Antimicrobial Resistance & Infection Control

Background: workforce innovative solutions are warranted to respond to the critical global lack of healthcare professionals and sustain delivery of quality patient care. The Patient Care Technician program was one of the strategies implemented to address this challenge by developing a timely pool of workforce who can take non-complex tasks, alleviating workload on other professionals such as registered nurses. However, since this strategy was recently introduced, its implementation and impact on the delivery of care have not yet been sufficiently investigated. Objectives: This study examines the motivations, experiences, and career aspirations of patient care technician students, alongside program providers perceptions and challenges in program delivery. Design & Methods: A qualitative phenomenological study was conducted at three institutions in Western Saudi Arabia, including two tertiary hospitals and a university. Semi-structured interviews were conducted with 27 participants; students, lecturers, preceptors, and management staff. Policy documents were also analyzed, and data were examined using Colaizzis seven-step method. Findings: Four key themes emerged: (1) reconciling motivations and influences, (2) training dynamics, (3) career advancement, and (4) navigating acceptance. patient care technician students often felt overqualified for their roles, leading to dissatisfaction and career redirection. The programs effectiveness was hindered by unclear career pathways and the need for greater cultural sensitivity. Conclusions: Recruiting bachelors degree graduates for patient care technician students roles may be inefficient, as these positions could be filled by lower-degree holders, potentially reducing costs. Implications: To enhance workforce stability, healthcare policymakers should establish clear career pathways, align job roles with educational qualifications, and adapt the program to local cultural and professional expectations. Addressing these issues can optimize the roles of patient care technician students within the healthcare system and serve as a model for similar workforce strategies globally.

Antimicrobial resistance (AMR) in ESKAPE pathogens represents a major global health threat. Although these organisms are well established as causes of healthcare-associated infections, aquatic environments may function as reservoirs and transmission pathways for resistance. This systematic review aimed to estimate the prevalence of AMR in ESKAPE pathogens isolated from water and wastewater and to compare resistance patterns with those observed in human clinical isolates. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251020930). PubMed, Embase, and the Cochrane Library were searched to January 14, 2025. Eligible studies were original research reporting antimicrobial susceptibility data for ESKAPE pathogens isolated from both aquatic environmental matrices and clinical samples. Pooled resistance prevalence was estimated using generalized linear mixed models, with heterogeneity assessed using {tau}{superscript 2} and I{superscript 2} statistics and small-study effects evaluated by funnel plots and Eggers test. Of 304 records identified, 18 studies met the inclusion criteria. The pooled overall resistance prevalence was 0.46 (95% CI: 0.36-0.57), with heterogeneity (I{superscript 2} = 98.8%). Resistance was higher in clinical isolates (0.67; 95% CI: 0.55-0.77) than in environmental isolates (0.24; 95% CI: 0.14-0.39), and environmental resistance was greater in effluent-impacted waters than in non-effluent sources. Interpretation is limited by methodological heterogeneity, selective isolation approaches in environmental studies, and imprecision due to small and unevenly distributed samples. Overall, AMR in ESKAPE pathogens remains more prevalent in clinical settings, but aquatic environments, particularly wastewater, represent resistance reservoirs, underscoring the need for standardized methodologies within a One Health framework. Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251020930, CRD420251020930 HighlightsAntimicrobial resistance was higher in clinical isolates than in aquatic isolates. Resistance patterns showed extreme heterogeneity across studies. Effluent-impacted waters showed higher resistance than non-effluent sources. Higher environmental resistance in some classes reflected methodological artifacts.

BackgroundRespiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in children, often leading to hospitalisation in infants. In low-resource settings where routine RSV diagnostics are unavailable, clinical overlap with bacterial pneumonia frequently results in unnecessary antibiotic use, contributing to antimicrobial resistance. ObjectiveTo evaluate the frequency and clinical determinants of antibiotic use among RSV-positive children under two years at a tertiary hospital in Ghana. MethodsThis cross-sectional study was conducted from June to November 2023 at the Department of Child Health, Korle Bu Teaching Hospital. Children with acute respiratory illness were enrolled and tested for RSV using molecular point-of-care and reverse transcriptase-polymerase chain reaction methods. Antibiotic use and clinical characteristics were analysed among RSV-positive cases. ResultsOf 128 children enrolled, 72 (56.2%) tested positive for RSV. Among these, 48 (66.7%) received antibiotics. Antibiotic use was significantly associated with markers of disease severity, including hypoxia (p = 0.009), tachypnea (p = 0.015), dyspnea (p < 0.001), and hospital admission (p < 0.001). Only 11 (23%) had suspected or confirmed bacterial co-infections. ConclusionA substantial proportion of RSV-positive children received antibiotics. These findings underscore the importance of antimicrobial stewardship programs, rapid diagnostics, and preventive interventions, such as maternal RSV vaccination. Strengthening diagnostic capacity and clinical decision-making in pediatric care is crucial for reducing inappropriate antibiotic use and addressing antimicrobial resistance in low-resource settings.

Sepsis caused by drug-resistant pathogens remains a major contributor to under-five mortality in low- and middle-income countries, threatening progress toward Sustainable Development Goal (SDG) 3.2. Blood culture, the gold standard for sepsis diagnosis and antimicrobial stewardship, remains underutilised in routine pediatric care. This study assessed the extent and determinants of blood culture utilisation among hospitalised children under five years with suspected sepsis at four antimicrobial resistance (AMR) surveillance sites in Uganda. We conducted a cross-sectional mixed-methods study involving retrospective review of 384 pediatric patient records and in-depth interviews with 20 clinicians. Modified Poisson regression was used to identify factors associated with blood culture requests, while thematic analysis explored behavioral and contextual influences on diagnostic practices. Blood cultures were requested in 28.1% of suspected sepsis cases. Higher utilisation was independently associated with markers of clinical severity, including severe acute malnutrition (adjusted prevalence ratio [aPR] 1.3, 95% CI: 1.14-1.34), sickle cell disease (aPR 1.3, 95% CI: 1.19-1.40), and presence of WHO danger signs (aPR 1.1, 95% CI: 1.00-1.14). Senior clinician involvement (aPR 1.2, 95% CI: 1.08-1.32) and consultant review (aPR 1.4, 95% CI: 1.21-1.48) were also associated with higher use, while prior antibiotic exposure reduced the likelihood of blood culture request (aPR 0.9, 95% CI: 0.84-0.96). Qualitative findings identified four overarching themes influencing diagnostic behavior: motivation amid systemic constraints, institutional and environmental barriers, mentorship and teamwork, and emotional fatigue in the context of adaptive practices. Despite high clinician awareness, blood culture utilisation remains low, driven primarily by health system fragility, inefficient workflows, and emotional exhaustion rather than knowledge gaps. Improving utilisation will require integrated behavioral, workflow, and structural interventions, including clinical decision support and strengthened microbiology laboratory capacity, to enhance pediatric sepsis care, antimicrobial stewardship, and progress toward SDG 3.2.

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

BackgroundThe never-ending emergence of superbugs casts a shadow over the victorious age of antibiotics. In fact, the triumph of antibiotics was previously viewed in retrospection as our final victory over bacteria. Bacteria like Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli are now raising an alarming number of infections across hospitals and communities around the globe. The objective was to evaluate the implications for antimicrobial stewardship based on identifying the antibiotic resistance profiles, genotype mechanisms, and trends in common pathogenic bacteria found in various hospitals across Iraq. MethodsWe used a two-fold approach that was comprehensive in scope and involved both efficient multicenter surveillance as well as cutting edge genetic analysis to unravel the complex topography of antibiotic resistance. We provided a geographically heterogeneous but diverse set of clinically obtained isolates to participate in hospitals for a period of 24 months and concentrated our efforts on prioritized pathogens K. pneumoniae, A. baumannii, E. coli, P. aeruginosa, and S. aureus that are well known to pose serious threats. Beginning with clinically obtained isolates sourced across the entire globe, we used standardized techniques such as broth microdilution to first undertake phenotyping in a central reference lab to establish microbial identity based on resistance phenotypes to a set of prioritized antibiotics that include carbapenems, third generation cephalosporins, or fluoroquinolones. Finally, we derived data concerning the emergence patterns and geographic distribution of resistant microbes such as MRSA or CRE. We used genome-wide sequencing to unlock information concerning the genetic blueprints for a set of specifically chosen isolates based on their representational diversity across geographic locales, resistance phenotypes, and specific times. ResultsThe sample was made up of Escherichia coli (n = 225), Klebsiella pneumoniae (n = 185), Staphylococcus aureus (n = 135), Pseudomonas aeruginosa (n= 90), and Acinetobacter baumannii (n = 125). Ceftriaxone resistance was found in 80.4% of E. Coli, ciprofloxacin resistance in 45.6%, and meropenem resistance in 15.1%. K. pneumoniae exhibited 38.9% resistance to aminoglycosides and 70.2% resistance to carbapenems. The percentage of MRSA in S. aureus was 55.5%. P. aeruginosa showed 22.2% resistance to colistin, 37.8% resistance to piperacillin tazobactam, and 50.0% resistance to ceftazidime. Imipenem resistance was found in 85.6% of A. baumannii isolates, whereas colistin resistance was found in 28.8% of isolates. In all, 3.4% of isolates are pan-drug-resistant (PDR), 14.6% are extensively drug-resistant (XDR), and 52.1% are multidrug-resistant (MDR). WGS identified common genes such bla_NDM-1, bla_OXA-48, mcr-1, aac (6)-Ib, and plasmid replicons IncF, IncL/M, and IncI2. Carbapenem resistance in Gram-negative bacteria rose by around 18% over the course of five years. ConclusionsThis study shows that the rapid spread of complex genetic information in bacteria causes antibiotic resistance problems. High-level resistance represents an expected consequence of the spread of resistance genes and successful bacteria within healthcare systems. We demonstrate in our results that our expertise in overcoming resistance at a molecular level will play a crucial role in combating infectious diseases in the coming years.

From 2021 to 2025, MRSA emerged as a major multidrug-resistant pathogen in the study area. Among 545 S. aureus isolates, 67.2% were MRSA, disproportionately affecting children under five (26.5%) and males (55.5%). Case incidence more than doubled by 2025, suggesting rising transmission or resistance. Most isolates were hospital-associated (85.2%), predominantly from outpatients (88.5%), with middle ear discharge as the main source (67%). Gentamicin showed the highest susceptibility (72.1%), while penicillin G resistance was nearly universal (96.7%). The majority (93.4%) were multidrug-resistant, with high MARI values indicating widespread and likely inappropriate antibiotic use. These findings reflect a complex interplay between pathogen behavior, antimicrobial use, and healthcare practices. Increasing MRSA burden may stem from inadequate infection control, poor stewardship, or enhanced community transmission. Incorporating molecular typing could deepen understanding of strain diversity and resistance mechanisms to guide targeted interventions

ObjectivesDiagnosis of community-acquired Legionnaires disease (CALD) relies on microbiological testing. Routine testing in hospitalised CAP patients has low positivity rates. We externally validated a Legionella prediction score, assessed its applicability in routine care, and explored potential updates. MethodsWe analysed data from 196 CALD patients from 20 Swiss hospitals and 196 Legionella-negative CAP controls matched by date of diagnosis ({+/-}14 days; August 2022-March 2024). We assessed the availability of the original score predictors (fever, no/dry cough, hyponatremia, elevated CRP, elevated LDH, low platelet count) in routine care and the original scores discriminative performance. The dataset was split into development and validation cohorts to evaluate whether simplifying modifications improved predictive performance. ResultsThe original score showed 91% (95% CI: 86-96%) sensitivity and 35% (95% CI: 28-42%) specificity at a cut-off [&ge;]2; LDH was infrequently measured, and platelet count was a poor predictor. The simplified SwissLEGIO score (fever >38{degrees}C, sodium <133 mmol/L, CRP >180 mg/L, no/dry cough, prior {beta}-lactam therapy) maintained high sensitivity (88-92%) and showed improved specificity (46-58%) at cut-off [&ge;]2. ConclusionThe SwissLEGIO score is an easy-to-apply screening tool to rule out CALD in hospitalised CAP patients with scores <2 and may reduce testing by 36-52% at a CALD prevalence of 4%.

This systematic review and meta-analysis aimed to evaluate the effectiveness of relaxation interventions on anxiety, depression, stress, and quality of life in women with infertility. A comprehensive search of PubMed, OVID MEDLINE, CINAHL(R), Google Scholar, and Korean databases was conducted for articles published through March 2025. Keywords included combinations of terms related to infertility, ART, and nursing or psychotherapeutic interventions. The search identified 759 records, of which 13 met the eligibility criteria. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data analysis was performed using R software (version 4.3.2). The meta-analysis included 10 randomized controlled trials (RCTs) and three non-randomized controlled trials (NRCTs), comprising 1,215 women undergoing ART. Intervention groups received relaxation programs, while comparison groups received usual care or no intervention. Relaxation interventions were associated with significant reductions in anxiety (Hedges g = -0.69) and depression (Hedges g = -0.38), and significant improvements in quality of life (Hedges g = 0.25). No statistically significant effect was observed for stress (Hedges g = -0.01; 95% CI: -0.49 to 0.47). Heterogeneity and risk of publication bias were determined to be low. Overall, relaxation programs demonstrated beneficial effects on anxiety, depression, and quality of life, but not on stress levels. Relaxation interventions appear to support the psychological well-being of women undergoing ART, with particular benefit for women with a history of repeated treatment failure. Individualized, woman-centered approaches may be more responsive to the needs of this population than universal or group-based models of care.

BackgroundMedical oxygen is an essential medicine that is often unavailable for patients when they need it. We explored if Outsourced Oxygen to the Bedside (O2B) pilots, where private providers deliver a package of services, were successful in ensuring reliable oxygen access at the patient bedside. MethodsWe conducted a sequential explanatory mixed-methods assessment of O2B pilots in Kenya, Nigeria, India, Tanzania, and Uganda from September 2024 - January 2025. A quantitative cross-sectional facility audit described facility contexts, tested equipment functionality and assessed healthcare worker (HCW) oxygen knowledge. Qualitative interviews with HCWs and managers explored experiences of O2B pilots. ResultsWe studied 28 of the 80 facilities participating in the pilots, 179 HCWs completed the knowledge survey, and 59 qualitative interviews were conducted. In the audit, we found O2B provided oxygen equipment more functional and usable than non-O2B equipment: 49.0% vs 30.1% (p-value<0.001) for cylinders, 82.9% vs 20.3% (p-value<0.001) for concentrators, and 84.0% vs 70.0% (p-value=0.172) for pulse oximeters. Overall, 21.8% (39/179) of HCWs had received training from O2B providers, and their oxygen knowledge was slightly higher than those who had not (mean score 15.3/24 vs 13.9/24, p-value=0.002). Qualitative interviews highlighted positive changes in oxygen access and the ability to treat patients, but also mixed understandings of the O2B services being provided, and requests for additional services. ConclusionO2B pilots appear to improve medical oxygen access, with effective maintenance and repair services being a key mechanism. However, tailoring to local needs and remaining gaps in HCW capacity need to be addressed.

The global nursing workforce is aging, yet limited research has explored the lived experiences of never married nurses entering midlife and later adulthood. Existing studies have primarily focused on burnout and retention, with less attention to the social and existential dimensions of aging without a spouse or children. This study aimed to explore the experiences of never married clinical nurses aged 40 years and older, focusing on perceptions of aging, professional identity, social support, and future security. A qualitative descriptive design was employed. Twenty-five never married nurses aged 44-62 years were recruited through purposive sampling from intensive care, emergency, medical, surgical, oncology, outpatient, and community departments across four government hospitals. Semi-structured interviews were conducted and analyzed using reflexive thematic analysis. Trustworthiness was ensured through member checking, peer debriefing, and maintenance of an audit trail. Four themes were identified: Nursing as a Life Anchor, where professional identity provided meaning and structure; Independence Coexisting with Loneliness, reflecting autonomy alongside episodic loneliness; The Invisible but Available Workforce, describing expectations of greater work availability due to single status; and Anticipating an Uncertain Future, capturing concerns about retirement, declining health, and limited advocacy in later life. Never married aging nurses experience a complex balance of professional fulfillment, autonomy, vulnerability, and uncertainty. Healthcare organizations should recognize this subgroup and consider equitable workload policies, tailored retirement planning, and psychosocial support to promote well-being and workforce sustainability.

Compassion fatigue is a well-documented hazard among healthcare and veterinary professionals, yet the psychological toll on informal caregivers of feral cat colonies, likely numbering several tens of thousands in Portugal, remains largely unexplored. This cross-sectional study examines internal and external factors associated with the secondary traumatic stress component of compassion fatigue among 172 informal caregivers in Portugal. Secondary traumatic stress refers to work-related secondary exposure to individuals who have experienced extremely stressful or traumatic events. Structured telephone interviews assessed sociodemographics, colony management, compassion satisfaction, resilience, spiritual well-being, and perceived social support. Univariate and multivariable linear regression identified predictors of compassion fatigue. Results indicate that 47% of participants experienced moderate compassion fatigue, and 10% reported high levels. Multivariable analysis revealed that caring for large colonies (more than 25 cats) and being unemployed were significantly associated with higher fatigue. Conversely, older age, higher perceived family support, and the resilience dimension of serenity served as protective factors. Interestingly, finding meaning in life was positively correlated with fatigue, suggesting that caregivers who perceive their role as central to their life purpose may become more emotionally invested, increasing vulnerability to distress when unable to help animals. Official colony registration and formal institutional support did not significantly alleviate fatigue. These findings highlight that institutional support alone is insufficient to mitigate fatigue among informal caregivers, who experience significant distress driven by both practical burdens and profound emotional involvement. The most frequently reported concern among caregivers was the inability to cover the costs of feeding and veterinary care for the cats. Interventions must address both external needs (e.g., support to cover veterinary and feeding expenses for the cats) and internal coping mechanisms. Implementing psychosocial support alongside trap-neuter-return programs may also improve caregiver well-being and foster sustainable urban feral cat management. This underscores a One Health perspective, demonstrating that animal health is closely interconnected with human well-being and environmental health.

BackgroundKlebsiella pneumoniae is a common cause of neonatal sepsis in Africa, and is frequently hospital acquired. We recently reported an outbreak of multidrug-resistant K. pneumoniae sepsis amongst neonates at a rural hospital in The Gambia, West Africa, involving 57 cases and case fatality of 60%. Here we undertook a retrospective pathogen genomic epidemiology study of clinical and environmental K. pneumoniae isolated during the outbreak, to identify the outbreak strain, refine the epidemic curve, confirm the environmental sources of contamination, monitor control of the outbreak, and characterise the outbreak strain in the context of the local and global pathogen population. Methods and FindingsWe sequenced all blood culture isolates identified as K. pneumoniae from patients aged 0-59 months (n=51 available, 77% from neonates), together with K. pneumoniae cultured from environmental samples during the outbreak investigation (n=16), and 56 stored blood culture surveillance isolates available from the previous decade (34 from neonates). Sequencing was performed using Oxford Nanopore Technologies (ONT) Mk10 flowcells and a PromethION instrument, yielding mostly complete genomes (79%). Genomic analysis revealed 23% of isolates were K. quasipneumoniae and identified the outbreak strain as K. pneumoniae ST39 with capsular (K) locus KL62. This strain was responsible for 29 cases (16 fatalities) and was identified in three samples of intravenous fluids collected from the neonatal ward during the investigation. It harboured a [~]187 kbp IncF plasmid carrying the extended-spectrum beta-lactamase (ESBL) gene blaCTX-M-15 and aac(3)-IId, encoding resistance to third-generation cephalosporins and gentamicin, respectively. The outbreak strain was not identified amongst historical surveillance isolates, and it was distinct from a KL23-ST39 strain responsible for an earlier outbreak at the Sir Edward Francis Small Teaching Hospital in Banjul, the countrys capital 7 years prior. Comparing the outbreak strain with publicly available genome data for ST39 and its associated sublineage (SL) 39, we observed SL39 has diversified into three common clonal groups, each associated with multiple K types, that have spread across Africa, Asia and Europe and have been associated with outbreaks of neonatal sepsis in Africa and elsewhere. We find SL39 is typically multidrug resistant, however the specific ESBL and carbapenemase genes vary by geographic location. ConclusionsPathogen whole-genome sequencing refined our understanding of the outbreak, allowing more precise identification to refine case numbers and case fatality calculations, and for precise identification of multi-use intravenous fluid bags as the source of the outbreak despite other samples being culture-positive for unrelated K. pneumoniae. This highlights the importance of infection prevention and control in reducing neonatal fatalities in low-resource settings, and the critical risk associated with multi-use reagents and equipment when caring for vulnerable neonates. The genomic analysis enabled us to identify and characterise the outbreak strain at high resolution, and together with global data highlights SL39 as an emerging high-risk multidrug-resistant, globally distributed clone of K. pneumoniae, capable of sustained transmission and high fatality.

IntroductionAccess to medical oxygen remains a challenge, with 60% of the worlds population lacking access to quality oxygen services. We explored whether outsourced oxygen to the bedside (O2B), where private providers offer bundles of oxygen services, could be adopted and scaled across diverse health systems, to improve patient access to oxygen. MethodsQualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeria, Tanzania, Kenya and Uganda, who had taken part in an O2B pilot. Interviews were conducted between 19th November 2024 and 25th January 2025, and explored the feasibility, fidelity, acceptability, perceived benefits and weaknesses of five O2B models. Analysis used a pragmatic codebook approach, with inductive and deductive coding, informed by implementation science frameworks. ResultsWe conducted 59 interviews, with managers and HCWs from 20 health facilities. We identified five themes relating to the potential for O2B pilots to be adopted within the health system: effect on oxygen culture, feasibility of whole of facility solutions, promotion of local ownership, being willing but unsure about the ability to pay, and the desire for hybrid tailored service models. HCWs and facility staff raised several positive factors within these themes but highlighted that understanding local facility needs and tailoring the services to embed within existing structures were important for sustainability. ConclusionOverall, the O2B service approach shows potential for implementation beyond the pilots, but more understanding of how to optimize service delivery packages to different facility needs, while also prioritizing affordability is needed.

Good leadership is a crucial aspect for a good primary healthcare system and for enhancing patient health outcomes. This qualitative exploratory study sought to explore the leadership role played by family medicine registrars in bedside teaching at Mangochi District Hospital and Nkhoma Mission Hospital in Malawi. Focus group discussions were held with healthcare workers who worked under the registrars, and the data was analyzed qualitatively using inductive and deductive analysis. From the study, it was established that the registrars have good clinical leadership skills, including working in collaboration, mentorship, ethical behavior, flexibility, and resourcefulness. However, the effectiveness of the leadership role is limited by a lack of clear role boundaries, mentorship, limited participation in system decision-making, and a lack of feedback. The family medicine registrars demonstrated high levels of interpersonal and professional competencies, which have a high potential for improving leadership roles. The study has provided useful insights on how the leadership training in the Master of Family Medicine course at Kamuzu University of Health Sciences (KUHeS) can be improved.

Emergency nursing is essential to healthcare systems worldwide. Triage plays a pivotal role in emergency nursing, prioritizing patients based on the urgency of their medical condition and focusing on rapid assessment and prioritization of patient care according to their condition and its severity. In the emergency department, the triage nurse assesses vital signs and gathers information from the patient to determine the severity of their condition. This aims to provide appropriate medical intervention quickly for life-threatening cases and minimize waiting times for less critical cases, thus contributing to the efficient allocation of scarce resources. Our study aimed to evaluate the triage knowledge, skills, and practices of emergency nurses in Mafraq, Jordan. MethodsA cross-sectional study used a previously validated questionnaire. Fifty emergency nurses from two public and one private hospital in Mafraq participated. We collected data through an online survey then analyzed in SPSS. Results92% of nurses had sufficient triage knowledge ([&ge;]60%), while 14% exhibited deficient triage skills (<60%) and 86% had moderate skills (60-80%). Regarding practices, 32% rated as "poor" (<60%) and 68% as "adequate" (>60%). Length working in emergency, hospital type significantly related to nurses triage knowledge, skills, and practices. ConclusionThe study underscores continual trainings, simulation programs and mentorships importance for enhancing emergency nurses triage knowledge, skills, especially in rural settings. Implementing clear triage protocols, continuous support and integrating triage competencies into curricula are recommended to improve overall triage competency

BackgroundTyphoid fever incidence estimates are central to policy decisions on vaccine introduction and investments in non-vaccine prevention and control but are often unavailable. We explored whether prevalence metrics from sentinel studies of community-onset bloodstream infections could accurately predict local Salmonella Typhi (S. Typhi) incidence. MethodsUsing a previous systematic review (January 2018-December 2024), we identified studies reporting both typhoid incidence and prevalence of community-onset bloodstream infections from sentinel sites. From authors, we requested data on blood culture isolates and analysed four metrics: (i) S. Typhi prevalence among probable pathogens, (ii) S. Typhi rank order, (iii) S. Typhi to Escherichia coli ratio, and (iv) S. Typhi to stably endemic organisms ratio. Typhoid incidence was categorized as low (<10), medium (10-100) or high (>100) per 100,000 person-years. We used univariate ordinal regression to assess the association between each metric and typhoid incidence level. The model performance was evaluated by the c-statistic, sensitivity, and specificity. FindingsAnalysis of 29 study sites (20 Africa, 9 Asia) yielded 4,625 probable pathogens. The median (IQR) typhoid incidence was 140 (28-319) per 100,000 person-years. All metrics were associated with increased typhoid incidence level: for each 1% increase in S. Typhi prevalence OR 1.07 (95%CI 1.02-1.15); rank order OR 0.25 (95%CI 0.06-0.64); log S. Typhi to E. coli ratio OR 2.91 (95%CI 1.45-7.42); log S. Typhi to stably endemic organisms ratio OR 3.69 (95%CI 1.69-11.3). A parsimonious model using S. Typhi prevalence alone achieved c-statistics of 0.87 (0.58-0.97), 0.76 (0.51-0.91), and 0.88 (0.69-0.96) for low, medium, and high incidence, respectively. InterpretationSentinel prevalence metrics from bloodstream infections, particularly S. Typhi prevalence among probable pathogens, could be useful for inferring local typhoid fever incidence where direct data are unavailable. FundingGates foundation Research in contextO_ST_ABSEvidence before this studyC_ST_ABSGlobally, annual deaths from typhoid fever were estimated at 71,954 (95% uncertainty interval 38,051 to 118,560) in 2023. Typhoid conjugate vaccines (TCV) are recommended for regions with high typhoid incidence. Implementation, however, can be challenging due to a lack of local incidence data. Generating community incidence estimates requires expensive and time-consuming large prospective or hybrid surveillance studies, or novel techniques such as serology or environmental surveillance. Our previous study proposed that metrics from sentinel healthcare facilities such as the prevalence of Salmonella Typhi (S. Typhi) among all bloodstream pathogens or its rank order relative to other pathogens could serve as proxy for community incidence. However, contemporaneous incidence and prevalence data from the same time and location were limited in our previous study. To explore typhoid incidence estimation strategies, we searched PubMed and MEDLINE on January 8, 2026 with search terms including keywords of "typhoid fever", "incidence", and "prediction" without restrictions to language or publication date. Previous studies estimated incidence based on complex country-level covariates and disease modelling that lack ease of applicability for policy decisions. Recognising the need for pragmatic tools, we explored whether prevalence metrics from sentinel studies of community-onset bloodstream infections could accurately predict local S. Typhi incidence. Added value of this studyOur study was based on typhoid incidence studies that had available data for isolates of bloodstream infections. Of 29 sites across Africa and Asia with 4,625 probable pathogens, we found that all four sentinel metrics were significantly associated with typhoid incidence level. We demonstrated that a parsimonious model using S. Typhi prevalence alone achieved good discriminative performance in identifying high incidence settings. Implications of all the available evidenceWhen typhoid incidence estimates are unavailable, prevalence metrics from sentinel studies of community-onset bloodstream infections could help policymakers infer typhoid incidence and optimise resource allocation in water, sanitation, and hygiene, and TCV introduction.

BackgroundHospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP), particularly those caused by multi-drug resistant organisms (MDROs), often require newer antibiotic treatment. The efficacy and safety of newer antibiotics compared to generic antibiotics in randomized controlled trials (RCTs) have not been evaluated before. MethodsIn this systematic review, we searched RCTs in the United States National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Ovid MEDLINE, Clinical Trials.gov and Google Scholar databases published between 2013 and 2025. The primary efficacy endpoint was 28-day all-cause mortality. Secondary efficacy endpoints were clinical and microbiological response. Safety endpoint was nephrotoxicity. ResultsWe identified eight eligible RCTs involving 2,881 patients (1,450 patients treated with newer antibiotics and 1,431 patients treated with generic antibiotics) with HABP/VABP. The meta-analysis did not reveal any significant differences between newer and generic antibiotics for all-cause mortality at day 28 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.72-1.30), clinical response (RR 1.04, 95%CI 0.93-1.17), and microbiological response (RR 1.05, 95%CI 0.89-1.24). However, newer antibiotics showed significant lower occurrences of nephrotoxicity compared to colistin component (RR 0.30, 95%CI 0.11-0.79). In subgroup analysis, newer antibiotic regimens demonstrated significant improvement in microbiological eradication of carbapenem-resistant Gram-negative bacilli (RR 1.50, 95%CI 1.18-1.90). ConclusionsNewer antibiotics showed similar efficacy and safety in treating HABP/VABP compared to generic drugs. The superiority in microbiological eradication of carbapenem-resistant Gram-negative bacilli of newer antibiotics could suggest that future trials should be targeted for those patients to improve understanding of their therapeutic use and pathophysiology of these conditions. Key pointsNewer antibiotics, despite broader antimicrobial coverage, have not significantly outperformed generic comparators in terms of 28-day all-cause mortality, clinical, or microbiological response in patients with Gram-negative HABP/VABP. This may reflect limitations in current trial designs focused primarily on regulatory approval.

BackgroundDespite widespread recognition that patient safety learning can transcend national boundaries, no international patient safety learning system (PSLS) currently exists. There is no expert consensus on the purpose, key requirements, or feasibility of such a system. ObjectiveTo gain consensus from an international panel of healthcare experts regarding the key requirements and feasibility of a potential international PSLS, with or without an incident reporting function. MethodsA two-round modified online Delphi study was conducted with 21 international healthcare experts in patient safety and learning systems, representing all six continents. The study was informed by a prior systematic literature review and semi-structured key-informant interviews with safety-critical industry experts. Panellists rated statements on a 9-point Likert-like scale. Consensus was defined a priori as [&ge;]70% agreement (ratings 7-9) with an interquartile range (IQR) [&le;]2.00. A post-hoc threshold of [&ge;]80% was applied to identify the strongest areas of consensus. ResultsOf 73 experts invited, 21 completed round one (29% response rate) and 15 completed round two (71% retention). Across two rounds, 103 statements were evaluated; consensus was achieved on 85 (83%) at the [&ge;]80% threshold across all four domains: purposes (15/19 statements); key functions and features (17/22); patient safety incidents and criteria for international concern (19/24 combined); and enablers and challenges (34/38). The panel endorsed a proposed framework for an international PSLS and generated novel consensus-based lists of patient safety incidents and criteria for determining what should be shared internationally. ConclusionsInternational healthcare experts broadly agree on the purposes, key functions, and feasibility of an international PSLS. The consensus-derived framework provides a foundation for future feasibility research and potential pilot implementation. Validation with frontline end-users is an essential next step. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSNational patient safety learning systems vary considerably in design, governance, and the degree to which they generate actionable learning, and no international system currently exists to enable systematic cross-border sharing and learning from patient safety data. What this study addsThis is the first Delphi study to establish international expert consensus on the purposes, key functions and features, and feasibility of an international Patient Safety Learning System (PSLS), producing novel consensus-based lists of patient safety incidents relevant to international sharing and criteria for determining what constitutes a risk of international concern. How this study might affect research, practice or policyThe proposed framework and consensus-derived criteria provide a starting point for feasibility research and potential pilot implementation by organisations such as the World Health Organization (WHO), in alignment with the Global Patient Safety Action Plan 2021-2030. The findings also highlight the structural prerequisites -- including a standardised international taxonomy, governance frameworks, and equitable participation mechanisms -- that must be addressed before implementation can proceed.

BackgroundBehavioral telemetry--the analysis of clinical actions NOT taken--may identify care process failures associated with adverse outcomes. While missed nursing care predicts outcomes in survey-based studies, objective EHR-derived measures are lacking. We hypothesized that missing routine cognitive assessment in ICU patients with low acute physiologic derangement would predict mortality independent of illness severity. MethodsRetrospective cohort study using MIMIC-IV (2008-2022, Beth Israel Deaconess Medical Center) with external assessment of documentation practices in eICU (208 US hospitals). We identified ICU admissions with SOFA 0-2 (low acute physiologic derangement), excluding neurological ICUs. Orientation documentation was classified within 24 hours. Primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, sex, SOFA, and Charlson Index. ResultsAmong 46,004 ICU patients with SOFA 0-2, 4,737 (10.3%) had no orientation documentation within 24 hours. These patients had 24.68% mortality versus 7.57% early-assessed and 4.56% late-assessed. After adjustment, missing orientation was associated with 4.29-fold higher odds of death (95% CI 3.95-4.65; E-value 8.0). In SOFA=0 patients (N=23,670), the signal strengthened (OR 5.65, 95% CI 5.03-6.35; E-value 10.8). Late-assessed patients had the LOWEST mortality (OR 0.65), arguing against reverse causation. Patients without orientation had 22% MORE chart events (1,600 vs 1,309), arguing against neglect. External assessment revealed that among 166 eICU hospitals with [&ge;]100 eligible patients, only 5% documented orientation routinely--92% lack the infrastructure to detect this signal. ConclusionsIn ICU patients with low acute physiologic derangement, absence of orientation assessment is associated with 4-6 fold increased mortality. This association may identify care process failures not captured by severity scores, though prospective studies are needed to establish causality. Key PointsO_ST_ABSQuestionC_ST_ABSDoes absence of routine orientation assessment predict mortality in ICU patients with low acute physiologic derangement (SOFA 0-2), independent of illness severity? FindingsIn this cohort study of 46,004 ICU patients with SOFA 0-2, those without orientation documentation within 24 hours had 4.29-fold higher adjusted odds of death (95% CI 3.95-4.65). In SOFA=0 patients, the signal strengthened to OR 5.65 (E-value 10.8). Patients assessed late (6-24h) had the LOWEST mortality (OR 0.65), arguing against reverse causation. Among 166 eICU hospitals, only 5% document orientation routinely--92% lack the infrastructure to detect this signal. MeaningMissing routine cognitive assessment may identify care process failures associated with increased mortality. The finding that 92% of US ICUs lack the documentation infrastructure to detect this signal reveals a systemic gap in care process monitoring. What is Already Known on This TopicMissed nursing care--care omissions--predicts patient mortality in survey-based studies. Nurse staffing ratios are associated with mortality, but the mechanism is poorly understood. No objective, EHR-derived measure exists to detect care process omissions in real time. What This Study AddsFirst EHR-based operationalization of the missed nursing care construct, enabling objective, real-time detection. Missing orientation assessment associated with 4-6 fold increased mortality (OR 4.29 in SOFA 0-2; OR 5.65 in SOFA=0). Signal strengthens in SOFA=0 patients (E-value 10.8), suggesting finding is not driven by acute illness severity. Argues against reverse causation: late assessment has BETTER outcomes than early or no assessment. Argues against neglect: patients without assessment had MORE documentation, not less. Argues against immortal time bias: Never Documented patients had LONGER ICU stays (7.58 vs 3.09 days). Quantifies association: 10.3% of patients account for 27.2% of deaths. Reveals systemic gap: 92% of US ICUs lack the documentation infrastructure to detect this signal.