Role of noscomial infection informatics surveillance system in the prevention and control of multidrug-resistant organisms infections

OBJECTIVE: To analyze the role of nosocomial infection informatics surveillance system in the prevention and control of multidrug-resistant organisms(MDROs) infections. METHODS: The First Affiliated Hospital of Guangdong Pharmaceutical University was selected as the study subjects, which had adopted the nosocomial infection informatics surveillance system since Jan.2020. The period of Jan.to Dec.2020 were regarded as the study period, and Jan.to Dec.2019 were regarded as the control period. The situation of nosocomial infection and MDROs infections in the two periods were retrospectively analyzed. RESULTS: The incidence of nosocomial infections and underreporting of nosocomial infection cases in this hospital during the study period were 2.52%(1 325/52 624) and 1.74%(23/1 325), respectively, and the incidences of ventilator associated pneumonia(VAP), catheter related bloodstream infection(CRBSI), catheter related urinary tract infection(CAUTI)were 4.10(31/7 568), 2.11(14/6 634), and 2.50(25/9 993) respectively, which were lower than those during the control period(P< 0.05). The positive rate of pathogenic examination in the hospital during the study period was 77.95%(1 269/1 628), which was higher than that during the control period(P<0.05), the overall detection rate of MDROs was 15.77%(206/1 306), the detection rates of MDROs in Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa and Staphylococcus aureus were lower than those during the control period(P<0.05). CONCLUSION: The development and application of the informatics technology-based surveillance system of nosocomial infection could effectively reduce the incidence of nosocomial infections and device related infections, decrease the under-reporting of infection cases, and also reduce the detection rate of MDROs as well as the proportion of MDROs detected in common pathogenic species.

Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.

Synthesis of new 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole derivatives as potential cytotoxic and antimicrobial agents

Globally cancer is the second leading cause of death;a drug that can cure cancer with the utmost negligible side effects is still a distant goal. Due to increasing antibiotic resistance, microbial infection remains a grave global health security threat. The ongoing coronavirus pandemic increased the risk of microbial and fungal infection. A new series of 3-(4-methyl-2-arylthiazol-5-yl)-5-aryl-1,2,4-oxadiazole (7a-t) have been synthesized. The structure of synthesized compounds was confirmed by the spectrometric analysis. The newly synthesized compounds were screened for cytotoxic activity against breast cell lines MCF-7 and MDA-MB-231. Against the MCF-7 cell line compounds 7f, 7 g and 7n showed excellent activity with GI50 0.6 muM to <100 nM concentration. Compound 7b showed good activity against MDA-MB-231 cell line with GI50 47 muM. The active derivatives 7b, 7e, 7f, 7 g and 7n were further evaluated for cytotoxicity against the epithelial cell line derived from the human embryonic kidney (HEK 293) and were found nontoxic. The thiazolyl-1,2,4-oxadiazole derivatives were also screened to evaluate theirs in vitro antimicrobial potential against Escherichia coli (NCIM 2574), Proteus mirabilis (NCIM 2388), Bacillus subtilis (NCIM 2063), Staphylococcus albus (NCIM 2178), Candida albicans (NCIM 3100) and Aspergillus niger (ATCC 504). Amongst the 7a-t derivatives, six compounds 7a, 7d, 7f, 7n, 7o, 7r showed good antifungal activity against C. albicans and eight compounds 7c, 7d, 7 g, 7h, 7i, 7k, 7l and 7o showed good activity against A. niger. The potential cytotoxic and antifungal activity suggested that the thiazolyl-1,2,4-oxadiazole derivatives could assist in the development of lead compounds for the treatment of cancer and microbial infections.Copyright © 2022 The Authors

Peculiarities of Periodontal Pocket Microbiome in Patients with Generalized Periodontitis in the Post-Covid Period

The oral cavity, like the lungs, is often referred to as the <<ecological niche of commensal, symbiotic, and pathogenic or-ganisms,>> and the emigration and elimination of microbes between them are constant, ensuring a healthy distribution of saprophytic microorganisms that maintains organ, tissue, and immune homeostasis. The prolonged hospital stays due to COVID-19 complications, cross-infection, oxygenation therapy through the mask or incubation, and long-term intravenous infusions limit the patient's ability to care about the oral cavity, regularly clean teeth, floss interdental, etc., which creates extremely favorable conditions for colonization by aerobic and anaerobic pathogens of the oral cavity and periodontal pockets and leads to the rapid progression of chronic generalized periodontitis in this category of patients in the future. The goal of the study was to assess the state of the microbiome of the periodontal pockets of dental patients in the post-covid period. Methods. The object of the study was 140 patients with generalized periodontitis of the I and II stages of development in the chronic course (GP), among which 80 patients had coronavirus disease in the closest past. The patients were randomized by age, sex, and stage of GP development. The diagnosis of periodontal disease was established according to the classification by Danilevskyi. The bacteriological material for aerobic and facultative anaerobic microflora and yeast-like fungi was collected from periodontal pockets with a calibrated bacteriological loop and immediately seeded on blood agar. Results. Significant qualitative and quantitative changes in the nature of the oral microbiocenosis were observed in patients with GP after the recent coronavirus disease, compared with similar patients who did not suffer from COVID-19. We have noticed almost complete disappearance of bacteria that belong to the transient representatives of the oral microflora such as Neisseria, corynebacteria (diphtheria), micrococci, and lac-tobacilli. The main resident representatives of the oral microflora, i.e., alpha-hemolytic Streptococci of the mitis group, were found in all healthy individuals and patients of groups A and C, but in 30.0 +/- 4.58% of patients in group B, alpha-hemolytic streptococci in the contents of periodontal pockets are present in quantities not available for detection by the applied method (<2.7 lg CCU/mL). In terms of species, Streptococcus oralis and Streptococcus salivarius are more characteris-tic in gingival crevicular fluid in healthy individuals (93.8% of selected strains). In 68.4 +/- 3.32% of patients in group A, 64.0 +/- 3.43% of patients in group B, and 67.5 +/- 3.76% of patients in group C, the dominant species were Streptococcus gordonii and Streptococcus sanguinis (p<0.01), which increased pathogenic potential as they produce streptolysin-O, inhibit complement activation, bind to fibronectine, actively form biofilms on the surface of tooth enamel and gum epithelial surface, and can act as an initiator of adhesion of periodontal pathogens. The other representatives of the resident microflora of the oral cavity - Stomatococcus mucilaginosus and Veillonella parvula for the patients of group C are also found in periodontal pockets with a significantly lower index of persistence and minimal population level. In the post-covid period, both the population level and the frequency of colonization of periodontal pockets by Staphylo-cocci and beta-hemolytic Streptococci decreases rapidly. For these patient groups, unlike for those that did not suffer from COVID-19, we did not find any case of colonization with Staphylococcus aureus, as well as beta-hemolytic Streptococci and Epidermal staphylococcus were also absent. The most characteristic in the post-covid period is a decrease in the proportion of alpha-hemolytic Streptococci, an increase in the proportion of yeast-like fungi of Candida species, as well as the appearance of a significant number of gram-negative rod-shaped bacteria (Enterobacteria and Pseudomonads). In periodontal patien s, the microbial count is approximately 2 orders of magnitude lower than in those with GP who did not suffer from COVID-19 (p<0.05). Conclusions. The overpassed coronavirus disease due to intensive antibiotic therapy leads to a marked decrease in the number of viable saprophytic microorganisms in the periodontal pockets of patients with GP. In the post-covid period for the patients with GP, there is a decrease in the level of colonization of periodontal pockets by species of resident oral microflora - alpha-hemolytic Streptococci, reduction of resident micro-organism's species, and almost complete disappearance of transient microflora. On the other hand, the frequency of colonization of periodontal pockets by fungi species, enterobacteria, and pseudomonads significantly increases. There are more expressed disorders in the periodontal pocket's microbiome for the patients with a severe and complicated course of coronavirus disease, such as post-covid pulmonary fibrosis, which requires reconsideration of approaches to therapeutic and pharmacological treatment in this category of patients.Copyright © 2022, Zabolotny Institute of Microbiology and Virology, NAS of Ukraine. All rights reserved.

Complications and Outcomes of Peritoneal Dialysis in Indian Subcontinent: Two Decades of Experience from a Single Centre

Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) was first introduced in 1990. It is now being considered at per or even better than MHD in many centers in India. Regional Institute of Medical Sciences (RIMS),Imphal is a tertiary care hospital in Northeastern part of India which is surrounded by neighboring states and border states of Myanmar where communication, transport, renal health care system is least developed. Many patient used to die due to lack of availability of hemodialysis facility. Since September 2001, CAPD programme was started at RIMS hospital, Imphal to treat the patient of CKD in Manipur, other neighboring states and Myanmar. It has been already more than 21 years and 736 number of PD catheter insertion is done at RIMS till September 2022. Method(s): Tenckhoff catheters were implanted either trans-peritoneally by surgeon or percutaneously by the nephrologist under local anaesthesia. All the details data about the patients were collected and accumulated. Accumulation and collection of data is constantly done by designated analyzers in RIMS centers in order to be continually updated on the demographics of renal patients using PD. These data were constantly documented and analyzed to assess the outcome and complications of PD. A total of 736 CKD patients were implanted with CAPD catheter between September 2001 to September 2022 and their detail data were analysed. Result(s): Out of total 736 PD cases there were 276 episodes of peritonitis. 58.6% cases had single episode of peritonitis as in Table -1. Out of 276 episodes of peritonitis 27 cases were culture positive.The leading causative agent of peritonitis was Staphylococcus aureus (37% of culture positive cases). Staphylococcus epidermidis was responsible for 18.5% of culture positive episodes as shown in Table-2. The incidence of ESI was 0.03 per person-years.The most common infective organism was S. aureus which was responsible for 12 (52%) of cases Table-3. Out of total 736 PD cases 72 patients were shifted to HD over the twenty one -year period, refractory peritonitis was the most common cause of technique failure ( 41.6 %) (Table- 4). A total of 125(16.9%) patients among 736 had PD catheter tip migration of which 46% were surgically removed and re-inserted. Omentectomy was require in 14.4 % of patient due to omental wrap around PD catheter (Table 5). There were 443 admissions to the hospital by these PD patients during the study period, of which 173(39%)were due to peritonitis. Non-peritoneal infections were the second most common cause responsible for 98(22.1%) hospital admissions. The non-peritoneal infections included covid 19 pneumonia in 5 patients (Table 6). Out of 736 patients, 145 patients(14.7%) were continuing on PD and12 patients (1.6%)underwent renal transplantation(Table-8). Conclusion(s): Our study suggests that there has been considerable improvement in overall outcome and mortality in patients on PD over the 20 years period. Peritonitis is the most common complication associated with PD. Having a well-trained staff will decrease the complications. This modality of renal replacement therapy in terms of long-term survival and quality of life and should be encouraged at the national level. No conflict of interestCopyright © 2023

Effect of Long-Term Use of Alcohol-Containing Handwashing Gels on the Biofilm-Forming Capacity of Staphylococcus epidermidis.

The spread of coronavirus disease 2019 (COVID-19) has promoted the use of hand sanitizers among the general population as recommended by health authorities. Alcohols, which are used in many hand sanitizers, have been shown to promotes the formation of biofilms by certain bacteria and to increase bacterial resistance to disinfection. We investigated the effect of continued use of alcohol-based gel hand sanitizer on biofilm formation by the Staphylococcus epidermidis resident strain isolated from the hands of health science students. Hand microbes were counted before and after handwashing, and the ability to produce biofilms was investigated. We found that 179 (84.8%) strains of S. epidermidis isolated from hands had the ability to form biofilm (biofilm-positive strains) in an alcohol-free culture medium. Furthermore, the presence of alcohol in the culture medium induced biofilm formation in 13 (40.6%) of the biofilm-negative strains and increased biofilm production in 111 (76.6%) strains, which were classified as low-grade biofilm-producing. Based on our findings, there is no clear evidence that the continued use of alcohol-based gels results in the selection of strains with the capacity to form biofilms. However, other disinfectant formulations that are more commonly used in clinical settings, such as alcohol-based hand-rub solutions, should be tested for their long-term effects.

Dentist's Knowledge and Behavior on the Use of Smart Phones in Clinical Environment and their association with Cross Infections

Background: The use of smart phones inside hospitals especially in clinically sensitive areas is a subject of debate because it may improve the quality of healthcare but can also be a vehicle of hospital acquired infections. Aim: To determine dentist's knowledge and behavior related to the use of smart phones in clinical environment and to determine the presence of microbial growth on these devices. Methods: This is a cross-sectional study in which validated survey tool was used to collect data about knowledge and behavior of 397 dental graduates from 8 dental colleges of Pakistan, regarding their usage of smart phones in clinical environment. Bacterial isolates were collected from the smart phones of 45 participants from Fatima Memorial Dental Hospital, Lahore. Results: The SPTC Scale was used to divide the participants into 3 categories;low, moderate and high users. The behavior related to smart phone usage in clinical environment was significantly different among the participants. Moderate users had significantly higher average behavior score of 3.7 (p-value = 0.034). The growth of pathogenic bacterial flora was greater on high users of smart phones (95%,) whereas those participants who were low users the percentage was 37%. Conclusion: Hospital-acquired infections (HAIs) are increasing significantly in number of patients and these can be prevented by adhering to proper hand hygiene practices and if hand hygiene is improved the amount of bacterial load will be less and disinfection of smart phone devices will not be required.

BLOODSTREAM INFECTIONS IN PATIENTS WITH COVID-19 TREATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of the study is to determine the incidence of bloodstream infections in COVID19 patients treated with ECMO in relation to steroid days and days of ECMO cannulation. METHODS: Retrospective analysis of data for COVID19 patients treated with ECMO in a tertiary academic medical center from January 2020 until July 2021 was performed. Data including baseline patients’ characteristics, type, and duration of ECMO support, type and days of steroids used, blood culture results, and organism type were collected. An institutional review board (IRB) approval was obtained before data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A Total of 34 patients were analyzed, 3 of them were on (Veno-Arterial) VA ECMO and 31 on (Veno-Venous) VV ECMO, 32 out of 34 (94%) patients received steroids (Dexamethasone alone 16 patients, Methylprednisolone 1 patient and 15 patients received multiple steroid types). Seventeen patients had positive blood cultures (50%), average steroid days for patients with positive blood cultures was 21.6 days compared to 11.8 days for patients with negative blood cultures (P-Value:0.01), Average ECMO days for patients with positive blood cultures was 40.5 days compared to 18.8 days for patients with negative blood cultures ( P-Value:0.01). Staphylococcus epidermidis was found in 47% of the cultures, Enterococcus Faecalis was found in 24% of cultures while MRSA, MSSA, and Candida Albicans were found in 6% of cultures. CONCLUSIONS: Bloodstream Infections during ECMO cannulation are common and carry significant morbidity and mortality in patients. Longer ECMO days and longer duration of steroid use were found to be associated with higher rates of bloodstream infections in our patient’s sample. This could be related to the instrumentation risk or immunosuppression from steroids or other factors not evaluated in this study. CLINICAL IMPLICATIONS: Bloodstream infections are common in patients treated with ECMO, the risk of infections increases with longer ECMO and steroid days. Knowledge of such risks and trying to minimize them such as cautious use of steroids might help in the prevention of infections. Further studies are needed to better assess this risk. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah

Effect of Dexamethasone protocol on peak C-reactive protein, incidence of positive blood cultures and ICU mortality in invasively ventilated SARS-CoV-2 patients

Introduction: Severe COVID-19 viral pneumonitis, requiring invasive mechanical ventilation, has a mortality rate approaching 45%.1 The RECOVERY trial demonstrated that Dexamethasone protocol (6 mg a day for up to 10 days, commenced early) decreased 28 days' mortality for this cohort from 41.4% to 29.3% (OR 0.64;95% CI 0.51-0.81).2 More generally, a study confirmed corticosteroids' beneficial effect in COVID-19 patients which was more prominent in females, younger patients (<65) and with higher C-reactive protein (CRP) levels (in excess of 150 mg/ L). Importantly, it did not increase incidence of bacteremia or fungemia.3 In another study, responders to corticosteroids (more than 50% of CRP levels reduction in 72 hours) had reduced risk of death ( 25.2% vs. 47.8% in nonresponders;OR 0.37, P<0.001).4 In our district general hospital, the Dexamethasone protocol was introduced and used consistently at the beginning of COVID-19 second wave. Therefore, an impact of this intervention could be detected by comparing the outcomes between SaRS-CoV-2' patients admitted during Wave-1 versus Wave-2. Concomitant antibiotics (Co-amoxiclav and Clarithromycin) were introduced at the same time, but this practice varied. Objectives: To detect impact of Dexamethasone protocol on COVID-19 invasively ventilated ICU patients' outcomes by using retrospective analysis. Methods: The information on ICU mortality, peak CRP levels (irrespectively of peak-time, but most manifested within 10 days from admission) and incidence of positive blood cultures (if resulted from both sampling tubes) was collected from trust databases after the last patient's ICU discharge. Wave-1 was defined as SARS-CoV-2 PCR confirmed patients admitted to the hospital from 1/3/2020 until 31/5/ 2020. Wave-2 period was from 1/10/2020 until 28/2/2021. Mann Whitney U test was used for CRP numbers. Results: Number of ICU patients requiring mechanical ventilation: 34 (W-1) versus 39 (W-2). There was no statistical difference in age and gender. ICU mortality was: 41% (W-1) versus 44% (W-2). Incidence of bacteremia was: 24% (W-1) versus 46% (W-2). The bulk of the difference was due to coagulase negative coccal flora and Staphylococcus epidermidis;increase from 1 to 11 cases. Medians (quartiles 1 -3) of peak CRP levels were: 336 (264 -415) (W-1) versus 264 (172 -379) (W-2), P-0.042. The difference was even more pronounced when looking at peak CRPs of W-2 survivors: median 234 (150 -270). It was statistically significant for this group in comparisons between W-2 non-survivors and W-1 survivors, P -0.021 and 0.017 correspondingly. Conclusion: Our data (bearing in mind loss of some due to inter-hospital transfers and overall limited numbers) did not demonstrate any significant difference in ICU mortality of mechanically ventilated patients which could be attributed to the protocol. Statistically significant differences in average peak CRP levels between the COVID-19 waves (especially for Wave-2 ICU survivors) may be explained by the Dexamethasone protocol impact. This agrees with previous data.4 There was a significant increase in incidence of positive blood cultures due to bacterial flora usually considered contaminants.

Bacterial pattern in adult decompensated liver cirrhosis ascitic fluid infection during first 5 months of second wave Covid-19 pandemic at tertiary hospitals in Jakarta Indonesia

Objectives: To find out bacterial pattern of ascitic bacterial infection in adult decompensated liver cirrhosis during Covid-19 pandemic at three tertiary referral hopsitals in Jakarta. Materials and Methods: 18 years old or more decompensated liver cirrhosis patient due to any cause with grade 2 or more ascites admitted consecutively to emergency room, inpatient and outpatient unit in Jakarta's three tertiary referral hospitals: Cipto Mangunkusumo National General Hospital, Gatot Soebroto Central Army Hospital, Fatmawati General Hospital would be performed paracentesis ascitic tap during January to May 2021. Bedsite aerobic and anaerobic bacterial blood culture bottles of 10 mL inoculation ( aerobic BACT/ALERT® FA Plus and anaerobic BACT/ALERT® FN Plus bioMerieux Incorporation) were acquired under aseptic and antiseptic standards before antibiotic administration or at least 4 h after it. Diphtheroids species, Bacillus species and Staphylococcus epidermidis were considered contaminant. Results: There were 98 ascitic culture specimens from 98 grade 2 and more ascites decompensated liver cirrhosis patients. Basic characterisitic data included: 32.6% female, 67.4% male, history of hospitalization and antibiotic admission in the last previous 3 months 76.5%, due to viral hepatitis B 38.5%. Bacterial growth was found in 11 specimens ( 11.1%) including 6 aerobic gram negative ( 54.5%): Aeromonas hydrophila, Enterobater aerogenes, Klebsiella pneumonia ( 2 specimens), Acinetobacter species, Pseudomonas aeruginosa and 5 aerobic gram positive ( 45.4%): Enterococcus faecalis, Staphylococcus cohnii ssp cohnii, Staphylococcus cohnii ssp urealyticus, Staphylococcus haemolyticus, Micrococcus luteus. There were no positive culture for Escherichia coli and anaerobic bacteria. Conclusion: During second wave of Covid-19 pandemic in Jakarta, there were almost equal proportion of gram positive and negative bacterial in adult decompensated liver cirrhosis ascitic fluid bacterial infection patients in tertiary hospitals. This result reminds clinicians of bacterial pattern shift in ascitic fluid infection in decompensated liver cirrhosis during pandemic.

Etiology and Antimicrobial Resistance of Secondary Bacterial Infections in Patients Hospitalized with COVID-19: A Retrospective Analysis

Background. One of the complications in patients hospitalized with COVID-19 is a secondary bacterial infection. Its frequency can reach 15%, which makes it important to determine the etiology and antimicrobial resistance of the key pathogens responsible for the development of this pathology, in order to further improve the practice of prescribing and increase the effectiveness of antimicrobial chemotherapy. Aims — to assess the etiological structure and antibiotic resistance of the main pathogens of SBIs to improve the practice of antibiotic prescription. Methods. This retrospective study reviewed medical records of the patients hospitalized with COVID-19 in the Moscow city hospital No. 4 between April 28 and November 1, 2020. Demographic, clinical outcomes, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. Results. Among 3180 patients hospitalized with COVID-19, 220 (6.9%) patients had acquired SBIs, and 50.0% of cases were fatal. The mean age was 72.7 ± 13.07 years. A higher mortality rate was observed in the group of critical patients (63%). 560 strains of bacteria isolated from the SBIs (58.8% isolated from lungs, 21% from urine and 20.2% from blood). 330 strains (58.9%) were Gram-negative bacteria. 109 patients had infections with mixed bacteria. 45 of them (20.5% of the total number of patients included in the study) had 2 pathogens, and 64 patients (29.1%) 3 or more strains. The top three bacteria of SBIs were A. baumannii (23.6%;132/560), K. pneumoniae (22.9%;128/560), and S. epidermidis (10.4%;58/560). The isolation rates of carbapenem-resistant A. baumannii were 97%. Cefoperazone/sulbactam was the most active antibiotic against this pathogen with 62.1% sensitivity. Among K. pneumoniae strains, the level of resistance to carbapenems was 77.4% to meropenem and 54% to imipenem. The proportion of resistant strains to tigecycline and to colistin was 4 and 2.3% respectively. Meticillin resistance was present in 38.5% of S. aureus. 50% of E. faecium strains were vancomycinresistant. Conclusions. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main pathogens, and the resistance rates of the major isolated bacteria were generally high, which indicates that more accurate use of antibacterial agents is necessary for SBIs in patients hospitalized with COVID-19.

CRIOPRESERVAÇÃO DE CÉLULAS PROGENITORAS HEMATOPOÉTICAS COLETADAS POR PUNÇÃO ASPIRATIVA DA MEDULA ÓSSEA: UMA SÉRIE DE CASOS

Introdução: Devido à pandemia do novo Coronavírus, a criopreservação tem sido recomendada para garantir a continuidade do transplante de medula óssea (TMO) alogênico não aparentado independentemente da fonte de células. Porém, a criopreservação de células progenitoras hematopoéticas coletadas por punção aspirativa da medula óssea (CPH,MO) é menos utilizada e poucos dados estão disponíveis na literatura. Objetivo: descrever a experiência do Centro de Processamento Celular do Cetebio/Fundação Hemominas com a criopreservação de CPH,MO para utilização terapêutica em TMO. Métodos: Trata-se de um estudo do tipo série de casos e a casuística foi composta por oito unidades de CPH,MO criopreservadas entre 10/2020 e 06/2021. As unidades de CPH,MO foram submetidas à deseritrocitação utilizando hidroxietilamido (HES) 450/0,7 e, em seguida, à centrifugação para desplasmatização. O volume da camada leucocitária foi ajustado para atingir a concentração de células nucleadas final ≤2 × 108 NC/mL após a adição da solução de criopreservação (5%HES/5%DMSO). As unidades foram congeladas em freezer mecânico a -80°C e armazenadas em tanque a vapor de nitrogênio. Resultados: oito unidades de CPH,MO foram criopreservadas para utilização em nove pacientes;uma unidade foi dividida para uso em dois pacientes pediátricos irmãos HLA idênticos. Uma (11,1%) unidade foi criopreservada para o uso autólogo e oito (88,9%) para uso alogênico não aparentado. Cinco (55,6%) pacientes eram do sexo masculino. A média de idade dos pacientes foi 14,7 ± 19,1 anos (1–42). Um (11,1%) paciente possuía neuroblastoma, um (11,1%) LMC, um (11,1%) LMA, um (11,1%) síndrome de Griscelli, dois (22,2%) síndrome de Wiskott-Aldrich e três (33,3%) LLA. O volume (mL) médio das unidades pré e pós-processamento foi 756,9 ± 411,7 e 78,7 ± 45,8, respectivamente. O volume (mL) médio de hemácias pré e pós-processamento foi 239,1 ± 150,8 e 27,02 ± 16,9, respectivamente. A média do total de células nucleadas (x108) pré e pós-processamento foi 153,07 ± 80,0 e 120,01 ± 67,7, respectivamente. A média de células CD34+ viáveis (x106) pré e pós-processamento foi 131,7 ± 74,0 e 120,2 ± 77,8, respectivamente. Quatro (50%) unidades apresentaram teste microbiológico positivo (Staphylococcus hominis, Staphylococcus epidermidis, Corynebacterium sp e Staphylococcus aureus). A viabilidade celular (%) média pós-descongelamento em amostras de segmento foi 66,1 ± 8,5. Os ensaios clonogênicos realizados em amostras pré-processamento (n = 6), pós-processamento (n = 8) e pós-descongelamento (n = 7) apresentaram crescimento positivo. Seis (66,6%) unidades foram liberadas para uso terapêutico, das quais cinco (83,3%) possuímos os dados da enxertia. Nenhum paciente apresentou falha de enxertia ou óbito após a infusão. O tempo médio de enxertia de granulócitos e plaquetas foi 17 ± 5,8 e 19,5 ± 9,2 dias, respectivamente. Discussão: A redução do volume possibilitou a criopreservação do material, sendo que a recuperação celular foi satisfatória. Os testes de controle de qualidade realizados em todas etapas do processo evidenciaram a qualidade e segurança do procedimento e foram corroborados pelos dados de enxertia. Alertamos, entretanto, sobre a necessidade de cuidados adicionais com os pacientes devido ao volume de hemácias a ser infundido e à contaminação bacteriana, mais frequentemente observada nas unidades de CPH,MO. Conclusões: A criopreservação CPH, MO apresentou resultados satisfatórios, demonstrando que a metodologia utilizada é segura e eficiente.

Investigating the Anti-Viral and Anti-Bacterial activities of Jordanian Medicinal plants: A narrative review

The diversity in Jordan’s flora due to its geographical areas make is well noted in the scientific literature. The challenge of disease and death caused by infectious diseases like viruses and bacteria, and as infectious diseases evolve and pathogens develop resistance to existing pharmaceuticals, the search for new novel leads, possibly with different modes of action, against bacterial and viral diseases has intensified in recent years. The intent of this review is to provide prevalent information on the antibacterial and antiviral potential in medicinal plants in Jordan, mode of action, type of viruses and bacteria, and phytochemical contents. It has been demonstrated by several studies presented in this review that medicinal plants in Jordan are rich in phytochemicals and possess antiviral and antibacterial properties.

Impact of Antibiotic Prophylaxis Prior to Treatment with Steroids and Tocilizumab in COVID-19 Patients

Background. The incidence of bacterial or fungal coinfections in COVID-19 patients is low. The incidence of nosocomial superinfections is higher, especially related to ICU admission. Treating COVID-19 with steroids plus tocilizumab (TCZ) has been associated with superinfections. Therefore, the use of antibiotic prophylaxis prior to infusion of TCZ could be considered to reduce the risk of life-threatening superinfections in critically ill patients. Methods. Retrospective, single center cohort study. COVID-19 patients older than 14 years, admitted to Hospital Central de la Defensa (Madrid, Spain) from Mar 5th to Nov 24th, 2020 with a diagnosis of COVID-19 were included. Local protocols suggested antimicrobial prophylaxis before the infusion of TCZ. Medical records, treatments received, and microbiological data of all patients who received TCZ were reviewed. Microbiological isolates were considered in the 14 days following the administration of TCZ. Two ID specialists independently reviewed the medical record and decided to qualify the isolate as superinfection or colonization. Results. 2,069 patient records were analyzed. 70 patients received TCZ;all of them were admitted to ID wards and under steroid treatment. 45 (64,5%) patients received antibiotic prophylaxis. The preferred antibiotics were ceftriaxone (N = 18) and ceftobiprole (N = 14). No significant differences were found in age, Charlson index or COVID-19 SEIMC-Score. 24 isolates were detected in 14 patients (18 bacterial, 6 fungal). 17 isolates were considered superinfections;the most frequent isolates were C. albicans (N=5), E. faecalis (N=3) and S. epidermidis (N=2). There were no statistically significant differences between the different prophylaxis strategies in terms of in-hospital mortality or ICU admission. However, patients who received ceftobiprole tended to have fewer isolates and fewer superinfections than those receiving ceftriaxone (ceftobiprole group: 2 isolates in 1 patient, 1 (7,1%) patient with superinfection;ceftriaxone 11 isolates in 5 patients, 4 (22,2%) patients with superinfection) (p= 0,35, Fisher exact test). Conclusion. Antibiotic prophylaxis prior to infusion of TCZ in patients with COVID-19 and receiving steroids could determine the profile of bacterial and fungal superinfections.

Staphylococcus epidermidis Controls Opportunistic Pathogens in the Nose, Could It Help to Regulate SARS-CoV-2 (COVID-19) Infection?

Staphylococcus epidermidis is more abundant in the anterior nares than internal parts of the nose, but its relative abundance changes along with age; it is more abundant in adolescents than in children and adults. Various studies have shown that S. epidermidis is the guardian of the nasal cavity because it prevents the colonization and infection of respiratory pathogens (bacteria and viruses) through the secretion of antimicrobial molecules and inhibitors of biofilm formation, occupying the space of the membrane mucosa and through the stimulation of the host's innate and adaptive immunity. There is a strong relationship between the low number of S. epidermidis in the nasal cavity and the increased risk of serious respiratory infections. The direct application of S. epidermidis into the nasal cavity could be an effective therapeutic strategy to prevent respiratory infections and to restore nasal cavity homeostasis. This review shows the mechanisms that S. epidermidis uses to eliminate respiratory pathogens from the nasal cavity, also S. epidermidis is proposed to be used as a probiotic to prevent the development of COVID-19 because S. epidermidis induces the production of interferon type I and III and decreases the expression of the entry receptors of SARS-CoV-2 (ACE2 and TMPRSS2) in the nasal epithelial cells.

Non-Woven Infection Prevention Fabrics Coated with Biobased Cranberry Extracts Inactivate Enveloped Viruses Such as SARS-CoV-2 and Multidrug-Resistant Bacteria.

The Coronavirus Disease (COVID-19) pandemic is demanding the rapid action of the authorities and scientific community in order to find new antimicrobial solutions that could inactivate the pathogen SARS-CoV-2 that causes this disease. Gram-positive bacteria contribute to severe pneumonia associated with COVID-19, and their resistance to antibiotics is exponentially increasing. In this regard, non-woven fabrics are currently used for the fabrication of infection prevention clothing such as face masks, caps, scrubs, shirts, trousers, disposable gowns, overalls, hoods, aprons and shoe covers as protective tools against viral and bacterial infections. However, these non-woven fabrics are made of materials that do not exhibit intrinsic antimicrobial activity. Thus, we have here developed non-woven fabrics with antimicrobial coatings of cranberry extracts capable of inactivating enveloped viruses such as SARS-CoV-2 and the bacteriophage phi 6 (about 99% of viral inactivation in 1 min of viral contact), and two multidrug-resistant bacteria: the methicillin-resistant Staphylococcus aureus and the methicillin-resistant Staphylococcus epidermidis. The morphology, thermal and mechanical properties of the produced filters were characterized by optical and electron microscopy, differential scanning calorimetry, thermogravimetry and dynamic mechanical thermal analysis. The non-toxicity of these advanced technologies was ensured using a Caenorhabditis elegans in vivo model. These results open up a new prevention path using natural and biodegradable compounds for the fabrication of infection prevention clothing in the current COVID-19 pandemic and microbial resistant era.

Anesthetic Management of a Child With Propionic Acidemia Complicated by Bacteremia and Severe Acute Respiratory Syndrome Coronavirus 2.

Propionic acidemia (PA) is a rare, multi-systemic inborn error of metabolism. PA results from an impaired activity of the mitochondrial enzyme, propionyl-CoA carboxylase (PCC). PCC holds an essential role in the catabolic pathways for odd-chain fatty acids, cholesterol side-chains and branched-chain amino acids. Errors in these pathways result in the accumulation of toxic metabolites that may advance into end-organ damage and dysfunction. Clinical manifestations of PA include relapsing courses of severe metabolic acidosis, concurrent viral or bacterial infection, episodic vomiting, gastroesophageal reflux disease (GERD), seizures, developmental delay, hypotonia, hyperammonemia, osteopenia, pancreatitis and cardiomyopathy. This case describes a 3-year-old boy with PA who presented with an acute metabolic crisis, precipitated by Staphylococcus epidermidis (S. epidermidis) bacteremia and severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) co-infection. He required anesthetic management for surgical removal of an infected central venous port. Anesthetic care for this patient presented the unique challenges of metabolic decompensation amidst infection with SARS-CoV-2. Options for anesthetic care for patients with PA have been elucidated in the literature. However, to our knowledge, this is the first case to describe anesthetic management in a PA patient with SARS-CoV-2.