The emergence of carbapenem-resistant Escherichia coli (CREC) poses crucial challenges in clinical management, requiring continuous monitoring to inform control and treatment strategies. This study aimed to investigate the genomic and epidemiological characteristics of CREC isolates obtained from a tertiary hospital in China between 2015 and 2022. Next-generation sequencing was used for genomic profiling, and clinical data from patients were integrated into the analysis. ST405 (21.2%), ST167 (20.3%) and ST410 (15.9%) were the most prevalent of the 30 distinct sequence types (STs) identified among the 113 unique CREC isolates. Infections caused by the ST405 CREC clone and severe underlying diseases were associated with higher in-hospital mortality rates, particularly in patients aged ≥65 years. Furthermore, the ST405 clone exhibited a greater number of virulence and resistance genes than non-ST405 CREC clones. The virulence gene eaeX and resistance genes mph(E) and msr(E) were exclusively found in ST405 clones, while other virulence genes (agn43, ipad and malX) and resistance genes (armA, catB3 and arr-3) were more prevalent in this clones. Additionally, ST405 showed higher minimum inhibitory concentrations for both meropenem and imipenem and showed superior growth under the meropenem challenge. Galleria mellonella virulence assays revealed that the ST405 CREC clone was more virulent than other predominant CREC STs. Our findings underscore the clinical threat posed by the ST405 CREC clone, which exhibits both enhanced virulence and extensive drug resistance. These results highlight the urgent need for stringent surveillance and targeted interventions to curb its further dissemination and prevent potential outbreaks.

It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group.

For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration.

The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years.

Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).

 Postneurosurgical meningitis (PNM) is a serious medical condition with high mortality and morbidity caused by Gram positive organisms like Staphylococcus aureus and Gram-negative organisms like Acinetobacter baumannii. Optimum concentration of antibiotics in the cerebrospinal fluid (CSF) to treat these infections is difficult to achieve. Intraventricular antibiotic administration bypasses the blood-brain barrier and can achieve high CSF concentration without causing systemic toxicity.

 Retrospective review of all patient records were done to identify patients who developed postneurosurgical meningitis and received intraventricular antibiotic therapy during the period of July 2017 to December 2022. Demographic and clinical data along with the type of antibiotic, route, dose, and duration of administration were collected. CSF parameters before and after intraventricular antibiotic administration were collected and analyzed.

 Twenty-six patients with postneurosurgical meningitis received intraventricular antibiotic therapy. Intracranial tumors were the most common underlying pathology followed by aneurysms. In all, 17/26 patients had received vancomycin and 9/26 patients had received colistin. External ventricular drain was used in 17/26 cases and Ommaya reservoir was used in 9/26 cases. Six patients showed growth of organism in CSF before starting intraventricular antibiotics, while one patient remained culture positive despite treatment. Of the 26 patients, 3 died despite treatment. There were significant changes in the CSF parameters after intraventricular antibiotic therapy.

 Intraventricular administration of antibiotic provides an alternative therapeutic option in the management of patients who are not responding or poorly responding to systemic antibiotics.

Infections by multidrug resistant (MDR) bacteria are increasing and vary across regions and hospitals. We aimed to assess the epidemiology, prevalence, and outcomes of bacterial infections in patients with decompensated cirrhosis, comparing liver transplant (LT) and non-LT centers in Catalonia.

This is a multicenter retrospective study including all patients with decompensated cirrhosis and bacterial infections hospitalised between January 2021 and 2022 from 5 university hospitals in the Barcelona metropolitan area. Two of them were LT centres. Clinical, laboratory, microbiological data, and in-hospital mortality were collected.

A total of 576 infections were reported in 352 patients. LT centers had more health-related infections, recurrent infections, and septic shock than non-LT centers, while there were no differences in cirrhosis severity, acute-on-chronic liver failure (ACLF) or comorbidities. Although the most commonly isolated microorganisms and types of infection were similar in both centers, LT centers had higher rates of extended-spectrum beta-lactamase (12% vs. 6%), carbapenem (3% vs. 0%) and piperacillin-tazobactam resistant bacteria (14% vs. 7%). MDR rate was also higher in LT centers (38% vs. 25%, p = 0.02) and varied across hospitals (18%-42%, p < 0.05). Furthermore, in-hospital mortality was higher in LT centers (20% vs. 10%; p = 0.01). Independent predictors of in-hospital mortality were septic shock, ACLF, Child-Pugh, age, and leukocyte count.

Our study showed differences in epidemiology, prevalence of MDR infections, and outcomes across university hospitals, particularly between centers with and without LT. Further studies are warranted to unveil the nuances of bacterial infections across different healthcare institutions in Europe and elsewhere.

The benefit of high-dose trimethoprim/sulfamethoxazole (trimethoprim component ≥ 8 mg/kg/day) treatment for Stenotrophomonas maltophilia infections remains unclear. We aimed to evaluate the effect of high-dose trimethoprim/sulfamethoxazole treatment on outcomes in patients with S. maltophilia bacteraemia.

We conducted a single-centre retrospective cohort study (2004-23) that included patients treated with trimethoprim/sulfamethoxazole for monomicrobial S. maltophilia bacteraemia. The patients were categorized into two groups based on the trimethoprim/sulfamethoxazole dose: high-dose (trimethoprim component ≥ 8 mg/kg/day) and low-dose (trimethoprim component < 8 mg/kg/day) groups for comparison. The primary endpoint was 30-day mortality. Adverse drug events between groups were also compared. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) analysis were performed.

A total of 143 patients treated with trimethoprim/sulfamethoxazole for S. maltophilia bacteraemia were included: 41 (28.7%) received the high-dose regimen, and 102 (71.3%) received the low-dose regimen. There was no significant difference in 30-day mortality between the high- and low-dose group (39.0% versus 26.5%; P = 0.139). Multivariable regression revealed that high-dose trimethoprim/sulfamethoxazole therapy was not associated with mortality (adjusted OR 1.96, 95% CI 0.75-5.10; P = 0.167) after adjustment. The IPTW-adjusted regression yielded consistent results. More adverse drug events were reported in the high-dose group (31.7% versus 12.7%, P = 0.008).

High-dose trimethoprim/sulfamethoxazole for S. maltophilia bacteraemia was not associated with improved outcomes while more frequent adverse drug events were observed. The sample size and retrospective design limit the study's conclusions. Future studies that address these limitations are needed to confirm the results.

Differences exist between Infectious Diseases Society of America guidance and European Society of Clinical Microbiology and Infectious Diseases guidelines on treating pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB). This study compared the outcomes of colistin-based and high-dose ampicillin/sulbactam-based combination therapies in patients with CRAB nosocomial pneumonia. A retrospective cohort study was conducted at a university-affiliated hospital in South Korea. Patients received either a colistin-based regimen with a loading dose followed by a maintenance dose (June 2021-May 2022) or a high-dose ampicillin/sulbactam-based regimen with sulbactam 9 g/day (October 2022-September 2023). The primary outcome was 28-day all-cause mortality; secondary outcomes included 14-day/28-day clinical success rates and 14-day/28-day kidney injury based on the Risk, Injury, Failure, Loss, End-stage renal disease score. Logistic and Poisson regression analyses were used to compare outcomes between groups. Among 179 patients enrolled in the study, 84 received the colistin-based regimen and 95 received the high-dose ampicillin/sulbactam-based regimen. The ampicillin/sulbactam group showed significantly lower 28-day mortality (20% vs. 61%; adjusted relative risk [aRR] = 0.16, 95% CI 0.08-0.32). Clinical success rates were higher in the ampicillin/sulbactam group at both 14 days (39% vs. 23%; aRR = 2.19, 95% CI 1.10-4.37) and 28 days (55% vs. 32%; aRR = 2.71, 95% CI 1.14-5.20). Additionally, 28-day kidney injury was lower in the ampicillin/sulbactam group (0.63 ± 1.16 vs. 1.06 ± 1.35; aRR = 0.56, 95% CI 0.40-0.79). High-dose ampicillin/sulbactam-based combination therapy demonstrates superior outcomes over colistin-based combination therapy for CRAB nosocomial pneumonia, including lower mortality, higher clinical success rates, and reduced kidney injury.

The diagnostic accuracy of presepsin (P-SEP) in the newborn is still under evaluation.

In a multicenter study, we studied the accuracy of P-SEP as a diagnostic marker of late-onset sepsis (LOS) in critical newborns with underlying disorders, to define the most accurate cut-off to distinguish infected from uninfected patients.

Sixty-nine/351 newborns without infections at admission developed LOS. The median P-SEP value at T0 (admission) was 518.0 ng/L (IQR 313.0-789.0), without significant differences related to underlying diseases (p=0.52). In neonates who developed LOS, P-SEP increased at the onset of infection (T1) (median: 816.0 ng/L) and after 24-48 h (median: 901.0 ng/L) compared with their value at admission (median: 560.0 ng/L) (p<0.01 and p=0.03, respectively). The area under the ROC curve at T1 was 0.71 (95 % CI 0.65-0.78) when all cases of sepsis were included in the analysis and increased to 0.74 (95 % CI 0.66-0.81) considering only confirmed sepsis. Approximately two-thirds of patients were correctly classified, setting the cut-off at 713 ng/L, with a negative predictive value of 89.0 %.

At a cut-off of 713 ng/L, P-SEP has good accuracy in diagnosing LOS in critically ill newborns. In uninfected newborns, the median value of P-SEP is not influenced by any underlying pathology.

Procalcitonin (PCT) is a biomarker for bacterial infections, with controversial utility in diagnosing hospital-acquired pneumonia (HAP) in neurosurgical intensive care unit (NICU) patients. Establishing an optimal PCT cutoff value could enhance diagnostic accuracy. This retrospective single-center study included NICU patients hospitalized between January 1, 2021, and December 31, 2022, who underwent routine serum PCT measurement. HAP was diagnosed based on clinical, biochemical, microbiological, and radiological data. The optimal PCT cutoff value was identified using the Youden Index. Associations between PCT levels, radiological findings, sputum cultures, and confirmed HAP were analyzed using chi-square tests. A multivariate logistic regression was performed to identify independent predictors of elevated PCT. Among 2363 patients, 193 met inclusion criteria, and 148 were diagnosed with HAP. The optimal PCT cutoff value was 0.095 ng/mL, yielding a sensitivity of 89.2% and specificity of 93.3% (p < 0.001). This cutoff resulted in a positive likelihood ratio of 13.3 and a negative likelihood ratio of 0.116. Radiological signs of pneumonia and positive sputum cultures were observed in 48.4% and 78.4% of HAP cases, respectively, but neither showed a significant association with HAP (p = 0.135 and p = 0.056). Leukocytosis was significantly associated with HAP but had low specificity, while CRP showed a non-significant trend. In multivariate analysis, only confirmed HAP independently predicted PCT elevation. PCT, with a cutoff value of 0.095 ng/mL, shows high diagnostic accuracy for HAP in NICU patients and could enhance early identification and treatment. Our findings suggest that elevated PCT is primarily driven by HAP rather than non-infectious inflammatory triggers such as trauma or recent surgery. Further prospective studies are warranted to validate these findings.

The COVID-19 pandemic changed the healthcare environment and raised concerns about the impact on nurse staffing and healthcare-associated infections (HAIs), but evidence on this impact is lacking. This study evaluated changes in nurse staffing levels in South Korea and their impact on healthcare-associated COVID-19 infection (HA COVID-19). A total of 67,154 cases were included, and survival analysis was performed using a Cox proportional hazards model to assess the association between nurse staffing and HA COVID-19. Among patients admitted to intensive care units and general wards, 11.7% and 15.1%, respectively, contracted COVID-19 in the hospital after admission. Survival analysis showed that HA COVID-19 increased as the nurse-to-patient ratio increased in general wards. Additionally, compared with medical institutions that do not operate fixed night shift nurses, HA COVID-19 increased as the proportion of night nurses increased, but it decreased to less than 10%. This study shows that securing nurses and operating an appropriate proportion of night nursing staff is important for infection control. To prepare for the spread of infectious diseases and implement infection prevention activities, it is necessary to secure an appropriate level of nursing staff; maintaining an appropriate proportion of night shift nurses will help reduce HAIs.

To provide a comprehensive analysis of the epidemiological characteristics and clinical features of pathogens and explore the risk factors for post-liver transplant (LT) bacterial infections.

A retrospective analysis was conducted at Xiang'an Hospital of Xiamen University and the First Affiliated Hospital of Zhengzhou University between 2021 and 2024. Binary logistic regression analysis was performed to identify independent risk factors, including clinical characteristics and genetic polymorphisms related to infections within the first month after LT.

Two hundred forty-two liver transplant donors and recipients were included. Klebsiella pneumoniae (19.0%) was the most common gram-negative bacterium, whereas Staphylococcus aureus (7.1%) was the predominant gram-positive pathogen. A respiratory tract infection was the most common bacterial infection. Binary logistic regression analysis revealed that the recipient SLCO1B1 rs4149015 AA genotype, preoperative hypertension, and low preoperative red blood cell count were independent risk factors for post-LT infection in recipients.

Our analysis revealed the risk factors for and clinical manifestations of bacterial infections as well as their polymorphisms. These findings provide valuable insights into the early detection and prevention of bacterial infections, revealing potential avenues for the development of methods to prevent such infections and therefore improve patient prognosis after LT.

Explants due to infected spinal cord stimulation (SCS) devices are a significant concern, leading to complex care needs and high costs. This study aimed to evaluate the cost of explant and subsequent management in patients in cases of device infection.

This retrospective study analyzed data over eight years (2014-2022) at a UK neuromodulation center. Cases of explant due to infection were identified from a departmental data base. Data were collected from electronic clinical care records. Patient admission costs were retrieved from the accounting services using cost pool groups. Electrical neuromodulation equipment costs were obtained from National Health Service England data bases specific to each manufacturer.

Among 215 explants, 23 were attributed to infection, with 22 of 23 involving the implantable pulse generator. A total of 16 of 23 cases (70%) met the criteria for deep surgical site infection, whereas seven cases occurred after 90 days. Microbiological cultures confirmed infections in nine of 23 cases (39%). In five cases, explant was performed owing to pus observed around the hardware during revision surgery that grew no bacteria after culture. The median time to explant due to infection was 42 days [29-356]. The median cost of explant and follow-up care was £16,957 [£5,243-£26,823], with higher costs observed when reimplantation was attempted (£26,172 [£18,753-£37,427]). Reimplantation of the neuromodulation device was attempted in 13 of 23 patients (57%). Successful reimplant was limited and achieved in only eight of 13 cases (62%). The median time to reimplantation was 193 days [181-658] postexplant, and the reinfection rate in those who were reimplanted was 30%. Ultimately, a successful reimplant was achieved in 35% of patients (eight of 23) after explant due to suspected infection.

The findings emphasize the need for preventive strategies to mitigate infection risk and reduce costs. Improved understanding of infection management may ultimately help reduce the clinical and economic burden of SCS infections. Attempts to reestablish the therapy need careful consideration and counseling of patients.

Portal vein thrombosis (PVT) is a common complication in liver cirrhosis. Bacterial infections (BIs) may increase PVT risk through bacterial translocation, systemic inflammation, and coagulation dysfunction, but evidence is limited.

This study investigates the 6-month risk of onset of PVT in patients hospitalized with BIs.

This post-hoc analysis included 563 cirrhotic patients hospitalized between 2011 and 2021, with or without BIs diagnosis, and followed for 6 months post-discharge. Patients with HCC outside of Milan criteria were excluded. The main endpoint was the onset of PVT, diagnosed via abdominal ultrasound or CT/MRI.

BI was diagnosed in 146 patients (26 %). Forty-seven patients (8.5 %) experienced PVT events within 6 months, including 15 (10 %) with BIs and 32 (7.8 %) without (p = 0.4). Logistic regression showed no significant effect of BI on PVT occurrence (OR 1.35, 95 % CI 0.69-2.54), even after adjusting for confounding factors. However, urinary tract infections were independently associated with higher PVT risk (OR 3.17, 95 % CI 1.05-10.8, p = 0.048). Other infection sites (pneumonia, spontaneous bacterial peritonitis-SBP, spontaneous bacteremia) and isolated microbial strains (n = 77) were not associated with increased PVT risk. When analyzing the population excluding patients with HCC, the risk of developing PVT was significantly higher in patients with previous BI, regardless of the severity of liver disease (OR 2.92, 95 % CI 1.06-8.16).

In this large cohort, BIs did not significantly increase PVT risk within 6 months post-hospitalization in cirrhotic patients. However, when the cohort was reduced to patients without HCC, the risk of PVT appears to be significant.

Unicompartmental knee arthroplasty (UKA) is an effective treatment for single-compartment knee osteoarthritis. However, some patients experience lateral compartment pain after UKA. The impact of lateral compartment intra-articular injection on infection risk of the medial prosthesis and therapeutic outcomes in these patients remains controversial.

This study aims to evaluate the impact of lateral compartment intra-articular injection after UKA on the risk of medial prosthetic joint infection, as well as its therapeutic effect on lateral compartment pain and inflammation. We hypothesized that lateral compartment intra-articular injection in patients with post-UKA lateral pain could provide better pain relief and functional outcomes without increasing the risk of medial prosthetic infection.

This retrospective cohort study included patients who experienced lateral compartment pain after UKA at Jinshan Branch of Shanghai Sixth People's Hospital between January 2018 and December 2020. Patients were divided into two groups: those who received lateral compartment intra-articular injection for pain management (injection group) and those who received only oral medication (control group). The primary outcome was medial prosthetic infection rate within 6 months post-injection. Secondary outcomes included pain scores, knee function, and quality of life.

A total of 249 patients with post-UKA lateral compartment pain were included (144 in the injection group, 105 in the control group). There was no significant difference in medial prosthetic infection rates between the two groups (2.1% vs. 2.9%, p = 0.812). The injection group showed significantly better pain relief (VAS score) and knee function (KSS score) at 1 week and 1 month post-injection (p < 0.05). Quality of life measures (SF- 36) also showed improvements in the injection group at these early time points.

Intra-articular injection after UKA does not increase the risk of infection and may provide better short-term pain relief and functional outcomes. These findings support the safety and potential efficacy of this approach in managing apparent lateral knee post-operative pain and enhancing early recovery after UKA. However, larger prospective studies are needed to confirm these results and further explore the long-term impact of this intervention.

The presence of cells in urine and in particular White Blood Cells (WBCs) is often associated with Urinary Tract Infections (UTIs) and other diseases. Non-invasive screening of WBCs requires the development of cost-effective point of care diagnostic tools. Infrared (IR) spectroscopy has the potential to identify and quantify cells in urine. However, the quantification of cells by compact IR spectrophotometers can be hindered by the presence of highly concentrated interfering biomolecules. The use of separation procedures can assist in identifying and quantifying cells but reduces the point of care capabilities of the technology. In this study, we propose coupling cytocentrifugation with transflection IR spectroscopy for the isolation and quantification of cells in urine. Urine samples were spiked with monocytes and T-lymphocytes, cyto-centrifuged onto low-e slides and measured in transflection mode. An optional cell clean-up step, either performed before (by resuspending in PBS) or after the cytocentrifugation (by soaking the slide in water), was evaluated. In a first experiment using monocytes, IR band areas were linear (R2 = 0.98) in the 8 × 103-2 × 105 cells mL-1 range, thus demonstrating the detection of cells at pathological numbers (pyuria, i.e., >104 WBCs mL-1). Secondly, to mimic real samples with varying cell types, urine samples containing both monocytes and T-lymphocytes were analysed to determine their concentration simultaneously. Partial Least Squares (PLS) regression enabled the simultaneous quantification of two types of different cells, yielding prediction errors of 2 × 104 cells mL-1 for monocytes and 4 × 104 cells mL-1 for T-lymphocytes. The results suggest that the technique has the potential to be implemented as a fast, simple, versatile, and cost-effective method for quantifying and profiling cells in urine.

Nosocomial infections are a significant public health problem worldwide, affecting hundreds of millions of patients annually. However, studies on nosocomial infections specifically focused on pediatric patients in Ethiopia are limited. Therefore, this study aimed to assess the prevalence of nosocomial infections and associated factors among children admitted at Jimma Medical Center, southwest Ethiopia.

An institution-based retrospective cross-sectional study design was conducted from June 1 to 30, 2023. Data were collected from the medical records of children. A systematic random sampling technique was employed to select a total of 417 medical records. Data were collected using structured checklists. The collected data were entered into Epi-data version 4.6, and Statistical Package for Social Science version 26.0 was used for analysis. The variables with a p-value less than 0.05 were considered as statistically significant.

A total of 417 (92.87%) medical records of the pediatric patient the inclusion criteria. Of these, 99 (23.74%) of pediatric patients developed nosocomial infections. Malnutrition [AOR = 2.01; 95% CI: 1.18, 3.42], length of hospital stay [AOR = 3.19; 95% CI: 1.73, 5.90], antibiotics received at admission [AOR = 4.76; 95% CI: 1.86, 12.15], being on mechanical ventilation [AOR = 5.04; 95% CI: 2.44, 10.43], blood transfusion [AOR = 4.51; 95% CI: 2.43, 8.35], and urinary catheter [AOR = 3.26; 95% CI: 1.72, 6.18] were significantly associated.

The findings of this study indicated that nearly a quarter of children developed nosocomial infections. Malnutrition, length of hospital stay, antibiotics received at admission, being on mechanical ventilation, urinary catheter, and blood transfusion contributed to the development of nosocomial infections. Therefore, the concerned bodies should immediately prevent nosocomial infections and improve identified factors.

Hospital-acquired infections (HAIs) represent a persistent challenge in healthcare, contributing to substantial morbidity, mortality, and economic burden. Artificial intelligence (AI) offers promising potential for improving HAIs prevention through advanced predictive capabilities.

To evaluate the effectiveness, usability, and challenges of AI models in preventing, detecting, and managing HAIs.

This integrative review synthesized findings from 42 studies, guided by the SPIDER framework for inclusion criteria. We assessed the quality of included studies by applying the TRIPOD checklist to individual predictive studies and the AMSTAR 2 tool for reviews.

AI models demonstrated high predictive accuracy for the detection, surveillance, and prevention of multiple HAIs, with models for surgical site infections and urinary tract infections frequently achieving area-under-the-curve (AUC) scores exceeding 0.80, indicating strong reliability. Comparative data suggest that while both machine learning and deep learning approaches perform well, some deep learning models may offer slight advantages in complex data environments. Advanced algorithms, including neural networks, decision trees, and random forests, significantly improved detection rates when integrated with EHRs, enabling real-time surveillance and timely interventions. In resource-constrained settings, non-real-time AI models utilizing historical EHR data showed considerable scalability, facilitating broader implementation in infection surveillance and control. AI-supported surveillance systems outperformed traditional methods in accurately identifying infection rates and enhancing compliance with hand hygiene protocols. Furthermore, Explainable AI (XAI) frameworks and interpretability tools such as Shapley additive explanations (SHAP) values increased clinician trust and facilitated actionable insights. AI also played a pivotal role in antimicrobial stewardship by predicting the emergence of multidrug-resistant organisms and guiding optimal antibiotic usage, thereby reducing reliance on second-line treatments. However, challenges including the need for comprehensive clinician training, high integration costs, and ensuring compatibility with existing workflows were identified as barriers to widespread adoption.

The integration of AI in HAI prevention and management represents a potentially transformative shift in enhancing predictive capabilities and supporting effective infection control measures. Successful implementation necessitates standardized validation protocols, transparent data reporting, and the development of user-friendly interfaces to ensure seamless adoption by healthcare professionals. Variability in data sources and model validations across studies underscores the necessity for multicenter collaborations and external validations to ensure consistent performance across diverse healthcare environments. Innovations in non-real-time AI frameworks offer viable solutions for scaling AI applications in low- and middle-income countries (LMICs), addressing the higher prevalence of HAIs in these regions.

Artificial Intelligence stands as a transformative tool in the fight against hospital-acquired infections, offering advanced solutions for prevention, surveillance, and management. To fully realize its potential, the healthcare sector must prioritize rigorous validation standards, comprehensive data quality reporting, and the incorporation of interpretability tools to build clinician confidence. By adopting scalable AI models and fostering interdisciplinary collaborations, healthcare systems can overcome existing barriers, integrating AI seamlessly into infection control policies and ultimately enhancing patient safety and care quality. Further research is needed to evaluate cost-effectiveness, real-world applications, and strategies (e.g., clinician training and the integration of explainable AI) to improve trust and broaden clinical adoption.

Peritonitis is a surgical emergency arising mostly from the perforation or rupture of an abdominal hollow viscus. Surgical operations for peritonitis are often attended by high morbidity and sometimes mortality in severe cases. Surgical site infection (SSI) is perhaps the most common post-operative morbidity following laparotomy for peritonitis.

To compare the rate of SSI in abdominal operations for peritonitis following wound irrigation with povidone iodine versus normal saline at a tertiary health institution in Nigeria.

This was a prospective, comparative hospital-based study over a year. Consecutive consenting adult patients were randomised into two groups in this study. The first group (A) used 500 mL of 1% povidone iodine for subcutaneous wound irrigation, while the second group (B) used 500 mL of normal saline for subcutaneous wound irrigation. Wound irrigation was done after an appropriate surgical procedure had been carried out based on the pathology. Wounds were assessed for SSI for up to 30 days after operation using the definition criteria by the Centre for Disease Control and Prevention (CDC). SSI rates were compared between the two groups.

Fifty-eight consecutive patients with generalised peritonitis over a one-year period were enrolled in this study, but 53 patients who completed the study were analysed. Thirty patients were males and 23 were females, and their mean age was 40.83 ± 17.96 years. Overall, 15 (28.3%) patients had incisional SSI. There were nine (34.6%) cases in the povidone group, while there were six (22.2%) in the saline group. This difference was not statistically significant (P = 0.32). Klebsiella species were the dominant organisms isolated from the infected wounds.

Wound irrigation with povidone iodine after laparotomy for peritonitis did not reduce the rate and severity of surgical site infection more when compared to normal saline. We suggest further studies with a large number of patients in a multi-centre study to explore further the effect of povidone iodine versus normal saline wound irrigation on SSI following laparotomy for peritonitis.

Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality. HAIs become crucial in patients with neurological illnesses, as they need invasive procedures and extended care, prolonging the hospital stay in most cases. In this study, we report the type, microbial etiology, and outcome of patients with HAIs in a Neurology Intensive Care Unit setting.

In this prospective study, 213 neurologically ill patients were recruited. Patient demographics, primary diagnosis, comorbidities, invasive interventions, device specific data, and length of hospital stay were recorded. Data collected for each episode of HAI included- site of infection, causative organisms, and susceptibility. Site specific infections were categorised as per CDC/NHSN definitions for HAIs.

The median age of patients was 60 years (range 15-88) and 66.70 % were male. HAIs were observed in 135 (63.38 %) patients. Majority of the patients had stroke (ischemic/haemorrhagic) [n = 142;66.66 %] followed by neuromuscular [n = 18; 8.45 %] and seizure disorder [n = 14; 6.57 %]. Most prevalent site of HAIs was urinary tract infections (UTI) (n = 80;37.55 %) followed by pneumonia (n = 74;34.74 %) and blood stream infections (n = 53;24.88 %). 209 patients (98.12 %) underwent urinary catheterization, 90 (42.3 %) required intubation and mechanical ventilation, and 70 (32.86 %) central venous catheterisations. Amongst various HAIs, commonly isolated bacterial pathogens in UTI were Escherichia coli [18/48;37.59 %], Enterococcus [10/48;20.83 %] while Candida species [35/40;87.50 %] was the most common amongst fungal pathogens. Causative organisms in Pneumonia were Klebsiella pneumoniae (27/104;25.96 %), Acinetobacter baumannii (n = 25/104;24.03 %), and Pseudomonas aeruginosa [14/104;13.46 %]. Among the blood stream infections, Staphylococcus species were the most common [39/161;24.22 %] followed by candida species [5/161;3.10 %]. Out of 55 patients who died, HAI was observed in 39 patients (70.90 %). Mean length of hospital stay was 17.56 ± 13.17 days. Presence of coronary artery disease, pulmonary site infection, low Glasgow Coma Scale, central venous catheterization, mechanical ventilation, abnormal chest x-ray, and multiple site infections were significantly associated with high mortality (p < 0.05).

In our study 63.38% of neurological patients had HAIs. The most common sites were urinary, pulmonary, and blood stream infections. Device associated infections were common and significantly associated with poor outcome. Considering the high incidence of HAIs early recognition and treatment of site-specific pathogens may improve the outcome in these patients.

The incidence of surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) patients undergoing surgical correction varies but is commonly reported between 0.5 and 6.7 %. The identification of modifiable risk factors is crucial to preventing these infections in the AIS population. Some potential modifiable risk factors include the use of stainless-steel implants, a larger volume of instrumentation and an increased volume of blood products transfused. However, evidence in support of these factors and others representing true risk for the development of SSI is limited and often varies. We aimed to determine the incidence of SSI in AIS undergoing primary scoliosis fusion at our hospital, and explore demographic and clinical variables in the development of SSI in AIS.

This was a case control retrospective study. Patients aged 10-19 year-old that underwent posterior spinal fusion for initial correction of AIS at our hospital between the years 2012-2020 were eligible. Patients with any previous spine surgery or spine fracture were excluded. A descriptive analysis was then performed on the data.

Of the 334 patients on which data was collected, one SSI was identified resulting in an incidence of infection of 0.3 %. The largest ethnicity represented was Caucasian with 254 patients. The average age was 14.3 years with averaged follow-up of 6.6 years. The majority of patients (252) received implants composed of titanium and cobalt chrome. The average operation duration was 5 h and 7.7 min, and the average hospital stay was 4.2 days. The average amount of blood loss was 553 ml. Chlorhexidine wipes or some other antimicrobial preparation was used on 197 patients and betadine solution was used on 321.185 patients were recorded to have received either antibiotic-loaded allograft or antibiotic powder and 326 patients were recorded to have received intraoperative antibiotics.

The long term clinical follow up of our study and low incidence of infection provide additional evidence for the benefit of antimicrobial techniques and risk factor mitigation previously suggested in the literature for the prevention of SSI in AIS.

Level III.

Pancreatic Stone Protein (PSP) seems to have higher accuracy for sepsis detection compared to other biomarkers. As PSP has never been studied in patients with liver failure (LF), our purpose was to assess its accuracy for diagnosis of infection and prognosis in this population.

We conducted a prospective pilot cohort study on patients with LF consecutively admitted to the Intensive Care Unit of a liver transplant center in 2021-2023. Ongoing overt infection was an exclusion criterion. Daily measurements of biomarkers were performed until discharge, death, or for 21 days. Analysis was performed by adjusting the baseline for the first infection episode (median on D3), which was the reference for those non-infected.

Sixteen patients were included, 7 with acute and 9 with acute-on-chronic LF. Median age was 54 (interquartile range 42-64) years, half were female, with admission SOFA score of 10 (IQR 8-12). Hospital mortality was 43.8% (n = 7). An infection was observed in 8 patients, who presented non-significantly higher levels of PSP than non-infected ones during follow-up. Levels were higher in non-survivors than survivors (p < 0.05 from D4 on and since the day of infection considering only infected patients). Similarly, patients under renal replacement therapy had higher PSP levels than others (p < 0.05, D2 to D7 after admission).

This pilot study provides early insights into PSP kinetics, suggesting a potential role for prognosis in patients with LF. PSP rises in both ALF and ACLF to levels sustainably higher than those expected for healthy adults. Further research is needed to reassess its diagnostic accuracy for infection and redefine cut-offs in this population.

Carbapenem-resistant Enterobacterales (CRE) are an important threat to the health of solid organ transplant recipients (SOTr); data comparing outcomes of SOTr with CRE to non-SOTr with CRE are lacking. A matched cohort study was performed within 2 prospective, multicenter, cohort studies (Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales and Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales 2). The epidemiology, desirability of outcome rankings outcomes, and mortality of SOTr and non-SOTr hospitalized in the United States (December 2011-August 2017) with clinical isolates with Centers for Disease Control and Prevention-defined CRE were compared. In total, 121 SOTr and 242 matched non-SOTr were included. Fifty-one percent of isolates met infection criteria. SOTr were younger (P < .001), less acutely ill (P = .029), less often had a malignancy history (P = .006), and more often were admitted from home (P < .001) than non-SOTr. SOTr had more favorable adjusted desirability of outcome rankings outcomes; a randomly selected SOTr had a 58% (95% confidence interval, 53%-64%) probability of a better outcome as compared to a randomly selected non-SOTr. All-cause 30-day mortality was 14% (17/121) in SOTr vs 25% (60/242) in non-SOTr, P = .018. After stabilized inverse probability weighted adjustment, SOTr had a 7% lower 30-day mortality risk than non-SOTr (95% confidence interval, -15% to 1%). SOTr with CRE do not have worse outcomes than matched patients without transplant history.

Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but potentially devastating complication. The imaging findings associated with such infections are not well described or quantified. The purpose of this study was to describe and quantify the frequency of the characteristic magnetic resonance imaging (MRI) findings of infection following ACL reconstruction.

Seventeen cases were identified from 2010 to 2018, confirmed to meet established definitions for deep infections, and had an MRI obtained within ten days of diagnosis of infection. Two board-certified musculoskeletal radiologists evaluated and scored MRI studies with a predetermined set of imaging characteristics. Cohen's kappa (±) was utilized to determine the extent of agreement between the radiologists. Associations between graft type and microbiologic results and MRI findings were assessed.

The overall infection rate was 0.42%, diagnosed at a median 35 days postoperatively (range 9-411). Grafts were retained in 11 of 17 (64.7%) infected cases and 9 patients (52.9%) required repeat irrigation and debridement. Common imaging findings included complex lamellated effusions (k ​= ​0.86), fluid within the femoral tunnel (k ​= ​0.91), and femoral tunnel resorption (k ​= ​0.83). Subcutaneous edema and edema surrounding the femoral tunnel were also identified in the majority of cases. There was no evidence of cortical destruction of the tunnels or chondrolysis. All acute infections demonstrated complex lamellated effusions, whereas all simple effusions were seen in chronic cases. No associations were found between index ACL graft type or microbiologic results and MRI findings.

Interrater agreement for common imaging findings, including effusion pattern, edema surrounding the graft tunnels and tunnel resorption was near perfect within infected ACL reconstructed knees. MRI can provide valueable information regarding postoperative infection after ACL reconstruction.

Level IV- epidemiological observational study.

Nosocomial bloodstream infections (BSIs) in critically ill patients can cause clinical deterioration, extend intensive care unit (ICU) stays, and increase mortality risk. Extracorporeal membrane oxygenation support (ECMO) is a known risk factor for BSI, and infections in these patients are assumed to have a worse prognosis. However, no comparative studies exist between ECMO and non-ECMO patients.

A three-year prospective observational study was conducted in a 24-bed medical ICU. Consecutive nosocomial BSIs episodes were recorded, and BSIs in mechanically ventilated patients were analyzed based on ECMO treatment status.

A total of 98 BSI episodes were included: 30 (30.6%) in ECMO and 68 (69.3%) in non-ECMO patients. The total number of ECMO patients during the study period was 110, with a bacteraemia rate of 27.7% (20.26 episodes per 1000 treatment-days). In non-ECMO patients, the BSI rate was 7.9% (p<0.001). ECMO patients were younger and had fewer co-morbidities. BSI type and aetiology were similar between groups, but severity was higher in ECMO patients. Although multidrug-resistant microorganisms were more frequent in ECMO patients, the appropriate treatment rate was similar. ICU-mortality was 66.6% in ECMO patients and 30.8% in non-ECMO patients (p <0.001). However, CRRT (OR 3.67), SOFA score (OR 1.54) and COVID-19 diagnosis (OR 1.54) were the only independent risk factors associated with mortality in BSI patients.

Although BSI was more frequent and severe in ECMO patients, ECMO support was not independently related to mortality in patients with healthcare-associated BSI.

We investigated the effect of single-nucleotide polymorphisms (SNPs) in the high mobility group box 1 (HMGB1) gene on morbidity and mortality after liver transplantation (LT). Among 120 LT recipients and their living donors, the genotypes of HMGB1, and the SNPs rs2249825, rs1045411, rs1412125, and rs1360485 were determined. There were no significant associations between these four SNPs and the incidence of rejection or mortality. However, the incidence of early allograft dysfunction (EAD) (n = 43), which presents as functional insufficiency within 1 week of LT, was significantly higher in recipients with the GC + CC allele of rs2249825 (n = 17/34) than in those with the GG allele (n = 26/86) (p = 0.044). Although the impact of donor HMGB1 SNPs on the incidence of EAD was not statistically significant, recipients with the GC + CC allele of rs2249825 who received liver grafts from donors with the same genotype had the highest incidence of EAD (p = 0.052). In contrast, the donor TC + CC allele of rs1412125 was an independent risk factor for the development of sepsis (n = 33) in LT recipient (OR = 3.05, 95 % CI = 1.18-7.87, p = 0.021). Thus, the SNPs of the HMGB1 gene in either recipients or donors were not associated with mortality but influenced the incidence of EAD and sepsis, likely being a predictive biomarker for the risk of serious complications after LT.

Surgical site infection (SSI) prevention "bundles" have been shown to reduce rates of SSI in adult colorectal surgery (CRS) patients. Our purpose was to investigate the association between selection and timing of preoperative antibiotics and incidence of SSI in pediatric CRS patients.

We performed a retrospective analysis of a prospectively collected cohort study spanning January 2019-December 2022 comparing the incidence of SSI in all pediatric CRS patients at a single institution before and after implementation of a surgical "bundle" focused on appropriate selection and timely administration of prophylactic antibiotics. Antibiotic selection and timing were each categorized compliant or noncompliant. SSIs were stratified into superficial, deep incisional, and organ space infections. The primary outcome was incidence of SSI within 30 d of operation. Logistic regression analysis was performed.

Full compliance was noted in 56% of cases in the prebundle cohort and 88% of cases in the postbundle cohort. SSI rates were decreased by 44%. A logistic regression model failed to identify antibiotic selection or timing as an independent predictor of SSI.

The implementation of this perioperative surgical bundle was associated with a reduction in superficial SSI in pediatric CRS patients. Notably, specific adherence to antibiotic selection and timing of administration alone were not found to be predictive for reduction in SSI rates. These findings may support the use of surgical bundles in SSI reduction in pediatric patients undergoing CRS.

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality. Temperature management (TM) is recommended since hyperthermia is associated with worse outcomes. Pneumonia is a frequent occurrence following OHCA, and some studies suggest that TM may have a negative impact on its development. Selective digestive decontamination (SDD) is used in some centers to reduce the incidence of pneumonia in intensive care unit (ICU), but its use remains controversial. This study aims to assess the incidence, risk factors and clinical course of VAP after OHCA. Methods: We conducted a retrospective cohort study on 169 consecutive OHCA patients after their admission in ICU. All patients were treated with TM and SDD. Pharyngeal swabs were analyzed twice weekly. The primary outcome was the incidence of VAP and non-VAP. Secondary aim was to identify the risk factors associated with VAP and its effect on patients' outcome. Results: Incidence of VAP was 5.3%, while incidence of non-VAP was 9.5%. In multivariate analysis, male gender (sHR 3.01; CI 1.1-7.9), increase of white blood cells (WBC) count > 30% over 5 days (sHR 2.32; CI 1.23-3.9), heart disease (sHR 2.4; CI 1.36-4.59), and bacterial colonization of the pharynx (sHR 2.79; CI 1.13-4.39) were significantly associated with VAP. Conclusions: Pharyngeal colonization could be useful to identify patients at higher risk of VAP development. The low rate of VAP in this cohort suggests that SDD can prevent VAP after OHCA. Further studies are needed to explore the potential of SDD in OHCA patients.

To assess the predicting value of neutrophil percentage-to-albumin ratio (NPAR) and modified Glasgow Prognostic Score (mGPS) for Stroke-Associated Pneumonia (SAP) occurrence among stroke patients.

We recruited stroke patients (aged 18 years) hospitalized at Tianjin First Central Hospital from January 2022 to February 2023 for this retrospective cohort study. NPAR was categorized into four groups by considering the quartiles: Q1 (<1.38), Q2 (≥1.38 and <1.62), Q3 (≥1.62 and <1.87), Q4 (≥1.87). SAP incident was the primary outcome in this study. Univariate and multivariate logistic regression models were employed to explore the association between NPAR, mGPS and SAP occurrence among individuals with stroke. Besides, we compared the predicting value of NPAR and mGPS for SAP occurrence by the receiver operating characteristic (ROC) curve.

Our study encompassed 851 patients with stroke. One hundred and forty-seven patients (17.27%) developed SAP. After accounting for confounding factors, we observed significant positive association of high NPAR with SAP occurrence [(for the third quartile: odds ratio (OR)=2.35, 95% confidence interval (CI): 1.01-5.47; for the fourth quartile: OR=3.35, 95% CI: 1.44-7.77)]. Additionally, the results also indicated that mGPS 1 (OR=2.26, 95% CI: 1.25-4.08) and mGPS 2 (OR=7.37, 95% CI: 2.63-20.70) were related to the increased probability of SAP, respectively. ROC analysis demonstrated that both the NPAR [area under the curve (AUC)=0.729, 95% CI: 0.687-0.771] and mGPS (AUC=0.671, 95% CI: 0.627-0.716) exhibited good predictive power for SAP occurrence. Based on the DeLong test, the predictive value of NPAR for SAP may be significantly superior to that of mGPS (P<0.05).

Our findings suggest that both NPAR and mGPS serve as reliable biomarker for assessing SAP risk in stroke patients, with NPAR demonstrating superior predictive value for SAP compared to mGPS.

Skin adhesives containing 2-octyl cyanoacrylate are a common source of allergic contact dermatitis (ACD), a complication of postoperative wound healing. Few studies have described postoperative cutaneous reactions to skin adhesives and their clinical management. The aim of this study was to review the incidence, descriptions, and clinical management of surgical site ACD caused by 2-ocyl cyanoacrylate. A comprehensive systematic literature search was conducted in September 2023 of the PubMed/MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science (Clarivate Analytics, Philadelphia, PA), and Cochrane databases (Cochrane Library, John Wiley & Sons, Ltd., Hoboken, NJ) for studies reporting ACD after skin closure with liquid adhesives containing 2-octyl cyanoacrylate. Additionally, we queried the FDA Manufacturer and User Facility Device Experience (FDA MAUDE, U.S. Food and Drug Administration, Silver Spring, MD) in September 2023 and retrieved clinician-inputted records of ACD caused by liquid adhesives containing 2-octyl cyanoacrylate from 2014 to2023. Nine articles were included for review, with a median of 102 patients exposed to 2-octyl cyanoacrylate for surgical site skin closure. The reported incidence of cutaneous reactions to 2-octyl cyanoacrylate ranged from 0.5% to 14%. The review also included 609 unique FDA MAUDE records reporting surgical site skin reactions to 2-octyl cyanoacrylate. Orthopedic procedures were the most common type of procedure, representing 47% of FDA MAUDE records. Nineteen clinical descriptors of cutaneous reactions were utilized. Topical corticosteroids and oral antihistamines were the most commonly prescribed treatments to manage postoperative cutaneous reactions. Reported incidences of cutaneous reactions to 2-octyl cyanoacrylate vary widely and guidelines for clinical management remain unclear. The FDA MAUDE provides important insights to cutaneous reactions to 2-octyl cyanoacrylate including surgery-type, cutaneous descriptors, and clinical management. Future research is needed to identify patients at risk of 2-octyl cyanoacrylate skin reactions in the preoperative setting.

Bloodstream infections (BSIs) significantly contribute to the morbidity and mortality in paediatric burn patients from low- and middle-income countries; with common pathogens like Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa frequently being multidrug resistant (MDR). Due to the growing prevalence of MDR BSIs, antimicrobial stewardship needs to be improved with perhaps more targeted initial antimicrobial use. The study describes the aetiology, and timing of burn-associated BSIs and MDR infections in paediatric burn patients admitted to two paediatric surgery units in Tshwane District, South Africa.

This multi-centre retrospective review analysed paediatric burn patients (ages 0-12 years) admitted between January 2020 and December 2022 to two public hospitals in Tshwane District, South Africa. Collected data was from patient records and the National Health Laboratory System TrakCare database. BSIs were defined according to the CDC criteria.

Of 245 burn patients admitted, 18.8% (n = 46) developed BSIs. From 63 positive blood cultures, the most common isolates were S. aureus (n = 19; 30%), Acinetobacter baumannii (n = 18; 29%), and P. aeruginosa (n = 10; 16%). Collectively, gram negative bacteria were responsible for most BSIs (n = 41; 65%). Candida spp accounted for 9% (n = 5). Thirty-five pathogens (56%) were MDR; this included methicillin-resistant S. aureus (MRSA) (n = 7; 11%), carbapenem-resistant A. baumannii (n = 16; 25%), and P. aeruginosa (n = 6; 10%). The median time to the first positive blood culture was 5 days (IQR: 3-12) (gram positive organisms: median: 5 days [IQR: 3-15}); gram negative organisms: median: 8 days [IQR: 4-20]; Fungal: median: 9 days [IQR: 8-27]; p-value 0.37). In the first week, S. aureus caused 32% of infections, including five MRSA cases. Gram negative bacteria dominated weeks two and three, with fungal and polymicrobial infections mainly in weeks two and four.

Our findings show that as gram positive and gram negative infections predominantly occurred early in the admission period, while polymicrobial infections are more frequently observed later. Consequently, initial targeted narrow-spectrum antimicrobial use is not possible. Instead, antimicrobial de-escalation should be prioritized once culture results are available. Efforts should shift from a focus on treating BSIs to preventing them through wound care and infection control measures. Broad-spectrum antibiotics should be used judiciously and quickly de-escalated to minimise antimicrobial resistance development.

BackgroundHospital-acquired infections (HAIs) are associated with morbidity and mortality in children following congenital cardiac surgery. Our center performs approximately 200 congenital surgeries a year, but infection rates and risk factors remain unknown. This study aims to identify HAI prevalence, risk factors, and outcomes.MethodsRetrospective cross-sectional study of children who underwent congenital cardiac surgery between 2018 and 2022. The infection risk factors were identified using univariate and multivariate analyses. Assessed outcomes are length of stay, duration of mechanical ventilation, and mortality.ResultsOut of 653 patients, 102 (15.6%) developed an infection. Independent risk factors for infection included preoperative critical care admission (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.01-7), delayed sternal closure (OR, 3.3; 95% CI, 1.37-8.0), peritoneal drain (OR, 12.7; 95% CI, 1.65-97), heterotaxy syndrome (OR, 5.6; 95% CI, 1-31), and extracorporeal membrane oxygenation (ECMO) placement in the critical care unit (OR, 10.6; 95% CI, 1.8-64.2). The pediatric critical care and hospital stays of patients with infections were significantly longer with 12.79 (12.15) days versus 4.07(5.47) days and 25.53 (16.86) days versus 10.21 (7.5) days, respectively. Infected patients had a longer mechanical ventilation duration, 169.5 (264.8) versus 28.16 (53.6) hours. Infections were associated with a higher mortality rate, with 7 (6.9%) versus 12 (2.2%).ConclusionsThe prevalence of HAIs following cardiac surgery was 15.6%. Preoperative critical care unit admission, delayed sternal closure, heterotaxy syndrome, peritoneal drain, and ECMO placement in the critical care unit were independent risk factors. Infected patients have worse outcomes. Preventive strategies are greatly needed.

Postoperative pulmonary complications (PPCs) are frequent after abdominal surgery and significantly affect postoperative outcomes. Intraoperative protective ventilation (IPV) has been demonstrated to mitigate PPCs. However, the comparative effectiveness of two common IPV regimens-IPV with or without periodic lung recruitment manoeuvres (PLRM)-in preventing PPCs is unclear. This study aims to compare the effects of these two IPV regimens on PPCs.

This study is a prospective, double-blinded, randomised controlled trial. A total of 1060 patients at intermediate or high risk for PPCs, scheduled to undergo major abdominal surgery, will be enrolled and randomly assigned to receive either an IPV with PLRM (intensive IPV group) or an IPV without PLRM (moderate IPV group). Patients assigned to the intensive IPV group will receive positive end-expiratory pressure (PEEP) of 6-10 cm H2O with lung recruitment manoeuvres performed every 30 min. Patients in the moderate IPV group will receive the same level of PEEP without lung recruitment manoeuvres. Both groups will receive a tidal volume of 7 mL/kg predicted body weight and an inspired oxygen fraction of 0.3-0.4. The primary outcome is respiratory failure within the first 7 postoperative days. Secondary outcomes include other PPCs, extrapulmonary complications, unplanned admissions to the intensive care unit, length of postoperative hospital stay and mortality from any cause.

This protocol has been approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. The first participant was recruited on 9 October 2022, with an estimated completion date of 30 May 2025. The results of this trial are expected to be published in peer-reviewed journals.

NCT05556174.

A functional immune system is essential for recovery from pneumonia; hence, measuring and monitoring immune-status indicators is clinically important. This study aimed to determine whether QuantiFERON monitoring (QMF) could predict healthcare-associated infection (HCAI) according to the immune-status of patients with pneumonia.

Prospective, observational, single-center study, patients ≥19 years hospitalized for pneumonia between October 2020 and November 2021. QFM was performed at hospital admission (D1) and seven days after (D2). Data from 90 patients in the D1 QFM group were analyzed, which was further divided into the non-healthcare-associated infection (non-HCAI, n = 41, 45.6%) and HCAI (n = 49, 54.4%) groups.

The D1 and D2 QFM levels were both significantly higher in the non-HCAI group than in the HCAI group (D1 hCAI vs non-HCAI: 4.40 vs 5.75 IU/mL, D2 hCAI vs non-HCAI: 4.38 vs 6.10 IU/mL). Analysis of the change in D1 and D2 QFM levels by each group showed that D2 QFM levels increased over D1 QFM levels in the non-HCAI group (5.75 vs 6.10 IU/mL), while D2 QFM levels decreased over D1 QFM levels in the HCAI group (4.40 vs 4.38 IU/mL). D1 QFM was consistently negatively correlated with TNF-α and CRP. The integrated analysis of D1 QFM and CCI and D1 QFM and CURB-65 had fair to predict the occurrence of HCAI.

QFM can be used to predict the immune-status of patients in the context of healthcare-associated infections. These findings provide important insights into the current understanding of pneumonia treatment and recovery.

The VINCat programme focuses on monitoring surgical site infections (SSI) in caesarean sections (CS) performed across affiliated hospitals.

The study included CS performed from 2008 to 2022, with a follow-up of 30 days after the intervention. The analysis of cumulative incidence rate of SSI was stratified into three 5-year periods (Periods 1-3). SSI was defined according to the National Healthcare Safety Network (NHSN) classification. SSI surveillance was carried out in accordance with the methodology established by the VINCat programme.

From 2008 to 2022, 36,387 CS were surveyed at 34 hospitals: 13,502 in Period 1, 12,985 in Period 2 and 9900 in Period 3. The mean age was 33 years. Overall, SSI incidence fell from 3.81% in Period 1 to 2.66% in Period 3 (rho=-0.838; p<0.001). Superficial SSI decreased from 3.1% in Period 1 to 2.15% in Period 3 (rho=-0.795; p<0.001). The rate of organ-space SSI remained consistent across all three periods, maintaining a rate of 0.27 (rho=-0.092; p=0.745). Culture was performed in 58.9% of infections. The microorganisms most frequently identified were Staphylococcus aureus (20.64%), Coagulase-negative staphylococci (CoNS) (13.52%), and Escherichia coli (11.27%). Antibiotic prophylaxis was appropriate in 73.76% of the procedures.

Appropriate monitoring of post-CS SSI rates allows the implementation of preventive measures to reduce their incidence.

Surgical site infections (SSIs) were recognized to be the most common complication of neurological surgery, with substantial life quality threats to patients and additional cost burdens to healthcare facilities. This study sought to expound the infection characteristics of class I incision and provide clinical indication for the prevention and treatment of SSIs.

A 2-year retrospective analysis was conducted according to patients who performed neurological surgery with class I incision in a tertiary comprehensive hospital in Shaanxi Province, China. Case mix index (CMI)-adjusted and national nosocomial infection surveillance (NNIS) risk index-adjusted SSI rate were utilized for analytical standardization. The SSIs were specifically analyzed according to various departments, surgeons, and surgical classifications.

6046 surgical cases were finally included in our study. The majority of the American Society of Aneshesiologists (ASA) score and NNIS risk index of surgeries were allocated in level 2 and score 1. Our study found 121 SSI cases, with the crude infection rate of 2.00%. 95.04% were organ/space infection. The most of the infection were found in the surgeries with score 1 (68.60%) of the NNIS risk index. The main surgical classification was resection of space occupying lesions (61.96%). The highest crude and NNIS risk index adjusted infection were individually found in hybrid operation (11.67%) and endoscopy-assisted resection of space occupying lesions (13.33%). 21 of 54 surgeons were found to have SSIs. We found the main pathogenic bacteria was Staphylococcus epidermidis (22.81%), and the commonly prophylactic used antibiotics was Cefazolin (51.95%).

Our study found the main infection was among surgeries with score 1 of NNIS risk index and the surgical classification of endoscopy-assisted resection of space occupying lesions. We indicated specific attention should be paid to the surgeon and surgical classification with highest infection rate to control and prevent SSIs.

Central line-associated bloodstream infections (CLABSI) are among the most common and preventable hospital-acquired infections in pediatric and neonatal intensive care units (PICU-NICU). CLABSI is a common etiology of late-onset sepsis and is associated with high morbidity and mortality. The aim of this study was to describe the incidence of CLABSI in PICUs and NICUs in our geographical setting.

Descriptive study conducted as part of the VINCat program, investigating the incidence of CLABSI in NICUs and PICUs at acute care hospitals in Catalonia from 2013 to 2022. The annual CLABSI incidence rate was calculated by multiplying the total detected cases in a year by 1000 and dividing by the total patient-days with central venous catheter (CVC).

NICU: The overall incidence rate was 5.59 per 1000 patient-days. Peripherally inserted CVC was involved in 59.8% of catheter-related infection, and an overall median duration of 7 days from catheter insertion to the onset of infection. PICU: The overall incidence rate was 3.62 per 1000 patient-days. Jugular venous access (44.1%) was the most common location of infections, with a median of 12 days to CLABSI. Gram-positive bacteria, especially coagulase-negative Staphylococci, were the most prevalent in both units.

A standardized surveillance system based on the calculation of the incidence rate of CLABSI in PICUs and NICUs can broaden our understanding of this HAI and will guide the implementation of measures of infection control and prevention.

Colorectal surgery has the highest surgical site infection (SSI) rates of all abdominal surgeries. Epidemiological surveillance is an excellent instrument to reduce SSI rates, but its effects may be time-limited and need to be monitored periodically. This study analyses the effectiveness of an interventional surveillance programme with regard to reducing SSI rates after elective colorectal surgery.

Cohort study analysing a SSI surveillance programme in elective colorectal surgery over a 15-year period. Prospectively collected data were stratified by 5-year periods (Periods 1, 2 and 3), and SSI rates, length of stay, readmission, mortality and microbiological aetiology were investigated.

A total of 64,074 operations were included (42,665 colon surgery and 21,409 rectal surgery). Overall SSI incidence in colon surgery fell from 19.6% in Period 1 to 7.6% in Period 3 (rho=-0.961). Organ-space SSI (O/S-SSI) was 8.3% in Period 1 and 4.7% in Period 3 (rho=-0.815). In rectal surgery, overall SSI fell from 20.6% to 12.8% (rho=-0.839), and O/S-SSI from 8.5% to 8.3%, the latter difference being non-significant. The intervention that achieved the greatest SSI reduction was a preventive bundle comprising six measures. Hospital stay and mortality rates decreased, while SSIs after discharge and readmissions increased. An increase in Gram-positive cocci and fungi, and reductions in Gram-negative bacteria and anaerobes were detected for both incisional and O/S-SSI.

Detailed analysis of SSI rates allows the design of strategies for reducing their incidence. An interventional surveillance programme was effective in decreasing SSI rates in colorectal surgery.

We report a hospital outbreak caused by Burkholderia cepacia that occurred in 16 patients admitted to intensive care units in Elazığ, Türkiye, between 19 March and 23 April 2024.

The outbreak investigation was initiated on 23 March 2024, four days after B. cepacia was detected in four different patients. Environmental samples were collected from various parts of the hospital to find the source of the outbreak. Arbitrarily Primed Polymerase Chain Reaction (AP-PCR) was performed to determine the genetic relationship between environmental and patient samples.

In total, 16 of 18 B. cepacia isolates were obtained from tracheal aspirate culture. A total of 10 of 16 patients developed hospital-acquired pneumonia due to B. cepacia. Among the environmental cultures in the intensive care units, only the respirator bacterial filter grew. The isolate obtained here was in the same cluster as the isolate obtained from patient samples, resulting in a dominant clustering rate of 94.4%.

Improper and inappropriate use of respirators and equipment can lead to outbreaks. Early detection of the outbreak, identification of the source, and taking appropriate measures quickly to contain the outbreak are key.

We compared the efficacy of chlorhexidine-impregnated central lines (CLs) with plain CLs in preventing central line-associated bloodstream infections (CLABSIs) in critically ill patients.

The study was conducted from April 2023 to August 2024 in 8 hospitals across India, Malaysia, Papua New Guinea, Colombia, Egypt, and Turkey. Data were collected prospectively using the INICC Surveillance Online System. Cases and controls were recruited simultaneously. Data were analyzed using t tests, χ² tests, and Fisher exact tests when indicated. Relative risks (RR) and their corresponding 95% confidence intervals (CI) were calculated.

A total of 6,672 patients were included. Patients with impregnated CLs had 4,721 CL-days, while those with plain CLs had 18,822 CL-days. The CLABSI rate in patients with impregnated CLs was 1.48 per 1,000 CL-days, compared to 4.78 per 1,000 CL-days in those with plain CLs (RR=0.31, 95%CI=0.14-0.67, P=.003). A subgroup analysis excluding patients with hemodialysis but using central venous catheters (CVCs) showed 1.72 CLABSIs per 1,000 CL-days in patients with impregnated CVCs compared to 5.84 per 1,000 CL-days in those with plain CVCs (RR=0.29, 95%CI=0.12-0.68, P=.004).

This study highlights the significant benefits of impregnated CLs over plain CLs in reducing CLABSI rates, achieving a 69% decrease in incidence.

Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.

Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.