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: Periprosthetic hip infections (PHIs) are troublesome complications of hip arthroplasties. The gold standard procedure for treating chronic PHI is a 2-stage approach. Recently, however, more conservative approaches have been developed to spare the osseointegrated components and avoid sequestra, bone loss, devascularization, and difficult reconstructions. The partial two-stage approach, which leaves the well-fixed component in situ and removes the loosened component, may be an effective strategy.
Objective: This paper, a narrative mini-review, analyzed the preliminary results of a partial 2-stage approach to treating chronic hip arthroplasty infections.
Methods: Pertinent papers describing the partial 2-stage approach (leaving the well-fixed component in situ and removing the loosened component) were collected and evaluated.
Results: Six main case series were selected. A total of 76 patients were included. Many patients were treated with socket removal and stem retention with quite similar surgical techniques. Many cases included highly virulent bacteria, and no pre-operative selection about comorbidities was performed. The first outcomes of this approach were promising, with a rate of infection control ranging from 81.3% to 100% at mid-term follow-up.
Conclusion: This approach proved good at mid-term follow-up; however, many concerns still exist. In particular, the indications are imprecise, and the role of biofilm is still unclear. Despite the first good outcomes, the partial 2-stage approach for chronic PHI should be validated by multicenter prospective studies.