Objectives: Octenidine dihydrochloride is a topical antiseptic that has been demonstrated to decrease the microbial burden of bacteria colonizing the skin. Various applications of octenidine have been studied with evidence supporting reductions in Staphylococcus aureus infections. MRSA carriers are at a higher risk of MRSA bacteremia and can be identified early during admission through screening. This study aimed to evaluate the impact of octenidine on the incidence of hospital-onset (HO) MRSA bacteremia amongst MRSA carriers. Methods: A quasi-experimental before-and-after interventional study was conducted in a single 1700 bed academic teaching hospital. From December 2021 onwards, five days of intranasal octenidine and daily octenidine bathing until discharge was introduced only for MRSA carriers. Screening for MRSA colonization status occurs on admission (either by nasal PCR or nasal, axilla and groin culture, and upon inpatient transfer or through clinical cultures. An HO-MRSA bacteremia event is defined as occurring more than 3 days from admission or more than 14 days from the last positive date. Baseline yearly incidence of HO-MRSA bacteremia for 2021, and the proportion occurring in MRSA and non-MRSA carriers was determined. This was then compared to yearly incidence observed post-intervention in 2022 and 2023. Results: Between 2021-2023, the yearly incidence of HO-MRSA bacteremia in carriers decreased steadily from a baseline of 11 to 10 and then to 6 per 1000 patients. In contrast, over the same period the yearly incidence in non-MRSA carriers initially increased from a baseline of 0.26 to to 0.33, before decreasing to 0.22 per 1000 patients. Overall yearly incidence decreased by a greater proportion in those receiving octenidine compared to those who did not – 45.5% vs 15.4%. Conclusion: Intranasal octenidine and daily octenidine bathing when performed on a high risk group such as MRSA carriers, reduces the incidence of HO-MRSA bacteremia.

Objectives: Hand hygiene is the cornerstone of infection prevention and control. Factors associated with hand hygiene compliance continues to be a key focus of research today. Choosing the ‘right’ alcohol-based hand rub (ABHR) is pivotal in mitigating ICD (irritant contact dermatitis) caused or aggravated by repetitive use of ABHRs. 31% of our healthcare workers (HCW)s reported worsening of their underlying eczema from repetitive use of the incumbent ABHR, whilst 74% experienced either dryness or ICD. In this study, we aim to evaluate two ethanol-based hand rubs against the incumbent hand rub (ethanol and n-propanol mix) to determine if skin tolerability and incidence of ICD can be improved. Methods: 500 HCWs from three departments were invited to participate in a survey to evaluate skin tolerability and user’s acceptability of the 1) incumbent ABHR (i-ABHR) (176 responded) and (2) New ABHR 1 (n-ABHR-1) (147 responded), whilst 190 HCWs from one department were invited to trial 3) New ABHR 2 (n-ABHR-2) (87 responded) using the WHO protocol 1 for handrub evaluation over the course of two weeks for each product respectively. Results: For skin tolerability assessment, only n-ABHR-2 achieved the product acceptability criteria of ≥75% of the participants choosing scale 5 or higher, whereas the other two ABHRs did not. Only 47.7% felt that i-ABHR provided acceptable moisture content. Product acceptability wise, only n-ABHR-2 achieved the acceptable criteria for all measurements. For n-ABHR-1, 45% experienced ICD or dryness, whilst 9% reported worsening of underlying eczema. For n-ABHR 2, 23% reported ICD whilst 1% experienced worsening of underlying eczema. Conclusion: In conclusion, n-ABHR-2 was a more suitable alternative compared to i-ABHR and n-ABHR-1 in terms of acceptability and skin tolerability, particularly for those with underlying eczema. Further investigation is warranted to determine if the low ICD rate could be maintained longer-term to ensure hand hygiene compliance.

Objectives: Data on primary care antibiotic prescription practices for children in Southeast Asia, which are essential for policy, quality improvement and patient safety, are lacking. We aimed to describe this gap and to benchmark prescription practices against international standards. Methods: Antibiotic prescriptions for children (age <18 years) who visited six public primary care clinics in Singapore between 2018 and 2021 were extracted and categorized according to the World Health Organization Access, Watch, Reserve (WHO AWaRe) classification. Quality indicators from the European Surveillance of Antimicrobial Consumption Network (ESAC- Net) and National Institute for Health and Care Excellence (NICE) guidelines were used as a measure of appropriateness of antibiotic prescribing. Descriptive statistics and T-test was used to compare prescription rates pre- and post-COVID-19 pandemic. Results: 19,325 and 20,692 oral and topical antibiotics were prescribed for 831,669 visits, with a prescription rate of 2.3% and 2.5% respectively. Mean antibiotic prescriptions fell significantly post-pandemic (2020–2021), compared to pre-pandemic numbers (1062.8 to 604.5 prescriptions per month) (p <0.001). The majority (95.8%) of prescriptions belonged to the Access group. Watch group antibiotics constituted 6.1% of the total antibiotics prescribed for respiratory conditions (n = 562). While prescriptions were low (4.1%) and well within EASC-Net quality indicator limits of 0-20% for respiratory infections, prescriptions for otitis media were significantly high (56.6%). Approximately 1 in 2 children received antibiotics as recommended by NICE guidelines for both respiratory infections (n=4,622, 51.5%) and otitis media (n=204, 51.8%). Conclusions: Primary care antibiotic prescriptions for children in Singapore decreased post- COVID-19. However, high rates of otitis media prescriptions and only 50% appropriateness for respiratory infections and otitis media emphasize the need for targeted improvements in these areas.

Background: Enhancing environmental hygiene resulted in a reduction of multidrug-resistant microorganisms colonization and healthcare-associated infections. There has been less studies to compare the effects of practice observation with other methods. This study aimed to compare correlations between visual inspection, practice observation and aerobic colony count (ACC) and verify the effectiveness. Methods: A prospective study was conducted in a medical intensive care unit from May 2021 to November 2022. High-touch surfaces were assessed by visual inspection (clean or not clean) and practice observation (compliant or not compliant) to compare the correlations by using ACC with the cut-off point of 2.5 CFU/cm2 as a golden standard. Results: Among 569 samples, the pass rate by ACC was 90.5%, the clean rate by visual inspection was 73.3%, and the compliant rate by practice observation was 47.1%. The concordance was 245 surfaces (43.1%) of the three methods. There was no correlation between visual inspection and ACC (p<0.001, φ=0.184). The correlations were weak positive between visual inspection and practice observation and between practice observation and ACC (p<0.001, φ=0.212, 0.233). The median aerobic colony count of “compliant” group (0.00 CFU/cm2) was significantly lower than “not compliant” (0.40 CFU/cm2) (p<0.001). The median aerobic colony count of “clean” groups (0.08 CFU/cm2) was also significantly lower than “not clean” groups (0.20 CFU/cm2) (p<0.001). Conclusion: Practice observation is more reliable than visual inspection. Therefore, visual inspection can be used for low risk area to maintain visibly clean. In high risk area, an integrated program is critical to combine practice observation with other methods to monitor cleanliness.

Objectives: Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop- Mediated Isothermal Amplification (LAMP) method is faster and easier to perform compared to polymerase chain reaction (PCR)-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance. Methods: We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method limit of detection (LOD) and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The LOD of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI. Results: The LOD of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the LOD of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation. Conclusions: This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.

Objectives: Vertebral Osteomyelitis (VO) poses a formidable challenge, manifesting as infectious pathology affecting the vertebral body and intervertebral disc, marked by persistent back pain, unresponsiveness to conventional treatment, and elevated inflammatory markers. Timely therapy is crucial, emphasizing its impact on patient outcomes and aligning with antimicrobial stewardship principles. This study investigates the consequences of delayed appropriate antibacterial therapy on clinical outcomes, emphasizing its relevance within the context of optimizing antibiotic utilization. Methods: In a single-center cross-sectional study from January 2012 to December 2022, we focused on adult VO patients, diverging from standardized therapies to explore real-world treatment approaches. Criteria included clinical presentation, bacteriologic evidence, or imaging studies. Data, collected through the hospital’s clinical management software (HIS system), included demographic features, diseases, clinical history, laboratory findings, microbiological diagnoses, radiological details, complications, and outcomes. This analysis aims to provide nuanced insights into diverse management strategies and associated clinical outcomes related to VO while highlighting the pivotal role of antimicrobial stewardship. Results: The study involved 230 adult VO patients (mean age 64.7 years, male predominance 30.8%)(Table1). Positive microbiology cultures were found in 58.7% of cases, predominantly Gram-positive organisms. Patients with appropriate initial therapy had significantly lower severe back pain rates than those with inappropriate therapy (OR = 0.308, 95% CI 0.098, 0.971, p=0.044)(Table 2). Conclusions: Inappropriate antibiotics for VO treatment compromise symptomatic relief, emphasizing the pivotal role of antimicrobial stewardship. The study reveals significantly lower overall mortality rates and improved clinical symptoms with appropriate antibiotic therapy. In the context of VO’s severe illness and rapid deterioration, urgent enhancements in diagnostics and early appropriate antimicrobial therapy are crucial. This research provides substantive insights for optimizing VO management within the framework of antimicrobial stewardship, aiming to enhance patient outcomes and reduce healthcare system burdens.

Introduction: Stroke is the second leading cause of death worldwide, accounting for 4.4 million (9%) of the total 50.5 million deaths per year. Infections are among the highest complicating factors of stroke, particularly respiratory tract infections occurring in 23-65% of stroke patients. Stroke complications such as pneumonia and sepsis require ICU care and the use of antibiotics, which poses a risk of antibiotic resistance. The aim of this study is to determine the profile of antibiotic resistance and the factors influencing antibiotic resistance in pneumonia among stroke patients treated in the ICU. Method: This study uses a retrospective descriptive method involving 84 stroke patients with pneumonia treated at the ICU of RSUP Dr. Kariadi Semarang from January 2022 to December 2023. Results: Among stroke patients with pneumonia, 62 patients (73.8%) developed sepsis, with 64.5% of them experiencing antibiotic resistance. There was no significant difference in antibiotic resistance between stroke patients with pneumonia and those without pneumonia (p = 0.382). There was also no significant difference in antibiotic resistance between pneumonia patients with stroke who developed sepsis and those who did not (p = 0.756). The most commonly found bacteria were A. baumannii, P. aeruginosa, and K. pneumoniae. The antibiotic most commonly showing resistance was Ampicillin. Patients with diabetes mellitus had a 5.2 times higher risk of experiencing antibiotic resistance. Conclusion: Antibiotic resistance can occur in stroke patients with pneumonia and those progressing to sepsis. Diabetes mellitus is a significant risk factor for antibiotic resistance. Antibiotic management programs and infection control are needed to prevent antibiotic resistance in the ICU.

Introduction: Nosocomial Bloodstream infection (BSI), including central line-associated blood stream infection (CLABSI) is important causes of morbidity and mortality. There are few studies describing the epidemiology of BSI in Viet Nam. Methods: A cross-sectional descriptive study was conducted in 3 intensive care units (ICUs) of the University Medical Center (UMC), Ho Chi Minh City from 2017 to 2022. The UMC service microbiology database was accessed to identify positive blood culture specimens during the period 2017–2022. Demographic and clinical details, antimicrobial management and patient outcome information were extracted from medical and laboratory records. Results: Of the 695 unique bacterial and fungal BSI episodes identified during the study period, 232 (33.4%) were community-acquired (CA), and 463 (66.6%) hospital-acquired (HA). The rate of BSI was 11.4% (463 cases/4.069 patients), in which CLABSI accounted for 59.8%. The incidence of CLABSI was 13.2% (307 cases/2.320 catheter patients) and the incidence rate was 5.8 cases per 1.000 catheter-days. On multivariable analysis, severe underweight, patient origin, central line placed in the femoral vein, duration catheter-days were significantly associated with CLABSI. We observed that prolonged duration catheter were the main risk CLABSI with 2.7- fold for 14-28 cathter-days (OR=2.7, 95% CI 2.4-3.1), 7.3-fold for more than 28 catheter-days (OR=7.3, 95% CI 5.7-9.4). The most common organisms were Gram-negative bacteria (76.2%), with K. pneumoniae (31.4%) and A. baumannii (12%) most prevalent. Gram-negative bacteria and Candida were more likely to cause infections in patients in critical care units. In addition, patients with BSI had significantly greater ICU costs than patients with Non-BSI (422 million VND (IQR 239–680) vs 184 million VND (IQR 18–92), p <0.05) Conclusions: Our data suggest that catheter duration is an important risk factor for CLABSI in the ICU. A significant daily increase in the risk of CLABSI after 28 days may warrant CVC replacement if intravascular access is necessary beyond that period.

Objective: Antimicrobial resistance will become one of the most lethal conditions, which will raise burdens in many sectors across the One Health spectrum. The irrational use of antibiotics without proper monitoring is one of the causes of antimicrobial resistance. The quality of antimicrobial usage could be evaluated quantitatively using the Defined Daily Dose (DDD) method and qualitatively using the Gyssens method. This study aims to evaluate the antimicrobial usage qualitatively. Method: This is a retrospective study using data from the electronic medical record of Adam Malik Hospital within the period of July 2022–December 2023. All adult patients (>18 years old) in the internal medicine ward with a history of antimicrobial prescriptions were included in this study. The quality evaluation was carried out by the researchers, of whom three of them are members of the hospital’s antimicrobial stewardship program (PPRA) team. Result: There are 293 cases of antimicrobial use included in this study. Most of the population in this study was female (51.9%), in the 18–59 year group (74.1%), and respiratory tract infection was mostly diagnosed in this study (31.2%). Based on the Gyssens analysis, only 33% of cases of antimicrobial usage were appropriate (category 0). It means more than half of the antimicrobial use in internal medicine wards were irrational. Conclusion: The rationality of antimicrobial use is one of the most important ways to reduce the rate of antimicrobial resistance. This study shows only 33% of cases of appropriate antimicrobial usage, which is relatively low. Because irrational antimicrobial use can lead to antimicrobial resistance, prolonged length of stay and mortality, efforts need to be taken to improve the quality of antimicrobial use.

Objectives: Six types of chemical indicators (CIs) are specified in ISO11140-1 for monitoring steam sterilization processes (SSP). Types3-6 are “internal” CIs, placed inside packs to assess attainment of sterilizing conditions. Type4 CIs have an ink patch which changes colour during the SSP. Type5 CIs exist as an ink patch which changes colour or a “moving front” (MF) format where a dye migrates along a wick reaching a pass/fail marker point. This study compares the requirements for type4 versus type5 CIs according to ISO11140-1, evaluates the claims of some type4 and 5 CIs with regard SSP parameters, and tests the ability of type5 CIs to meet specified performance and variability of response. Methods: We reviewed ISO requirements and stated commercial claims of type4 and 5 CIs. Samples of several Type5 CIs were exposed to increasing times at a temperature of 121oC in a CI Evaluating Resistometer. Upon completion of the test cycle samples were removed and the length of the ink migration measured and charted. Results and Conclusions: According to ISO11140-1 requirements, Type4 CIs need not respond to all SSP variables. Type4 CIs can have stated values (SV) which are unrelated to SSP parameters used. The tolerances for the pass/fail window for a Type5 CI is better than for a Type4. The performance of a Type5 CI has a relationship to that of a biological indicator (BI). The performance requirements for Type5 CIs are more prescriptive. MF- CIs provide greater clarity for interpretation compared to the colour change of some CIs. The SVs and colour change of type4 CIs are specified by the manufacturer. The minimum SVs for Type5 CIs are prescribed in ISO11140-1. When tested, there was considerable variation in the response of some Type5 MF-CIs; a factor not addressed in ISO11140-1.