Antimicrobial Resistance & Infection Control

Background Peripheral intravenous cannulation is common procedure in neonatal care, yet it carries a significant risk of local complications that can compromise therapy and prolong hospital stay. Understanding the timing and predictors of Peripheral intravenous cannulation related local complications is crucial for improving neonatal outcomes. This study aimed to determine the incidence, timing, and predictors of Peripheral intravenous cannulation related local complications among neonates admitted to public hospitals in the Tigray, northern Ethiopia. Methods A prospective cohort study was conducted among 528 neonates who underwent peripheral intravenous cannulation. Data were collected using structured questionnaires and observational checklists. Neonates were followed for up to 96 hours. Cox proportional hazards regression was used to identify predictors of local peripheral intravenous cannulation related complications, with Kaplan Meier analysis to estimate complication free survival. Model assumption was assessed using Schoenfeld residuals and goodness of fit evaluated by Cox-Snell residuals, with variables showing p < 0.05 in the multivariable model considered statistically significant. Result The overall incidence of local peripheral intravenous cannulation -related complications among neonates was 41%, yielding an overall incidence rate of 8.85 per 1,000 catheter-hours. The median time to complication was 78 hours (95% CI: 67-80). The multivariable analysis identified the following independent predictors: chronic illness (AHR=1.54, 95% CI: 1.15-2.07), absence of saline flushing (AHR =1.83, 95% CI: 1.39-2.41), non-visible veins (AHR =2.07, 95% CI: 1.55-2.76), three or more insertion attempts (AHR =1.85, 95% CI: 1.15-2.98), cannula placement in the leg (AHR =1.84, 95% CI: 1.28-2.64), and cubital fossa (AHR =1.62, 95% CI: 1.10-2.39). Conclusion Local Peripheral intravenous cannulation complications in neonates are common and occur early, particularly among high-risk groups. Intervention such as routine IV-line flushing, careful vein selection, minimizing repeated insertion attempts, and avoiding high risk insertion sites can reduce complications. Close monitoring of neonates with chronic conditions and adherence to cannula replacement guidelines are recommended. Ongoing training for health care providers is essential to improve Peripheral intravenous cannulation care and neonatal outcomes.

BackgroundEmergency obstetrics and newborn care training improves the knowledge and skills of healthcare professionals. However, there is limited evidence on training programs that had been informed by training needs analysis. The aim of the study was to determine training needs of registered midwives to inform a training program. MethodsA descriptive cross-sectional study design was used to collect data from N=202 midwives who worked at two comprehensive emergency obstetrics and neonatal care hospitals. Simple random sampling was used to select respondents. Ethics approval was obtained before conducting the study. Data were collected from November 2023 to January 2024 using an adapted self-administered Hennessy Hicks Training Needs Questionnaire. SPSS version 29 was used to analyze the data. Descriptive statistics, means and standard deviations were calculated. The differences between task importance and task performance were determined for each of the measured items. A paired sample t-test was used to establish the significance of the differences between each of the five category pairs with p=<.05. ResultsThe mean age of the 202 respondents was 38.06{+/-}6.9 years. The midwives predominantly fell into the age group 40-44 years (n=53, 22.2%), and they had an average of 5-9 years of work experience (n=75, 37.1%). Training needs were perceived for all the measured items. The research/ audit category emerged as the highest (M=2.23{+/-}1.05) training need, followed by clinical (1.94{+/-}0.55), administrative (1.70{+/-}1.03), communication (1.57{+/-}0.79) and supervisory tasks (1.14{+/-}0.76). Differences between each of the five category pairs were statistically significant with p=<.05. The highest specific training need was newborn resuscitation (n= 61, 30.2%). ConclusionThe study highlights the need for training on research and clinical tasks. RecommendationTailor training according to the identified needs for the effective management of emergency obstetrics and newborn complications.

Background Antimicrobial stewardship (AMS) and infection prevention and control (IPC) are complementary strategies to improve patient safety and address antimicrobial resistance (AMR). In low- and middle-income countries (LMICs), they are often implemented separately, reducing effectiveness. Evidence on integrating AMS and IPC in routine hospital practice remains limited. Objective To evaluate the feasibility of an integrated AMS-IPC improvement approach and describe changes in implementation in Vietnamese hospitals. Methods We conducted a multisite quality improvement initiative in four hospitals within the national AMR surveillance network in Viet Nam (March-September 2025). We used US-CDC tools to guide the implementation, including the Global Antibiotic Stewardship Evaluation Tool (G-ASET) and the Infection Control Assessment and Response (ICAR) tool. Baseline assessments were followed by feedback, multidisciplinary action planning, and targeted capacity building. Follow-up occurred 2-5 months later. Changes were analysed descriptively using quantitative scores and qualitative synthesis, and reported following the SQUIRE 2.0 guidelines. Results All hospitals had established IPC programmes at baseline, while AMS maturity varied. G-ASET scores improved across all sites, with greater gains in hospitals starting from lower baselines. Key improvements included leadership and governance, education and training, stewardship actions, and monitoring and reporting. IPC practices aligned with AMS priorities also improved, particularly transmission-based precautions, environmental cleaning, and cross-team coordination. Infrastructure-dependent areas, such as water safety, showed limited short-term progress. Conclusions An integrated AMS-IPC approach using repeated assessment and feedback is feasible and associated with meaningful improvements. This model offers a scalable strategy for strengthening hospital responses to AMR in LMICs and informs national programmes.

BackgroundMetronidazole (MTZ) is a first-line antibiotic for several enteric infections. Its use is common in low-income countries, where most primary-care consultations are conducted by nurses. However, increasing resistance among some enteric pathogens is a growing concern. Using WHO guidelines, we conducted a register-based cross-sectional study to assess MTZ prescribing practices and their determinants in public and private primary healthcare facilities in South Benin. MethodsWe performed a register-based cross-sectional study covering the year 2020 in 11 primary healthcare facilities (5 public and 6 private) in Abomey-Calavi, South Benin, following WHO recommendations. In total, 200 visits per facility were selected using systematic random sampling. The primary outcome was the prevalence of MTZ prescription. Determinants of MTZ prescription were identified using multivariable logistic regression analysis. ResultsIn total, 2,200 medical visits were analyzed. The median age of patients was 19 years, and 57% were female. Antimalarials were prescribed in 52% of visits. Antibacterial agents were prescribed in the majority of visits, with MTZ being the second most frequently prescribed antibiotic (18%), after aminopenicillins (27%). In multivariable analysis, digestive symptoms (adjusted odds ratio [aOR], 8.65; 95% confidence interval [CI], 6.49-11.6), genitourinary symptoms (aOR, 6.84; 95% CI, 3.18-15.0), and skin lesions (aOR, 2.39; 95% CI, 1.58-3.60) were independently associated with increased odds of MTZ prescription. In contrast, fever (aOR, 0.66; 95% CI, 0.49-0.87), respiratory symptoms (aOR, 0.44; 95% CI, 0.26-0.71), and malaria (aOR, 0.21; 95% CI, 0.15-0.28) were associated with decreased odds. Visits in the private sector were also associated with higher odds of MTZ prescription compared with the public sector (aOR, 2.31; 95% CI, 1.78-3.02). ConclusionMTZ is the second most commonly prescribed antibiotic in primary care in the study area, with its use largely driven by digestive symptoms. Further studies are needed to assess the appropriateness of this prescription. Additionally, research is warranted to understand better the determinants of higher antimicrobial prescribing in the private healthcare sector. Highlights- MTZ is the second most prescribed antibiotic in the study area. - MTZ prescription is primarily driven by digestive symptoms. - The private healthcare sector is independently associated with higher MTZ prescription rates. - Antimicrobial prescribing is generally higher in private healthcare facilities than in public facilities.

BackgroundElectronic prescribing registries are widely used for antimicrobial stewardship surveillance. Existing indicators predominantly measure structure or process, while validated outcome indicators remain rare. The present study evaluates how well rule-based measures capture clinically meaningful postdiagnostic antibiotic decision making in pediatric febrile urinary tract infection. MethodsWe conducted a retrospective, multicenter validation study including all empirically treated febrile UTI episodes across three Swedish pediatric emergency departments. Prescribing outcomes were classified using registry rules and compared with outcomes determined by clinician review and laboratory findings. Guidance Ratio (GR) and Discontinuation Ratio (DR) were calculated monthly and in aggregate for both clinically validated- and registry rule classifications. ResultsIn total, 909 febrile UTI episodes were included across all sites. The rule-based GR was 49%. GR increased consistently with stronger diagnostic evidence. Among the 431 episodes with clinician-adjudicated follow-up, 63% resulted in guided treatment; 28% discontinued treatment, and 9% lacked follow-up documentation. The rule-based algorithm showed a sensitivity of 0.78 and a specificity of 1.00 for identifying guided outcomes. Monthly rule-based GR tracked validated temporal patterns but underestimated absolute values. A calibration function substantially improved agreement. ConclusionsRule-based indicators captured overall prescribing patterns but underestimated the level of prescribing concordant with guidelines. Validation against clinician reviewed reference data enabled calibration and improved the interpretability of indicators based on registry data for antimicrobial stewardship.

ObjectiveTo explore the application effect of AI agent-assisted root cause analysis in the management of quality inspection defects in the Central Sterile Supply Department (CSSD) and to systematically compare it with traditional manual analysis methods. MethodsA retrospective case simulation comparative study was conducted. Thirty typical CSSD quality inspection defect cases were selected. Root cause analysis was performed independently by an AI agent-assisted analysis group and a traditional manual analysis group. Using the consensus results of a high-level expert panel as the "gold standard," a quantitative comparison was made across four dimensions: analysis quality, efficiency, practicality, and process experience, employing t-tests and Mann-Whitney U tests. ResultsCompared with the traditional method, the AI-assisted group demonstrated a significantly higher root cause identification accuracy rate (85.6% vs. 72.3%, P<0.001), superior analysis depth (4.4 points vs. 3.6 points, P<0.001), significantly shorter time consumption per case analysis (18.5 minutes vs. 35.2 minutes, P<0.001), and generated more innovative corrective measures (1.8 items/case vs. 0.7 items/case, P<0.001). There was no statistically significant difference between the two groups regarding the feasibility of the proposed measures (4.0 points vs. 4.2 points, P>0.05). ConclusionThe AI agent-assisted root cause analysis method significantly improves the accuracy, depth, and efficiency of analyzing quality inspection defects in the CSSD and facilitates the discovery of more innovative solutions, demonstrating high application value and promotion potential. Implications for Nursing ManagementThis study provides empirical evidence that AI agent technology can be integrated into CSSD quality management to enhance defect analysis efficiency and accuracy. Nursing managers should consider adopting AI-assisted tools to standardize root cause analysis processes, reduce reliance on senior staff experience, and enable faster, data-driven decision-making. The reduced training burden and improved novice performance suggest that AI can help address workforce skill gaps. Future implementation should focus on human-AI collaboration, with managers ensuring adequate training, maintaining human oversight, and periodically updating the knowledge base to reflect local clinical contexts.

Aim To examine ethnic inequalities in recruitment outcomes and workforce representation across pay bands among nursing and midwifery staff, and to assess whether routinely collected administrative data can generate reproducible indicators for workforce equality monitoring. Design Retrospective observational study. Methods We analyzed routinely collected administrative data from one NHS Board in Scotland. This included annual staff-in-post data for 2021/22 to 2024/25 and pooled recruitment data on interviewed candidates and conditional job offers for 2021/22 to 2023/24. Ethnicity was grouped as White and non-White. Analyses focused on Bands 5, 6 and 7. Recruitment outcomes were assessed using relative risks for receipt of a conditional job offer among interviewed candidates, comparing White and non-White applicants. Workforce representation across pay bands was assessed using representation quotients. Analyses were descriptive and unadjusted. Results White applicants were more likely than non-White applicants to receive a conditional job offer following interview across all pay bands examined. Inequalities were also evident at Band 5, the usual entry point to registered practice. Workforce composition analyses showed a corresponding gradient in representation, with non-White staff overrepresented in Band 5 and underrepresented in Bands 6 and 7, with little change over the study period. Conclusion Routinely collected administrative data can generate reproducible indicators of ethnic inequality in recruitment and workforce representation. Embedded within existing workforce systems, such analyses could strengthen workforce equality monitoring, support benchmarking and enhance accountability across healthcare settings. Impact Utilising routine administrative data for workforce equality monitoring can support policy and practice aimed at improving accountability, retention and workforce sustainability across health systems. Reporting Method This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. Patient or Public Involvement This study did not include patient or public involvement in its design, conduct, or reporting.

Background Antibiotic use is prevalent in hospitals, driving the emergence of drug-resistant pathogens. We investigated the contextual influences on antibiotic prescribing behaviour across hospitals in high, middle, and low-income countries in Asia with an aim to provide actionable insights to improve prescribing behaviour. Methods We conducted a large qualitative study across ten institutions in Singapore, Nepal, and Thailand. Semi-structured interviews and ethnographic observations involving physicians, nurses, pharmacists, and management staff were conducted. Data were analysed thematically using QSR NVivo 14. Findings A total of 194 interviews were conducted amongst physicians (54{middle dot}1%), nurses (19{middle dot}6%), pharmacists (12{middle dot}4%), and management staff (13{middle dot}9%). Structural factors such as limited microbiology laboratory capabilities, concerns about antibiotic quality, weak infection prevention and control policies, and the lack of relevant, updated guidelines were prominent drivers for prolonged and broad-spectrum antibiotics prescriptions. Where these system supports were in place, prescribing decisions were less defensive and more targeted, although prescriber responsibility and concerns about immediate patient deterioration continued to influence practice. Across settings, clinicians tended to prioritise short-term perceived benefits of antibiotic treatment over the longer-term risks of antimicrobial resistance.

Background: Rising antibiotic resistance challenges empirical therapies for urinary tract infections (UTIs). This study evaluated the microbial etiology, susceptibility profiles, and multidrug resistance (MDR) patterns of uropathogens among outpatients at the Berekum Holy Family Hospital, Ghana. Methods: This cross-sectional study (February to August 2021) screened 263 symptomatic outpatients. Mid-stream urine samples underwent quantitative culture, biochemical identification, and antimicrobial susceptibility testing via the Kirby-Bauer disc diffusion method following the 2021 CLSI guidelines. Results: Significant bacteriuria prevalence was 22.8% (60/263). UTIs predominated in females (78.3%, 47/60; p = 0.1501) and individuals [&ge;]45 years (33.3%, 20/60). Gram-negative rods accounted for 90.0% of isolates, primarily Escherichia coli (26.7%), Citrobacter spp. (25.0%), and Enterobacter spp. (21.7%); Staphylococcus aureus (10.0%) was the only Gram-positive pathogen. Extreme phenotypic resistance was observed against piperacillin/tazobactam (98.3%), cefotaxime (93.3%), tetracycline (88.3%), and cefoperazone (85.0%). Conversely, highest therapeutic susceptibilities were retained by amikacin (78.3%), levofloxacin (61.7%), and gentamicin (58.3%). Conclusion: The high prevalence of MDR uropathogens against advanced beta-lactamase inhibitor combinations and cephalosporins necessitates an immediate re-evaluation of regional empirical protocols. Amikacin, levofloxacin, and gentamicin remain viable options prior to culture confirmation. These findings establish a crucial phenotypic baseline to guide localized prescribing policies and regional antimicrobial resistance tracking strategies.

The inappropriate use of antimicrobials enhances antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) is a coordinated effort of prescribers, pharmacists, and nurses. Still, local data regarding AMS-related knowledge, attitudes, and practices (KAP) are scarce in many low and middle-income countries. We evaluated KAP regarding AMS among the healthcare providers at Komfo Anokye Teaching Hospital (KATH), Ghana, and found the related factors. A cross-sectional survey in the form of a descriptive survey was conducted among medical doctors, pharmacists, and nurses at KATH. Knowledge, attitude, and practice were evaluated using a structured questionnaire. The scores were converted into percentages and classified as good (>=60%) or poor (<60%). Chi-square tests were used to test associations, and logistic regression to predict good KAP (p<0.05). A total of 349 healthcare professionals participated, which comprised: 91 medical doctors (26.1%), 101 pharmacists (28.9%), and 157 nurses (45.0%). The majority of the respondents had formal AMS/AMR training (69.6%), and 37.0% had updated training the previous year. Only 18.6% demonstrated good AMS-related knowledge, although attitudes were largely positive (95.7% good) and reported practices were mostly appropriate (77.4% good). In multivariable models, greater years of practice (5-9 years: adjusted odds ratio [AOR] 2.32; >=15 years: AOR 2.77) and formal training (AOR 2.94) were associated with good knowledge. Formal training was also associated with good attitudes (AOR 5.19). Compared with medical doctors, nurses had lower odds of good practice (AOR 0.29), while pharmacists had higher odds (AOR 1.41). Participants with 10-14 years of experience had higher odds of good practice (AOR 3.18). This study revealed that marked knowledge deficits exist, despite favourable attitudes and generally good self-reported AMS practices. Role-tailored, competency-based AMS training with regular updates and reinforcement through practical stewardship tools is needed to translate positive attitudes into evidence-based prescribing and administration behaviours.

Culture plays a crucial role in health; family, community, culture, and social conventions all have a significant impact on how an infant with jaundice is treated. Written or unwritten rules govern what parents and the community are allowed to do, which may have a detrimental effect on the neonates care. ObjectivesThe study explored how social expectations affect midwives management of neonatal jaundice at the St Patricks hospital in Maase-Offinso, in the Ashanti region of Ghana. MethodA total of seventeen midwives were sampled purposively using an exploratory descriptive design. Participants were engaged in interviews and focus group discussion after ethical approval was obtained. A semi-structured focus group discussion guide and interview guide was used to collect data. ResultsThe study discovered that the treatment of neonatal jaundice was adversely affected by social pressures, misconceptions, maternal choices, and spiritual views. Mothers and midwives socially approved sunbathing, and there were indications that grandmothers disapproved hospital care for their grandchildren. ConclusionCulture, family and social norms cannot be separated from health especially for the neonate whose means of identification is to belong to a family. Consequently, it is essential to respond to social influences, cultural conventions, and the various cultures of families with a culturally sensitive approach.

BackgroundAn upsurge in Streptococcus pyogenes infections 2022-2023 highlighted potential benefits of point-of-care tests (POCT) to support clinical pathways, prevent outbreaks, and optimise antibiotic use. ObjectivesWe conducted a pilot research study in a west London paediatric emergency department (ED) to determine whether a molecular POCT had potential to alter management in children who were also having a conventional throat swab taken for culture. MethodsChildren <16 years presenting to ED who had a throat swab requested by a clinician were invited to have a second swab taken for research purposes only. Clinical management was unaffected by the research swab result, which was processed using a molecular POCT that was not approved for use in the host NHS Trust. ResultsPrevalence of streptococcal infection was low during the study (May 2023-June 2025); swab positivity in symptomatic children was 12.8% (6/47). Overall, 38/49 (77.6%) participants who had throat swabs received antibiotics. Of those children recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Mean time to reporting of positive throat swab culture results was 3.67 days (range 3-5 days) leading to occasional delay in treatment, although POCT identified positive results within minutes. ConclusionAntibiotic use was frequent and could be avoided or stopped by use of a rule out POCT in over three-quarters of children in the ED, if suspicion of S. pyogenes is the main driver for prescribing. POCT were easy to process and produced immediate results compared with culture, in theory enabling timely decision-making and avoiding treatment delay.

BackgroundAntimicrobial resistance (AMR) surveillance is essential for quantifying and monitoring the burden of AMR among World Health Organization (WHO) priority pathogens. We analysed Tunisian AMR surveillance system (TARSS) data across five sentinel hospitals from 2014 to 2022. MethodsWe conducted a retrospective isolate-level analysis for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Temporal, ward, and specimen associations were quantified using multivariable logistic regression models. Sex and age categories were explored in secondary models due to missingness. Temporal trends were assessed using Cochran-Armitage test, and co-resistance was summarised for third-generation cephalosporin and carbapenem phenotypes. We also evaluated temporal dynamics of 3GCR and CR profiles. ResultsA total of 35,525 E. coli, 14,325 K. pneumoniae, 9,679 P. aeruginosa, and 5,597 Acinetobacter spp. were reported to TARSS between 2014 and 2022. Mean annual MDR prevalence was high for Acinetobacter spp. (85.1%), moderate for K. pneumoniae (45.5%) and for P. aeruginosa (27.1%), and lower for E. coli (17.5%). Adjusted models indicated increased odds of resistance to several antibiotics, whereas E. coli showed decreased odds. Intensive care unit (ICU) and blood isolates were associated with higher odds of resistance in all pathogens. ConclusionThis nine-year multi-hospital analysis reveals a high prevalence of AMR across the four WHO priority pathogens, settings, and specimen types, with increasing resistance for some pathogen-antibiotic combinations. The higher odds of clinically important resistance amongst ICU and blood isolates support the use of ward-level antibiograms and stratified stewardship and infection prevention measures.

Objective: To evaluate the feasibility of nurse-led ultrasound hip screening for newborns and infants during home visits, focusing on whether trained public health nurses (PHNs) can obtain interpretable images for orthopedic pediatric surgeons' diagnosis, imaging error patterns, immediate operational challenges, and follow-up results of infants with suspected developmental dysplasia of the hip (DDH). Design: Pilot prospective cohort study. Sample: Forty-two infants were screened. PHNs conducted ultrasound hip screenings during home visits. Measurements: Diagnostically interpretable images, as determined by two pediatric orthopedic surgeons. Results: Diagnostically interpretable images of 75/84 (89.3%) hips were obtained. Surgeons identified three error patterns: incomplete visualization of the ilium (n = 2), joint capsule (n = 1), or bony roof (n = 2). Infant crying was an operational challenge (n = 1). Thirty-three (78.6%) hips were normal, four (9.5%) had abnormal findings requiring abduction exercises, three (7.1%) were referred to a hospital, and two (4.8%) failed imaging. One hip was diagnosed with subluxation, which went undetected by physical or risk screening. Conclusion: Nurse-led ultrasound hip screening for newborns and infants during home visits is feasible and may aid in early DDH detection. Further studies should assess diagnostic accuracy, cost-effectiveness, and long-term outcomes.

Introduction: Antibiotic misuse is a major driver of antimicrobial resistance (AMR), contributing to an estimated 1.27 million deaths globally. In Kenya, inappropriate antibiotic use is shaped by health-seeking behaviors and sociodemographic factors. However, little is known about how adults with productive coughs seek and use antibiotics, or how sociodemographic factors underpin these practices. This study explored antibiotic-seeking pathways, usage patterns, and the sociodemographic factors influencing these practices among adults with productive coughs attending selected chest and tuberculosis clinics in Nairobi County, Kenya. Methodology: A facility-based cross-sectional study was conducted among 400 adults ([&ge;]18 years) with productive coughs. Data were collected using a structured questionnaire on sociodemographic characteristics, antibiotic-seeking pathways, and use patterns. Results: Most participants were male (65.0%) and employed (67.0%), with 68.3% earning below Ksh 10,000 (approximately USD 80) monthly and 35.8% having basic education. A history of smoking (37.3%), tuberculosis (32.0%), or other comorbidities (29.8%) was common. Among 347 (86.7%) antibiotic users, 46.4% obtained antibiotics through general practitioners (GP) only, 31.4% via both GP and over-the-counter (OTC) sources, 15.3% from OTC only, and 6.9% through self-medication. Females were more likely to self-medicate (13.3% vs. 3.2%) and had higher odds of antibiotic use (cOR: 2.00; 95% CI: 1.04-4.10). Tuberculosis history was linked to greater GP reliance (61.7% vs. 37.4%). Low-income participants mainly used GP-only sources, while higher-income earners favored GP plus OTC routes (RRR: 2.67; 95% CI: 1.41-5.05). Empirical use was common (71.1%), dominated by Amoxicillin (90.8%), with multiple antibiotic use reported by 67.2% of the participants. Conclusion: Antibiotic use among adults with productive coughs in Nairobi was widespread and largely empirical, dominated by Amoxicillin and Amoxicillin/Clavulanic acid. Self-medication, unregulated antibiotic access, and inappropriate use highlight the urgent need for stricter prescription enforcement and strengthened stewardship programs to promote rational antibiotic use and curb AMR.

BackgroundThe hospital environment is increasingly recognized as a critical reservoir for antimicrobial-resistant (AMR) bacteria. In sub-Saharan Africa, maternity wards represent high-risk settings where environmental contamination poses a direct threat to vulnerable mothers and neonates. Despite this, there is a significant lack of data integrating phenotypic resistance with whole-genome sequencing (WGS) to understand antimicrobial resistance (AMR) in these settings. This study characterized the AMR patterns and genomic features of ESBL-producing Escherichia coli and Klebsiella spp. isolated from maternity ward surfaces in Yaounde, Cameroon. MethodsA cross-sectional environmental study was conducted across four maternity wards. Isolates were identified via standard microbiological methods, and antimicrobial susceptibility testing against 13 antibiotics was performed following EUCAST 2024 guidelines. Short-read WGS was utilized to identify sequence types (STs), plasmid incompatibility groups, antibiotic resistance genes (ARGs), and virulence factors. Plasmid-ARG association networks were constructed to visualize resistance dynamics. ResultsNineteen ESBL-producing Enterobacterales were identified, comprising 15 E. coli and four Klebsiella isolates. High levels of multidrug resistance were observed against ciprofloxacin, penicillins, and third-generation cephalosporins. While the isolates remained sensitive to colistin and imipenem, alarming resistance to meropenem was detected. Genomic analysis revealed the presence of globally disseminated high-risk lineages, including E. coli ST131, ST1193, and ST410, alongside Klebsiella ST1324 and ST489. Critical resistance determinants, including ESBLs, AmpC enzymes, and carbapenemases (NDM and OXA-48-like), are frequently associated with epidemic plasmids such as IncF, IncA/C2, and IncL/M. Additionally, the isolates harboured virulence factors characteristic of extraintestinal pathogenic Enterobacterales. ConclusionsThe widespread presence of high-risk carbapenemase-producing clones on maternity ward surfaces identifies the hospital environment as a significant AMR reservoir in Yaounde. These findings highlight the urgent need for reinforced infection prevention and control (IPC) measures, robust antimicrobial stewardship, and the integration of genomic surveillance to safeguard highly susceptible maternal and neonatal populations from life-threatening infections.

BackgroundHand hygiene remains a cornerstone of infection prevention in surgical practice, particularly in orthopedic operating theatres where inadequate aseptic technique can increase the risk of surgical site infections and implant-related complications. Despite well-established recommendations from the World Health Organization (WHO) regarding proper surgical hand-scrubbing techniques, compliance in many healthcare settings remains inconsistent. Clinical audits provide a structured approach to evaluating adherence to such guidelines and implementing targeted improvements. This study aimed to assess baseline hand-scrubbing practices in an orthopedic operating theatre at a regional hospital in northern Pakistan and evaluate the impact of educational interventions on compliance with WHO standards. MethodsA prospective closed-loop clinical audit was conducted in the orthopedic operating theatre of Regional Headquarter Hospital Skardu, Pakistan, from December 1, 2025, to February 1, 2026. Approximately 40 healthcare personnel, including consultants, residents, nurses, and operating theatre assistants, participated in the audit. Baseline hand-scrubbing practices were observed during routine surgical sessions using a structured checklist based on WHO hand hygiene guidelines. Following the baseline assessment, educational interventions were introduced, including live demonstrations of correct hand-scrubbing techniques and placement of visual reminder posters in the scrub area. Post-intervention compliance was re-evaluated using the same checklist. Compliance rates before and after the intervention were compared using appropriate statistical analysis, with significance set at p < 0.05. ResultsBaseline observations revealed suboptimal compliance with recommended hand-scrubbing standards, particularly with regard to scrubbing duration, coverage of all hand surfaces, and proper drying technique. Following the educational intervention, significant improvements were observed across all evaluated components. Compliance with scrubbing duration of at least two minutes increased from 45% to 90%, coverage of all hand surfaces improved from 50% to 88%, proper antiseptic usage increased from 60% to 93%, and correct drying technique improved from 55% to 87%. Adherence to overall aseptic protocol also increased from 70% to 95%. All observed improvements were statistically significant (p < 0.001). ConclusionsThis prospective clinical audit demonstrates that structured educational interventions, including live demonstrations and visual reminders, can significantly improve compliance with recommended hand-scrubbing practices in orthopedic operating theatres. Regular audits combined with targeted educational strategies represent practical and cost-effective measures for improving infection control practices and enhancing patient safety in surgical settings.

BackgroundPseudomonas aeruginosa is a major cause of healthcare-associated infections in paediatric settings, where its persistence in moist environments such as hospital water and wastewater systems poses a particular risk to neonates and immunocompromised children. AimThe aim of this study was to showcase the long-term survival and transmission of P. aeruginosa in a large tertiary childrens hospital in England which is crucial to develop strategies for water-safe care. MethodsEnvironmental P. aeruginosa isolates were collected from taps, sinks, showers, and baths in augmented care areas of a 330-bed tertiary childrens hospital built to NHS water-safety standards. Clinical isolates were classified as invasive (blood, cerebrospinal fluid, and bronchoalveolar lavage) or non-invasive (respiratory, urine, ear, abdominal, and rectal surveillance). Variable number tandem repeat (VNTR) profiles and metadata were extracted from PDF reports, de-identified, deduplicated, and curated using Python and R. FindingsThis retrospective study analysed nine-locus VNTR profiles of 457 P. aeruginosa isolates submitted to the UK Health Security Agency from a large tertiary childrens hospital, identifying 56 isolate clusters (each with [&ge;]2 isolates), of which 19 (34%) contained at least one invasive isolate. The most persistent cluster (Cluster 1, n=20) spanned from July 2016 to September 2024, containing environmental and clinical (invasive and non-invasive) isolates. ConclusionThese findings demonstrate long-term persistence of certain genotypes and temporal overlap between environmental and clinical isolates, highlighting the difficulty in detecting and eradicating P. aeruginosa in hospital water and wastewater systems and reinforcing the need for continuous rigorous water system controls.

Introduction Antibiotic use drives antimicrobial resistance, and optimizing prescribing in skilled nursing facilities (SNFs) - which care for medically complex residents in congregate settings characterized by frequent care transitions and diagnostic uncertainty - presents unique challenges. Antimicrobial stewardship (AMS) in SNFs has therefore become a focus of quality improvement efforts by federal and state health agencies. We aimed to identify factors that facilitate and hinder AMS implementation in SNFs. Methods A qualitative study of AMS implementation was conducted in Southern Arizona SNFs randomly sampled to represent urban/suburban, border, and rural regions. Semi-structured interviews were conducted with administrators, clinicians, and nonclinical staff within participating facilities. Interview transcripts were analyzed using constant comparative analysis, with both directed and emergent coding, facilitated by NVivo 12 software. Findings From 04/13/2019 through 12/13/2019, 57 interviews were conducted with 9 administrators, 38 clinical providers, and 10 nonclinical staff across 6 urban/suburban, 2 border, and 2 rural facilities. Analysis identified two thematic categories: "influencer themes," which describe specific barriers and facilitators to AMS implementation, and "system themes," which characterize SNFs as complex adaptive systems shaped by interacting staff roles, care transition challenges, and differing perceptions of AMS practices within the same facility. Key facilitators included effective internal communication, ongoing AMS education, and clinician AMS champions. Primary barriers included poor interfacility communication during care transitions, limited access to diagnostic resources, enculturated prescribing norms, and tension between immediate infection control priorities and long-term AMS goals. Conclusions Findings suggest that AMS implementation in Arizona SNFs is best understood as a systems-level process emerging from interactions among staff roles, organizational workflows, and care transitions, rather than solely from individual prescribing decisions. Recognizing SNFs as complex adaptive systems highlights the importance of communication structures, local champions, and feedback mechanisms. It underscores the need for coordination strategies within and across SNFs to sustain AMS interventions.

ObjectiveTo evaluate the diagnostic performance of FeverPAIN and Centor with point-of-care test (POCT) results for Group A Streptococcus (GAS) among children and adults presenting with sore throat in community pharmacies. MethodsCross-sectional analysis of patients aged six years and over with sore throat presenting to community pharmacies across Wales delivering the Sore Throat Test and Treat (STTT) service from November 2018 to September 2024. Patients who scored FeverPAIN [&ge;]2 or Centor [&ge;]3 and were able to undergo POCT were eligible for analysis. We described GAS positivity by age group and assessed diagnostic performance of FeverPAIN at the National Institute for Health and Care Excellence (NICE) antibiotic threshold ([&ge;]4), reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). We estimated potential overtreatment and undertreatment if antibiotics were supplied based on FeverPAIN alone. ResultsAmong 73,617 eligible patients, 37.0% (n=27,220) tested POCT-positive for GAS. Positivity was highest in children aged 6-10 years (47.0%: 5,339/11,371). FeverPAIN was used in 92.5% (n=68,099) of assessments. At the NICE-recommended threshold for antibiotic treatment (FeverPAIN [&ge;]4), sensitivity was 55.0% (95% CI: 54.4-55.6%) and specificity 77.0% (95% CI: 76.6-77.4%). PPV was 57.6% (95% CI: 57.0-58.2%) and NPV 75.1% (95% CI: 74.7-75.5%). Overall AUROC was 0.70 (95% CI: 0.70-0.71), with the lowest AUROC of 0.69 (95% CI: 0.68-0.70) observed among children aged 6-10 years. Using FeverPAIN alone would undertreat 44% and overtreat 23% of patients based on POCT results. ConclusionsFeverPAIN alone showed limited diagnostic performance for identifying GAS, with more pronounced discordance observed among children. Incorporating POCTs within community pharmacy sore throat pathways may support more targeted antibiotic prescribing. Our findings support a re-evaluation of the role of POCTs within community pharmacy sore throat pathways.