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Review
. 2024 Sep 12;37(3):e0016022.
doi: 10.1128/cmr.00160-22. Epub 2024 Aug 9.

Vaccines and monoclonal antibodies to prevent healthcare-associated bacterial infections

Léo Sauvat  1   2   3   4 , Paul O Verhoeven  1   2   5 , Julie Gagnaire  3   4 , Philippe Berthelot  1   2   3   4 , Stéphane Paul  1   2   6 , Elisabeth Botelho-Nevers #  1   2   4   6 , Amandine Gagneux-Brunon #  1   2   4   6
Affiliations
Review

Vaccines and monoclonal antibodies to prevent healthcare-associated bacterial infections

Léo Sauvat et al. Clin Microbiol Rev. .

Abstract

SUMMARYHealthcare-associated infections (HAIs) represent a burden for public health with a high prevalence and high death rates associated with them. Pathogens with a high potential for antimicrobial resistance, such as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and Clostridioides difficile, are responsible for most HAIs. Despite the implementation of infection prevention and control intervention, globally, HAIs prevalence is stable and they are mainly due to endogenous pathogens. It is undeniable that complementary to infection prevention and control measures, prophylactic approaches by active or passive immunization are needed. Specific groups at-risk (elderly people, chronic condition as immunocompromised) and also healthcare workers are key targets. Medical procedures and specific interventions are known to be at risk of HAIs, in addition to hospital environmental exposure. Vaccines or monoclonal antibodies can be seen as attractive preventive approaches for HAIs. In this review, we present an overview of the vaccines and monoclonal antibodies in clinical development for prevention of the major bacterial HAIs pathogens. Based on the current state of knowledge, we look at the challenges and future perspectives to improve prevention by these means.

Keywords: healthcare-associated infections; hospital infections; immunization; infection control; monoclonal antibodies; vaccines.

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Conflict of interest statement

E.B.-N. is principal investigator in vaccine trials sponsored by Pfizer, Moderna, Janssen, MSD, GSK, and Sanofi Pasteur. E.B.-N. participated in advisory boards for Pfizer, Moderna, Janssen, MSD, GSK, and Sanofi Pasteur with payments made for her institution, no personal payment. A.G.-B. is principal investigator in trials for monoclonal antibodies sponsored by Astra Zeneca, and sub-investigator in vaccine trials sponsored by Pfizer, Moderna, Janssen, MSD, GSK, and Sanofi Pasteur. A.G.-B. participated in advisory boards for Pfizer, GSK, and MSD with payments made for her institution, and received support for participation in meetings by Pfizer, MSD, Moderna, and GSK. All others authors on this manuscript have no relevant financial or other relationships to disclose.

Figures

Fig 1
Fig 1
Main bacterial pathogens targeted by vaccine or monoclonal antibodies to prevent HAIs. The main bacterial pathogens with identified development of vaccines or monoclonal antibody in clinical trial phase: S. aureus and C. difficile have the highest number of studies. Moreover, C. difficile has the only recommended antibody therapy to prevent recurrence. Among Gram-negative bacteria, P. aeruginosa and E. coli have emerging leads.
Fig 2
Fig 2
Risk factors of acquisition of healthcare-associated bacterial infection. Review of risk factors associated with HAI during hospital care on four key points: patient characteristics, treatment exposure, hospital care, and intervention at risk.
Fig 3
Fig 3
Vaccine platforms in development to prevent bacterial HAIs. Vaccines can be categorized into types based on the technology used to develop them. The main vaccine platforms used to develop bacterial HAIs vaccine: mainly conjugate or subunit vaccine, toxoid vaccine, inactivated whole cell (IWC), DNA or RNA vaccine, bacterial ghost, and outer membrane vesicle (OMV).
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