Journal of Hospital Infection

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.

Background Pseudomonas 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. Aim The aim of this study was to showcase the long-term survival and transmission of P. aeruginosa in a large tertiary children's hospital in England which is crucial to develop strategies for water-safe care. Methods Environmental P. aeruginosa isolates were collected from taps, sinks, showers, and baths in augmented care areas of a 330-bed tertiary children's 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. Findings This retrospective study analysed nine-locus VNTR profiles of 457 P. aeruginosa isolates submitted to the UK Health Security Agency from a large tertiary children's 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. Conclusion These 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.

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.

PurposeTo quantify and compare the peak force applied on the glottis during endotracheal intubation across five laryngoscopy techniques, two intubation conditions (standard and simulated laryngospasm), and two operator experience levels, and to assess the effects of stylet use and operator anthropometric characteristics on applied force. MethodsThis prospective, manikin-based experimental study enrolled 50 operators (30 experienced, 20 less experienced). Each performed endotracheal intubation using five techniques: direct laryngoscopy and videolaryngoscopy with a Macintosh blade, each with and without stylet, and videolaryngoscopy with a hyperangulated blade with stylet. A calibrated force sensor positioned at the glottis measured peak forces during standard and simulated laryngospasm conditions. Non-parametric statistical methods were used (Mann-Whitney U, Wilcoxon signed-rank, Friedman tests); effect sizes are reported as rank-biserial correlations. ResultsAcross all techniques, median glottic forces ranged from 4.8 N (IQR: 3.3-6.5) for videolaryngoscopy without stylet to 11.1 N (IQR: 7.5-14.5) for direct laryngoscopy with stylet under standard conditions. No significant differences in applied force were observed between experienced and less experienced operators for any technique-condition combination (all adjusted p = 1.0; |r| [&le;] 0.27). Stylet use significantly increased glottic force across all conditions and groups (median increases 3.4-7.3 N; all p < 0.001; rank-biserial r [&ge;] 0.75). Videolaryngoscopy with a Macintosh blade produced significantly lower forces than hyperangulated videolaryngoscopy under standard conditions (adjusted p = 0.049). Neither grip strength nor hand size correlated with applied force. ConclusionGlottic force during endotracheal intubation is determined primarily by technique and stylet use, not operator experience or anthropometrics. Stylet use is the single largest modifiable contributor to glottic force. These findings have implications for device selection, clinical training, and strategies to minimize airway trauma during intubation. IMPLICATION STATEMENTThis manikin-based study quantifies glottic forces during endotracheal intubation across laryngoscopy techniques, stylet use, and operator experience levels, providing the first comprehensive characterization of right-hand forces transmitted through the tube. Stylet use consistently and substantially increases glottic force regardless of technique or operator experience, informing device selection and training strategies to minimize airway trauma.

BACKGROUNDAutomated antimicrobial susceptibility testing (AST) systems are crucial for accurate, timely detection of drug-resistant microbial isolates. This meta-analysis assessed the performance of the BD Phoenix ("Phoenix", BD Diagnostic Solutions), Vitek(R) 2 ("Vitek 2", bioMerieux), and DxM MicroScan WalkAway ("MicroScan", Beckman Coulter, Inc.) AST systems relative to common reference methodology. METHODSA systematic literature search in Ovid (MEDLINE and Embase) yielded 275 unique (not duplicated) records, with 44 additional records retrieved from handsearching; 39 studies met inclusion criteria. Categorical agreement (CA), essential agreement (EA), very major errors (VMEs), and major errors (MEs) for the three instruments were compared to a common reference method. Ratios of proportions were analyzed using random-effect meta-regression. RESULTSThe instruments did not differ significantly in CA, EA, or ME. Vitek 2 showed a higher overall VME rate than Phoenix ([~]44% higher; Vitek 2-to-Phoenix ratio = 1.44; p=0.062 [approaching significance]) and MicroScan (74% higher; ratio = 1.74; p=0.045). No appreciable difference was observed for VME between Phoenix and MicroScan. Subgroup analyses should be interpreted cautiously due to limited overall significance indicating varying performance across systems. Vitek 2 generally had higher relative VMEs for gram-negative organisms and lower relative VMEs for gram-positive organisms, whereas Phoenix showed the opposite pattern. MicroScan had relatively low VMEs when stratified by Clinical and Laboratory Standards Institute (CLSI) criteria; no differences in VMEs were observed using European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. CONCLUSIONAlthough some VME differences were noted, overall performance of the three systems was comparable. Organism- and drug-specific VME patterns--and updates to CLSI criteria over time--highlight the importance of continued monitoring of current breakpoints for all three instruments.

BackgroundUnited Kingdom Standards for Microbiology Investigations limits the pre-analytical delay of blood cultures to a maximum of four-hours between collection and incubation. Compliance with this delay standard is a measure of the ability of a microbiology service to support the management of sepsis which is a life-threatening complication of infection. A positive blood culture confirms the infection and an early result is critical to the effective management of the condition. Delayed results lead to the prolongation of empiric broad spectrum antimicrobial therapy which is considered a causal factor in the emergence of antimicrobial resistance. This retrospective observational study documents compliance with the standard by microbiology services in England in 2022/23. The impact of laboratory centralisation on the ability of microbiology services to comply with this standard is examined. MethodsFreedom of Information requests were submitted to 116 National Health Service Trusts/administrative units in England requesting retrospective audit data showing compliance with the recommended pre-analytical delay standard. Data relating to service configuration and cost were also requested. ResultsResponses were received from 89 Trusts (76.7%) managing 146 hospitals. Overall, the rate of compliance was low, with only four hospitals (2.7%) showing full compliance and 31.5% showing >80% compliance. ConclusionsPoor rates of compliance with the PAD standard are a concern as prompt attention to blood cultures improves patient outcomes from sepsis and supports antimicrobial stewardship. Laboratory centralisation has resulted in withdrawal of staff and facilities from some hospitals with insufficient investment in others, leading to a demonstrable inability of many hospitals to comply with this standard. Compliance will require investment in microbiology services. The financial implications of the improvements proposed should be evaluated in the context of overall health care and community benefits.

Bubble continuous positive airway pressure (bCPAP) is a low-cost respiratory support device that has demonstrated different outcomes for children with severe pneumonia in different settings. Some differences in outcomes may be attributable to implementation factors (e.g., patient monitoring and feeding practices). We aimed to characterize bCPAP reach, implementation fidelity, and safety outcomes for children with severe pneumonia in Pakistan. We conducted a prospective cohort study at Aga Khan University Hospital and Abbasi Shaheed Hospital from February through May 2025. We enrolled children 1-59 months who met WHO criteria for severe pneumonia within 24 hours of presentation to the emergency department. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, or death. We reported the proportion of children receiving bCPAP ("reach") and constructed a mixed-effects, multinomial logistic regression model with robust standard errors to report: fidelity (child location in a highly monitored area, continuous monitoring, avoidance of unplanned disruptions to bCPAP, and avoidance of oral feeding); safety (aspiration events and pneumothorax); bCPAP failure (death, respiratory support escalation, or leaving against medical advice); and in-hospital mortality. Of 165 children with severe pneumonia, 88 (53%) received bCPAP over 141 bCPAP days. The average predicted probabilities (95% CI) of our fidelity measures were: 85% (78-92%) for location in a highly monitored area; 56% (51-60%) for continuous monitoring; 66% (57-75%) for continuous bCPAP without disruptions; 46% (36-55%) for avoidance of oral feeding while on bCPAP. Among children receiving bCPAP, 9 (10%) experienced an aspiration event, 1 (2.2%) experienced a pneumothorax; 19 (22%) experienced bCPAP treatment failure. One child (1.1%) died; 6 (6.8%) required respiratory support escalation; 14 (16%) left against medical advice. We identified several gaps in bCPAP reach and fidelity. These may be modifiable by individual-and team-targeted strategies to reduce bCPAP-related complications and pneumonia-related child deaths.

BackgroundAntimicrobial surfaces incorporated into high-touch public areas are used as a passive intervention to reduce surface microbial load and reduce the spread of infections. However, usually such surfaces lack proof of their antimicrobial activity in real use conditions and against a wider variety of microbes. This study evaluated the real-world performance of copper, TiO2-, silver- and quaternary ammonium compound (SiQAC)-based surfaces, which are commercially available and have proven antibacterial activity in lab tests. The surfaces were introduced to five study sites in diverse environments to collect data on bacterial load, community structure and taxonomic profile over several months. ResultsCopper surfaces introduced to shopping basket handles consistently exhibited the strongest antimicrobial performance, with significant reductions in aerobic bacterial counts and bacterial DNA, accompanied by clear shifts in microbial community composition. These shifts included reduction of several human-associated and opportunistic taxa and relative enrichment of environmentally resilient, stress-tolerant genera. TiO2-based photocatalytic coating reduced bacterial load in kindergarten tables under field conditions but did not significantly alter overall community structure. Silver-based surfaces on university campus tables showed minimal effects on microbial load and composition despite confirmed antibacterial activity in laboratory testing. Analogously to silver, SiQAC-based coating despite being active in lab conditions showed no decrease in bacterial load in real use conditions. When applied onto cafeteria and animal clinic tables SiQAC coating displayed context-dependent effects, with modest, genus-specific changes and increased richness in a high-contact cafeteria environment, but no significant impact in a low-biomass animal clinic setting. Viability based analysis revealed that on most of the surfaces a notable fraction of detected microbial DNA originated from non-viable cells. ConclusionsThis multisite field study demonstrates that the real-world performance of antimicrobially coated surfaces is strongly context dependent and cannot be reliably predicted from laboratory testing alone. Moreover, to understand the effect of antimicrobial coatings on surface microbial communities, real-use monitoring is needed.

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.

Background: Chest tube infection is one of the complications of the tube thoracostomy. Infectious complications may develop in 2% to 25% of patients who undergo thoracotomy tube placement. The use of prophylactic antibiotics to prevent infections associated with thoracostomy tubes remains a subject of debate. Current practices in managing infections related to tube thoracostomy are hindered by the lack of comprehensive and localised data on the microbial profile and their resistance patterns. Objective: To determine the prevalence of thoracostomy tube infections and associated clinical characteristics among patients treated with a thoracostomy tube at KCMC Zonal Referral Hospital. Methodology: Prospective cohort study done at KCMC Zonal Referral Hospital. Include all patients undergoing thoracostomy tube insertion from September 2024 to April 2025. Results: A total of 84 patients underwent tube thoracostomy during the study time. Of these 22 (26.2%) developed SSI. Out of the 22 samples collected, 17 (77.3%) had positive culture results. The most commonly identified pathogens were Pseudomonas aeruginosa (41.2%) and Staphylococcus aureus (29.4%). The highest overall susceptibility was observed with amikacin, effective against 10 (58.8%) of the tested organisms. The most common resistance was observed against ceftazidime (56.3%) and piperacillin-tazobactam (50.0%). Prolonged chest tube duration (>7 days) was the strongest independent predictor of tube thoracostomy infection. Conclusion: This study revealed a high prevalence of tube thoracostomy infection. Prolonged tube duration and admission to a non-surgical ward care emerge as key risk factors for SSI. These findings underscore the importance of limiting chest tube duration when clinically feasible and ensuring optimal postoperative care environments to minimise the risk of infection.

Hospital-acquired infections are a known and growing problem worldwide. Far-UVC is a novel disinfection method that inactivates bacteria with limited penetration into human skin or eyes. A clustered, unmatched, randomized control trial (RCT) will be implemented in two Bolivian hospitals. The intervention arm will receive functioning Far-UVC lamps, whereas the control arm will receive identical lamps that do not emit UV light (shams). Based on baseline data, 40 lamp fixtures will be installed above hospital sinks, 10 per arm per hospital. Environmental samples (air and surface swabs) will be collected and analyzed via culture and sequencing. Simultaneously, air chemical monitoring data will be collected.

AimsBacteriophage (phage) propagation has traditionally relied on bacterial culture media containing animal-derived ingredients; however, safety concerns with animal-derived materials for production of phages for therapeutic use limit their acceptability. We compared animal-free and traditional media formulations, and evaluated their effects on phage yield, bactericidal activity, and genomic characteristics, hypothesizing no significant differences would be observed. Methods and ResultsPhages targeting Pseudomonas aeruginosa (n=8) and Staphylococcus aureus (n=1) were propagated in solid and liquid media containing animal-free (AF) or animal-derived (LB) peptones. Kinetic assays were used to assess phage suppression of host bacterial growth. In a mock therapeutic phage screen, spot tests, Efficiency of Plating (EOP) and kinetic assays were performed against novel bacterial targets. Whole genome sequencing of phages and their bacterial hosts propagated in AF or LB broth was used to observe genomic differences between formulations. Animal-free peptone did not impact phage yield, with both AF and LB phage stocks growing to high titers ([&ge;]108 PFU/mL). Kinetic assay results showed similar suppression indices for AF and LB-grown phages. Likewise, phage screen spot test, EOP, and kinetic assay results were similar between AF and LB phages. Comparisons of phage and bacterial genome annotations showed no major differences arising from media formulation. ConclusionsFindings suggest animal-free peptones do not significantly alter phage yield, bactericidal activity, or genomic characteristics, supporting use of animal-free medium for medicinal phage manufacture. This is one of the first studies to systematically combine phenotypic and genomic assessment of phages and hosts across animal-free and traditional media. Impact StatementPhage therapy is increasingly used to treat antimicrobial resistance infections. Emerging guidelines and regulations for the manufacture of phage therapeutics will impact laboratory processes and materials used for phage production. Here, we explored the use of an animal-free medium for medicinal phage propagation, providing data on phage yield and metrics of phage activity.

BackgroundChildren with tracheostomies experience frequent and recurrent acute respiratory infections (ARIs). While cultured respiratory pathogens can inform ARI diagnosis, it is unknown if their presence in the airway affects future ARI risk. ObjectiveTo identify predictors of frequent (3+) ARIs within 36 months of tracheostomy. MethodsWe conducted a single-center, retrospective cohort study of children with tracheostomies placed between 2010-2016. Medical records were reviewed for each encounter in which a respiratory culture was obtained over the 3 years post-tracheostomy. ARIs were defined using encounter ICD-9/10 codes. Logistic and Poisson regression were used to model the association between clinical and microbiologic predictor variables with having frequent (3+) ARIs and the total number of ARIs per child. Mediation analysis using stepwise regression models further evaluated the role of P. aeruginosa. ResultsAmong 436 children, 631 diagnosed ARIs occurred within 36 months of tracheostomy; 20.2% of children had 3+ ARIs. Pseudomonas aeruginosa was isolated in 25% of children and was more common among those with 3+ ARIs compared with 0-2 ARIs (56.8% vs 20.7%, p<0.001). Those with early P. aeruginosa isolation were more likely to have 3+ ARIs (aOR 3.38, 95% CI 1.97-5.81), and this relationship persisted when analyzing ARIs and P. aeruginosa counts. Identification of P. aeruginosa partially mediated the relationship of ventilator dependence with ARI frequency. ConclusionIsolation of P. aeruginosa, particularly early and repeated isolation, is associated with frequent ARIs in the 3 years after tracheostomy and is an important partial mediator. Findings may inform risk stratification and targeted treatment strategies.

ImportanceCurrent guidelines from the World Health Organization, Centers for Disease Control and Prevention, and Academy of Breastfeeding Medicine recommend discarding all milk remaining in bottles immediately after infant feeding. However, these recommendations lack supporting microbiological evidence from studies of actual infant feeding, imposing substantial financial and emotional burden on the 78 million families worldwide who bottle-feed their infants. ObjectiveTo determine (1) the financial, emotional, and time burden associated with bottle feeding and parental milk disposal practices, and (2) bacterial growth in leftover human milk and formula under different storage conditions. Design(1) Cross-sectional online survey (January 2023-February 2024) and (2) prospective microbiological cohort study. Setting(1) Online survey, (2) infants recruited in Hannover, Germany Participants(1) Survey respondents (n=1056; 99% mothers) and (2) healthy, full-term, bottle-fed infants (n=44; 17 humanmilk, 27 formula) aged 0-12 months. Main Outcomes and MeasuresParental burden scores, milk disposal frequency, and bacterial colony-forming units (CFU)/ml in milk samples before feeding, immediately after feeding, and at 4, 8, and 24 hours post-feeding at 4{degrees}C and 20{degrees}C. ResultsAmong surveyed parents, 46% discarded leftover milk daily, yet 84% reported they would keep milk longer if deemed safe. In microbiological testing, median bacterial burden in humanmilk increased from 4200 CFU/ml (range 300-350,000) pre-feeding to 24,600 CFU/ml (range 1900-29,004,400) post-feeding, but showed no significant further increase at 4 hours (p=0.82) or 8 hours (p=0.64) when stored at either 4{degrees}C or 20{degrees}C. Formula showed similar stability: median CFU/ml increased from 0 (range 0-10,700) to 11,700 (range 1900-630,000) post-feeding, with no significant change at 4 hours (p=0.91) or 8 hours (p=0.73) at either temperature. Significant bacterial growth occurred only after 24 hours at 20{degrees}C (p<0.001). Conclusions and RelevanceBacterial burden in leftover infant milk remained stable below concerning thresholds for 8 hours when refrigerated and 4-8 hours at room temperature, challenging current guidelines that mandate immediate disposal. Evidence-based guideline revision could reduce financial burden and milk waste for families around the globe without compromising infant safety. Key PointsO_ST_ABSQuestionC_ST_ABSHow long is it safe to offer leftover milk in a bottle to an infant that has previously drunk from it? FindingsThe number of bacteria in leftover human milk or formula did not significantly increase from 0 to 8h post-feeding in milk bottles sampled from 44 infants, regardless of whether the milk was kept at room temperature or refrigerated. MeaningLeftover milk may be safely reoffered beyond the limits of the current guidelines.

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.

Endocavity ultrasound transducers, particularly transvaginal ultrasound (TVUS) probes, contain intricate structures such as notches, grooves, lens surfaces, and handle edges that are highly susceptible to microbial contamination yet difficult to disinfect using conventional high-level disinfection (HLD) methods. This study evaluated the efficacy of a novel ultraviolet-C light-emitting diode (UV-C LED) HLD system in eliminating microbial contamination from these complex probe surfaces. Two TVUS probes were sampled from predefined high-risk regions before and after disinfection following clinical use. Probe A was sampled at the top and bottom notches and both sides of the handle, while Probe B was assessed at the lens, edges, and bent groove regions. Microbial contamination was quantified using swab sampling, culture on agar plates, and identification via MALDI-TOF. Environmental sampling of examination and disinfection rooms was also performed. To assess this system robustness, probe sites were repeatedly inoculated with Bacillus subtilis spores and evaluated following UV-C treatment. Before UV-C treatment, contamination rates ranged from 25% to 57% across sampled regions, with microbial loads reaching up to 3.9 log CFU. Identified organisms included Staphylococcus epidermidis, Pseudomonas koreensis, Bacillus cereus, and Propionibacterium spp. Probe sheaths were also predominantly contaminated with Staphylococcus epidermidis., with counts reaching up to 4.3 log CFU, Environmental sampling revealed diverse microbiota, with higher contamination levels in examination rooms compared to disinfection areas. Following 90 seconds of UV-C exposure, no microbial growth was detected on any sampled site, indicating 100% decontamination. Additionally, UV-C treatment achieved >6.7 log reduction of B. subtilis spores across all tested regions. These findings demonstrate that UV-C LED technology provides rapid, effective, and consistent high-level disinfection of complex TVUS probe surfaces, supporting its potential as a rapid and reliable disinfection modality in clinical setting.

Objective. To evaluate the diagnostic and prognostic significance of C reactive protein (CRP) level dynamics within the first five days after surgery for the early detection of surgical site infections (SSI) and to identify independent risk factors, taking into account regional specifics of surgical management (types of surgeries, duration of procedures), as well as the local hospital microbial landscape. Materials and Methods. A single-center retrospective cohort analysis of data from 127 patients who underwent surgical procedures between 2022 and 2024 was conducted. CRP levels on postoperative days 1, 3, and 5 were assessed, and delta values were calculated. Descriptive statistics, ROC analysis, and multivariate logistic regression were used to identify predictors of SSI. Results. Patients with SSI lacked the physiological decrease in CRP levels by day 5. The most informative indicator was the CRP level on day 3: a threshold of >106 mg/L was associated with a high risk of SSI (AUC=0.76; sensitivity 85%, specificity 63%). Independent predictors of SSI included surgery duration (OR=1.015 per 1 min; p<0.001) and the increase in CRP between days 3 and 5 (delta CRP3-5: OR=1.027; p=0.023). A combined model (clinical parameters + CRP) demonstrated the highest predictive ability (AUC=0.79). Conclusion. Monitoring CRP dynamics, particularly on days 3 and 5, is a highly informative and accessible method for the early diagnosis of SSI. A CRP threshold of >100 mg/L on day 3 and its subsequent increase should serve as a trigger for in-depth diagnostic investigation and rationalization of antimicrobial therapy. Keywords: C reactive protein, postoperative complications, surgical site infection, antibiotic therapy, predictive factors, diagnosis

IntroductionAcinetobacter is a highly diverse genus which includes a range of common pathogenic species such as A. baumannii, A. lwoffii etc. Acinetobacter species causes bacteremia, pneumonia, wound infections, Urinary tract infections in community as well as hospital settings. A. baumannii is one of the ESKAPE pathogen which makes it even more lethal as antibiotics cannot action on this. AimTo isolate Acinetobacter species from various clinical samples and to check their antimicrobial susceptibility pattern by VITEK {square} Compact in SGT Hospital, Gururam, Haryana. ResultsOut of total 6673 samples 595 were the positive isolates from which 35 were Acinetobacter isolates which were received from various wards of the hospital. Occurrence of Acinetobacter was seen more in males(57.14%) as compare to females (46.8%). A total of 31 strains were A. baumannii, 3 were A. lwoffi and 1 strain was of A. haemolyticus. Prominent presence of Acinetobacter was seen in Blood (48.57%) specimen along with pus(22.85%), endotracheal (22.85%), tracheal (2.85%) and eye swabs (2.85%). All the isolates were resistant to piperacillin/tazobactam (100%), ceftriazone (100%), amikacin (100%), gentamicin (100%) ciprofloxacin (91.42%), ceftazidime (91.42%), cefepime (88.57%), levofloxacin (88.57%) and trimethoprim/sulfamethoxazole (80%). Colistin susceptibility was observed in 88.57% of the isolates. ConclusionAcinetobacter is a common pathogen in hospital acquired as well as in community acquired infections as it is a opportunistic pathogen hence to identify the Acinetobacter species and to understand their antimicrobial resistance pattern this study was conducted.

Hospital-acquired infections driven by ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) are highly prevalent. Premise plumbing, sinks and drains, seeds these organisms into patient environments via aerosolization and subsequent surface contamination. We measured viable ESKAPEE pathogens and overall microbial communities in and around sinks in two high-burden hospitals in La Paz, Bolivia, using culture and 16S rDNA sequencing. In a prospective observational study (May-August 2025), we collected 233 surface swabs and 39 air samples across four sink-related surface categories and in room air. Samples were plated on selective media for ESKAPEE identification and quantified as colony-forming units (CFU) normalized to 100 cm2 or 6000 L. DNA was extracted, and the full 16S rDNA gene was sequenced on PacBio Revio, analyzed via DADA2/QIIME2 and R. We detected viable presumptive ESKAPEE pathogens in 74.7% surface swabs and 74.4% air samples. Sink basins were most contaminated (mean 31CFU/100 cm2, 95 % CI16-46); concentrations declined with distance from the drain. Klebsiella/Enterobacter spp. showed the highest mean concentration across samples; S. aureus was most frequently detected (54.4% of samples). Hospital-specific differences were evident in culture positivity (Hospital A 85% vs. Hospital B 66.9%) and community composition (PERMANOVA P = 0.001; sample location explained 21.9% vs. 11.7% of variation). 16S profiling confirmed elevated relative abundances of Klebsiella, Enterococcus, and Enterobacter in basins relative to distant surfaces and air. The hospitals studied had high levels of ESKAPEE pathogens, underscoring the need for control measures.