Infection Control and Hospital Epidemiology最新文献

{"title":"Healthcare-associated infections in Italian long-term care facilities: a machine learning analysis of a 12-month cohort.","authors":"Anna Caterina Leucci, Elena Sasdelli, Luana Caselli, Elisa Fabbri, Elena Berti, Costanza Vicentini, Carla Maria Zotti, Katrien Latour, Enrico Ricchizzi","doi":"10.1017/ice.2026.10413","DOIUrl":"https://doi.org/10.1017/ice.2026.10413","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the incidence of healthcare-associated infections (HAIs) in Italian long-term care facilities (LTCFs) and to evaluate whether an artificial intelligence (AI) approach, through unsupervised machine learning (ML), could stratify residents into clinically distinct groups with differing susceptibility to HAIs.</p><p><strong>Design: </strong>Prospective cohort study with 12-month follow-up.</p><p><strong>Setting: </strong>24 LTCFs in Italy, participating in the European Centre for Disease Prevention and Control 12-month longitudinal study on HAIs in LTCFs, 2022-2023.</p><p><strong>Participants: </strong>395 residents enrolled across the participating LTCFs.</p><p><strong>Methods: </strong>Incidence measures of HAIs (rate and ratio) were estimated, using generalized estimating equations. A hierarchical cluster analysis based on residents' clinical and demographic characteristics was implemented as an unsupervised ML approach.</p><p><strong>Results: </strong>Overall, 75 HAIs per 100 residents (95% CI, 70.3-78.3) and 0.23 HAIs per 1,000 resident-days (95% CI, 0.11-0.76) were estimated. Respiratory tract infections (29.5%, 95% CI 24.2-31.1), COVID-19 (26.3%, 95% CI 22.1-28.4), and urinary tract infections (15%, 95% CI 11.0-35.4) were the most frequent. Clustering identified two reproducible resident groups: Group 1 (39%), more independent and cognitively preserved, with fewer comorbidities and lower infection incidence; and Group 2 (61%), more dependent and clinically complex, with higher incidence of HAIs. Cluster stability was high (mean ARI = 0.83).</p><p><strong>Conclusions: </strong>This study confirms the high burden of HAIs in Italian LTCFs and provides exploratory evidence that AI-based clustering can identify reproducible HAI susceptibility profiles in a setting where such approaches have been scarcely applied.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Split-surface randomization as a pragmatic design for early-phase environmental disinfection trials.","authors":"Bobby G Warren, Amanda M Graves, Aaron Barrett, Guerbine Fils-Aime, Nicholas A Turner, Becky A Smith, Deverick J Anderson","doi":"10.1017/ice.2026.10445","DOIUrl":"https://doi.org/10.1017/ice.2026.10445","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma therapy: key infection prevention practices and strategies for safety risk reduction - CORRIGENDUM.","authors":"Rebecca A Stern, Jennifer Andrews, Katherine Bashaw, Thomas R Talbot","doi":"10.1017/ice.2026.10457","DOIUrl":"https://doi.org/10.1017/ice.2026.10457","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of time to antibiotic optimization following inadequate or excessive empiric therapy on clinical outcomes.","authors":"Yusuke Niinuma, Nobuhisa Ishiguro, Yuki Morikaku, Keita Hanaoka, Keisuke Kagami, Mitsuru Sugawara, Yoh Takekuma","doi":"10.1017/ice.2026.10420","DOIUrl":"https://doi.org/10.1017/ice.2026.10420","url":null,"abstract":"<p><strong>Objective: </strong>Inadequate empiric therapy for sepsis has been correlated with heightened mortality; however, bloodstream infections do not uniformly manifest as severe presentations. Empiric administration of broad-spectrum antibiotics may result in adverse events and treatment failure. This study aimed to evaluate the impact of time to antibiotic optimization on outcomes of patients with bloodstream infections who received either inadequate or excessive empiric therapy.</p><p><strong>Methods: </strong>This single-center retrospective study included patients aged ≥18 years with positive blood culture results and confirmed antimicrobial susceptibility between April 2018 and March 2024. The primary endpoint was a composite outcome of all-cause 30-day mortality, microbiological failure, and antibiotic modification due to insufficient efficacy. The secondary endpoints included adverse event-related discontinuation in the excessive group.</p><p><strong>Results: </strong>Of the 1943 patients screened, 405 met the inclusion criteria. In the inadequate group (<i>n</i> = 150), antimicrobial stewardship team intervention was associated with treatment success (OR, 0.38; 95% CI, 0.15-0.90; <i>P</i> = .028), whereas time to optimization was not associated with any of the outcomes. In the excessive group (<i>n</i> = 255), delayed optimization (≥64 h) was a risk factor for treatment failure (OR, 2.63; 95% CI, 1.14-6.07; <i>P</i> = .023). Later optimization (≥100 h) was also linked to higher antibiotic discontinuation due to adverse events.</p><p><strong>Conclusion: </strong>Delayed optimization was independently associated with adverse outcomes in cohorts receiving excessive empiric therapy. These findings emphasize the importance of prompt de-escalation of broad-spectrum antibiotics to mitigate treatment failure and treatment discontinuation attributable to adverse events.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hidden failure modes of large language models in healthcare-associated infection surveillance: a structured evaluation using NHSN definitions.","authors":"Mamdooh Alzyood, Alfred Veldhuis, Hayley Stevenson, Samina Sheikh","doi":"10.1017/ice.2026.10444","DOIUrl":"https://doi.org/10.1017/ice.2026.10444","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are increasingly explored for healthcare-associated infection (HAI) surveillance, but their reliability in applying formal National Healthcare Safety Network (NHSN) definitions is not well characterized. This study evaluates GPT-5.1 Thinking's accuracy and rationales in classifying NHSN-defined infections.</p><p><strong>Methods: </strong>Seventy synthesized case vignettes containing complete, organized clinical data representing five NHSN infection types, including complex edge cases, were assessed using 2025 NHSN surveillance definitions. GPT-5.1 Thinking classified cases under three prompting strategies: standard, structured, and constrained. Quantitative accuracy metrics and qualitative inductive content analysis of rationales and failure modes were performed.</p><p><strong>Results: </strong>Overall accuracy across 210 classifications improved from 78.6% (standard prompt) to 88.6% (structured) and 95.7% (constrained). Performance was highest for infections with clear anatomical or radiographic criteria (surgical site infections [SSI], ventilator-associated pneumonia [VAP]) and lowest for infections involving complex exclusion rules (central line-associated bloodstream infection [CLABSI], <i>Clostridioides difficile</i> infection [CDI]). Constrained prompting enhanced adherence to NHSN rules but did not eliminate errors in hierarchical exclusions. Content analysis identified three recurrent failure categories: prioritization of clinical plausibility over surveillance logic, failure to apply quantitative and temporal thresholds, and errors in hierarchical source attribution.</p><p><strong>Conclusion: </strong>GPT-5.1 Thinking shows potential to support infection surveillance under strict constraints but exhibits systematic limitations, including overreliance on clinical intuition and difficulty with complex exclusion pathways. Currently, LLMs are unsuitable for autonomous NHSN classification but may serve as supervised decision-support tools with robust human oversight. Further development is needed to enhance LLMs' ability to synthesize surveillance definitions and complex situational characteristics critical for effective HAI surveillance, though fully autonomous deployment would require further validation. These findings are based on synthetic data that may differ from real-world clinical data in ways likely to overestimate the accuracy of these tools.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of antimicrobial prophylaxis procedures in cardiac surgery patients with delayed sternal closure.","authors":"Ahmed Albakheet, Brian Schuler, Felicia Wang, Justin Culshaw, Jeffrey Pearson","doi":"10.1017/ice.2026.10441","DOIUrl":"https://doi.org/10.1017/ice.2026.10441","url":null,"abstract":"<p><p>Implementation of a 24-hour antimicrobial prophylaxis guideline for patients with delayed sternal closure significantly reduced broad-spectrum post-operative antimicrobial use without increasing surgical site infection risk in 75-patient cohort. The median duration of prophylaxis decreased from 120 to 45 hours, and surgical site infection rates were 3% pre-intervention versus 0% post-intervention.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-5"},"PeriodicalIF":2.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active surveillance cultures and cohorting for carbapenem-resistant <i>Acinetobacter baumannii</i> in an endemic setting: an interrupted time-series analysis.","authors":"Regev Cohen, Shelly Lipman-Arens, Orna Ben-Natan, Aliza Vaknin, Mohammed Ganayem, Yael Galnoor Tene, Linor Ishay, Olga Simon Feld, Milena Pitashny, Alvira Zbiger, Rena Abilevitch, Said Younis, Elias Tannous","doi":"10.1017/ice.2026.10427","DOIUrl":"https://doi.org/10.1017/ice.2026.10427","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) is a major challenge, yet the role of hospital-wide active surveillance cultures (ASC) outside outbreak settings remains debated. We assessed the impact of targeted ASC and cohorting integrated with an established infection prevention and control (IPC) program in an endemic setting on CRAB epidemiology.</p><p><strong>Methods: </strong>A retrospective study was conducted at a 515-bed university hospital in Israel (January 2016-August 2025; 2020-2021 excluded). Screening of high-risk patients commenced in January 2023 utilizing four-limb skin sponges, with comprehensive implementation and patient cohorting initiated in July 2023. Outcomes were CRAB present on admission (POA) and hospital-acquired CRAB (overall and clinical subsets). We fit quasi-Poisson ITS models (January 2022-August 2025) with log link and exposure offsets (admissions for POA; hospital days for acquired); total counts were modeled with negative binomial regression. Cases averted were estimated with rate-based and ITS counterfactuals.</p><p><strong>Results: </strong>POA detection increased markedly after screening implementation (median 0.72 to 2.98 per 1,000 admissions), revealing a large reservoir of admission carriage. Overall hospital-acquired CRAB rates showed no sustained decline. In contrast, hospital-acquired clinical-CRAB fell substantially after July 2023 (mean 3.93 to 0.97 per 10,000 hospital-days), with a marked post-intervention level reduction in the ITS model (Incidence-rate ratio (IRR) 0.224, 95% CI 0.071-0.072, <i>P</i> = .0103). Counterfactual analyses estimated approximately 60-70 hospital-acquired clinical CRAB cases averted during follow-up.</p><p><strong>Conclusions: </strong>In an endemic setting, hospital-wide ASC targeting high-risk patients unmasked extensive admission carriage and, combined with cohorting and other IPC measures, was associated with a substantial reduction in acquired clinical-CRAB cases.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a large language model for surveillance of central line-associated bloodstream infections at a pediatric medical center.","authors":"Connor Stevenson, Matthew McHugh, Angela Alburei, Sharad Singh, Elyse Morin, Rajiv Kolagani, Joseph Fishbein, Larry K Kociolek, Ayelet Rosenthal","doi":"10.1017/ice.2026.10435","DOIUrl":"https://doi.org/10.1017/ice.2026.10435","url":null,"abstract":"<p><p>We assessed the accuracy of a large language model (LLM) for clinical decision support for central line-associated bloodstream infection (CLABSI) identification. Comparing LLM-assisted to manual review, the LLM could efficiently identify CLABSI and secondary BSIs with high sensitivity and specificity. Infection preventionists reported high satisfaction with the tool.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative evaluation of a program to implement antimicrobial stewardship for asymptomatic bacteriuria: how site attributes affected uptake.","authors":"Jonah Pesikoff, Tyler J Brehm, Larissa Grigoryan, Barbara W Trautner, Trenton M Haltom","doi":"10.1017/ice.2026.10436","DOIUrl":"10.1017/ice.2026.10436","url":null,"abstract":"<p><strong>Objective: </strong>Determine site attributes affecting uptake of a national, multi-site antimicrobial stewardship project focused on reducing unnecessary urine culture orders and antibiotic prescriptions for asymptomatic bacteriuria (ASB).</p><p><strong>Methods: </strong>Forty-one United States Veterans Affairs Medical Centers (VAMCs) were randomized into two arms: \"Technical Assistance\" (TA) or the \"Virtual Learning Collaborative\" (VLC). TA sites could request one-on-one guidance from the coordinating center, and VLC sites participated in semimonthly informational webinars. Otherwise, we provided TA and VLC sites with the same resources to educate healthcare professionals on proper ASB management. At the intervention's conclusion, we conducted 45-60-minute semi-structured interviews with local site leads and focus groups with their teams. TA and VLC sites were sampled based on time spent on intervention implementation, resulting in 19 participants across varying roles (e.g., pharmacists, physicians). We iteratively coded transcripts using thematic analysis.</p><p><strong>Results: </strong>We propose five considerations for how site attributes informed uptake of our stewardship initiative: (1) existing connections with leadership and important contacts; (2) workplace structure and culture; (3) previous and concurrent antimicrobial stewardship initiatives; (4) availability of existing resources (e.g., time); and (5) personnel turnover (e.g., daily provider transition, job turnover).</p><p><strong>Conclusions: </strong>We recommend conducting pre-intervention interviews to identify site-specific obstacles and then tailoring the intervention to site-specific needs. Additionally, we stress the importance of sites' prior experiences with antibiotic stewardship and the availability of personnel to work on stewardship initiatives. Ultimately, a better understanding of sites' unique environments is an essential step for improving uptake of antimicrobial stewardship projects.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":2.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudo-outbreak of <i>Burkholderia contaminans</i> in a breast imaging center.","authors":"Sharon C Thompson, Emily C Sickbert-Bennett, Lauren C DiBiase, David C Weber, Lisa C Teal","doi":"10.1017/ice.2026.10433","DOIUrl":"https://doi.org/10.1017/ice.2026.10433","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}