- Press Release Distribution

Study shows how ‘superbacteria’ were prevented from spreading in a large tertiary hospital

The findings also showed that containment may be impaired if patients stay more than two days in the emergency room

( Rapid identification of patients contaminated by “superbacteria” known as “carbapenem-resistant Enterobacteriaceae” (CRE), with early isolation of these patients, reduces transmission in hospital emergency departments. However, keeping them in the emergency room (ER) for more than two days undermines containment because it increases the risk of infection via colonization.

These are the key findings of a study by a group at the University of São Paulo’s Medical School (FM-USP) in Brazil. An article on the study is published in the journal Clinical Infectious Diseases.

Enterobacteria are gram-negative bacteria that cause infections in hospitals and clinics. They include Escherichia coli, a cause of urinary infections and hemorrhagic colitis, and Klebsiella pneumoniae, which can lead to pneumonia and bloodstream infections. CRE are considered a threat to public health because they are hard to treat. Carbapenem antibiotics are usually the last line of defense against infections caused by these microorganisms.

“Our study focused on an intervention in an overcrowded ER, a hotspot for CRE transmission. We found that the intervention reduced CRE transmission in the ER and the rest of the hospital,” Matias Chiarastelli Salomão, first author of the article, told Agência FAPESP. He is an infectious disease specialist and a member of the Hospital Infection Control Subcommittee at the Central Institute of Hospital das Clínicas (HC), the hospital complex run by FM-USP. 

Previous research conducted in the ER showed that 6.8% of admitted patients were colonized by CRE and 18% were contaminated during their stay in the ER. 

According to a report published in 2022 by the World Health Organization (WHO), seven out of every 100 patients admitted to acute-care hospitals are infected with at least one healthcare-associated infection (HAI) during their hospital stay in high-income countries, and 15 in low- and middle-income countries. One in ten die as a result on average.

The aims of the study, Salomão explained, included trying to understand and seek alternative ways of preventing infections acquired in the ER from spreading to other parts of the hospital. “The intervention was pragmatic and can be applied elsewhere. As for the finding that an ER stay of more than two days impairs containment, we see this as due to the fact that the ER’s structure wasn’t equipped for long-stay patients. In other words, beds were too close together and hand hygiene stations too far apart, among other problems,” he said.


The study was conducted in the ER of Hospital das Clínicas, which has 800 beds but is often so overcrowded that it holds double that number, some of whom stay for more than 11 days. 

FAPESP supported the study via a regular research grant awarded to Icaro Boszczowski, last author of the article. 

The study was divided into two phases, a baseline phase on February 3-28, 2020, before the first COVID-19 patient was admitted to the hospital, and the intervention proper, from September 14 to October 1, 2022. The hospital was entirely dedicated to COVID-19 cases from April 1 to August 31, 2020, after which it was gradually reopened for other types of patient.

Phase 1 focused on determining the prevalence and incidence of patients colonized by CRE admitted to the ER. Patients who stayed in the ER for longer than 24 hours occupied beds and gurneys in close proximity to each other while waiting to be transferred.

In phase 2, the intervention, patients admitted to the ER were screened for CRE during the first 24 hours of their stay. If they tested positive for superbacteria, they were isolated until discharge – 90% of those isolated were infected by Klebsiella pneumoniae. Cleaning and disinfection procedures were similar and antimicrobial use was monitored in both phases.

The results obtained by culture and molecular test showed that colonization at admission was 3.4% and that CRE infection acquisition rates fell from 4.6% to 1% during the intervention. A stay of more than two days in the ER was a significant risk factor for CRE acquisition.

“The idea for the study began at the hospital, as all intensive-care patients had been routinely screened for CRE on admission to the ICU and every week thereafter since 2014, and secondary colonization rates had fallen significantly as a result. However, another study found that superbacteria were entering via the ER,” said Salomão, who first studied the problem for his PhD research.

Two other articles resulted from the work done in this period, the latest of which was published in Emerging Infectious Disease in 2020.  

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at and visit FAPESP news agency at to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at




MDMA increases feelings of connection during conversation, showing promise for therapy

MDMA, commonly known as ecstasy, is a recreational psychedelic drug often used at parties and dance clubs because it creates feelings of closeness and social connection with others. Because of this “empathogenic” effect, researchers are also interested in its potential use as a complement to traditional talk therapy. In fact, two recent successful clinical trials support the use of MDMA-assisted therapy as a treatment for post-traumatic stress disorder (PTSD). Researchers at the University of Chicago published a study in Scientific Reports on September 22, 2023, that looked more closely at the pharmacological ...

Internationally recognized thoracic oncologist Dr. Taofeek K. Owonikoko named Executive Director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center

Internationally recognized thoracic oncologist Dr. Taofeek K. Owonikoko named Executive Director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center
University of Maryland School of Medicine (UMSOM) Dean Mark T. Gladwin, MD, and University of Maryland Medical Center (UMMC) President and CEO Bert W. O’Malley, MD, announced today that Taofeek K. Owonikoko, MD, PhD, a distinguished physician-scientist with a global reputation in thoracic oncology, has been appointed Executive Director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC). Dr. Owonikoko will join the UMSOM faculty as the Marlene and Stewart Greenebaum Professor in Oncology in the Department of Medicine and Executive Director of the UMSOM ...

Meat taxes and other livestock emissions regulations could be feasible, acceptable and effective, argue climate researchers

Meat taxes and other livestock emissions regulations could be feasible, acceptable and effective, argue climate researchers. #### Article URL: Article Title: High ‘steaks’: Building support for reducing agricultural emissions Author Countries: Germany, UK Funding: This work was financially supported by the Robert Bosch foundation (Junior Professorship grant to LM) The funder had no role in study design, data collection and analysis, decision to publish, ...

Accelerated radiation treatment could reduce head and neck cancer patient burden in low- and middle-income countries

SAN DIEGO, October 2, 2023 — A type of head and neck cancer predominantly diagnosed in people who reside in low- and middle-income countries may be treated effectively with fewer, but higher doses of radiation, a large new international study suggests. The study – a randomized phase III clinical trial involving 10 countries across four continents – found delivering a course of radiation in 20 rather than 33 treatment sessions was just as effective at controlling cancer for patients with alcohol and tobacco-related, locally advanced disease, without increasing side ...

October issues of American Psychiatric Association journals look at factors influencing depression and PTSD, guidance on handling drugs laced with fentanyl, and more

The latest issues of three of the American Psychiatric Association’s journals, The American Journal of Psychiatry, Psychiatric Services and The American Journal of Psychotherapy are now available online. The October issue of The American Journal of Psychiatry is focused on research devoted to understanding factors influencing depression, PTSD, and suicidal behavior. Highlights include: Genetic Contribution to the Heterogeneity of Major Depressive Disorder: Evidence From a Sibling-Based Design Using Swedish National Registers. Maternal Perinatal Stress Trajectories and Negative Affect and Amygdala Development in Offspring. Networks of Neurodevelopmental Traits, Socioenvironmental ...

Men with metastatic prostate cancer live longer thanks to new drugs

Men with metastatic prostate cancer live longer thanks to new drugs
Survival rates for men with metastatic prostate cancer have increased by an average of six months, something which coincides with the gradual introduction of ‘dual treatment’ since 2016. This is according to a register study of all Swedish men diagnosed between 2008 and 2020. The results are published in the medical journal JAMA Network open. Dual treatment means that patients receive both standard hormone therapy (GnRH therapy) and chemotherapy or androgen receptor blockers. Research has previously shown that men receiving this treatment live approximately one year longer than those receiving GnRH treatment alone. “Dual treatment for men with newly diagnosed metastatic ...

A more effective experimental design for engineering a cell into a new state

A strategy for cellular reprogramming involves using targeted genetic interventions to engineer a cell into a new state. The technique holds great promise in immunotherapy, for instance, where researchers could reprogram a patient’s T-cells so they are more potent cancer killers. Someday, the approach could also help identify life-saving cancer treatments or regenerative therapies that repair disease-ravaged organs. But the human body has about 20,000 genes, and a genetic perturbation could be on a combination of genes or on any of the over 1,000 transcription factors that regulate the genes. ...

How the hippocampus distinguishes true and false memories

Let’s say you typically eat eggs for breakfast but were running late and ate cereal. As you crunched on a spoonful of Raisin Bran, other contextual similarities remained: You ate at the same table, at the same time, preparing to go to the same job. When someone asks later what you had for breakfast, you incorrectly remember eating eggs. This would be a real-world example of a false memory. But what happens in your brain before recalling eggs, compared to what would happen if you correctly recalled cereal? In a paper published in Proceedings ...

Drier savannas, grasslands store more climate-buffering carbon than previously believed

Photos Savannas and grasslands in drier climates around the world store more heat-trapping carbon than scientists thought they did and are helping to slow the rate of climate warming, according to a new study.   The study, published online Oct. 2 in Nature Climate Change, is based on a reanalysis of datasets from 53 long-term fire-manipulation experiments worldwide, as well as a field-sampling campaign at six of those sites.   Twenty researchers from institutions around the globe, including two at the University of Michigan, looked at where and why fire has changed the amount of carbon stored in topsoil. They found that within savanna-grassland regions, ...

Ancient architecture inspires a window to the future

Ancient architecture inspires a window to the future
A centuries-old technique for constructing arched stone windows has inspired a new way to form tailored nanoscale windows in porous functional materials called metal-organic frameworks (MOFs). The method uses a molecular version of an architectural arch-forming “centring formwork“ template to direct the formation of MOFs with pore windows of predetermined shape and size.[1]. New MOFs designed and made in this way range from narrow-windowed materials with gas separation potential to larger-windowed structures with potential medical applications due to their excellent oxygen-adsorption capacity. “One of the most challenging ...


Tracing how the infant brain responds to touch with near-infrared spectroscopy

These are the world's most effective charities

When is an aurora not an aurora?

Advisory panel issues field-defining recommendations for US government investments in particle physics research

Doctors discover many patients at UNC’s Inflammatory Bowel Disease Clinic screen positive for malnutrition

BNL: Advisory panel issues field-defining recommendations for U.S. government investments in particle physics research

International collaboration uses faculty member’s research on ancient Roman migration, seeks to understand Balkan genomic history

USF Health Heart Institute doctors are upbeat about cardiac regeneration

AI-driven breakthroughs in cells study: SFU-UBC collaboration introduces "MCS-detect" for advancements in super-resolution microscopy

Advisory panel issues field-defining recommendations for investments in particle physics research

$3.8 million NIH grant to fund Southwest Center on Resilience for Climate Change and Health

What happens when the brain loses a hub? 

Study reveals Zika’s shape-shifting machinery—and a possible vulnerability

RIT leading STEM co-mentoring network

Genetic mutations that promote reproduction tend to shorten human lifespan, study shows

CAMH develops potential new drug treatment for multiple sclerosis

Polyethylene waste could be a thing of the past

A dynamic picture of how we respond to high or low oxygen levels

University of Toronto researchers discover new lipid nanoparticle that shows muscle-specific mRNA delivery, reduces off-target effects.

Evolving insights in blood-based liquid biopsies for prostate cancer interrogation

Finding the most heat-resistant substances ever made

Time-tested magnesium oxide: Unveiling CO2 absorption dynamics

Engaging heterosexual men more effectively could slash HIV infections in Uganda

A fork in the rhod: Janelia researchers unveil comprehensive collection of rhodamine-based fluorescent dyes

The Gerontological Society of America congratulates new 2023 awardees

Texas A&M Institute part of national effort to harness nuclear laser fusion for limitless energy

How health system hesitancies contributed to COVID risks

Stand Up to Cancer names Julian Adams, Ph.D., President and CEO

Immersive VR goggles for mice unlock new potential for brain science

Racial and ethnic differences in hospice use among Medicaid-only and dual-eligible decedents

[] Study shows how ‘superbacteria’ were prevented from spreading in a large tertiary hospital
The findings also showed that containment may be impaired if patients stay more than two days in the emergency room