The European Confederation of Medical Mycology Candida III was a pan-European, multicenter observational study of adult patients with blood culture-proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a subanalysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU patients, non-ICU patients had a higher comorbidity burden (median Charlson comorbidity index [CCI] 6 vs 5 in ICU patients, P = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan-Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, P = .003) and the longest hospital stay, even after excluding all cases with a fatal outcome before day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an infectious disease or clinical microbiology consultant, and initial treatment with an echinocandin, respectively, higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher comorbidity rates, non-ICU patients with candidemia had higher survival rates.

BACKGROUND Ciprofloxacin resistant Klebsiella pneumoniae is common or emerging in many geographies, and knowledge of local resistance rates is important for empirical therapy. Whilst there are known K. pneumoniae ciprofloxacin resistance determinants, there is a lack of systematic data on the effect of determinants, alone and in combination, and there are no publicly accessible tools for predicting resistance from whole genome sequence data. METHODS The KlebNET-GSP AMR Genotype-Phenotype Group aggregated a matched genotype-phenotype dataset of n=12,167 K. pneumoniae species complex ( Kp SC) isolates from 27 countries between 2001-2021. We developed a rules-based classifier to predict ciprofloxacin resistance by categorizing the number of quinolone resistance determining regions mutations in gyrA and parC , the number of plasmid-mediated quinolone resistance genes, and the presence/absence of aac(6ʹ)-Ib-cr (which can acetylate ciprofloxacin). Predictive performance was assessed using the discovery dataset, for which we re-phenotyped discrepant isolates; and validated using externally contributed datasets (n=7,030 Kp SC isolates). RESULTS The rules-based classifier predicted R vs S/I with categorical agreement, sensitivity, and specificity >96%, and major/very major error rates <4%. Performance was similar across diverse Kp SC sources (human, animal, other), species, and intra-species lineages. External validation of the classifier yielded overall 93.12% categorical agreement [95% confidence interval (CI), 92.50-93.74%], 8.65% major errors [95% CI, 7.34-9.97%], and 6.20% very major errors [95% CI, 5.51-6.90%]. We implemented the classifier in Kleborate, a command-line tool that is integrated into the Pathogenwatch web platform. Using this to assess the global distribution of ciprofloxacin resistance determinants in Kp SC genomes available in Pathogenwatch (n=31,319, from 109 countries between years 2000-2023), we observed a significant positive association between national quinolone consumption rates and predicted ciprofloxacin resistance (R2=0.20, p=0.004). CONCLUSIONS Ciprofloxacin resistance phenotypes can be reasonably predicted from genotypes, which is sufficient for informing surveillance. However, unexplained resistance remains and accuracy is insufficient for clinical applications. We demonstrate the value of aggregating genotype-phenotype data to explore resistance mechanisms and develop predictors, but highlight complexities in combining phenotype data from different assays and standards. ### Competing Interest Statement The authors have declared no competing interest. Bill & Melinda Gates Foundation, INV025280, INV077266 Wellcome Trust, 226432/Z/22/Z European Union‘s Horizon 2020 Research and Innovation Programme, 773830 Trond Mohn Foundation, TMF2019TMT03 SARA project (Surveillance of Antimicrobial Resistance in Africa, through a grant from the French Ministry of Europe and Foreign Affairs within the Fonds de solidarité pour les projets innovants (FSPI) Academy of Medical Sciences Health Foundation UK Vietnam MRC Newton Fund, MR/N029399/1 RG83380 National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, NIHR207397

Excessive antibiotic utilization in hospital settings catalyzes the emergence and dissemination of multidrug resistant (MDR) bacteria, with sanitary facilities serving as critical vectors for their propagation. This study investigated the impact of patient antibiotic exposure on microbial diversity in hospital sanitary facilities, as well as the emergence of uniform communities and prospering taxa under antibiotic pressure. For this purpose a cross-sectional study was conducted between September 2022 and April 2023 from eight hospitals in seven cities across five countries, representing a diverse mix of tertiary care, military, oncological, psychiatric, and general teaching hospitals to analyze bacterial population differences in hospital toilets on wards with high versus minimal antibiotic administration using 16s rRNA amplicon sequencing. PCoA analysis with Bray-Curtis and unweighted UniFrac metrics revealed microbial clustering influenced by antibiotic exposure and geography. Among all taxa analyzed, Enterococcus showed the strongest and most consistent association with high-exposure environments, making it one of the most striking findings in our dataset. Routine overuse of antimicrobial agents aimed at false patient safety promotes a high-risk environment in the sanitary facilities of respective wards. Hence, the issue of hospital acquired infections with MDR pathogens transcends mere pathogen spread, entailing significant changes to both environmental and microbial landscapes over time. The situation signals an emerging ecological problem within healthcare environments, and highlights the urgency for an integrated approach to antimicrobial stewardship. The low detection of key nosocomial Gram-negative genera likely reflects the focus on toilets rather than sinks or showers.

Introduction: Mold, which includes the components and metabolic products of mold fungi as well as other factors associated with moisture, such as yeasts, bacteria (actinobacteria) and mites, occurs indoors when there is increased moisture. In addition to known causes of damp/mold damage such as structural defects (including thermal bridges, rising damp, insufficient ventilation), water damage and incorrect ventilation and heating options, construction work plays an important role in hospitals and medical practices. Methods: The AWMF S2k guideline “Medical clinical diagnostics for indoor mold exposure” was first published in 2016. Following a new systematic literature search, an updated version of this guideline was published in October 2023 with the cooperation of various medical disciplines and other experts. The guideline is intended to close the existing knowledge gap in terms of rational and efficient medical diagnosis in cases of indoor mold contamination. Recommendations are given on general and specific examination methods. Non-evidence-based diagnostic methods, some of which are still used in practice, are not recommended. Furthermore, treatment options for health problems and diseases caused by mold fungi are presented. It is explained why, in most cases, indoor measurements of molds, their components or metabolites are not required for medical evaluation. Results: Individuals who are immunosuppressed (grade 2 and 3 of the immunosuppression grades according the Commission for Hospital Hygiene and Infection Prevention [KRINKO] at the Robert Koch Institute [RKI]), or are suffering from severe influenza, severe COVID-19, cystic fibrosis and uncontrolled bronchial asthma are at increased risk of exposure to mold fungi. For these patients, exposure to mold damage must be ruled out in the clinic and practice as well as in the home environment. Conclusion: If, despite all precautionary measures, moisture/mold damage can be detected in the environment of these particularly vulnerable patients, it must be remediated immediately. Indoor measurements of mold exposure are not indicated for medical reasons. Rather, all measures that help to avoid moisture damage are crucial for prevention.

Abstract Background Despite advances in antifungals, Candida infections still have a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes, highlighting the need to understand and manage these infections. Methods In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with confirmed candidemia. Data collected included patient demographics, risk factors, hospital stay length (with a 90-day follow-up), diagnostic procedures, Candida species, treatment details, and outcome. Controls were matched in a 1:1 ratio from the same hospitals, ensuring similarity in age, underlying illness, ICU versus normal ward stay, and recent major surgery. The study described overall and attributable mortality and assessed survival probability for both cases and controls. Results The study included 171 pairs consisting of patients with candidemia and matched controls from 28 institutions. In those with candidemia, overall mortality was 40.4%. The attributable mortality was 18.1% overall but differed among the causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata, 7.7% for Candida parapsilosis, and 63.6% for Candida tropicalis). Regarding risk factors, the presence of central venous catheter, total parenteral nutrition, and acute or chronic kidney disease were significantly more common in cases versus controls. Length of hospitalization and ICU stay were significantly longer in candidemia cases (20 days (IQR 10-33) vs. 15 days (IQR 7-28); p=0.004). Conclusion Although overall mortality remains high in this matched case/control analysis, attributable mortality has decreased compared to historical cohorts. This may be due to a better prognosis for candidemia caused by Candida albicans, which has an attributable mortality of 7.7%, while candidemia cases caused by non-albicans Candida exhibit higher attributable mortality. Disclosures Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria Jean-Pierre Gangneux, Prof., Gilead: Honoraria|MundiPharma: Advisor/Consultant|MundiPharma: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Matteo Bassetti, PhD, Angelini: Advisor/Consultant|Angelini: Honoraria|Astellas: Advisor/Consultant|Astellas: Honoraria|bioMerieux: Advisor/Consultant|bioMerieux: Honoraria|Cidara: Advisor/Consultant|Cidara: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Menarini: Advisor/Consultant|Menarini: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Nabriva: Advisor/Consultant|Nabriva: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Tetraphase: Advisor/Consultant|Tetraphase: Honoraria

Microorganisms inhabiting hostile Arctic environments express a variety of functional phenotypes, some of clinical interest, such as haemolytic ability and antimicrobial resistance. We studied haemolytic bacterial isolates from Arctic habitats, assessing their minimum inhibitory concentration (MIC) against antimicrobials. We then performed whole genome sequencing and analysed them for features conferring antimicrobial resistance. MIC data showed that Micromonospora spp. belong to 33% non-wild type (NWT) for erythromycin and penicillin and 22% NWT for tetracycline. Both Pseudomonas spp. belong to 43% NWT for nalidixic acid and streptomycin and 29% NWT for colistin. Finally, the Pedobacter isolate was in 80% NWT for antimicrobials tested. Whole-genome sequencing analyses revealed that fluoroquinolones, tetracyclines, macrolides and penams were the most frequent drug classes against which genotypic resistance was found. Additionally, resistance genes to heavy metals and disinfectants were identified. Our research demonstrates the presence of antimicrobial resistance in bacteria from Arctic habitats and highlights the importance of conservation efforts in these environments, where anthropogenic influence is becoming more evident. Furthermore, our data suggest the possible presence of novel resistance mechanisms, which could pose a threat if the responsible genes are transferable between species or become widespread due to environmental stress and alterations brought about by climate change.

Zusammenfassung Die von der Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin (GHUP) federführend aktualisierte Leitlinie „Medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen – Update 2023“ ist Gegenstand des vorliegenden Beitrags. Schimmelwachstum im Innenraum ist als ein potenzielles Gesundheitsrisiko zu betrachten, auch ohne dass ein quantitativer und/oder kausaler Zusammenhang zwischen dem Vorkommen einzelner Arten und Gesundheitsbeschwerden gesichert werden kann. Es liegt keine Evidenz für einen kausalen Zusammenhang zwischen Feuchte-/Schimmelschäden und Krankheiten des Menschen vor. Wesentliche Gründe dafür sind das ubiquitäre Vorkommen von Schimmelpilzen und und bislang unzureichende diagnostische Methoden. Es liegt lediglich ausreichende Evidenz für folgende Assoziationen von Feuchte-/Schimmelschäden und folgenden Erkrankungen vor: allergische Atemwegserkrankungen, allergische Rhinitis, allergische Rhinokonjunktivitis, Allergische bronchopulmonale Aspergillose (ABPA), andere Allergische bronchopulmonale Mykosen (ABPM), Aspergillom, Aspergillus-Bronchitis, Asthma (Manifestation, Progression, Exazerbation), Begünstigung von Atemwegsinfekten, Bronchitis (akut, chronisch), Community-acquired Aspergillus-Pneumonie, Exogen-allergische Alveolitis (EAA), invasive Aspergillosen, Mykosen, Organic Dust Toxic Syndrome (ODTS) [Arbeitsplatzexposition], pulmonale Aspergillose (subakut, chronisch) und Rhinosinusitis (akut, chronisch invasiv oder granulomatös, allergisch). Dabei ist das sensibilisierende Potenzial von Schimmelpilzen im Vergleich zu anderen Umweltallergenen deutlich geringer einzuschätzen. Aktuelle Studien zeigen europaweit eine vergleichsweise geringe Sensibilisierungsprävalenz von 3–22,5 % gemessen an der Gesamtbevölkerung. Eingeschränkte oder vermutete Evidenz für eine Assoziation liegt vor hinsichtlich des atopischen Ekzems (atopische Dermatitis, Neurodermitis, Manifestation), Befindlichkeitsstörungen, chronisch obstruktive Lungenerkrankung (COPD), Geruchswirkungen, Mucous Membrane Irritation (MMI) und Sarkoidose. Inadäquate oder unzureichende Evidenz für eine Assoziation liegt vor für akute idiopathische pulmonale Hämorrhagie bei Kindern, Arthritis, Autoimmunerkrankungen, chronisches Müdigkeitssyndrom (CFS), Endokrinopathien, gastrointestinale Effekte, Krebs, luftgetragen übertragene Mykotoxikose, Multiple chemische Sensitivität (MCS), Multiple Sklerose, neuropsychologische Effekte, neurotoxische Effekte, plötzlicher Kindstod, renale Effekte, Reproduktionsstörungen, Rheuma, Schilddrüsenerkrankungen, Sick-Building-Syndrom (SBS), Teratogenität und Urtikaria. Das Infektionsrisiko durch die in Innenräumen regelmäßig vorkommenden Schimmelpilzarten ist für gesunde Personen gering, die meisten Arten sind in die Risikogruppe 1 und wenige in 2 (Aspergillus fumigatus, Aspergillus flavus) der Biostoffverordnung eingestuft. Nur Schimmelpilze, die potenziell in der Lage sind, Toxine zu bilden, kommen als Auslöser einer Intoxikation in Betracht. Ob im Einzelfall eine Toxinbildung im Innenraum stattfindet, entscheiden die Umgebungs- und Wachstumsbedingungen und hier vor allem das Substrat. Von Geruchswirkungen und/oder Befindlichkeitsstörungen kann bei Feuchte-/Schimmelschäden im Innenraum grundsätzlich jeder betroffen sein. Hierbei handelt es sich nicht um eine akute Gesundheitsgefährdung. Prädisponierende Faktoren für Geruchswirkungen können genetische und hormonelle Einflüsse, Prägung, Kontext und Adaptationseffekte sein. Prädisponierende Faktoren für Befindlichkeitsstörungen können Umweltbesorgnisse, -ängste, -konditionierungen und -attributionen sowie eine Vielzahl von Erkrankungen sein. Besonders zu schützende Risikogruppen bezüglich eines Infektionsrisikos sind Personen unter Immunsuppression nach der Einteilung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI), Personen mit schwer verlaufender Influenza, Personen mit schwer verlaufender COVID-19 und Personen mit Mukoviszidose (zystischer Fibrose), bezüglich eines allergischen Risikos Personen mit Mukoviszidose (zystischer Fibrose) und Personen mit Asthma bronchiale. Die rationale Diagnostik beinhaltet die Anamnese, eine körperliche Untersuchung, eine konventionelle Allergiediagnostik einschließlich gegebenenfalls Provokationstests. Zum Vorgehen bei Schimmelpilzinfektionen wird auf die entsprechenden Leitlinien verwiesen. Hinsichtlich der Mykotoxine existieren zurzeit keine brauchbaren und validierten Testverfahren, die in der klinischen Diagnostik eingesetzt werden könnten. Präventivmedizinisch ist wichtig, dass Schimmelpilzbefall in relevantem Ausmaß aus Vorsorgegründen nicht toleriert werden darf. Zur Beurteilung des Schadensausmaßes und zum Vorgehen wird auf den „Schimmelpilzleitfaden“ des Umweltbundesamtes verwiesen.

This article is an abridged version of the updated AWMF mould guideline "Medical clinical diagnostics in case of indoor mould exposure - Update 2023", presented in July 2023 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft fur Hygiene, Umweltmedizin und Praventivmedizin, GHUP), in collaboration with German and Austrian scientific medical societies, and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. There is no evidence for a causal relationship between moisture/mould damage and human diseases, mainly because of the ubiquitous presence of fungi and hitherto inadequate diagnostic methods. Sufficient evidence for an association between moisture/mould damage and the following health effects has been established for: allergic respiratory diseases, allergic rhinitis, allergic rhino-conjunctivitis, allergic bronchopulmonary aspergillosis (ABPA), other allergic bronchopulmonary mycosis (ABPM), aspergilloma, Aspergillus bronchitis, asthma (manifestation, progression, exacerbation), bronchitis (acute, chronic), community-acquired Aspergillus pneumonia, hypersensitivity pneumonitis (HP; extrinsic allergic alveolitis (EEA)), invasive Aspergillosis, mycoses, organic dust toxic syndrome (ODTS) [workplace exposure], promotion of respiratory infections, pulmonary aspergillosis (subacute, chronic), and rhinosinusitis (acute, chronically invasive, or granulomatous, allergic). In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitization prevalence of 3-22,5 % in the general population across Europe. Limited or suspected evidence for an association exist with respect to atopic eczema (atopic dermatitis, neurodermatitis; manifestation), chronic obstructive pulmonary disease (COPD), mood disorders, mucous membrane irritation (MMI), odor effects, and sarcoidosis. (iv) Inadequate or insufficient evidence for an association exist for acute idiopathic pulmonary hemorrhage in infants, airborne transmitted mycotoxicosis, arthritis, autoimmune diseases, cancer, chronic fatigue syndrome (CFS), endocrinopathies, gastrointestinal effects, multiple chemical sensitivity (MCS), multiple sclerosis, neuropsychological effects, neurotoxic effects, renal effects, reproductive disorders, rheumatism, sick building syndrome (SBS), sudden infant death syndrome, teratogenicity, thyroid diseases, and urticaria. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 ( Aspergillus fumigatus , A. flavus ) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, water activity, temperature and above all the growth substrates. In case of indoor moisture/mould damage, everyone can be affected by odor effects and/or mood disorders. However, this is not an acute health hazard. Predisposing factors for odor effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly regarding infection risk are immunocompromised persons according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission fur Krankenhaushygiene und Infektionspravention, KRINKO) at the Robert Koch-Institute (RKI), persons suffering from severe influenza, persons suffering from severe COVID-19, and persons with cystic fibrosis (mucoviscidosis); with regard to allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma must be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections, the reader is referred to the specific guidelines. Regarding mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medical point of view, it is important that indoor mould infestation in relevant magnitudes cannot be tolerated for precautionary reasons. For evaluation of mould damage in the indoor environment and appropriate remedial procedures, the reader is referred to the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).

Im Jahr 2016 wurde in Deutschland die AWMF-S2k-Leitlinie "Medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen" eingeführt. Die Leitlinie basiert auf einem standardisierten Verfahren der AWMF einschließlich einer systematischen Literaturrecherche unter Einbeziehung mehrerer medizinischer Fachrichtungen. Da die AWMF zur Aufrechterhaltung einer Leitlinie eine regelmäßige Aktualisierung vorgibt, hat die Expertengruppe eine erneute Literaturrecherche vorgenommen und die Leitlinie aktualisiert. Die neue Medline-Recherche für die aktuelle Version der Leitlinie wurde bis Juni 2022 mit zusätzlichen Suchbegriffen durchgeführt. Die Suchergebnisse wurden durch ein Abstract-Screening und ggf. die evidenzbasierte Auswertung der Volltexte bewertet und weiter eingegrenzt. Darüber hinaus wurden die medizinischen Leitlinien zu verwandten Themen berücksichtigt. Seit Oktober 2023 liegt die aktualisierte Leitlinie vor.

Background: In the clinical setting, surface disinfection is an important measure to reduce the risk of cross transmission of micro-organisms and the risk of nosocomial infections. Standardized methods can be used to evaluate disinfection procedures, as well as the effectiveness of the active ingredients used for disinfection. However, despite standardization, the results of such methodologies are still determined by several factors, and incorrect results may lead to invalid assumptions about the effectiveness of a disinfectant, posing significant health risks for patients and health personnel. Aim: The objective of this study was to evaluate several determinants for the recovery of Pseudomonas aeruginosa and other test organisms to establish their influence on the results of standardized disinfection methodologies, and to find Gram-negative strains that can be used as suitable replacements for P. aeruginosa. Methods: The effects of inoculum application method, drying time, temperature and carrier material on the survival and recovery of the test organisms were evaluated using Student's t-test, one-way analysis of variance and Tukey's multiple comparison test. Findings and conclusions: Temperature, drying time, application method and carrier material were found to affect the recovery of P. aeruginosa cells significantly, and therefore influence the outcome of the methodologies used. This study also showed that P. aeruginosa could be replaced with the Gram-negative species Acinetobacter baumannii, a test organism used in many standardized methodologies, which responds better under the same circumstances and has a behaviour similar to that of P. aeruginosa in disinfectant efficacy tests. (c) 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Background: Respiratory syncytial virus (RSV) is known as a major cause of respiratory tract infection in adults and children. Human-to-human transmission occurs via droplets as well as direct and indirect contact (e.g. contaminated surfaces or hands of medical staff). Therefore, applicable hygiene measures and knowledge about viral inactivation are of utmost importance.Aim: To elucidate the disinfection profile of RSV.Methods: The study evaluated the virucidal efficacy of oral rinses specifically designed for children, World Health Organization (WHO)-recommended hand-rub formulations, and ethanol, as well as 2-propanol against RSV in a quantitative suspension test (EN14476). The stability of RSV on stainless steel discs was assessed and its inactivation by different surface disinfectants (EN16777) investigated. Findings: All tested oral rinses except one reduced infectious viral titres to the lower limit of quantification. The two WHO-recommended hand-rub formulations as well as 30% ethanol and 2-propanol completely abolished the detection of infectious virus. Infectious RSV was recovered after several days on stainless steel discs. However, RSV was efficiently inactivated by all tested surface disinfectants based on alcohol, aldehyde, or hydrogen peroxide.Conclusion: Oral rinses, all tested hand-rub formulations as well as surface inactivation reagents were sufficient for RSV inactivation in vitro.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Hypervirulent Klebsiella pneumoniae strains (hvKp) can cause invasive community-acquired infections in healthy patients of all ages. In this study, the prevalence of putative hvKp in a German tertiary center was investigated and hvKp were characterized by phenotypic and molecular assays. All K. pneumoniae isolates in routine microbiological diagnostics from a single center were screened by string-testing over a period of 6 months. String-test positive (≥ 0.5 mm) isolates were re-evaluated on different media and under various conditions (aerobe, anaerobe). For string-test positive isolates, genes (magA, iutA, rmpA and rmpA2) associated with hypermucoviscosity and hypervirulence were amplified by multiplex PCR. PCR-positive isolates were subjected to whole-genome sequencing and sedimentation and biofilm formation assays. From 1310 screened K. pneumoniae isolates in clinical routine 100 isolates (7.6%) were string test positive. From these, 9% (n = 9) were defined as putative hvKp (string-test+/PCR+). Highest rate of string-test-positive isolates was observed on MacConkey agar under aerobic conditions. Amongst these nine putative hvKp isolates, the international lineage ST23 carrying hvKp-plasmid pKpVP-1 was the most common, but also a rare ST86 with pKpVP-2 was identified. All nine isolates showed hypermucoviscosity and weak biofilm formation. In conclusion, 9% of string-positive, respectively 0.69% of all K. pneumoniae isolates from routine were defined as putative hypervirulent. MacConkey agar was the best medium for hvKp screening.

Background: Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis, and mainly transmitted via faecal-oral contamination or consumption of contaminated food products. However, limited data on the surface stability and HEV sensitivity to chemical disinfectants are available. Aim: To establish an HEV-based carrier assay to evaluate its surface stability and the virucidal activity of nine surface disinfectants. Methods: A recently developed robust HEV-3 cell culture system for an HEV-based carrier assay. Findings: Alcohol-based disinfectants were insufficient to eliminate HEV infectivity, whereas disinfectants based on aldehyde, peracetic acid, oxygen, and/or quaternary ammonium inactivated HEV. Conclusion: These findings have strong implications for the recommendation of evidence-based hygiene guidelines to reduce HEV transmission. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Da standardisierte mikrobiologische Kulturen von Punktionsflüssigkeiten und Gewebeproben bei implantatassoziierten Infektionen oft keinen Erregernachweis ergeben, werden Sonikation und „polymerase chain reaction“ (PCR) heute zusätzlich methodisch eingesetzt. Erregerspektren und bisherige mikrobiologische Standards werden mit den neuen Methoden Sonikation und PCR auf Übereinstimmung der Ergebnisse untersucht. In dieser deskriptiven, retrospektiven Beobachtungsstudie wurden die Daten von 133 Patienten ausgewertet, bei denen während einer Revisionsoperation mit Verdacht auf eine implantatassoziierte Infektion eine Gelenkprothese, Osteosynthesematerial oder ein Spacer entfernt und zur Sonikation eingeschickt wurde. Ein Erregernachweis wurde mittels Kultur von periimplantärem Material in 40,1 % und mittels Sonikation in 42,5 % erbracht. Jeweils am häufigsten wurden Koagulase-negative Staphylokokken (KNS) nachgewiesen. Insgesamt stimmten die Ergebnisse in 71,7 % der Fälle überein. Bei den diskrepanten Fällen konnten durch die Sonikation mehr Anaerobier nachgewiesen werden, und diese insbesondere bei Osteosynthesematerial und Knieprothesen. PCR-Analysen in 21 Fällen ergaben in 14,3 % einen Erregernachweis und zeigten in 57,1 % bzw. 66,7 % Übereinstimmung mit den Ergebnissen periimplantärer Gewebekultur bzw. Sonikation. Die vorliegenden Ergebnisse weisen auf einen Sensitivitätsgewinn der Sonikation insbesondere für schwer anzüchtbare Anaerobier und einen Spezifitätsgewinn durch die Sonikation hin. PCR-Analysen sollten speziellen Fragestellungen vorbehalten sein.

Einleitung Die Bildung von bakteriellem Biofilm auf Cochlea Implantaten kann zu therapierefraktären Infektionen führen wie chronischen Hautekzemen im Bereich des Sprachprozessors. Wenig ist bekannt über dessen spezifische Morphologie auf Cochlea Implantaten. Im Rahmen dieser Untersuchung wurde der bakterielle Biofilm sowohl auf dem Implantat als auch auf dem Sprachprozessor quantifiziert und mittels Raster-Elektronenmikroskopie dargestellt.