Hospital Practices and Research

Abstract Neonatal Intensive Care Units (NICUs) face a persistent challenge in controlling healthcare-associated infections (HAIs), with reported rates ranging from 6% to 25% globally. While traditional infection control strategies have focused on symptomatic patients and high-risk groups, a growing body of evidence suggests that “silent spreaders,” asymptomatic carriers of multidrug-resistant organisms (MDROs) among healthcare workers, parents, and neonates themselves may represent a critical blind spot in current surveillance paradigms. If this is the case, then fundamental assumptions underpinning NICU infection control may warrant reexamination. We argue that existing approaches, which rely heavily on active surveillance cultures (ASCs) and hand hygiene compliance, are structurally ill-suited to detect asymptomatic transmission. Emerging genomic, environmental, and data-driven methodologies offer not merely incremental improvements but a necessary reconceptualization of surveillance itself.

Abstract Background: Hospital-acquired infections (HAIs), particularly device-associated infections (DAIs) in ICUs, pose a significant global health burden, especially in low- and middle-income countries.
Objectives: This study aims to estimate the HAI burden by analyzing DAI rates and resistance patterns in ICU settings, contributing to evidence-based infection control strategies.
Methods: We conducted a six-month prospective observational study in the adult ICU of GTBH (July–December 2024), focusing on patients with DAIs. Incidence and device utilization rates were calculated using CDC-standardized metrics based on device and patient days.
Results: Out of 286 patients, 40 developed a total of 62 DAIs, comprising 25 cases of ventilator-associated pneumonia (VAP) (40.3%), 19 cases of catheter-related bloodstream infections (CLABSI) (30.65%), and 18 cases of catheter-associated urinary tract infections (CAUTI) (29.03%). VAP had the highest cumulative infection rate (22.6%), followed by CLABSI (21%) and CAUTI (10.8%). Acinetobacter baumannii was the dominant isolate in VAP cases, Klebsiella pneumoniae and Enterobacter spp. were predominant in CLABSI cases, and non-albicans Candida was the leading pathogen in CAUTI cases. Significant antimicrobial resistance was observed, especially among Acinetobacter and Pseudomonas species. Notably, the case fatality rate among DAI patients reached 57.5%.
Conclusion: In conclusion, our surveillance study highlights a substantial burden of DAIs in the ICU, with VAP being the most prevalent. The dominance of multidrug-resistant pathogens and the striking 57.5% fatality rate emphasize the urgent need for robust infection control, tailored stewardship programs, and continuous local epidemiological monitoring.

Abstract Background: Emergence and dissemination of resistance to carbapenems among carbapenemase-producing Enterobacteriaceae (CPE) has led to limited therapeutic options for patients infected with CPE. Objectives: This study aimed to determine the prevalence of CPE colonization among newly admitted patients scheduled for surgery, identify the risk factors for acquiring CPE, and assess post-surgical outcomes among CPE carriers. Methods: A total of 152 patients scheduled for various types of planned surgery were included in the study. Two rectal swabs were collected from each patient and processed following the CDC-recommended method for screening Carbapenem-resistant Enterobacteriaceae (CRE). Probable CRE colonies were then tested using the mCIM for carbapenemase production according to CLSI guidelines. Patients were followed up after two months to monitor for any post-surgical infections. Surveillance swab sampling was conducted to detect the spread of CPE in the hospital environment by CPE carriers. Results: A high occurrence (15.13%) of CPE colonization was recorded in patients admitted for different planned surgeries. A history of antibiotic therapy was significantly associated with CPE acquisition (P<0.001). A significantly higher proportion of CPE carriers developed post-surgical infections compared to non-carriers (87% vs. 13.1%; P<0.0001). All the patients who developed post-surgical infections with CRE were already harboring CPE in their intestines. On environmental sampling, 15 (65.2%) of the 23 CPE-colonized patients were found to be positive for CPE. Conclusion: High rates of intestinal carriage of CPE among freshly admitted patients, as detected in our study, pose a risk to individuals for CPE infection, leading to antibiotic therapy, long-term hospital stays, and loss of daily wages. Therefore, infection control policies should be formulated by hospitals to screen for CPE carriage during hospital admission, followed by containment of CPE to prevent transmission.

Abstract Background: Device-Associated Infections (DAIs) pose significant challenges in healthcare settings, leading to increased morbidity, mortality, and healthcare costs. Understanding the impact of the COVID-19 pandemic on DAIs and device utilization rates is crucial for optimizing infection control practices and enhancing patient safety.
Objectives: This study aims to elucidate the shifts in infection rates, specifically CAUTI, VAP, and CLABSI in a tertiary care centre before and after the onset of the global pandemic.
Methods: In this retrospective study, we analysed trends in DAIs and device utilization rates before (October 2019 - March 2020) and after (August 2021 - January 2022) the COVID-19 pandemic. Data on urinary catheter days, central line days, ventilator days, and rates of Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infection (CLABSI), and Ventilator-Associated Pneumonia (VAP) were collected from medical records.
Results: According to the findings of the present study, fluctuations in CAUTI, CLABSI, and VAP rates pre- and post-pandemic, with no significant difference in infection rates between the two periods (P >0.05) were observed. There was a notable increase in urinary catheter days post-pandemic, accompanied by reductions in ventilator days and central line days. The urinary catheter utilization ratio substantially increased post-pandemic, while ventilator and central line utilization ratios showed slight declines.
Conclusion: This study highlights the dynamic nature of DAIs and device utilization rates in the wake of the COVID-19 pandemic. Implementing evidence-based protocols and continuing research in infection control practices are essential for optimizing healthcare delivery and enhancing patient safety in the post-pandemic era.

Abstract Background: A comprehensive overview of ESKAPE pathogens, highlighting their antibiotic resistance mechanisms and the urgent need to address the clinical impact of these pathogens in bloodstream infections.
Objectives: The aim of the present study was to observe the prevalence and trends of antibiotic susceptibility profiles of ESKAPE blood pathogens in Intensive Care Units (ICUs), providing valuable insights for improving patient care and infection control.
Methods: A detailed description of our descriptive cross-sectional study conducted in various ICUs, including blood sample collection, antibiotic susceptibility testing, and data management and statistical analysis.
Results: The findings of the present study reveal insight into the distribution of ESKAPE pathogens in different ICUs, with a focus on prevalence, age-specific variations, and antibiotic resistance patterns.
Conclusion: A thorough discussion on the clinical implications of our results, emphasizing the high prevalence of Acinetobacter baumannii, Staphylococcus aureus, and Klebsiella pneumoniae, and the concerning levels of antibiotic resistance observed.

Abstract The African continent is a known malaria-endemic region. Amid the COVID-19 pandemic, COVID-19/malaria co-infection is of critical importance in Africa due to the similarities in the manifestation of their symptoms. To avert compromising the health status of individuals on the African continent during the COVID-19 pandemic, this commentary sought to examine the link between COVID-19 and malaria, outlining strategies for improving the diagnosis and prevention of COVID-19 and malaria in Africa. A scale-up of malaria-focused care should be considered to ensure adequate reporting of COVID-19 cases in Africa. Likewise, individuals who present for malarial testing should be linked to COVID-19 testing and treatment care in Africa. Also, surveillance activities should be scaled up to ensure accurate COVID-19 case reporting and improved case notification. Regular refresher trainings should be organized for healthcare workers to promote healthcare service delivery.