Objectives: The incidence of hospital-acquired infections (HAIs) related to the formation of biofilms reaches 80% of the total cases of infection in the world. It can infect patients using invasive medical equipment such as orthopaedics implants. Biofilm-related implant orthopaedics infections account for approximately 65% of all bacterial infections. Once bacteria adhere to the implant, a bacterial community established biofilm that can enhance resistance to antibiotics up to 1000 times. Therefore, an appropriate strategy is needed to eradicate biofilm. Chlorhexidine as an antiseptic and levofloxacin as an antibiotic are often used in the orthopaedics’ setting. This study investigated in vitro antibiofilm activity of chlorhexidine and levofloxacin against bacterial isolates obtained from patient with implant orthopaedics-related infections. Methods: Ten clinical isolates of bacteria with strong biofilm-producer were collected from patients with orthopaedics implant-related infections including Staphylococcus aureus (n=2), Staphylococcus haemolyticus (n=1), Serratia marcescens (n=2), Pseudomonas aeruginosa (n=2), Proteus mirabilis (n=1), Acinetobacter baumannii (n=1) and Klebsiella pneumoniae (n=1). The inhibition and eradication activity of chlorhexidine and levofloxacin on biofilm growth were performed using microtiter broth dilution method in 96-well plates. The minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC) were determined using the MTT (3-(4-5- dimethylthiazol-2-yl)2,5-dyphenyl tetrazolium bromide) reduction assay. Results: This study found that chlorhexidine inhibited the growth of Gram-positive bacterial biofilms by 80% with MBIC80 values ranged from 4-16 μg/ml and eradicated 80% of biofilm with MBEC80 value was 32 μg/ml. For Gram-negative bacterial biofilms, the ability of chlorhexidine to inhibit 80% of biofilm growth was indicated by MBIC80 values ranged from 8-16 μg/ml and to eradicate 80% of biofilm with MBEC80 values ranged from16-64 μg/ml. Meanwhile, levofloxacin can inhibit the growth of Gram- positive bacterial biofilms by 80% with MBIC80 values ranged from 1-4 μg/ml and can eradicate 80% of biofilm with MBEC80 values ranged from 16-32 μg/ml. For Gram-negative bacterial biofilms, the MBIC80 values of levofloxacin ranged from 1-16 μg/ml and the MBEC80 values ranged from 4-32 μg/ml. Conclusions: This result indicated that chlorhexidine and levofloxacin are potential to inhibit and eradicate bacterial biofilm. However, further studies need to be done for clinical evaluation.

Objective: Carbapenem-resistant Gram-Negative Bacteria (CR-GNB) are a current global concern. CR-GNB in hospitalized patients with bacteremia is a critical health concern due to its high level of resistance to antibiotics and is associated with high mortality rates. This study aims to identify the prevalence of CR- GNB from blood specimens of patients in Adam Malik Hospital. Method: A retrospective cross-sectional study was carried out on blood specimens of patients received at the Clinical Microbiology Laboratory Adam Malik Hospital from January 2023 to December 2023. The bacterial isolates were identified using BD™ Bruker MALDI Biotyper and the susceptibility of the isolates to various antimicrobial agents was tested using the automated antimicrobial susceptibility tests. We performed a descriptive statistical analysis of the Gram-negative bacterial growth from blood specimens and antimicrobial susceptibility against each bacterial isolate. Results: There were 939 bacterial isolates obtained from blood culture, and 57% (534/938) were Gram-negative. The most prevalent Gram-negative bacteria were Klebsiella pneumoniae (22.09%), Escherichia coli (19.84%), Pseudomonas aeruginosa (9.20%), and Acinetobacter baumannii (7.89%). Among all the Gram-negative isolates, 18,1% were carbapenem-resistant. The most prevalent Gram-negative bacteria that are resistant to carbapenems were A. baumannii (56.4%);22/39), K. pneumoniae (25.2%; 27/107), P. aeruginosa (22.7%; 10/44), Proteus mirabilis (20%; 1/5) and Enterobacter cloacae (18.6%);8/43). The highest antimicrobial susceptibility for the most prevalent CR-GNB were amikacin for E. cloacae, P. aeruginosa and A. baumannii (87,5%, 60 %; 40%; respectively), trimethoprim-sulfamethoxazole for K. pneumonia (66,7%), tigecycline for E. cloacae (87,5%). Conclusion: The prevalence of CR-GNB from blood specimens in Adam Malik Hospital was 18,1%. The most common CR-GNB isolates were Acinetobacter baumannii, K. pneumoniae, P. aeruginosa, and Enterobacter cloacae. The infection control program is a critical action to prevent the transmission of CR-GNB, particularly in hospital settings.

Background and objective: Preparation of medical devices is a critical component of healthcare services. Used reusable items require reprocessing and sterilization, which eliminate contaminant microorganisms, to ensure safety and availability prior to subsequent applications. The objective of this research is to develop medical device preparation guidelines which address existing quality issues for quality services. Methods: This action research was conducted in three phases. Phase one, research planning, literature review of APSICS guideline and work system development techniques 5M model. Phase Two included guideline implementation, observation and analysis. In the 1st year, staff members were trained to perform duties according to the new guidelines, new inspection categories were added, and cleaning procedures were improved. In the 2nd year, new policies for collection of used items were implemented, ATP test was introduced to improve microorganism detection. The team oversaw more staff training and quality control of RO water used in cleaning medical devices in the 3rd year. In the 4th year, more staff members were trained and water supply pipes were replaced to accommodate increasing RO water demands. Trained staff members received follow- ups and percentages of reprocessed medical items that passed quality criteria were monitored. Phase three was analysis and evaluation, using the number of staff members who received training, percentages of reprocessed medical items that passed quality criteria. Results: The number of staff members who performed tasks correctly increased every year. The percentage of reprocessed reusable medical items which met quality requirements from 2018 - 2022 showed a steady increase (R2 = 0.860) (91.82, 95.33, 98.95, 98.68 and 99.42, respectively).The score for compliance to APSICS guideline for cleaning & decontamination processes from 2020 - 2022 increased continuously (78.57,96.43, and 100.00). Conclusion: The approaches to medical device preparation align with 5M model requiring proper management for maximum efficiency and cost effectiveness.

Objective: To describe a collaboration effort between gynae-oncology and infection control unit in a sustainable surgical side infection prevention program Methods: In January 2023, gynae-oncologist noted a surge in surgical side infection (SSI) in gynae-oncology unit in Sabah Women and Children’s Hospital (SWACH), Kota Kinabalu, Sabah, Malaysia. The increasing trend of SSI was further confirmed by active surveillance started in January and February 2023. The SSI rate was found to be up to 46.2% (6 out of 13) in the elective gynae-oncology cases and 5 out of 15ases (31.2%) in February 2023.

Outbreak interventions taken place. A combined continuous medical education of the latest SSI guidelines was carried out in the gynae-oncology unit including clinical nurses, clinicians and infection control team (ICT).

Ward clinical nurses and infection control nurses developed SSI prevention program based on the latest SSI guideline and started ward clinical nurse education. An active SSI surveillance team was formed consisting ward sister and one clinical nurse, chief clinicians and infection control nurse to collect SSI cases. Results: SSI rate had reduced and maintained since March 2023. The SSI rate was maintained at zero except June and August with one superficial SSI respectively. Since September until December 2023 there was no SSI detected in active surveillance. Conclusions: Collaborative effort and understanding between clinical services and infection control unit are important in creating an effective and sustainable infection prevention program. Effective infection prevention program is not necessarily expensive. In fact, a highly motivated team, simple and practical approach can have amazing results.

Introduction: Infection by Extended Spectrum Beta-Lactamase (ESBL)-producing bacteria in Intensive Care Unit (ICU) is associated with treatment failure, prolonged hospital stay, increased costs and patient mortality. The factors of infection by ESBL-producing bacteria are important to figure out so that prevention and control efforts can be made. The aim of the study is to understand the risk factors associated with ESBL- producing bacteria infections in ICU of Jogja Hospital. Method: This case control study included ICU’s patients who have an infection with confirmed E. coli or K. pneumoniae based on microbiological examination from January-December 2023. The patient’s data were obtained from the medical record to find the risks factors. Cases were defined as E. coli or K. pneumoniae ESBL, while controls were defined as non ESBL E. coli or K. pneumoniae. Bivariate analysis was carried out on independent variables (sex, age, length of hospitalization, comorbidity, history of cephalosporin, duration of antibiotic, utilization of urinary catheter and central venous catheter, exposure to mechanical ventilation, and presence of open wounds). Risk factors with P values <0.25 on bivariate analysis were included in multivariate logistic regression analysis. Two- sided P values less than 0,05 were considered statistically significant. Result: There were 30 patients with ESBL-producing E. coli or K. pneumoniae (cases) and 32 patients with non ESBL-producing E. coli or K. pneumoniae (controls). Based on multivariate analysis, the presence of open wounds has statistical significance, OR 6.52 (IK 95% p = 0.011). Conclusion: The presence of open wounds is associated with the occurrence ESBL-producing E. coli or K. pneumoniae infection in ICU of Jogja Hospital.

Background: The surgical site infection (SSI) event is still the main cause of morbidity and increases the length of stay (LOS) in a hospital, costs, and deaths. One of the causes of SSI is nurses’ non-compliance with aseptic techniques. Exposure can be increased and variability in aseptic techniques can be minimized by implementing the aseptic non-touch technique (ANTT) strategy. This research investigated the effectiveness of implementing the ANTT method on reducing the number of SSI events in postoperative patients. Methods: This research used a pragmatic evaluation method with a mixed methods approach. The ANTT method was implemented through five stages i.e., planning, launching, educating, assessing, and monitoring. Data were collected using pre/post-questionnaires, structured interviews, and audit observations via the electronic audit. This research was conducted for 24 months and involved 138 nurses from three hospitals. Results: The mean compliance rate of aseptic techniques after implementing the ANTT method was 93%, with the glove use at 92%, contaminated gloves at 0%, aseptic area at 84%, contaminated aseptic area at 0%, disinfected procedure trays at 75%, protected keypart at 84%, contaminated keyparts by hands/ equipment at 2.6%, and hand hygiene after gloves at 98%. The rate of SSI events dropped from 0.3% to 0.1% in 12 months. There was a significant difference between the pre and post-implementation of the ANTT (P-value < 0.001). Moreover, implementing the ANTT method effectively reduced the SSI events in postoperative patients (P-value < 0.001). Conclusions: The implementation of ANTT improved compliance with safe and effective aseptic techniques. The ANTT compliance audit results reflect a reduction in the incidence of SSIs, thereby reducing costs and LOS in postoperative patients. The program will be expanded to five other group hospitals.

Objectives: Infection with antibiotic resistant organisms has become a global problem, including in cases of pneumonia. Multi drug resistance organism (MDRO) has an impact on mortality, morbidity, and health costs. There are several risk factors that play a role in the incidence of MDRO in community acquired pneumonia. The purpose of this study was to analyze the risk factors for the incidence of MDRO in hospitalized patients with community acquired pneumonia at Wahidin Sudirohusodo Hospital. Methods: This study used an analytic observational method with a retrospective cohort. Data were taken from patient medical records from July-December 2023. Results: There were 49 (46.7%) MDRO and 56 (53.3%) non-MDRO. Based on statistical tests, MDRO infection is associated with comorbid malignancy (p value 0.002) and cardiovascular comorbidities (p value 0.015). The most common pathogens found were Acitenobacter baumanii (22.8%) and Klebsiella pneumonia (20%). Conclusions: Risk factors associated with the incidence of MDRO in community acquired pneumonia patients are malignancy and cardiovascular disease.

Objectives: Healthcare-associated respiratory viral infections (HA-RVI) remain a threat despite the fading memory of the pandemic. To better understand the impact of HA-RVI, we reviewed endemic respiratory viral infections in our tertiary academic hospital just before the pandemic. Methods: A retrospective analysis of a hospital epidemiology database with all patients tested positive for respiratory viruses between Jan2016 – Dec2019 was conducted. Testing was ordered by attending physicians and done using immunofluorescence assays or multiplex PCR. HA-RVI patients were identified based on positive virologic tests >48 hours after admission. Data analyses were performed on Vassar Stats. Results: Of the 1700 patients included in this study, 315(18.5%) had HA-RVI while 1385(81.5%) had community-acquired infections (CAI). Influenza, enterovirus/rhinoviruses and respiratory syncytial virus were the most common viruses. Compared with CAI, HA-RVI patients were older (mean age 37.129.7 vs 21.427.5 years, p<0.001), had recent hospitalisations (OR 1.5, 95% CI:1.1-2.1, p=0.007), underlying bronchial asthma or COPD (OR 2.8, 95% CI:1.5-5.3, p=0.002) and were immunosuppressed (OR 7.6, 95% CI:4.3-13.4, p<0.001). Interestingly, HA-RVI patients were less likely to have fever (49.8% vs 66.4%, p<0.001), cough (42.2% vs 67.3%, p<0.001) or shortness of breath (17.5% vs 26.6%, p=0.02). Despite fewer symptoms, HA-RVI patients were more likely to have pneumonia with abnormal chest x-rays (33.3% vs 22.7%, RR 1.14, 95% CI:1.02-1.29, p=0.04), longer lengths of stay (mean 21.236.7 vs 514 days, p<0.001), higher rates of ICU admission (14.9% vs 8.1%, OR 2.0, 95% CI:1.4-2.9, p<0.001), and mortality (4.8% vs 0.6%, OR 8.6, 95% CI:3.6-20.5, p<0.001). Conclusions: Patients who are older, have pre-existing respiratory disorders or are immunosuppressed face greater HA-RVI risk. HA-RVI patients are less likely to exhibit typical respiratory infection symptoms, potentially delaying diagnosis. This probably contributes to increased morbidity and mortality associated with HA-RVI which underscore the importance of hospital infection prevention even for endemic respiratory viruses.

Introduction: Nowadays, surgical site infection is one of the four common types of healthcare-associated infections. There are many preventive measures applied and surgical hand hygiene (SHH) is the most effective and the simplest measure. This study aimed to assess the knowledge, practices of SHH among staff and the relationship between knowledge and practice of SHH in Viet Nam. Methods: An analytical cross-sectional study was conducted at the University Medical Center (UMC) in Ho Chi Minh City in 2022. The study employed a set of pre-prepared questions for the knowledge assessment section. For the practical assessment section, the research team conducted indirect observation through cameras and filled out a monitoring checklist. The data were analyzed using Stata 13.2. Results: Of the 271 healthcare workers, surgeons had the highest proportion at 48.7%, which was 18.6 times higher than that of anesthesiologists. The majority of healthcare workers received training on SHH, accounting for a rate of 95.6%. Among the participants, the overall compliance of SHH before entering the operative room accounted for 85.6%. The percentage of correct general knowledge reached 73.8%, and there was a relationship between correct knowledge and correct practice with p < 0.01. Conclusion: Our data suggests that having correct general knowledge of SHH is a crucial factor in accurately practicing SHH. Therefore, providing training to impart accurate knowledge about SHH to healthcare staff is necessary to enhance the overall compliance rate of SHH before entering the operating room.

Background: Throughout healthcare, the physical environment presents an important source of pathogens that can cause healthcare associated infections (HAIs) To keep patients safe, hospitals must maintain a clean environment and minimize the presence of pathogens. Objectives: 1. To identify through environmental monitoring the level of cleanliness in area of pediatrics isolation ward. 2.To assessments of environmental cleaning practice of environmental service (EVS) staff, and healthcare worker. Methodology: This retrospective study was done in pediatrics isolation ward, tertiary hospital. Sample sizes were 1 EVS staff, 3 nurses aid, and 102 environmental sites. Data were collected from database of infection control program between February 29, to March 2, 2024 via Infection control assessment and response (ICAR: tool for assessing cleaning practice of EVS staff, personnel by direct performance observations), visual assessment, and monitored the residual bioburden by adenosine tri phosphate (ATP) tests, and swab culture of the surface. Data were analyzed by using descriptive statistics. Results: The results of this study revealed that level of cleanliness in area of ward by ATP test found, contaminated spots were highest (61.76%, 21/34) and clean spots were lowest (38.24%, 13/34), while swab culture method found contaminated spots were higher (55.88%, 19/34), clean spots were lower (44.12%, 15/34), and visual monitoring found contaminated and clean spots were 35.29%, 12/5 and 64.71%, 22/34 respectively. The most of contaminated sites were bed rails, toilet sink, Treatment and IV care car, door handle, mop, Light scope & blade (5.88%, 6/102). As the results proved the most organisms were Acinetobacter spp., Escherichia coli, and Pseudomonas spp., respectively. Conclusion: This study suggests that the environmental cleaning in specialized area must be monitored continuous with standard methods. It is necessary to promote education and training staffs follow update practice guidelines, especially the participation of disciplinary team motivated effective activities in reducing the microbial contamination.

Objectives: In the face of the complicated developments of the COVID-19 epidemic, the increasing number of cases, accompanied by an increase in the number of personal protective equipment has contributed mainly to the increased amount of medical solid waste. Updating knowledge and practicing the correct classifications of solid medical waste according to regulations is an urgent issue to minimize the risk of pandemic spread, health, and the environment, as well as responding to incidents and exposures. To determine the proportion of health workers with correct knowledge and practice in classifying solid medical waste and related factors at District 4 Hospital, Ho Chi Minh City. Methods: A cross-sectional study was conducted on 149 health workers at District 4 hospital in 2022. Self- administrated questionnaires including personal data, 50 knowledge questions and practice checklists for solid medical waste classification were used. Determine the relationship using the Χ2 test, PR, and the 95% confidence interval. Results: Health staff have knowledge account for 87.25%; general practice 53,69%. Knowledge of color coding non-infectious hazardous waste accounts for less than 50%. Waste bin cleaning 9.4%, exposure reporting procedures 30.87%. The age group >30, the subclinical departments, the information sources from radio, and friends have a higher rate of practice correctly than the other group, p < 0.05. Conclusions: Health staff have correct knowledge account for 87.25%; correct practice account for 53.69%. Health facilities need to maintain training on solid waste classification knowledge, focusing on color coding, symbols, handling and responding to incidents of exposure to medical waste and occupational safety. Fully equipped with different means of communication to instruct, supervision classification, collection and transportation of solid waste to take timely remedial measures.

Background/Objectives: CSF shunts are widely used in neurosurgery practice for temporary or permanent CSF diversion. Patients on CSF shunts are at risk of device-associated CNS infections particularly ventriculitis or meningitis. The study objectives were to delineate the risk factors and infection rates for various shunt procedures and their microbial etiology. Methods: This is a single center prospective cohort study. The study period was 2 years (October 2020- September 2022). Patients were categorised using IDSA criteria as Contamination or Colonisation or Infection. Device days were also collected from the Hospital information system (HIS) for calculation of infection rates. Microbial etiology was identified by culture of CSF and shunt catheter tips. Cox regression model was used to estimate hazard risk for various risk factors. Results: During the 2-year study period, 161 shunts were inserted.133 were ventriculo-peritoneal (VP) shunts, 19 were lumbo-peritoneal (LP) shunts, 6 were subduro-peritoneal (SDP) shunts, 2 were syringo- subarachnoid (SS) shunt and 1 cysto-peritoneal (CP) shunt. Hydrocephalus was the commonest indication for a shunt insertion (71.4 %). There were 8 VP shunt and 1 LP shunt infections during the study period. The average infection rates for VP and LP shunts were 6 and 5.2 per procedure, respectively. Gram negative bacteria caused most of the shunt infections (7/9, 77%). The most common organism causing shunt infection was Klebsiella pneumoniae (n=4, 44%), followed by Staphylococcus aureus (n=2, 22%). The risk factors which were independently associated with increased risk for shunt infection were Pre-OP ASA score >3 [HR:8.28, p - 0.013], presence of associated perioperative systemic [HR:3.89, p-0.01] or scalp infections [HR:3.53, p-0.005]. Conclusion: VP and LP shunt infection rates were similar in our study. Klebsiella pneumoniae was the commonest causative agent causing shunt infection. High Pre-OP ASA score and associated perioperative scalp or systemic infections were independent risk factors for shunt infection.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare associated infections. Colonization with MRSA increases the risk of subsequent nosocomial infection. The primary concern regarding widespread use of mupirocin is the emergence of mupirocin resistance. A prospective cross-sectional study in Singapore in 2013, found mupirocin resistance to be 31.6% in Changi General Hospital (CGH). Annual usage of mupirocin (g) in CGH was 36870 and hospital-onset MRSA bacteremia was 1.1/10,000 patient-days in 2013. Objective: To study the impact of hospital measures to reduce mupirocin resistance among MRSA by detection of mupirocin resistance in screening isolates. Method: Changi General Hospital is a 1000 bedded acute care hospital. Hospital wide measures were instituted in CGH to reduce mupirocin resistance in MRSA included a) universal body wash with Octenidine for all hospitalized patients in the wards with MRSA cubicles b) 2% mupirocin ointment removed from formulary (available for nasal decolonization only) A study was conducted on MRSA screening isolates from the Microbiology Laboratory between May and September 2019. These were obtained by swabbing nasal, axilla and groin on all newly admitted patients as part of an active surveillance program since 2013. The swabs were streaked onto MRSAiiselective media plates which were incubated at 35 °C for 20 hours and stored at 4 °C. E-test was performed to determine the susceptibility and minimum inhibitory concentration (MIC) of MRSA isolates to mupirocin, oxacillin and vancomycin, following the CLSI guidelines for S. aureus. MPCR (multiplex polymerase chain reaction) assay was used for the simultaneous identification of ileS-2 (primers MupA and MupB) and mecA (primers MecA1 and MecA2). PCR amplification of ileS- 2 gene for high level mupirocin resistance and Mec A gene was performed on Touch thermal cycler. Results: 200 MRSA isolates were tested. E-test revealed 5 isolates were detected to be High Level mupirocin- resistant (2.5%) and 69 isolates were detected to be oxacillin-resistant (74%). The MPCR assay detected mecA gene in 100% and ileS-2 gene in 3 isolates (1.5%). Conclusion: Our study indicated the low prevalence of high level mupirocin resistance among MRSA screening isolates in 2019 in CGH. This suggested that the hospital wide measures to reduce mupirocin resistance were effective.

Background: Urinary tract infection (UTI) is the most dominant case, around 40% of healthcare-associated infections (HAIs). UTI related to catheter placement called as Catheter-Associated Urinary Tract Infection (CAUTI). Catheterization is considered as a port of entry that lead to infection. In sepsis patients, CAUTI can significantly affect clinical outcomes. Prolonged CAUTI can worsen but can be prevented via suitable intervention, particularly in septic patients with urine catheters. To effectively prevent and manage diseases, gathering data focusing on surveillance is essential. Hence, examining multiple risk variables associated with CAUTI is vital, including age, gender, diabetes mellitus, kidney failure, frequency and duration of catheterization, and duration of antibiotic usage before urine culture. Method: A quantitative study using a cross-sectional design by selecting samples using total sampling was conducted at RSPAD Gatot Soebroto (n=42). All sepsis patients using catheters met the inclusion criteria. The data obtained was analysed (univariate, bivariate and multivariate), which will be presented in table and narrative format. Results: It was found that 21 sepsis patients with catheters confirmed CAUTI. Risk factors in septic patients with catheters that have a significant relationship with CAUTI are diabetes mellitus (p=0.013), kidney failure (p=0.005), length of stay (p=0.013), duration of antibiotic usage before urine culture (p=0.031), frequency of catheterization (p=0.028), and duration of catheterization (p=0.013). However, age (p=0.739) and gender (p=0.757) did not have a significant relationship. In the multivariate test was found that the most significant variables were kidney failure (p=0.006; OR=22.219; 95%CI=2.424- 293.744) and duration of catheterization (p=0.009; OR=19.147; 95%CI=2.070-177.149). Conclusion : Our findings indicate that kidney failure and duration of catheterization are the most significant risk factors for septic patient who develop CAUTIs. To enhance the clinical outcomes of sepsis patients prone to CAUTI, it is crucial to identify the risk factors as a part of treatment management and infection prevention control.

Objectives: Meropenem has become one of the most widely used antibiotics and is considered to be the drug of choice for empirical treatment in patients with pneumonia. The aim of this study is to evaluate factors associated with the use of Meropenem as a broad-spectrum antibiotic in a referral hospital in Makassar. Methods: In a retrospective observational study we conducted over one-month period (January- February 2024), adult patients diagnosed with pneumonia who received Meropenem were selected. We included data such as length of stay, admission to the intensive care unit, use of ventilator, basis of prescription (either empirical or culture-based), and laboratory profiles such as white blood cell count, procalcitonin levels, blood culture and resistance towards antibiotics. Results: Over one-month period, thirty patients admitted to our hospital with pneumonia were evaluated. Among these patients, several factors such as admission in intensive care unit, use of ventilator, and procalcitonin levels showed statically significance (p < 0,05) while blood culture and antibiotic resistance showed minimal impact towards utilization of Meropenem in patients with pneumonia. Conclusions: In conclusion, our study indicates that Meropenem usage for pneumonia treatment is significantly influenced by admission to the intensive care unit, use of ventilator, and specific laboratory parameters such as procalcitonin levels. Further research with larger scale is needed to evaluate utilization of Meropenem in clinical practices.

Introduction: A common form of Renal Replacement Therapy is haemodialysis. Haemodialysis (HD) patients require a vascular access. Because of Frequent hospitalization the HD patients are at higher risk of developing infections. Positive Blood culture, IV antimicrobial use and signs of inflammation at vascular access site are the three dialysis events that can cause substantial morbidity and mortality in patients.The objective is to identify and implement strategies to prevent dialysis events within the facility by providing appropriate analyses of dialysis events. Methodology: A prospective surveillance study was performed between April’23 and November’23 at our outpatient HD facility. All HD patients were eligible for the study if they received HD on first two working days of the month. We conducted a pre-stage study for two months from April’23 to May’23 and collected data. After detailed analysis, implementation measures were included in month of June’23. The surveillance was regarded as a process improvement project and further data for dialysis events were collected till month of November’23. Interventions: The following interventions were adopted as process improvement in hemodialysis unit; 1). Revision of the current antimicrobial policy of dialysis unit 2). Implementation of Core interventions to prevent the dialysis event like hand hygiene observation, catheter/vascular access care observation, staff education, patient education, catheter removal, CHG for skin preparation, Catheter hub disinfection and regular surveillance with feedback of Dialysis events. 3). Revised policy for regular RO water plant disinfection and microbiological testing Results: 755 patients were reviewed for dialysis events during the 09-month study period. A total of 16 dialysis events were reported with overall dialysis events rates was - 2.09/100 patient-months. The rate of IV antimicrobial use was-1.19/100 patient-months and the positive blood culture rate was-0.92/100 patient-months Gram-negative bacilli were predominant in patients with central lines (n = 9); however, skin commensals and gram negative bacilli were also identified in patients with fistula or graft (n = 2). A reduction in dialysis events from 3.3 /100 patient days to 1.08/100 patient days was observed after the implementation of core interventions. Conclusion: Dialysis events were significantly more frequent in patients with tunnelled or non-tunnelled central venous lines compared to those with fistula or graft. In haemodialysis patients, good compliance with antimicrobial policy and regular monitoring of core interventions will reduce the risk of dialysis events.

Background: The rate of Healthcare Associated Infection (HAI) in the ICU is five to seven times higher compared to general. The aim of this study was to determine the incidence and risk factors for HAI in the ICU at Dr. Cipto Mangunkusumo hospital. Methods: This study use retrospective data, adult patients age ≥ 18 years who were treated in ICU and suspected diagnosis of HAI (including Ventilator associated pneumonia, Catheter associated urinary tract infection, Central line associated bloodstream infection and Surgical site infection) in period from October 2022 – January 2023 were included in this study. We analyze the examination results of each specimen with identification, antibiotic susceptibility test and genomic data using whole genome sequencing. Results: There were a total of 160 specimens with 108 positive culture results. The organisms that most commonly cause infections from blood specimens are Klebsiella pneumoniae (3/11), Acinetobacter baumannii (1/11) and Pseudomonas aeruginosa (1/11). For sputum specimens, the causative pathogens obtained included K. pneumoniae (23/57), A. baumannii (11/57), and P. aeruginosa (9/57). Meanwhile, for urine specimen the main bacteria causing infection was K. pneumoniae (4/7). In the antibiotic suscpetibility test, the results showed Carbapenem Resistant Organisms (CRO), namely A. baumannii 89.5% (17/19), K. pneumoniae 76.3% (29/38), P. aeruginosa 40% (4/10), and E. coli 20% (1/5) with positive ESBL presentation are 15,8% in K. pneumoniae and 40% in E. coli. Conclusion: We found that the most common risk factor for HAI was the use of medical devices. HAI infections that occurred from all the specimens we took were mainly caused by Klebsiella pneumoniae. The results of antibiotic resistance are also a matter of note because there are many organism that cause HAI were also Carbapenem-resistant antibiotics with variations in resistance genes (CTX-M, CTX-M-1, SHV, TEM).

Objectives: Antibiotic resistance is a global issue that has significant negative effects on both health and the economy. Klebsiella pneumoniae is grouped with Enterococcus faecium, Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. (ESKAPE) as multidrug-resistant (MDR) bacteria worldwide. The challenges associated with controlling life-threatening infections caused by MDR organisms have pushed research focus toward alternative treatments, which include bacteriophage therapy. Therefore, this study aimed to isolate the carbapenem-resistant K. pneumoniae (CRKP) specific phages from the hospital sewage water effluent for future application in a clinical setting. Methods: Sewage samples were obtained from different points of hospital effluent. The collected samples were primarily filtrated and centrifuged to recover, purify, and concentrate the bacteriophage. The lytic phages were detected using a spot assay. Subsequently, the specific CRKP phages were isolated using the double agar layer method, where the four CRKP clinical isolates were used as the host system. Results: Altogether, 30 sewage samples were collected from different points of hospital treatment plant at the Hospital Universiti Sains Malaysia (Hospital USM). Each samples were screened with four different clinical CRKP strains, giving rise to a total of 120 screened plates. Lytic phages were isolated in 50 /120 (41.70%) of the screened plates. The diameter of isolated CRKP lytic phages ranged between 0.01-0.7 cm. The phage titer ranged between 6×103−1.6×109 plaque- forming units per milliliter (PFU/ml). Conclusion: The lytic phages were isolated in abundance from the hospital treatment plant and exhibited a wide range of inhibitions against the CRKP, indicating its therapeutic potential in the future. However, further studies are required to comprehend the process of in vivo phage-mediated selection.

Background: With the increasing cases of multi-resistant organism infection, Antimicrobial Stewardship Programs (ASP) is an important tool in combating this rising challenges. The objective of this study is to review whether the approach of the reduction in usage of second and third generation cephalosporin group antibiotics reduces the incidence of ESBL E.coli and ESBL Klebsiella pneumoniae (KP) cases in Sabah Women and Children Hospital (SWACH) from 2021 until 2023. Methods: After discussion with the head of clinical services, the preferred empirical antibiotic of respective unit was switched to ampicilin-sulbactam or amoxicillin clavulanic acid instead of second or third generation cephalosporin. ASP team actively surveillant and monitored the above mentioned antibiotic, cephalosporin usage would be prescribed only to pre-determined indications, while others will be actively switched to ampicilin-sulbactam and amoxicilin- clavulanic acid. This study summarized the usage of Injection second and third generation of cephalosporin group antibiotics from year 2021 to year 2023 and compare with the incidence of ESBL cases per 100 patients admission during the same period. Usage of pediatric antibiotic described in number of vials over total number of admission, while adult antibiotic usage described in Defined daily dose (DDD). Occurrence of ESBL cases described in total number of cases/100 patient admission. The trend will then compared to the baseline ESBL E coli and KP in SWACH in the year prior this intervention. Results: For pediatric and adult O&G populations, we observed that the usage of overall cephalosporin group antibiotics showed a decreasing trend since year 2021 till year 2023 and a slight reduction in ESBL E coli and KP was observed at the same period. However, in adult oncology group, despite overall reduction in usage of cephalosporin group antibiotic except injection cefepime, the rate of ESBL E coli showed a slight increase. Conclusion: Coordinated efforts between stewardship programs and infection control are essential for reversing conditions that favor the emergence and dissemination of multidrug resistant gram negative bacteria within hospital.

Introduction: Optimising antibiotic prescribing in hospitals through antimicrobial stewardship (AMS) initiatives is essential in addressing the global threat of antimicrobial resistance. Methods: Point prevalence surveys were performed in April 2019 and November 2022 utilizing the Hospital National Antimicrobial Prescribing Survey (NAPS) tool. The study aimed to evaluate the prevalence of antibiotic use among inpatients and monitor antibiotic prescribing quality in 2022 compared to 2019 in a Malaysian teaching hospital as part of AMS core elements. Results: The prevalence of antibiotic use remained relatively stable between 2019 and 2022 (44.1% vs. 42.3%), with no significant change observed. Prescription patterns, including the type of antimicrobials, treatment modalities, and prescriptions per patient, showed insignificant differences between the two surveys. Antibiotics from the World Health Organisation (WHO) Access group constituted up to 47% of prescriptions in 2022, while usage of antibiotics from Watch group decreased from 57% to 53%, albeit insignificantly. Notably, there was a non- significant increase in appropriate prescribing for surgical prophylaxis in 2022 (40% vs 16.7%, p=0.078), alongside a less prevalent in prolonged surgical prophylaxis (28% in 2022 vs. 50% in 2019). Despite static prevalence and prescribing patterns, compliance with guidelines (p<0.006) and appropriate prescribing (p<0.002) showed significant improvement. The likelihood of compliance and appropriate prescribing was approximately 1.8-fold higher in 2022 compared to 2019. However, an increase in prescription of unnecessary broad-spectrum antibiotics was observed (23.1% vs 48%, p=0.002). Multiple logistic regression revealed that inappropriate prescribing significantly occurred when antibiotic indication was poorly documented (adjusted OR 3.67;95% CI 1.28–10.53; p=0.016). Conclusion : While prescribing patterns remained relatively unchanged, our findings highlight notable improvement in antibiotic prescribing quality. However, challenges persist, including the increased use of unnecessary broad-spectrum antibiotics. Continued efforts in AMS are imperative to address these issues and further enhance prescribing practices.