Prevalence of multidrug-resistant Gram-negative bacteria from blood cultures and rapid detection of beta-lactamase-encoding genes by multiplex PCR assay

Introduction This study aimed to determine the prevalence of multidrug-resistant Gram-negative bacteria (GNB) from blood cultures in a tertiary-care hospital and the multiplex PCR assay's ability to detect resistance genes. Methods A total of 388 GNB isolates obtained from hospitalized patients between November 2019 and November 2021 were included in the study. Antimicrobial susceptibility testing was done by VITEK 2 system and broth microdilution method. Beta-lactamase-encoding genes were detected by multiplex PCR assays, BioFire-Blood Culture Identification 2 (BCID2) panel (bioMerieux, France). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically with VITEK AST-GN71 card (bioMerieux, France). The isolates of GNB were classified into multidrug-resistant, extensively-drug-resistant, and pandrug-resistant categories, and their prevalence and distribution in different wards, including coronavirus diseases 2019 (COVID-19) intensive care units (ICU), were calculated. Results Results revealed that all isolates of Acinetobacter baumannii and Pseudomonas aeruginosa were multidrug-resistant as well as 91.6% of Enterobacter cloacae, 80.6% of Proteus mirabilis, and 76.1% of Klebsiella pneumoniae, respectively. In fermentative bacteria, blaOXA-48-like (58.1%), blaNDM (16.1%), blaKPC (9.7%) and blaVIM (6.5%) genes were detected. More than half of Enterobacter cloacae (58.3%) and Klebsiella pneumoniae (53.7%) produced ESBLs. Among non-fermenters, the blaNDM gene was carried by 55% of Pseudomonas aeruginosa and 19.5% of Acinetobacter baumannii. In the COVID-19 ICU, Acinetobacter baumannii was the most common isolate (86.1%). Conclusions This study revealed high proportions of multidrug-resistant blood isolates and various underlying resistance genes in Gram-negative strains. The BCID2 panel seems to be helpful for the detection of the most prevalent resistance genes of fermentative bacteria.Copyright © GERMS 2022.

Experimental study of the disinfection performance of a 222-nm Far-UVC upper-room system on airborne microorganisms in a full-scale chamber

222-nm Far-UVC light is an emerging and promising tool for rapidly inactivating airborne pathogens. In this study, we experimentally evaluated the performance of a 222-nm Far-UVC upper-room disinfection system with a 15 W Far-UVC lamp in a full-scale chamber (11.9 m3). One gram-positive bacteria, namely Staphylococcus epidermidis and two gram-negative bacteria, namely Escherichia coli and Salmonella enterica were selected for the experiments. The aerosolized bacteria were injected into the chamber and exposed to 222-nm Far-UVC light. The first-order decay rates of indoor bioaerosols concentration with and without Far-UVC treatment were estimated. According to the results, the 222-nm Far-UVC induced decay rates of three bacteria were 0.0611 ± 0.003, 0.409 ± 0.048, and 0.474 ± 0.015 min−1, respectively. Besides, the UV susceptibility constants (Z-values) of these three bacteria were estimated as 0.157, 0.974, and 1.18 m2/J, respectively. The gram-positive bacteria, S. epidermidis, showed higher resistance to Far-UVC light as compared to the gram-negative bacteria, E. coli and S. enterica. In addition, a case study on airborne SARS-CoV-2 indoor transmission was simulated, and the infection risk of SARS-CoV-2 was compared using the Far-UVC and enhanced ventilation approaches. The results showed that both UV inactivation and ventilation approaches can significantly reduce the infection risk. More importantly, the Far-UVC may be a feasible and sustainable solution for reducing infection risk and improving indoor air quality. © 2023 Elsevier Ltd

Recent Updates on Bacterial Secondary Metabolites to Overcome Antibiotic Resistance in Gram-Negative Superbugs: Encouragement or Discontinuation?

The rapid spread of COVID-19 has dramatically changed our perspective about how we should be well prepared for upcoming health disasters in the future. Like COVID-19, the world does not seem prepared to fight the slow-moving pandemic, i.e., antimicrobial resistance (AMR). At present, more than 7, 00, 000 people per year across the globe succumb to drug-resistant infections. According to several reports, if we fail to respond, AMR could lead to the loss of ten million lives and trillions of money by 2050. Among the different pathogens affecting human health, the World Health Organization (WHO) has recently announced a priority list of drug-resistant bacteria to pave the way for the development of new antibiotics. Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa are the most notorious ones and are responsible for the majority of healthcare-associated infections. These pathogens come under the critical threat category because they express resistance to all of the current antibiotics. The modern combinatorial chemistry approaches and chemical genomics have been unsuccessful to provide enough new antibiotics. In stark contrast to this, natural products have been gifted with remarkable chemical diversity and biological activity. Our modern antibiotic armamentarium was built from microbes' natural products, especially Streptomyces spp. and Bacillus spp. isolated in the golden era. Today, the antibiotic discovery pipeline has almost dried up, in part due to the rediscovery of already known compounds from bacteria, and no new classes emerged from bacteria until recently. These novel natural antibacterial agents from bacteria resurged a spark in the exploitation of bacteria to find new chemical entities. This chapter mainly focuses on natural antimicrobials and adjuvants isolated from the bacterial domain in the last two decades, i.e., from 2001 to 2020, and their status to fight drug-resistant Gram-negative superbugs. We have also described briefly the discovery of synthetic compounds based on natural scaffolds. In conclusion, the bacterial natural products comprise a goldmine to fight superbugs, and future research should be focused on exploring new antimicrobials from bacterial diversity. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Influence of Nitrogen-Doped Carbon Dot and Silver Nanoparticle Modified Carbon Paste Electrodes on the Potentiometric Determination of Tobramycin Sulfate: A Comparative Study

Two inexpensive and simple methods for synthesis of carbon nanodots were applied and compared to each other, namely a hydrothermal and microwave-assisted method. The synthesized carbon nanodots were characterized using transmission electron microscopy (TEM), ultraviolet-visible (UV-Vis), photoluminescence (PL), Fourier transform-infrared spectroscopy (FTIR), and X-ray diffraction (XRD). The synthesized microwave carbon nanodots had smaller particle size and were thus chosen for better electrochemical performance. Therefore, they were used for our modification process. The proposed electrodes performance characteristics were evaluated according to the IUPAC guidelines, showing linear response in the concentration range 10−6–10−2, 10−7–10−2, and 10−8–10−2 M of tobramycin with a Nernstian slope of 52.60, 58.34, and 57.32 mV/decade for the bare, silver nanoparticle and carbon nanodots modified carbon paste electrodes, respectively. This developed potentiometric method was used for quantification of tobramycin in its co-formulated dosage form and spiked human plasma with good recovery percentages and without interference of the co-formulated drug loteprednol etabonate and excipients.

Effectiveness of a Self-Decontaminating Coating Containing Usnic Acid in Reducing Environmental Microbial Load in Tertiary-Care Hospitals.

Surfaces have been implicated in the transmission of pathogens in hospitals. This study aimed to assess the effectiveness of an usnic-acid-containing self-decontaminating coating in reducing microbial surface contamination in tertiary-care hospitals. Samples were collected from surfaces 9 days before coating application, and 3, 10, and 21 days after its application (phases 1, 2, 3, and 4, respectively). Samples were tested for bacteria, fungi, and SARS-CoV2. In phase 1, 53/69 (76.8%) samples tested positive for bacteria, 9/69 (13.0%) for fungi, and 10/139 (7.2%) for SARS-CoV-2. In phase 2, 4/69 (5.8%) samples tested positive for bacteria, while 69 and 139 samples were negative for fungi and SARS-CoV-2, respectively. In phase 3, 3/69 (4.3%) samples were positive for bacteria, 1/139 (0.7%) samples tested positive for SARS-CoV-2, while 69 samples were negative for fungi. In phase 4, 1/69 (1.4%) tested positive for bacteria, while no fungus or SARS-CoV-2 were detected. After the coating was applied, the bacterial load was reduced by 87% in phase 2 (RR = 0.132; 95% CI: 0.108-0.162); 99% in phase 3 (RR = 0.006; 95% CI: 0.003-0.015); and 100% in phase 4 (RR = 0.001; 95% CI: 0.000-0.009). These data indicate that the usnic-acid-containing coating was effective in eliminating bacterial, fungal, and SARS-CoV-2 contamination on surfaces in hospitals.Our findings support the benefit ofan usnic-acid-containing coating in reducing the microbial load on healthcare surfaces.

Evaluation of DNA Extraction Methods for Reliable Quantification of Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

Detection and quantification of DNA biomarkers relies heavily on the yield and quality of DNA obtained by extraction from different matrices. Although a large number of studies have compared the yields of different extraction methods, the repeatability and intermediate precision of these methods have been largely overlooked. In the present study, five extraction methods were evaluated, using digital PCR, to determine their efficiency in extracting DNA from three different Gram-negative bacteria in sputum samples. The performance of two automated methods (GXT NA and QuickPick genomic DNA extraction kit, using Arrow and KingFisher Duo automated systems, respectively), two manual kit-based methods (QIAamp DNA mini kit; DNeasy UltraClean microbial kit), and one manual non-kit method (CTAB), was assessed. While GXT NA extraction kit and the CTAB method have the highest DNA yield, they did not meet the strict criteria for repeatability, intermediate precision, and measurement uncertainty for all three studied bacteria. However, due to limited clinical samples, a compromise is necessary, and the GXT NA extraction kit was found to be the method of choice. The study also showed that dPCR allowed for accurate determination of extraction method repeatability, which can help standardize molecular diagnostic approaches. Additionally, the determination of absolute copy numbers facilitated the calculation of measurement uncertainty, which was found to be influenced by the DNA extraction method used.

Bacterial Co-infections and Susceptibility patterns among admitted COVID 19 patients during 3rd wave of pandemic, in a Tertiary Care Hospital. Lahore

Objective: To check the Bacterial Co-infections and Susceptibility patterns among admitted COVID-19 patients during 3rd wave of pandemic. Study Design: Descriptive Cross Sectional study. Setting: Department of Microbiology, Combined Military Hospital Lahore Pakistan. Period: May 2021 to August 2021. Material & Methods: Six hundred and twelve COVID-19 positive patients having positive bacterial cultures were processed, Antibiotic susceptibility testing was done by Kirby-Bauer diffusion technique, all antibiotics were reported using breakpoints recommended in clinical and laboratory standards institute (CLSI 2021). Results: Out of 612 patients, 348 (56.9%) were male and 264 (43.2%) were female. Mean age of the patients was 57.2 ± 14.4 years with a range of 22 to 89 years. Bacterial coinfection was present in 70.4% of the patients. Gram negative bacteria (94.4%) were more prevalent in COVID-19 patients as compared to gram positive isolates (5.6%). Antibiotic sensitivity pattern of Staphylococcus aureus showed a high resistance against penicillin, ampicillin, tetracycline and doxycycline. Conclusion: Our study reported a high prevalence of bacterial coinfections in COVID-19 patients infected during the third wave of pandemic. A high percentage of gram negative species were identified in our study population, this could be due to the suppression in the immunity of individuals due to severity of COVID-19 infection and already present Antimicrobial resistance. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Evaluation of antibiotics resistance in Southern Iran in light of COVID-19 pandemic: A retrospective observational study.

Background and Aims: Antimicrobial resistance (AMR) was taken as one of the high-priority long-lasting public health issues, although it might have been underrated in terms of COVID-19 pandemic emergence. Regarding limited data on assessing the pandemic effect on AMR trend in Iran, this study aimed to describe the epidemiology of antibiotics resistance during the COVID pandemic in southern Iran. Methods: This descriptive study was conducted on 2675 patients' samples collected and processed in a referral COVID-19 center hospital in southern Iran from March 21, 2019, to February 18, 2020 (prepandemic), and February 19, 2020, to March 21, 2021 (pandemic). Susceptibility test results in sensitivity and resistance levels were compared in prepandemic and pandemic periods. Results: Compared to prepandemic, the inpatient number has increased almost three times. On the other hand, there are around four times fewer outpatients now. More than 85% of the specimens were found in urine samples. In all, 92.22% of all bacteria samples were Gram-negative isolates, with Escherichia coli accounting for 59.19% of them. The change rate of Gram-negative bacteria resistance to antimicrobials is an average of 7.74% (p < 0.001). On the other hand, the average change rate of Gram-positive bacteria resistant to antibiotics has decreased by 19.3% (p = 008). As a forerunner among other Gram-negative bacteria, the average change rate for Pseudomonas aeruginosa and Klebsiella pneumonia resistance to monitored antibiotics was 89% and 66.3%, respectively (p < 0.001). Conclusion: During the Covid-19 pandemic, the increase in AMR among Gram-negative bacteria, particularly P. aeruginosa and K. pneumonia, was observed compared to the prepandemic. This further limits treatment options, and endangers global public health.

Correlation between inflammatory parameters and bloodstream infections caused by multidrug resistant Gram-negative bacteria in critically ill COVID-19 patients – retrospective single-center study

Objectives: During the COVID-19 pandemics we have seen in critically ill COVID-19 patients treated in the intensive care unit the parallel outbreak of multidrug resistant Gram-negative bacteria bloodstream infections, mainly Acinetobacter baumannii and Klebsiella pneumoniae. Methods: We conducted a retrospective cohort single-center study. The aim was to investigate the incidence, etiology and impact of intensive care unit bloodstream infections in COVID-19 patients admitted to the COVID-19 intensive care unit with a known burden of multidrug resistance and to evaluate the possibility that inflammatory parameters levels measured at two different time points of treatment can early predict multidrug resistant Gram-negative bacteria bloodstream infections and enable timely beginning of bacterial targeted antimicrobial therapy. Results: Our study confirmed that procalcitonin values of 2,46 mcg/L and neutrophil/lymphocyte ratio of 28,9 could be a reliable indicators for high risk stratification of multidrug resistant Gram-negative bacterial infection origin in critically ill COVID-19 patients (Mann Whitney U test, P=0,02). Conclusion: Monitoring dynamic shift of inflammatory parameters in critically ill COVID-19 patients could reliably help clinician to recognize the multidrug resistant Gram-negative bacteria bloodstream infections and start with the antimicrobial therapy in a timely manner. © 2022 Hrvatski Lijecnicki Zbor. All rights reserved.

Bacterial contamination on used face masks in healthcare personnel

Background: Face masks have been worn universally and for long periods of time by healthcare personnel during the COVID-19 pandemic. They are frequently touched or adjusted with the hands and may come in contact with various surfaces and high-touch sites when taken off and on even briefly. These activities present opportunities for face masks to become contaminated with microorganisms. Nursing homes have high rates of multidrug-resistant bacteria and low PPE compliance;therefore, contamination of face masks in this setting may be of great interest. We investigated bacterial colonization status on used face masks in healthcare personnel, including assessing the presence of clinically important and multidrug-resistant bacteria. Methods: At a nursing home serving mostly post–acute-care patients, we collected 69 face masks from personnel at the end of the user's work shift. Information about the mask and the user was also collected via a self-reported survey. Face masks were incubated in BHI broth overnight at 36°C and 10 μL was then plated on selective and differential plates. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and gram-negative bacteria (GNB) resistant to several antibiotic classes were identified using standard microbiological methods. Resistance testing for cefoxitin (S. aureus), ciprofloxacin, meropenem, tetracycline, erythromycin, gentamicin, trimethoprim–sulfamethoxazole, and ceftazidime with and without clavulanic acid (gram-negative bacteria) was performed using the disc diffusion technique on Mueller-Hinton plates (Kirby Bauer). Results: The job categories of face mask users were competency-evaluated nursing assistant or nursing assistant (22.73%), nurse (12.12%), and other or administrative (37.88%). Overall face mask contamination rates for MRSA (0%) and VRE (3.3%) were low;however, methicillin-susceptible S. aureus was found on 11 masks (15.9%). High contamination and resistance rates were found for gram-negative bacteria, with 113 isolates. Among them, 69 (60.9%) were resistant to at least 1 antibiotic, most commonly was erythromycin (59.4%). Additionally, higher rates of clinically important pathogenic gram-negative bacteria were identified: 14.3% of masks were contaminated with Klebsiella pneumoniae, 13.0% were contaminated with Enterobacter spp, and 4.2% were contaminated with Escherichia coli. Importantly, there were no significant differences in the total number of isolates of potential clinical significance recovered from masks worn >6 hours versus those worn <6 hours. Conclusions: Among nursing-home healthcare workers, face masks were often contaminated with multiple organisms, including potentially pathogenic bacteria and antibiotic-resistant gram-negative organisms. This contamination may pose a risk for transmission if face masks are not properly used and/or disposed of after wearing. Prolonged duration of face-mask wearing, however, was not associated with increased contamination rates.Funding: NoneDisclosures: None

Pseudomonas aeruginosa countrywide outbreak in hospitals linked to pre-moistened non-sterile washcloths, Norway, October 2021 to April 2022.

In November 2021, a clonal outbreak of Pseudomonas aeruginosa of novel sequence type ST3875 was detected in three patients who died of bloodstream infections in one hospital. By 25 April 2022, the outbreak included 339 cases from 38 hospitals across Norway. Initial hospital reports indicate Pseudomonas infection as the main contributing cause in seven deaths. In March 2022, the outbreak strain was identified in non-sterile pre-moistened disposable washcloths, used to clean patients, from three lots from the same international manufacturer.

Changes made to UK action plan on AMR

On 16 May 2022, the UK Government announced changes to the commitments made in the UK 5-year national action plan to tackle antimicrobial resistance (AMR). The national action plan is in its third year of delivery and these changes were required to meet the commitments. In total, 93 commitments have been reworded, 17 new commitments have been added, and eight commitments have been removed. As well as reflecting lessons learned during the COVID-19 pandemic, the proposed changes aim to: (1) improve the surveillance of AMR and antimicrobial use;(2) improve the availability of data to better understand the prevalence of AMR across human health and animals;(3) reflect priorities identified by the UK AMR Research Programme to explore and evaluate antimicrobial use, prescribing, new therapeutics, diagnostics, stewardship and resistance across both human health and animals;(4) reflect the particular role the UK is playing internationally in non-traditional and informal political groupings, including supporting the UK Special Envoy on AMR and taking a lead role in AMR interest groups;and (5) introduce 4 new commitments to reduce urinary tract infections (UTIs), in support of the national action plan ambition to halve healthcare associated Gram-negative bloodstream infections (GNBSIs) by 2024.

Prevalence and Antimicrobial Susceptibility Pattern of Secondary Gram-negative Bacteria Isolated from Severe Acute Respiratory Syndrome Coronavirus Disease 2 Patients in A Tertiary Care Hospital

Prior to the Severe Acute Respiratory Syndrome Coronavirus Disease 2 (SARS-CoV-2) pandemic, the rise in antimicrobial resistance was a major source of concern in public health. However, due to the novelty of SARS-CoV-2 infection during the pandemic, antibiotics were administered prior to laboratory testing for secondary gram-negative bacteria (SGNB) in order to avoid or reduce the occurrence of SGNB infection. The purpose of this study was to investigate the etiology, prevalence, and antimicrobial susceptibility pattern of gram-negative bacteria (GNB) isolated from SARS-CoV-2 positive patients. Respiratory and blood samples were collected from confirmed SARS-CoV-2 positive patients. They were subsequently cultured and bacterial isolates identified according to standard microbiological protocols. Antimicrobial susceptibility testing (AST) was performed and interpreted according to Clinical & Laboratory Standards Institute (CLSI) 2021 guidelines. A total of sixty-four non-repetitive GNB were isolated from respiratory samples and twenty-two GNB from blood samples. K. pneumoniae was the major cause of SGNB, followed byAcinetobacter species. K. pneumoniae had over 60% resistance to beta-Lactam combination agents, cephalosporin, and the carbapenem group of antibiotics. In the current study, we observed that K. pneumoniae was the major cause of SGNB and had high resistance to the antimicrobial agents. Hence, it is important that the epidemiology and susceptibility patterns of circulating organisms causing SGNB infection are always monitored to inform clinical treatment and decrease the occurrence of antibiotic-resistant bacteria.

The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19.

BACKGROUND: The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). METHODS: This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. RESULTS: Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). CONCLUSIONS: Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.

CHARACTERISTICS OF RESPIRATORY TRACT BACTERIAL MICROFLORA DETECTED IN PATIENTS SUFFERING FROM COMMUNITY-ACQUIRED PNEUMONIA DURING CONTINUING SPREAD OF THE NEW CORONAVIRUS INFECTION IN KHABAROVSK CITY (DECEMBER 2020 — MARCH 2021).

Objective of the research — to specify respiratory tract bacterial microflora in patients suffering from community-acquired pneumonia (CAP) during initial and repeat examination. To determine local factors affecting microflora in the cohort examined. Materials and methods. Surveillance subject — 241 patients with CAP differed by their status and age who stayed in two healthcare facilities of the Khabarovsk city. Examination of respiratory smears was performed. Results. Indices of Gram-negative enterobacteria (30.8% [22.6–39.7%]) and Gram-negative nonfermentable bacteria (14.5% [8.6–21.7%]), isolated from patients hospitalized in healthcare institution No. 1 and mostly comprised of the elderly (aged over 61 years — 82.0%;74.3–88.6%) with more severe disease state including patients at the ICU, were higher compared to data obtained from healthcare institution No. 2 (19.8% (13.4–27.0);6.1% (2.7–10.8) respectively). Prevalent pathogen was Klebsiella pneumoniae — 13.6% (7.8–20.6) and 10.7% (6.0–16.5). Identification of Acinetobacter baumannii complex — 6.4% (2.6–11.7) and 3.1% (0.8–6.7) — should be also noted. A high percentage of drug-resistant bacterial variants was observed and for Klebsiella pneumoniae totaled 66.7% (41.8–87.4) and 57.1% (32.2–80.2) at the healthcare institutions No. 1 and No. 2, respectively. A. baumannii complex drug resistant variants were found in 85.7% (52.7–99.97) at healthcare institution No. 1. All isolates of A. baumannii complex at the healthcare institution No. 2 were drug resistant. High prevalence of Candida spp. was revealed in both healthcare institutions reaching 54.5% (45.2–63.7) and 58.0% (49.5–66.3), respectively, with minimal detection rate of classic pathogens such as S. pneumoniae — 5.4% (2.0–10.4) and 5.3% (2.1–9.8) and H. influenzae — 3.6% (0.9–7.9) and 3.8% (1.2–7.7), respectively. Repeat examination of 122 patients conducted 7–10 days later showed diverse changes in microflora spectrum regardless of the healthcare institution that was manifested as loss or emergence of drug-resistant variants as well as simultaneous presence of different variants of the same pathogen. Conclusion. The results obtained evidence about complexity and variety of mechanisms underlying microorganism community formation during the course of infectious process in patients. Local factors influencing microflora characteristics of patients at the two healthcare institutions were revealed. (English) [ FROM AUTHOR] Цель исследования — определить бактериальную микрофлору респираторного тракта больных внебольничной пневмонией (ВП) при их первичном и повторном обследовании, выявить локальные факторы, влияющие на показатели микрофлоры у наблюдаемого контингента. Объект наблюдения — 241 больной ВП из двух лечебных учреждений г. Хабаровска, различающихся по статусу и возрастному составу пациентов. Исследованы респираторные мазки. В ЛПУ № 1, в котором сосредоточены пациенты старше 61 года — 82,0% (74,3–88,6) с более тяжелым течением болезни, в том числе пациенты РАО, показатели выявления грамотрицательных энтеробактерий — 30,8% (22,6–39,7) и неферментирующих грамотрицательных бактерий — 14,5% (8,6–21,7) были выше по сравнению с ЛПУ № 2 — 19,8% (13,4–27,0) и 6,1% (2,7–10,8) соответственно группам возбудителей. Ведущий возбудитель в обоих ЛПУ — Klebsiella pneumoniae — 13,6% (7,8–20,6) и 10,7% (6,0–16,5). Следует отметить регистрацию Acinetobacter baumannii complex — 6,4% (2,6–11,7) и 3,1% (0,8–6,7). Характерна высокая доля участия лекарственноустойчивых вариантов — 66,7% (41,8–87,4) и 57,1% (32,2–80,2) для K. pneumoniae, в ЛПУ № 1 и ЛПУ № 2 соответственно, и для A. baumannii complex — в ЛПУ № 1 их вклад составил 85,7% (52,7–99,97), в ЛПУ № 2 все изоляты имели лекарственную устойчивость. В обоих ЛПУ у больных отмечены высокие показатели выявления грибов рода Candida — 54,5% (45,2–63,7) и 58,0% (49,5–66,3) соответственно, и минимальные уровни классических возбудителей: S. pneumoniae — 5,4% (2,0–10,4) и 5,3% (2,1–9,8) и H. influenzae — 3,6% (0,9–7,9) и 3,8% (1,2–7,7) соответственно. Через 7–10 дней при повторном обследовании 122 больных отмечено разнонаправленное из менение микрофлоры, независимое от статуса ЛПУ, и проявляющееся как по линии утраты лекарственноустойчивых вариантов, так и в приобретении их или одновременном присутствии разных вариантов одного возбудителя. Полученные результаты свидетельствуют о сложности и множественности механизмов формирования популяции микроорганизмов в динамике инфекционного процесса у больного. Выявлены локальные факторы, влияющие на показатели микрофлоры больных в двух лечебных учреждениях. (Russian) [ FROM AUTHOR] Copyright of Russian Journal of Infection & Immunity is the property of National Electronic-Information Consortium and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Comparison of the certified Copan eSwab system with commercially available cotton swabs for the detection of multidrug-resistant bacteria in rectal swabs.

BACKGROUND: Rectal swabs are well-implemented screening tools for multidrug-resistant bacteria (MDRB). Since certified swabs such as the Copan eSwab system experienced a delivery bottleneck during the COVID-19 pandemic, commercially available alternatives such as commonly used double-tipped cotton swabs had to be investigated, especially considering their similarity to professional cotton swabs for microbiological purposes. METHODS: Diagnostic properties of commercial cotton swabs (comparable to Q-tips) and Copan eSwabs were qualitatively compared in a prospective single-center study using microbiological standard cultures and PCR methods for the detection of multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci (VRE). RESULTS: A total of 196 swab pairs were collected from 164 participants. MDRB were detected in 36 of 164 cases (22%). There were neither false-negative nor false-positive results using commercial cotton swabs. In 8 of 196 samples (4.1%) MDRB species were detected only by using cotton swabs, including vancomycin-resistant Enterococcus faecium, OXA-48 producing Escherichia coli, ESBL-producing Klebsiella pneumoniae and ESBL-producing Escherichia coli. DISCUSSION: Commercial cotton swabs turned out to be a reliable alternative to Copan eSwabs. For practical use as a screening tool, relevant storage- and manufacturer-related contamination must be ruled out beforehand. CONCLUSIONS: Commonly available double-tipped cotton swabs can be used for rectal MDRB screening in the event of supply shortages of certified swabs. Further studies should clarify their suitability as a sampling system for nasopharyngeal MRSA carriage or even for the molecular biological detection of SARS-CoV-2.

Economic burden of healthcare-associated infection due to carbapenem-resistant gram-negative bacilli in a tertiary general hospital of Qinghai Province

OBJECTIVE: To explore the prevalence of carbapenem-resistant gram-negative bacilli(CRO) infection and the economic burden in a tertiary general hospital of Qinghai province. METHODS: The clinical data, length of hospital stay and costs of hospitalization were retrospectively collected from the patients with Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa hospital-acquired infection who were hospitalized in Qinghai Provincial Hospital from Jan 2017 to Dec 2017. The patients were divided into the drug-resistant group and the non drug-resistant group according to the result of drug susceptibility testing. The length of hospital stay and hospitalization cost were compared between the two groups of patients. RESULTS: A total of 521 patients were involved in the study, 120 of who had CRO infection(the drug-resistant group), and 40 had carbapenem-sensitive organisms infection(the non drug-resistant group). The median length of hospital stay of the drug-resistant group was 19 days, the median total hospitalization cost was 31 292 yuan;the median length of hospital stay of the non drug-resistant group was 15 days, the median total hospitalization cost was 22 610 yuan, and there were significant differences between the two groups(P<0.05). Stratified analysis showed that the median length of hospital stay of the patients with carbapenem-resistant K.pneumoniae infection was 17 days, the medial total hospitalization cost 25 227 yuan, the length of hospital stay of the non drug-resistant group was 14 day, the median total hospitalization cost 20 326 yuan;the median lengths of hospital stay of the patients with respiratory tract infection and the patients with bloodstream infection were respectively 19 days and 30 days in the drug-resistant group, the median total hospitalization costs were respectively 30 315 yuan and 30 050 yuan;the median lengths of hospital stay of the patients with respiratory tract infection and the patients with bloodstream infection were respectively 15 days and 13 days in the non drug-resistant group, the median total hospitalization costs were respectively 21 562 yuan and 24 853 yuan, and there were significant differences(P<0.05). CONCLUSION: The hospital-acquired CRO infection may lead to the increase of length of hospital stay and hospitalization cost of the hospitalized patients as well as the economic burden. It is necessary to take effective measures to reduce the incidence of hospital-acquired CRO infection.

Application of an Ultrasonic Nebulizer Closet in the Disinfection of Textiles and Footwear.

The emergence of the coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of disinfection processes in health safety. Textiles and footwear have been identified as vectors for spreading infections. Therefore, their disinfection can be crucial to controlling pathogens' dissemination. The present work aimed to evaluate the effectiveness of a commercial disinfectant aerosolized by an ultrasonic nebulizer closet as an effective method for disinfecting textiles and footwear. The disinfection was evaluated in three steps: suspension tests; nebulization in a 0.08 m3 closet; nebulization in the upscaled 0.58 m3 closet. The disinfection process of textiles and footwear was followed by the use of bacteriophages, bacterial spores, and bacterial cells. The disinfection in the 0.58 m3 closet was efficient for textiles (4 log reduction) when bacteriophage Lambda, Pseudomonas aeruginosa, and Bacillus subtilis were used. The footwear disinfection was achieved (4 log reduction) in the 0.08 m3 closet for Escherichia coli and Staphylococcus aureus. Disinfection in an ultrasonic nebulization closet has advantages such as being quick, not wetting, being efficient on porous surfaces, and is performed at room temperature. Ultrasonic nebulization disinfection in a closet proves to be useful in clothing and footwear stores to prevent pathogen transmission by the items' widespread handling.

Prior use of antibiotics and immunosuppression are risk factors for fracture-related infection during the COVID-19 pandemic period: a Brazilian prospective cohort study.

BACKGROUND: Little is known about the role of COVID-19 pandemic period on the epidemiology of fracture-related infection (FRI). The present study summarizes the changes in the prevalence, microbiology, and risk factors of FRI during this period. METHODS: A prospective single-center cohort study assessed in the setting of COVID-19 pandemic (2020-2021), clinical, microbiological aspects, and independent risk factors (RF) of FRI. RFs were estimated by bivariate and multivariable analyses using prevalence ratio (PR) with significance at P < 0.05. Kaplan-Meier analysis was performed to evaluate treatment outcomes. RESULTS: Overall, 132 patients were analyzed, with patients with age over 65 years accounting 65.1%. FRI was diagnosed in 21(15.9%) patients. Independent RFs for FRI were recent and preoperative use of systemic antibiotics (PR: 7.0, 95% confidence interval (95% CI): 2.2 - 22.4, p = 0.001) and cancer (PR: 9.8, 95% CI: 2.0 - 48.8, p = 0.005). Cultures yielded Gram-negative bacteria in 77.8%, 33.3% were MDR. CONCLUSIONS: We found higher rates of FRI, predominating in the elderly with closed femoral fractures during the COVID-19 pandemic. Prior use of antibiotics and immunosuppression conditions were independent factor for FRI. Our outcomes provide evidence to avoid the empirical use of antibiotics prior to surgery for fracture stabilization.

Synthesis, Spectroscopic Studies for Five New Mg (II), Fe (III), Cu (II), Zn (II) and Se (IV) Ceftriaxone Antibiotic Drug Complexes and Their Possible Hepatoprotective and Antioxidant Capacities

Magnesium, copper, zinc, iron and selenium complexes of ceftriaxone were prepared in a 1:1 ligand to metal ratio to investigate the ligational character of the antibiotic ceftriaxone drug (CFX). The complexes were found to have coordinated and hydrated water molecules, except for the Se (IV) complex, which had only hydrated water molecules. The modes of chelation were explained depending on IR, 1HNMR and UV–Vis spectroscopies. The electronic absorption spectra and the magnetic moment values indicated that Mg (II), Cu (II), Zn (II), Fe (III) and Se (VI) complexes form a six-coordinate shape with a distorted octahedral geometry. Ceftriaxone has four donation sites through nitrogen from NH2 amino, oxygen from triazine, β-lactam carbonyl and carboxylate with the molecular formulas [Mg(CFX)(H2O)2]·4H2O, [Cu(CFX)(H2O)2]·3H2O, [Fe(CFX)(H2O)(Cl)]·5H2O, [Zn(CFX)(H2O)2]·6H2O and [Se(CFX)(Cl)2]·4H2O and acts as a tetradentate ligand towards the five metal ions. The morphological surface and particle size of ceftriaxone metal complexes were determined using SEM, TEM and X-ray diffraction. The thermal behaviors of the complexes were studied by the TGA(DTG) technique. This study investigated the effect of CFX and CFX metal complexes on oxidative stress and severe tissue injury in the hepatic tissues of male rats. Fifty-six male rats were tested: the first group received normal saline (1 mg/kg), the second group received CFX orally at a dose of 180 mg/kg, and the other treated groups received other CFX metal complexes at the same dose as the CFX-treated group. For antibacterial activity, CFX/Zn complex was highly effective against Streptococcus pneumoniae, while CFX/Se was highly effective against Staphylococcus aureus and Escherichia coli. In conclusion, successive exposure to CFX elevated hepatic reactive oxygen species (ROS) levels and lipid peroxidation final marker (MDA) and decreased antioxidant enzyme levels. CFX metal complex administration prevented liver injury, mainly suppressing excessive ROS generation and enhancing antioxidant defense enzymes and in male rats.