Journal of Hospital Infection最新文献

{"title":"Inverse probability weighting leads to more accurate incidence estimates for healthcare-associated infections in intensive care units – results from two national surveillance systems","authors":"C. Vicentini ,&nbsp;R. Bussolino ,&nbsp;M. Perego ,&nbsp;D. Silengo ,&nbsp;F. D'Ancona ,&nbsp;S. Finazzi ,&nbsp;C.M. Zotti","doi":"10.1016/j.jhin.2024.10.009","DOIUrl":"10.1016/j.jhin.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Two main approaches are employed to monitor healthcare-associated infections (HAIs): longitudinal surveillance, which allows the measurement of incidence rates, and point prevalence surveys (PPSs). PPSs are less time-consuming; however, they are affected by length-biased sampling, which can be corrected through inverse probability weighting. We assessed the accuracy of this method by analysing data from two Italian national surveillance systems.</div></div><div><h3>Methods</h3><div>Ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI) incidence measured through a prospective surveillance system (GiViTI) was compared with incidence estimates obtained through conversion of crude and inverse probability weighted prevalence of the same HAIs in intensive care units (ICUs) measured through a PPS. Weighted prevalence rates were obtained after weighting all patients inversely proportional to their time-at-risk. Prevalence rates were converted into incidence per 100 admissions using an adapted version of the Rhame and Sudderth formula.</div></div><div><h3>Findings</h3><div>Overall, 30,988 patients monitored through GiViTI, and 1435 patients monitored through the PPS were included. A significant difference was found between incidence rates estimated based on crude VAP and CLABSI prevalence and measured through GiViTI (relative risk 2.5 and 3.36; 95% confidence interval 1.42–4.39 and 1.33–8.53, <em>P</em>=0.006 and 0.05, respectively). Conversely, no significant difference was found between incidence rates estimated based on weighted VAP and CLABSI prevalence and measured through GiViTI (<em>P</em>=0.927 and 0.503, respectively).</div></div><div><h3>Conclusions</h3><div>When prospective surveillance is not feasible, our simple method could be useful to obtain more accurate incidence rates from PPS data.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 73-81"},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of vancomycin-resistant Enterococcus faecium in Dutch healthcare institutes: a nationwide survey","authors":"M. Mulder ,&nbsp;K.E.W. Vendrik ,&nbsp;S.A.M. van Kessel ,&nbsp;D.W. Notermans ,&nbsp;A.F. Schoffelen ,&nbsp;J. Flipse ,&nbsp;A.P.A. Hendrickx ,&nbsp;W.C. van der Zwet ,&nbsp;C. Schneeberger-van der Linden","doi":"10.1016/j.jhin.2024.09.028","DOIUrl":"10.1016/j.jhin.2024.09.028","url":null,"abstract":"<div><h3>Background</h3><div>Vancomycin-resistant <em>Enterococcus faecium</em> (VRE_fm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VRE_fm management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VRE_fm management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VRE_fm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures.</div></div><div><h3>Methods</h3><div>Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VRE_fm clearance and VRE_fm outbreaks.</div></div><div><h3>Findings</h3><div>The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VRE_fm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VRE_fm screening versus 50% of the LTCFs. VRE_fm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VRE_fm-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities.</div></div><div><h3>Conclusion</h3><div>This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VRE_fm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VRE_fm data on a regional/national level.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 51-59"},"PeriodicalIF":3.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous tunneling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a multicentre, open-label, randomized, controlled trial","authors":"Eung Tae Kim MD ,&nbsp;Jae Hwan Lee MD ,&nbsp;Dong Jae Shim MD ,&nbsp;Yohan Kwon MD ,&nbsp;Soo Buem Cho MD ,&nbsp;Ki Jun Kim MD ,&nbsp;Doyoung Kim MD ,&nbsp;Jinoo Kim MD ,&nbsp;Eu Suk Kim MD ,&nbsp;Hoyong Jun MD ,&nbsp;Youn Jeong Kim MD ,&nbsp;Jinyeong Kim MD ,&nbsp;Eun Jin Kim MD ,&nbsp;Chung-Jong Kim MD ,&nbsp;Kang-Il Jun MD ,&nbsp;Myoung Jin Shin RN ,&nbsp;Chang Jin Yoon MD ,&nbsp;Seungjae Lee PhD ,&nbsp;Soon-Young Song MD ,&nbsp;Je Hwan Won MD","doi":"10.1016/j.jhin.2024.10.008","DOIUrl":"10.1016/j.jhin.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).</div></div><div><h3>Methods</h3><div>We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).</div></div><div><h3>Results</h3><div>From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (<em>n</em>=662) and cPICC (<em>n</em>=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30–1.38, <em>p</em>=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, <em>p</em>=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, <em>p</em>=0.99) was not different between both groups.</div></div><div><h3>Conclusion</h3><div>Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Borderline oxacillin-resistant Staphylococcus aureus: an emerging threat in the hospital environment.","authors":"Gareth Hughes, Susan Wilkinson, Jean Harker, Itisha Gupta, Elisabeth Holden, Mark Garvey","doi":"10.1016/j.jhin.2024.09.029","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.09.029","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators for using administrative data for surveillance purpose: a narrative overview","authors":"V. Boulanger ,&nbsp;A. MacLaurin ,&nbsp;C. Quach","doi":"10.1016/j.jhin.2024.09.027","DOIUrl":"10.1016/j.jhin.2024.09.027","url":null,"abstract":"<div><div>Although administrative data are not originally intended for surveillance purposes, they are frequently used for monitoring public health and patient safety. This article provides a narrative overview of the barriers and facilitators for the use of administrative data for surveillance, with a focus on healthcare-associated infection (HAI) in Canada. In this case, only articles on administrative data in general or related to HAI were included. Validation study and meta-analyses on administrative data accuracy were excluded. Medline, Embase and Google Scholar were searched as well as references list of all included articles, for a total of 90 articles included. Our analysis identified 78 barriers at the individual, organizational and systemic levels and outlined 75 facilitators and solutions to improve administrative data utilization and quality. This narrative overview will help to understand barriers, facilitators and offer practical recommendations for optimizing the use of administrative data.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 25-36"},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of Mycobacterium gordonae in heater–cooler units: a five-year prospective surveillance of devices frequently subjected to chloramine-T booster disinfection","authors":"S. Ditommaso ,&nbsp;J. Garlasco ,&nbsp;G. Memoli ,&nbsp;A. Curtoni ,&nbsp;A. Bondi ,&nbsp;A. Ceccarelli ,&nbsp;M. Giacomuzzi","doi":"10.1016/j.jhin.2024.10.006","DOIUrl":"10.1016/j.jhin.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Worldwide, the detection of <em>Mycobacterium chimaera</em> in LivaNova heater–cooler units (HCUs) has led to their replacement with other HCUs, although non-tuberculous mycobacteria (NTM) have been reported also for HCUs produced by other manufacturers. In almost all hospitals of our region, LivaNova HCUs have been replaced with Maquet HCU40s, regularly disinfected with chloramine-T.</div></div><div><h3>Aim</h3><div>To report the results of the surveillance over a 63-month operation period of the Maquet devices, and to provide a trend in NTM positivity over time.</div></div><div><h3>Methods</h3><div>Twenty-nine Maquet devices (HCU40 and HU35) were monitored by two culture methods and propidium monoazide polymerase chain reaction (PMA-PCR) method. The trend in NTM positivity rate was evaluated through the Locally Estimated Scatterplot Smoothing regression and then modelled over time through segmented logistic regression.</div></div><div><h3>Findings</h3><div>The data acquired during the study period demonstrate a remarkable increase in the positivity rate, especially after the third year (maximum slope change at 1280 days). Non-tuberculous mycobacteria were isolated in 150 water samples (37.2%); 100% and 62% of HCU40 and HU35 devices, respectively, were colonized with non-tuberculous mycobacteria. The most frequently detected species were <em>Mycobacterium gordonae</em> (73%) followed by <em>Mycobacterium chelonae</em> (41%) and <em>Mycobacterium paragordonae</em> (11%).</div></div><div><h3>Conclusion</h3><div>Preventive strategies by disinfection with chloramine-T did not effectively reduce non-tuberculous mycobacteria colonization of Maquet devices. Although, to date, no cases of postoperative invasive infections linked to Maquet devices have been reported, our microbiological results emphasize the need for (1) designing changes to increase safety of devices and (2) researching and developing new disinfection protocols including alternative molecules.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 9-16"},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative incidence of vancomycin-resistant Enterococcus faecium detection by patient characteristics or possible exposures: prioritization of patients for active screening culture","authors":"K. Furuya ,&nbsp;T. Yamagishi ,&nbsp;K. Suzuki ,&nbsp;K. Sugiyama ,&nbsp;M. Yamamoto ,&nbsp;M. Koyama ,&nbsp;A. Yamada ,&nbsp;R. Sasaki ,&nbsp;J. Kurioka ,&nbsp;H. Kurai ,&nbsp;K. Tanaka ,&nbsp;M. Nakagawa ,&nbsp;Y. Kanazawa ,&nbsp;S. Onoda ,&nbsp;H. Inoue ,&nbsp;M. Koshiko ,&nbsp;H. Kurosu ,&nbsp;T. Shimada ,&nbsp;T. Sunagawa ,&nbsp;M. Sugai ,&nbsp;Y. Hakamata","doi":"10.1016/j.jhin.2024.08.013","DOIUrl":"10.1016/j.jhin.2024.08.013","url":null,"abstract":"<div><h3>Background</h3><div>The target population for active surveillance culture (ASC) of vancomycin-resistant <em>Enterococcus</em> species (VRE) by stool or rectal swabs has not been fully determined during VRE outbreaks in healthcare settings in non-VRE endemic situation.</div></div><div><h3>Aim</h3><div>To evaluate cumulative incidences of VRE detection during a vancomycin-resistant <em>Enterococcus faecium</em> outbreak to determine reasonable target populations for ASC.</div></div><div><h3>Methods</h3><div>Cases included inpatients whose first VRE-positive sample was obtained at Shizuoka General Hospital between February 2022 and January 2023, during which we conducted admission screening for possible high-risk patients, bi-weekly screening of all inpatients, admission and discharge screening in the high-care unit, and screening of contacts in each ward using stool or rectal samples. We calculated cumulative incidences of VRE detection for those screened by patient characteristics or possible exposure.</div></div><div><h3>Findings</h3><div>Among 60 cases identified, 55 (92%) were by ASC. Cumulative incidence was higher for contacts (6.4%, 15/234) than for those identified by other screening methods (0.5%, 40/8565). Among the patients identified through admission screening, those previously hospitalized in areas of reported VRE outbreaks had the highest cumulative incidence (6.6%, 5/78) followed by patients requiring toilet assistance (3.7%, 6/161). A bundle approach including ASC and prompt contact precautions by the hospital infection control team, local public health centre, and local and national infection control experts helped terminate the outbreak in seven months.</div></div><div><h3>Conclusion</h3><div>Patients with contacts, prior hospitalization in areas with known VRE outbreaks, and who need toilet assistance appear to be high-risk populations for VRE detection and are candidates for ASC.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 70-76"},"PeriodicalIF":3.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laboratory-acquired infection in clinical laboratories and the incidence rate after Brucella exposure risk events: a systematic review and meta-analysis","authors":"M. Wang ,&nbsp;W. Sun ,&nbsp;C. Zhou ,&nbsp;S. Wang ,&nbsp;Q. Shi ,&nbsp;J. Lin ,&nbsp;H. Mi ,&nbsp;B. Hu ,&nbsp;J. Pan ,&nbsp;X. Gao","doi":"10.1016/j.jhin.2024.10.004","DOIUrl":"10.1016/j.jhin.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Personnel in clinical microbiology laboratories face heightened risks of occupational infections, due to the potential for pathogenicity in clinical samples.</div></div><div><h3>Aim</h3><div>To summarize the characteristics of laboratory-acquired infections (LAIs) and review exposure incidents in clinical laboratories, and to conduct a meta-analysis to estimate post-exposure incidence rates and evaluate the efficacy of post-exposure prophylaxis (PEP) following <em>Brucella</em> exposures.</div></div><div><h3>Methods</h3><div>A systematic search across PubMed, Embase, Web of Science, CNKI, Wanfang, CMB, and the ABSA LAI database extracted relevant literature published from January 1^st, 1990, to August 31^st, 2023, including case reports and laboratory exposure risk events. Negative-binomial regression was used to estimate the relative increase in reported numbers per year of LAIs. Meta-analysis was performed to estimate the incidence rate (IR) of LAIs among exposed laboratory personnel after <em>Brucella</em> exposure risk events.</div></div><div><h3>Findings</h3><div>A total of 164 LAIs were reported in hospital laboratories. Negative-binomial regression analysis indicated no significant decline in annual LAIs reports (relative risk and 95% CI: 0.98 (0.97, 1.00); <em>P</em> = 0.052). The leading pathogens were <em>Brucella</em> spp. (55.5%), <em>Neisseria meningitidis</em> (7.3%), and <em>Shigella sonnei</em> (5.5%). The meta-analysis revealed that the incidence rate for <em>Brucella</em>-related LAIs among laboratory personnel was 60 per 100,000 laboratory personnel. Laboratory personnel exposed to high-risk <em>Brucella</em> incidents faced a notably elevated infection risk, estimated at 80 per 100,000 laboratory personnel. Compared with high-risk <em>Brucella</em> exposures with PEP, highrisk <em>Brucella</em> exposures without PEP had a 6.33-fold increase in the risk of <em>Brucella</em> infection.</div></div><div><h3>Conclusions</h3><div>Clinical laboratory personnel remain at infection risk, with no reduction in reported LAI cases, mainly resulting from <em>Brucella</em> acquisitions. PEP was shown to be effective against high-risk <em>Brucella</em> exposures.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 135-144"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nationwide mixed-methods study of gaps and barriers to implementation of antimicrobial stewardship programmes in hospitals in Indonesia","authors":"R. Sinto ,&nbsp;R. Limato ,&nbsp;S.P. Radiani ,&nbsp;M.N. Huda ,&nbsp;H. Surendra ,&nbsp;A.W. Praptiwi ,&nbsp;Y. Herman ,&nbsp;B.A. Musaffa ,&nbsp;G. Lazarus ,&nbsp;N.P.J. Day ,&nbsp;D. Limmathurotsakul ,&nbsp;A. Karuniawati ,&nbsp;R.L. Hamers","doi":"10.1016/j.jhin.2024.10.001","DOIUrl":"10.1016/j.jhin.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>There is an urgent need to understand the implementation barriers of antimicrobial stewardship programmes (ASPs) in low- and middle-income countries.</div></div><div><h3>Methods</h3><div>We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March–December 2023). We used a self-assessment questionnaire with a scoring system, and multi-level ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGDs) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results.</div></div><div><h3>Results</h3><div>A total of 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 (interquartile range (IQR) 1–5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9–62.5%), classifying 41 (8.0%) hospitals as inadequate (0–25%), 237 (45.9%) as basic (26–50%), 179 (34.7%) as intermediate (51–75%) and 59 (11.4%) as advanced (76–100%). Scores were highest for hospital leadership support (83.4% (IQR 66.7–100%)), followed by ASP team and infectious disease training (66.7% (IQR 55.6–77.8%)); education (50% (IQR 0.0–75.0%)); ASP interventions (43.8% (IQR 18.7–68.7%)); hospital infrastructure (42.9% (IQR 14.3–71.4%)); and monitoring, reporting and feedback (40.9% (IQR 27.3–54.5%)). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level Public Health Development Index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioural skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation.</div></div><div><h3>Conclusions</h3><div>Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 77-87"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotyping of Candida tropicalis isolates uncovers nosocomial transmission of two lineages in Italian tertiary care hospital","authors":"B. Spruijtenburg ,&nbsp;E. De Carolis ,&nbsp;C. Magri ,&nbsp;J.F. Meis ,&nbsp;M. Sanguinetti ,&nbsp;T. de Groot ,&nbsp;E.F.J. Meijer","doi":"10.1016/j.jhin.2024.10.003","DOIUrl":"10.1016/j.jhin.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Candida tropicalis</em> is a medically important yeast with increasing antifungal resistance, but nosocomial transmission is rarely reported. This study genotyped <em>C. tropicalis</em> isolates from Italian hospitals to uncover potential nosocomial transmission and assess resistance.</div></div><div><h3>Methods</h3><div>In total, 197 <em>C. tropicalis</em> isolates from 161 patients were collected from five centres from 2013 to 2023. Short tandem repeat (STR) genotyping was conducted on all isolates, and a selection of 24 isolates were typed with whole-genome sequencing (WGS) and the novel Fourier-transform infrared (FTIR) spectroscopy method. Antifungal resistance was investigated with microbroth dilution and WGS.</div></div><div><h3>Results</h3><div>STR genotyping revealed seven clusters with isolates from multiple patients. WGS single nucleotide polymorphism (SNP) analysis on five groups of isolates with related STR genotypes also separated these isolates into five groups, of which two groups contained a cluster of isolates from different patients distinguished by ≤59 SNPs. In comparison, sequential isolates within three patients were differentiated by ≤141 SNPs. The two <em>C. tropicalis</em> WGS clusters also clustered based on FTIR genotyping, although this method did not separate the isolates into five groups. None of the 24 isolates were resistant to common antifungals.</div></div><div><h3>Conclusions</h3><div>WGS SNP analysis indicated nosocomial transmission of two lineages within the same hospital, highlighting the need for enforced infection prevention measures and routine genotyping on this common yeast in clinical settings. While both STR and FTIR genotyping also clustered these lineages, WGS SNP analysis is required to determine whether isolates were transmitted clonally.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 115-122"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}