Other specific DSP article suggested by Editorial Board
Variation of healthcare associated infections at a tertiary hospital in Southwest China over a 5-year period (2019-2023): a retrospective observational study.
Authors: Liang D et al
Abstract
Background: Healthcare-associated infections (HAIs), which are associated with prolonged hospitalization and increased mortality, remain a global challenge. The COVID-19 pandemic paradoxically reduced some HAIs through enhanced hygiene measures but exacerbated others due to resource diversion, with effects after policy changes remaining unclear. Therefore, this study analyzed HAIs distribution, pathogenic microorganisms distribution, and antibiotic susceptibility capturing the period surrounding strict COVID-19 control measures in a southwest China tertiary hospital. Methods: We conducted a retrospective study at a tertiary hospital in southwest China from 2019 to 2023. Data were extracted from real-time surveillance system, where HAIs were initially diagnosed by clinicians and subsequently verified by infection control personnel. The HAI incidence rate was calculated per 1000 hospital stays, and negative-binomial regression was used to compare incidence rates across years. Results: This study enrolled 2808 HAI cases, with 1665 males and 1143 females, averaging 61.37 years old. The incidence rates of HAIs from 2019 to 2023 were 1.75, 1.12, 0.98, 1.31, and 1.30 per 1000 hospital stays, respectively. Hematology (323, 11.50%), cardiology (309, 11.00%), and neurology (262, 9.33%) were the top three departments with the highest HAI rates. Lower respiratory tract (1198, 42.66%), bloodstream (419, 14.92%), and urinary tract (406, 14.46%) were the most common HAI sites. Klebsiella pneumoniae (173, 15.22%), Escherichia coli (155, 13.63%), and Acinetobacter baumannii (136, 11.96%) were the most frequent pathogenic microorganism. Acinetobacter baumannii was resistant to most antibiotics. Klebsiella pneumoniae was most resistant to cefuroxime Axetil, cefuroxime and ceftriaxone. Escherichia coli was most resistant to sulfamethoxazole and trimethoprim, ceftriaxone and cefuroxime. These three pathogenic microorganisms were all susceptible to tigecycline. Conclusions: The incidence rates of HAIs fluctuated over the years, peaking in 2019, suggesting potential shifts in infection control dynamics. Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii were the predominant pathogens, and tigecycline may be considered as a potential option against these pathogens. The study highlights the importance of enhancing infection control measures in high-risk departments and sites, optimizing antibiotic stewardship, and continuously monitoring HAI trends to inform evidence-based infection control policies.
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Antimicrobial stewardship programs in a network of Canadian acute care hospitals: a cross-sectional survey.
DOI: 10.1017/ash.2025.181
Authors: McGill E et al
Abstract
Objective: Antibiotics are essential to combating infections; however, misuse and overuse has contributed to antimicrobial resistance (AMR). Antimicrobial stewardship programs (ASPs) are a strategy to combat AMR and are mandatory in Canadian hospitals for accreditation. The Canadian Nosocomial Infection Surveillance Program (CNISP) sought to capture a snapshot of ASP practices within the network of Canadian acute care hospitals. Objectives of the survey were to describe the status, practices, and process indicators of ASPs across acute care hospitals participating in CNISP.
Design: The survey explored the following items related to ASP programs: 1) program structure and leadership, 2) human, technical and financial resources allocated, 3) inventory of interventions carried and implemented, 4) tracking antimicrobial use; and 5) educational and promotional components.
Methods: CNISP developed a 34-item survey in both English and French. The survey was administered to 109 participating CNISP hospitals from June to August 2024, responses were analyzed descriptively.
Results: Ninety-seven percent (106/109) of CNISP hospitals responded to the survey. Eighty-four percent (89/106) reported having a formal ASP in place at the time of the study. Ninety percent (80/89) of acute care hospitals with an ASP performed prospective audit and feedback for antibiotic agents and 85% (76/89) had formal surveillance of quantitative antimicrobial use. Additionally, just over 80% (74/89) provided education to their prescribers and other healthcare staff. Conclusions: CNISP acute care hospitals employ multiple key aspects of ASP including implementing interventions and monitoring/tracking antimicrobial use. There were acute care hospitals without an ASP, highlighting areas for investigation and improvement.
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Tailor swiftly: lessons learned from a nationwide implementation of an antimicrobial stewardship program for asymptomatic bacteriuria
DOI: 10.1017/ash.2025.63
Authors: Haltom TM et al
Abstract
Objective: Overtreatment of asymptomatic bacteriuria (ASB) is a major cause of antibiotic overuse. A nationwide implementation of an ASB antimicrobial stewardship intervention was facilitated in 41 Veterans Affairs facilities. Twenty-one sites participated in a Virtual Learning Collaborative (VLC) with monthly webinars. The assessment was done of what VLC teams learned from one another in these webinars.
Methods: The bi-monthly VLC webinars featured expert presentations and spotlighted 1-2 site teams, asking them to discuss their barriers and facilitators for the intervention. Data come from analyses of descriptive field notes from the webinars and chat transcripts. Field notes were analyzed using the “sort and sift, think and shift” method. Common strategies thematically were sorted and labeled, sifted through illustrative quotes, and iteratively the results were discussed to reach consensus.
Results: Across 22 webinars (August 2023-April 2024), sites discussed different resources, team membership, and organizational structures. Sites had to “tailor swiftly” to their site needs and target audiences by adapting educational materials for timing, length, audience, and outreach location. Sites used five tailoring strategies to implement the antimicrobial stewardship program: Organizational and Structural Strategies, Recruitment Strategies, Data- and Information-Based Strategies, Interpersonal Strategies, and Resource Provision.
Conclusion: VLC webinars allowed sites to share tips and strategies for the implementation of a nationwide antimicrobial stewardship program wherein rapid tailoring and local adaptations were effective. The supportive approach to tailoring allowed implementation sites to adapt antimicrobial stewardship materials and intervention delivery to their different resources and organizational contexts
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The intersection of the social determinants of health and antimicrobial resistance in human populations: a systematic review.
Authors: Shutt AE et al
Abstract
Introduction: The social determinants of health (SDoH) impact the emergence and spread of antimicrobial resistance (AMR). A systematic review of literature was conducted for mapping evidence on the intersection of SDoH, drug-resistant infections, antibiotic use, and public-facing interventions.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, PsycINFO and Scopus were searched for published evidence in English between 2000 and 2022. Covidence software was used for data extraction. The evidence was mapped to the SDoH frameworks and the systematic review objectives.
Results: Of 17 252 retrieved papers, 16 636 were included in title and abstract review, with 153 included in data extraction (126 empirical studies and 27 papers with secondary data). Of these, 92/126 (73%) were quantitative, 23/126 (18%) qualitative and 11/126 (9 %) mixed methods. There was evidence from high income 60/126 (47%), lower-middle income 41/126 (33%), low income 14 (11%) and upper-middle income 11 (9%) countries.There is limited evidence associated with the complete range of SDoH in different populations. Reported determinants affecting the risk of exposure to and spread of AMR include (a) socioeconomic status and the associated impact on health seeking behaviours, (b) housing-living in a deprived area and overcrowding and (c) knowledge linked with education affecting practices, exacerbated by interconnected complexity with the associated influence of socioeconomic status. A gap in understanding the upstream systems which create inequality and negatively impact SDoH is evident. Numerous definitions are used to identify vulnerable populations. There is very limited research examining specific population groups, for example, traveller communities and the disabled. Reported interventions focus on awareness programmes with little evidence on sustained behaviour change.
Conclusions: This review identified the need to (a) develop policies and context-specific solutions to manage upstream determinants, (b) include population groups where current evidence is limited and (c) prioritise community-based research using co-production methods.
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Efficacy and safety of 8-week regimens for the treatment of rifampicin-susceptible pulmonary tuberculosis (TRUNCATE-TB): a prespecified exploratory analysis of a multi-arm, multi-stage, open-label, randomised controlled trial
Authors: Prof Nicholas I Paton, MD
Abstract
Background :WHO recommends a 2-month optimal duration for new drug regimens for rifampicin-susceptible tuberculosis. We aimed to investigate the efficacy and safety of the 8-week regimens that were assessed as part of the TRUNCATE management strategy of the TRUNCATE-TB trial.
Methods: TRUNCATE-TB was a multi-arm, multi-stage, open-label, randomised controlled trial in which participants aged 18–65 years with rifampicin-susceptible pulmonary tuberculosis were randomly assigned via a web-based system, using permuted blocks, to 24-week standard treatment (rifampicin, isoniazid, pyrazinamide, and ethambutol) or the TRUNCATE management strategy comprising initial 8-week treatment, then post-treatment monitoring and re-treatment where needed. The four 8-week regimens comprised five drugs, modified from standard treatment: high-dose rifampicin and linezolid, or high-dose rifampicin and clofazimine, or bedaquiline and linezolid, all given with isoniazid, pyrazinamide, and ethambutol; and rifapentine, linezolid, and levofloxacin, given with isoniazid and pyrazinamide. Here, we report the efficacy (proportion with unfavourable outcome; and difference from standard treatment, assessed via Bayesian methods) and safety of the 8-week regimens, assessed in the intention-to-treat population. This prespecified exploratory analysis is distinct from the previously reported 96-week outcome of the strategy in which the regimens were deployed. This trial is registered with ClinicalTrials.gov (NCT03474198).
Findings: Between March 21, 2018, and March 26, 2020, 675 participants (674 in the intention-to-treat population) were enrolled and randomly assigned to the standard treatment group or one of the four 8-week regimen groups. Two 8-week regimens progressed to full enrolment. An unfavourable outcome (mainly relapse) occurred in seven (4%) of 181 participants on standard treatment; 46 (25%) of 184 on the high-dose rifampicin and linezolid-containing regimen (adjusted difference 21·0%, 95% Bayesian credible interval [BCI] 14·3–28·1); and 26 (14%) of 189 on the bedaquiline and linezolid-containing regimen (adjusted difference 9·3% [4·3–14·9]). Grade 3–4 adverse events occurred in 24 (14%) of 181 participants on standard treatment, 20 (11%) of 184 on the rifampicin-linezolid regimen, and 22 (12%) of 189 on the bedaquiline-linezolid regimen.
Interpretation:
Efficacy was worse with 8-week regimens, although the difference from standard treatment varied between regimens. Even the best 8-week regimen (bedaquiline-linezolid) should only be used as part of a management strategy involving post-treatment monitoring and re-treatment if necessary.”
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Long-term effects of azithromycin mass administration to reduce childhood mortality on Streptococcus pneumoniae antimicrobial resistance: a population-based, cross-sectional, follow-up carriage survey
Authors: Akuzike Kalizang’oma, PhD
Abstract
Background : Mass drug administration (MDA) programmes with the macrolide antibiotic azithromycin to reduce childhood mortality are expanding in Africa; however, concerns remain about the long-term effects of these programmes on antimicrobial resistance (AMR). We aimed to evaluate the persistence and spread of Streptococcus pneumoniae AMR following a community-randomised MDA trial.
Methods: his population-based, cross-sectional, pneumococcal carriage survey was conducted in Mangochi, Malawi, 3·5 years after the MORDOR trial, in which communities received twice-yearly azithromycin or placebo for 2 years. Eligible participants in this carriage survey were children aged 4–9 years who lived in an azithromycin-treated or placebo-treated cluster during the MORDOR trial, and children aged 1–3 years who were resident in a cluster but born after the MORDOR trial ended. Nasopharyngeal swabs were collected from participants and analysed by whole genome sequencing; pneumococcal genomes obtained from a distant site in Malawi, in which MDA had not been conducted, were used as reference genomes. The primary outcome was the prevalence of S pneumoniae macrolide resistance, comparing placebo-treated and azithromycin-treated clusters at baseline, 6 months post-MDA, and 3·5 years post-MDA.
Findings: Between April 8 and May 14, 2021, 924 children aged 1–9 years were screened, of whom 19 were excluded and 905 were recruited to the follow-up carriage survey: 452 from azithromycin-treated clusters and 453 from placebo-treated clusters of the MORDOR trial. We assessed 426 isolates from these participants (190 from azithromycin-treated clusters and 236 from placebo-treated clusters), as well as samples from the baseline of the MORDOR trial (164 isolates; 83 from azithromycin-treated clusters and 81 from placebo-treated clusters) and from 6 months post-MDA (223 isolates; 119 from azithromycin-treated clusters and 104 from placebo-treated clusters). In azithromycin-treated clusters, macrolide resistance increased from 21·7% (95% CI 14·2–31·7; 18 of 83 isolates) at baseline to 31·9% (24·2–40·8; 38 of 119 isolates) 6 months post-MDA and to 32·1% (25·9–39·0; 61 of 190 isolates) 3·5 years post-MDA. In placebo-treated clusters, resistance increased from 21·0% (13·5–31·1; 17 of 81 isolates) at baseline to 25·0% (17·7–34·1; 26 of 104 isolates) 6 months post-MDA and to 30·9% (25·4–37·1; 73 of 236 isolates) 3·5 years post-MDA. No significant differences were observed in odds ratios between treatment groups across the survey timepoints: 0·97 (95% CI 0·36–2·55) at baseline, 1·46 (0·67–3·17) at 6 months post-MDA, and 1·12 (0·66–1·91) at 3·5 years post-MDA. Macrolide resistance in the non-MDA site remained stable: 16·9% (95% CI 12·8–21·8; 45 of 267 isolates) at baseline, 16·5% (13·3–20·3; 70 of 424 isolates) at 6 months, and 16·5% (12·5–21·4; 44 of 267 isolates) at 2·5 years. Among children born into azithromycin-treated clusters after MDA, macrolide resistance was 36·0% (27·7–45·1; 41 of 114 children). Multidrug resistance to at least three antibiotic classes was significantly higher in azithromycin-treated (p=0·0015) and placebo-treated (p<0·0001) clusters than in the comparator population at 3·5 years post-MDA and was associated with integrative conjugative elements.
Interpretation : Azithromycin MDA is associated with macrolide resistance that persists and potentially spreads to untreated populations. The co-existence of multidrug resistance and transmissible resistance on integrative conjugative elements in these populations is a public health concern. Careful monitoring of AMR is essential in areas where MDA is implemented.
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Moral tensions when providing care to MDRO carriers: a qualitative study among healthcare providers in Dutch hospitals and nursing homes
Authors: Carlijn Damsté, MA MSc
Abstract
OBJECTIVES : To prevent the spread of multi-drug resistant organisms (MDROs), adherence to infection prevention measures is essential. However, these measures can negatively affect both patients and healthcare providers (HCPs), leading to various moral tensions. We aimed to investigate moral tensions in providing care to MDRO carriers as experienced by HCPs.
METHODS: We performed semi-structured interviews with 29 HCPs from 2 hospitals and 3 nursing homes. We conducted a thematic analysis with a double-coder process supported by ATLAS.ti software.
RESULTS: We identified four moral tensions. First, HCPs experience tension between wanting to prevent transmission and safeguarding patients’ well-being. HCPs struggle with being less recognizable to patients, which they feel hampers care quality. Second, HCP grapple with justifying the increased time spent on carriers, which comes at the expense of other patients, within the context of scarce time. Third, HCPs experience concerns about personal safety and health while caring for others. Most HCPs are very aware of the transmission risk and feel unsure to what extent they are protected. Fourth, HCPs feel tension between the necessity to care and the environmental impact of personal protective equipment (PPE). Few HCPs blame themselves when using PPE unnecessarily.
CONCLUSIONS: HCPs and their organizations should acknowledge and act on moral tensions to contribute to professional well-being and improvement of care for MDRO carriers.”
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The role of high-sensitivity C-reaction protein in the prediction of long-term mortality in people living with HIV: Results from the IDEA-TB cohort study in Kenya
Authors: Fausto Ciccacci
Abstract
Higher HS-CRP is linked to increased mortality in a Kenyan cohort.
HS-CRP combined with CD4 count and viral load improves mortality prediction.
HS-CRP > 3.68 mg/L indicates lower survival probability.”
Other specific DSP article suggested by Editorial Board
Appropriateness of piperacillin-tazobactam prescriptions: a prospective multicentre study
Authors: Pierre-Marie Roger