BACKGROUND:Pseudomonas aeruginosa is a major cause of healthcare-associated bloodstream infections, and its resistance patterns can vary by hospital setting, care unit, and time. This study compared resistance patterns of P. aeruginosa isolates recovered from blood cultures at two tertiary university hospitals in Türkiye and Hungary. METHODS:This retrospective, multicenter and cross-sectional surveillance study included the first eligible bloodstream P. aeruginosa isolates obtained from patients admitted to intensive care units (ICUs) and non-ICU wards between 2020 and 2023. Class-based resistance patterns to carbapenems, cephalosporins, and fluoroquinolones, as well as multidrug resistance (MDR), were evaluated using predefined criteria. Annual trends and center-by-year interactions were analyzed using log-binomial regression, while independent associations and exploratory period differences were assessed using logistic regression. RESULTS:A total of 703 patients were included (Turkish center = 180, Hungarian center = 523). Multivariate analyses identified independent associations of ward type with four resistance outcomes, center with cephalosporin resistance; year with fluoroquinolone resistance and MDR; and gender with fluoroquinolone resistance. Cephalosporin, fluoroquinolone, and MDR resistance declined significantly over time, whereas the decrease in carbapenem resistance was borderline at the Hungarian center. No significant annual trends were observed at the Turkish center, and the center-by-year interactions were nonsignificant. Exploratory analyses showed lower resistance in 2022-2023 than in 2020-2021 in Hungary but not in Türkiye. CONCLUSION:Resistance patterns in bloodstream P. aeruginosa isolates varied by center, care setting and time. ICU-focused surveillance and locally tailored stewardship strategies may support the management of these infections.
INTRODUCTION:Life expectancy has risen significantly in people with cystic fibrosis (PwCF) with the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators. This has resulted in new infection challenges for PwCF, including the increasing employment of dentures, which have been shown to harbour CF-related bacterial pathogens. HYPOTHESIS/GAP STATEMENT:To date, there is no evidence-based infection prevention and control (IPC) guidance, specific to the CF community, on how to optimally clean and disinfect dentures in PwCF, including the efficacy of denture cleaning formulations against CF pathogens. AIM:To examine the in vitro bactericidal activity of two leading brands of denture cleaning formulations against planktonic suspensions of CF-related bacterial pathogens. METHODOLOGY:CF and bronchiectasis-related bacterial pathogens were employed in this study, including Pseudomonas aeruginosa, methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Burkholderia multivorans, Burkholderia cenocepacia and Stenotrophomonas maltophilia. Planktonic suspensions of each organism was exposed to denture cleaning fluid for 20 min and recovery of surviving cells attempted through direct plating and enhanced enrichment methods. RESULTS:Pseudomonas aeruginosa was able to survive for the suggested manufacturers' exposure time (3 min). All bacteria were unable to be recovered following 20 min exposure to each of the denture cleaning formulations, as well as following enrichment in nutrient broth at both 24 h and 48 h, indicating that both formulations were completely bactericidal to all organisms tested, after exposure for 20 min. CONCLUSION:This study indicates that the five clinically important species of CF bacterial pathogens tested were not able to remain culturable for 20 min in planktonic form, in commonly used retainer/denture-cleaning formulations widely available on the UK High Street. Survival of Pseudomonas aeruginosa was possible if exposed for the 3 min, as indicated with the instructions of these products. Employment of successful evidence-based cleaning and disinfection regimens of retainers/dentures in people with CF will help break the chain of transmission of CF pathogens, which is especially important during eradication treatments for first isolates, thereby avoiding re-infection. Clinically, the findings of this study are important to the small number of younger individuals with CF who wear dentures, and to CF adolescents and young people with CF who wear retainers, as well as providing data for an emerging aging CF population, where dentures will become more common. Further work is however required to establish the most effective retainer/denture cleaning regimen, as well as to examine the more complex survival dynamics of these organisms on naturally derived retainer/denture biofilm, associated with dental plaque.
BACKGROUND:NTM soft tissue infection outbreaks in Venezuela (2006) exposed failures of locally marketed high-level disinfectants (HLDs), with only international products meeting standards. After renewed NTM outbreaks in 2024, we re-evaluated locally manufactured products claiming HLD, sterilant, or sporicidal activity. METHODS:We collected 14 locally marketed disinfectants: 11 labeled HLD and three labeled intermediate-level. Active ingredients included QACs, glutaraldehyde, organic acids, alcohols, and a strong base. Efficacy was tested using EN 14348 (mycobactericidal) and EN 17126 (sporicidal) under clean and dirty conditions. HLD required ≥4-log10 spore reduction; intermediate-level required 4-log10 mycobacteria reduction. FINDINGS:Only one glutaraldehyde-based product met HLD criteria. Three correctly labeled intermediate-level disinfectants showed mycobactericidal activity under both conditions. One HLD-labeled product demonstrated only mycobactericidal activity, warranting reclassification as intermediate-level. All other products failed, especially under organic load, and should be classified as low-level disinfectants. CONCLUSIONS:Despite label claims, most locally marketed disinfectants failed efficacy standards, revealing a critical regulatory gap. For hospital disinfection, we recommend product selection rely on independently verified efficacy data, not manufacturer claims. Similar deficiencies likely exist elsewhere, underscoring the need for systematic regional testing to ensure effective infection control.
OBJECTIVE:Masks can be used to reduce the transmission of respiratory viruses via airborne and respiratory droplets. The objective was to evaluate the overall performance of masks and mask materials considering different use scenarios simulating real use conditions. METHODS:The filtration capability of 15 types of masks and filter materials useable as insert in masks were tested at two different face velocities (10 and 25 cm/s). Four of these masks were tested at two additional face velocities (17.5 and 32.5 cm/s). Seven of these masks were exposed to aerated simulated exhaled breath condensate (EBC) for 1-24 h and their filtration efficiency was tested immediately following exposure. RESULTS:The filtration efficiency of non-woven masks decreased by 1-17% as the face velocity of the challenge aerosol stream increased. On the other hand, an increase in the face velocity did not reduce the filtration efficiency of woven and knitted materials and of two of the commercial cotton masks. For the cloth masks, the filtration efficiency decreased by up to 20% after EBC exposure. There was no correlation between the EBC exposure and the pressure drop. CONCLUSION:The face velocity range specified for ASTM testing is too large and should be revised as the filtration efficiency can vary considerably within that range. Cloth masks should be worn with a filter and the filter be removed after a maximum of 8 h to prevent a decrease in filtration efficiency due to breath condensate accumulation.
BACKGROUND:The Clinical Excellence Commission (CEC) implemented workshops to strengthen health worker capability in donning and doffing personal protective equipment (PPE) for high-consequence infectious diseases (HCIDs). This evaluation aimed to assess participants' self-reported competence and confidence in performing HCID PPE procedures following training. METHODS:A quantitative post-training survey was administered following 52 workshops delivered across New South Wales between 2024 and 2025. The training used a blended learning approach, combining preparatory e-learning modules with structured face-to-face practical sessions. A total of 216 health workers completed the survey, which collected demographic data, training experience, and self-reported competence and confidence in performing donning, doffing, and PPE buddy procedures. RESULTS:Respondents represented a wide range of clinical roles, including strong participation from rural and regional facilities. Most participants had completed the preparatory e-learning and video modules, which were rated as highly useful. Participants reported high levels of confidence in performing HCID PPE procedures. The majority (89.2%) indicated a perceived need for ongoing refresher training, most commonly preferring annual or biennial updates. Participants also reported high perceived value of face-to-face training for supporting skill development and real-world readiness. CONCLUSION:The blended HCID PPE workshop model was well received and supported participants' self-reported competence and confidence in performing key PPE procedures. Future studies should incorporate pre- and post-training assessments, objective measures of performance, and evaluation of any cascade training implemented by individual healthcare facilities.
BACKGROUND:Environmental cleaning and disinfection are central components of infection prevention and control in hospital settings. Disinfectants are chemical agents designed to kill or inactivate microorganisms, including bacteria, viruses, fungi, and spores. The term 'residual activity' has increasingly been associated with disinfectants in recent years, describing a product's ability to have a materially sustained antimicrobial effectiveness over time. METHODS:A desktop review of current Australian policies, standards, and guidelines was completed to catalogue references and recommendations pertaining to the use of disinfectants with residual activity claims for the purpose of environmental cleaning and disinfection in hospital settings. RESULTS:The review revealed a paucity of regulatory guidance and recommendation at both national and jurisdictional levels in Australia with respect to the use of disinfectants with residual activity claims. CONCLUSION:Despite the growing prevalence of such claims, there is no contemporary infection prevention and control guidance in Australia relevant to disinfectants and claims of residual activity. There is no current regulatory guidance supporting the use of disinfectants with residual activity in substitute of established cleaning and disinfection practices in hospital and health service settings. Further implications for infection prevention and control practice are discussed.
BACKGROUND:Australia is recognised as a leading contributor to infection prevention and control (IPC) randomised controlled trials. However, the broader landscape of Australian IPC research has not been comprehensively mapped. This bibliometric review examined research trends, thematic focus areas, and methodological approaches in Australian IPC research over the past two decades. METHODS:A systematic search of Scopus identified IPC-related documents from January 2003 to September 2025. Eligible documents reported original IPC research involving an Australian population and included at least one author with an Australian institutional affiliation. Reviews required an Australian author. Following screening in Covidence, metadata from included documents were analysed using the web application Biblioshiny® to assess publication trends, citation patterns, authorship networks, and international collaboration. Manual thematic coding was undertaken, and reporting followed the BIBLIO checklist. RESULTS:A total of 841 documents from 241 sources were included in the analysis. Publication output increased notably from 2013 onward, with further growth during 2020-2021 and again in 2025. Surveillance was the most common research theme (18.2% [153/841]). Observational designs dominated the literature (44.9% [378/841]), while randomised controlled trials accounted for just 1.2% (10/841) of documents. There was extensive international collaboration, involving authors from 81 countries. CONCLUSION:Australian IPC research output has expanded considerably but remains concentrated within a limited number of themes and is dominated by single-centre observational studies. These findings highlight opportunities to diversify methodologies, strengthen evidence quality, and better align future research with IPC practice and policy priorities.
BACKGROUND:Hospital-acquired complications (HACs) have recently been introduced in Australia as a quality-of-care metric. These use International Classification of Diseases (ICD) codes to identify potentially avoidable complications, including healthcare-associated infections. We sought to determine the positive predictive value (PPV) of the HAC algorithms in detecting hospital-acquired pneumonia (HAP) and healthcare-associated urinary tract infections (HA-UTI) using traditional surveillance as the standardised comparator. METHODS:We conducted a retrospective analysis at Alfred Health. For both HAP and UTI, we selected 50 admitted episodes with ICD codes that satisfied the HAC definition. We applied standardised surveillance definitions to these episodes, based on European Centre for Disease Prevention and Control (ECDC) guidance. This involved a manual review of documentation and results by an Infection Prevention and Control Nurse Consultant. PPVs were calculated by comparing ICD-code diagnoses with surveillance-confirmed infections. RESULTS:The PPV for the HAP algorithm was 20% (95% CI: 11.0-33.2%). Among non-confirmed cases, 23% (9/40) had no radiological evidence of pneumonia, and 23% (9/40) had symptoms or consolidation on admission. Of the ten true HAP cases, 50% (5/10) were ventilator-associated. The PPV for the HA-UTI algorithm was 58% (95% CI: 44.2-70.6%), with 71% (15/21) of false positives due to asymptomatic bacteriuria. CONCLUSIONS:We found that current HAC algorithms based on ICD coding data did not reliably predict HAP and HA-UTI as defined by standardised surveillance. Given their use in healthcare funding, further validation and improvement of current algorithms should be explored.
BACKGROUND:Data on absenteeism of healthcare personnel (HCP) in post-COVID-19 pandemic seasons are scarce. We studied the morbidity and absenteeism associated with influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and respiratory syncytial virus (RSV) infection among HCP in Greece during 2024-2025. METHODS:We followed 4421 hospital-based HCP from November 11, 2024, to May 25, 2025. The main outcomes of interest were incidence of absenteeism and length of absence. A multivariable regression model was used to assess association between length and reason for absenteeism, vaccination status, and HCP characteristics. RESULTS:A total of 645 absenteeism episodes occurred (14.6 episodes per 100 HCP). The mean duration of absence was 3.4 days, totaling 2190 days during the study period. COVID-19, influenza, RSV infection, and asymptomatic SARS-CoV-2 infection were diagnosed in 31.9%, 14.4%, 0.9%, and 0.3% of absenteeism episodes, respectively. Overall, SARS-CoV-2 infection (COVID-19 or asymptomatic infection), influenza, and RSV infection accounted for 36.1%, 18.0%, and 1.1% of total workdays missed, respectively. The multivariable regression model indicated that COVID-19 diagnosis was associated with 1.37 [95% confidence interval (CI): 1.14-1.60] more days of absence compared to HCP with absenteeism due to other reasons, while influenza vaccination was associated with 0.81 (95% CI: 0.31-1.31) fewer days of absence compared to no vaccination. The influenza vaccine effectiveness against influenza-associated absenteeism was 55.4% CONCLUSION: COVID-19 and seasonal influenza remain the prevalent causes of absenteeism in HCP during 2024-2025. HCP who had received the influenza vaccine had less absenteeism than unvaccinated HCP.
BACKGROUND:Healthcare-associated infections (HAI) remain a major challenge in neonatal intensive care units (NICU), particularly in resource-limited settings. The combination of high neonatal vulnerability and the rise of multidrug-resistant organisms substantially increases morbidity, mortality, and healthcare costs. AIM:This study aimed to describe the epidemiological, clinical, and bacteriological characteristics of HAI in a neonatal intensive care unit of a developing country, to assess associated morbidity and mortality. METHODS:A retrospective analytical study was conducted over three years (November 2020-November 2023) in the Neonatology Department of Hédi Chaker University Hospital, a level III referral center in Tunisia. All neonates hospitalized for ≥48 h with clinically or biologically suspected HAIs confirmed by positive blood culture were included. RESULTS:Among 4382 hospitalized neonates, 82 cases of HAI were identified. Preterm (85.4%) and low-birth-weight (82.9%) infants were the most affected. The main clinical signs were altered skin color (68.3%) and hemodynamic instability (65.8%). Gram-negative bacilli accounted for 93.9% of all isolates, with Klebsiella pneumoniae being the predominant pathogen (57 cases, 69.5%), showing multidrug resistance in 91.2% of isolates. Empirical therapy most often combined imipenem and amikacin (46.3%). The overall mortality rate was 58.5%, significantly associated with hemodynamic instability and birth weight <1400 g. CONCLUSION:HAI remains a serious issue in resource-limited settings, driven by high antimicrobial resistance and specific vulnerability factors. Strengthening infection prevention protocols and multidisciplinary surveillance is crucial to reduce morbidity and mortality.
BACKGROUND:Catheter-associated urinary tract infections (CAUTIs) are a significant cause of morbidity and healthcare costs in acute care settings. CAUTI surveillance is essential for identifying infection trends and implementing targeted prevention strategies. We performed hospital wide CAUTI surveillance to establish baseline CAUTI rates. METHODS:Data for all patients at the City Campus of Royal Melbourne Hospital with a positive urine culture between July 2024 and June 2025 were reviewed prospectively. CAUTI cases were identified according to standardised surveillance definitions, with remaining records classified as either healthcare associated UTI, community associated, indwelling catheter in situ and asymptomatic, or no indwelling catheter and asymptomatic. RESULTS:During the 12-month period, a total of 1334 urine culture positive results were reviewed for 1042 patients. Community associated urinary tract infections were most common, followed by healthcare associated urinary tract infections, comprising 51% and 10% of positive urine cultures reviewed, respectively. Only 8% were identified as CAUTI. The overall CAUTI rate was 3.1 (95% CI: 2.6-3.8) per 1000 catheter-days and the Intensive Care Unit specific rate was 5.4 (95% CI: 3.3-8.2) per 1000 catheter-days. CONCLUSIONS:The baseline surveillance data revealed that CAUTIs accounted for a small proportion of all positive urine cultures within our hospital. Hospital wide CAUTI surveillance presents significant logistical and resource challenges. Continued surveillance and more in-depth analysis are required to determine the most efficient and impactful allocation of surveillance resources.
BACKGROUND:Antimicrobial resistance (AMR) in Neonatal Intensive Care Units (NICUs) is a growing public health concern, particularly due to ESKAPE pathogens, which are major causes of severe healthcare-associated infections. METHODS:This retrospective cohort study analyzed the incidence, resistance patterns, and risk factors of invasive ESKAPE infections in a Brazilian NICU from 2015 to 2024, using National Healthcare Safety Network surveillance data. RESULTS:Among 2035 admitted neonates, 6.7% developed invasive ESKAPE infections, with incidence increasing from 3.5% in 2015 to 9.2% in 2024. A total of 173 infection episodes were identified, predominantly bloodstream (59.5%) and urinary tract infections (34.7%). Klebsiella pneumoniae (52%) was the most frequent pathogen, followed by Staphylococcus aureus (26.6%) and Enterobacter cloacae (16.8%). As the study included only ESKAPE isolates exhibiting resistance to at least one antimicrobial agent, all isolates had an AMR phenotype; among them, 54.9% classified as multidrug-resistant (MDR) and 3.5% as extensively drug-resistant (XDR). ESBL production was detected in 28.3% of isolates. Prior exposure to broad-spectrum antimicrobials-especially carbapenems (OR = 25.71), glycopeptides (OR = 8.69), and fourth-generation cephalosporins (OR = 8.23)-was significantly associated with infection. Infections prolonged hospital stay and were associated with a 23.5% case-fatality rate, which was more than twice the mortality rate observed among neonates without invasive healthcare-associated infections. Mortality was particularly high in Acinetobacter baumannii infections. CONCLUSIONS:These findings underscore the urgent need for strengthened surveillance, infection prevention, and antimicrobial stewardship strategies in NICUs.
BACKGROUND:To describe the epidemiology and spatiotemporal distribution of enterovirus-related central nervous system (CNS) infections in Queensland over 23 years, focusing on age-specific burden, cerebrospinal fluid (CSF) profiles, and area incidence. METHODS:Retrospective, state-wide observational study using laboratory-confirmed cases from public hospitals and laboratory/pathology services throughout Queensland, Australia, from 1 January 2000 to 31 December 2022. RESULTS:After removing duplicate person identifiers and records with missing essential data, 3390 unique patients were included, where 57.3% were male. The median age was 2.97 years (IQR 0.1-25.8). Newborns (<28 days) and infants and young children (one month to 4 years old) accounted for 20.2% and 32.5% of cases, respectively. The average annual incidence rate was 3.5 per 100,000 inhabitants per year. CSF analyses showed mononuclear-predominant pleocytosis (median white blood cell count, 83 cells/μL, IQR 13.7-300), elevated protein (median, 580 mg/L, IQR 410-800), and preserved glucose (median, 3.0 mmol/L, IQR 2.7-3.4). The one-year case fatality rate was low (five deaths; 1.4 per 1000 cases). 3278 with valid Queensland postcodes contributed to spatial analyses. Spatial analysis revealed widespread geographic distribution, especially in coastal areas. The time series showed an increasing trend during the study period, particularly among newborns. CONCLUSIONS:In the last 2 decades, enterovirus-related CNS infections in Queensland have mainly affected newborns and young infants, with high one-year survival. The burden is widespread, with occasional high-incidence clusters in sparsely populated coastal areas, highlighting the importance of ongoing neurologic diagnostic capacity and locally responsive surveillance.
Background Catheter associated bloodstream infections (CLABSI) are the most frequently reported healthcare-associated infections in pediatric intensive care units (PICUs). Largely preventable, CLABSI have prompted the global implementation of care bundles aimed at reducing infection rates, healthcare costs, length of stay, and mortality. Objective - To evaluate and compare the effectiveness of various care bundles in reducing CLABSI rates per 1000 catheter-days in PICUs. Methods A systematic review of 23 original studies identified through PubMed, Embase, SciELO, BVS, and Scopus databases, selected in accordance with PRISMA guidelines. For each study, CLABSI rates before and after bundle implementation were extracted, and percentage reductions were calculated. Results Baseline CLABSI rates ranged from 2.0 to 25.2 per 1000 catheter-days. Intervention durations varied from 3 months to 9 years. Post-intervention rates ranged from 0.7 to 14.3 per 1000 catheter-days. No study achieved a zero CLABSI rate although positively, over half of the studies reported a reduction superior to 50%. Methodological weaknesses significantly limited the reliability of effect estimates. Conclusion Care bundles are associated with meaningful reductions in CLABSI rates in PICUs. Although most studies lack rigorous design, the consistent improvements observed support their effectiveness. Randomized controlled trials would be needed to determine the effect size of individual bundle components.
BACKGROUND:Hepatitis B virus (HBV) infections are a critical public health issue, especially in lower resource setting where the potential for chronic infections is increased. In Nepal an HBV vaccination program has been in place since the early 2000s, though knowledge and awareness of HBV has been recorded as being low within community settings. This study explored inequalities which may influence the overall healthcare system within Nepal regarding HBV, specifically vaccination programs, knowledge, awareness, and stigma associated with HBV. METHODS:In-depth interviews (n = 21) were conducted with healthcare professionals from different healthcare districts in Nepal. These interviews were then transcribed before thematic analysis was performed. RESULTS:Several potential sources of inequality of service provision were identified. Awareness of HBV was reasonable among the participants; however, level of knowledge was variable. Participants felt while the vaccination program had been somewhat successful, there were still several areas in the Nepalese health system which needed to be strengthened to further mitigate risk of HBV infections. This included the need to strengthen and standardise vaccination processes within Nepal. CONCLUSION:Based on our findings, efforts to provide appropriate resources and equipment to community health centres needed to be reinforced. An increase is also needed in education and awareness programs around health issues, specifically those involving infectious diseases such as Hepatitis B at the community level. There also should be continued commitment to enhancing the healthcare services provided in rural and other underserved areas of Nepal.
BACKGROUND:Healthcare-associated infections remain a major global challenge, and hand hygiene is a key measure to prevent transmission. Healthcare worker compliance remains variable across settings, and evidence of knowledge, attitudes, and practices across the Western Pacific Region has not been comprehensively synthesised. METHODS:A scoping review was conducted using the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR. Primary studies of any design examining healthcare workers' hand hygiene knowledge, attitudes, and/or practices in the Western Pacific Region were included. Data were extracted and synthesised descriptively, and determinants influencing practice were mapped to the Theoretical Domains Framework to identify determinants of hand hygiene behaviour. Study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS:Ninety-eight studies met the inclusion criteria; most were conducted in high-income countries, and none were from Pacific Island Countries and Territories. Quantitative descriptive designs predominated (n = 55), followed by quantitative non-randomised studies (n = 26); mixed-methods (n = 8), qualitative (n = 7), and randomised controlled trials (n = 2) were uncommon. HCWs generally reported high knowledge and positive attitudes in self-report surveys, but these were not consistently reflected in observed practice. Compliance was commonly higher after patient contact than before contact, and adherence to all WHO "5 Moments" was uncommon. Key barriers included workload pressures, limited resources, organisational culture, and training gaps, particularly in lower-resourced settings. TDF mapping emphasised the influence of social influences, environmental context and resources, and reinforcement beyond knowledge alone. CONCLUSION:Hand hygiene in the Western Pacific Region is shaped by behavioural and contextual determinants, with important evidence gaps in lower-resourced and Pacific settings.
BACKGROUND:Antibiotic-resistant infections are known to pose a significant challenge to cancer patients, with increased morbidity, mortality and financial burden; however, less is known about their potential impact on health-related quality of life (HRQoL) in this population. This study aimed to assess HRQoL, its predictors, and quality-adjusted life years (QALYs) in cancer patients with antimicrobial-resistant infections (ARG) compared to those with antimicrobial-sensitive infections (ASG) and no infection. METHODS:A prospective cohort observational study was conducted among (N = 657) hospitalized adult cancer patients categorized into three groups: no infection (n = 150), ASG (n = 159), and ARG (n = 348), for 18 months. HRQoL was assessed using the EQ-5D-5L tool. RESULTS:Patients with ARG reported lower HRQoL, with a mean utility score of 0.391 and EQ-VAS score of 41.79, compared to ASG (0.468; 49.31) and no infection (0.533; 55.39) (P < 0.001). However, multidrug-resistant (MDR) and extensively drug-resistant (XDR) groups demonstrated significantly lower HRQoL scores (utility: 0.417 & 0.372; EQ-VAS: 44.3 & 40.02) than ASG. QALYs declined progressively (no infection: 0.046, sensitive: 0.036, resistant: 0.025; p < 0.001). MDR & XDR infections were associated with the lowest QALYs (0.028 & 0.022). Predictors identified that contributed to poorer HRQoL included age >60 years (β = -0.102), Length of stay (β = -0.019), Rural residence (β = -0.006), Stage IV of cancer (β = -0.014), Bloodstream infection (β = -0.038), and Urinary tract infections (β = -0.052), Use of Invasive devices (β = -0.055), Pneumonia (β = -0.137) and Sepsis (β = -0.274). CONCLUSION:Antimicrobial-resistant infections significantly impact HRQoL and QALYs in cancer patients compared with those with antimicrobial-sensitive infections and those without infections.
Background/Purpose A surge in group A Streptococcus disease (GAS) has been observed globally since late 2022, but little is known about potential changes in infection site and outcome. We aim to describe changes in infection sites and outcomes of all severe non-superficial GAS infections confirmed in our laboratory between 2018 - 2023, including the surge period of 2022-2023. Methods We conducted a retrospective cohort study in a 2,500-bed hospital network from 2018-2023. We included all cases of severe non-superficial GAS infection. This included invasive GAS according to local surveillance definitions, and cases of GAS from non-sterile sites with radiological or surgical evidence of deep-tissue infection. We compared infection sites and outcomes during the GAS surge period (October 2022- September 2023) to the pre-surge period (October 2018 - September 2022). Results 493 episodes of non-superficial severe GAS infection were included. Of these, 267/493 (54%) occurred during the 2022-2023 surge period. Non-superficial, severe GAS infections during the surge period were more likely to occur in paediatric patients (47% vs 26%, p <0.01), affect multiple body sites (25% vs 18%, p = 0.04) and involve the otolaryngeal system (27% vs 13%, p < 0.01); and were less likely to be single-site skin and soft tissue infections (49% vs 64%, p < 0.01). Rates of overall operative management (71%), intensive care admission (18%), and mortality (2%) were stable over the study period. Conclusion The surge in GAS cases in Australia has been associated with changing infection sites but similar outcomes. GAS infections are associated with high morbidity and healthcare burden.
Background Surgical site infections (SSI) is a leading cause of healthcare-associated morbidity and cost globally. However, contemporary data on SSI incidence and economic burden in Malaysia are scarce. This study aimed to estimate the incidence and healthcare costs associated with SSI following caesarean section (C-section) in a Malaysian public hospital. Methods A retrospective cohort study was conducted at a tertiary mother and children public hospital in Malaysia, involving patients aged 18 and above who underwent C-section from January 2019 to May 2024. Patients were followed for 30 days postoperatively. Clinical and cost data were obtained from medical records, hospital databases, government gazettes and published literatures. Total direct costs were calculated by matching patient-level resource use with unit cost data. Results Among 19,736 C-section, 295 SSI were identified, resulting in an incidence of 1.49 per 100 C-sections. Most infections were superficial and observed in emergency C-section. Obesity (49.5%) and diabetes (39.0%) were the commonly observed risk factors. The mean postoperative length of stay was 4.33 days. SSI-related costs totalled RM 714,776 [Ringgit Malaysia (RM) 1 = United States Dollar (USD) 0.23], with procedures and facility-based care being major cost drivers. The mean hospitalization cost per patient was RM 4,178. Conclusion Although the incidence was lower than global estimates, the rising trend and associated healthcare burden highlight the need for enhanced infection prevention strategies such as optimising surgical techniques, strengthening SSI surveillance and implementing evidence-based care bundles. Investing in targeted preventive interventions is essential to improving maternal outcomes and reducing the economic strain on Malaysia's public healthcare system.
Objective: This study aimed to assess the current IPC practices at private-sector drug retail outlets in Southern Punjab, Pakistan, and to explore the facilitators and barriers to effective IPC implementation in these settings. Methods: A cross-sectional survey was conducted from July to October 2025, where data were collected from the pharmacists and pharmacy assistants working at private-sector drug retail outlets located in Southern Punjab, Pakistan. A structured questionnaire was designed following IPC guidelines from the World Health Organization, Centers for Disease Control and Prevention, and United States and National Institutes of Health, Pakistan. Multiple linear regression analysis was used to find the independent factors associated with IPC practices. p-value of <0.05 was considered statistically significant. Results: Out of total 187 drug retail outlets, 134 (71.7%) participated in the study. The majority of outlets exhibited suboptimal IPC practices (n = 112; 83.6%) and insufficient essential IPC resources (n = 71; 53.0%). Primary barriers associated with suboptimal IPC measures included staff non-compliance (n = 120; 89.6%), lack of formal monitoring mechanisms (n = 119; 88.8%), absence of IPC training opportunities (n = 118; 88.1%) and insufficient supervision (n = 117; 87.3%). Multiple linear regression analysis identified male gender (beta = -0.249, p = 0.005) and availability of IPC resources (beta = 0.217, p = 0.004) as significant factors associated with IPC practices. Conclusion: Suboptimal IPC practices were observed at drug retail outlets due to staff commitment and regulatory deficits. Context-specific IPC policies were needed to explicitly address these gaps.
