Eurosurveillance - Volume 31, Issue 18, 07 May 2026

Accurate, fully automated systems may increase efficiency of healthcare-associated infections (HAI) surveillance.

We aimed to validate the performance of a fully automated surveillance system for central-line-associated bloodstream infections (CLABSI) in critically ill patients in Switzerland.

We conducted a multicentre retrospective study across six secondary and tertiary care hospital networks’ intensive care units (ICU). A centrally hosted, fully automated algorithm was implemented to detect catheter-related bloodstream infections (CRBSI), CLABSI and ICU-onset bloodstream infections (ICU-BSI). Algorithm performance was validated against an anonymised manual review of random samples of positive blood cultures. Incidence data were computed for each hospital.

From January 2022 to December 2023, we analysed 131,166 patient days, 108,719 catheter days and 7,832 positive blood cultures from 1,931 ICU patients. Median age was 65 years (interquartile range (IQR): 53–73), 458 (23.7%) were female. For CLABSI and CRBSI, the algorithm demonstrated a specificity of 95.3% (95% confidence interval (CI): 92.7–97.0), sensitivity of 86.5% (95% CI: 79.8–91.2), positive predictive value of 87.0% (95% CI: 80.4–91.7) and negative predictive value of 95.1% (95% CI: 92.5–96.8). CRBSI/CLABSI and ICU-BSI incidence rates were 3.23/1,000 catheter days (95% CI: 2.91–3.57) and 2.42/1,000 patient days (95% CI: 2.17–2.70), respectively. Most identified microorganisms for CRBSI/CLABSI were Staphylococcus epidermidis (15.1%; 53/351), Enterococcus faecium (9.1%; 32/351) and E. faecalis (5.7%; 20/351).

We demonstrate feasibility and external validity of a fully automated system for CLABSI surveillance in critically ill patients, supporting its integration into national HAI prevention and control strategies.

The Canadian Sentinel Practitioner Surveillance Network routinely undertakes multiplex respiratory virus testing, vaccine effectiveness (VE) estimation by test-negative design (TND), and whole genome sequencing (WGS) of vaccine-targeted viruses.

To estimate 2025/26 LP.8.1 VE against community-based COVID-19, including variant-specific, and explore the impact of other respiratory viruses among COVID-19 cases and/or controls.

Participants were ≥ 12-year-old outpatients presenting with acute respiratory illness between 26 October 2025 and 07 March 2026. COVID-19 vaccination information was registry-based. Primary TND analyses excluded influenza virus-infected controls. Sensitivity analyses explored inclusion and/or exclusion of influenza and other respiratory viral infections among COVID-19 cases and/or controls. WGS supported VE interpretation and variant-specific estimation.

We included 3,802 participants (2,832 (74%) aged 12–64 years; 970 (26%) aged ≥ 65 years), with 310 COVID-19 cases (29 vaccinated; 9%) and 3,492 controls (577 vaccinated; 17%). At median 9 weeks post-vaccination, LP.8.1 VE was 48% (95%CI: 21 to 66): 44% (95%CI: −12 to 72) for 12–64 and 53% (95%CI: 21 to 73) for ≥ 65-year-olds. In sensitivity analyses, VE was stable for ≥ 65-year-olds. Among 12–64-year-olds, VE decreased when including influenza virus infections among controls but increased when excluding co-infections, recognising uncertainty with reduced sample size. Against viruses that failed vs succeeded WGS, VE was 26% (95%CI: −63 to 66) vs 53% (95%CI: 24 to 71), 63% (95%CI: 30 to 80) against the XFG variant. Most SARS-CoV-2 co-infections with semi-quantification, including those failing WGS, showed higher viral load for the non-SARS-CoV-2 infection.

The 2025/26 LP.8.1 vaccine approximately halved the medically attended COVID-19 risk. Multiplex testing to identify primary co-infections among cases, or correlated vaccine-preventable infections among controls, may address VE under-estimation.

Candidozyma auris is a fungal pathogen of major concern, that frequently exhibits multidrug resistance and causes healthcare-related outbreaks worldwide. Italy experienced a large nosocomial outbreak in early 2020, with subsequent sporadic cases or small clusters in different regions.

To provide an overview of the C. auris population structure, genomic diversity, and spread in Italy.

Genome sequences from Italian C. auris isolates (n = 68) were obtained either from public databases, or by whole-genome sequencing of available isolates (n = 17) from previously uncharacterised and/or recently emerged (2025) cases. The sequence dataset was complemented with whole genome sequences of international isolates (n = 139) to conduct a global phylogenetic analysis based on core-genome single nucleotide polymorphisms. Genetic mutations associated with antifungal resistance were investigated.

All Italian isolates belonged to clade I (South Asian) but were interspersed among different subclades. Subclade Ic isolates were of a single lineage, characterised by the HMG1 ^P238H mutation. This lineage spread over four regions. Subclade Ib members were more diverse, and associated with local or imported single cases, as well as nosocomial clusters following sporadic, independent C. auris introductions from countries in southern Europe. A putative new subclade (Id) was identified, involving isolates from Italy and an eastern European country. Subclades Ib-c-d exhibited lineage-specific genetic signatures in antifungal-resistance-associated loci (CDR1, ERG11, TAC1B).

In Italy, C. auris strains form a complex population, resulting from emergence or evolution of clade I sub-lineages following, in some instances, sporadic introductions from other European countries. Strengthened screening protocols remain essential for inter-facility transfers and for patients with prior healthcare exposure abroad.