BACKGROUND:Hand hygiene (HH) is central to infection prevention, but evidence from oncology hospitals - where patients are immunosuppressed and strict adherence is critical - remains limited. We aimed to describe the implementation and development of a HH group and its associated activities in an oncology hospital, as well as to evaluate their impact on HH compliance, alcohol-based hand rub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. METHODS:This analysis examined long-term trends in HH performance in a tertiary oncology hospital in Brazil (2010-2024), using adherence, ABHR consumption, and HHSAF scores to assess the impact of a multi-modal programme. Trend analyses of HH adherence, ABHR consumption, and HHSAF scores over time were performed using linear regression. RESULTS:After the HH group was established in 2013, the programme rapidly progressed to the advanced HHSAF level, accompanied by a significant upward trend in HH adherence (P < 0.01), increasing from a baseline of 26%-88% in 2022. In contrast, no significant trend was observed for ABHR consumption (P = 0.29), although levels remained consistently above the World Health Organization (WHO)-recommended threshold. System change was the strongest multi-modal component, whereas institutional safety climate remained the weakest. CONCLUSION:Unlike most published studies focused on short-term campaigns or isolated interventions, our work evaluated the real-world sustainability of a WHO-based multi-modal programme implemented in routine hospital practice. Sustained improvement was driven by a permanent, structured, multi-disciplinary HH group, resulting in long-term advanced HHSAF performance with increasing trends in HH compliance.

Introduction/Objectives: Primary bloodstream infections associated with central venous catheter (CLABSI) represent an important challenge in intensive care units (ICUs), especially in oncology patients due to immunosuppression. Early identification of factors related to the increase in these infections is essential for prevention and control. The Affinity Diagram is a tool that organizes ideas by similarity, promotes collective reasoning, and facilitates identification of causes and action planning. This study aimed to describe the identification, based on the nursing team’s perceptions, of factors associated with the increase in CLABSI in an oncology ICU, using the Affinity Diagram to support preventive interventions. Methods: A qualitative, descriptive, exploratory study conducted by the infection control nursing team and the oncology ICU nursing team, with participation of about 40 professionals (nurses and technicians), distributed across two shifts. After presentation of data showing increased CLABSI and an explanation of the pathophysiology, participants answered—via post-its—the question: “Which factors may be contributing to the increase in CLABSI?” Responses were grouped into categories by similarity on a flip chart, followed by group discussion to identify critical points related to infection prevention. Results: Analysis of the 51 contributions revealed six main categories: hand hygiene (33.3%)—low adherence and lack of supplies; connector disinfection (17.6%); dressing (15.7%)—failures in changing, maintenance, and protection; CVC insertion (15.7%)—breaks in sterile technique and management of the first dressing; workload overload (9.8%)—high work demand; medication preparation (7.8%)—inadequate disinfection of ampoules and use of dirty trays. Based on the nonconformities identified, a workshop on Healthcare-Associated Infections (HAIs) was conducted with a focus directed toward CLABSI prevention. Conclusion: The Affinity Diagram proved to be a useful tool to stimulate collective critical thinking, identify factors related to the increase in CLABSI, and support targeted educational actions. Active listening and team involvement were fundamental to align perceptions, strengthen good practices, and improve infection prevention in the oncology ICU.

Uterus transplantation (UTx) is an emerging therapeutic option for women with absolute uterine factor infertility, requiring intensive immunosuppression that increases susceptibility to opportunistic infections such as cytomegalovirus (CMV). Evidence guiding CMV management in UTx remains limited. The authors report a case of CMV reactivation in a 34-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome who underwent successful living-donor UTx. The patient received induction with methylprednisolone and basiliximab, followed by maintenance immunosuppression with tacrolimus, azathioprine, and prednisone. Antiviral prophylaxis with ganciclovir/valganciclovir was administered for three months. After prophylaxis discontinuation, routine surveillance detected CMV DNAemia approximately five months post-transplant, leading to treatment with valganciclovir and temporary postponement of embryo transfer. Following viral clearance, embryo transfer was successfully performed. During early pregnancy, low-level CMV DNAemia recurred. Given concerns about antiviral teratogenicity, management focused on the reduction of immunosuppression, including tacrolimus dose adjustment and discontinuation of azathioprine, with close monitoring via cervical biopsies. CMV DNAemia resolved spontaneously without antiviral therapy, and no rejection episodes or CMV disease occurred. This case highlights the complex balance between infection control and graft preservation in UTx recipients, particularly during pregnancy. It suggests that individualized reduction of immunosuppression may be a safe and effective strategy for managing CMV reactivation when antiviral therapy is contraindicated. Additionally, it supports the concept that the uterine graft may exhibit relatively low immunogenicity. Further studies are needed to define optimal immunosuppressive thresholds and standardized CMV management protocols in this unique transplant population.

Introduction/Objective: Vancomycin-resistant Enterococcus spp. (VRE) are multidrug-resistant microorganisms frequently isolated in liver transplant (LT) patients. In this population, VRE infection is potentially associated with worse clinical outcomes. The objective of this study was to identify the main risk factors associated with VRE infection in the post-transplant period and to develop a risk prediction score for VRE infection. Methods: Historical cohort study including all adults who underwent LT between 2010 and 2022 in a tertiary-care hospital. Follow-up was from 90 days before transplant to 180 days after transplant. The outcome was VRE infection within the first 180 days after LT. Bivariate and multivariate analyses were performed using the Fine–Gray model, considering death as a competing risk. Prediction model metrics were calculated weekly, considering VRE colonization as a time-dependent variable, and described by ROC curves, sensitivity, specificity, accuracy, precision, and F1 score. Results: A total of 1,209 patients were included; of these, 77 (6.4%) developed VRE infection post-transplant, most of which were intra-abdominal infections (58.4%). The main risk factors identified were: need for renal replacement therapy (OR 2.01; 95% CI 1.4–2.8), intraoperative bleeding (OR 4.01; 95% CI 2.7–6.0), post-transplant VRE colonization (OR 7.59; 95% CI 5.1–11.1) and pre-transplant colonization (OR 3.19; 95% CI 2.2–4.5), retransplantation (OR 3.85; 95% CI 2.6–5.6) and ICU length of stay (OR 1.01; 95% CI 1.0–1.02). Conversely, history of viral hepatitis (OR 0.54; 95% CI 0.3–0.7), autoimmune hepatitis (OR 0.33; 95% CI 0.1–0.6), Charlson comorbidity score (OR 0.84; 95% CI 0.7–0.9) and deceased-donor transplant (OR 0.23; 95% CI 0.1–0.3) were protective factors. All these variables were incorporated into the risk prediction model. The final score presented an area under the curve between 76.01% and 84.75%, with sensitivity from 75.13% to 89.33% and specificity from 74.6% to 85.87%. Conclusion: It was possible to develop a risk prediction score for VRE infection in liver transplant recipients with good discriminative performance. The proposed tool may support targeted surveillance and prevention strategies in higher-risk populations.

Introduction/Objectives: Clostridioides difficile (CD) infection is one of the main gastrointestinal complications related to healthcare-associated infections (HAIs), with great clinical impact. In oncology patients, it is even more relevant, since these patients are more susceptible to severe forms with worse clinical outcomes, which can lead to delays in oncology treatment and other impacts such as blocking beds for isolation, greater use of personal protective equipment, restriction of visits, difficulties in bed management, and risk of transmission to other patients. This report aims to describe the impact of environmental and hand hygiene measures to control HAIs due to CD. Method: Retrospective descriptive, quasi-experimental (pre- and post-intervention) study in an exclusive pediatric oncology hospital, from April 2024 to May 2025, with data extracted from the active epidemiological surveillance system of the HICC. Incidence rates of HAIs due to CD (per 1000 patient-days) were compared before and after the intervention. Result: In the period from April to September (pre-intervention), a high rate of HAIs due to CD was observed, with an average incidence of 4.7 cases/1000 patient-days, highlighting August 2024 (4 cases; 14.7 cases/1000 patient-days). After identifying the increase, in September trainings were conducted on environmental cleaning, guidance on contact precautions, hand hygiene with soap and water, and the surface cleaning product for rooms of suspected and confirmed cases was changed to a quaternary ammonium compound with chlorine dioxide. After the intervention, there was a drop in the number of cases in the following months, resulting in an average rate of 2.8 cases/1000 patient-days (October/2024 to May/2025). In January, February, and May 2025 no HAIs due to CD were observed. Conclusion: Eliminating CD is challenging because transmission occurs through contact and its spores can persist for long periods in the environment, being resistant to common hospital disinfectants and even to hand hygiene with alcohol gel. Environmental cleaning and decontamination is the most economical strategy to prevent spread, colonization, and infection by CD. The measures implemented for environmental control of CD appear to be associated with a reduction in HAI cases caused by this agent.

PURPOSE:Donor-derived infections (DDIs) caused by multidrug-resistant organisms (MDROs) are rare but potentially devastating complications of solid organ transplantation (SOT), with limited evidence on transmission risk and clinical outcomes. METHODS:We conducted a systematic review in accordance with PRISMA 2020 guidelines, including case reports, case series, and cohorts describing SOT donors with MDRO that reported recipient's infection outcomes (1999-2025). Individual-level data were extracted when available. Meta-analyses of proportions were performed, and bivariable and multivariable logistic regression models were used to identify factors independently associated with DDI and mortality. RESULTS:46 studies comprising 435 donors and 544 transplants were included. Kidney (43.8%), lung (29.2%), and liver transplants (22.7%) were the most frequent. Carbapenem-resistant Enterobacterales (38.9%) predominated in donor isolates. The overall transmission rate was 26.6% (IC95%: 14.3-44.2) despite targeted antimicrobial prophylaxis in 86.5% of high-risk recipients. In multivariable analyses, positive preservation fluid (PF) cultures (p < 0.001), high-risk donor's cultures (p < 0.001), and liver transplantation (p = 0.02) were independently associated with increased transmission, whereas positive culture at screening donation (p < 0.001) and carbapenem resistant Acinetobacter baumannii (p = 0.02) isolation was associated with a lower risk of transmission. Respiratory donor cultures (p = 0.006) were independently associated with transmission in lung transplant-specific models. CONCLUSIONS:MDRO in SOT donors are associated with high transmission rates. PF for all SOT and respiratory cultures in lung transplant are key predictors of transmission, supporting organ- and site-specific donor screening and microbiological surveillance to mitigate transmission.

Introduction/Objectives: In hospital environments, surfaces close to the patient are more frequently touched by hands, mainly by healthcare professionals, and therefore require frequent cleaning. Contaminated surfaces can serve as reservoirs for pathogens, making the environment a significant risk to patients. The objective of the study was to present an approach that allows people who work directly in this service to understand the role of each professional in environmental hygiene, through a playful method, in an easy and fast way, “Who cleans what.” Methodology: After defining the responsibilities of each team, meetings were held with the Hospitality, Hygiene and Cleaning (outsourced) teams and the SCIH, with the aim of developing strategies that are easy to understand. Photographs of ward beds and intensive care unit beds were used, in which surfaces were marked with specific colors and geometric figures, considering the possibility of the existence of collaborators with color blindness. The Hygiene and Cleaning team came to be represented by a blue circle, nursing by a green square, and the chambermaids by an orange triangle. Results: The SCIH conducted training aimed at the Hospitality/chambermaids and Hygiene and Cleaning (outsourced) teams. Of the total of 272 collaborators from the Hygiene and Cleaning team, 257 (94.48%) were trained. In the Hospitality/chambermaids team, 68 are part of the workforce, of which 46 (67.64%) participated in the training. The training sessions took place in two Units of the Institution, totaling 303 collaborators trained. Conclusion: The playful instrument used proved to be a useful training tool, easy to understand and very well accepted among collaborators, with the potential to assist in improving the process.

Invasive candidiasis is associated with high morbidity and mortality, and the rising of antifungal resistance underscores the need for new therapies. Rezafungin, a second-generation echinocandin, enables once-weekly dosing, achieves high plasma concentrations, and shows potent in vitro activity. We report two Brazilian cases showing its clinical utility: (i) fluconazole-resistant Candida tropicalis bloodstream infection in a patient with colorectal cancer and chronic kidney disease and (ii) azole-refractory C. albicans esophagitis in a patient with autoimmune polyglandular syndrome type 1. Both achieved rapid clinical response and microbiological clearance. These are the first documented cases of rezafungin use for invasive candidiasis in Brazil.

BACKGROUND:Bacterial infections can negatively impact post-liver transplant morbidity and mortality, and the impact of incipient spontaneous bacterial peritonitis or bacterascites from intraoperative ascitic fluid is unknown. The present study's objectives were to analyse the risk factors for post-liver transplant infection and survival within 30-days after transplant. METHODS:This is a single-center retrospective cohort study of liver transplant patients from 2010‒2017, whose ascitic fluid collected during transplant was sent for analysis. Survival analysis using the Kaplan-Meier method and Cox regression in the multivariate analysis was used to determine risk factors for post-transplant infection and survival. RESULTS:Of 297 patients, 22 had intraoperative SBP, 40 had bacterascites, and 235 had a normal ascitic fluid. 67% were male, median age 53-years, and median MELD score of 24. In multivariate analysis, there was no association between the presence of SBP or the presence of bacterascites and the occurrence of infection or death, and although it was not clinically significant, there was a trend towards worse survival in the bacterascites group. Patients undergoing post-transplant reoperation (OR = 2.28, 95% CI 1.12-4.60, p = 0.022), post-transplant MDR colonization (OR = 4.39, 95% CI 2.61-7.39, p < 0.001), and post-transplant dialysis (OR = 2.20, 95% CI 1.31-3.69, p = 0.003) had a higher rate of infection in the first 30-days after transplantation; pre-transplant MDR colonization, early graft dysfunction and low body mass index were independent predictors of worse survival. CONCLUSIONS:Intraoperative SBP and bacterascites that received targeted treatment did not impact infections nor survival rates up to 30-days after liver transplant, while most episodes were treated. In this population of severe patients with ascites, patients undergoing reoperation, post-transplant MDR colonization and post-transplant dialysis were at higher risk of infection.

Introduction/Objectives Most evidence on mortality related to ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT) comes from general intensive care units (ICUs), with limited data on critically ill oncology patients. This study aimed to characterize the microbiologic profile and resistance patterns in an oncology hospital and to assess their impact on 14-day mortality. Methods Retrospective analysis of VAP and VAT cases in an oncology ICU in Brazil (January to December 2024), evaluating bacterial frequencies, multidrug-resistant organisms, and mortality. The chi-square test was used to assess the association of multidrug resistance (MDR) and sample type (blood or respiratory secretion) with mortality. Results Among 85 ICU patients, VAT was more frequent (59%) than VAP (41%). Most were male (60%), with a median age of 61 years, and had solid tumors (85%), mainly lung and head-and-neck cancers. Of 109 samples, Pseudomonas aeruginosa (27%), Klebsiella pneumoniae (20%), and Stenotrophomonas maltophilia (17%) were the most common pathogens. MDR rates were particularly high in Acinetobacter baumannii (82%). The same microorganisms were isolated from blood and respiratory tract in four patients. Patients infected with S. maltophilia, Acinetobacter spp., Serratia marcescens, P. aeruginosa, and K. pneumoniae had longer hospital stays, with median durations >10 days. Device use was also prolonged in patients with infections due to S. marcescens, K. pneumoniae, and Acinetobacter spp., with median device duration >7 days. Overall 14-day mortality was 55%. MDR was not associated with mortality (p = 0.3), but infections with positive blood cultures were associated with significantly higher mortality (86% vs. 49%; p = 0.012). Conclusion This study provides valuable information on the microbiologic profile of patients with VAP and VAT in an oncology ICU and its impact on mortality. Mortality was not associated with MDR, possibly reflecting the high baseline risk due to underlying onco-hematologic conditions. However, patients with positive blood cultures had significantly higher mortality, suggesting a more invasive infectious process.

Background:Most evidence on ventilator-associated pneumonia (VAP)-related and ventilator-associated tracheobronchitis (VAT)-related mortality comes from general ICU settings, with limited data on critically ill cancer patients. This study aimed to characterize the microbiological profile and resistance patterns in an oncology hospital and evaluate their impact on 14-day mortality. Methods:We conducted a retrospective analysis of VAP and VAT cases in an oncology ICU in Brazil (Jan-Dec 2024), assessing bacterial frequency, multidrug-resistant organisms (MDRO), and mortality. Multivariate analysis was used to identify the variables significantly associated with mortality. Results:Among 85 ICU patients, tracheobronchitis was more frequent (59%) than pneumonia (41%). Most were male (61%) with a median age of 62 years and had solid tumors (85%), mainly in the lungs and neck. Of 109 samples, P. aeruginosa (27%), K. pneumoniae (20%), and S. maltophilia (17%) were the most common pathogens. MDRO was particularly high in A. baumannii (82%). Overall, 14-day mortality was 55%. MDR was not associated with mortality (p = 0.3), but VAP (OR 4.20, p = 0.004) and infections with positive blood culture (OR 5.38, p = 0.023) were independently associated with mortality. Conclusion:This study provides valuable insights into the microbiological profile of patients with VAP and VAT in an oncological ICU and its impact on mortality. Mortality was not associated with MDR, possibly reflecting the high baseline risk from underlying conditions. However, patients with positive blood cultures had significantly higher mortality, suggesting a more invasive disease.

Introduction/Objectives Hepatitis B vaccination is recommended for patients who will undergo or are undergoing cancer treatment, aiming to prevent infection by the hepatitis B virus (HBV) and reduce the risk of viral reactivation. Hepatitis B surface antibodies (anti-HBs) alone are the only detectable serologic marker in individuals who acquired immunity through vaccination. Higher anti-HBs titers are associated with greater protection against HBV infection. The aim of this study was to evaluate anti-HBs titers induced by vaccination in patients with cancer. Methods This retrospective study included data from patients aged ≥ 18 years diagnosed with cancer between January 2011 and December 2023. Immunity induced by hepatitis B vaccination was defined as reactive anti-HBs with nonreactive anti-HBc. Anti-HBs titers were classified as strongly reactive (≥ 100 IU/L) or weakly reactive (10–99 IU/L). Bivariate and multivariate analyses were conducted to assess categorical variables associated with the presence of strongly protective anti-HBs titers (outcome). Results A total of 5,267 cancer patients with reactive anti-HBs (immunity induced by hepatitis B vaccination) were included. Among them, 2,794 (53.0%) had strongly reactive titers and 2,473 (47.0%) had weakly reactive titers. In multivariate analysis, a higher proportion of elevated titers was observed in the 18–39-year age group (57.7%) compared with those ≥ 60 years (44.2%) (OR = 1.64; 95% CI: 1.39–1.94; p < 0.001), and also in the 40–59-year group (53.1%) compared with those ≥ 60 years (OR = 1.42; 95% CI: 1.20–1.67; p < 0.001). Female patients had a higher proportion of elevated titers (55.8%) compared with males (46.2%) (OR = 1.39; 95% CI: 1.20–1.60; p < 0.001). No statistically significant differences were observed regarding ethnicity/skin color (p = 0.359) or primary cancer site (solid tumors vs. hematologic neoplasms) (p = 0.822). Conclusion In a population of cancer patients with immunity induced by hepatitis B vaccination, more than half had anti-HBs titers considered strongly protective. Younger individuals and females had a higher proportion of strongly protective titers, suggesting that age and hormonal factors influence the immune response to vaccination.

Mycobacterium kansasii comprises one of the most common and most pathogenic nontuberculous mycobacteria, particularly in immunocompromised individuals. This retrospective observational study aimed to describe the epidemiology, clinical characteristics, and outcomes of M. kansasii infections in 13 cancer patients from Instituto do Cancer do Estado de Sao Paulo, Brazil, from January 2011 to September 2023. Of the 19 initial positive cultures, 13 fully met diagnostic criteria for M. kansasii infections. Solid tumors occurred the most (69.2%), and only 38.4% of patients were undergoing chemotherapy at diagnosis. Smoking was the most frequent previous characteristic in these cases (76.9%). Fever (53.4%), cough (46.1%) and dyspnea (30.7%) were the most common symptoms. Multiple nodules (46.1%) and cavities (46.1%) were the most common radiological findings. Overall, seven patients (53.8%) received at least 12 months of therapy. One-year overall mortality totaled 38.4-22.2% in patients with solid tumors and 75% in patients with hematologic malignancies. In conclusion, M. kansasii infections were predominantly pulmonary in this series of cancer patients, which showed a high frequency of other respiratory comorbidities, especially smoking. Mortality occurred in several patients, particularly among those with hematological malignancies.

Introduction/Objective Hepatitis B is a health condition caused by hepatitis B virus (HBV), associated with high morbidity and mortality. HBV can integrate into the host genome via covalently closed circular DNA (cccDNA) and may reactivate under immunosuppressive conditions such as cancer treatment. The objective of this study was to evaluate the prevalence of HBV infection in oncologic patients and to characterize this population demographically. Methods Retrospective study of adult oncology patients in a specialized health service between 2010 and 2023, who underwent serology for anti-HBc, the marker of prior exposure to HBV. Linear regression analysis was used to evaluate anti-HBc prevalence over time, and multivariate logistic regression to assess the association of demographic characteristics with reactive anti-HBc. Ethnicity/skin color was based on self-identification. Results During the study period, 125,985 oncologic patients were seen, and 28,869 underwent anti-HBc testing. The prevalence of HBV infection was 13.4% (n = 3,857). There was a statistically significant reduction in prevalence over time, from 16.5% in 2010 to 9.9% in 2023. In multivariate analysis, male patients (34.6% of the sample) had an 89% higher likelihood of being anti-HBc reactive compared with females (OR = 1.89; 95% CI: 1.76–2.04; p < 0.001). Patients aged ≥ 60 years had a 4.40-fold higher likelihood of being reactive compared with those ≤ 40 years (OR = 4.40; 95% CI: 3.77–5.12; p < 0.001). White patients represented 61.4% of the population; the others (mixed race, Black, Indigenous, and Asian) were categorized as non-white (19.2%). Non-white patients had a 25% higher chance of being anti-HBc reactive compared with white patients (OR = 1.25; 95% CI: 1.15–1.35; p < 0.001). Conclusion This study demonstrated a significant prevalence of HBV infection in the oncologic population (13.4%), higher than in the general population, and associated with male sex, age ≥ 60 years, and non-white ethnicity/skin color. Despite the decreasing trend over time, prevalence remained elevated (9.9%) in 2023. The data may support public health actions aimed at prevention and control of HBV infection in oncologic populations.

Introduction/Objectives Primary bloodstream infections associated with central venous catheters (CLABSI) represent serious adverse events in oncology patients hospitalized in intensive care units (ICUs), contributing to increased morbidity, length of stay, and hospital costs. In June 2024, a marked increase in the incidence density (ID) of CLABSI was identified in a 34-bed oncological ICU. The objective of this study was to describe the extraordinary actions adopted and to evaluate their impact on reducing the infection rate. Methods A quasi-experimental study with retrospective analysis, conducted in a public quaternary oncology hospital. The intervention occurred between July and September 2024. Initially, a root cause analysis was conducted using the Ishikawa diagram. Subsequently, corrective measures were defined using the 5W2H tool and included: in-person training on catheter insertion and maintenance, daily bedside audits using checklists, intensified active surveillance, implementation of the central venous catheter maintenance bundle in the electronic medical record, technovigilance of vascular access devices, and feedback of indicators with a shared action plan. Intervention effectiveness was assessed by comparing the CLABSI incidence density (number of infections per 1,000 catheter-days) before and after the intervention, using a chi-square test for two Poisson rates. Statistical significance was considered at p < 0.05. Results The CLABSI ID in June 2024 reached 10.8, a value well above the 2023 annual average (3.8). After the intervention, a progressive decline in incidence density was observed: July (5.8), August (5.5), and September (0.0) infections per 1,000 catheter-days (p = 0.005). Care audits demonstrated greater adherence to recommended practices, with immediate correction of nonconformities. The multidisciplinary approach fostered team engagement and contributed to the sustainability of the implemented actions. Conclusion The adoption of structured interventions based on root cause analysis and multidisciplinary strategies significantly reduced the ID of CLABSI in an oncological ICU. The sustained decline, together with improved adherence to safe practices, demonstrates the positive impact of educational actions, systematic audits, and proactive risk management. The results reinforce the importance of continuous surveillance and engagement of healthcare teams in infection prevention.

Carbapenemase-producing Enterobacterales (CPE) represent a major global health threat due to limited therapeutic options and high mortality. While isolates harboring a single carbapenemase are increasingly common, polymicrobial bloodstream infections involving multiple carbapenemase-producing species remain rare and pose substantial diagnostic and therapeutic challenges. We describe a case of polymicrobial bloodstream infection in a neutropenic patient with relapsed acute myeloid leukemia. Blood cultures yielded three distinct Enterobacterales species. Identification was performed by MALDI-TOF MS, antimicrobial susceptibility testing followed CLSI guidelines, and carbapenemase production was screened by immunochromatographic assay and PCR. Whole-genome sequencing was conducted for all isolates, with in silico multilocus sequence typing, resistome characterization, plasmid replicon analysis, and phylogenetic reconstruction. A literature review (2015–2025) was performed to contextualize this finding. Three carbapenem-resistant Enterobacterales were simultaneously isolated from blood cultures: Citrobacter freundii producing NDM-1, Klebsiella michiganensis producing IMP-16, and Enterobacter hormaechei producing KPC-2. One isolate harbored mcr-9 gene. The patient developed septic shock but was successfully treated with a targeted combination therapy of ceftazidime-avibactam plus aztreonam, supplemented with amikacin, alongside catheter removal and supportive care. Follow-up blood cultures were negative, and no secondary transmission was detected. We report a case of a polymicrobial bloodstream infection caused by three different carbapenemase-producing Enterobacterales species, each expressing a distinct carbapenemase. This case underscores the clinical value of rapid molecular diagnostics, highlights the need for strengthened surveillance and tailored antimicrobial strategies in high-risk patients facing extreme antimicrobial resistance scenarios.

Hepatitis E virus (HEV) infection can progress to chronic hepatitis in immunosuppressed individuals. The seroprevalence of hepatitis E among people living with HIV remains controversial. In this systematic review and meta-analysis, the pooled global seroprevalence of hepatitis E among people living with HIV is estimated. This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO. Searches were conducted in the PubMed, Embase, and Web of Science databases. The seroprevalence of hepatitis E (anti-HEV IgG) among people living with HIV was estimated by meta-analysis using the random-effects model. Subgroup meta-analyses were performed for each continent. A total of 88 studies from 5 continents were included; most were conducted in European countries (48.9%). The pooled seroprevalence of HEV infection was 16.0% (95% CI, 13.0-18.0; I2 = 97.7%). Subgroup analyses revealed seroprevalence rates of 12.0% in Europe, 24.0% in Asia, 19.0% in Africa, and 11.0% in the Americas, and a notably high prevalence was observed in low-income countries (37.0%). Sensitivity analyses restricted to studies with sample sizes of more than 200 participants and risk of bias score ≥ 7 indicated seroprevalence estimates of 18.0% and 15.0%, respectively. In conclusion, this meta-analysis demonstrates a pooled global seroprevalence of HEV infection of 16.0% among people living with HIV, ranging from 11.0% to 24.0% across the continents.

Hepatitis B is a health threat with regional variations in prevalence. Our aim was to conduct a systematic review and meta-analysis of available data on the prevalence of hepatitis B virus (HBV) in Latin America and the Caribbean (LAC). A literature search was conducted from 2000 to 2024 using the databases Medline, Embase, LILACS and Web of Science, following PRISMA guideline. Search terms included: “hepatitis B virus”, “HBsAg”, “HBV”, “prevalence”, and “Latin America and the Caribbean”. Random-effects meta-analysis was performed to estimate the prevalence of HBV (HBsAg), and the I2 statistic was used to assess heterogeneity between studies. Subgroup and meta-regression analyses were performed to investigate possible sources of heterogeneity. In total, 190 studies were included in the analysis and the estimated global prevalence of HBV was 1.0

Introduction/Objective The development of antimicrobial resistance is a natural evolutionary phenomenon of bacteria and is exacerbated by intensive antibiotic use in health care, agriculture, and livestock, making infections harder to treat. This study aims to analyze factors associated with 30-day survival in oncologic patients infected with carbapenem-resistant Gram-negative bacteria (CRGNB). Methods Multicenter retrospective cohort study of cancer patients >17 years admitted to five centers in the states of São Paulo and Espírito Santo, Brazil, between January 2022 and December 2023, who received at least 48 hours of effective antibiotic therapy for CRGNB infections. Patients with polymicrobial infections were excluded. The outcome was death within 30 days after infection. Bi- and multivariate analyses were performed using Cox regression, and proportional hazard assumptions were assessed using Schoenfeld residual plots. Variables with p < 0.1 in bivariate analysis or with clinical/biological plausibility were included in the multivariate model. Those that reduced the −2 log-likelihood or had p ≤ 0.05 were retained in the final model. Results A total of 126 patients were included (mean age 60.9 ± 14.7 years); most (75.4%) had infections due to Enterobacterales, while Pseudomonas spp. (15.1%) and Acinetobacter baumannii complex (9.5%) were less frequent. The most common infectious foci were bloodstream infection (35.7%), pneumonia (25.4%), and urinary tract infections (15.1%). The 30-day survival rate was 57.1%. In multivariate analysis, factors associated with risk of death were age (HR = 1.044; p < 0.001), metastasis (HR = 2.186; p = 0.010), cirrhosis (HR = 14.677; p = 0.014), SOFA score (HR = 1.145; p < 0.001), and combination antibiotic therapy (HR = 2.216; p = 0.008). Shorter time to initiation of effective antibiotic therapy (HR = 0.803; p < 0.001) and pyelonephritis as the infectious focus (HR = 0.199; p = 0.005) were protective factors. Conclusion Thirty-day mortality among oncologic patients infected with CRGNB was high and influenced by factors related to infection severity, underlying disease burden, and antibiotic management. These findings reinforce the importance of rapid diagnosis and early treatment of infections in high-risk populations.

Invasive fusariosis (IF) is one of the most aggressive mold infections in patients with acute leukemia, characterized by rapid dissemination, high rates of fungemia, and limited antifungal susceptibility. Its impact is particularly severe in middle-income countries, yet single-center data from these settings remain scarce. We conducted a retrospective study of all patients with acute leukemia and proven IF, diagnosed according to EORTC/MSG criteria, from January 2011 to August 2023. Demographic, clinical, therapeutic, and outcome variables were analyzed. Twenty-six patients were identified. Median age was 46.5 years, and 53.8