Foo MZQ, Yong Y, Lai DCM
… +8 more, Arora S, Aung MK, Oo AM, Chan DYW, Sim JXY, Wee LE, Ling ML, Venkatachalam I
Am J Infect Control
· 2026 Apr · PMID 41183730
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INTRODUCTION: Carbapenem-resistant Enterobacterales (CRE) bacteremia poses a major clinical challenge due to limited treatment options and high mortality. This study compared mortality between CRE and non-CRE bacteremia...INTRODUCTION: Carbapenem-resistant Enterobacterales (CRE) bacteremia poses a major clinical challenge due to limited treatment options and high mortality. This study compared mortality between CRE and non-CRE bacteremia and evaluated the impact of empirical and definitive antibiotic therapy. A subgroup analysis explores outcomes in carbapenemase-producing (CP)-CRE versus non-CP-CRE bacteremia. METHOD: This retrospective cohort study included adults (≥ 18 years) with Enterobacterales bacteremia admitted to Singapore General Hospital from January 2016 to September 2024. Patients were grouped into CRE (n = 270) and non-CRE (n = 2462), with CRE further stratified into CP-CRE (n = 111) and non-CP-CRE (n = 159). Kaplan-Meier and Cox proportional hazards regression analyses identified mortality risk factors. RESULTS: CRE bacteremia demonstrated higher 30-day mortality (31.9% vs 22.8%) and 1-year mortality (62.6% vs 44.7%) (P < .01 for both). CRE cases frequently involved central line-associated bloodstream infections (CLABSIs) (7.4% vs 2.9%) and polymicrobial infections (16.3% vs 4.2%) compared to non-CRE (P < .001 for both). Appropriate definitive therapy significantly reduced 30-day (aHR: 0.30, 95% CI: 0.25-0.37, P < .001) and 1-year mortality (aHR: 0.58, 95% CI: 0.50-0.67, P < .001) in CRE, with similar benefit in CP-CRE (30-day aHR: 0.24, 95% CI: 0.14-0.42, P < .001; 1-year aHR: 0.59, 95% CI: 0.38-0.92, P = .02). CONCLUSION: High mortality from CRE bacteraemia can be mitigated by rapid, definitive therapy, underscoring the importance of timely diagnosis and access to effective agents.
Kang YJ, Haas JP, Landerfelt PE
… +4 more, Razmpour OR, Becker ER, Joski P, Cimiotti JP
Am J Infect Control
· 2026 Feb · PMID 41177263
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BACKGROUND: Coronary artery bypass graft (CABG) is a common procedure that can result in surgical complications. METHODS: Cross-sectional study of 757 acute care hospitals performing CABG surgery. Data on 24,066 Medicare...BACKGROUND: Coronary artery bypass graft (CABG) is a common procedure that can result in surgical complications. METHODS: Cross-sectional study of 757 acute care hospitals performing CABG surgery. Data on 24,066 Medicare beneficiaries were merged with data from the American Hospital Association Annual Survey and ZIP code-based community characteristics from the Social Vulnerability Index (SVI). Multivariate logistic regression models were fit to estimate the association between social vulnerability and CABG surgical site infection (SSI). RESULTS: Minority Status and Language were associated with an increase in the likelihood of CABG SSI. In a fully adjusted model, patients from the highest Minority Status and Language SVI quartile had a 60% increase in the likelihood of CABG SSI compared to the lowest SVI quartile. DISCUSSION: These findings suggest that racial and language differences that exist within communities' impact Medicare beneficiaries who undergo CABG surgery. These differences result in a higher risk for SSI. CONCLUSIONS: It is imperative that health care organizations and clinicians recognize that community factors can place surgical patients at increased risk for infection and may require community-based interventions.
Am J Infect Control
· 2026 Mar · PMID 41175986
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BACKGROUND: Antimicrobial therapy is the management cornerstone of patients with bloodstream infections (BSIs). We aimed to investigate the application of an antibiotic spectrum index (ASI) to assess hospital-onset Clost...BACKGROUND: Antimicrobial therapy is the management cornerstone of patients with bloodstream infections (BSIs). We aimed to investigate the application of an antibiotic spectrum index (ASI) to assess hospital-onset Clostridioides difficile infection (hCDI) when treating individuals with BSIs. METHODS: In a retrospective multicenter cohort consisted of treatment-naïve and hospitalized adults experiencing community-onset BSIs, the association of ASIs and hCDI was recognized after adjusting for the independent predictors of hCDI. RESULTS: Of the total 2,966 patients, each day of prolonged antimicrobial therapy was associated with an average increase of 11% for the likelihood of hCDI; each additional 30 units of total ASIs was linked to an average increase of 146%; and each additional unit of daily ASIs was associated with an average increase of 22%. Notably, the total ASI demonstrated superior performance in predicting hCDI, as reflected by the area under the receiver operating characteristic curve (AUROC = 0.971), compared with the total duration of antimicrobial administration (AUROC = 0.956). CONCLUSIONS: The ASI metrics applied to assess hCDI episodes following the initiation of antimicrobial therapy in treating patients with community-onset BSIs proved effective. Accordingly, incorporating ASI-based assessments into antimicrobial stewardship programs might serve as a practical approach to mitigate hCDI risk.
Ruch KE, Rodriguez A, Ostrosky-Zeichner L
… +1 more, Brown EL
Am J Infect Control
· 2026 Feb · PMID 41175985
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BACKGROUND: Infection preventionists (IPs) are critical to reducing healthcare-associated infections, yet orientation and training remain inconsistent. CIC is the professional standard, but variability in training may af...BACKGROUND: Infection preventionists (IPs) are critical to reducing healthcare-associated infections, yet orientation and training remain inconsistent. CIC is the professional standard, but variability in training may affect exam preparedness and certification outcomes. METHODS: A cross-sectional survey of 128 Texas IPs (October 2023-January 2024) evaluated training experiences, CIC certification status, and resource utilization. Logistic regression identified predictors of exam preparedness and certification. RESULTS: Of respondents, 60.3% were CIC certified, although 58.5% reported feeling unprepared for the exam. On-the-job training was the primary method across most competency areas. Rural IPs were significantly less likely to be certified compared with urban peers (OR, 2.99; 95% CI, 1.14-7.82; P = .026). Inadequate training predicted failure to achieve certification (OR, 0.21; 95% CI, 0.06-0.67; P = .008). Use of the APIC and Epidemiology Roadmap and APIC and Epidemiology Text was associated with greater perceived preparedness. CONCLUSIONS: Training gaps, particularly in rural settings, limit CIC readiness. Expanding access to structured educational programs and standardized resources may improve certification success and strengthen the infection prevention workforce.
Willingham M, Cunningham C, McCord J
… +1 more, Graves P
Am J Infect Control
· 2026 Jan · PMID 41175984
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Accurate blood culture collection is essential for guiding appropriate antibiotic therapy, with contamination posing a risk to diagnostic reliability. The American Society for Microbiology recommends contamination rates...Accurate blood culture collection is essential for guiding appropriate antibiotic therapy, with contamination posing a risk to diagnostic reliability. The American Society for Microbiology recommends contamination rates below 3% for optimal patient outcomes. In collaboration with the emergency and microbiology departments, a large rural hospital implemented a standardized blood culture collection kit as a quality improvement initiative that led to a reduction in contamination rates, reaching a low of 0.97% over several months.
Satoh N, Shibuya M, Nomura Y
… +7 more, Suzuki R, Yoneda R, Ohki D, Tsuboi M, Okushin K, Takahashi N, Tsutsumi T
Am J Infect Control
· 2026 Mar · PMID 41175982
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BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal intensive care units (NICUs) continue to pose serious challenges. Despite the importance of active surveillance, molecular typing, and...BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal intensive care units (NICUs) continue to pose serious challenges. Despite the importance of active surveillance, molecular typing, and decolonization for containment, Japan lacks national implementation guidelines. METHODS: This study retrospectively analyzed 3 MRSA outbreaks at our NICU from 2022 to 2023. Routine surveillance included obtaining weekly nasal cultures and monthly polymerase chain reaction-based open-reading frame typing (POT). Following outbreaks, whole-genome sequencing (WGS) was conducted on isolates from neonates, a mother, and health care personnel. We compared WGS and POT to evaluate outbreak resolution and transmission tracking. RESULTS: POT identified a predominant strain (106-137-80) but failed to differentiate epidemiologically unrelated cases. Conversely, WGS demonstrated higher resolution, confirming mother-to-child transmission, identifying community-acquired infections, and revealing genetically linked strains overlooked by POT alone. WGS implicated health care personnel as potential vectors and identified persistent strains within the NICU. CONCLUSIONS: Although POT remains practical for routine surveillance, WGS offers superior accuracy in outbreak analysis and complex transmission mapping. However, the total replacement of POT with WGS is not feasible. A combined strategy establishing outbreak criteria at each facility, using POT for routine screening, and employing WGS during outbreaks, may enhance infection control and shorten MRSA outbreak duration.
Devnani M, Kaur M, Kaur H
… +5 more, Kaur R, Thomas ER, Guleria C, Singh SM, Biswal M
Am J Infect Control
· 2026 Mar · PMID 41173326
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BACKGROUND: Hospital acquired infection (HAIs) remain a major global health challenge, particularly in low- and middle-income countries (LMICs). Although hand hygiene (HH) is one of the most effective measures to prevent...BACKGROUND: Hospital acquired infection (HAIs) remain a major global health challenge, particularly in low- and middle-income countries (LMICs). Although hand hygiene (HH) is one of the most effective measures to prevent HAIs, healthcare workers' (HCWs') compliance remains suboptimal, and patient participation in infection prevention and control is limited. This study assessed patients' perceptions of HAIs and HH, and identified factors associated with their willingness to remind HCWs to adhere to HH practices. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Chandigarh, India, among 240 general ward patients selected through systematic sampling. Data were collected using a validated structured questionnaire and analyzed using descriptive and inferential statistics. RESULTS: Over half (53%) of participants were aware of HAIs, yet only 35% had received education from HCWs on infection prevention. While 78% believed that reminding HCWs to perform HH could reduce infection risk, only 6.7% had ever reminded nurses and 2.1% had reminded doctors. Reluctance stemmed from hierarchical barriers, fear of offending staff, and assumptions of adequate compliance. CONCLUSIONS: Despite positive attitudes, actual patient engagement in HH promotion was minimal. Targeted education and institutional support are essential to empower patients as active partners in infection prevention.
Am J Infect Control
· 2026 Apr · PMID 41173325
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BACKGROUND: This nationwide survey aimed to assess hematology nurses' knowledge, attitudes, and practices (KAP) and its influencing factors on preventing and controlling multidrug-resistant organisms (MDROs) infections....BACKGROUND: This nationwide survey aimed to assess hematology nurses' knowledge, attitudes, and practices (KAP) and its influencing factors on preventing and controlling multidrug-resistant organisms (MDROs) infections. METHODS: This cross-sectional study surveyed hematology nurses at 185 hospitals across 26 provinces and municipalities in mainland China. Descriptive analysis, correlation tests, generalized linear models, and decision tree modeling were used to assess the current status of KAP and influencing factors. RESULTS: A total of 1,984 nurses participated. The median scores for KAP, management, and surveillance in preventing and controlling MDROs infections among study subjects were 44 (out of a total of 53, 83%), 60 (out of a total of 60, 100%), 210 (out of a total of 210, 100%), 53 (out of a total of 58, 91%), and 10 (out of a total of 10, 100%), respectively. Correlation analyses revealed significant positive associations between MDROs infections management and KAP dimensions. The generalized linear models and decision tree analysis showed MDROs infections management and hematology nurses' attitudes were strong predictors of their practices, especially the perceived importance of MDROs infections management (β = 1.13, P < .001), key process management (β = 1.17, P < .001), and staff training (β = 1.90, P < .001). CONCLUSIONS: This study highlights strong hospital MDROs management boosts nurses' KAP, enhancing MDROs infections control and prevention in hematology settings.
Gomes MS, de Britto-Costa LF, Levin AS
… +2 more, Ho YL, Centres for Antimicrobial Optimisation Network
Am J Infect Control
· 2026 Apr · PMID 41167479
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BACKGROUND: Survivors of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia endure complex hospitalizations; their perspectives remain underexplored. METHODS: We conducted a qualitative study at a tertiary ho...BACKGROUND: Survivors of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia endure complex hospitalizations; their perspectives remain underexplored. METHODS: We conducted a qualitative study at a tertiary hospital. Survivors (≥18 years) of CRAB bloodstream infection from 2019 to 2024, discharged ≥6 months, were invited to narrative video-call interviews. Interviews were analyzed using critical discourse analysis (CDA) to examine meanings around hospitalization, health care communication, and understanding of resistant bacteria. RESULTS: Nine participants were interviewed. Narratives revealed: (1) hospitalization process and aftermath---profound emotional distress, physical limitations, and long-lasting consequences, with comparisons of life "before" and "after"; (2) barriers in patient-professional communication---limited or absent explanations about procedures, invasive devices, or the infection itself, leading to feelings of alienation and lack of autonomy; and (3) understanding of antibiotic-resistant bacteria---none could define multi-drug resistance, several were unaware of their CRAB diagnosis. Even patients with high health literacy (eg, HIV, aspergillosis, or CMV) did not recall adequate information about antibiotic resistance, underscoring systemic communication gaps. DISCUSSION: Encouraging patient involvement in infection prevention (eg, reminding staff about hand-hygiene) is promising but underused. Participants sometimes feared adverse reactions when speaking up. CONCLUSION: Structured healthcare-associated infections (HAIs) education with patient participation in hand-hygiene reminders is a feasible, patient-centered approach that may improve understanding and shared safety. Implementation could use scripted bedside prompts and brief teach-back, supported by plain-language leaflets and bedside posters co-designed with patients.
Pellegrino R, Montagnani C, Timitilli E
… +4 more, Tondo A, Venturini E, Chiappini E, Galli L
Am J Infect Control
· 2026 Apr · PMID 41167478
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BACKGROUND: Managing central-line-associated bloodstream infections (CLABSI) in children with long-term central venous catheters (CVC) is challenging. Catheter salvage strategy (CSS) can be attempted when intravenous the...BACKGROUND: Managing central-line-associated bloodstream infections (CLABSI) in children with long-term central venous catheters (CVC) is challenging. Catheter salvage strategy (CSS) can be attempted when intravenous therapy is essential. METHODS: A retrospective cohort study at a tertiary-care paediatric hospital evaluated CLABSI management and compared outcomes between CSS and CVC removal, including all children with CLABSI from January 2021 to June 2024. CSS was defined as CVC retention for ≥ 72 hours after starting empiric antibiotic therapy. Outcomes assessed included fever and bacteraemia persistence at 72 hours, hospital stay, complications, recurrence within 60 days, and treatment failure. RESULTS: Among 111 CLABSI episodes (23 short-term, 88 long-term CVCs) early CVC removal was applied in 18.9%. CSS occurred in 88.6% of long-term CLABSIs. Early removal was associated with non-tunnelled CVCs, multi-lumen CVCs, and Candida spp. or Staphylococcus aureus CLABSI. CSS was associated with oncological patients and/or stem-cell transplant recipients. CSS achieved a 61.4% success rate without significant differences in treatment success between CSS and early CVC removal groups, nor across different pathogens. CONCLUSIONS: CSS was widely used with a success rate of 61.4% without differences across pathogens. Further studies are needed to define CSS's role in children according to the aetiology and patient characteristics.
Kovar L, Gould C, Marchand S
… +3 more, Vandygriff C, Hrabowski-Grier D, Hurst L
Am J Infect Control
· 2026 Feb · PMID 41167477
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BACKGROUND: Measles, a highly infectious virus, can cause outbreaks in low-vaccinated communities. In January 2025, a community-wide outbreak in the South Plains of Texas prompted a hospital serving pediatric and women's...BACKGROUND: Measles, a highly infectious virus, can cause outbreaks in low-vaccinated communities. In January 2025, a community-wide outbreak in the South Plains of Texas prompted a hospital serving pediatric and women's patients to rapidly develop and implement infection prevention protocols to treat measles patients while protecting patients, visitors, and staff within the hospital. This article explains infection prevention and control strategies utilized by the hospital during a community-wide measles outbreak and processes implemented to mitigate exposures. METHODS: A multidisciplinary team collaborated to educate staff on the Centers for Disease Control and Prevention (CDC) measles infection prevention guidance and ensured access to necessary resources for protection. The hospital temporarily converted rooms to negative pressure, constructed a screening shed for patients arriving at the emergency department, developed signage to direct measles patients, provided roving fit testing, and worked with public health officials. RESULTS: Ninety-eight patients presented to the hospital for measles. Fifty eight were confirmed via reverse transcription-polymerase chain reaction or IgM tests, and 9 were diagnosed clinically. There were 810 patients hospitalized simultaneously with the measles patients, and none returned or were reported as secondary cases linked to hospital exposure. CONCLUSIONS: The implemented interventions successfully prevented measles secondary cases associated with the hospital.
Koy V, Preechawong S, Ear D
… +4 more, Phal S, Sok S, Coffey M, Murray JC
Am J Infect Control
· 2026 Mar · PMID 41167476
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BACKGROUND: Effective sterilization of devices used for medical procedures is essential for reducing the risk of healthcare-associated infections. Limited data are available from lower-middle-income countries on the qual...BACKGROUND: Effective sterilization of devices used for medical procedures is essential for reducing the risk of healthcare-associated infections. Limited data are available from lower-middle-income countries on the quality of sterilization processing practices or strategies for improving quality. This study developed an approach to collecting and using data on sterilization processing practices as part of the first phase of improving sterilization quality in Cambodia. METHODS: Five early implementation national, provincial, and district hospitals were selected. Evidence-based data collection tools and methods that assessed the proportion of sterilization practice standards met were adapted for local use. Multistakeholder hospital teams assessed environments and practices in sterilization processing areas, calculated indicators, interpreted data, identified gaps and barriers, and developed action plans. Team-based problem-solving was used to guide bottom-up engagement, communication, and staff motivation to implement change. RESULTS: Across 5 hospitals, practice gaps were identified for instrument washing (0/24 [0%] cold water pre-rinse, 18/64 [28%] manual washing, 7/32 [22%] manual rinsing, and 0/24 [0%] drying standards met); inspection and packing (11/39 [28%] inspection and function testing, 21/71 [30%] packing, 21/30 [70%] wrapping, and 7/35 [20%] labeling standards met); sterilization (10/59 [17%] sterilizer loading, 10/28 [36%] sterilizer unloading, and 7/63 [11%] recording standards met); and sterile storage (71/130 [55%] sterile storage and 21/62 [34%] sterile-stock management standards met). Environments had limited one-way workflow, separation from patient care, and availability of handwashing resources. Hospital teams used data to develop short-term action plans to improve sterilization practice quality using local experience and resources. CONCLUSIONS: New evidence-based tools and indicators proved practical and effective for assessing sterilization processing practices in hospitals. Collection and use of local data enabled multistakeholder hospital teams to prioritize problems and work on solutions to problems tailored to the local context. This approach has potential applicability to other hospitals in Cambodia and elsewhere as the foundation of an approach to improve the quality of sterilization practices.
Cai B, Lu F, Yang Y
… +8 more, Li T, Li D, Lu H, Qin J, Chen M, Li M, Zhang M, Ban H
Am J Infect Control
· 2026 Apr · PMID 41151730
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BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is one of the important opportunistic pathogens causing nosocomial infections. This study aims to investigate a suspected outbreak of CRPA in a kidney transp...BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is one of the important opportunistic pathogens causing nosocomial infections. This study aims to investigate a suspected outbreak of CRPA in a kidney transplant ward. METHODS: Clinical data of 6 kidney transplant recipients with positive CRPA tests from September 5th to 30th, 2023, were collected, and environmental sampling. A retrospective investigation was conducted on CRPA infections and positive drainage fluid cases in the ward from 2019 to 2023. Whole genome sequencing (WGS) of CRPA isolates was conducted to identify potential transmission routes. Emergency intervention measures were implemented. FINDINGS: CRPA was detected in the drainage fluid or urine of 6 patients after renal transplantation, with the infection sites being the surgical site. The positive rate of CRPA in renal transplant drainage fluids in 2023 (5.07%) was significantly higher than that of 2019 to 2022 (0.36%) (P < .001). The multi-locus sequence typing showed complete consistency in the allele scores of 7 housekeeping genes among 11 CRPA isolates, which also exhibited 100% similarity of resistance genes and 93.91% similarity of virulence genes. Pairwise comparisons of single nucleotide polymorphisms indicated that the differences between H2-H6 and H1 were no more than 5 single nucleotide polymorphisms. CONCLUSIONS: A cluster of CRPA was found among kidney transplant recipients, attributed to contamination of drainage fluid due to the failure to adhere to protocols during the collection of drainage fluid. These findings highlight the necessity for enhanced postoperative drainage catheter management.
Am J Infect Control
· 2026 Jan · PMID 41115471
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This study provides the first national-level data on measuring defects in sterile processing departments (SPDs). Over 90% of SPDs reported at least one defect in a single week, with higher defects in facilities that repo...This study provides the first national-level data on measuring defects in sterile processing departments (SPDs). Over 90% of SPDs reported at least one defect in a single week, with higher defects in facilities that reported inconsistent usage of quality checklists or tracking systems and lacked staff certification requirements. These findings highlight the need for systemic interventions, such as workflow standardization, integrated tracking, and uniform staff certification requirements to improve SPD performance and patient safety.