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Background: Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods: We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results: Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an "advanced" level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions: Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement. [ABSTRACT FROM AUTHOR]

Background: Systematic surveillance of Clostridioides difficile infection (CDI) in our institution showed a reduction in the incidence of healthcare associated CDI (HA-CDI) during COVID-19 pandemic. Aim: Our objective was to search for factors related to this reduction. Methods: We retrospectively studied the trend of the incidences of HA-CDI, Multidrug Resistant (MDR) organisms, total antibiotic and chlorine consumptions as well as the influence of the last two on the incidence of HA-CDI. Results: During COVID-19 pandemic, the HA-CDI incidence was reduced with respect to the previous years, although total antibiotic consumption was found to increase (p <.01). MDR organisms' incidence was found to increase (p <.01), as well as the chlorine consumption (p =.04) which was the only factor to be related to the decreased rates of HA-CDI (r = −0.786, p <.05). Discussion: In our institution, COVID-19 epidemic overlapped with the reduction in the HA-CDI's incidence. This could be due to faithful compliance with the contact precaution measures but then, we would expect the incidence of MDR organisms to decrease as well. Chlorine usage for environmental cleaning was generalized during pandemic. It was the only factor to be related to the decreased rates of HA-CDI, highlighting the importance of environmental cleaning as a measure for HA-CDI prevention. [ABSTRACT FROM AUTHOR]

Purpose: To discern whether reduced infection rates were attributed to antiseptic solutions or mechanical rectal irrigation. Patients and Methods: After receiving ethical approval, the study included patients who underwent transrectal prostate biopsy due to elevated PSA or abnormal digital rectal examination findings, and prostate cancer under active surveillance, at Tepecik Training and Research Hospital between April 2022 and June 2023. Standard antibiotic prophylaxis was administered. Patients were randomized into three equal groups according to the rectal irrigation strategy. Results: Overall complications occurred in 4%. Despite distinct cleaning agents, there was no significant difference in infection rates (p = 0.780) or fever incidence (p = 0.776). Pathological analyses revealed comparable outcomes (p = 0.764). Conclusion: The study challenges the prevailing belief that antiseptic solutions are indispensable for infection prevention, as saline demonstrated similar efficacy. Limitations include data gaps from potential external hospital visits and absent rectal microorganism swab culture. While TRUS-PB remains the gold standard, this study suggests that mechanically cleansing the rectal mucosa with saline—a cost-effective, side-effect-free alternative—may be a viable infection prevention method, particularly beneficial for patients with antiseptic allergies. The findings prompt a reconsideration of the necessity of antiseptic solutions in TRUS-PB, offering an alternative approach to mitigate infectious complications. [ABSTRACT FROM AUTHOR]

This European Society of Clinical Microbiology and Infectious Diseases guideline provides evidence-based recommendations to support a selection of appropriate antibiotic use practices for patients seen in the emergency department (ED) and guidance for their implementation. The topics addressed in this guideline are (a) Do biomarkers or rapid pathogen tests improve antibiotic prescribing and/or clinical outcomes? (b) Does taking blood cultures in common infectious syndromes improve antibiotic prescribing and/or clinical outcomes? (c) Does watchful waiting without antibacterial therapy or with delayed antibiotic prescribing reduce antibiotic prescribing without worsening clinical outcomes in patients with specific infectious syndromes? (d) Do structured culture follow-up programs in patients discharged from the ED with cultures pending improve antibiotic prescribing? An expert panel was convened by European Society of Clinical Microbiology and Infectious Diseases and the guideline chair. The panel selected in consensus the four most relevant antimicrobial stewardship topics according to pre-defined relevance criteria. For each main question for the four topics, a systematic review was performed, including randomized controlled trials and observational studies. Both clinical outcomes and stewardship process outcomes related to antibiotic use were deemed relevant. The literature searches were conducted between May 2021 and March 2022. In April 2022, the panel members were formally asked to suggest additional studies that were not identified in the initial searches. Data were summarized in a meta-analysis if possible or otherwise summarized narratively. The certainty of the evidence was classified according to the Grading of Recommendations Assessment, Development and Evaluation criteria. The guideline panel reviewed the evidence per topic critically appraising the evidence and formulated recommendations through a consensus-based process. The strength of the recommendations was classified as strong or weak. To substantiate the implementation process, implementation trials or observational studies describing facilitators/barriers for implementation were identified from the same searches and were summarized narratively. The recommendations on the use of biomarkers and rapid pathogen diagnostic tests focus on the initiation of antibiotics in patients admitted through the ED. Their effect on the discontinuation or de-escalation of antibiotics during hospital stay was not reported, neither was their effect on hospital infection prevention and control practices. The recommendations on watchful waiting (i.e. withholding antibiotics with some form of follow-up) focus on specific infectious syndromes for which the primary care literature was also included. The recommendations on blood cultures focus on the indication in three common infectious syndromes in the ED explicitly excluding patients with sepsis or septic shock. Most recommendations are based on very low and low certainty of evidence, leading to weak recommendations or, when no evidence was available, to best practice statements. Implementation of these recommendations needs to be adapted to the specific settings and circumstances of the ED. The scarcity of high-quality studies in the area of antimicrobial stewardship in the ED highlights the need for future research in this field. [ABSTRACT FROM AUTHOR]

Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion. We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay. In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P =0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel. Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting. • Multi-modal strategy reduced EVDAI rates. • Multi-modal strategy did not reduce the hospital length of stay and the mortality. • Multi-modal strategy can be implemented without barriers by neurosurgical staff. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has declared antimicrobial resistance (AMR) as one of the top ten public health threats faced by humanity. Carbapenems are currently the last option β-lactam antibiotics for treatment of both hospital and community acquired infections. The rapid rise and spread of carbapenem resistant organisms (CRO) is a global concern highlighting the need for early detection and isolation of patients. A total of 226 non- repeat, carbapenem resistant Gram-negative isolates were subjected to carbapenemase detection. Three phenotypic methods like Modified Hodge Test (MHT), RAPIDEC® CARBA NP kit (bioMérieux, France) and Chromogenic agar were used and a cartridge based molecular method Xpert® Carba-R (Cepheid) was used on all the study samples for detection of carbapenemases. The results of MHT, RAPIDEC® CARBA NP and CHROMagar were same for both Enterobacteriaceae and Non Fermenters (except for CHROMagar, which is applicable only for Enterobacteriaceae). Xpert® Carba R could not detect genes in all the phenotypically positive organisms for carbapenemase production. However, there was no statistically significant difference between the three phenotypic tests and Xpert® Carba R used for the detection of carbapenem resistance. Preserving the last resort antimicrobials is the need of the hour, as there are few therapeutic options for treating infections caused by carbapenem-resistant bacteria. Early detection, followed by strict implementation of infection prevention and control strategies to stall the dissemination of such organisms is the best way and needs to be implemented on a war footing. [ABSTRACT FROM AUTHOR]

Introduction: Getah virus (GETV) is a multi-host virus found in pigs, horses, and blue foxes. Clinically, GETV can cause fever, diarrhea, and reproductive disorders in pigs, representing significant threats to pig breeding. At present, few studies have examined the pathogenicity of GETV in pigs of different ages. Methods: In the present study, a new strain, named GETV-QJ, was isolated from clinically ill pigs, and whole genome sequencing analysis was performed. Besides the pathogenicity of piglets and pregnant sows of this strain was further studied. Results: the results illustrated that the strain belonged to group III. The strain had 93.6%-96.3% homology with other subtypes, and its homology with the same subtype strain ranged 96.5%-99%. Further studies on the pathogenicity of the virus indicated that this strain caused severe diarrhea, fever, and intestinal and lung damage in 7-day-old piglets, resulting in their death. The piglet survival rate was 0%. In pregnant sows, this strain did not cause fever, death, or abortion, but it induced viremia, which affected the farrowing performance of sows and led to reduced piglet survival. Discussion: In this study, we isolated a highly virulent group III and comprehensively established a pathogenic model of GETV in piglets and sows, providing a reference and guidance for the prevention and control of this infection. [ABSTRACT FROM AUTHOR]

Background: A review of key learnings from the response to the COVID-19 pandemic in nursing homes in Ireland can inform planning for future pandemics. This study describes barriers and facilitators contributing to COVID-19 outbreak management from the perspective of frontline teams. Methods: A qualitative study involving ten online focus group meetings was conducted. Data was collected between April and June 2023. The focus group discussions explored the views, perceptions and experiences of COVID-19 Response Team (CRT) members, clinical/public health experts who worked with them, and care professionals who worked in frontline managerial roles during the pandemic. All nine Community Healthcare Organisations and six Public Health Areas in Ireland were represented. Inductive reflexive thematic analysis was carried out using NVivo Pro 20. Results: In total, 54 staff members participated in focus group meetings. Five themes were developed from a thematic analysis that covered topics related to (1) infection prevention and control challenges and response to the pandemic, (2) social model of care and the built environment of nursing homes, (3) nursing home staffing, (4) leadership and staff practices, and (5) support and guidance received during the pandemic. Conclusions: The response to the COVID-19 pandemic has resulted in a steep learning curve, internationally and in Ireland. Preparing better for future pandemics not only requires changes to infection control and outbreak response but also to the organisation and operation of nursing homes. There is a great need to strengthen the long-term care sector's regulations and support around staffing levels, nursing home facilities, governance, use of technology, infection prevention and control, contingency planning, and maintaining collaborative relationships and strategic leadership. Key findings and recommendations from the Irish example can be used to improve the quality of care and service delivery at local, national, and policy levels and improve preparedness for future pandemics, in Ireland and internationally. [ABSTRACT FROM AUTHOR]

Background: The hospital wastewater system has been reported as a source of nosocomial acquisition of carbapenemase producing Enterobacteriaceae (CPE) in various settings. Cleaning and disinfection protocols or replacement of contaminated equipment often fail to eradicate these environmental reservoirs, which can lead to long-term transmission of CPE. We report a successful multimodal approach to control a New Delhi metallo-beta-lactamase positive Klebsiella pneumoniae (NDM-KP) nosocomial outbreak implicating contamination of sink traps in a low-incidence setting. Methods: Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated P-traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication. Results: Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Following the introduction of combined IPC measures, no new case was subsequently detected and sink traps remained negative for NDM-KP within 6 months after the intervention. Conclusion: The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of P-traps and connecting pieces, was successful in the control of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE). [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis represents a significant cause of morbidity and mortality among infants in healthcare settings. This study explored nurses' experiences in preventing and managing neonatal sepsis in the Tamale metropolis. Methods: An exploratory, descriptive qualitative cross-sectional study design was used, and data was collected using semi-structured interviews. The sample size was determined at the point of data saturation of fifteen participants. Thematic analysis was employed to identify codes, subthemes, and themes within the interview transcripts. Results: Three major challenges nurses face in preventing and managing neonatal sepsis, including (1) the absence of a protocol for handling newborns upon admission, (2) an excessive workload that made it difficult for staff to follow infection prevention protocols, and (3) inadequate, obsolete and/or lack of equipment that caused devices to be overused. The nurses also identified critical psychological and emotional difficulties they encounter as a result of working within such a stressful environment. Other activities nurses conducted were handwashing before and after every procedure, infection prevention, and separating the babies in the incubator. In managing babies with neonatal sepsis, nurses provided daily treatment, hygiene care, and supported activities of living. The nurses also assert that the availability of resources, appropriate staff, and critical skills are important for preventing and managing neonatal sepsis. Conclusion: The lack of basic working consumables like gloves, syringes, and needles, inadequate staff, and lack of defined protocol of care were identified as critical challenges that hamper the care provided in neonatal care units. Hospital authorities must focus attention on addressing the critical challenges faced by neonatal care units. Also, measures should be instituted to address the emotional and psychological concerns associated with nursing care. Future research must consider the level of influence of each of the challenges enumerated on nurses' overall health. Plain language summary: In many developing countries deaths of under-five children are associated with neonatal sepsis - an acute infection that occurs in those less than 28 days old. Nurses are critical in the care and services rendered to these babies and their families in the neonatal care units. This study assessed the experiences of nurses in providing care to neonates. The data was collected using an interview guide among nurses working in neonatal care units in the Tamale metropolis. Analysis was done using the thematic data analysis method. Some challenges were identified by nurses to be associated with the care of babies with neonatal sepsis. These challenges included a lack of definitive protocols of care; higher workload; inadequate, obsolete, and lack of basic equipment and consumables. Nurses employed handwashing techniques to prevent infection among babies with neonatal sepsis. Services providers must focus attention on providing the requisite support to nurses caring for babies with neonatal sepsis to improve the care experiences. [ABSTRACT FROM AUTHOR]

Background: Burn patients are more likely to get healthcare‐associated infections (HAIs). The current study aimed to investigate the characteristics of HAI and mortality risk factors among burn patients admitted to a tertiary center in Iran. Methods: A retrospective study was conducted in 2021 on burn patients who developed HAI after hospitalization in a tertiary center in Ahvaz, Iran. The records of patients admitted and managed between March 2019 and March 2020 were reviewed. Statistical analysis was carried out using IBM SPSS Version 26, with p < 0.05 considered statistically significant. Results: Of the 1,659 admitted patients, 395 (23.8%) developed HAI during the study period. After excluding patients with incomplete medical records and those with fungal or viral infections, 363 patients remained. The majority of these cases occurred in male patients. The most common type of HAI was burn wound infection (56.2%). Patients were mainly affected by Gram‐negative bacteria, Pseudomonas aeruginosa (39.7%), while the most common Gram‐positive bacteria was Staphylococcus epidermididis (9.6%). The most common antibiotic resistance among P. aeruginosa‐infected patients was reported against imipenem, followed by gentamicin and ciprofloxacin; however, the mentioned organism was mainly sensitive to colistin. Gender, age, bloodstream infection (BSI), ventilator‐associated infection (VAI), ICU admission, and total burned surface area (TBSA) resulted in 3.585, 1.028, 2.222, 7.469, 5.278‐, and 1.031 times higher mortality rates, respectively. Conclusion: Female gender, advanced age, BSI, VAI, and ICU admission are risk factors for HAI. These findings emphasize the need for focused infection prevention and management to improve high‐risk burn patient survival. [ABSTRACT FROM AUTHOR]

Background: There are over ten vaccine candidates for tuberculosis (TB) in the clinical pipeline that require testing in TB-prevalent populations. To accelerate the clinical development of TB vaccines, a directory of clinical trial centres was established in sub-Saharan Africa (SSA) to assess capacity for conducting late-stage TB vaccine trials. Methods: TB vaccine-related parameters were identified, and trial centres in SSA were identified and prioritized based on whether they had experience with TB or non-TB vaccine trials. A survey was sent to identified centres, and the resulting directory presents their capacity for TB vaccine trials. Centres that identified as eligible for TB vaccine trials also had the opportunity to participate to the survey. This article provides an overview of the TB vaccine clinical trial centre directory, including the number and distribution of centres, their general characteristics, and their experience with prior TB vaccine trials. It includes information on the capacity of the centres, such as laboratory biosafety level, patient support, and community engagement. It also includes a case study to demonstrate how the directory can be used to identify trial centres with specific capabilities needed for a particular TB vaccine trial. Results: Of the 134 identified centres, 56 provided information. Of these centres, 51 (91%) had phase 3 clinical trial experience and previous TB trials were conducted at 38 centres. Regarding TB vaccine trials, 19 centres conducted prevention of disease trials, 14 conducted prevention of infection trials, and 27 had no experience with TB vaccine clinical trials. From the respondents, 29 centers in South Africa were identified that could potentially conduct TB vaccine trials, followed by Tanzania (5), Kenya (5), Nigeria (3), and Uganda and Ethiopia (2 each). Trial sites in other countries were underrepresented, based on this survey. Conclusion: The establishment of a clinical trial centre directory can provide a basis for decision-making by various stakeholders. Despite some limitations in survey methodology, the findings suggest opportunities for expanding the evaluation of clinical trial capacity in other disease-prevalent countries and continents. Such data would be valuable in further enriching the Clinical Trial Community which a resource that geographically highlights clinical trial investments and capacities in African research ecosystem. Summary points: New TB vaccine candidates need to be assessed in clinical trials in countries with high rates of TB in the coming years. An open-access directory of TB vaccine clinical trial centres in sub-Saharan Africa was established, providing an overview of the capacity to conduct clinical trials for TB vaccine candidates (http://www.edctp.org/our-work/coordination-tb-vaccine-funded-research/directory-tb-vaccine-clinical-trial-sites-sub-saharan-africa/). The directory is intended for clinical triallists, funders, policymakers, and researchers to accelerate the clinical development of novel TB vaccines by providing useful information. Regular updates are necessary to ensure the directory remains relevant for vaccine development and feeds into the continental Clinical Trials Community (https://ctc.africa/). [ABSTRACT FROM AUTHOR]

Objective: The emergence of resistance to colistin, the last resort for treating severe infections caused by Pseudomonas aeruginosa, poses a significant threat to public health. This meta-analysis aimed to investigate the prevalence of colistin resistance in clinical isolates of P. aeruginosa. Method: A comprehensive search of MEDLINE (PubMed), Web of Science, and Scopus databases was conducted to identify relevant articles published until December 2023. Subsequently, a meta-analysis was performed using Stata software to examine the pooled prevalence of colistin resistance and to conduct subgroup analyses. Results: A total of 619 studies were included in the meta-analysis, revealing a global prevalence of colistin resistance of 1% among all P. aeruginosa isolates. Furthermore, cystic fibrosis patients exhibited the highest resistance to colistin, with a prevalence of 7% among the examined diseases. Conclusion: The increase in colistin resistance in P. aeruginosa in recent years from 2% (in the period of 2006-2010) to 5% (in the period of 2020-2023) underscores the need for implementing infection prevention programs, using appropriate treatment regimens, and disseminating comprehensive information on antimicrobial resistance patterns. These measures are crucial for addressing this growing public health concern. [ABSTRACT FROM AUTHOR]

Periprosthetic infection and prosthetic loosing stand out as prevalent yet formidable complications following orthopedic implant surgeries. Synchronously addressing the two complications is long‐time challenging. Herein, a bioactive glass scaffold (BGS) functionalized with MgCuFe‐layered double hydroxide (LDH)‐derived sulfide nanosheets (BGS/MCFS) is developed for vascularized osteogenesis and periprosthetic infection prevention/treatment. Apart from the antibacterial cations inhibiting bacterial energy and material metabolism, the exceptional near‐infrared‐II (NIR‐II) photothermal performance empowers BGS/MCFS to eliminate periprosthetic infections, outperforming previously reported functionalized BGS. The rough surface topography and the presence of multi‐bioactive metal ions bestow BGS/MCFS with exceptional osteogenic and angiogenic properties, with 8.5‐fold and 2.3‐fold enhancement in bone mass and neovascularization compared with BGS. Transcriptome sequencing highlights the involvement of the TGF‐β signaling pathway in these processes, while single‐cell sequencing reveals a significant increase in osteoblasts and endothelial cells around BGS/MCFS compared to BGS. [ABSTRACT FROM AUTHOR]

Background: Emerging infectious diseases like the Ebola Virus Disease (EVD) pose significant global public health threats. Uganda has experienced multiple EVD outbreaks, the latest occurring in 2022. Frontline healthcare workers (HCWs) are at increased risk, yet there is insufficient evidence of existing knowledge of EVD of these HCWs. We aimed to assess the readiness of Uganda's emergency HCWs to manage EVD and identify their training needs to inform targeted capacity-building interventions for future outbreaks. Methods: This multicentre nationwide cross-sectional study was conducted from July to September 2023 among HCWs providing emergency care in 14 secondary and tertiary hospitals across Uganda. Participants were consecutively recruited using the probability-proportional-to-size sampling technique, and data was collected using a self-reported questionnaire. Factors associated with EVD knowledge were identified through a mixed-effect linear model. Results: Data from 691 eligible HCWs with a median age of 32 (IQR: 28–38) was analyzed (response rate: 92%). Only one-third (34.4%, n = 238) had received EVD training in the past year. The median EVD knowledge score was 77.4% (IQR: 71.2 − 83.4%). EVD knowledge was associated with longer professional experience in years (β: 0.21, 95% CI: 0.03 to 0.39, p = 0.024) and higher level of education: diploma (β: 3.37, 95% CI: 1.49 to 5.25, p < 0.001), undergraduate degree (β: 6.45, 95% CI: 4.11 to 8.79) and postgraduate degree (β: 7.13, 95% CI: 4.01 to 10.25, p < 0.001). Being a doctor (β: 2.55, 95% CI: 0.35 to 4.74, p = 0.023), providing care in the obstetrics/gynecology department (β: −1.90, 95% CI: −3.47 to − 0.32, p = 0.018), previous EVD training (β: 2.27, 95% CI: 0.96 to 3.59, p = 0.001) and accessing EVD information through social media (β: 2.52, 95% CI: 1.17 to 3.88, p < 0.001) were also significantly associated with EVD knowledge. HCWs were mostly interested in training on management (92.9%), infection prevention and control (87.1%), and clinical presentation (84.1%), and preferred physical (51.5%) and hybrid (38.2%) training modes. Conclusion: Our study shows that the readiness of HCWs in Uganda to respond to EVD outbreaks varies by individual factors and information sources. We recommend targeted training and suggest future research on educational innovations and social media's potential to fill knowledge gaps. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. Methods: We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Results: Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Conclusions: Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy. [ABSTRACT FROM AUTHOR]

Identifying risk factors associated with the carriage of antimicrobial-resistant (AMR) bacteria in dogs is crucial to understanding their epidemiology and for developing and refining targeted control measures. However, relevant data is scattered and conflicting findings have been reported. This systematic review aimed to compile risk factors associated with the carriage of AMR-Enterobacterales in dogs worldwide and to identify relevant knowledge gaps for directing future research. A systematic review was conducted according to PRISMA guidelines, searching PubMed, CABi, and Scopus databases for studies reporting risk factors for acquiring AMR-Enterobacterales in dogs. After screening peer-reviewed, English-language studies by title/abstract, eligible studies were subjected to a full-text assessment, data extraction, risk-of-bias assessment, and qualitative synthesis. In the initial search, 774 articles were identified, including 274 duplicates. After screening by title/abstract, 77 articles were subjected to full-text review, from which 40 were eventually selected for data extraction, including 29 cross-sectional, six cohort, and five case-control studies. The most frequently investigated risk factors for AMR-Enterobacterales carriage in dogs were antimicrobial use (28 of 40), age (24), sex (22), hospitalization (19), and feeding raw diet (14). Of these, antimicrobial use was themost common risk factor significantly associated with AMR-Enterobacterales (19/28), followed by raw diet (9/14) and hospitalization (8/19). Our synthesis emphasized the importance of increasing awareness regarding the prudent use of critically important antimicrobials (CIAs), such as fluoroquinolones, in companion animal practices, strengthening infection prevention and control procedures in veterinary clinics and hospitals and educating caregivers about the potential risks of feeding raw diets in order to reduce the burden of AMR-bacteria in dogs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the presence of ESKAPE organisms on the hands of students working in the intensive care unit (ICU) at a veterinary academic hospital. Methods: A cross-sectional study was conducted among students working in an ICU at a veterinary academic hospital in South Africa. Students were sampled before the start of the ICU shift using a modified glove-juice method. Standard microbiological techniques and a series of polymerase chain reaction (PCR) assays were used to identify and characterize the bacteria. All the isolates were tested for resistance against a specific panel of antibiotics using the disk diffusion method. Proportions of bacterial species and their antimicrobial-susceptibility profiles were calculated. Results: At screening, all the veterinary students (n = 62) carried at least one of the ESKAPE organisms on their hands. Escherichia coli was the most isolated organism (76%, 47/62), followed by P. aeruginosa (48%, 30/62), A. baumannii (47%, 29/62), E. faecium (35%, 22/62), K. pneumoniae (27%, 17/62), and S. aureus (24%, 15/62). A reduced proportion of isolates were recovered from the samples, E. coli (26%, 12/47), E. faecium (23%, 5/22), P. aeruginosa (43%, 13/30), A. baumannii (24%,7/29), K. pneumoniae (41%, 7/17), and S. aureus (20%, 3/15). Most of the organisms showed a high proportion of resistance to at least one antibiotic. Multidrug resistance was reported among just over half (56%, 5/9) of E. coli, 40% (2/5) of E. faecium, 100% (13/13) of P. aeruginosa, and 33% (1/3) of S. aureus isolates. Conclusion: Students working in the ICU carry several organisms belonging to the ESKAPE group of organisms before contact with patients. Moreover, MDR resistance was common among this group of organisms. The findings of the present study underscore the importance of infection prevention and control (IPC) strategies to help reduce the likelihood of the spread of these organisms to personnel, owners, family members, and patients. [ABSTRACT FROM AUTHOR]

Recent information regarding the characteristics of people living with human immunodeficiency virus (HIV) (PLWH) is lacking. Therefore, we examined the incidence of HIV infection and epidemiologic characteristics of PLWH in South Korea using recent National Health Insurance Service database data. The HIV infection rate was 4.13 per 100,000 in 2017, 4.19 per 100,000 in 2018, 6.61 per 100,000 in 2019, 5.98 per 100,000 in 2020, 8.81 per 100,000 in 2021, and 4.14 per 100,000 in 2022. In 2016, the mean age of PLWH was 45.7 years (SD: 13.8 years), and it gradually increased to 49.0 years (standard deviation: 13.7 years) in 2022 over 7 years in South Korea. The proportion of male individuals among PLWH was 90.7% (19,970/22,026) in 2016, and it gradually increased to 92.3% (22,943/24,857) in 2022 over 7 years in South Korea. The proportion of anti-retroviral therapy (ART) users among PLWH in South Korea was 92.6% (20,388/22,026) in 2016, and it gradually increased to 97.9% (24,328/24,857) in 2022 over 7 years. In this population-based cohort analysis, we presented the HIV infection incidence and epidemiologic features of PLWH in South Korea. This study's results may influence future infection prevention strategies and policies for PLWH. [ABSTRACT FROM AUTHOR]

Simple Summary: Trueperella pyogenes is a significant opportunistic pathogen that can infect a wide range of animals and humans. Understanding its virulence factors and antibiotic resistance mechanisms is essential for the prevention and control of infections. Presently, research predominantly concentrates on Trueperella pyogenes in dairy cows and pigs, with limited investigations into its prevalence in small ruminants like sheep and goats, despite their importance as food sources. In light of the rapid expansion of China's sheep and goat industry, this study focused on the isolation rate of Trueperella pyogenes from clinical samples obtained from various farms in western China. The objectives were to identify virulence genes and assess drug resistance characteristics in the isolated strains. Furthermore, the genetic relationships and virulence gene profiles, including antibiotic resistance gene carriage, were evaluated in selected isolates. The study underscored the threat posed by Trueperella pyogenes to sheep and goats and highlighted the high levels of antibiotic resistance observed. These findings provide crucial insights for the prevention and treatment strategies on farms and advocate for the prudent use of antibiotics to mitigate the transmission of drug-resistant bacteria through the food chain, thereby protecting human health. Trueperella pyogenes is a significant opportunistic pathogen that causes substantial economic losses in animal agriculture due to its ability to infect various animal tissues and organs. Limited research has been conducted on the prevalence and biological characteristics of T. pyogenes isolated from sheep and goats. This study aimed to isolate T. pyogenes from clinical samples of sheep and goats in western China, examining genetic evolutionary relationships, antibiotic resistance, and virulence genes. Between 2021 and 2023, standard bacteriological methods were used to isolate and identify T. pyogenes from 316 samples (209 from goats and 107 from sheep) collected from 39 farms. Susceptibility to 14 antibiotics was tested using broth microdilution per CLSI guidelines, and PCR detected eight virulence genes. Whole-genome sequencing analyzed genetic relationships and gene carriage status in 39 isolates. The results indicated that 86 strains of T. pyogenes were isolated from 316 samples, yielding an isolation rate of 27.2% (goats n = 47, 22.5%; sheep n = 39, 36.4%). The virulence genes plo, cbpA, nanH, nanP, fimA, fimC, and fimE were present in 100%, 66.7%, 64.1%, 71.8%, 69.2%, 59.0%, and 82.1% of isolates, respectively, with none carrying the fimG gene. The dominant virulence genotype was plo/nanH/nanP/fimA/fimC/fimE. The isolates exhibited resistance to erythromycin (44.2%, 38/86), gentamicin (38.4%, 33/86), sulfamethoxazole/trimethoprim (37.2%, 32/86), tetracycline (32.6%, 28/86), and streptomycin (32.6%, 28/86), and low resistance to chloramphenicol (14.0%, 12/86), ciprofloxacin (7.0%, 6/86), penicillin (5.8%, 5/86), and clindamycin (4.7%, 4/86). All isolates were susceptible to cefotaxime, vancomycin, and linezolid. Among the 86 isolates, 37 (43.0%) displayed multidrug resistance (MDR) characteristics. The whole genome sequencing of 39 isolates identified eight types of resistance genes, including ant(2″)-Ia, ant(3″)-Ia, cmlA1, cmx, erm(X), lnu(A), sul1, and tet(W). Except for tet(W), erm(X), and sul1, the other resistance genes were reported for the first time in T. pyogenes isolated in China. The drug susceptibility test results and resistance gene detection for the isolated strains were consistent for tetracycline, erythromycin, gentamicin, and sulfisoxazole. Similar allelic profiles and genetic evolutionary relationships were found among isolates from different farms. This study highlights the antibiotic resistance status and virulence gene-carrying rate of Trueperella pyogenes, providing a basis for clinical medication. [ABSTRACT FROM AUTHOR]

Laser assisted in situ keratomileusis (LASIK) surgery is the leading and most performed refractive surgery nowadays. A possible complication of LASIK surgery is infectious keratitis which can lead to disastrous corneal damage and result in permanent loss of vision. LASIK procedures have become increasingly accessible, and the demand for refractive surgery has risen among patients, challenging the medical field to improve the prevention of post-operative infections. Nevertheless, a wide range of pathogens have been described as responsible for post-LASIK keratitis. However, non-tuberculous mycobacterial keratitis remains an infrequent occurrence and is poorly described in the literature. To the best of our knowledge, this is the first ever reported case of post-LASIK keratitis caused by Mycobacterium wolinskyi. We describe the clinical and microbial characteristics, leading to its challenging treatment choice. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethods and MeasuresResultsConclusionStudies have shown that healthcare innovation adoption is complex. Using Long-lasting insecticidal nets (LLINs), an innovation for malaria prevention, the study aimed to understand factors considered in the adoption of healthcare innovations in Africa.Using qualitative methods, we interviewed 10 household heads in Ghana who had freely received LLINs during a malaria campaign. We analyzed our data using a deductive thematic analysis approach utilizing the protection motivation theory (PMT) as our framework.We found that the constructs of PMT: perceived severity, perceived vulnerability, perceived response efficacy, and perceived self-efficacy influenced the adoption of healthcare innovation (i.e. LLINs). We also found that misconceptions about malaria infection and prevention influenced the perceived response efficacy of LLINs which could undermine LLINs usage.The constructs of PMT are important in the decision to use LLINs. Misconceptions about malaria infection and prevention could undermine the decision to use LLINs. Future studies should investigate ways to address these misconceptions. [ABSTRACT FROM AUTHOR]

Background: Pregnant patients were a significant population to consider during the pandemic, given the impact of SARS-CoV-2 infection on obstetric outcomes. While COVID testing was a central pillar of infection control, it became apparent that a subset of the population declined to test. At the same time, data emerged about pregnant persons also declining testing. Yet, it was unknown why pregnant patients declined tests and if those reasons were similar or different from those of the general population. We conducted this study to explore pregnant patients' attitudes, access, and utilization of COVID-19 testing to support healthcare for infection prevention management for this unique and medically complex population. Methods: We conducted a qualitative study of patients who were currently or recently pregnant during the early stages of the pandemic and received outpatient prenatal care at one of the participating study sites. An interview guide was used to conduct in-depth telephone interviews. Coding was performed using NVivo, and analysis was conducted using Grounded Theory. Results: The average age of the participants (N = 37) was 32 (SD 4.21) years. Most were < 35 years of age (57%) and self-described as White (68%). Qualitative analysis identified themes related to barriers to COVID-19 testing access and use during pregnancy, including concerns about test accuracy, exposure to COVID-19 in testing facilities, isolation and separation during labor and delivery, and diminished healthcare quality and patient experience. Conclusions: The implementation of widespread and universal COVID testing policies did not address the unique needs and challenges of pregnant patients as a medically complex population. It is important to understand the reasons and implications for pregnant patients who declined COVID testing during the current pandemic to inform strategies to prevent infection spread in future public health emergencies. [ABSTRACT FROM AUTHOR]

Brazil and Argentina are two of the South American countries that perform the highest number of solid organ transplant procedures globally each year. These procedures are not exempt from risks for the recipient, and there is a risk of donor‐derived infections. Risk mitigation measures for disease transmission from donor to recipient are essential, and biovigilance systems play a crucial role to inform authorities and provide data for the definition of screening procedures and prevention of donor‐derived infections. We herein describe the biovigilance systems in Brazil and Argentina and provide some data regarding potential and effective donors. [ABSTRACT FROM AUTHOR]

Background: Adherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. Methods: We employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants' workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model. Result: A total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services. Conclusion: This study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment. [ABSTRACT FROM AUTHOR]

Healthcare textiles serve as key reservoirs for pathogen proliferation, demanding an urgent call for innovative interventions. Here, a new class of Smart Fabrics (SF) is introduced with integrated "Repel, Kill, and Detect" functionalities, achieved through a blend of hierarchically structured microparticles, modified nanoparticles, and an acidity‐responsive sensor. SF exhibit remarkable resilience against aerosol and droplet‐based pathogen transmission, showcasing a reduction exceeding 99.90% compared to uncoated fabrics across various drug‐resistant bacteria, Candida albicans, and Phi6 virus. Experiments involving bodily fluids from healthy and infected individuals reveal a significant reduction of 99.88% and 99.79% in clinical urine and feces samples, respectively, compared to uncoated fabrics. The SF's colorimetric detection capability coupled with machine learning (96.67% accuracy) ensures reliable pathogen identification, facilitating accurate differentiation between healthy and infected urine and fecal contaminated samples. SF holds promise for revolutionizing infection prevention and control in healthcare facilities, providing protection through early contamination detection. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the impact of education on nurses’ compliance with standardization and isolation precautions. Methods: The study employs a pre-test post-test design. The study was conducted between September 2022 and September 2023 with 100 nurses in the intensive care and isolation units of a public hospital where patients with confirmed cases of SARS-CoV-2 infection were admitted. Data were collected utilising the Standard Precautions Compliance Scale and the Isolation Precautions Compliance Scale. The compliance of nurses with standard and isolation methods was examined in both time periods. Results: The mean total score of the Compliance to Isolation Measures Scale was higher after the education (T1=55.39±7.39, T2=77.50±9.68; t=8.372, p<0.001). The mean total score of the Compliance to Standard Precautions Scale was higher after the education (T1=10.38±2.46, T2=14.43±4.29; t=6.298, p<0.001) Conclusion: Education on the importance of using personal protective equipment, isolation, and compliance with standard precautions led to an increase in the variety and usage rates of nurses’ protective equipment. [ABSTRACT FROM AUTHOR]

Background: Consumption of raw cow's milk has repeatedly been shown to protect from asthma, allergies, and respiratory infections. As raw milk bears potential health hazards, it cannot be recommended for prevention. Therefore, we performed an intervention study with microbially safe but otherwise minimally processed cow's milk. Here we describe feasibility and safety of the trial. Methods: The MARTHA trial (DRKS00014781) was set up as a double‐blind randomized intervention in a population residing in Bavaria. Infants from 6 to 36 months of age consumed minimally processed cow's milk (intervention arm) or ultra‐heat‐treated (UHT) semi‐skimmed milk (comparator arm). Results: At the age of 6 to 12 months, 260 infants were enrolled, with 72% having a family history of atopy. The extensive screening system for milk consumption and symptoms suggestive of adverse events was well accepted with 22,988 completed weekly surveys and an average completion of 82% surveys sent out. The children consumed the study milk on average on 457 days (61% of intervention days). The intervention proved to be safe without any case of milk allergy or milk intolerance under the intervention in both arms. All 6 cases of serious adverse events were unrelated to milk. The most common reason was unscheduled hospitalization of more than 3 days. Conclusions: The intervention with minimally processed milk and the study instruments proved feasible. During the age of 6 to 36 months, there was no increased risk of milk allergy in a population with a substantial proportion of family history of atopy. [ABSTRACT FROM AUTHOR]

The article evaluates three commercial lateral flow immunoassays for detecting carbapenemases in Gram-negative bacteria, emphasizing the importance of accurate identification for infection control and treatment. Results showed varying detection capabilities for different carbapenemase families, underscoring the need for timely identification. The document provides a detailed overview of various strains of bacteria, their species, and the carbapenemases they possess, essential for understanding resistance patterns and aiding in research and treatment strategies. The study found that while all three systems exhibited 100% specificity, some variants were missed, indicating challenges in diagnostic sensitivity and the need for further testing to enhance performance. [Extracted from the article]

Objectives Design Methods Results Conclusions Physical distancing and handwashing can be important infection prevention measures during an infectious disease outbreak such as the COVID‐19 pandemic. To stimulate these behaviours, knowledge of psychosocial determinants as well as contextual factors is vital. We present longitudinal, within‐person analyses of the impact of contextual and psychosocial factors on handwashing and distancing behaviour.We used individual‐level data (186,490 participants completing 971,899 surveys) from the Corona Behavioural Unit COVID‐19 Cohort, a dynamic cohort study conducted during 26 months of the COVID‐19 pandemic in the Netherlands.Fixed‐effects models were employed to estimate within‐person associations between psychosocial factors and behaviour, combined with main and moderating effects of contextual factors.Pandemic severity was associated with more handwashing and distancing behaviour, while the duration of the pandemic had little effect. Within‐person changes in response efficacy were most relevant for changes in both handwashing and distancing behaviour, while self‐efficacy, descriptive norms and perceived severity of infecting others affected behaviour indirectly. These effects were stable over time. Associations were larger in cross‐sectional models, indicating that such models tend to overestimate effects.Our study highlights the importance of longitudinal data and within‐person models to detect possible causal associations. The results suggest that during an outbreak, government and public health professionals should clearly communicate the severity of the pandemic (e.g., hospitalization rates) and the effectiveness of recommended prevention measures in reducing that risk; and seek to improve people's capabilities and opportunities to adhere to guidelines, for example, by modifying the environment. [ABSTRACT FROM AUTHOR]

Lifestyle (LS)-related risk factors are the most important factors for increasing noncommunicable chronic diseases (NCDs). Coronavirus disease 2019 (COVID-19) is known to have a significant impact on LS, exposing patients with NCDs to adverse outcomes. This study aimed to investigate the LS changes after the COVID-19 pandemic and the strategies that can be used to manage the LS changes in the four levels of disease prevention. The prevalence of LS-related problems such as obesity and overweight has an upward trend and physical activity has declined dramatically in COVID-19 pandemic time. COVID-19 pandemic can worsen the patients' mental disorders or, as a major stressor, trigger mental disorders in the people. Moreover, stress and anxiety of pandemic situation may induce the consumption of smoking and alcohol in societies under disease. In addition, poor sleep and excessive use of social networks have been associated with poor health outcomes. LS modification is a substantial strategy for the prevention and management of NCDs that due to the pandemic situation, has become more serious now. The comprehensive LS modification program can promote various dimensions of knowledge, attitude, and LS-related behaviors at four levels of prevention. Primordial prevention by preventing LS-related risk factors, primary prevention by reducing or eliminating LS-related risk factors, secondary prevention by using LS modification in the treatment approach, and tertiary prevention by integrating LS interventions into rehabilitation make up the basics of a comprehensive LS reform program. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a stigmatised disease with intersectional associations with poverty, HIV, transmission risk and mortality. The use of visible TB infection prevention and control (IPC) measures, such as masks or isolation, can contribute to stigma. Methods: To explore stigma in this condition, we conducted in-depth individual interviews with 18 health workers and 15 patients in the rural Eastern Cape of South Africa using a semi-structured interview guide and narrative approach. We used reflexive thematic analysis guided by line-by-line coding. We then interpreted these key findings using Link and Phelan's theoretical model of stigma, related this to stigma mitigation recommendations from participants and identified levels of intervention with the Health Stigma and Discrimination Framework. Results: Participants shared narratives of how TB IPC measures can contribute to stigma, with some describing feeling 'less than human'. We found TB IPC measures sometimes exacerbated stigma, for example through introducing physical isolation that became prolonged or through a mask marking the person out as being ill with TB. In this context, stigma emerged from the narrow definition of what mask-wearing symbolises, in contrast with broader uses of masks as a preventative measure. Patient and health workers had contrasting perspectives on the implications of TB IPC-related stigma, with patients focussing on communal benefit, while health workers focussed on the negative impact on the health worker-patient relationship. Participant recommendations to mitigate TB IPC-related stigma included comprehensive information on TB IPC measures, respectful communication between health workers and patients, shifting the focus of TB IPC messages to communal safety (which could draw on ubuntu, a humanist framework) and using universal IPC precautions instead of measures targeted at someone with infectious TB. Conclusions: Health facilities may unwittingly perpetuate stigma through TB IPC implementation, but they also have the potential to reduce it. Evoking 'ubuntu' as an African humanist conceptual framework could provide a novel perspective to guide future TB IPC stigma mitigation interventions, including policy changes to universal IPC precautions. [ABSTRACT FROM AUTHOR]

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has become a significant threat to global health. The application of chemical disinfectants is an effective infection control strategy to prevent the spread of CRKP in hospital environments. However, bacteria have shown reduced sensitivity to clinical disinfectants in recent years. Furthermore, bacteria can acquire antibiotic resistance due to the induction of disinfectants, posing a considerable challenge to hospital infection prevention and control. This study collected 68 CRKP strains from the Fifth Affiliated Hospital of Xinjiang Medical University in China from 2023 to 2024. These strains were isolated from the sputum, urine, and whole blood samples of patients diagnosed with CRKP infection. Antibiotic susceptibility tests were performed on CRKP strains. Concurrently, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of disinfectants (benzalkonium bromide, 1% iodophor disinfectant, alcohol, and chlorine-containing disinfectant) against the test isolates were determined by the broth microdilution method. The efflux pump genes (cepA, qacE, qacEΔ1, qacEΔ1-SUL1, oqxA, and oqxB) were detected using polymerase chain reaction. The results showed that 21 out of the 68 CRKP strains exhibited extensive drug resistance, whereas 47 were nonextensively drug-resistant. The MIC value for benzalkonium bromide disinfectants displayed statistically significant differences (p < 0.05) between extensively drug-resistant (XDR) and non-XDR strains. Additionally, the MBC values for benzalkonium bromide disinfectants and 1% iodophor disinfectants displayed statistically significant differences (p < 0.05) between XDR and non-XDR strains. The detection rates for the efflux pump genes were as follows: cepA 52.9%, qacE 39.7%, qacEΔ1 35.2%, qacEΔ1-SUL1 52.9%, oqxA 30.8%, and oqxB 32.3%. The detection rate of the qacEΔ1-SUL1 gene in XDR CRKP strains was significantly higher than in non-XDR CRKP strains (p < 0.05). This indicates a potential link between CRKP bacterial disinfectant efflux pump genes and CRKP bacterial resistance patterns. Ongoing monitoring of the declining sensitivity of XDR strains against disinfectants is essential for the effective control and prevention of superbug. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of selective digestive tract decontamination (SDD) in intensive care units (ICUs). SDD has been shown to have consistent advantages in reducing mortality, nosocomial infections, and duration of organ support without evident side effects. However, the level of implementation of SDD in European ICUs remains poor. The article suggests that the translation of evidence into practice guidelines, the formation of an international consensus guideline/position paper, and a comprehensive implementation strategy involving a multidisciplinary team are necessary for successful implementation of SDD in daily ICU practice. [Extracted from the article]

Background: An October, 2021 review of Public Health Ontario's COVID-19 guidance for congregate settings such as shelters and long-term care homes demonstrated that this guidance did not include references to ventilation or filtration. In April 2022, an interdisciplinary team with expertise in indoor air quality (IAQ), engineering, epidemiology, community programming and knowledge translation launched a virtual ventilation and filtration consultation program for community spaces in Toronto, Ontario. The program gives people working in community spaces direct access to IAQ experts through 25-min online appointments. The program aims to help reduce the risk of COVID-19 transmission in community spaces, and was designed to help compensate for gaps in public health guidance and action. Methods: Representatives from participating organizations (n. 27) received a link to an online survey via email in April 2023. Survey questions explored the impacts of the program on topics such as: purchase and use of portable air filters; maintenance and use of bathroom fans; and, maintenance and modification of HVAC systems. Survey participation was anonymous, and no demographic information was collected from participants. Results: Representatives from 11 organizations completed the survey (40%). Of those who responded, nine (82%) made changes as a result of the program, with eight (73%) making two or more changes such as purchasing portable air filters and increasing routine maintenance of HVAC systems. Conclusions: When presented with brief access to expert support and tailored plain language guidance, people working in community spaces increased their use of ventilation and filtration strategies for COVID-19 infection prevention and control. [ABSTRACT FROM AUTHOR]

Background: The need for effective non-pharmaceutical infection prevention measures such as contact tracing in pandemics remains in care homes, but traditional approaches to contact tracing are not feasible in care homes. The CONTACT intervention introduces Bluetooth-enabled wearable devices (BLE wearables) as a potential solution for automated contact tracing. Using structured reports and reports triggered by positive COVID-19 cases in homes, we fed contact patterns and trends back to homes to support better-informed infection prevention decisions and reduce blanket application of restrictive measures. This paper reports on the evaluation of feasibility and acceptability of the intervention prior to a planned definitive cluster randomised trial of the CONTACT BLE wearable intervention. Methods: CONTACT was a non-randomised mixed-method feasibility study over 2 months in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection methods included routine data from the devices, case report forms, qualitative interviews (with staff and residents), field observation of care, and an adapted version of the NoMaD survey instrument to explore implementation using Normalisation Process Theory. Quantitative data were analysed using descriptive statistical methods. Qualitative data were thematically analysed using a framework approach and Normalisation Process Theory. Intervention and study delivery were evaluated against predefined progression criteria. Results: Of 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82% (n = 178) participated. Device loss and damage were significant: 11% of resident devices were lost or damaged, ~ 50% were replaced. Staff lost fewer devices, just 6%, but less than 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Structured and reactive feedback was variably understood by homes but unlikely to be acted on. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. Study participation benefits did not outweigh perceived burden and were amplified by the pandemic context. CONTACT did not meet its quantitative or qualitative progression criteria. Conclusion: CONTACT found a large-scale definitive trial of BLE wearables for contact tracing and feedback-informed IPC in care homes unfeasible and unacceptable — at least in the context of shifting COVID-19 pandemic demands. Future research should co-design interventions and studies with care homes, focusing on successful intervention implementation as well as technical effectiveness. Trial registration: ISRCTN registration: 11204126 registered 17/02/2021. [ABSTRACT FROM AUTHOR]

Mycoplasma contamination of continuous cell cultures and collection viral strains remains a serious problem in the biotechnology industry and experimental research. The frequency of mycoplasma contamination of cultured cell lines and viruses is 15–35%, and in some cases up to 80%. Mycoplasmas cause various changes in cultures contaminated by them, including cell death. They have immunomodulatory properties and affect the yield of certain viruses propagated in cell cultures. Mycoplasmas do not have a cell wall, are able to pass through a bacterial filter, have the smallest genome (≈580 kb) among bacteria, and are capable of independent reproduction and existence. These microorganisms are resistant to most antibiotics commonly used in cell culture. Derivative groups of tetracyclines and fluoroquinolones (BM-Cyclin®, Ciprobay®, Baytril®, Plasmocin®, MRA) have shown certain effectiveness in decontaminating viral strains and cell cultures from mycoplasmas. Timely, highly sensitive detection and prevention of mycoplasma infection is of great importance. For routine scanning of mycoplasma infection of continuous cell cultures and viral strains, the methods of indicator cell culture (cytochemical) and polymerase chain reaction (PCR) are recommended, or for more accuracy, microbiological analysis of mycoplasma colonies on a special medium. [ABSTRACT FROM AUTHOR]

Objective: To assess the compliance with French guidelines for the prevention of central venous catheter (CVC)-related infections in two university hospitals. Methods: An observational audit was conducted in 7 wards using a digital tool. Results: The prerequisite of hand hygiene (HH) were respected by 90% of health-care worker; 86% performed HH prior to equipment preparation and 59% repeated it prior to infusion. Wearing gloves when necessary and rinsing were respected in 46.7% and 75.6% of the observations. Conclusion: Findings showed an acceptable level of adherence to recommended practices for CVC management. However, barriers of unrespect evidence-based recommendations need to be investigated in depth. [ABSTRACT FROM AUTHOR]

Background: Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates. Purpose: To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies. Methods: This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis. Results: Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey. Implications for Practice and Research: Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://www.w3.org/1999/xlink). [ABSTRACT FROM AUTHOR]

Cardiac device infections (CDIs) are a serious complication in patients with implanted devices, resulting in increased morbidity, prolonged hospital stay, and increased healthcare costs. The effective management of these infections involves a combination of appropriate antibiotic therapy and preventive strategies aimed at reducing the risk of infection. The role of antibiotic prophylaxis in infection prevention is crucial, including the emerging use of antibiotic-supported tools and other local antibiotic delivery systems, which may reduce the risk of infection at the device implant site. In this contemporary review, we provide an overview of the prophylactic treatment and different antibiotic regimens for the treatment of CDIs, emphasizing early diagnosis, appropriate choice of antibiotics, and individualized treatment. [ABSTRACT FROM AUTHOR]

While approved vaccines for COVID-19 provide protection against severe disease and death, they have limited efficacy in the prevention of infection and virus transmission. Mucosal immunity is preferred over systemic immunity to provide protection at the point of entry against pathogens such as SARS-CoV-2. VaxForm has developed an oral vaccine delivery platform that elicits mucosal and systemic immune responses by targeting immune cells in the gut through C-type lectin receptors. The technology consists of microencapsulating the vaccine with an enteric polymer, which also results in enhanced thermostability. This article describes the formulation development and in vivo testing of a novel protein-based oral COVID-19 vaccine using this technology. Results demonstrate successful induction of immune response in mice and showed that the particle size of the vaccines following administration can impact the ratio of mucosal to systemic response. Immunogenicity and thermostability of liquid suspension and dry powder versions of the vaccine were compared in mice. The liquid suspension vaccine showed excellent heat resistance by maintaining immunogenicity after 14 days of storage at 60 °C. While further investigation is needed to determine correlates of protection and duration of response for mucosal immunity, this study demonstrates the vaccine's potential as a COVID-19 booster to enhance mucosal protection in humans and improve global access by lowering the cost of production, removing cold-chain requirements, and allowing self-administration. [ABSTRACT FROM AUTHOR]

Background: Despite the advances in medical science, the epidemic of infectious diseases has faced serious challenges to the health system of countries, so the purpose of this study was to identify obstacles and management strategies to prepare for planning preventive measures and better care in dealing with infectious diseases in hospitals. Method: The current qualitative research was of the grounded theory type, which was conducted in 2023. The semistructured interview questions were obtained from experts. The initial selection of the sample was made from experts in the field of health and treatment from all over the country. The snowball method was used to increase the sample volume until it reached sufficient Value. After analyzing the data through MAXQDA2020 software, this research reached saturation by interviewing 20 experts. Results: Four main areas, 15 subthemes, and 93 codes were identified in the management of epidemics, which included leadership and management (planning, physical structure, information management, financial resources, manpower, medicine and equipment, and internal and external coordination), Stewardship (macro policy and syndromic care system), safety and resilience (crisis management and emergency and disaster risk management), management of infectious diseases (instructions, education, infection prevention and control, treatment management). Conclusion: This study presents the strategies of the health system in dealing with the epidemic of infectious diseases to overcome the obstacles and challenges of preparation and response, which can help health managers in designing future programs, and finally, it shows that hospitals should have a plan for resilience in crises. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections are infections that patients acquire during hospitalization or while receiving healthcare in other facilities. They represent the most frequent negative outcome in healthcare, can be entirely prevented, and pose a burden in terms of financial and human costs. With the development of new AI and ML algorithms, hospitals could develop new and automated surveillance and prevention models for HAIs, leading to improved patient safety. The aim of this review is to systematically retrieve, collect, and summarize all available information on the application and impact of AI in HAI surveillance and/or prevention. Methods: We conducted a systematic review of the literature using PubMed and Scopus to find articles related to the implementation of artificial intelligence in the surveillance and/or prevention of HAIs. Results: We identified a total of 218 articles, of which only 35 were included in the review. Most studies were conducted in the US (n = 10, 28.6%) and China (n = 5; 14.3%) and were published between 2021 and 2023 (26 articles, 74.3%) with an increasing trend over time. Most focused on the development of ML algorithms for the identification/prevention of surgical site infections (n = 18; 51%), followed by HAIs in general (n = 9; 26%), hospital-acquired urinary tract infections (n = 5; 9%), and healthcare-associated pneumonia (n = 3; 9%). Only one study focused on the proper use of personal protective equipment (PPE) and included healthcare workers as the study population. Overall, the trend indicates that several AI/ML models can effectively assist clinicians in everyday decisions, by identifying HAIs early or preventing them through personalized risk factors with good performance. However, only a few studies have reported an actual implementation of these models, which proved highly successful. In one case, manual workload was reduced by nearly 85%, while another study observed a decrease in the local hospital's HAI incidence from 1.31% to 0.58%. Conclusions: AI has significant potential to improve the prevention, diagnosis, and management of healthcare-associated infections, offering benefits such as increased accuracy, reduced workloads, and cost savings. Although some AI applications have already been tested and validated, adoption in healthcare is hindered by barriers such as high implementation costs, technological limitations, and resistance from healthcare workers. Overcoming these challenges could allow AI to be more widely and cost-effectively integrated, ultimately improving patient care and infection management. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to identify the main issues related to public patient safety campaigns reflected in Korean online news. This study utilized a text-mining method to identify keywords and topics related to patient safety campaigns. Methods: The data collection period was from 1 January 2022 to 31 December 2023, and 4110 news articles were extracted. Through data preprocessing, 2661 duplicated news and 1213 unrelated news were removed, and 236 news were selected. Using the NetMiner program, keyword co-occurrence frequency calculation, keyword centrality analysis, and topic modeling analysis were performed. Results: The results showed that the most frequently mentioned keywords with high degree centrality, betweenness centrality, and closeness centrality in online news were "hospital", "medical", "medicine", "project", and "treatment". The topics of online news related to the patient safety campaign were "patient-centered care for medical safety", "health promotion projects at a regional institution", "hand hygiene education to prevent infection", "healthcare quality improvement through the Mint Festival", and "safe use of medicines". Conclusions: This study analyzed patient safety campaign news topics using text network analysis and topic modeling. It was confirmed that patient safety campaigns are essential for fostering a patient safety culture, improving medical quality, and encouraging patient participation in hospitals. Therefore, to build a safe medical environment, it is necessary to establish an effective patient safety campaign for not only medical staff providing medical care, but also patients and their caregivers, and for this, cooperation and participation from various professional occupations are necessary. [ABSTRACT FROM AUTHOR]

Introduction: Vaccination is one of the most effective infection prevention strategies. Viruses with high mutation rates -such as influenza-escape vaccine-induced immunity and represent significant challenges to vaccine design. Influenza vaccine strain selection is based on circulating strains and immunogenicity testing in animal models with limited predictive outcomes for vaccine effectiveness in humans. Methods: We developed a human in vitro vaccination model using human tonsil tissue explants cultured in 3D perfusion bioreactors to be utilized as a platform to test and improve vaccines. Results: Tonsils cultured in bioreactors showed higher viability, metabolic activity, and more robust immune responses than those in static cultures. The in vitro vaccination system responded to various premanufactured vaccines, protein antigens, and antigen combinations. In particular, a multivalent in vitro immunization with three phylogenetically distant H3N2 influenza strains showed evidence for broader B cell activation and induced higher antibody cross-reactivity than combinations with more related strains. Moreover, we demonstrate the capacity of our in vitro model to generate de novo humoral immune responses to a model antigen. Discussion: Perfusion-cultured tonsil tissue may be a valuable human in vitro model for immunology research with potential application in vaccine candidate selection. [ABSTRACT FROM AUTHOR]

Background: Comprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable. Methods: From January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a 'traffic light' (present, in progress, not present) matrix. Each PICT's overall status in achieving IPC core components was summarised using descriptive statistics. Results: Fifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records. Conclusions: Identifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia. Methods: A cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers' socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version. Results: In total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23–65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23–108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all). Conclusions: Low levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust. [ABSTRACT FROM AUTHOR]

Background: The outcome of heart transplantation is significantly affected by perioperative infections. Individualised immunosuppression strategies are essential to reduce the risk of such infections. Case presentation: We report the successful management of a 56-year-old male patient diagnosed with dilated cardiomyopathy who underwent heart transplantation. During the perioperative period, the patient was prescribed cefoperazone sodium and sulbactam sodium, which induced a severe skin reaction: toxic epidermal necrolysis (TEN). The patient was treated with prednisone, immunoglobulins, etanercept, and other active immunomodulatory measures, together with an individualised anti-rejection regimen and physical therapy. The systemic rash resolved within a month, and the patient was successfully discharged after surgery. Conclusion: Effective management of heart transplantation necessitates balancing immunosuppression and infection prevention. Individualised immunosuppressive strategies are critical for optimal clinical outcomes. [ABSTRACT FROM AUTHOR]