resistant (XDR) nosocomial pathogen. Ceftolozane/tazobactam(C/T) and ceftazidime/avibactam (CAZ/AVI), novel combinations, were recently approved for the treatment of MDR Gram-negative pathogens. Objective: To assess the in vitro activity of C/T & CAZ/AVI and against MDR/XDR P. aeruginosa isolates, detect the synergistic activity of CAZ/AVI plus aztreonam (ATM) against metallo-ß-lactamase) MßL(producers and to determine the virulence profile of the studied isolates. Methods: Eighty P. aeruginosa strains were isolated from hospitalized patients and screened for their antimicrobial susceptibility pattern by disk diffusion test. Different resistance mechanisms; beta-lactam hydrolyzing enzymes (ESßLs, AmpC, and class A & B carbapenemases), biofilm production and efflux pump-mediated colistin resistance mechanisms were characterized by the corresponding phenotypic methods. Multiplex PCR verified some resistance (blaVIM, blaKPC, mcr-1 & mcr-2) and virulence (exoU and exoS) genes. We applied E-test strip superposition method to detect synergistic effect between CAZ/AVI and ATM. Results: 32.5% and 52.5% of P. aeruginosa isolates were recovered as MDR and XDR isolates respectively. The frequency of beta-lactamase production reached 12.5% for ESßLs, 46.25% for AmpC, 21.4% for class A and 55.4% for class B carbapenemases. About 81.3% and 63.7% of the isolates proved susceptibility to CAZ/AVI and C/T respectively. While only 36.3% were ATM susceptible. Interestingly, combined use of CAZ/AVI with ATM completely restored susceptibility among MßL strains. Conclusion: Synergistic combination of CAZ/AVI with ATM could be promising therapy against MDR/XDR P. aeruginosa infections with MßL production. [ABSTRACT FROM AUTHOR]

Background: Pseudomonas aeruginosa is an opportunistic pathogen that represents a global public health threat. Immunocompromised hosts and cystic fibrosis patients are primarily susceptible to high morbidity and mortality due to pulmonary tract colonization with mucoid Pseudomonas aeruginosa. Differentially expressed virulence factors govern Pseudomonas aeruginosa pathogenicity in different sites of infection. Therefore, the detection of site-specific virulence genes in Pseudomonas aeruginosa isolates may potentially predict the level of Pseudomonas aeruginosa pathogenicity and the outcome in infected patients. Objectives: This study aims to phenotypically and genotypically characterize nosocomial Pseudomonas aeruginosa isolates from different clinical specimens to determine the frequency of LasB, ExoS and Nan1 virulence genes in the collected isolates relative to the site and severity of Pseudomonas aeruginosa infection using conventional polymerase chain reaction. Methods: The study was carried out on 30 Pseudomonas aeruginosa isolates collected from hospitalized patients who have been diagnosed with respiratory tract, bloodstream or burn infection in Tanta University Hospitals. Pseudomonas aeruginosa isolates were phenotypically characterized using standard microbiology techniques and genotypically characterized using conventional PCR for the detection of LasB, ExoS and Nan1 virulence genes. Results: Both Nan1 and ExoS genes were detected in Pseudomonas aeruginosa isolates from 30% of respiratory and burn infections but they were undetectable in all isolates from bloodstream infections. While, LasB gene was detected in all types of clinical specimens (100% of respiratory specimens, 90% of pus and 90% of blood specimens). A significant correlation was found between the site, severity of infection and the presence of multiple virulence genes. Conclusion: Our study reveals site and severity specific detection of certain Pseudomonas aeruginosa virulence genes which may suggest site and severity specific pathogenesis of certain Pseudomonas aeruginosa strains. Our data also imply that precision targeting of specific virulence factors detected in certain infection sites and/or severity should improve therapeutic outcomes of Pseudomonas aeruginosa infections. [ABSTRACT FROM AUTHOR]

Background: Enterococci, particularly those that produce biofilm, can cause different infections ranging from simple infections to sepsis. This study aims to understand the effect of sub-inhibitory concentrations of antibiotics (ampicillin, vancomycin, ciprofloxacin and tetracycline) on biofilm formation of Enterococcus and its association with virulence genes (asa1, esp and gel E). Methods: This cross-sectional study included Enterococci strains isolated from different microbiological samples. Disk diffusion and microtiter plate techniques were used to examine the isolates antibiotic sensitivity and biofilm production respectively. Isolates were investigated for asa1, esp and gel E genes using multiplex PCR. Minimum inhibitory concentration (MIC) of ampicillin, vancomycin, ciprofloxacin, and tetracycline for strong biofilm forming isolates was determined by broth microdilution then the sub-MIC effect of these antibiotics on their biofilm formation was evaluated. Results: A total of 80 Enterococcus (65 Enterococcus faecalis and 15 Enterococcus faecium) strains were identified. Compared to Enterococcus faecalis, Enterococcus faecium showed higher antibiotics resistance and lower biofilm formation. asa 1, esp and gel E genes were detected in 44.6%, 60.0% and 76.9% of Enterococcus faecalis and 40.0%, 33.3% and 26.7% of Enterococcus faecium respectively with higher frequency of these genes among biofilm forming isolates. Of the four selected antibiotics, sub-inhibitory concentrations of only ampicillin and vancomycin significantly enhanced biofilm density of Enterococcus faecalis while Enterococcus faecium was not significantly affected. Conclusion: Increased biofilm formation in some isolates at different sub-MIC ensures the significance of appropriate antibiotic use to reduce the danger of resistant bacteria selection. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii (AB) is a gram-negative bacterium and a main source of nosocomial infection that mainly affect immunocompromised individuals. Methylene blue (MB) is commonly used for staining in microbiology but in this article MB is used as resisting agent against AB. The main aim of this study is to find the most possible cure against A. baunannii. Isolated strains of A. baumannii were subcultured on Muller-Hinton agar (MHA) containing MB and sub-cultured on eosin methylene blue (EMB). Then antibiotic susceptibility testing (AST) and minimum inhibitory concentration (MIC) were determined. The A. baumannii isolates were highly inhibited by EMB medium but showed growth on MHA plates containing MB. The results infer that A. baumannii shows sensitivity against Meropenem. In-vitro studied effect of methylene blue shows inhibition against carbapenem resistance A. baumannii growth was also inhibited by EMB agar. AB strains showed sensitivity against synergistic combinational drugs (Meropenem + Amikacin), (Meropenem + Ciprofloxacin) (Imipenem + Tobramycin), these strains showed resistance against additive combinational drugs (Meropenem + Cefepime) and (Imipenem + Tobramycin), (Ciprofloxacin), (Cefepime) as compared with individually. [ABSTRACT FROM AUTHOR]

In an era of increasing antibiotic resistance among pathogens, the treatment options for infectious diseases are diminishing. One of the clinical groups especially vulnerable to this threat are patients who are hospitalized in intensive care units due to ventilator-associated pneumonia caused by multidrug-resistant/extensively drug-resistant Gram-negative bacteria. In order to prevent the exhaustion of therapeutic options for this life-threatening condition, there is an urgent need for new pharmaceuticals. Novel β-lactam antibiotics, including combinations of cephalosporins with β-lactamase inhibitors, are proposed as a solution to this escalating problem. The unique mechanism of action, distinctive to this new group of siderophore cephalosporins, can overcome multidrug resistance, which is raising high expectations. In this review, we present the summarized results of clinical trials, in vitro studies, and case studies on the therapeutic efficacy of cefoperazone-sulbactam, ceftolozane-tazobactam, ceftazidime-avibactam, and cefiderocol in the treatment of ventilator-associated pneumonia. We demonstrate that treatment strategies based on siderophore cephalosporins and combinations of β-lactams with β-lactamases inhibitors show comparable or higher clinical efficacy than those used with classic pharmaceuticals, like carbapenems, colistin, or tigecycline, and are often associated with a lower risk of adverse events. [ABSTRACT FROM AUTHOR]

Patients hospitalized in ICUs with severe COVID-19 are at risk for developing hospital-acquired infections, especially infections caused by Pseudomonas aeruginosa. We aimed to describe the evolution of P. aeruginosa infections in ICUs at CHRU-Nancy (France) in patients with severe COVID-19 during the three initial waves of COVID-19. The second aims were to analyze P. aeruginosa resistance and to describe the antibiotic treatments. We conducted a retrospective cohort study among adult patients who were hospitalized for acute respiratory distress syndrome due to COVID-19 and who developed a hospital-acquired infection caused by P. aeruginosa during their ICU stay. Among the 51 patients included, most were male (90%) with comorbidities (77%), and the first identification of P. aeruginosa infection occurred after a median ICU stay of 11 days. Several patients acquired infections with MDR (27%) and XDR (8%) P. aeruginosa strains. The agents that strains most commonly exhibited resistance to were penicillin + β-lactamase inhibitors (59%), cephalosporins (42%), monobactams (32%), and carbapenems (27%). Probabilistic antibiotic treatment was prescribed for 49 patients (96%) and was subsequently adapted for 51% of patients after antibiogram and for 33% of patients after noncompliant antibiotic plasma concentration. Hospital-acquired infection is a common and life-threatening complication in critically ill patients. Efforts to minimize the occurrence and improve the treatment of such infections, including infections caused by resistant strains, must be pursued. [ABSTRACT FROM AUTHOR]

In recent years, antibiotic therapy has encountered significant challenges due to the rapid emergence of multidrug resistance among bacteria responsible for life‐threatening illnesses, creating uncertainty about the future management of infectious diseases. The escalation of antimicrobial resistance in the post‐COVID era compared to the pre‐COVID era has raised global concern. The prevalence of nosocomial‐related infections, especially outbreaks of drug‐resistant strains of Staphylococcus aureus, have been reported worldwide, with India being a notable hotspot for such occurrences. Various virulence factors and mutations characterize nosocomial infections involving S. aureus. The lack of proper alternative treatments leading to increased drug resistance emphasizes the need to investigate and examine recent research to combat future pandemics. In the current genomics era, the application of advanced technologies such as next‐generation sequencing (NGS), machine learning (ML), and quantum computing (QC) for genomic analysis and resistance prediction has significantly increased the pace of diagnosing drug‐resistant pathogens and insights into genetic intricacies. Despite prompt diagnosis, the elimination of drug‐resistant infections remains unattainable in the absence of effective alternative therapies. Researchers are exploring various alternative therapeutic approaches, including phage therapy, antimicrobial peptides, photodynamic therapy, vaccines, host‐directed therapies, and more. The proposed review mainly focuses on the resistance journey of S. aureus over the past decade, detailing its resistance mechanisms, prevalence in the subcontinent, innovations in rapid diagnosis of the drug‐resistant strains, including the applicants of NGS and ML application along with QC, it helps to design alternative novel therapeutics approaches against S. aureus infection. [ABSTRACT FROM AUTHOR]