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Microorganisms
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Healthcare-Associated Infections and Antimicrobial Therapy
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Healthcare-Associated Infections and Antimicrobial Therapy

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 8816

Special Issue Editors

Dr. Diamantis P. Kofteridis

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Guest Editor
Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
Interests: antimicrobial stewardship; Infection control; Infectious diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Petros Ioannou

E-Mail Website
Guest Editor
Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
Interests: clinical microbiology; infectious diseases; endocarditis; mycoses; fungal infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Hospital-acquired infections occur frequently among hospitalized patients and are associated with a significant increase in morbidity and mortality. The most common hospital-acquired infections include bloodstream infections, respiratory tract and urinary tract infections. Currently, several changes regarding the epidemiology and microbiology of hospital-acquired infections are noted, and they mostly have to do with the increasing problem of antimicrobial resistance either in Gram-positives, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, or in Gram-negatives, such as carbapenem-resistant Enterobacterales, extensively-drug resistant and pan-drug resistant Acinetobacter baumannii, and multi-drug resistant Pseudomonas aeruginosa. The problem of increasing antimicrobial resistance leaves few therapeutic options, leading to the revival of old antibiotics or the use of antimicrobial combinations in difficult-to-treat pathogens.

To obtain a better understanding of the problem of hospital-acquired infections and the changes in their antimicrobial treatment, this Special Issue aims to bring together original studies and literature reviews related to the epidemiology, microbiology, clinical characteristics, treatment and outcomes of these infections. Furthermore, studies focusing on antimicrobial stewardship and infection control regarding hospital-acquired infections are also welcome.

Dr. Diamantis P. Kofteridis
Dr. Petros Ioannou
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (7 papers)

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Research

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12 pages, 1378 KiB  
Article
Device-Associated Infections in COVID-19 Patients: Frequency of Resistant Bacteria, Predictors and Mortality in Medellín, Colombia
by Diana Patricia Ocampo, Lina María Echeverri-Toro, Judy Natalia Jiménez, Lorena Salazar, Carlos Vargas, Gustavo Roncancio, Maria Alejandra Roa and Johanna Marcela Vanegas
Microorganisms 2024, 12(4), 640; https://doi.org/10.3390/microorganisms12040640 - 22 Mar 2024
Viewed by 775
Abstract
Introduction: Increased antimicrobial use during the COVID-19 pandemic has raised concerns about the spread of resistant bacteria. This study analyzed the frequency of device-associated infections (DAI) caused by resistant bacteria, the predictors of these infections, and 30-day all-cause mortality in patients with and [...] Read more.
Introduction: Increased antimicrobial use during the COVID-19 pandemic has raised concerns about the spread of resistant bacteria. This study analyzed the frequency of device-associated infections (DAI) caused by resistant bacteria, the predictors of these infections, and 30-day all-cause mortality in patients with and without COVID-19. Methods: A retrospective cohort study was conducted on DAI patients admitted to the ICU (intensive care unit) in 20 hospitals in Medellin, Colombia (2020–2021). The exposure assessed was the COVID-19 diagnosis, and outcomes analyzed were resistant bacterial infections and 30-day mortality. Clinical and microbiological information was collected from surveillance databases. Statistical analysis included generalized linear mixed-effects models. Results: Of the 1521 patients included, 1033 (67.9%) were COVID-19-positive and 1665 DAI were presented. Carbapenem-resistant Enterobacteriaceae (CRE) infections predominated during the study (n = 98; 9.9%). The patients with COVID-19 had a higher frequency of metallo-beta-lactamase-producing CRE infections (n = 15; 33.3%) compared to patients without the disease (n = 3; 13.0%). Long-stay in the ICU (RR: 2.09; 95% CI: 1.39–3.16), diabetes (RR: 1.73; 95% CI: 1.21–2.49), and mechanical ventilation (RR: 2.13; 95% CI: 1.01–4.51) were CRE infection predictors in COVID-19 patients, with a mortality rate of 60.3%. Conclusion: CRE infections were predominant in COVID-19 patients. In pandemic situations, the strategies to control DAI should be maintained to avoid infections caused by resistant bacteria, such as length of stay in the ICU and duration of mechanical ventilation. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
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10 pages, 590 KiB  
Article
Antimicrobial Use during the SARS-CoV-2 Pandemic in a Greek Tertiary University Hospital
by Dimitrios Biros, Sempastian Filippas-Ntekouan, Diamantina Limperatou, Angelos Liontos, Rafail Matzaras, Konstantina-Helen Tsarapatsani, Nikolaos-Gavriel Kolios, Christiana Pappa, Maria Nasiou, Eleni Pargana, Ilias Tsiakas, Valentini Samanidou, Lazaros Athanasiou, Revekka Konstantopoulou, Haralampos Milionis and Eirini Christaki
Microorganisms 2024, 12(3), 623; https://doi.org/10.3390/microorganisms12030623 - 20 Mar 2024
Viewed by 658
Abstract
In cases of SARS-CoV-2 hospitalization, despite low bacterial co-infection rates, antimicrobial use may be disproportionately high. Our aim was to quantify such usage in COVID-19 patients and identify factors linked to increased antibiotic use. We retrospectively studied patients with SARS-CoV-2 infection who were [...] Read more.
In cases of SARS-CoV-2 hospitalization, despite low bacterial co-infection rates, antimicrobial use may be disproportionately high. Our aim was to quantify such usage in COVID-19 patients and identify factors linked to increased antibiotic use. We retrospectively studied patients with SARS-CoV-2 infection who were hospitalized at our institution during the pandemic. In the initial two waves of the pandemic, antimicrobial use was notably high (89% in the first wave and 92% in the second), but it decreased in subsequent waves. Elevated procalcitonin (>0.5 μg/mL) and C-reactive protein (>100 mg/L) levels were linked to antibiotic usage, while prior vaccination reduced antibiotic incidence. Antimicrobial use decreased in the pandemic, suggesting enhanced comprehension of SARS-CoV-2′s natural course. Additionally, it was correlated with heightened SARS-CoV-2 severity, elevated procalcitonin, and C-reactive protein levels. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
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11 pages, 1125 KiB  
Article
Cutibacterium avidum: A Potent and Underestimated Pathogen in Prosthetic Hip Joint Infections
by Johanna Karlsson, Nina Kamenska, Erika Matuschek, Holger Brüggemann and Bo Söderquist
Microorganisms 2024, 12(3), 432; https://doi.org/10.3390/microorganisms12030432 - 20 Feb 2024
Viewed by 860
Abstract
Cutibacterium avidum has recently been reported as a rare cause of prosthetic joint infections (PJIs), contrary to Cutibacterium acnes, which is well established as a cause of PJIs, especially in shoulder arthroplasties. Two specific risk factors for PJI due to C. avidum [...] Read more.
Cutibacterium avidum has recently been reported as a rare cause of prosthetic joint infections (PJIs), contrary to Cutibacterium acnes, which is well established as a cause of PJIs, especially in shoulder arthroplasties. Two specific risk factors for PJI due to C. avidum have been reported: obesity and the skin incision approach. Here, we report four cases of hip PJIs caused by C. avidum admitted over a 30-month period at a single center. Whole-genome sequencing revealed that the four C. avidum strains were all individual strains and did not originate from a common source, such as an outbreak. Antibiotic susceptibility tests showed that the isolates were fully susceptible, and none carried known antibiotic resistance genes. In conclusion, the occurrence of four cases of PJI caused by C. avidum over a limited time at a single center may indicate that this pathogen is underestimated and is either emerging or more common than previously recognized. The patients presented overt signs of infection during surgery, indicating that C. avidum is a virulent pathogen. None of the previously reported risk factors for C. avidum PJI applied to these patients as only one was obese and none were operated on using a direct anterior skin incision approach. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
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15 pages, 301 KiB  
Article
Evaluation of Febrile Neutropenia in Hospitalized Patients with Neoplasia Undergoing Chemotherapy
by Maria Bachlitzanaki, George Aletras, Eirini Bachlitzanaki, Ippokratis Messaritakis, Stergos Koukias, Asimina Koulouridi, Emmanouil Bachlitzanakis, Eleni Kaloeidi, Elena Vakonaki, Emmanouil Kontopodis, Nikolaos Androulakis, Georgios Chamilos, Dimitrios Mavroudis, Petros Ioannou and Diamantis Kofteridis
Microorganisms 2023, 11(10), 2547; https://doi.org/10.3390/microorganisms11102547 - 12 Oct 2023
Viewed by 1194
Abstract
Febrile neutropenia (FN) is a common but serious complication encountered in patients with cancer and is associated with significant morbidity and mortality. In this prospective study, 63 patients with solid tumors under chemotherapy or immunotherapy were admitted to the hospital due to febrile [...] Read more.
Febrile neutropenia (FN) is a common but serious complication encountered in patients with cancer and is associated with significant morbidity and mortality. In this prospective study, 63 patients with solid tumors under chemotherapy or immunotherapy were admitted to the hospital due to febrile neutropenia, confirmed through clinical or microbiological documentation. The aim of this study was to provide a comprehensive overview of the epidemiological and microbiological characteristics of hospitalized neutropenic patients with solid tumors undergoing treatment. Additionally, we aimed to assess the duration of neutropenia and identify factors influencing patient outcomes. The median age of patients was 71 ± 10.2 years, most of which were males (66.7%), and the primitive tumor location was the lung (38.1%), with most patients (82.5%) being at disease stage IV. The median duration of neutropenia was three days (range 1–10), and, notably, mucositis was significantly associated with neutropenia lasting ≥3 days (p = 0.012). Patients with lung cancer (38.1%) and patients with stage IV disease (82.5%) presented a higher risk of FN, although these differences did not reach statistical significance. The site of infection was identifiable in 55.6% of patients, with positive cultures detected in 34.9% and positive blood cultures (BC) drawn in 17.5% of cases. Gram-positive bacteria were the predominant causative agents in BC (63.6%), with Staphylococci being the most prevalent among them (66.7%). The median duration of hospitalization was nine days (range, 3–43 days), and most patients showed improvement or cure of infection (16.9% and 74.6%, respectively). Among recorded risk factors, the Eastern Cooperative Oncology Group (ECOG) performance status (PS) appears to be statistically significant. Patients with an impaired PS score (2–4) experienced worse outcomes and higher likelihood of mortality (p = 0.004). Regarding the outcome, a longer duration of neutropenia was also statistically significant (p = 0.050). Of the patients, 12.7% ultimately succumbed to their conditions, with 37.5% attributed to infections. FN is a common yet serious complication in solid tumor patients. Adequate knowledge of the predictors of mortality and the microbiological causes are of utmost importance to allow accurate diagnosis and prompt treatment as they significantly influence patient outcomes. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
11 pages, 277 KiB  
Article
Bacterial Contamination of Mobile Phones Used by Healthcare Workers in Critical Care Units: A Cross-Sectional Study from Saudi Arabia
by Nabil Dhayhi, Nader Kameli, Mohammed Salawi, Amjad Shajri, Vinod Kumar Basode, Abdullah Algaissi, Edrous Alamer, Majid Darraj, Khalid Shrwani and Abdulaziz H. Alhazmi
Microorganisms 2023, 11(8), 1986; https://doi.org/10.3390/microorganisms11081986 - 02 Aug 2023
Cited by 1 | Viewed by 1849
Abstract
Background: Healthcare-associated infections (HAIs) present a formidable challenge for healthcare institutions, resulting in heightened mortality, morbidity, and economic burden. Within healthcare settings, various equipment and materials, including mobile phones, can potentially act as sources of infection. This study sought to examine the occurrence [...] Read more.
Background: Healthcare-associated infections (HAIs) present a formidable challenge for healthcare institutions, resulting in heightened mortality, morbidity, and economic burden. Within healthcare settings, various equipment and materials, including mobile phones, can potentially act as sources of infection. This study sought to examine the occurrence of bacterial contamination on mobile phones utilized by healthcare workers (HCWs) in intensive care units (ICUs), pediatric intensive care units (PICUs), neonatal intensive care units (NICUs), and cardiac care units (CCUs) within a central hospital (CH) and two peripheral hospitals (PHs) situated in the southwestern province of Saudi Arabia. Materials and methods: We collected a total of 157 samples from mobile phones utilized by HCWs across all ICUs in the CH and PHs. These samples underwent bacteriological analysis to evaluate the degree of bacterial contamination. Results: We found that 45 out of 55 samples from physicians (81.81%) and 58 out of 77 samples from nurses (75.32%) showed bacterial contamination. Contamination rates on HCWs’ mobile phones in the ICU, PICU, and NICU departments of the CH were observed at 69.56%, 80.95%, and 70.27%, respectively. Furthermore, the overall contamination rates in the ICUs, NICUs, and CCUs of the PHs were 78.26%, 88.88%, and 66.66%, respectively. The overall contamination rates of mobile phones in the CH and PHs were 72.11% and 81.13%, respectively. Conclusion: These findings underscore the necessity of routinely disinfecting the mobile phones of HCWs to mitigate the risk of cross-contamination. Implementing robust disinfection protocols can significantly contribute to curtailing the propagation of bacterial pathogens and reducing the incidence of HAIs in healthcare settings. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
12 pages, 1006 KiB  
Article
Evaluation of Plasma Lipocalin-2 as a Predictor of Etiology and Severity in Adult Patients with Community-Acquired Pneumonia
by Lucía Boix-Palop, Andrea Vergara, Emma Padilla, Diego Martínez, Ana Blanco, Josefa Pérez, Esther Calbo, Jordi Vila and Climent Casals-Pascual
Microorganisms 2023, 11(5), 1160; https://doi.org/10.3390/microorganisms11051160 - 28 Apr 2023
Viewed by 1050
Abstract
The aim of this study was to evaluate the diagnostic performance of plasma Lipocalin-2 (LCN2) concentration in adult patients with community-acquired pneumonia (CAP) to determine its etiology, severity and prognosis. A prospective observational study involving adults with CAP from November 2015 to May [...] Read more.
The aim of this study was to evaluate the diagnostic performance of plasma Lipocalin-2 (LCN2) concentration in adult patients with community-acquired pneumonia (CAP) to determine its etiology, severity and prognosis. A prospective observational study involving adults with CAP from November 2015 to May 2017 was conducted. Plasma LCN2 concentration was measured upon admission by a modified enzyme immunoassay coupled with chemiluminescence (Architect, Abbott Laboratories). The diagnostic performance of LCN2, C-reactive protein (CRP) and white blood cell to predict bacterial CAP was assessed. A total of 130 patients with CAP were included: 71 (54.6%) bacterial CAP, 42 (32.3%) unknown origin CAP and 17 (13.1%) viral CAP. LCN2 was higher in bacterial CAP than in non-bacterial CAP (122.0 vs. 89.7 ng/mL, respectively) (p = 0.03) with a limited ability to distinguish bacterial and non-bacterial CAP (AUROC: 0.62 [95% CI 0.52–0.72]). The LCN2 cutoff ≥ 204 ng/mL predicted the presence of pneumococcal bacteremia with an AUROC of 0.74 (sensitivity 70%, specificity 79.1%). Regarding severity, as defined by CURB-65 and PSI scores, there was a significant linear trend in the mean concentration of LCN2, exhibiting a shift from the low-risk to the intermediate-risk and high-risk group (p < 0.001 and 0.001, respectively). LCN2 concentration was associated with severity in adult patients with CAP. However, its utility as a biomarker to discriminate viral and bacterial etiology in CAP is limited. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
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Review

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16 pages, 1695 KiB  
Review
Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance
by Georgios Schinas, George Dimopoulos and Karolina Akinosoglou
Microorganisms 2023, 11(9), 2214; https://doi.org/10.3390/microorganisms11092214 - 31 Aug 2023
Cited by 1 | Viewed by 1637
Abstract
Antimicrobial resistance (AMR) poses a significant global health challenge, exacerbated by the COVID-19 pandemic. Antimicrobial stewardship programs (ASPs) are crucial in managing this crisis, with diagnostic stewardship (DS) emerging as a key component. DS refers to the appropriate use of diagnostic tests to [...] Read more.
Antimicrobial resistance (AMR) poses a significant global health challenge, exacerbated by the COVID-19 pandemic. Antimicrobial stewardship programs (ASPs) are crucial in managing this crisis, with diagnostic stewardship (DS) emerging as a key component. DS refers to the appropriate use of diagnostic tests to optimize patient outcomes, improve antimicrobial use, and combat multi-drug-resistant (MDR) organisms. Despite its potential, understanding and application of DS remain ambiguous in multiple respects, which, however, do not directly implicate the implementation of such initiatives. DS is particularly important for resident physicians who are often at the forefront of patient care and can significantly influence future AMR strategies. This review provides a comprehensive overview of DS, discussing its importance, potential challenges, and future directions. It emphasizes the need for resident physicians to understand DS principles and integrate them into their clinical practice from the beginning of their careers. The review also highlights the role of various stakeholders in implementing DS and the importance of continuous education and training. Ultimately, DS is not just a clinical tool but a philosophy of care, essential for a more responsive, humane, and effective healthcare system. Full article
(This article belongs to the Special Issue Healthcare-Associated Infections and Antimicrobial Therapy)
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