Background: Healthcare workers (HCWs) are particularly exposed to biological risk, including SARS-CoV-2 infection. In order to contrast the current pandemic and alleviate the burden of the disease on the healthcare system, a mass vaccination campaign against COVID-19 has been launched worldwide. Aim To evaluate the impact of COVID-19 vaccination in HCWs exposed to SARS-CoV-2, to describe the clinical presentation of COVID-19 in infected HCWs, and to investigate clinical and occupational risk factors for breakthrough infection. Design: Retrospective cohort study. Methods: The cohort of HCWs of Trieste Hospitals were followed up from 1 March 2020, to 30 November 2021 (21 months). All HCWs were periodically screened for SARS-CoV-2 infection by real-time PCR (RT–PCR) analysis. Clinical data were obtained through routine medical surveillance records. Risk factors for SARS-CoV-2 infection were investigated by univariable as well as multivariable logistic regression analysis. Results: Among 4394 HCWs routinely screened for SARS-CoV-2 by PCR on nasopharyngeal swab, a total of 800 incident cases were identified during the entire study period (1 March 2020 to 30 November 2021). Five hundred and sixty-four cases occurred before, and 236 after the start of the vaccination campaign against COVID-19, of whom 155 received a complete vaccination scheme before SARS-CoV-2 infection. Breakthrough infection was featured by mild or no symptoms and was significantly associated with the male sex, BMI > 25, and diabetes mellitus. Some categories of HCWs (physicians and nurse aids/auxiliary personnel) were at a higher risk of breakthrough infection. Conclusions: Fully vaccinated HCWs were less likely to acquire symptomatic as well as asymptomatic SARS-CoV-2 infection. Risk factors for SARS-CoV-2 infection after a full COVID-19 vaccination scheme included the male gender, diabetes mellitus, and overweight. HCWs with higher exposure to COVID-19 patients were at higher risk of breakthrough infection.

/pdf/risk-of-vaccine-breakthrough-sars-cov-2-infection-and-288ukjer.pdf

Risk of Vaccine Breakthrough SARS-CoV-2 Infection and Associated Factors in Healthcare Workers of Trieste Teaching Hospitals (North-Eastern Italy)

Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on "Implementing an Antibiotic Stewardship Program" were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature:

High performance of coal dust suppression with waste activated sludge using microbially induced calcite precipitation technology

Discontinuation of antimicrobial therapy in adult neutropenic haematology patients: A prospective cohort.

Abstract We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii -infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p = 0.835). Univariate analysis revealed the association of mechanical ventilation (p = 0.002) and bacterial growth in tracheal aspirate (p = 0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak. 

https://www.nature.com/articles/s41598-022-25493-8.pdf

The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit

Implementation of an antimicrobial stewardship program for patients with febrile neutropenia.

This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. ABSTRACT Objective: We aimed to describe the risks of health care workers (HCWs) getting COVID-19, and analyze the transmission routes and dynamics of the infection. Methods: This is a prospective observational study. We screened 624 HCWs from April 1 to May 15, 2020, in a hospital with 300 hospital beds, in Istanbul, Turkey. All the HCWs working at high-risk areas (COVID wards, emergency departments, and intensive care units) were routinely screened every four weeks. The HCWs were grouped as high, moderate, low and none according to their risk of infection. Results: Out of 1300 total HCWs, 42 (3.2%) were diagnosed as COVID-19, 39 (3%) were confirmed by polymerase chain reaction (PCR) test. Among 42 symptomatic cases, 26 (62%) HCWs were hospitalized, mainly because of isolation needs, 62% received hydroxychloroquine (HCQ) alone, 11.5% HCQ + azithromycin, and 11.5% favipiravir only. All survived. We detected nine asymptomatic cases out of 550 HCWs (1.6%) in our screening for antibody levels. In none of the nine asymptomatic HCWs, SARS-CoV-2 RNA was not detected by PCR. In multivariate analysis for detecting the risk factors of the SARS-CoV-2 infection, working in high-risk areas (OR:5.2, CI:1.99-13.6, p=0.001), and not to use proper personal protective equipment (PPE) (OR:5.9, CI:1.66-21.2, p=0.006) increased the risk of infection. Conclusion: Routine screening of asymptomatic HCWs with antibody tests might be useful, but its effectiveness was limited. The HCWs working in high-risk areas had significantly higher risk. The strict use of appropriate PPE was effective in prevention.

The Risk of SARS-CoV-2 Infection among Healthcare Workers

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department.

Elimination of healthcare-associated Acinetobacter baumannii infection in a highly endemic region.

Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study

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