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- Multidrug resistance assessment of indoor air in Portuguese long-term and acute healthcare settingsPublication . Santos-Marques, C.; Teixeira, C.; Pinheiro, R.; Brück, W. M.; Pereira, Sónia Gonçalves; dos Santos Marques, Catarina; Silva Teixeira, Camila; Pinheiro, Rafael; Gonçalves Pereira, SóniaBackground: Knowledge about air as a pool of pathogens and multidrug resistance (MDR) in healthcare units apart from hospitals is scarce. Aim: To investigate these features in a Portuguese long-term healthcare unit (LTHU) and a central hospital (CH). Methods: Air samples were collected and their microbial load (bacteria and fungi) determined. Bacterial isolates were randomly selected for further characterization, particularly identification by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry, antimicrobial susceptibility testing, and polymerase chain reaction screening of extended-spectrum b-lactamases, carbapenemase genes and mecA gene, with RAPD profile assessment of positive results of the latter. Findings: A total of 192 samples were collected (LTHU: 86; CH: 106). LTHU showed a statistically significantly higher bacterial load. CH bacteria and fungi loads in inpatient sites were statistically significantly lower than in outpatients or non-patient sites. A total of 164 bacterial isolates were identified (MALDI-TOF: 78; presumptively: 86), the majority belonging to Staphylococcus genus (LTHU: 42; CH: 57). The highest antimicrobial resistance rate was to erythromycin and vancomycin the least, in both settings. Eighteen isolates (11%) were classified as MDR (LTHU: 9; CH: 9), with 7 MDR Staphylococcus isolates (LTHU: 4; CH: 3) presenting mecA. Nine non-MDR Staphylococcus (LTHU: 5; CH: 4) also presented mecA. Conclusion: The current study highlights that healthcare unit indoor air can be an important pool of MDR pathogens and antimicrobial resistance genes. Also, LTHUs appear to have poorer air quality than hospitals, as well as supportive areas compared to curative care areas. This may suggest possible yet unknown routes of infection that need to be explored.
- How have covid-19 prevention measures affected professionals working at nursing homes?Publication . Santos-Marques, Catarina; Mangas, Catarina; Marques, Tânia; Gil, Ana Paula; Ramalho, Nelson; Pereira, Sónia Gonçalves
- Infection prevention and control strategies against carbapenem resistant Enterobacteriaceae: a systematic reviewPublication . Santos-Marques, Catarina; Ferreira, Helena; Pereira, Sónia GonçalvesBackground: Antimicrobial resistance is exponentially worsening, and the spread of prevalent carbapenem resistant Enterobacteriaceae (CRE) is a major contributor to this global concern. Infection prevention and control strategies are increasingly consolidated key tools to control this worldwide problem. Aim: To identify, collect and analyse available evidence regarding the impact of infection prevention and control strategies on prevalent CRE dissemination. Methods: Pubmed®, Scopus® andWeb of Science® were searched systematically for articles published between 1th January 2017 and 30th June 2020, guided by the research question ‘What are the most effective and efficient strategies to prevent and control infection/colonisation caused by Carbapenemresistant Escherichia coli and Carbapenem resistant Klebsiella pneumoniae?’. Findings: Eleven thousand six hundred and thirty-five publications were found, but after applying the inclusion and exclusion criteria, only 30 were selected. The majority of reviewed studies (n = 24) were performed in outbreak situations, 26 studies occurred in acute care units and of those, 17 in intensive care units . From the set of implemented infection prevention and control measures, in 29 studies surveillance cultures were applied, in 23 studies patients were isolated or cohorted and, in general, all described the implementation of standard and contact precaution measures. Conclusion: This systematic review underlines the importance of infection prevention and control strategies in CRE dissemination, standing out the need of further studies outside outbreak and intensive care units contexts. Investment increments and training and educating of all involved are also important contributors to shift this problem, but still with relevant gaps in their implementation, in all types of care units, that need to be addressed.