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.

Surveillance Study on Bacterial Contamination Associated With Automated Teller Machines of Different Banks in Jazan Region

The environmental surfaces play an important role in the spread of pathogens and infectious diseases. Human are particularly susceptible to pick up microbes from environmental objects, especially from publicly and regularly used objects. The Automated teller machines (ATMs) are very likely to be the reservoir of different kinds of microorganisms, both pathogenic and non-pathogenic. In our study, we investigated the microbial contamination of multiple ATM machines in Jazan region. This is a descriptive cross-sectional study which was conducted between September to November, 2021. A sum of 42 sample were collected which yielded a total of 15 isolated bacterial species that was identified as follows: Bacillus spp. (73%), CoNS. (15%), Staphylococcus aureus (14%), Pseudomonas luteola (12.5%), Pantoea agglomerans (10%), Acinetobacter baumannii (7.5%), Escherichia coli (5%), Enterobacter cloacae (5%), and other 5 Gram negative species (total of 12.5%). Antibiotic susceptibility pattern of the isolates to commonly prescribed antibiotics showed that the highest resistant species are S. aureus (44%), CNS (48%) and E. coli (40%), while all the other bacteria showed varied degrees of resistance to the antibiotics tested. These results suggest that ATMs machines may play a role in transmission of drug resistant bacteria in Jazan, therefore, creating a public health risk. Intriguingly, our study comes after a large-scale and intense hygienic COVID-19 awareness programs. Hence, there is an urgent need to implement and improve hygienic practices and regulation when using such public machines.

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.

TIGECYCLINE INDUCED ACUTE PANCREATITIS: A RARE CASE PRESENTATION

CASE: An 81-year-old female with multiple co-morbidities including recent covid-19, presented to the emergency room with shortness of breath. On arrival, she was febrile with a temperature of 101F, pulse 100 beats/min, respiratory rate 14, blood pressure 196/163 and saturating at 75% on 10 L non-rebreather mask. Initial blood work showed WBC 10.9, lactic acid 1.7, BUN/creatinine 27/1.7 (consistent with her baseline), ABG showed pH 7.37, PCO2 49, PO2 88, HCO3 27.9. Chest x-ray demonstrated volume loss in the left hemithorax, airspace disease in the left mid lung and lung base. Due to suspicion for superimposed bacterial pneumonia and positive blood cultures for staphylococcus haemolyticus, she was started on vancomycin and azithromycin. Choice of antibiotics was challenging as she was allergic to penicillin and cephalosporins. During hospitalization, her kidney function deteriorated, vancomycin was substituted with tigecycline on day 3. Day 5 of treatment, she developed multiple episodes of vomiting with epigastric pain, lipase was 4523. Acute pancreatitis was diagnosed with tigecycline presumed to be the inciting agent in the absence of other risk factors such as gall stones, chronic alcohol use, elevated triglycerides, previous known episodes of pancreatitis or any other causative medications. Tigecycline was switched back to vancomycin and she received aggressive IV fluid hydration which also improved her kidney function. Within 48 hours, the patient had improved oxygen saturation, resolution of her abdominal pain, and good oral intake marking significant overall clinical progress. She was discharged on home oxygen and few more days of IV vancomycin for bacteremia. IMPACT/DISCUSSION: Tigecycline is a broad-spectrum glycylcycline antimicrobial agent belonging to the tetracycline class of antibiotics. Tetracyclines have been associated with acute pancreatitis in literature, and concerns about tigecycline-induced acute pancreatitis have been raised over the past decade in post marketing surveys, we described one such case above. Using the Naranjo Adverse Drug reaction probability scale, a score of 6 was achieved, indicating that the patient's pancreatitis was probably related to tigecycline. CONCLUSION: We recommend physicians monitor patients for signs and symptoms of pancreatitis including abdominal pain after initiating treatment with tigecycline. There should be a low threshold for ordering lipase levels and abdominal CT imaging where indicated. If the patient has symptoms concerning for acute pancreatitis, consider stopping tigecycline and switching to a different class of antibiotics immediately.

In silico identification and exploration of a new non-toxic antimicrobial peptide of medicinal leech microbiome

Antimicrobial agents are demanded to treat infectious diseases, one of the leading causes of death worldwide. Longstanding thoughtless use of antibiotics has led to the development and spread of drug-resistant microorganisms. This problem has become especially acute within the Covid-19 pandemic. Antimicrobial peptides (AMPs) are considered as effective therapeutic agents that are less prone to the development of bacterial resistance than antibiotics. In the present study, we identified antimicrobial non-toxic peptides from the leech metagenome protein database using a gradient boosting approach (CatBoost). The antimicrobial activity of the peptides was tested against Grampositive and Gram-negative bacteria (Bacillus subtilis, Staphylococcus aureus, Staphylococcus haemolyticus, Escherichia coli, Mycobacterium smegmatis). One of the analyzed peptides, peptide HMAMP-2, showed the best antimicrobial activity against the tested bacteria at low concentrations. Viability and hemolysis evaluation of cells incubated with peptides demonstrated peptide HMAMP-2 did not affect cell viability at high concentrations. It was experimentally shown that the peptide killed pathogens due to the membranolytic mechanism of action. According to nuclear magnetic resonance analysis, the peptide adopted an a-helical structure in a membrane environment. In addition, we demonstrated that peptide Hm-AMP2 binds to LPS, which supported the immunomodulatory properties of the peptide. Thus, peptide Hm-AMP2 is characterized as a promising non-hemolytic and non-toxic antimicrobial compound. Peptide Hm-AMP2 is likely involved in the regulation of the inflammatory response of the innate immune system, which should be studied further. The developed algorithm for the identification of antimicrobial peptides with a reduced toxic effect can be used for the rational design of effective non-toxic antibacterial agents.

EVALUATION OF THE TWO IN-PATIENT HOSPITALS ON POTENTIAL ENVIRONMENTAL HAZARD DURING THE PERIOD OF NEW CORONAVIRUS INFECTION IN THE KHABAROVSK CITY (DECEMBER 2020 — MARCH 2021)

Microbiological monitoring after infectious diseases in the system of epidemiological surveillance implies simultaneous pathogen identification both among patients and in hospital environment. Our aim is to assess potential hospital environmental hazard for the two in-patient infectious disease hospitals of the Khabarovsk city by using bacteriological and epidemiological analysis during new coronavirus disease pandemic. Materials and methods. Bacteriological assessment of nasopharyngeal microflora in 241 patients suffering from community-acquired pneumonia that were hospitalized in the two prevention and treatment facilities of the Khabarovsk city was performed. Sanitary-bacteriological control of hospital environment (428 hospital environment samples and 91 air samples) was carried out in parallel. Bacteriological assessment was performed with classical methods. Identification of isolated bacteriological pathogens and evaluation of drug-resistant strains were carried out by utilizing bacteriological analyzer Vitek 2 Compact. Results. Nine different pathogens (Pseudomonas aeruginosa, Pseudomonas stutzeri, Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus) were isolated in 20 out of 428 samples — 4.7% [2.7–6.7]. Half of isolated agents — 2.3% [0.9–3.8] — were represented by drug-resistant isolates (10 out of 20 isolates) including 5 carbapenem-resistant isolates (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae) and 5 isolates with multiple drug resistance (Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus). Air samples contained pathogenic biological agents found in 6 out of 91 samples — 6.6% [1.5–11.7], and half of them — 3.3% [0.6–7.9] — were identified as drug-resistant variants, including S. aureus и S. haemolyticus. One of the surveyed hospitals was recognized as more hazardous due to microflora isolated from intensive care unit (A. baumannii and P. aeruginosa were resistant to 3rd–4th generation cephalosporins and carbapenems). Conclusion. Revealed circulation of wide range of microorganisms isolated from environment of two in-patient hospitals indicates high risk of healthcare-associated infections formation. Intensive care units can serve as a reservoir of healthcare-associated infections due to high percentage of patients with severe disease cases (“main reservoir” of drug-resistant strains).