Infection Prevention Society

要旨 【背景】 市中発症メチシリン耐性黄色ブドウ球菌（MRSA）感染症のうち，白血球を破壊する毒素Panton–Valentine leukocidin（PVL）産生株の報告が増加している。 【症例】 生来健康な，税関職員として日常的に海外からの渡航者と接していた40歳代の男性が，全身筋肉痛と発熱を主訴に近医を受診し，肺に多発結節影を認め肺炎と診断され，抗菌薬治療目的に入院した。入院翌日ショックとなり，精査加療目的で当院へ転院した。来院時，頻呼吸，頻脈，血圧低下，全身に網状皮斑を認めた。血液検査で乳酸アシドーシス，PaO 2 低下，血球減少，凝固異常を認めた。胸部単純CT検査で両側肺野に空洞病変を伴う多発結節影を認め，喀痰・血液培養からMRSAが検出された。壊死性肺炎を伴うMRSA菌血症，敗血症性ショックと診断し，人工呼吸管理，持続的血液透析濾過療法を含む集中治療を行った。経過中，多発筋内膿瘍も出現し，長期抗菌薬投与と膿瘍ドレナージを要したが，第128病日に独歩退院した。遺伝子解析で本株のMLST型は家畜関連MRSA（LA–MRSA）との関連も疑われるST1232で， pvl 遺伝子陽性と判明し，日本では報告が少ない型であった。 【結語】 遺伝子解析は病態理解や特定の遺伝子変異をもつ病変に対しての効果的な薬の使用などの治療選択に加え，感染経路特定など感染症対策にも寄与する可能性がある。

IntroductionLung adenocarcinoma (LUAD), the most common subtype of non-small cell lung cancer, is a form of malignant pulmonary nodule that requires clinical differentiation from benign pulmonary nodules (BPN). The mechanisms underlying the development of LUAD are complex, and effective non-invasive methods for differentiating BPN from LUAD are lacking. This study aimed not only to distinguish BPN from LUAD using gut fungi and serum metabolites, but also to establish an integrated network of gut fungi–metabolite–cytokine interactions.MethodsFecal and serum samples from individuals with BPN and patients with LUAD were subjected to internal transcribed spacer sequencing, ultra-performance liquid chromatography–tandem mass spectrometry, and multiplex Luminex assays to quantify gut fungi, metabolites, and cytokines, respectively.ResultsA significant difference in gut fungal communities was observed between the BPN and LUAD groups. Multiple genera and species were more abundant in LUAD than in BPN. Docosapentaenoic acid n-6 (DPAn-6), indole-3-propionic acid (IPA), and interferon-γ-induced protein 10 (IP-10) were significantly elevated in the LUAD group. The integrated model established using a combination of gut fungi and metabolites demonstrated excellent performance in distinguishing BPN from LUAD. A network of interactions was established among differentially abundant gut fungi, serum metabolites, and cytokines.ConclusionOur study identifies a novel panel of fungal and metabolite biomarkers for differentiating between BPN and LUAD, and constructs a multi-omics network that provides new insights into investigating the mechanistic role of gut mycobiota dysbiosis in LUAD.

The global healthcare landscape continually emphasizes the critical importance of high-quality and safe patient care, with nurses serving as the foundational providers at the point of care, significantly influencing patient outcomes. Persistent issues, including adverse events, patient dissatisfaction, and nursing workforce challenges, necessitate a comprehensive understanding of the obstacles nurses face and the strategies they employ to uphold standards. The objective of this review was to systematically synthesize existing literature to identify the principal challenges encountered by nurses and explore effective strategies for enhancing the quality and safety of care delivery. This integrative literature review, utilizing a rigorous systematic approach to collate findings from diverse international studies, revealed that major challenges include pervasive occupational burnout, suboptimal nurse-to-patient staffing ratios, communication breakdowns, and a poor organizational work environment. Key strategies identified for enhancing care quality and safety center on fostering supportive work climates, implementing robust staffing policies, utilizing professional development programs focused on precision health and safety competencies, and strengthening interprofessional collaboration. The major recommendation is for healthcare systems to implement multi-faceted, nurse-centered interventions that address both systemic and individual factors. In conclusion, addressing nurses’ challenges through strategic, evidence-based initiatives is essential for improving the nursing work environment, which directly correlates with enhanced patient care quality and safety. The implications of these findings are substantial for healthcare policymakers and organizational leadership, guiding targeted resource allocation and policy development.

The development of disposable gloves and the discovery that good hand hygiene are essential for protecting patients are among the most important developments in the history of infection prevention and control, and are both essential for protecting patients and healthcare workers. Although there are international-level guidelines for glove use and hand hygiene during patient care, there are major issues concerning compliance. The overuse of gloving does not only contribute to reduced patient safety and increased healthcare-associated infections, but leads directly to environmental degradation and labor rights abuses.

Abstract Microbial genome-wide association study (GWAS) tools often require manual data processing steps, lack comprehensive workflows, and are limited by scalability issues, thus hindering the exploration of bacterial genetic traits. To address these challenges, we developed BaGPipe, an automated and flexible bacterial GWAS pipeline built using Nextflow and incorporating Pyseer for association analysis. BaGPipe integrates all essential components of a bacterial GWAS—spanning pre-processing, statistical analysis, and downstream visualisation—into a unified workflow that is reproducible and easy to deploy across diverse computational environments. BaGPipe was validated on a publicly available dataset ofStreptococcus pneumoniaewhole-genome sequences, and reproduced published findings with improved computational efficiency. BaGPipe was then applied to a dataset ofStaphylococcus aureuswhole-genome sequences, successfully identifying known and novel antibiotic resistance associations. By offering an accessible, efficient, and reproducible platform, BaGPipe accelerates bacterial GWAS and facilitates deeper exploration into the genetic underpinnings of phenotypic traits.Impact StatementThe increasing availability of bacterial genome sequences has created an opportunity for robust, reproducible tools to facilitate the discovery of novel genotype-phenotype associations. Despite the demonstrated utility of genome-wide association studies (GWAS) in identifying genetic determinants of disease, toxicity and antibiotic resistance, existing tools for bacterial GWAS often involve fragmented workflows requiring extensive manual intervention, limiting their adoption and reproducibility. Here, we introduce BaGPipe, a fully integrated bacterial GWAS pipeline that automates pre-processing, statistical analysis, and visualisation, thereby streamlining the entire workflow. With its flexibility, scalability, and ease of use, BaGPipe makes bacterial GWAS more accessible to researchers, enabling faster and more reliable insights into microbial genetics. This is an important step towards overcoming the computational and logistical barriers that have constrained bacterial GWAS, ultimately accelerating research into microbial evolution, resistance mechanisms, and the genetic basis of other key phenotypic traits.Data SummaryBaGPipe is freely available athttps://github.com/sanger-pathogens/BaGPipe. TheStreptococcus pneumoniaeinput dataset is available from the Pyseer tutorial (https://pyseer.readthedocs.io/en/master/tutorial.html#). TheStaphylococcus aureussequencing assemblies can be sourced from their ERS accession numbers provided in supplementary data. The reference assemblies, listed in the supplementary, can be sourced from NCBI.

More extensive and cohesive studies on quadriceps tendon rupture (QTR) repair surgery are required to guide effective treatment strategies. Therefore, in this study, we aimed to identify predictors of subjective functional recovery following QTR repair surgery. This multicentre retrospective cohort study enrolled 191 adults (age ≥ 18years) who underwent surgical unilateral QTR repair (2010-2022) and had ≥ 1-year postoperative follow-up at three trauma centres in Germany. Multiple linear regression and moderation analyses evaluated seven patient-centred factors and eight treatment-related predictors of the International Knee Documentation Committee (IKDC) and Tegner-Lysholm Knee scores. The participants ( meanage = 62.3years) had mean (standard deviation) IKDC and Tegner-Lysholm Knee scores of 67.4 (19.4) and 74.8 (22.5), respectively. Male sex, lower body mass index (BMI), shorter time to surgery, and early rehabilitation adoption predicted higher functional scores (p < 0.05). Smoking and suturing techniques showed no significantmain effects. Age was negatively correlated with IKDC scores when transosseous sutures were applied but not when suture anchors were used. Notably, 6% of the cohort were affected by complications such as re-rupture or deep vein thrombosis. Patient-centred factors (sex and BMI) and treatment-related factors (timing of surgery and rehabilitation protocols) significantly influence postoperative functional outcomes in patients with QTR. Early surgical intervention and dynamic rehabilitation protocols are important for optimising recovery, and suture anchor techniques may be advantageous in older patients. Further research is essential to improve QTR management strategies and enhance patient outcomes. IV-Retrospective cohort study without a comparison group.

Background: Infection preventionists (Ips) have self-reported surveillance as the most time-consuming job task (1,2). APIC’s MegaSurvey 2020 reported that 60% of Ips consider themselves proficient or expert within this competency domain (2). Accurate coding of health care acquired infections is critical to identifying epidemiologically significant events, using data to improve practice, and compliance with state and federal mandated CMS reporting (3,4). Validated case study scenarios were distributed to infection preventionists to better understand how experience level and time spent performing surveillance affects interrater reliability (IRR) in applying the National Healthcare Safety Network (NHSN) surveillance definitions (5,6). Methods: Case study scenarios determined to have high item discrimination were added to an online test bank and distributed annually to Ips of varying experience levels and care settings as part of a mandatory training program (5). The test bank currently consists of forty-two validated questions. Each year, the participants receive approximately thirty questions, including twenty randomly selected from the test bank and ten beta scenarios under development. Only validated test bank scenarios are used to calculate the passing score of 85%. Participants are blinded to which questions are test bank scenarios versus beta scenarios. Additional information was gathered at the beginning of the test to determine CIC status, years of experience, and weekly hours spent doing surveillance. Data was analyzed for passing score on the first attempt for testing years 2019, 2021, 2022, and 2023. Results: Thirty-six Ips passed the IRR test on the first attempt (33%). Of those who passed on the first attempt, twenty-nine (81%) were certified and twenty-two (61%) reported at least nine hours a week performing surveillance. Of the seventy-three Ips (67%) who did not pass on the first attempt, thirty were certified (41%) and sixty (82%) reported performing surveillance for 8 hours or less per week. Conclusion: The first-time pass rate for certified and non-certified Ips was 33%, markedly lower than the self-reported proficiency rate of 60%. The majority of Ips who passed on the first attempt were certified and spent at least nine hours per week performing surveillance. certified and non-certified Ips who did not regularly perform surveillance as part of their weekly job tasks were less likely to pass the test on the first attempt. Given the first-time pass rate among all participants is below optimal, establishing inter-rater reliability systems and ongoing surveillance education for Ips is crucial to ensure accuracy of publicly reported data.