MORTALITY-ASSOCIATED SARS-COV-2 GENOMIC VARIANTS FROM PATIENTS HOSPITALIZED FOR SEVERE PNEUMONIA IN AGUASCALIENTES, MEXICO FROM 2020 TO 2023 (preprint)

The SARS-CoV-2 virus has caused a global health crisis, resulting in a significant loss of human lives. It is essential to report disease and mutation associations to provide ideas for public health interventions and preventive measures. In this study, to determine the association between genomic variants and the severity of pneumonia caused by SARS-CoV-2, a sequencing analysis of 150 patient samples with confirmed COVID-19 was conducted. These samples were collected between 2021 and 2023 and isolated in Aguascalientes, Mexico. The patient cohort had males and females ranging from 0 to 91 years old. Males accounted for 66% of the population analyzed. The Delta variant was the most prevalent lineage associated with deaths in 2021-2022, while the B.1.1.529 lineages emerged in mid-2022. Currently, the XBB lineage is the most commonly identified in Mexico. New mutations L95M and L46M in ORF 8 and ORF 9 were discovered in 30% and 20% of the sequences and are uniquely present in the studied population. These mutations are positively associated with patient death. This study provides valuable data to aid in understanding the evolution of SARS-CoV-2 in specific populations and explores the severity of the disease and mutation correlations.

A questionnaire-based survey of COVID-19 transmission in dental practice during the pandemic:comparison between the 1st-5th and the 6th-8th surges in Japan (preprint)

Background: Previously, we conducted a questionnaire survey on infection control measures and infection status among practicing dentists in Nagano prefecture, Japan, between February 2020 and September 2021 (1-5th surge of COVID-19 cases in Japan) and found that the risk of COVID-19 infection spreading through dental care was very low. However, it was noted that the low number of infected patients during the survey period may have been a contributing factor. Subsequently, an explosive increase in the number of infected patients was observed, raising the possibility of nosocomial infections in dental treatment settings. Therefore, in this study, we reexamined the infection situation in dental care settings at the time of infection spread and compared the results with those of previous reports. Materials and methods An online questionnaire-based survey on clinical activities, infection control measures, and confirmed or probable COVID-19 cases among patients and clinical staff were conducted between February 2022 to March 2023 (6-8th surge). Results The number of COVID-19 positive patients increased approximately 50-fold between the study periods. There was a 3.5-fold increase in the rate of treatment for infected patients. Even with the increased likelihood of contact with COVID-19 patients, no cases of infection during dental treatment were observed. Conclusions The results of this study indicate that even with the possibility of contact with COVID-19 during dental treatment, the likelihood of COVID-19 clusters occurring in dental practices is low if appropriate infection prevention measures are in place.

Perceptions of home hospitalization among the public and physicians in Israel: Findings from surveys conducted for the Dead Sea Health Policy Conference of 2022 (preprint)

Background Hospital at Home (HaH) is an alternative care model that delivers acute hospital-level services in patients’ homes. Despite its proven advantages and the accumulated experience with HaH worldwide, it did not gain a significant foothold in Israel until 2020, during the COVID-19 pandemic. The issue was highlighted at the Dead Sea Conference on Health Policy in 2022. This study examines and compares perceptions of HaH among the Israeli public (potential patients and their families) and among physicians (in the community and in the hospitals), Jewish and Arab, and identifies facilitators and barriers to expanding HaH in Israel. Methods Two online cross-sectional surveys were conducted. One survey was answered by 342 physicians, and the other by 424 members of the public aged 35+ recruited on the basis of quota sampling methodology for the variables of age, gender, district of residence, and population group. Descriptive statistics were used to examine perceptions of potential HaH stakeholders and to explore the association between variables, measured on a nominal scale, using chi-square tests. Multivariate relationships were analyzed using logistic regression. Results About 39% of the respondents in the survey of the public thought that the quality of care in HaH is as good or better than in the hospital system; 44% thought the safety of care is as good or better in HaH; and 58% thought the communication between patients/families and the healthcare professionals is as good or better in HaH. Physicians expressed greater confidence in HaH than the public; The parallel figures in the survey of physicians were 65%, 75%, and 91%. About 78% of the respondents in the survey of the public and 97% of the respondents in the physicians' survey view HaH as a good alternative to hospitalization and similar proportions would be interested in personally using HaH if offered to them or their families instead of traditional hospitalization. In the survey of the public, A lower proportion of Arab respondents and of respondents with income lower than average had a positive view of HaH than Jewish respondents and respondents with average income or higher. Physicians who practiced in community settings indicated a stronger preference for HaH over hospitalization than physicians who mainly practiced in hospitals. In an open-ended question in the survey of physicians, several significant barriers to expanding HaH in Israel were mentioned, with particular emphasis on the lack of specialized manpower needed to expand the services, a lack of resources, and insufficient awareness of the service, both among patients and the medical staff. Conclusions The findings suggest that HaH services can serve as a possible model for providing high-quality and safe medical service in Israel, a view that is gaining popularity among the public and in even more so among physicians. The findings of the survey can provide insights to policymakers concerning the opportunities and barriers to HaH, to facilitate the expansion of HaH services. The main recommendations that arise from the findings include increasing the public’s awareness of HaH services; reducing the burden on the patient’s family; tailoring HaH policy according to the various population groups in order to provide services in an equitable and culturally sensitive manner; recruiting hospital staffs to the effort including their involvement in the design and provision of HaH services and finally, investing resources to finance HaH activity and to train the specialized manpower that it requires.

Clinical Manifestations and Associated Mortality Factors of COVID-19: A large population-based study in Northeast of Iran: 2020-2021 (preprint)

Background: The emergence of the coronavirus disease in late 2019 (COVID-19) has become one of the greatest health problems of the 21st century. Many aspects of this viral disease are still hidden. The current study is conducted to investigate COVID-19’s clinical manifestation, mortality factors, and their association with each other in the COVID-19 pandemic in Razavi-Khorasan province, Iran. Methods & Materials: This retrospective epidemiological population-based study was conducted from January 21, 2020, to March 20, 2021. The data including demographic characteristics and clinical presentations of the patients were extracted from the Medical Care Monitoring System (MCMC), disease management portal in the deputy of health and Hospital Information System (HIS). Results: A total of 80499 patients were admitted to all hospitals of Khorasan-Razavi University of Medical Sciences with laboratory/clinical COVID-19 confirmed disease, between January 2020 and March 2021. The male-to-female ratio was 1.10:1 and the mean age of our COVID-19 individuals was 55.67 ± 23.27. The most frequently reported presenting symptoms at admission were respiratory distress (58.2%), fever (36.7%), and cough (34.9%), and alternation in smell/taste (0.9%) was the less frequent. Being male, aging older than 60 years and having comorbidities were significantly associated with higher mortality rates. Conclusion: Due to the genetic mutations in the virus and the emergence of the new variants of the virus, clinical presentations, and mortality rates of the COVID-19 have been shifted through three reviewed waves. Further studies are needed to determine the impact of the new variants of the virus on individuals.

Use of immune-modulating agents to regulate hyperinflammation in severe COVID-19; the assessment of tocilizumab use in combination with steroids (preprint)

Introduction COVID-19 infection might lead to hyperinflammatory state in severe cases leading to devastating outcomes. Immune modulation using steroids or other immune modulators can regulate the intensity of inflammatory response; however, this theory has not been adequately assessed in practice. The current study aims to investigate the use of corticosteroids alone or in combination with tocilizumab for the treatment of patients with severe COVID-19. Methods The current retrospective cross-sectional study has been conducted on 168 patients with severe COVID-19 infection who were categorized into three treatment groups of A: primary treatment with high-dose methylprednisolone (> 1 mg/kg) continued with tocilizumab; B: primary treatment with low-dose methylprednisolone (< 1 mg/kg) continued with tocilizumab and C: treatment with high-dose methylprednisolone (> 1 mg/kg) only. The parameters including clinical outcome, laboratory parameters, length of hospitalization, intensive care unit (ICU) admission requirement and drug-related adverse events were compared between the groups. Results The outcomes were significantly better in group B considering the shorter length of ICU stay, lower CRP, LDH, and higher oxygen saturation and platelet count in group B than the other groups (P-value < 0.05). Logistic regression assessment in crude and adjusted models revealed increased risks of mortality, the incidence of nosocomial infection and the incidence of adverse effects, including hepatic dysfunction, renal dysfunction and GIB in both groups A and C compared with group B (P-value < 0.05). Conclusion Based on the findings of this study, low-dose steroid continued with tocilizumab was superior over high-dose steroid alone or in combination with tocilizumab in terms of all evaluated parameters.

Mapping the scientific output of organoids for modeling animal and human infectious diseases: A bibliometric assessment (preprint)

The escalation of antibiotic resistance, pandemics, and nosocomial infections underscores the importance of research in both animal and human infectious diseases. Recent advancements in three-dimensional tissue cultures, or "organoids," have revolutionized the development of in vitro models for infectious diseases. Our study conducts a bibliometric analysis on the use of organoids in modeling infectious diseases, offering an in-depth overview of this field's current landscape. We examined scientific contributions from 2009 onward that focused on organoids in host‒pathogen interactions using the Web of Science Core Collection. Our analysis included temporal trends, reference aging, author and institutional productivity, collaborative networks, citation metrics, and keyword cluster dynamics. VOSviewer and CiteSpace facilitated this analytical assessment. The findings reveal significant growth and advancements in organoid-based infectious disease research. Analysis of keywords and impactful publications identified three distinct developmental phases in this area that were significantly influenced by outbreaks of Zika virus and SARS-CoV-2. Hans Clevers and his team are prominent within the author and institutional collaboration networks. The research also highlights the synergistic efforts between academia and publishers in tackling global pandemic challenges. Organoids are proving to be a promising tool in infectious disease research. Their integration into the field necessitates methodological refinements for better physiological emulation and the establishment of extensive organoid biobanks. These improvements are crucial for fully harnessing the potential of organoids in understanding infectious diseases and advancing the development of targeted treatments and vaccines.

A Bayesian approach to identifying the role of hospital structure and staff interactions in nosocomial transmission of SARS-CoV-2 (preprint)

Nosocomial infections threaten patient safety, and were widely reported during the COVID-19 pandemic. Effective hospital infection control requires a detailed understanding of the role of different transmission pathways, yet these are poorly quantified. Using patient and staff data from a large UK hospital we demonstrate a method to infer unobserved epidemiological event times efficiently and disentangle the infectious pressure dynamics by ward. A stochastic individual-level, continuous-time state-transition model was constructed to model transmission of SARS-CoV-2, incorporating a dynamic staff-patient contact network as time-varying parameters. A Metropolis-Hastings MCMC algorithm was used to estimate transmission rate parameters associated with each possible source of infection, and the unobserved infection and recovery times. We found that the total infectious pressure exerted on an individual in a ward varied over time, as did the primary source of transmission. There was marked heterogeneity between wards; each ward experienced unique infectious pressure over time. Hospital infection control should consider the role of between-ward movement of staff as a key infectious source of nosocomial infection for SARS-CoV-2. With further development, this method could be implemented routinely for real-time monitoring of nosocomial transmission and to evaluate interventions.

Examination of Influenza A Infection Rate, Its Determinants, and Seasonal Influenza Vaccine Effectiveness in the Post-COVID-19 Pandemic Era (preprint)

BackgroundIn the context of the COVID-19 pandemic, a pronounced wave of Influenza A occurred in the 2022/23 winter season under generally relaxed post-pandemic non-pharmaceutical preventive measures. AimThis study aimed to investigate the Influenza A infection rate, factors influencing its occurrence and seasonal Influenza vaccine effectiveness on seroconversion in the post-COVID-19 pandemic era. MethodsThe seroconversion of Anti-Influenza-A-Nucleoprotein/Matrix IgG was investigated in 402 healthcare workers (HCWs) during the winter season of 2022/2023 (23 May 2022 to 11 May 2023). The participants provided a serum sample and completed a study questionnaire both before and after the seasonal Influenza A wave (24 October 2022 to 8 January 2023). The levels of a vaccine-independent Anti-Influenza-A-Nucleoprotein/Matrix IgG were measured using the SERION ELISA classic Influenza A IgG assay, with a 2-fold increase as indicative of seroconversion after asymptomatic or symptomatic influenza infection. ResultsAmong the participants, 20.6% (95% CI 17.0-24.9%; 83/402) showed seroconversion. The multivariate logistic regression analysis revealed that the age category of [≥] 45 years (p=0.03) and regular patient contact (p=0.02) significantly influenced seroconversion. However, the factors male gender, BMI, smoking, household size, seasonal Influenza vaccination, and SARS-CoV-2 infection during the Influenza A season were not significantly associated with seroconversion. The effectiveness of the 2022/23 seasonal Influenza vaccine on seroconversion induced by Influenza infection was 22.6% (95% CI -17.1-50.6%). ConclusionDuring the initial Influenza A season following the COVID-19 pandemic, approximately 20% of HCWs contracted an Influenza A infection. This highlights a potential risk and a significant asymptomatic or symptomatic infection rate posing a theoretical risk for intrahospital transmission chains and nosocomial infections.

Taking hospital pathogen surveillance to the next level.

High-throughput bacterial genomic sequencing and subsequent analyses can produce large volumes of high-quality data rapidly. Advances in sequencing technology, with commensurate developments in bioinformatics, have increased the speed and efficiency with which it is possible to apply genomics to outbreak analysis and broader public health surveillance. This approach has been focused on targeted pathogenic taxa, such as Mycobacteria, and diseases corresponding to different modes of transmission, including food-and-water-borne diseases (FWDs) and sexually transmitted infections (STIs). In addition, major healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and carbapenemase-producing Klebsiella pneumoniae are the focus of research projects and initiatives to understand transmission dynamics and temporal trends on both local and global scales. Here, we discuss current and future public health priorities relating to genome-based surveillance of major healthcare-associated pathogens. We highlight the specific challenges for the surveillance of healthcare-associated infections (HAIs), and how recent technical advances might be deployed most effectively to mitigate the increasing public health burden they cause.

Collateral impacts of pandemic COVID-19 drive the nosocomial spread of antibiotic resistance: A modelling study.

BACKGROUND: Circulation of multidrug-resistant bacteria (MRB) in healthcare facilities is a major public health problem. These settings have been greatly impacted by the Coronavirus Disease 2019 (COVID-19) pandemic, notably due to surges in COVID-19 caseloads and the implementation of infection control measures. We sought to evaluate how such collateral impacts of COVID-19 impacted the nosocomial spread of MRB in an early pandemic context. METHODS AND FINDINGS: We developed a mathematical model in which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and MRB cocirculate among patients and staff in a theoretical hospital population. Responses to COVID-19 were captured mechanistically via a range of parameters that reflect impacts of SARS-CoV-2 outbreaks on factors relevant for pathogen transmission. COVID-19 responses include both "policy responses" willingly enacted to limit SARS-CoV-2 transmission (e.g., universal masking, patient lockdown, and reinforced hand hygiene) and "caseload responses" unwillingly resulting from surges in COVID-19 caseloads (e.g., abandonment of antibiotic stewardship, disorganization of infection control programmes, and extended length of stay for COVID-19 patients). We conducted 2 main sets of model simulations, in which we quantified impacts of SARS-CoV-2 outbreaks on MRB colonization incidence and antibiotic resistance rates (the share of colonization due to antibiotic-resistant versus antibiotic-sensitive strains). The first set of simulations represents diverse MRB and nosocomial environments, accounting for high levels of heterogeneity across bacterial parameters (e.g., rates of transmission, antibiotic sensitivity, and colonization prevalence among newly admitted patients) and hospital parameters (e.g., rates of interindividual contact, antibiotic exposure, and patient admission/discharge). On average, COVID-19 control policies coincided with MRB prevention, including 28.2% [95% uncertainty interval: 2.5%, 60.2%] fewer incident cases of patient MRB colonization. Conversely, surges in COVID-19 caseloads favoured MRB transmission, resulting in a 13.8% [-3.5%, 77.0%] increase in colonization incidence and a 10.4% [0.2%, 46.9%] increase in antibiotic resistance rates in the absence of concomitant COVID-19 control policies. When COVID-19 policy responses and caseload responses were combined, MRB colonization incidence decreased by 24.2% [-7.8%, 59.3%], while resistance rates increased by 2.9% [-5.4%, 23.2%]. Impacts of COVID-19 responses varied across patients and staff and their respective routes of pathogen acquisition. The second set of simulations was tailored to specific hospital wards and nosocomial bacteria (methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase producing Escherichia coli). Consequences of nosocomial SARS-CoV-2 outbreaks were found to be highly context specific, with impacts depending on the specific ward and bacteria evaluated. In particular, SARS-CoV-2 outbreaks significantly impacted patient MRB colonization only in settings with high underlying risk of bacterial transmission. Yet across settings and species, antibiotic resistance burden was reduced in facilities with timelier implementation of effective COVID-19 control policies. CONCLUSIONS: Our model suggests that surges in nosocomial SARS-CoV-2 transmission generate selection for the spread of antibiotic-resistant bacteria. Timely implementation of efficient COVID-19 control measures thus has 2-fold benefits, preventing the transmission of both SARS-CoV-2 and MRB, and highlighting antibiotic resistance control as a collateral benefit of pandemic preparedness.

Epidemiology of Primary and Recurrent Healthcare-Associated and Community-Associated Pediatric Clostridioides difficile Infection in Canada, 2015-2020.

Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections.

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

INTRODUCTION: Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. MATERIALS AND METHODS: Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. RESULTS: Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. DISCUSSION AND CONCLUSION: Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

Society for Healthcare Epidemiology of America Compendium updates 2022.

PURPOSE OF REVIEW: Healthcare-associated infections (HAIs) are a leading cause of preventable harm in US hospitals. Hospitals are required to conduct surveillance and report selected HAIs, including central line-associated bloodstream infections, catheter-associated urinary tract infections, colon and abdominal hysterectomy surgical-site infections, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridioides difficile infections, to the CDC's National Healthcare Safety Network. RECENT FINDINGS: Up until the COVID-19 pandemic, there was significant progress in reducing HAIs. However, the pandemic resulted in extraordinary challenges for infection prevention in hospitals. Increases in HAIs were observed throughout 2020 and 2021. The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals has recently been updated and provides common sense evidenced-based strategies to reduce HAIs. SUMMARY: The purpose of this review is to highlight important changes since the 2014 Compendium.

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance.

BACKGROUND: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. METHODS: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. RESULTS: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. CONCLUSIONS: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Clinical and microbiological patterns in critically ill patients with catheter-associated UTI: A report from Iran.

INTRODUCTION: Catheter-associated urinary tract infections (CAUTIs) are among the most common nosocomial infections with different clinical and microbiological characteristics. We studied these characteristics in critically ill patients. METHODOLOGY: This research was a cross-sectional study conducted on intensive care unit (ICU) patients with CAUTI. Patients' demographic and clinical information and laboratory data, including causative microorganisms and antibiotic susceptibility tests, were recorded and analyzed. Finally, the differences between the patients who survived and died were compared. RESULTS: After reviewing 353 ICU cases, 80 patients with CAUTI were finally included in the study. The mean age was 55.9 ± 19.1 years, 43.7% were male and 56.3% were female. The mean length of infection development since hospitalisation and hospital stay were 14.7 (3-90) and 27.8 (5-98) days, respectively. The most common symptom was fever (80%). The microbiological identification showed that the most isolated microorganisms were Multidrug-resistant (MDR) Enterobacteriaceae (75%), Pseudomonas aeruginosa (8.8%), Gram-positive uropathogens (8.8%) and Acinetobacter baumannii (5%). Fifteen patients (18.8%) died among whom infections with A. baumannii (75%) and P. aeruginosa (57.1%) were associated with more death (p = 0.005). CONCLUSIONS: Although A. baumannii and P. aeruginosa can be the most important pathogens for death, MDR Enterobacteriaceae are still a serious concern as causes of CAUTIs.

Wastewater-based epidemiology for surveillance of infectious diseases in healthcare settings.

PURPOSE OF REVIEW: Wastewater-based surveillance (WBS) (epidemiology) using near-source sampling (NSS) in large buildings, hospitals and care homes is reviewed covering three main areas: state-of-the-art WBS, benefits/opportunities NSS has for hospital infection control systems and new insights from hospital wastewater surveillance and policy implications. RECENT FINDINGS: Wastewater provides aggregate, anonymous sources of data where the spatial resolution can be linked to populations being served. In hospitals, clear links established between wastewater RNA-fragments signal to nosocomial COVID-19 cases/outbreaks. Detecting other targets from hospital wastewater such as antimicrobial resistance markers is considered a substantial opportunity for this technology. Other clinically relevant infections, that is influenza and monkeypox, can be perceived, and sub-variant resolution to target public health response in near real time to benefit hospital infection control. WBS can reduce hospitals' clinical testing requirements, as diagnostic costs are aggregated into fewer samples while still detecting single cases. SUMMARY: WBS using NSS can inform infectious disease monitoring earlier, faster and cheaper than conventional monitoring. Routine sampling using wastewater provides a platform for risk-based sampling and enables smarter allocation of resources. Finally, hospital wastewater can be used for the benefit of the wastewater surveillance field as a promising source to monitor emerging threats and resolve longstanding questions on faecal shedding. Hospital monitoring in low-income settings is considered a priority for future research.

Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit.

We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.

Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: a prospective observational cohort study.

OBJECTIVES: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients. METHODS: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models. RESULTS: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival. CONCLUSIONS: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs.

Knowledge of nosocomial infections, standard precautions, and source of information among physiotherapy undergraduates in Sri Lanka; an observational study.

BACKGROUND: Physiotherapists and physiotherapy undergraduates have direct contact with patients which make them transmitters of infections if they do not follow standard precautions. Hence, the purpose of this study was to assess the knowledge of nosocomial infections, standard precautions, and source of information among physiotherapy undergraduates in Sri Lanka. METHODS: An observational Google based survey study was conducted among 294 physiotherapy undergraduates, of which there were 103 in University of Peradeniya, 103 in University of Colombo, and 88 in General Sir John Kotelawala Defence University. The Infection Control Standardized Questionnaire comprising three domains: knowledge of nosocomial infections, standard precautions and hand hygiene was used for data collection along with a self-constructed data sheet for socio-demographic information and source of information. RESULTS: Participants achieved mean knowledge of 67.1 ± 16.8, 84.4 ± 14.7 and 66.4 ± 15.4 for nosocomial infections, standard precautions, and hand hygiene respectively. Of the total sample, 225 (76.5%) achieved adequate level of total knowledge. Eighty-three of them (28.3%) equally mentioned, formal teaching at faculty and informal sources as the most important source of knowledge. There was no significant impact of university and the duration of clinical exposure on knowledge of nosocomial infections, standard precautions, hand hygiene and total knowledge. The study year has a significant impact on standard precautions (P = 0.004) and total knowledge (P = 0.035) and final years had highest knowledge compared to the other study years. CONCLUSION: Knowledge of nosocomial infections and infection control measures were satisfactory among the physiotherapy undergraduates in Sri Lanka. Further developments of formal sources of information about nosocomial infections are recommended.

Implication of COVID-19 pandemic on the incidence of Clostridioides difficile infection in a Greek tertiary hospital.

Introduction. C. difficile infection (CDI) represents an important global threat. In the COVID-19 era, the multifactorial nature of CDI has emerged.Hypothesis - Aim. The aim was to assess the impact of COVID-19 pandemic on the incidence of CDI in a Greek hospital.Methodology. A retrospective study was performed throughout a 51 month period (January 2018 to March 2022), divided into two periods: pre-pandemic (January 2018 to February 2020) and COVID-19 pandemic (March 2020 to March 2022). The effects of the pandemic compared to the pre-pandemic period on the incidence of CDI [expressed as infections per 10 000 bed days (IBD)] were studied using interrupted time-series analysis.Results. Throughout the study, there was an increase in the monthly CDI incidence from 0.00 to 11.77 IBD (P<0.001). Interrupted time-series disclosed an increase in CDI incidence during the pre-pandemic period from 0.00 to 3.36 IBD (P<0.001). During the COVID-19 pandemic period the linear trend for monthly CDI rose from 2.65 to 13.93 IBD (P<0.001). The increase rate was higher during the COVID-19 pandemic period (r2 = +0.47) compared to the pre-pandemic period (r1 = +0.16).Conclusion. A significant increase of CDI incidence was observed, with the rate of the rise being more intense during the COVID-19 pandemic.