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Open research questions in Nosocomial Infections in ICU

38 unresolved questions extracted from the limitations and future-work sections of 443 Nosocomial Infections in ICU papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • These findings may support preliminary ICU risk stratification, but prospective validation and formal time-dependent exposure assessment are warranted.

    Pathogen characteristics and pre-index clinical factors associated with multidrug-resistant organism infections in intensive care unit patients · 2026 · DOI

  • The limited number of studies with small sample sizes and few randomized controlled trials in children with VAP will impact the generalizability and reliability of the findings. Furthermore, the use of inhaled antibiotics in various diseases and populations would have impacted the outcome. Our meta-analysis on the four RCTs still only included a maximum of three studies, with some analyses showing significant heterogeneity between these studies. „Conclusion and recommendations Using inhaled antibiotics with systemic antibiotics in children with ventilator-associated pneumonia did not result in statistically significant outcomes. We observed a minor, non-significant decrease in days on bacterial eradication, but no notable changes in clinical outcomes like MV, ICU stay, clinical success, or mortality. There was no increase in side effects, such as bronchospasm or nephrotoxicity, however close monitoring of each individual patient is still required. Larger randomized studies on specific populations are needed to confirm that inhaled antibiotics improve outcomes for children with VAP. Studies directly comparing amikacin and colistin are also important to determine if colistin is the best choice.

    Efficacy of inhaled antibiotics in children with ventilator-associated pneumonia: A systematic review and meta-analysis · 2026 · DOI

  • This meta-analysis has several limitations. Despite the consistent inclusion of multivariable-adjusted estimates, retrospective, single- center studies remain predominant, which may introduce selection bias and information bias. Because of the lack of standardized infec- tion definitions and the heterogeneity of ECMO populations, substan- tial residual heterogeneity persists for several factors. The limited number of studies within each infection-type subgroup restricted the power to detect subtle effect modifications. Moreover, the included studies span more than two decades, and ECMO technology has advanced rapidly, particularly after 2020; this may introduce temporal bias due to developments in extracorporeal membrane oxygenation technology and critical care practices. Prospective, multicenter studies using consensus infection definitions are essential to validate these findings.

    Risk factors for nosocomial infections in ECMO patients: a systematic review and meta-analysis · 2026 · DOI

  • This nationwide study has significant limitations. As in other HAIprevention initiatives, adjudication of VAP and the measured incidence of CLABSI and CAUTI may be influenced by local diagnostic and surveillance practices, including the frequency of culture ordering and how definitions are applied; culture stewardship alone can reduce reported CAUTI rates.36 To mitigate this, the study used a pre–post design in which each ICU served as its own control, established a complete one-year baseline, https://doi.org/10.1017/ice.2026.10434 Published online by Cambridge University Press Infection Control & Hospital Epidemiology 7 Table 1.

    Scaling up improvement: the drive to reduce healthcare-associated infections in public Brazilian intensive care units across all patient ages · 2026 · DOI

  • Currently, all implemented strategies (educational materials, assessment tools, infographics, etc.) are being prepared in part- nership with the Brazilian Ministry of Health and Anvisa to create a document outlining a multimodal strategy to prevent the three HAI analyzed and to make the implementation guidelines publicly available.

    Scaling up improvement: the drive to reduce healthcare-associated infections in public Brazilian intensive care units across all patient ages · 2026 · DOI

  • X u e t a l. 2 3 5 3 4 5 5 5 A B A B B B A A. 1 0 3 3 8 9 / f. m e d 2 0 2 6. 1 8 1 9 1 3 4 Xu et al. 10.3389/fmed.2026.1819134 mentioned above (such as particular dressing types or extubation timeframes), and many recommendations are based on clinical experience and observational data. This reflects the significant challenges in conducting prospective randomized controlled studies to evaluate the independent effectiveness of single infection prevention and control measures within the complex intervention that is ECMO. Cannulation itself compromises the integrity of the skin barrier, and the risk of infection correlates directly with the duration of catheterization (2). The application of transparent semipermeable film dressings over puncture sites provides an effective microbial barrier while enabling continuous visual assessment for early detection of infection signs. ELSO guidelines recommend avoiding unnecessary circuit access to maintain system integrity. All essential connections should utilize needleless connectors, with interfaces securely sealed using aseptic techniques to effectively block microbial invasion pathways (24, 33). Manerikar et al. (34) demonstrated that central venous catheter indwelling exceeding 8 days in ECMO patients was associated with higher rates of bloodstream infection and oxygenator secondary colonization. Therefore, daily assessment and prompt removal of non-essential lines are crucial for reducing potential infection portals at the source. Comprehensive skin management remains equally indispensable. Prophylactic dressings (such as hydrocolloid or foam dressings) should be placed beneath ECMO cannulas and monitoring devices to maintain clean, dry skin. This approach not only prevents pressure injuries but also serves as a critical measure for preserving the body’s natural barrier function. In refined skin and mucosal decolonization strategies, chlorhexidine serves as a critical broad-spectrum antiseptic agent. Systematic reviews indicate that chlorhexidine bathing can reduce the incidence of bloodstream infections by approximately 29% (IRR = 0.71, 95% CI 0.51–0.9) (35). A cluster-randomized trial published in JAMA demonstrated that combining chlorhexidine bathing with nasal mupirocin decolonization effectively reduced clinical culture positivity for staphylococcus aureus and methicillin-resistant staphylococcus aureus among ICU patients (36). However, evidence applicability to ECMO patients remains unclear, and existing results are conflicting. One study found that chlorhexidine plus mupirocin failed to reduce bloodstream infections in ECMO patients but unexpectedly increased enterococcal infections (11). Conversely, another study reported that a multi-site decontamination regimen including topical antibiotics significantly reduced infections (31).

    Prevention and management of nosocomial infections in patients undergoing extracorporeal membrane oxygenation: a summary of best evidence · 2026 · DOI

  • The study does not investigate the relationship between structured oral care adherence and patient outcomes, nor does it address barriers to implementing and sustaining oral care regimens in routine ICU nursing practice. Qualitative and implementation science studies are needed to understand compliance challenges and optimize integration of oral care into ICU protocols.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • The paper does not examine whether the beneficial effects of structured oral care differ based on patient demographics (age, comorbidities), duration of prior ICU admission, or underlying critical illness severity. Subgroup analysis of mechanically ventilated ICU patients stratified by these factors would identify patient populations most likely to benefit from the intervention.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • The relationship between oral cleanliness and pathogenic microorganism prevention in mechanically ventilated patients is inferred but not directly measured in this study. Direct sampling and analysis of oral flora versus respiratory tract secretions, along with identification of specific organisms that translocate from oral cavity to lungs in ventilated patients, is needed to establish this causal mechanism.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • The study lacks cost-effectiveness analysis despite acknowledging that reduced ICU length of stay implies lower healthcare delivery costs. A prospective economic evaluation comparing intervention costs against savings from shortened mechanical ventilation and ICU admission periods would strengthen the clinical and economic case for integrating oral care into routine ICU nursing practice.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • The paper does not specify the exact composition, frequency, or duration of the structured oral care protocol used in the intervention group. Future studies should standardize and clearly define the oral care regimen parameters (e.g., specific antimicrobial agents, brushing frequency, duration of each intervention) to enable reproducibility and comparison across different ICU settings.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • The study did not investigate the specific oral microorganisms (bacterial species and colonization patterns) that are reduced by the structured oral care intervention in mechanically ventilated ICU patients. Quantitative microbial analysis of oral biofilm before and after the intervention would establish the mechanistic link between oral hygiene improvements and decreased mechanical ventilation time.

    Impact of Adjuvant Oral Care on Clinical Outcomes in Mechanically Ventilated ICU Patients: A Randomized Controlled Trial · 2026 · DOI

  • Given the complexity of the ICU environment and the lack of consensus regarding the best management option for medical device-related orofacial lesions, PBMT seems to be a promising tool for that.

    Medical device-related orofacial ulcers: Report of two cases managed with photobiomodulation therapy · 2025 · DOI

  • Since both economic and human resources are scarce, countries are attempting to develop the most accurate ICU admission criteria that can minimize over- and undertriage.

    Determining the required level of care for patients with acute bacterial meningitis: case reports and literature review · 2021 · DOI

  • A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, gastrointestinal and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection.

    Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from North India · 2021 · DOI

  • PURPOSE: Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life.

    Basic Nursing Care to Prevent Nonventilator Hospital‐Acquired Pneumonia · 2013 · DOI

  • For mechanistic reasons, including low-dose exposure probability, further work on human risk estimates for LD employed the exponential and beta-Poisson models.

    A Quantitative Microbial Risk Assessment Model for Legionnaires' Disease: Animal Model Selection and Dose‐Response Modeling · 2007 · DOI

  • ATE is one of the most frequently performed surgical pro- cedures in children; however, its indications for preventing RTIs remain uncertain.

    The Impact of Adenotonsillectomy on Respiratory Tract Infections in Pediatric Patients: A Comparative Study Using a Korean Nationwide Population-Based Cohort · 2026 · DOI

  • A limitation of this study includes its retrospective, single- center design, which may immediate generalizability of the findings to other healthcare facilities.

    Evaluation of Antibiotic Use in Pediatric Patients with Bronchopneumonia Hospitalized at K.R.M.T Wongsonegoro Hospital · 2026 · DOI

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38 open questions have been extracted from the limitations and future-work passages of 443 Nosocomial Infections in ICU papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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