A progress report from the Centers for Disease Control and Prevention (CDC) shows that rates of healthcare-associated infections (HAIs) at US hospitals fell in 2023.

The 2023 National and State HAI Progress Report, based on data provided to the CDC's National Healthcare Safety Network by 38,000 acute-care hospitals, inpatient rehabilitation facilities (IRFs), and long-term acute-care hospitals (LTACHs), shows overall declines in HAIs compared with 2022. The declines, primarily seen in acute-care hospitals, reflect a continuing downward trend in the wake of the COVID-19 pandemic, with some HAIs falling below pre-pandemic levels.

Overall, US acute-care hospitals in 2023 saw a 15% decline in central line-associated bloodstream infections (CLABSIs) compared with 2022, an 11% drop in catheter-associated urinary tract infections (CAUTIs), and a 5% decline in ventilator-associated events (VAEs). Additionally, hospital-onset methicillin-resistant Staphylococcus aureus bacteremia was down 16% compared with 2022, and hospital-onset Clostridioides difficile infection (CDI) fell by 13%.

At the state level, 30 states performed better in 2023 on at least two infection types, 21 states performed better on three infection types, and 9 states performed better on four infection types.

The declines were not observed in all healthcare settings, however. In IRFs and LTACHs, only hospital-onset CDI fell significantly in 2023 (by 13% and 14%, respectively). IRFs also saw an 8% increase in CAUTIs. 

Progress needs to be sustained

Previous CDC reports showed that HAI rates in US hospitals rose significantly during the COVID-19 pandemic. The increase in HAIs, which followed years of declines, resulted from overwhelmed hospitals having fewer resources to devote to infection prevention and control and patient safety.

"While much progress has been made, more needs to be done to prevent healthcare-associated infections in a variety of settings," the CDC said. "Full engagement between local, state and federal public health agencies and their partners in the healthcare sector through initiatives such as prevention collaboratives is vital to sustaining and extending HAI surveillance and prevention progress."

Implementation of routine immunization of US adolescents with the quadrivalent (four-strain) meningococcal conjugate vaccine (MenACWY) was associated with reduced burden of invasive meningococcal disease (IMD), researchers reported yesterday in JAMA Network Open.

Using national incidence data from the US Centers for Disease Control and Prevention on cases of IMD caused by serogroups C, W, and Y of Neisseria meningitidis, a team led by researchers from Sanofi (maker of the MenACWY vaccine) conducted a modeling study to estimate the number of IMD cases and deaths among adolescents and young adults ages 11 to 23 that were prevented from the time the vaccine was recommended in 2005 through 2021. 

They also created a simulated counterfactual scenario in the absence of vaccination. Their aim was to investigate how the downward trajectory of IMD that began in the mid-1990s might have evolved without the vaccine.

Vaccine has aided downward trend         

Among the entire US population from 2005 to 2021, MenACWY vaccination prevented an estimated 172 cases of IMD (95% credible interval [CrI], 85 to 345) in US adolescents 11 to 15 years of age and 328 IMD cases (95% CrI, 164 to 646) among those aged 16 to 23 years. Absent vaccination, the cumulative incidence of IMD in those age-groups would have been at least 59% higher than reported over the same period with vaccination. When considering age groups separately, the incidence of IMD would have been 110% higher in the younger group and 47% higher in the older group.

Applying case-fatality rates of unvaccinated people derived from national data to the counterfactual scenario, the researchers found that vaccination averted an estimated 16 deaths (95% CrI, 8 to 31) among adolescents aged 11 to 15 years and 38 deaths (95% CrI, 19-75) among those aged 16 to 23 years.

"Given the severity of the disease and its potential lifetime sequelae, any decrease in vaccine uptake or in the level of protection within the US population could become a public health concern, especially during the high-risk period of late adolescence and early adulthood," the study authors wrote. 

Involving a new research tool named FlowBEAT, a study in Science Translational Medicine links self-targeting antibodies in the airways and nose to milder cases of COVID-19 and more efficient recovery in patients, which means a nasal swab could help predict disease severity.

The study is based on findings from 125 participants with varying levels of COVID-19 (from mild to severe) for up 2 years. The participants who had mild to moderate courses of illness had higher levels of autoantibodies in the nose.

Nasal autoantibodies play new role

The finding is counterintuitive, the authors explained: Previous studies have shown autoantibodies in the blood of a COVID-19 patient are a sign of more significant infection. But nasal autoantibodies had not been studied. 

The nasal autoantibodies showed up soon after infection, targeting an important inflammatory molecule produced by the patient's cells.

"The nasal autoantibodies showed up soon after infection, targeting an important inflammatory molecule produced by the patient's cells," said senior author Eliver Ghosn, PhD, from the Lowance Center for Human Immunology and Emory Vaccine Center, in a press release from Emory Health Sciences. "While autoantibodies in the blood were linked to bad prognosis, producing them only in the nose soon after infection is linked to efficient recovery."

The authors explained that the nasal autoantibodies likely latched on to viral molecules, preventing excessive inflammation, and helping the body return to homeostasis (healing) after infection. 

The authors said they will next use the FlowBEAT technology to study nasal autoantibodies during other viral infections.