Antimicrobial Resistance and Infection Control最新文献

{"title":"Clinical impact of a multidisciplinary remote-based hybrid antibiotic stewardship program in critically ill patients during COVID-19 pandemic in Korea: a prospective pilot implementation study.","authors":"Suhyun Lee, Soyun Park, Min Gu Shin, Hyeong Geun Jo, Kyeoul Jeong, Ji-Eun Yoon, Kyong Nam Ye, Yeo Jin Choi, Minseo Choe, Seungwon Yang, Pureunnarae Kang, Jung-Tae Kim, Sung Wook Kang, Eun Kyoung Chung","doi":"10.1186/s13756-026-01740-9","DOIUrl":"10.1186/s13756-026-01740-9","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use in intensive care units (ICUs); however, many institutions lack infectious disease specialists and pharmacy expertise for full implementation. The COVID-19 pandemic further disrupted conventional stewardship. While tele-stewardship models have shown promise, evidence for hybrid programs operating without infectious disease specialist leadership remains limited, particularly outside high-income countries. We developed a hybrid ASP (hASP) collaboratively led by an on-site intensivist and an off-site faculty clinical pharmacist to reduce inappropriate antibiotic use and improve outcomes in a resource-constrained ICU.</p><p><strong>Methods: </strong>This prospective, single-center, pre-post study was conducted in the medical ICU of a 733-bed university teaching hospital in Seoul, South Korea. The pre-intervention period (August to October 2017) with no ASP was compared with the post-intervention period (August to October 2020) following hASP implementation. Stewardship activities were primarily performed off-site by trained clinical pharmacists via secured messaging, telephone, and video conferencing, with on-site rounds every other weekday. Key outcomes were inappropriate antibiotic prescriptions per 100 patient-days, 30-day all-cause mortality, ICU length of stay, preventable adverse drug events, and days of therapy, assessed using Delphi-derived appropriateness criteria.</p><p><strong>Results: </strong>Thirty-three and 37 admissions were analyzed (364 and 251 patient-days). On-site activities were limited to three hours daily or less. Inappropriate prescriptions declined from 83.8 to 20.7 per 100 patient-days (p < 0.001), ICU length of stay from 14 to 6 days (p < 0.05), and preventable adverse drug events from 4.4 to 2.8 per 100 patient-days (p < 0.05). Thirty-day all-cause mortality was comparable (24.2% vs. 24.3%). The most frequent pharmacist interventions were dose optimization (47.8%) and antimicrobial discontinuation (40.6%), with an overall acceptance rate of 62.3%. Days of therapy for broad-spectrum antibiotics targeting multidrug-resistant organisms declined while those for narrower-spectrum agents increased, suggesting a shift toward targeted therapy.</p><p><strong>Conclusion: </strong>The hASP, collaboratively led by an intensivist and a faculty clinical pharmacist with off-site pharmacist-led interventions via virtual communication, significantly reduced inappropriate prescribing, ICU length of stay, and preventable adverse drug events. Hybrid stewardship models may serve as a feasible alternative to on-site programs in resource-limited settings.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular epidemiology of multidrug-resistant organisms on mobile phones: an observational study conducted at a German university hospital.","authors":"Daniel Hack, Tilman G Schultze, Volkhard A J Kempf, Jon Genuneit, Claudia Reinheimer, Stephan Göttig","doi":"10.1186/s13756-026-01739-2","DOIUrl":"10.1186/s13756-026-01739-2","url":null,"abstract":"<p><strong>Background: </strong>Mobile phones are integral to modern clinical workflows and increasingly bridge clinical and private environments. Yet, their role as portable high-touch surfaces in infection prevention remains insufficiently characterized. We hence assessed prevalence and molecular epidemiology of multidrug-resistant organisms (MDRO) on mobile phones used by healthcare workers (HCWs) at a German university hospital and compared them with devices used by non-HCWs.</p><p><strong>Methods: </strong>In this 30-month cross-sectional study, 232 HCW and 241 non-HCW mobile phones were analyzed to determine MDRO prevalence and overall bacterial count. A subset of devices was examined before and after disinfection with alcohol-based wipes. Whole genome sequencing with subsequent core genome multilocus sequence typing (cgMLST) was applied to identify clonal clusters.</p><p><strong>Results: </strong>MDRO prevalence was significantly higher on HCW phones compared to non-HCW phones (15.1% vs. 0.4%, p < 0.001), with particularly high rates on intensive care unit devices and shared phones (23.4% and 23.0%, respectively). Vancomycin-resistant Enterococcus faecium, predominantly the endemic ST117/CT71 clone, and methicillin-resistant Staphylococcus aureus were detected on 11.2% and 4.7% of devices, respectively. In contrast, no multidrug-resistant Gram-negatives (MDRGN) were identified, despite contamination with susceptible Enterobacterales or nonfermenters. cgMLST analyses revealed clonal MDRO strains mainly within wards and only rarely across wards, consistent with both local clustering and possible cross-ward dissemination. Total bacterial count did not predict MDRO detection. Alcohol-based wipes reliably eliminated MDRO from all tested devices.</p><p><strong>Conclusions: </strong>Given the high MDRO burden on HCW mobile phones and genomic clustering across wards, mobile phones may represent a relevant reservoir with potential to facilitate in-hospital MDRO dissemination. Standardized mobile phone disinfection routines - particularly for shared and ICU devices - should be considered in infection prevention strategies to reduce potential phone-associated MDRO transmission risk and may represent a conceptual \"Sixth Moment\" complementing the WHO \"Five Moments for Hand Hygiene\".</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of late onset bloodstream infections and use of preventive practices in very low birth weight infants in Spain: the NeoKissEs cohort surveillance experience.","authors":"Jose I Pijoan, Javier Pérez-López, Marisela Madrid, Carmen Ribes, Fátima Camba, Brar Piening, Begoña Loureiro","doi":"10.1186/s13756-026-01736-5","DOIUrl":"10.1186/s13756-026-01736-5","url":null,"abstract":"<p><strong>Background: </strong>Bloodstream infections (BSI), especially central line associated BSI (CLABSI) are common severe healthcare associated infections (HAI) in very low birth weight (VLBW) neonates (< 1500 g at birth) admitted to neonatal intensive care units (NICUs). However, surveillance systems are known to contribute to reducing HAI. Our objectives were firstly, to describe BSI and CLABSI incidence in the 2015-2018 period for VLBW from 40 level III NICUs reporting data back to NeoKissEs, the Spanish neonatal surveillance system, secondly, to describe NICU organizational features and level of use of a set of recommended infection prevention (IP) practices and finally, to assess their relationships with BSI/CLABSI incidence.</p><p><strong>Methods: </strong>This was a retrospective analysis of a prospective cohort of VLBW infants. Using an online survey of NICU-level IP data, analysis of surveillance of individual data and NICU-specific IP information using random intercept logistic and Poisson models was carried out. Unadjusted and risk-adjusted incidence of neonates with ≥ 1 BSI episodes and BSI/CLABSI rates were estimated.</p><p><strong>Results: </strong>Data from 5260 VLBW infants were reported. Incidence of neonates with ≥ 1 BSI episodes (1420 newborns, 27.0%) decreased significantly during the study period (18.7% reduction (p = 0.002)), BSI rates dropped by 23.5% (p < 0.001) and CLABSI rates by 18.4% (p = 0.062). Lower incidence was associated only with the existence of hand hygiene (HH) audit and feedback activities (OR 0.62 [95% confidence interval 0.41-0.96]).</p><p><strong>Conclusions: </strong>The NeoKissEs surveillance data show a high level of BSI, a downwards time trend and wide variation among NICUs in both BSI/CLABSI incidence and the extent of use of recommended IP practices. Systematic HH performance audit and feedback activities should be prioritized. NeoKissEs provides useful data for monitoring changes in BSI incidence and related factors.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13188392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on the incidence of Clostridioides difficile infection based on hospital surveillance data: a systematic review and meta-analysis.","authors":"Yi Zhao, Xuan He, Yifan Hu, Rui Su, Xinyao Liu, Dazhi Jin, Lilu Ding, Yu Chen","doi":"10.1186/s13756-026-01737-4","DOIUrl":"10.1186/s13756-026-01737-4","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) remains a substantial burden on healthcare systems worldwide. The COVID-19 pandemic has had profound and multifaceted effects on healthcare delivery and infection control practices, potentially influencing the epidemiology of CDI.</p><p><strong>Objective: </strong>To assess whether the coronavirus disease 2019 (COVID-19) pandemic has influenced the incidence of CDI and to explore potential contributing factors.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Seven databases were searched for relevant literature published from December 2019 to October 2025. Study quality was assessed via the Newcastle‒Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal tools. Random- or fixed-effects models were selected according to heterogeneity. Publication bias was evaluated via funnel plots and Egger's test, and sensitivity analyses were conducted. The primary outcome was the incidence rate of CDI, expressed as cases per 10,000 patient-days. Incidence rate ratios (IRR) were calculated to compare the incidence of CDI between the prepandemic and pandemic periods.</p><p><strong>Results: </strong>Sixteen studies were included. The pooled CDI incidence rate was 4.42 (95% CI: 3.37-5.46) per 10,000 patient-days in the prepandemic period and 3.80 (95% CI: 2.63-4.96) per 10,000 patient-days during the pandemic. The pooled incidence rate ratio was 0.80 (95% CI: 0.67-0.97), indicating a significant reduction in the incidence of CDI. This decline was associated with changes in medical practices (e.g., the suspension of nonurgent and high-risk procedures), antimicrobial stewardship practices, and strengthened infection control measures (e.g., enhanced hand hygiene and environmental disinfection) during the pandemic.</p><p><strong>Conclusion: </strong>Compared with the prepandemic period, the incidence of CDI decreased significantly during the COVID-19 pandemic. This finding suggests that strengthened infection prevention measures, improved antimicrobial stewardship, and adaptations in healthcare delivery may have contributed to reduced CDI transmission. Reinforcing these evidence-based foundational strategies may help mitigate ‌the risk of CDI and other healthcare-associated infections during future public health emergencies.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility and limitations of whole-genome sequencing via nanopore technology and Bayesian modeling for outbreak transmission inference.","authors":"Yuji Fujikura, Nozomi Ichie, Takaaki Hamamoto","doi":"10.1186/s13756-026-01741-8","DOIUrl":"10.1186/s13756-026-01741-8","url":null,"abstract":"<p><strong>Background: </strong>Traditional molecular epidemiological analysis has been limited in its ability to evaluate pathogen homology, making detailed transmission pathway estimation in outbreaks challenging. Bayesian reconstruction methods using whole-genome sequencing and epidemiological data enable estimation of temporal transmission relationships from within-host diversity. This study examined the practical utility and limitations of transmission pathway inference via whole-genome analysis with nanopore sequencers for SARS-CoV-2 and multidrug-resistant Acinetobacter (MDRA) outbreaks.</p><p><strong>Methods: </strong>Two outbreaks at the National Defense Medical College Hospital were analyzed: COVID-19 (9 individuals) and MDRA (22 cases). Transmission pathways were estimated via BadTrIP, an open-source Bayesian package for reconstructing transmission histories from genomic polymorphisms, with whole-genome sequencing performed on an Oxford Nanopore MinION. Input data included sample collection times, infection exposure periods, and nucleotide counts; SARS-CoV-2 genomes were obtained directly from nasopharyngeal swabs, whereas preserved bacterial isolates were used for MDRA.</p><p><strong>Results: </strong>During the SARS-CoV-2 outbreak, one patient and eight staff members were infected within one week, and BadTrIP inferred transmission from the index patient to multiple healthcare workers, followed by onward spread mainly among staff, consistent with descriptive epidemiology. The inferred transmission tree highlighted staff providing intensive oral care to the index patient and identified a staff member who intermittently worked unmasked, aligning with known infection prevention considerations, although mask effectiveness could not be formally quantified. In the MDRA outbreak, the inferred transmission network showed several high-probability links between patients on different wards with limited apparent contact, indicating discrepancies with ward-based spread, and spreader analysis identified only longer hospitalized duration as significantly associated with spreader status.</p><p><strong>Conclusions: </strong>BadTrIP is useful for transmission pathway estimation, although its accuracy depends on pathogen characteristics, outbreak duration, and sample properties. High concordance with clinical and epidemiological information was achieved for the short-term SARS-CoV-2 outbreak using directly sequenced clinical specimens, whereas the prolonged MDRA outbreak based on preserved isolates showed limited accuracy and epidemiologically difficult-to-explain links. BadTrIP therefore appears most informative for short- to intermediate-term outbreaks with sufficient genetic diversity and direct sampling, while transmission trees from long-term outbreaks using preserved isolates should be carefully interpreted as exploratory.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Everyone in this together\": a qualitative study on mothers as partners in infection prevention in a neonatal unit in Botswana.","authors":"Nidhee Jadeja, Samuel T Matula, Ludo Magagani, Margaret Mokomane, Nina Zhu, Susan E Coffin, Andrew P Steenhoff, Margaret Kagiso, Britt Nakstad, Alison Holmes, Jonathan Strysko","doi":"10.1186/s13756-026-01734-7","DOIUrl":"10.1186/s13756-026-01734-7","url":null,"abstract":"<p><strong>Background: </strong>Infection prevention and control (IPC) is critical in neonatal units to prevent healthcare-associated infections, yet research on IPC has primarily focused on healthcare workers, overlooking the role of family caregivers. In low-resource settings, mothers often take on essential caregiving responsibilities including IPC-related tasks, both a logistic necessity and a cultural norm, but their perspectives and experiences remain underexplored. This qualitative descriptive study aimed to explore mothers' experiences and perceptions of IPC in a neonatal unit in Gaborone, Botswana. Understanding maternal involvement in IPC is essential for developing effective interventions, particularly in settings where health systems face workforce shortages and resource constraints.</p><p><strong>Methods: </strong>Fifteen semi-structured interviews were conducted with mothers of infants admitted to the neonatal unit between June and December 2022. Data were analysed using thematic analysis.</p><p><strong>Results: </strong>Six themes were identified. Major themes related to (1) mothers' strong sense of responsibility for IPC and concerns about infection risks, (2) health system constraints (including supply shortages) that limited consistent IPC practice, (3) competing demands within restricted visiting times that required mothers to balance IPC with feeding and bonding, (4) variable communication with health care workers (HCWs) and limited comfort reminding staff about IPC, and (5) peer dynamics between mothers, including mutual reminders as well as tensions arising from shared feeding equipment. A minor theme that emerged was (6) mothers' emotional distress and its perceived impact on remembering and enacting IPC behaviours. Overall, mothers described high motivation to protect their infants but reported that time pressures, insufficient communication with HCWs, and resource limitations constrained IPC adherence, underscoring the need for structured IPC orientation and ongoing support for families in neonatal care.</p><p><strong>Conclusion: </strong>Mothers in this neonatal unit viewed themselves as key partners in IPC and were highly motivated to protect their infants, but their ability to consistently follow IPC practices was constrained by limited supplies, staffing pressures, restricted time for caregiving and bonding, and variable communication with HCWs. Mothers also expressed concerns about HCW adherence to IPC and described how emotional distress and peer dynamics could shape IPC behaviour. These findings underscore the need for structured IPC education and support for mothers in neonatal units, and the importance of integrating family-centred IPC policies into neonatal care. Future research should evaluate interventions that strengthen caregiver support, improve communication, and address contextual barriers and constraints to sustained IPC practice.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147571665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of WHO AWaRe Antibiotic Handbook training on antibiotics prescribing knowledge among private primary care providers: a vignette-based, prep-post pilot study in Patna, India.","authors":"Poshan Thapa, Prachi Shukla, Chandrashekhar Joshi, Sena Sayood, Pradeep Kumar Sinha, Diwash Timilsina, Mili Dutta, Madhukar Pai, Samira Abbasgholizadeh Rahimi, Sumanth Gandra","doi":"10.1186/s13756-026-01735-6","DOIUrl":"10.1186/s13756-026-01735-6","url":null,"abstract":"<p><strong>Introduction: </strong>Inappropriate antibiotic prescribing is a major concern in low- and middle-income countries (LMICs), particularly at the primary care level. The WHO AWaRe Antibiotic Handbook was introduced to promote rational antibiotic use, yet its real-world feasibility and potential impact remain underexplored. Our study evaluated the impact and usefulness of the WHO AWaRe Handbook training among private primary care providers (PCPs) in Patna, India.</p><p><strong>Methods: </strong>We conducted a pre-post pilot study among 145 private PCPs (40 formal PCPs (FPs) and 105 informal PCPs (IPs) in Patna, India. Participants received training from an infectious disease physician on the WHO AWaRe Antibiotic Handbook. Antibiotic prescribing knowledge was assessed before and after the intervention using clinical vignettes for four conditions: acute diarrhea, urinary tract infection (UTI), cellulitis, and community-acquired pneumonia (CAP). An endline survey evaluated the perceived usefulness of the intervention. Changes in prescribing knowledge was analyzed using McNemar's test for paired data.</p><p><strong>Results: </strong>The intervention significantly reduced overall antibiotic prescribing knowledge for acute diarrhea (p = 0.0003) and UTI (p = 0.0113), with greater reductions among IPs. No significant changes were observed for cellulitis (p = 0.3692) or CAP (p = 0.7150). Watch-category antibiotic prescribing significantly decreased for acute diarrhea (p < 0.0001), with no significant changes for other conditions. IPs showed greater improvements overall compared to FPs. The majority of PCPs (75%; n = 107) rated the training as moderately or very useful.</p><p><strong>Conclusion: </strong>Training private PCPs using the WHO AWaRe Handbook improved antibiotic prescribing knowledge for some common conditions, particularly among IPs. Future research should combine training with strategies that address broader contextual barriers, alongside tailored reinforcement interventions, and longer-term follow-up.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine says go, doctor says no: an ecological momentary assessment analysis examining clinicians' perceptions of, and their antibiotic prescribing behaviour when using rapid molecular diagnostic tests in intensive care.","authors":"Sarah-Jane F Stewart, Virve I Enne, Alyssa M Pandolfo, Yogini H Jani, David Brealey, Stephen J Brett, David M Livermore, Vanya Gant, Rob Horne","doi":"10.1186/s13756-025-01690-8","DOIUrl":"10.1186/s13756-025-01690-8","url":null,"abstract":"<p><strong>Background: </strong>Rapid molecular diagnostics such as the BioFire FilmArray Pneumonia Panel (the Pneumonia Panel) can improve antibiotic stewardship by supporting doctors to make more targeted antibiotic prescribing decisions faster compared to routine microbiology. However, factors influencing how these test results translate to individual prescribing decisions are poorly understood. The INHALE randomised controlled trial (RCT) evaluated the application of the Pneumonia Panel to manage suspected hospital-acquired and ventilator-associated pneumonias (HAP/VAP) in English intensive care unit (ICU) patients. This behavioural study examines clinicians perceived and actual antibiotic prescribing behaviour, within the INHALE RCT.</p><p><strong>Methods: </strong>Clinicians treating ICU patients completed brief questionnaires within 24 h of their prescribing decision for intervention-arm cases (N = 159), exploring factors influencing their decision and perceptions about the test results. Actual prescribing behaviour was extracted from the trial database. A 4-block hierarchical logistic regression identified predictors of prescriptions being consistent with Pneumonia Panel results.</p><p><strong>Results: </strong>65% (N = 104) of prescribing decisions were consistent with Pneumonia Panel results. The test result itself was a dominant factor: 88% (N = 98) of decisions were consistent when results were positive (pathogens found). However, only 13% (N = 6) of decisions were consistent when no pathogens were detected. Consequently, clinicians were often reluctant to eschew initial antibiotics or de-escalate early where appropriate, 'erring on the side of caution'. Clinicians perceptions, specifically the speed of results, concurrent antibiotic treatment, the patient having additional confirmed evidence of infection, and believing the patient is unlikely to have a non-respiratory infection predicted prescribing decisions being aligned with test results (all p < .05).</p><p><strong>Conclusions: </strong>Findings have implications for the roll-out of rapid diagnostics in practice, particularly regarding the management of negative results. Implementation strategies need to be behaviourally intelligent, connecting with how clinicians think and behave.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two years Bacillus cereus outbreaks: investigations and effective management of contamination in a neonatal intensive care unit.","authors":"Agathe Manin, Aubin Souche, Patricia Martins Simões, Pierre Cassier, Christine Barreto, Marine Butin","doi":"10.1186/s13756-026-01730-x","DOIUrl":"10.1186/s13756-026-01730-x","url":null,"abstract":"<p><strong>Background: </strong>Bacillus cereus is an emerging cause of fulminant nosocomial bacteremia in premature infants. Here we aimed to report the successful management of two successive waves of contamination, colonization and infections caused by this pathogen in one neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>This study reports all investigative, preventive, and management measures taken during these episodes (in 2023 and 2024) in a 3rd level NICU. A case was defined as an infection with B. cereus confirmed by at least one positive blood culture. Contamination was monitored by surface samples from the NICU and colonization by stool or skin samples from patients. The bacterial genomes were compared via multilocus sequence typing, core genome typing, and distance matrix.</p><p><strong>Results: </strong>Between January 2021 and May 2025, B. cereus were detected in 156 surface samples within the NICU, mainly in 2023 and 2024. Three patients developed a sepsis caused by B. cereus, including 2 fatal cases. Thirty-three others patients were colonized with B. cereus during this period but none developed B. cereus sepsis. A set of structural, logistical, hygiene, and air quality optimization measures were implemented in September 2023. The environmental contamination was considered as under control in February 2024, but a resurgence was observed in April 2024. Measures to control and prevent environmental contamination in the NICU were intensified, controlling the situation by August 2024. Residual circulation persists at low levels. Analyses revealed widespread contamination including NICU equipment, air, air treatment infrastructure, linen and maintenance equipment. A pluriclonal population was described, with more than 20 different clones circulating simultaneously. The three strains isolated from blood cultures were different but each one was also identified in the NICU environment.</p><p><strong>Conclusion: </strong>The detection of B. cereus, whether in carriers or in the environment, should trigger rapid investigations to identify entry points and the immediate implementation of barrier measures to protect the most vulnerable newborns. Care must be taken with respect to air treatment, laundry, and hand hygiene.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indoor air quality, hygiene practices and the antimicrobial resistance profiles of airborne bacteria in selected areas of a tertiary health facility in Ibadan, Nigeria.","authors":"Oluwadamilare Caleb Fabiyi, Godson Rowland Ana","doi":"10.1186/s13756-026-01733-8","DOIUrl":"10.1186/s13756-026-01733-8","url":null,"abstract":"<p><strong>Background: </strong>Hospital indoor air is contaminated with multidrug-resistant bacteria, and this contributes to their spread. However, there is limited information linking environmental and atmospheric factors to the levels of these resistant bacteria in indoor hospital air. Hence, this study assessed the levels of multi-drug resistant bacteria in the indoor air of a tertiary hospital and the contributing environmental and atmospheric factors.</p><p><strong>Methods: </strong>This cross-sectional study observed hygiene practices, sanitary conditions, occupancy ratio, activity rates, temperature and humidity levels in selected indoor areas of University College Hospital, Ibadan. Airborne bacteria were sampled with their loads via a volumetric sampler, and they were tested for susceptibility against 13 antibiotics via the disk diffusion method. Data was collected twice daily, thrice weekly for two weeks, and analyzed using SPSS version 26.</p><p><strong>Results: </strong>The hygiene practices observed varied across the sampled areas with the office area (10.00 ± 0.00) and psychiatry (9.17 ± 0.41) wards showing best practices, and the laundry area (6.00 ± 0.00) with the worst, sanitary conditions also followed a similar pattern. The study identified 93 bacterial isolates from the MacConkey agar, Staphylococcus aureus (33.3%), Bacillus species (31.18%), Klebsiella pneumoniae (15.05%), Escherichia coli (10.75%), and Coagulase-negative Staphylococcus (9.68%). The mean bacterial load (CFU/m³) varied significantly across sampled areas (p < 0.01): Laundry (2962.96 ± 547.59) > Children Emergency Ward (2537.03 ± 551.67) > Neurosurgery (2310.19 ± 560.31) > Psychiatry (1828.70 ± 431.93) > Office (421.30 ± 311.09), with the exception of office area, the loads were above the WHO acceptable limit of 1000 CFU/m³. Bacterial load correlated negatively with hygiene practices and sanitary conditions, but positively with occupancy ratio, activity levels, humidity and temperature, all p < 0.01. The identified bacteria exhibited a high multidrug resistance, this includes the identification of Methicillin Resistant Staphylococcus aureus and extended spectrum beta lactamases producing Escherichia coli and Klebsiella pneumoniae.</p><p><strong>Conclusion: </strong>Healthcare environments, particularly indoor air remains highly contaminated with multidrug-resistant bacteria, with environmental factors like hygiene, sanitation, occupancy, activity, and atmospheric factors like temperature and humidity contributing to their spread. Therefore, improved environmental practices, routine indoor air surveillance and antimicrobial stewardship is advocated.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}