This ecological study is the largest to date examining the association between rates of antibiotic use (AU) and hospital-onset (HO) Clostridioides difficile infection (CDI) in a tertiary university hospital in Serbia. There was no clear trend in the incidence of HO-CDI over time. Total utilization of antibacterials for systemic use increased from 38.57 DDD/100 bed-days (BD) in 2011 to 56.39 DDD/100 BD in 2021. The most commonly used antibiotics were third-generation cephalosporins, especially ceftriaxone, with maximum consumption in 2021 (19.14 DDD/100 BD). The share of the Access group in the total utilization of antibiotics ranged from 29.95% to 42.96% during the observed period. The utilization of the Reserve group of antibiotics indicated a statistically significant increasing trend (p = 0.034). A statistically significant difference in the consumption of medium-risk antibiotics from 2011 to 2021 was shown for penicillins and a combination of sulfamethoxazole and trimethoprim. The consumption of cefotaxime showed a statistically significant negative association with the rate of HO-CDI (r = −0.647; p = 0.031). Ampicillin and the combination of amoxicilline with clavulanic acid have shown a negative statistically significant correlation with the ID of HO-CDI (r = −0.773 and r = −0.821, respectively). Moreover, there was a statistically significant negative correlation between consumption of “medium-risk antibiotics” and the rate of HO-CDI (r = −0.677). The next challenging step for the hospital multidisciplinary team for antimicrobials is to modify the antibiotic list according to the Access, Watch, and Reserve classification, in such a way that at least 60% of the AU should be from the Access group, according to the World Health Organization recommendation.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resulting coronavirus disease 2019 (COVID-19) has caused a fast-moving pandemic. Diagnostic testing, aimed to identify patients infected with SARS-CoV-2, plays a key role in controlling the COVID-19 pandemic in different populations. (2) Methods: This retrospective cohort study aimed to investigate predictors associated with positive polymerase chain reaction (PCR) SARS-CoV-2 test results in hospitalized patients, healthcare workers (HCWs), and military personnel (MP) during 2020, before the widespread availability of COVID-19 vaccines. Persons with a positive test result were compared with persons with a negative test result in three cohorts during the study period. (3) Results: A total of 6912 respondents were tested, and 1334 (19.3%) of them had positive PCR SARS-CoV-2 test results. Contact with a known COVID-19 case within 14 days (p < 0.001; OR: 1.48; 95% CI: 1.25–1.76), fever (p < 0.001; OR: 3.66; 95% CI: 3.04–4.41), cough (p < 0.001; OR: 1.91; 95% CI: 1.59–2.30), headache (p = 0.028; OR: 1.24; 95% CI: 1.02–1.50), and myalgia/arthralgia (p < 0.001; OR: 1.99; 95% CI: 1.65–2.42) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of MP. Furthermore, fever (p < 0.001; OR: 2.75; 95% CI: 1.83–4.13), cough (p < 0.001; OR: 2.04; 95% CI: 1.32–3.13), headache (p = 0.008; OR: 1.76; 95% CI: 1.15–2.68), and myalgia/arthralgia (p = 0.039; OR: 1.58; 95% CI: 1.02–2.45) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of HCWs. Moreover, independent predictors of positive PCR SARS-CoV-2 test results in hospitalized patients were contact with a known COVID-19 case within 14 days (p < 0.001; OR: 2.56; 95% CI: 1.71–3.83), fever (p < 0.001; OR: 1.89; 95% CI: 1.38–2.59), pneumonia (p = 0.041; OR: 1.45; 95% CI: 1.01–2.09), and neurological diseases (p = 0.009; OR: 0.375; 95% CI: 0.18–0.78). (4) Conclusions: According to data gathered from cohorts of hospitalized patients, HCWs, and MP, before the widespread availability of COVID-19 vaccines in Serbia, we can conclude that predictors of positive PCR SARS-CoV-2 test results in MP and HCWs were similar. Accurate estimates of COVID-19 in different population groups are important for health authorities.

Background: Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. Methods: The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI. Results: SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III–IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159–2.189; p = 0.004) and LOS (RR: 1.074; 95% CI: 1.037–1.112; p < 0.001). Conclusions: Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement.

Background/Aim. Members of the Serbian Armed Forces participating in the United Nations (UN) Multi-dimensional Integrated Stabilization Mission in the Central African Republic (CAR) ? MINUSCA, are exposed to the bites of the Aedes genus mosquitoes, which are transmitters of some (or certain) arboviruses. The aim of the study was to determine the exposure, risk factors, and prevention and protection measures against infection with arboviruses in members of peacekeeping missions (PKM). Methods. The study included 1 36 members of UN PKM in CAR in two rotations during 2022/2023, lasting 8 and 6 months. Each respondent had to answer the questions of the designed epidemiological questionnaire for the returnees from PKM. The subjects? blood sera were tested for specific antibodies against Dengue, Zika, and Chikungunya viruses using an enzyme-linked immunosorbent assay (ELISA) test. Results. The number of seropositive individuals for arboviruses was 48 (35.3%). Most members, 23 (16.9%), were seropositive for the Dengue virus, slightly fewer for the Chikungunya virus, 14 ( 10.3%), and the fewest were seropositive for the Zika virus, 11 (8.1%). Our research shows that impregnating uniforms with repellent plays a significant role in preventing mosquito bites and the Zika virus infection. The number of days spent in the mission and the factors of gender and age did not show an influence on the occurrence of arbovirus infections. Conclusion. The members of PKM in the CAR have come into contact with Dengue, Zika, and Chikungunya viruses. This indicates that it is necessary to work on the constant improvement of prevention measures and protection of their health, including further serological tests, but also tests for the presence of various infectious microorganisms in this endemic area.

Causal assessment is a cornerstone of epidemiological research, providing a framework for understanding the relationships between exposures and health outcomes. In his seminal 1965 paper, Sir Austin Bradford Hill proposed nine criteria to guide the evaluation of causal associations. These criteria - strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy - continue to serve as foundational principles in modern epidemiology. However, the application of these criteria has evolved significantly in response to advances in scientific knowledge, statistical methodologies, and data availability. This paper revisits Hill's criteria within the context of contemporary challenges and opportunities in public health research. It explores the nuanced interplay between causality and risk quantification, particularly in chronic and multifactorial diseases where direct causation is elusive. Through historical and modern examples, the paper illustrates the enduring relevance and adaptability of Hill's framework. Additionally, the discussion emphasizes the importance of experimental and observational designs, the integration of advanced analytical techniques to emulate randomized trials, and the need to balance adherence to established principles with openness to novel discoveries. By revisiting Hill's criteria, this work underscores their continuing utility in navigating the complexities of causality in a rapidly evolving scientific landscape.