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Background: Pathogen surveillance is crucial but has become more challenging in the era of highly effective modulator therapy (HEMT), with many people with cystic fibrosis (PwCF) noting a considerable reduction or even absence of sputum on elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA). This challenge has been exacerbated by reduced face-toface contact with patients because of variable COVID-19 government restrictions on travel and social interaction (lockdowns) since March 20, relying on PwCF returning high-quality samples by mail. For those with pre-established bronchiectasis, it is likely that chronic infections and risk of new acquisition of infections remain on ELX/TEZ/IVA, although registry data suggest less prevalence of respiratory microorganisms on IVA [1]. We aimed to examine the impact of ELX/TEZ/IVA on frequency of respiratory pathogen surveillance and microorganism growth in our large, adult CF center. Method(s): A retrospective analysis of pathology results from respiratory samples received from March 19 to December 21, 2020, was completed for all patients commenced on ELX/TEZ/IVA at our CF center. Result(s): Respiratory samples from 216 PwCF who had commenced ELX/ TEZ/IVAwere analyzed. Median start date of ELX/TEZ/IVAwas October 10,2020. Before ELX/TEZ/IVA, the average number of respiratory samples per month was 108. This declined by 55% to an average of 48 per month when the first 50 PwCF commenced on ELX/TEZ/IVA and to 20 per month (82% reduction from pre-ELX/TEZ/IVA) when 100 PwCF had commenced ELX/ TEZ/IVA. The number of positive samples per month decreased from January 20, 2020, correlating with the introduction of ELX/TEZ/IVA and the reduction of respiratory samples received (Figure 1). The proportion of cough swabs and sputum samples remained similar from March 19 to December 21, 2020. (Six-month average showed that 19% of samples were cough swabs and 80% sputum for March to June 2019 and July to December 2021). We found no significant changes in proportion of samples positive for non-Pseudomonas spp. gram-negative organisms, Burkholderia spp., or gram-positive organisms (predominantly S. aureus) isolated over the period. There was a reduction by more than 50% of fungi and Candida spp. and a slight trend toward an increase in Pseudomonas spp. (mainly P. aeruginosa). Forty percent of PwCF who had one respiratory sample after ELX/TEZ/IVA initiation and 20% of those who had two or more samples showed a change in organism growth after ELX/TEZ/IVA initiation. In nearly 50% of these cases, the organism changed from gram negative to gram positive (P. aeruginosa to S. aureus in 69% of cases).(Figure Presented) Figure 1. Number of positive respiratory samples per month and number of people with cystic fibrosis on elexacaftor/tezacaftor/ivacaftor March 19 to December 21, 2020 Conclusion(s): The introduction of ELX/TEZ/IVA and its impact on sputum production has reduced surveillance of our patients' respiratory microbiology. This has been exacerbated by reduced face-to-face contact with patients due to the COVID-19 pandemic. The trends showa reduction in the isolation of fungi and yeasts and a slight increase in isolating Pseudomonas spp. In those who we have seen a change in organism growth, many have gone from gram-negative to gram-positive organisms. These data highlight the challenges of monitoring for new positive cultures and changes in microbiology cultures in the era of HEMT.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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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
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Curcumae Longae Rhizoma (CLR) is the rhizome of Curcuma longa L. Pharmacological studies show that CLR can be used to treat cervical cancer, lung cancer, lupus nephritis, and other conditions. In this paper, we review botany, traditional application, phytochemistry, pharmacological activity, and pharmacokinetics of CLR. The literature from 1981 to date was entirely collected from online databases, such as Web of Science, Google Scholar, China Academic Journals full-text database (CNKI), Wiley, Springer, PubMed, and ScienceDirect. The data were also obtained from ancient books, theses and dissertations, and Flora Reipublicae Popularis Sinicae. There are a total of 275 compounds that have been isolated from CLR, including phenolic compounds, volatile oils, and others. The therapeutic effect of turmeric has been expanded from breaking blood and activating qi in the traditional sense to antitumor, anti-inflammatory, antioxidation, neuroprotection, antibacterial, hypolipidemic effects, and other benefits. However, the active ingredients and mechanisms of action related to relieving disease remain ill defined, which requires more in-depth research and verification at a clinical level.
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SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: We present a case of Eggerthella bacteremia in a patient with COVID-19. CASE PRESENTATION: A 69-year-old woman presented to the emergency room with chief complaint of cough, dyspnea, and malaise. After testing positive with a home COVID-19 test three days earlier, she continued to have worsening respiratory status and was brought in via ambulance. She was found to be tachycardic and hypoxic, requiring high-flow oxygen to maintain saturation in the emergency department. Chest X-ray showed bilateral patchy opacities consistent with multifocal COVID-19 pneumonia, and she was admitted to the intensive care unit for acute hypoxic respiratory failure. COVID-19 drug therapy was initiated, including baricitinib, remdesivir and decadron. Shortly after hospitalization, she began to endorse worsening abdominal pain. Physical exam elicited tenderness to palpation of her right lower quadrant. Abdominal CT scan showed distal ileum fluid collection concerning for possible bowel perforation. She underwent exploratory laparotomy which confirmed perforation, and a small bowel resection with anastomosis was performed. Blood cultures were positive for gram-positive bacilli, which were further identified as Eggerthella species. She required mechanical ventilation for worsening respiratory function post-surgery but remained unresponsive on the ventilator. The patient was administered vancomycin but continued to decline and eventually expired. DISCUSSION: Eggerthella is an anaerobic, gram-positive bacilli present in the gut microflora. Eggerthella infection has most often been reported in intra-abdominal infections. However, cases of bacteremia infection remain sparse. Most infections have been associated with other gastrointestinal processes including Crohn's disease, ulcerative colitis, appendicitis, and diverticulitis abscesses. Our case involved a patient with no significant gastrointestinal history admitted for COVID-19 pneumonia infection on baricitinib complicated by bowel perforation and bacteremia. Bowel perforation is a known risk factor of baricitinib use, and these risks should be discussed with the patient before beginning therapy. Overall mortality for Eggerthella species infection remains high, with some estimates as high as 31%. Much remains unknown about the impact on gut microbiome by SARS-CoV-2, however, early research suggests a higher rate of fungal co-infection in patients with COVID-19. As the literature on COVID-19 expands, more and more unusual pathogens such as Eggerthella may be found to contribute to the morbidity and mortality of patients being treated for COVID-19. CONCLUSIONS: Unusual pathogens such as Eggerthella may complicate a patient's hospital course while undergoing treatment for COVID-19. Reference #1: Alejandra Ugarte-Torres, Mark R Gillrie, Thomas P Griener, Deirdre L Church, Eggerthella lenta Bloodstream Infections Are Associated With Increased Mortality Following Empiric Piperacillin-Tazobactam (TZP) Monotherapy: A Population-based Cohort Study, Clinical Infectious Diseases, Volume 67, Issue 2, 15 July 2018. Reference #2: Gardiner BJ, Tai AY, Kotsanas D, et al. Clinical and microbiological characteristics of Eggerthella lenta bacteremia. J Clin Microbiol. 2015. Reference #3: Lau SK, Woo PC, Fung AM, Chan K-M, Woo GK, Yuen K-Y. Anaerobic, non-sporulating, gram-positive bacilli bacteraemia characterized by 16s rrna gene sequencing. Journal of medical microbiology. 2004. DISCLOSURES: No relevant relationships by Kristin Davis No relevant relationships by Charles Peng
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Purpose : Exogenous endophthalmitis (EE) is the most serious complication of penetrating eye surgeries and open globe trauma (OGT). It is crucial to know the associated factors that will determine the final visual prognosis. The aim of the present study was to describe the epidemiological, clinical profile and visual outcomes (VO) predictors in patients with EE in a referral ophthalmology center. Methods : Retrospective, observational clinical study. Patients diagnosed with EE between January 2018 to September 2021 were included. Data collected included demographic characteristics, endophthalmitis origin, culture samples, microbiological diagnosis, initial and final best corrected visual acuity (BCVA), and treatment received. Major outcome was change in BCVA after endophthalmitis treatment and associated factors. T-test and Fisher's exact test for statistical analysis were used. Results : Seventy-three patients with EE were included. Surgery associated (SA) was the most common cause responsible for 39 cases (53.4%), followed by keratitis associated 18 cases (24.6%) and trauma associated (TA) 16 cases (21.9%). Gram-positive bacteria predominated in positive cultures (n= 35 [54.3%]). There was a statistically significant difference at mean age between TA group 41.1 ±18.7 years and SA group 59.9 ±20.9 years (p= 0.002). Final logMAR BCVA in the TA group was 4 ±0.9 (Snellen, light perception [LP]) and in the SA group was 2.7 ±1.7 (Snellen, Hand Motion [HM]). Fourteen (35.8%) patients in the SA group had a final BCVA ≥ 20/400;whereas in the TA group all patients had a final BCVA ≤ CF. Risk factors for non-improving BCVA after EE included OGT (p= 0.007) and initial BCVA of LP or worse (p <0.0001) in the SA group. There was no statistical difference in the final VO in patients that were treated with intravitreal injection (II) and those treated with vitrectomy (VTM) (p =0.40). Although 6 patients (75%) treated with VTM had an improvement in final BCVA compared with 12 (57.1%) of the patients just treated with II, this could be due to the sample number. We observed a tendency of diminishing cases of TA endophthalmitis after covid era, this could be associated with the isolation measures recommended. Conclusions : Surgery associated EE had a better visual prognosis than those with trauma associated EE. The initial BCVA is a meaningful indicator for final VO, being favorable when is better than HM.
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Background: Intensive care unit (ICU) admission during hematopoietic stem cell transplant (HSCT) is associated with poor prognosis1,2. Published series report a range of ICU admission rates from 24-40% of transplant patients, most frequent reasons involving septic shock, respiratory failure and veno-occlusive disease3. In addition, patients undergoing HSCT are at a high risk of severe morbidity and mortality associated with COVID-194. Aims: The aim of this study was to analyze outcome of HSCT patients requiring ICU admission in our center. Methods: We retrospectively analysed outcome of 752 patients who underwent HSCT in our centre from January/2008 to June/2021. Data were collected from patients' clinical histories. Results: 103 (14%) patients required ICU admission (baseline and HSCT characteristics on table). Median time to ICU admission was 42 days (-2-1765). Seven of these patients were admitted to ICU on two occasions giving a total of 110 consecutive ICU admissions available for analysis. Main reason for ICU admission was respiratory distress (74;67%), mainly due to pneumonia (53%) including a 3% caused by COVID19, pulmonary edema (26%) and pulmonary haemorrhage (8%). Septic shock was second most common cause for ICU admission (26;24%) due to gram-negative bacilli (47%), fungal (15%) gram-positive bacteria (13%), virus (10%) and others/idiopathic (16%). Other less frequent causes were veno-occlusive disease (11;10%), hepatic failure/encephalopathy (8;7%), haemorrhagic complications (6;5%), cardiorespiratory arrest (2%), GVHD (2%), cardiogenic shock (2%). Of the 110 ICU admissions, 37 (34%) required hemofiltration, of which 30 (81%) died;and 77 (70%) required orotracheal intubation, of which 59 (77%) died. During the 110 ICU admissions, 67 patients (61%) died in the ICU;of these, 40 (37%) received unrelated donor HSCT, 36 (33%) sibling donor, 16 (15%) haploidentical and 17 (16%) autologous. Median ICU length of stay of these patients was 13 days (range 1-76). The cause of death was the same reason for ICU admission. Eighteen (16%) patients were discharged from ICU and died prior to Hospital discharge and 24 (22%) survived to Hospital discharge and were classified as post-discharge survivors. Of these 24 cases, 19 (79%) remain alive while the others (5;21%) succumbed to underlying disease or complications post-HSCT. Off note, both patients with COVID19 pneumonia (haploidentical and autologous HSCT respectively) were discharged from ICU and remain alive to date, without major complications. Summary/Conclusion: In our study 14% of transplant recipients required ICU admission, slightly lower than previous reports. Most common cause of admission was respiratory failure, consistent with reported. Mortality rate during ICU admission was 61%;higher death rate observed in allogeneic transplantation and those requiring aggressive ICU treatments such as mechanical ventilation or hemofiltration. Although patients with COVID19 pneumoniae who require ICU admission are usually associated with adverse outcome, in our series they responded successfully to intensive treatment. ICU admission following HSCT is associated with poor prognosis, but should not be considered futile. (Table Presented).
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Objective: The study aimed to assess the antibiotic resistance pattern before and after the pandemic to provide the physicians with general guidance for antibiotic prescribing. Material and Methods: The yearly antibiograms of different tertiary care hospitals were extracted from Pakistan Antimicrobial Resistance (AMR) Network. The data timeline observed was from January 2016 to December 2020. The data were scrutinized to the most common organism studied with the most recurring antimicrobial used. Results: Among the Gram-positive organisms, increased resistivity against penicillin was observed against both the organism, while a good susceptibility was observed against vancomycin. Among the Gram-negative organisms, the highest resistance was observed in Ceftriaxone, Ciprofloxacin, and Cotrimoxazole. Staphylococcus aureus and Escherichia coli are the most prevalent organisms in tertiary care hospitals. Conclusion: While satisfactory susceptibility was observed in Amikacin and Piperacillin/Tazobactam. The post-pandemic era resulted in a decrease in AMR due to significant changes in antibiotic prescribing patterns. This report may guide future antibiotic prescribing.
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Introduction: The novel coronavirus (2019-nCoV) is a contagious virus that causes respiratory infection and has shown evidence of human-to-human transmission. In this infection the immunity of the patient is decreased;making them susceptible to various secondary infections. This leads to increased morbidity and mortality in these patients. Aim: To estimate the profile of secondary infections in hospitalised Coronavirus Disease-2019 (COVID-19) patients and analyse their antimicrobial susceptibility pattern. Materials and Methods: A cross-sectional study was conducted for a period of five months from June to October 2021, which included COVID-19 positive patients with secondary infection admitted in the dedicated COVID hospital, Maharaja Krishna Chandra Gajapati Medical College and Hospital (MKCG MCH), Berhampur, Odisha, India. Clinical samples like blood, urine, sputum, tissue biopsy and Bronchoalveolar Lavage (BAL) were collected aseptically from patients with COVID-19 and were processed in microbiology laboratory as per standard operating procedures. All the necessary information like demographic features (age, gender), associated co-morbidities and oxygen saturation levels of COVID-19 positive patients at the time of admission were collected and entered in a Microsoft Excel sheet for further analysis. Results of continuous variables were described by mean and range while categorical variables were described by frequency. All the generated data was analysed by Statistical Package for the Social Sciences (SPSS) 16.0. Results: A total of 438 patients suspected of COVID-19 were admitted during the study period, out of which 138 patients were positive for COVID-19 by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Out of 138 COVID-19 positive patients, 105 patients were willing to give samples and their samples were processed for bacterial and fungal culture and sensitivity. Total 18/105 (17.1%) samples were positive for bacterial and fungal growth. Blood Stream Infection (BSI) were seen in 14/18 (77.8%) and was predominantly associated with Staphylococcus aureus 5/14 (35.7%), followed by Enterococcus spp. 3/14 (21.4%). Out of total culture positive cases, 2/18 (11.1%) showed Urinary Tract Infection (UTI). Of the UTI cases Escherichia coli was isolated from 1/2 (50%) of cases. Out of total culture positive cases, 2/18 (11.1%) were identified having mucormycosis. All gram positive bacteria had shown maximum resistant to ampicillin and gram negative bacteria were resistant to ampicillin-sulbactam, levofloxacin, cotrimoxazole. Conclusion: In COVID-19 positive patients with secondary infection, early diagnosis and prompt treatment will lead to improved patient care and better outcome.
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Coronavirus disease 2019 (COVID-19) is an emerging serious global health problem. It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. This study was carried out on 100 samples of sputum from COVID-19 patients. During the laboratory diagnosis, 156 bacterial isolates were obtained from the positive samples . The Gram-positive bacteria isolates included Strptococcus pneumonia 64(40%) Streptococcus pyogenes, 7 (4%), Streptococcus mitis 1 (1%) Streptococcus mutus 1(1%), Streptococcus parasanguinis 1(1%) Staphylococcus eidermidis 10(6%), staphylococcus aureus 4 (2%), Micrococcus lutus,1 (1%). Whereas, Gram-negtive bacteria included Pseudomonas aeruginosa 9 (6%), E coli 10 (6%), Serratia marcescens, 3 (2%), Klebsiella pneumonia 31 (19%), H.influenzae 10 (6%) Acinetobacter baumannii, 4 (2%) .The isolates varied in their response against the antibiotics;and Gram positive bacteria were significantly (p<0.05) more sensitive to the antibiotic then Gram negative. To detect the Streptococcus pneumonia isolates, the house keeping Eno genes was screened. Results showed that all the isolates, had Eno gene (100%). Furthermore, This study was carried out in order to detect tet-L and ermB gene in 10 S.pneumonia isolates . genes were Results showed that all the isolates, numbering 10, had both tetL and ermB genes(100%).
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Purpose of Study Streptococcus intermedius is a Gram-positive bacterium that is part of normal oropharyngeal flora but can cause serious infections such as brain and liver abscesses. An increase of brain abscess cases related to sinusitis were recognized during the coronavirus disease 2019(COVID-19) pandemic. We present three cases of brain abscess related to sinusitis in pediatric patients. S. intermedius was isolated in all cases. Methods Used A retrospective chart review was performed in patients with brain abscess whose cultures grew S. intermedius during the COVID-19 pandemic. Summary of Results Case 1: A 6-year-old male with 4-day history of headaches, diagnosed with viral infection by his pediatrician. He was also seen at an Urgent Care facility for fevers and managed supportively. He then developed a seizure- like episode which prompted an emergency room (ED) visit. Head computerized tomography (CT) revealed bifrontal epidural abscess and pansinusitis. He underwent bifrontal craniotomy with evacuation of epidural abscess and maxillary antrostomy. He was treated with a prolonged course of IV antibiotics with good response to treatment and resolution of seizures. Case 2: A 9-year-old female with left eye pain and swelling for six days associated with headaches and emesis. She was diagnosed with a hordeolum at an ED. Worsening of symptoms prompted a second ED visit where a CT revealed preseptal cellulitis and abscess. Further imaging showed left orbital abscess with epidural abscess. She underwent bicoronal craniotomy with evacuation of abscess and maxillary antrostomy. Treatment also included a prolonged course of IV antibiotics. She was discharged at neurologic baseline. Case 3: A 14-year-old male with fever, left eye and forehead swelling for two weeks. At the initial ED visit, he was diagnosed with a 'boil' and prescribed antibiotics and steroids. He had interval improvement of swelling but continued with daily fevers and developed vomiting prompting another ED visit. He was admitted to the pediatric intensive care unit (PICU) due to hypertension and vision changes. Upon arrival to the PICU, he required immediate cardiopulmonary resuscitation due to pulseless ventricular tachycardia. Further workup demonstrated extensive subdural empyema and partial venous sinus thrombosis. Left decompressive hemicraniectomy and maxillary antrostomy was done emergently. He received a prolonged course of IV antibiotics. He developed right sided weakness, required nutritional and ventilatory support despite appropriate treatment. Conclusions S. intermedius can cause life threatening intracranial infections which may have increased during the COVID- 19 pandemic for reasons unknown. The diagnosis is often delayed as patients present with nonspecific symptoms. Prompt neurosurgical intervention and administration of prolonged antibiotics improve outcomes.
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Introduction: Critical care nosocomial infection (CCNI) increases risk of patient mortality and morbidity [1,2]. The impact of the Coronavirus 19 (2019-nCoV) pandemic on CCNI in terms of increased strain and infection control measures, is uncertain. Departmental strain has the potential to confound impact of infection control measures aimed to reduce CCNI incidence. This study will describe the impact of 2019-nCoV on non-COVID CCNI incidence and mortality. Methods: A retrospective cohort study of adult patients admitted to critical care in one Central London teaching hospital. CCNI incidence, (diagnosed ≥ 48 h post critical care admission), was compared between pre (Jan 2019-Feb 2020) and peak COVID (Mar 2020-Jun 2020). Results: Of 2,266 patients, 1788 were admitted pre and 478 peak COVID. Mean age was 57.2 years and 56.1 years pre and peak COVID respectively, with 35.5% and 37.4% of patients, female. There was a significant increase in rate of total CCNI incidence (1.6% to 3.6%) in the pre and peak period respectively. There was a significant increase in rate of incidence of gram negative bacterium and C. diff, but not in gram positive bacterium, MRSA, VRE and fungus. The increase in rate of peak (23.5%) compared to pre COVID (13.5%) CCNI non-COVID mortality, was not significant (Table 1). Conclusions: Increased infection control measures did not protect against non-COVID CCNI and mortality across all infection types. Increased strain is likely to confound additional infection control measures and resulted in excess patient non-COVID CCNI and mortality, secondary to the pandemic. Greater emphasis is needed to protect other patients from expected CCNIs. (Table Presented).
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Case Report We present a case of early-onset sepsis with enterococcus faecalis in a neonate born to a covid-positive mother. 36 week spontaneous vaginal delivery to a mother with late entry prenatal care. She presented with prolonged rupture of membranes of approximately 24 hours. She tested positive for COVID-19 upon admission, but was asymptomatic. At delivery, baby was noted to have foul-smelling and meconiumstained amniotic fluid increasing the risk for infection. CBC and blood culture were sent. Empiric ampicillin and gentamicin were started. The baby was placed in isolation due to COVID exposure but was found negative after 24 and 48 hours of life. At 18 hours of life the blood culture was noted to be positive for Gram positive cocci in chains, preliminarily thought to be Streptococci. Ampicillin therapy was increased to every 8 hours to cover for meningitis, and a repeat blood culture was sent. Lumbar puncture performed to rule out meningitis, revealed 30 WBCs and identification of gram-positive organisms on microscopy. The organism was identified as Enterococcus faecalis and was ampicillin sensitive. Patient completed a 10-day course of gentamicin and a 21-day course of ampicillin. The repeat blood culture showed no growth at 120 hours, a repeat lumbar puncture confirmed the infection cleared. The patient remained clinically stable and eventually discharged home. Early onset sepsis (EOS) with enterococcus faecalis in a neonate is extremely rare. The occurrence of EOS with meningitis due to this organism in the setting of being born to a COVID positive mother has not yet been described.