Articles

Background: Hospital-acquired infections (HAIs) caused by multidrug resistant (MDR) bacteria are a major public health problem especially in resource-limited settings. Local data on antimicrobial resistance (AMR) are crucial to inform empirical therapy and infection prevention. Objectives: To identify bacterial pathogens causing HAIs, determine their AMR profiles and independent risk factors for MDR infections in a tertiary hospital in Erbil City, Iraq. Materials and Methods: A cross-sectional study was done at Hawler Teaching Hospital between January and June 2026. Standard microbiological methods were used to analyse 200 clinical specimens from patients with HAIs (≥48 hr after admission). Antimicrobial susceptibility testing was performed according to CLSI 2024 guidelines. MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial classes. Multivariate logistic regression was used to assess independent risk factors. Results: Bacterial growth was obtained in 149 of 200 specimens (74.5%). The major pathogens were Escherichia coli (31.5%), Klebsiella pneumoniae (23.5%), Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (14.1%) and Acinetobacter baumannii (6.1%). In total, 69.1% of the isolates were MDR, with the highest rates in K. pneumoniae (80.0%) and A. baumannii (77.8%). Independent predictors of MDR infection were previous antibiotic use (AOR=4.45), ICU admission (AOR=3.92), and hospitalization >7 days (AOR=3.10). Conclusion: This study documented a significant burden of MDR-HAIs in Erbil City and determined modifiable clinical risk factors. The findings provide evidence to support antimicrobial stewardship, infection prevention and AMR surveillance in Iraqi healthcare settings.

Background: Antimicrobial resistance (AMR) is a major global public health threat that compromises the effectiveness of antimicrobial therapy. Nurses play a critical role in antimicrobial stewardship (AMS); however, evidence regarding their knowledge, attitudes, and practices (KAP) in the Philippine setting remains limited. Objective: To determine the knowledge, attitudes, and practices regarding antimicrobial stewardship among bedside nurses employed in selected tertiary hospitals in Baguio City, Philippines, and to examine the relationships between selected socio-demographic characteristics and AMS competencies. Methods: A quantitative descriptive cross-sectional correlational study was conducted among 119 bedside nurses from two tertiary hospitals in Baguio City. Data were collected using a modified, validated self-administered questionnaire. Descriptive statistics summarized respondents' characteristics and KAP scores. The Shapiro–Wilk test assessed normality. Univariate linear regression examined associations between socio-demographic characteristics and KAP outcomes. Statistical significance was set at p < 0.05. Results: Most respondents demonstrated moderate knowledge, highly positive attitudes, and favorable antimicrobial stewardship practices. Greater knowledge was significantly associated with better stewardship practices. Likewise, positive attitudes were positively associated with stewardship practices. Previous antimicrobial stewardship education and selected socio-demographic characteristics were associated with improved KAP outcomes. Conclusion: Bedside nurses demonstrated positive attitudes and favorable antimicrobial stewardship practices despite moderate knowledge levels. Strengthening competency-based antimicrobial stewardship education may enhance nurses' participation in stewardship initiatives and improve patient safety while contributing to national and global efforts to combat antimicrobial resistance.

Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively. Results: PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. Conclusion: Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.