Study of cases of Pseudomonas aeruginosa bacteria in patients with severe COVID-19

Pseudomonas aeruginosa can cause severe nosocomial infections and sepsis, especially in immunocompromised comorbid patients. The purpose of the study was to assess the frequency, clinical course, and the possibility of antimicrobial therapy for bloodstream infections caused by P. aeruginosa in patients with COVID-19. Material and methods. A retrospective single-center uncontrolled study was performed from October 1, 2020 to September 31, 2021 on the basis of a temporary infectious diseases hospital for patients with COVID-19 at the City Clinical Hospital No. 52, Moscow. During the analyzed period, 16 047 patients were admitted to the infectious diseases hospital. The study included 46 patients over 18 years of age with a diagnosis of COVID-19 confirmed by PCR RNA SARS-CoV-2 nasopharyngeal swab (U 07.1) and/or computed tomography (CT) of the lungs (U 07.2). Statistical data processing was carried out using the BioStat, 2009 program (AnalystSoft, USA). Results and discussion. P. aeruginosa has been isolated from the blood of 0.29% of patients with COVID-19. In the structure of bacteremia, P. aeruginosa accounted for 6.1%. In 87% of cases, pathogens were isolated from the blood of patients in the ICU. Most strains are classified as XDR phenotypes - 74% and MDR - 21.7%. The sensitivity of hospital strains of P. aeruginosa was: to colistin - 97%, to amikacin - 39.1%, meropenem - 32.6%. All patients had concomitant diseases: cardiovascular (60%), oncological (27.5%), diabetes mellitus (20%), obesity (22.5%) and others. In 47.5% of cases (19/40), the cause of bloodstream infections was ventilator-associated pneumonia. The mortality rate among patients with COVID-19 with P. aeruginosa bacteremia is 80%. Conclusion. The wide distribution of multidrug-resistant strains of P. aeruginosa limits the number of therapeutic options. In severe bloodstream infections caused by P. aeruginosa XDR, combined antibiotic therapy regimens with the inclusion of polymyxin B are advisable.Copyright © 2022 Tomsk Polytechnic University, Publishing House. All rights reserved.

Impact of elexacaftor/tezacaftor/ivacaftor on Pseudomonas aeruginosa acquisition and chronic infection at a single pediatric cystic fibrosis center

Background: As cystic fibrosis (CF) lung disease progresses, the airways become colonized with opportunistic pathogens such as Pseudomonas aeruginosa secondary to airway surface liquid depletion. Acquisition of P. aeruginosa is associated with decline in lung function and increase in treatment burden and mortality. In October 2019, the Food and Drug Administration approved elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), a highly effective modulator therapy (HEMT) for individuals aged 12 and older with one copy of the F508del CFTR mutation. ELX/TEZ/IVA increases the amount of and function of CF transmembrane conductance regulator (CFTR) in the respiratory epithelium, increasing mucociliary clearance (MCC) and reducing static airway mucous, a major trigger for chronic infection and inflammation. Method(s): A retrospective analysis of inhaled tobramycin (iTOB) prescriptions prescribed between January 1, 2016, and December 31, 2021, was performed. This captured data before and after ELX/TEZ/IVA approval at Children's Mercy Kansas City (CMKC). The number of individuals with new P. aeruginosa acquisition was determined by identifying electronic prescriptions for iTOB eradication courses. An eradication course was defined as a first lifetime prescription for iTOB or a new prescription for iTOB submitted at least 1 year after a previous prescription. The number of individuals considered chronically infected with P. aeruginosa was determined by identifying individuals receiving chronic iTOB prescriptions and confirmed by respiratory cultures indicating chronic infection based on the Leeds criteria (P. aeruginosa recovered in >=50% of airway cultures in the previous 12 months). Result(s): Eradication courseswere prescribed to 34 individuals in 2016 (15% of people receiving care at CMKC). The number of eradication prescriptions declined in 2020 and 2021, with only 15 (7%) individuals prescribed eradication therapy in 2020 and 12 (5%) in 2021. A similar pattern was observed for prescriptions for chronic infection. In 2016, 57 individuals (25% of our patient population) were receiving iTOB for chronic P. aeruginosa infection. Reductions were seen in 2020 and 2021, with 28 (13%) and 20 (9%) individuals prescribed chronic therapy, respectively. The number of individuals prescribed iTOB for P. aeruginosa eradication and chronic infection per year is represented in Figure 1.(Figure Presented)Conclusions: CMKC experienced a decrease in the number of courses of iTOB prescribed over the last 6 years. HEMT use is associated with greater MCC and anti-inflammatory effects affecting the airway microbiome. The decrease in respiratory cultures growing P. aeruginosa likely reflects these phenomena. A confounding factor is the SARS-CoV-2 pandemic and widespread use of HEMT. Clinic closures and implementation of telemedicine limited in-person patient visits during 2020 and 2021. Despite limited in-person visits, the average number of respiratory cultures per individual at CMKC in 2020 was 3.5, which is consistent with previous years.Wewere able to obtain frequent surveillance cultures through implementation of a drive-through respiratory specimen collection process. Hence, the decrease in number of iTOB courses cannot be attributed to a decrease in frequency of respiratory cultures, although we cannot assess the impact of school closures and a decrease in social gatherings on new P. aeruginosa acquisition or chronic infection. Looking at all these variables, the widespread use of HEMT likely played a significant role in reducing new P. aeruginosa acquisition and chronic P. aeruginosa infection.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Current status of alginate lyase from bacteria associated with marine brown algae as a combat agent against biofilm-related infection

Infection diseases are still the leading cause of death in lower and middle-income countries in the last decades. This as we know today is worsen by COVID-19, placing infectious disease as the global leading cause of death today.Onthe other hand, the morbidity and mortality of infection diseases on children around theworld is still alarming. In children, infectious disease is also the leading cause of death where lower respiratory infections are the more common, followed byDiarrhea and HIV/AIDS. The lower respiratory infections are often caused by biofilm forming bacteria such as Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Bacteria in biofilms are inherently more tolerant to antimicrobial treatment when compared directly to planktonic cells of the same strain. Many studies have shown that bacteria growing in biofilms are often thousands of times more tolerant to antimicrobial treatment than their planktonic counterparts. Therefore, degradation of biofilm produced by pathogenic bacteria is very important for lower respiratory infection treatment. It urges development of alginate lyase enzyme from bacteria associated with brown algae as antibiofilm agent. In the world, costs to eradicate bacterial biofilm are continuously increased while the market for products required in biofilm treatment is steadily growing. The large share of this segment in various areas of the world attributed to microbial products to remove, prevent, and manage biofilm. Current strategies in Combating bacterial biofilm infection includes quorum sensing inhibition, drug delivery system, photothermal therapy, photodynamic therapy, catalytic therapy, nano-agent, theranostics, and matrix destruction. A natural antibiofilm agent is alginate lyase (an enzyme), which can destroy the main part of biofilm. Marine brown algae are a source of bacteria producing natural depolymerization agent of antibiofilm. This is due to the high alginate content of brown algae compared to red or green algae. Alginate is the substrate of alginate lyase produced by marine bacteria. Administration of alginate lyase can disrupt or destroy biofilm, when traced using electron micrograph before and after treatment. Most studies on application of alginate lyase as antibiofilm agent in the world is focused on cystic fibrosis case of infection caused by Pseudomonas aeruginosa. Unspecified brown algae, followed by Sargassum sp. and Laminaria sp. have been mostly studied as source of bacterial alginate lyase without regards to their alginate contents. Hopefully the use of alginate lyase from bacteria associated with broader range of marine brown algae as antibiofilm agent could be expanded. The application should be enhanced to broader cases of biofilm-related infections in theworld, not only limited to cystic fibrosis cases.

Venovenous extracorporeal membrane oxygenation for treating very severe pneumonia in Aotearoa New Zealand: a 16-year experience

AIM: We sought to describe the aetiology, demographics and outcomes of patients with pneumonia undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) in Aotearoa New Zealand. METHODS: Retrospective observational study. RESULTS: Between January 2004 and August 2020, 133 patients underwent VV-ECMO for pneumonia. This VV-ECMO cohort is representative of the geographic and ethnic distribution of the population of Aotearoa New Zealand. Six-month survival was 85/133 (64%). A primary viral aetiology was identified in 63/133 cases (47%) with bacterial co-infection present in 34/63 viral pneumonias (54%). Primary bacterial pneumonia was identified in 48/133 cases (36%). Twenty-three (17%) of 133 patients developed necrotising pneumonia. The most commonly identified microorganisms were influenza A, Staphylococcus aureus and Streptococcus pneumoniae. Infection with Staphylococcus aureus or Streptococcus species was strongly associated with necrotising pneumonia (OR 10.18, 95% CI 3.52–37.13, P<0.0001). Necrotising pneumonia was more common in Māori and Pacific Peoples than in other ethnic groups (OR 3.08, 95% CI 1.16–7.96, P=0.02). DISCUSSION: Outcomes from VV-ECMO for pneumonia in Aotearoa New Zealand are comparable to large international series. Although the use of VV-ECMO was matched to the ethnic distribution of the population of Aotearoa New Zealand, Māori may have reduced access because they have higher rates of pneumonia than non-Māori.

Chronic Indolent Community-acquired Pneumonia due to Pseudomonas Infection in an Immunocompetent Patient- A Case Report

Pseudomonas is an uncommon cause of community-acquired pneumonia in immunocompetent patients. It is an opportunistic pathogen resulting in serious infection in patients who are hospitalised, mechanically ventilated, or immunocompromised. A 47-year-old male, forest worker without any co-morbidities presented with a history of chronic cough, fever, and shortness of breath complicated with pseudohemoptysis for 45 days. This patient was admitted and treated as a lower respiratory tract infection. Work-up for tuberculosis, invasive fungal balls, was negative but sputum culture revealed Pseudomonas aeruginosa growth. This case report demonstrates a rare Pseudomonas infection which can also cause chronic indolent respiratory illness in immunocompetent.

POS-692 THE CASE SERIES OF PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS AND NEUTROPHIL-TO-LYMPHOCYTE RATIO DURING PANDEMIC ERA

Introduction: Peritonitis is a major complication of Peritoneal Dialysis (PD), inadequate response to treatment, and the inflammatory state inherent in PD patients may result in hospitalization time and mortality. This Study aims to observe prognosis patients who Peritoneal Dialysis-Associated Peritonitis (PDAP) by Neutrophil-to-Lymphocyte Ratio (NLR). Methods: We have performed observation the incidences of peritonitis, causative organisms, clinical outcomes and mortality between patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) during pandemic era from January 2020-September 2021 in Central General Hospital Dr. Sardjito. Outcomes and clinical course of treatment in the selected patients were reviewed. Results: The Latest case, Male, 22 years old,the Peritoneal Equilibration Test (PET) results are Low. Since the end of August 2021 felt pain in the abdomen accompanied by cloudy dialysis fluid and sometimes there is fibrin. From routine blood examination, the results NLR is 2. The patient received Ceftriaxone and Gentamicin with the results of dialysate fluid culture obtained Klebsiella Pneumonia. The symptoms of peritonitis improved but on the 14th day the symptoms started to reappear, the antibiotics were continued and a re-culture was performed on the 15th day, Burkholderia Cepacia bacteria were sensitive to Meropenem, Trimethoprim/Sulfamethoxazole, and Ceftazidime. Next case, male, 71 years old, since 2014 using CAPD with the last evaluation of PET was High Average. Complaints were felt in early October 2020 with same symptoms. The NLR is 21 and the results of culture Staphylococcus Capitis. Patients receiving therapy with Vancomycin and evaluation of culture results negative. But in December 2020 the signs and symptoms appeared again with NLR 25. Because of the weakness condition, the patient was hospitalized with the culture results Pseudomonas Aeruginosa, sensitive to Ciprofloxacin, because of improvement, the patient was allowed outpatient. The results of the culture evaluation showed the bacteria were the same as sensitive to the same antibiotic group as well, but was replaced with Ceftazidim and Fluconazole. After 14 days of administration antibiotics, the complaints improved and the culture results were negative. In March 2021 the patient came back with the same complaints again related to recurrent peritonitis, with culture results showing Pseudomonas Aeruginosa infection and only sensitive to Ciprofloxacin and Gentamicin. The patient received both antibiotic therapy in an outpatient condition but in the course of his illness the patient died because COVID-19 in other hospital. For last case, the patient was 51 years old with PET Low Average results and NLR 6. The patient presented with persistent symptoms peritonitis 3 times continously after the evaluation but the culture results were always negative. In the treatment of the first infection, the patient had received therapy Ceftazidime and Gentamicin, but because the symptoms did not improve, the patient's antibiotics were then replaced with Ciprofloxacin, and the third evaluation was given Vancomycin even though the bacteria did not grow. Due to the condition of recurrent peritonitis infection in this patient, access to CAPD was then withdrawn and back to HD. Conclusions: According to our findings, the incidence of symptomatic PDAP maybe related with NLR, it can be a prognostic factor but still unclear. No conflict of interest