Other specific DSP article suggested by Editorial Board
Implementation considerations for integrated face and respiratory protection: a qualitative study.
Citation:- 10.1016/j.jhin.2025.02.022
Authors: Cordeiro L et alet al
Abstract
Background: The implementation of an innovative form of personal protective equipment (PPE) as an infection and prevention control measure for respiratory transmissible diseases is complex, with several elements to be addressed.
Aim: To make considerations for integrated face and respiratory protection implementation in clinical settings.
Methods: Multisite qualitative study with 87 health workers that compared traditional PPE or powered air purifying (PAPR) respirators with lightweight PAPR (L-PAPR). Semi-structured interviews were performed based on the Consolidated Framework for Implementation Research (CFIR).
Findings: Insights into L-PAPR implementation were found. The advantages consist of: enhanced sense of protection, pleasant ventilation, good visibility for both health worker and patient, no fogging of the visor interior, no movement restriction, and easy disinfection process. To enhance usability some barriers should be tackled: reduction of facial pressure; better accommodation for glasses and corrective lenses; reduction of number of steps for assembling the device; infrastructure provision for storage, charging and disinfection of the device; training of health workers for assembling, donning and doffing; and the cost benefit of implementation.
Conclusion: L-PAPR was overall perceived with advantages by many participants, and can be considered a potential option of PPE to be implemented to protect health workers during outbreaks of respiratory transmissible diseases.
Other specific DSP article suggested by Editorial Board
Clinical characteristics, antimicrobial resistance, and mortality of neonatal bloodstream infections in Northern Tanzania, 2022-2023.
Citation:- 10.1371/journal.pone.0319816
Authors: Moorthy GS et al
Abstract
Neonatal bloodstream infections (BSI) make a substantial contribution to morbidity and mortality in low- and middle-income countries (LMICs), but data on the epidemiology and antimicrobial resistance (AMR) in Tanzania are limited. We describe the prevalence, resistance patterns, and associated factors of neonatal BSI at the Kilimanjaro Christian Medical Centre (KCMC), a large referral hospital in northern Tanzania. We conducted a prospective, observational study involving infants aged 0-60 days with perinatal risk factors or clinical signs of sepsis. Aerobic blood cultures were obtained at enrollment and monitored using a continuously monitored blood culture instrument. Antimicrobial susceptibility testing was performed using standard phenotypic methods. Vital status was obtained on days 2, 7, and 28 post-enrollment. BSI was defined as the isolation of established neonatal pathogens, including yeast and coagulase-negative Staphylococcus spp. (CoNS). Early-onset BSI occurred on day of life (DOL) 0-2, while late-onset BSI occurred on DOL 3 or later. Among 236 enrolled infants, blood culture was obtained in 233. BSI occurred in 106 (45.5%) of 233 infants, 50 (47.2%) were early-onset, and 56 (52.8%) were late-onset BSI. The isolated pathogens included 58 (54.7%) Gram-positive bacteria, 40 (37.7%) Gram-negative bacteria, and 8 (7.5%) yeast. CoNS (n = 55, 51.9%) and Klebsiella pneumoniae (n = 35, 33.0%) were the most common pathogens. Notably, all K. pneumoniae isolates were extended-spectrum beta-lactamase producers, resistant to ampicillin and ceftriaxone. Among the 56 infants who died, 29 (51.8%) had BSI; 11 (19.6%) infants with EO-BSI, and 18 (32.1%) with LO-BSI. Infants requiring respiratory support at admission had a 1.89-fold increased adjusted odds of BSI (95% CI, 1.05-3.44). We found high prevalence of neonatal BSI due to bacteria with a high prevalence of AMR, and BSI was associated with high mortality. There is an urgent need for effective preventive, diagnostic, and therapeutic interventions to address BSI among hospitalized infants in northern Tanzania.
Other specific DSP article suggested by Editorial Board
Proteomic characterization of clinical Candida glabrata isolates with varying degrees of virulence and resistance to fluconazole.
Citation:- 10.1371/journal.pone.0320484
Authors: El Khoury P et al
Abstract
Candida glabrata, an opportunistic fungal pathogen, is a significant contributor to mortality among individuals with weakened immune systems. Antifungal drugs such as azoles work by inhibiting the Erg11 enzyme, altering the conversion of lanosterol to ergosterol. Resistance to azoles is increasing among Candida species worldwide, and in Lebanon. This study aims to determine the identity of cell wall proteins that could be involved in resistance and virulence in Candida glabrata Lebanese hospital isolates. Four isolates with varying degrees of resistance and virulence to fluconazole were subjected to proteomic analysis. Cell wall proteins of each isolate were extracted and analyzed using MALDI TOF TOF mass spectrometry to identify proteins responsible for virulence and resistance under exposure to fluconazole. Results showed the exclusive presence of efflux pumps such as Cdr1 and Pdr1 after exposure to fluconazole, in addition to other resistance mechanisms such as activation of multidrug transporter proteins and specific response pathways such as the RIM 101 pathway that could be involved in drug resistance and adhesion. Proteomic profiling exhibited proteins differentially detected in the virulent isolates such as the autophagy related proteins Atg 11 and Atg16, and stress response proteins Sgf11 and Alg2. In conclusion, our study suggests several mechanisms that contribute to resistance and virulence in C. glabrata.
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The spread of antimicrobial resistance in the aquatic environment from faecal pollution: a scoping review of a multifaceted issue.
Citation:- 10.1007/s10661-025-13860-7
Authors: Cheung C et al
Abstract
Antimicrobial resistance (AMR) is a major global health concern accelerated by the misuse and mismanagement of antibiotics in clinical and veterinary settings, leading to longer treatment times, increased costs and greater mortality rates. The environment can play a major role as a source and disseminator of AMR, with faecal pollution, from both anthropogenic and non-anthropogenic sources making a significant contribution. The review aimed to identify how faecal pollution contributes to AMR in surface water, focusing on current methods of source tracking faecal pollution. The databases used were Medline Ovid® and Scopus. From the search, 744 papers from January 2020 to November 2023 were identified, and after the screening, 33 papers were selected that reported on AMR, aquatic environments and faecal pollution and were published in English. The studies were from six different continents, most were from Europe and Asia indicating faecal pollution is influenced by spatiotemporal differences such as population and sanitation infrastructure. Multiple different methodologies were used with a lack of standardised methods making comparability challenging. All studies identified AMR strains of faecal indicator bacteria showing resistance to a wide variety of antibiotics, particularly beta-lactams and tetracyclines. Few studies investigated mobile gene elements with class 1 integrons being the most frequently studied. Wastewater treatment plants were significant contributors, releasing large amounts of AMR bacteria into the environment. Environmental factors such as seasonal differences, temperature, rainfall and UV exposure, along with local antibiotic usage influenced the local resistome. Animals, both wild and domestic, introduced antimicrobial resistance genes and potential pathogens into the aquatic environment. Overall, faecal pollution is a complicated issue with multiple factors contributing to and facilitating the spread of AMR. Standardisation of methods and surveillance, robust wastewater management and further research into AMR dissemination are needed to address the human health, animal health and environmental concerns.
Other specific DSP article suggested by Editorial Board
Risk Factors for Health Care-Associated Bloodstream Infections in NICUs.
Citation:- 10.1001/jamanetworkopen.2025.1821
Authors: Johnson J et al
Abstract
Importance: Neonates requiring intensive care are at high risk of health care-associated infections. In neonatal intensive care units (NICUs) in low-resource settings, the identification of modifiable risk factors can inform targeted prevention strategies to reduce the global burden of neonatal morbidity and mortality.
Objective: To describe the incidence of and the risk factors associated with health care-associated bloodstream infections (BSIs) in NICUs in Pune, India.
Design, setting, and participants: This multicenter prospective cohort study enrolled all neonates admitted to 3 NICUs in Pune, India, from May 1, 2017, to July 31, 2019. Neonates were followed up from admission until discharge, transfer, or death. This secondary data analysis included neonates admitted for 3 days or more and was completed on January 31, 2024.
Main outcomes and measures: The primary outcome was health care-associated BSIs, defined as a positive blood culture on or after admission day 3. Summary statistics, incidence of health care-associated BSIs, and hazard rate by characteristics of interest were generated. Among neonates admitted for 7 days or longer, the association between antibiotic exposure and infection risk was assessed.
Results: A total of 6410 neonates were admitted for 3 days or longer. The median gestational age was 34 weeks (IQR, 32-37 weeks), and 3560 (55.5%) were male. The incidence of health care-associated BSIs was 6.09 per 1000 patient-days. Most isolates were gram-negative organisms (n = 273 [66.3%]), of which 85.5% (202 of 236 isolates tested) were resistant to third- or fourth-generation cephalosporins and 44.8% (117 of 261 isolates tested) were resistant to carbapenems. The hazard rate of health care-associated BSIs was higher among neonates with central venous catheters, respiratory support, or urinary catheters within 3 days preceding infection. Of 3229 neonates admitted for 7 days or longer, 190 (5.8%) had health care-associated BSIs on or after hospital day 7, with an incidence of 3.22 per 1000 patient-days. Antibiotic exposure during the first week of admission was associated with a nearly 3-fold increase in the risk of health care-associated BSIs (adjusted hazard ratio, 2.82 [95% CI, 1.26-6.32]). Conclusions and relevance: In this cohort study of 6410 neonates admitted to 3 NICUs in Pune, India, the risk of health care-associated BSIs was associated with the presence of indwelling devices and prior antibiotic exposure. Future efforts should focus on mitigating the risks associated with indwelling devices and strengthening infection prevention and control and antimicrobial stewardship programs to prevent health care-associated infections.
Other specific DSP article suggested by Editorial Board
Interventions by Clinical Pharmacists Reduced Unnecessary Antibiotics Exposure for Early-Onset Sepsis in a Neonatology Department.
Citation:- 10.1111/apa.70070
Authors: Yao Y et al
Abstract
Aim: To observe the effect of pharmacist-led antimicrobial stewardship (AMS) on antibiotic exposure for infants with suspected early-onset sepsis (EOS).
Methods: A retrospective observational study was performed. The pharmacist was responsible for the development, education, and supervision of the implementation of the local EOS management protocol. In phase 1, the protocol was established completely according to the latest domestic consensus. In phase 2, the protocol was updated and defined which steps should be taken for specific risk factors and situations in which antibiotics were not necessary down to the detail.
Results: A total of 9880 neonates were enrolled. The antibiotic use rate decreased from 58.1% before AMS was implemented to 51.9% in phase 1, and further to 31.7% in phase 2 (p < 0.0001). Days of therapy per 100 patient days were 30.8, 28.3, and 24.8, respectively (p < 0.0001). Multidrug-resistant organism culture rate gradually decreased from 48.2% to 45.5% in phase 1, and further to 37.0% in phase 2 (p < 0.01). No difference in safety outcomes was observed between the intervention and baseline periods.
Conclusion: A practical AMS led by a pharmacist can safely and successfully reduce the prescription rate of antibiotics for EOS and the incidence of multidrug-resistant bacteria.
Other specific DSP article suggested by Editorial Board
Frequency of haematogenous periprosthetic joint infection due to bacteraemia caused by gram-positive cocci
Citation:- 10.1080/23744235.2025.2476530
Authors: Thompson, O
Abstract
Background: Presence of a prosthetic joint entails a life-long risk of haematogenous periprosthetic joint infection (hPJI) during bacteraemia. For bacteraemia with Staphylococcus aureus the hPJI frequency has been described to be up to 40% and for streptococci up to 20%, with large variation among reported frequencies.
Objectives: We aimed to investigate the hPJI frequency from bacteraemia with virulent gram-positive cocci in patients with hip and/or knee prosthesis.
Methods: A population and register based approach was used. Through cross-matching of blood cultures positive for virulent gram-positive cocci and data from the Swedish Arthroplasty Register, patients with at least one prosthesis in place during bacteraemia were identified. Medical records were reviewed if patients had concordant microbiological cultures in blood and synovial fluid, tissue or bone, to determine if hPJI was present. Absence of concordant cultures was interpreted as absence of hPJI.
Results: Of all 2392 episodes of bacteraemia identified during the study period, 143 (6%) caused at least one hPJI. The highest frequency of hPJI was observed for S. aureus (9.6%) and Streptococcus agalactiae (9.3%). Increasing number of prostheses in place, male sex and lower age were independently associated with hPJI. Bacteraemia with other species than S. aureus or S. agalactiae was associated with a lower hPJI risk.
Conclusion: The observational risk of hPJI from bacteraemia with virulent gram-positive cocci was much lower than in previous reports, especially for S. aureus, with an hPJI frequency of 9.6%.
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Plasma Mycobacterium tuberculosis cell-free DNA assay: a diagnostic tool for tuberculosis lymphadenitis
Citation:- 10.1080/23744235.2025.2478263
Authors: Ayalew, S
Abstract
Background: Bacterial confirmation in suspected tuberculosis lymphadenitis patients is challenging. This study evaluates plasma Mycobacterium tuberculosis cell-free DNA as a diagnostic tool for tuberculosis lymphadenitis.
Methods: A quantitative PCR assay targeting IS6110, IS1081, and cyp141 genes was performed on plasma samples. The study included 95 tuberculosis lymphadenitis patients and 60 controls. Sensitivity of the plasma Mycobacterium tuberculosis cell-free DNA assay was assessed against fine needle aspiration GeneXpert Ultra, fine needle aspiration culture, and fine needle aspiration cytology, while specificity was determined using control groups.
Results: Of the tuberculosis lymphadenitis cases, 71 (74.7%) were bacteriologically confirmed, and 24 (25.3%) were probable. In the control group, 50% had latent tuberculosis infection. The Mycobacterium tuberculosis cell-free DNA assay, targeting three genes, had an overall sensitivity of 65.3%, increasing to 70.4% for confirmed cases and 50% for probable cases, with specificity of 91.1%. Sensitivities for specific gene combinations were 62.1% for IS6110 and IS1081, 54.7% for IS6110 and cyp141, and 55.8% for IS1081 and cyp141. For individual genes, IS6110 showed 49.4% sensitivity (specificity: 93.3%), IS1081 had 51.6% (specificity: 96.0%), and cyp141 showed 28.4% (specificity: 96.7%). Combining positive results from all three genes in the cell-free DNA assay with fine needle aspiration culture and GeneXpert Ultra improved sensitivity to 76.8% and 85.3%, respectively.
Conclusion: This study demonstrated that Mycobacterium tuberculosis cell-free DNA can be detected in the plasma of over half of tuberculosis lymphadenitis patients. The plasma Mycobacterium tuberculosis cell-free DNA assay could serve as a valuable, less-invasive complement to existing fine needle aspiration diagnostics.
Other specific DSP article suggested by Editorial Board
Interventions by Clinical Pharmacists Reduced Unnecessary Antibiotics Exposure for Early-Onset Sepsis in a Neonatology Department.
Citation:- 10.1111/apa.70070
Authors: Fu, C., Ruan,
Abstract
Background: Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in children. Currently, there is limited literature on the clinical use of pathogen-targeted sequencing technologies and the systematic analysis of RSV infections in hospitalized children. The primary objective of this research was to evaluate the infection status and clinical manifestations associated with RSV in these pediatric patients.
Methods: Between July 2021 and November 2023, 5,021 children hospitalized due to respiratory infections or associated complications were enrolled at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Targeted next-generation sequencing (tNGS) was used to detect pathogens in their respiratory samples. Subsequently, the clinical data of children infected with RSV were systematically evaluated.
Results: Of the 5,021 children hospitalized with respiratory infections, RSV was detected in 1,080, yielding a detection rate of 21.5%. Among RSV-positive patients, only 8.6% (93/1080) experienced single infections, while the majority, 91.4% (987/1080), had co-infections with other pathogens. Among the observed infection patterns, RSV-viral-bacterial co-infection was the most prevalent, occurring in 524 cases (48.5%), followed by RSV-viral co-infection in 141 cases (13.1%). Among children with RSV co-infections, 43 additional microorganisms were detected, with cytomegalovirus, Haemophilus influenzae, and Streptococcus pneumoniae being the most prevalent. Of the 1,080 children diagnosed with RSV, 172 (15.9%) required ICU admission for monitoring. The median duration of hospitalization for the 1080 children diagnosed with RSV infection was 8 days. Of these, 1025 (94.9%) patients recovered and were discharged following treatment, while 54 (5.0%) of the patients’ family members requested voluntary discharge due to unsatisfactory outcomes or other reasons. Unfortunately, one child (0.1%) died despite receiving intensive medical treatment.
Conclusion: Due to the high incidence of RSV infections and associated ICU admissions, there is a critical need for effective vaccine development to protect infants and children. This study presents a comprehensive analysis of hospitalized pediatric patients with RSV, examining infection patterns, clinical manifestations, laboratory findings, imaging characteristics, complications, and prognosis.
Other specific DSP article suggested by Editorial Board
Cefiderocol treatment for patients infected by Stenotrophomonas maltophilia, Burkholderia cepacia complex and Achromobacter spp.: subgroup analysis from the PERSEUS study
Citation:- 10.1007/s10096-025-05109-5
Authors: Torre-Cisneros
Abstract
Purpose: This subgroup analysis of the PERSEUS study aimed to describe the effectiveness of cefiderocol treatment in the early access programme in Spain in patients infected by Stenotrophomonas maltophilia, Burkholderia cepacia complex (Bcc) or Achromobacter species.
Methods: In the retrospective, observational, multicentre PERSEUS study in Spain, the effectiveness and safety of cefiderocol treatment administered for at least 72 h up to 28 days in patients infected by Gram-negative bacteria, except Acinetobacter spp., in the early access programme was investigated. Patient demographics and baseline clinical characteristics, cefiderocol use, clinical cure at end of treatment, all-cause mortality at Day 28 were the main outcomes.
Results: A total of 20 patients had S. maltophilia infections, and 14 patients had other rare glucose non-fermenters (Bcc 8, Achromobacter spp. 5, Ralstonia mannitolilytica 1). The median (interquartile range [IQR]) age was 60.5 (48.0–65.5) years and 49.5 (33.0–59.0) years for patients with S. maltophilia and other rare non-fermenters, respectively. The majority of patients had respiratory tract infections (S. maltophilia 55%; other rare non-fermenters 71.4%), and median (IQR) duration of cefiderocol treatment was 10.0 (6.5–13.5) days and 8.0 (6–14) days, respectively. Clinical cure rates were 70%, 62.5% and 80.0% for patients with S. maltophilia, Bcc and Achromobacter spp., respectively. Corresponding 28-day all-cause mortality rates were 30.0%, 37.5% and 40.0%, respectively. One patient with R. mannitolilytica had clinical cure and survived to Day 28.
Conclusions: Cefiderocol is an important addition to the limited treatment options for patients infected by these rare glucose non-fermenting Gram-negative bacteria.