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Objectives: Bacterial coinfection occurred in 3.5% of COVID-19 patients, and secondary bacterial infection occurred in 14.3% of patients. In Indonesia, one of the guidelines for COVID-19 therapy is to administer azithromycin 500 mg per 24 hours for mild and moderate cases and azithromycin 500 mg per 24 hours and levofloxacin 750 g per 24 hours for severe cases with suspected secondary bacterial infection. At the beginning of the pandemic, many antibiotics were used, even without proven or suspected bacterial infection. We sought to determine changes in the resistance of "ESKAPE” bacteria (ie, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) to the antibiotics levofloxacin and azithromycin prior to and during the COVID-19 pandemic. Methods: The study was conducted retrospectively by examining the culture and sensitivity test results of "ESKAPE” bacteria to levofloxacin and azithromycin antibiotics in 2019 (before the pandemic) and April 2020–April 2021 (during the pandemic) in 4 hospitals in Yogyakarta. The number of samples represents all cultures completed within the specified period to detect antibiotic sensitivity patterns. Results: In a top referral hospital, resistance to levofloxacin and azithromycin increased significantly for E. faecium and P. aeruginosa, but at a private hospital, an increase in resistance to azithromycin and levofloxacin occurred for A. baumannii and for Enterobacter spp and resistance to levofloxacin increased significantly. At an academic hospital, there was a considerable decrease in S. aureus and E. faecium resistance to levofloxacin and azithromycin. At the government hospital, S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter baumannii, and Enterobacter spp developed resistance to levofloxacin. Conclusions: Resistance to azithromycin and levofloxacin by different ESKAPE bacteria increased on average during the COVID-19 pandemic.
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Brain aging and COVID-19 Many biological pathways that change with natural aging in the brain also changed in patients with severe COVID-19, say researchers who used RNA sequencing to assess changes in gene expression profiles in the brain of COVID-19 patients compared with uninfected individuals. The scientists observed that gene expression in the brain tissue of patients who died of COVID-19 closely resembled that of uninfected individuals aged 71 years or older. In genetially modified mice, the emergency mode of haematopoiesis ran without any detectable infection or increased interferon levels and these genetically modified animals were better able to fight off infection with the bacterium Listeria monocytogenes than normal mice.
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Background: Face masks have been worn universally and for long periods of time by healthcare personnel during the COVID-19 pandemic. They are frequently touched or adjusted with the hands and may come in contact with various surfaces and high-touch sites when taken off and on even briefly. These activities present opportunities for face masks to become contaminated with microorganisms. Nursing homes have high rates of multidrug-resistant bacteria and low PPE compliance;therefore, contamination of face masks in this setting may be of great interest. We investigated bacterial colonization status on used face masks in healthcare personnel, including assessing the presence of clinically important and multidrug-resistant bacteria. Methods: At a nursing home serving mostly post–acute-care patients, we collected 69 face masks from personnel at the end of the user's work shift. Information about the mask and the user was also collected via a self-reported survey. Face masks were incubated in BHI broth overnight at 36°C and 10 μL was then plated on selective and differential plates. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and gram-negative bacteria (GNB) resistant to several antibiotic classes were identified using standard microbiological methods. Resistance testing for cefoxitin (S. aureus), ciprofloxacin, meropenem, tetracycline, erythromycin, gentamicin, trimethoprim–sulfamethoxazole, and ceftazidime with and without clavulanic acid (gram-negative bacteria) was performed using the disc diffusion technique on Mueller-Hinton plates (Kirby Bauer). Results: The job categories of face mask users were competency-evaluated nursing assistant or nursing assistant (22.73%), nurse (12.12%), and other or administrative (37.88%). Overall face mask contamination rates for MRSA (0%) and VRE (3.3%) were low;however, methicillin-susceptible S. aureus was found on 11 masks (15.9%). High contamination and resistance rates were found for gram-negative bacteria, with 113 isolates. Among them, 69 (60.9%) were resistant to at least 1 antibiotic, most commonly was erythromycin (59.4%). Additionally, higher rates of clinically important pathogenic gram-negative bacteria were identified: 14.3% of masks were contaminated with Klebsiella pneumoniae, 13.0% were contaminated with Enterobacter spp, and 4.2% were contaminated with Escherichia coli. Importantly, there were no significant differences in the total number of isolates of potential clinical significance recovered from masks worn >6 hours versus those worn <6 hours. Conclusions: Among nursing-home healthcare workers, face masks were often contaminated with multiple organisms, including potentially pathogenic bacteria and antibiotic-resistant gram-negative organisms. This contamination may pose a risk for transmission if face masks are not properly used and/or disposed of after wearing. Prolonged duration of face-mask wearing, however, was not associated with increased contamination rates.Funding: NoneDisclosures: None
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What limited resources there are to support appropriate antimicrobial use focus on public hospitals rather than community health care.6 Ironically, 95 per cent of our antimicrobial use is in the community7 and up to half of this may be inappropriate.8 The purpose of this article is to provide an overview of the ongoing high-level initiatives for improving antimicrobial stewardship and the New Zealand antimicrobial prescribing landscape as it stands. The new Ngā Paerewa Health and Disability Services Standard sets minimum AMS requirements that some service providers (eg residential care and public hospitals) must meet to be certified under the Health and Disability Services (Safety) Act 2001.9 Not all primary care is included in this standard, but this could be rectified by developing a separate clinical care standard for antimicrobial stewardship that applies to all who prescribe, dispense or administer antimicrobials.6 AMS and infection prevention and control (IPC) are two human-health components within a wider New Zealand AMR action plan. Almost none of the recommendations in the 2017 action plan have been put into place, even though the "bar was set low" to see what could be achieved without additional investment.2 Opinion leaders - including Te Whatu Ora Health New Zealand AMS pharmacists, infectious disease physicians, clinical microbiologists, IPC nursing specialists and other experts - continue to push for national leadership and coordinated efforts on AMS, most recently in a 2021 New Zealand MedicalJournal viewpoint.6 A key stakeholder group, the New Zealand Antimicrobial Stewardship and Infection Pharmacist Expert Group (NAMSIPEG), has also led promotion of good AMS practices and activities for World Antimicrobial Awareness Week (WAAW).11 For 2020, it led a national initiative to improve indication documentation on antimicrobial prescriptions, and for 2021 a national initiative focusing on penicillin allergy.12,13,14 These are component parts to AMS and are applicable in primary care. Prescribing landscape for antimicrobials in Aotearoa New Zealand The implications of AMR for New Zealanders and the imminent threat it represents have been made plain by the Royal Society Te Apārangi in 201715 and the Office of the Prime Minister's Chief Science Advisor in 2021.2 Estimates suggest, without urgent action, infections due to resistant microorganisms could kill 10 million people globally each year by 2050.16 Using a predictive model, a systematic analysis published this year in The Lancet has already estimated that approximately 6.3 million deaths globally in 2019 were attributable to, or associated with, bacterial AMR.17 The consequences of increases in AMR for New Zealand will be enormous, given the reliance we have on effective antimicrobial therapy throughout medicine.
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Eye Protection Critical to Preventing sArS-CoV-2 Infection in Workers Authors of a study published in Infection Control & Hospital Epidemiology investigated how lapses in personal protective equipment use affected transmission of SARS-CoV-2 among health care workers (HCWs) and patients. Each exposure was documented, including the exposure source, type, and location;risk level;quarantine dates;test results;and personal protective equipment worn. Health Care-Associated Infections Increased During Second Year of Pandemic Authors of a study published in Infection Control & Hospital Epidemiology used data reported to the National Healthcare Safety Network by US hospitals to determine the effect of the second year of the COVID-19 pandemic on the incidence of health care-associated infections.
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[...]the development of antimicrobial resistance is increasing day by day. [...]they may be inadequate in the differentiation of infection from other pathological cases such as cancer or inflammation. [...]the development of effective treatment and imaging options for S. aureus is critical for avoiding the progression of infection and decreasing infection-related deaths. Among imaging techniques, nuclear medicine techniques (gamma camera, positron emission tomography (PET), and single-photon emission tomography (SPECT)) are advantageous systems due to their ability to image the whole body, provide three-dimensional functional and physiological images, and use with other imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) as hybrid systems (PET/CT, PET/MRI, SPECT/ CT) (Wu & Shu, 2018). The studies regarding 177Lu labeled radiopharmaceuticals have increased in recent years thanks to its advantages such as long physical half-live and large-scale production. 177Lu+3 can conjugate with various molecules (e.g., antibodies, peptides, glycoproteins, hydroxyapatite minerals) due to its empty s, p, and d orbitals (Banerjee, Pillai, & Knapp, 2015). [...]some 177Lu-radiopharmaceuticals containing antibiotic molecules like kanamycin, bleomycin, benzylpenicillin, sulfadiazine, and colistin were developed in the literature (Akbar et al., 2017;Karpuz et al., 2022;Naqvi et al., 2017;Shahzad et al., 2017;Yousefnia et al., 2010b) Tedizolid phosphate (TDZ), a second-generation oxazolidinone, was developed for linezolid-resistant S. aureus infections.
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Systematic disinfection of the stethoscope diaphragm is required to ensure that it does not act as a vector for cross-transmission of health-related diseases. Thus, an antimicrobial latex film could be used as a cover to inhibit pathogenic bacteria from growing on its surface. The aim of this work is to determine the antimicrobial activity and mechanical properties of antimicrobial natural rubber (NR) latex films with different types of antimicrobial agents (mangosteen peel powder (MPP), zinc oxide nanoparticles (ZnO NP), and povidone-iodine (PVP-I)). The antimicrobial loading was varied from 0.5, to 1.0, and 2.0 phr to monitor the effective inhibition of Gram-negative bacteria and fungi growth. For MPP and PVP-I antimicrobial agents, a loading of 2.0 phr showed good antimicrobial efficacy with the largest zone of inhibition. Simultaneously, ZnO NP demonstrated excellent antimicrobial activity at low concentrations. The addition of antimicrobial agents shows a comparable effect on the mechanical properties of NR latex films. In comparison to control NR latex film (29.41 MPa, 48.49 N/mm), antimicrobial-filled films have significantly greater tensile and tear strengths (MPP (33.84 MPa, 65.21 N/mm), ZnO NP (31.79 MPa, 52.77 N/mm), and PVP-I (33.25 MPa, 50.75 N/mm). In conclusion, the addition of antimicrobial agents, particularly ZnO NP, can be a better choice for NR latex films because they will serve as both an activator and an antimicrobial. In a clinical context, with regard to frequently used medical equipment such as a stethoscope, such an approach offers significant promise to aid infection control.
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The antimicrobial potential of Aspergillus sp., isolated from the Amazon biome, which is stored at the Amazon Fungi Collection-CFAM at ILMD/FIOCRUZ, was evaluated. The fungal culture was cultivated in yeast extract agar and sucrose (YES) for cold extraction of the biocompounds in ethyl acetate at 28 °C for 7 days in a BOD type incubator. The obtained extract was evaluated for its antimicrobial activity against Candida albicans and Gram-positive and negative bacteria by the “cup plate” method and the determination of the minimum inhibitory concentration (MIC) by the broth microdilution method. The extract was subjected to thin layer chromatography (TLC) and fractionated by open and semipreparative column chromatography. The fractions of interest had their chemical constituents elucidated by nuclear magnetic resonance and mass spectrometry. The elucidated molecule was evaluated for cytotoxicity against the human fibroblast strain (MRC5). The extract presented inhibitory activity against both Gram-positive and negative bacteria, with the range of inhibition halos from 5.3 to 14 mm in diameter and an MIC ranging from 500 to 15.6 μg/mL. Seventy-one fractions were collected and TLC analysis suggested the presence of substances with double bond groups: coumarins, flavonoids, phenolic, alkaloids, and terpenes. NMR and MS analyses demonstrated that the isolated molecule was kojic acid. The results of the cytotoxicity test showed that MRC5 cells presented viability at concentrations from 500 to 7.81 μg/mL. The kojic acid molecule of Aspergillus sp., with antibacterial activity and moderate toxicity at the concentrations tested, is a promising prototype of an alternative active principle of an antimicrobial drug.
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While the ongoing COVID‐19 pandemic affirms an urgent global need for effective vaccines as second and third infection waves are spreading worldwide and generating new mutant virus strains, it has also revealed the importance of mitigating the transmission of SARS‐CoV‐2 through the introduction of restrictive social practices. Here, it is demonstrated that an architecturally‐ and chemically‐diverse family of nanostructured anionic polymers yield a rapid and continuous disinfecting alternative to inactivate coronaviruses and prevent their transmission from contact with contaminated surfaces. Operating on a dramatic pH‐drop mechanism along the polymer/pathogen interface, polymers of this archetype inactivate the SARS‐CoV‐2 virus, as well as a human coronavirus surrogate (HCoV‐229E), to the minimum detection limit within minutes. Application of these anionic polymers to frequently touched surfaces in medical, educational, and public‐transportation facilities, or personal protection equipment, can provide rapid and repetitive protection without detrimental health or environmental complications.
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Nosocomial resistance in staphylococci and enterococci is challenging. The aim of this work was to conduct a multipoint study using molecular detections, antimicrobial resistances profiles, patient demographics and disease patterns for objective assessments of Staphilococcus aureus and other Gram-positive pathogens recovered from clinical infections in the Ha’il region. We have surveyed 188 non-duplicate Gram-positives against 22 antimicrobials for molecular-differentiation, resistance, patient demographics, and disease patterns from January–April 2021. According to definitions for acquired resistance, Staphylococcus aureus was the most frequent with multidrug resistant (65.4%), where MRSA was 60% (n = 72 out of 121). In age-identified patients, 43% were seniors ≥50 years, 38% 21–49 years, and 19% 0–20 years. In gender-identified patients, 63% were males, and 37% were females. While 25% of specimens were from the ICU, the majority (60%) of specimens were from surgical infection in other wards. Staphylococcus epidermidis was the second (15.4%) species of infection identified with 81% from bloodstream infections at the ICU and other wards. The majority of S. epidermidis patients (69%) were seniors ≥50 years, while other age groups 0–20 and 21–49 each had 14% isolates. Although S. epidermidis was multidrug-resistant, it was susceptible to many drugs. Enterococcus faecalis (13%) ranked third with two major infections;bloodstream (64%) and urinary-tract infections (36%) in mainly seniors (86%). Its isolates were fully resistant to oxacillin, penicillin, cefoxitin, and cefotaxime but nearly 100% susceptible to seven others. Other Gram-positive bacteria (6%) were susceptible to many antibiotics. The use of combinations of objective criteria is a well thought out approach in infection control. While the low-frequency of Gram-positives is an impressive achievement, future large-scale investigations should include all private hospitals, clinics and other cities over a longer sampling time to gain more insights. Although geriatric susceptibility can be justified by age and comorbidities, the staphylococcal infections in young adults and children is a global concern and warrants more vertical studies.
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Researchers at the Imperial College Hospital and School of Public Health in London examined patterns of bloodstream infection (BSI), hospital stay, and mortality before and during two waves of COVID-19 between January 2020 and February 2021. Despite a decrease in the number of total hospital admissions by 65% during the surges, mostly because of the suspension of elective activities, blood cultures were obtained at a rate nearly double that of pre-COVID, up from 86.8/1,000 patient days pre-COVID to 150.7/1,000 patient days during both COVID surges. The authors believe both the higher rate of contaminated cultures and the increase in hospital-acquired BSI can be directly traced to the effect of both COVID surges on the hospital system, with disruptions in care and breakdown of usual infection prevention practices.
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There have been major advancements in the treatment and prevention of COVID-19. [...]far, only remdesivir1 (Veklury) has received FDA approval for treatment of COVID-19 in adults and children 12 years and older, but its use in younger children is permitted only under an emergency use authorization (EUA). Morphine oral solution (2 mg/mL and 4 mg/mL) is now indicated for pediatric patients aged 2 to 17 years with acute pain severe enough to require an opioid analgesic when alternative treatments are inadequate.8 Safety and efficacy in this age group are supported by extrapolation from clinical evidence in adults and supportive data from an open-label safety and pharmacokinetic study in pediatric patients aged 2 to 17 years with postoperative acute pain. The labeling has been expanded to include safety and effectiveness in pediatric patients aged 12 to 17 years, offering this population an alternative nonopioid pain medication.10,11 This indication was based on extrapolation of efficacy from studies in adult patients combined with pharmacokinetic and safety data from 2 open-label studies with a combined 49 patients aged 12 to 17 years and an activecontrolled study in 76 pediatric patients aged 12 to 16 years. Dalbavancin (Dalvance) is a unique glycopeptide antibiotic that is approved in all pediatric patients from birth.14 It is indicated for the treatment of acute bacterial skin and soft tissue infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus.
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SARS-CoV-2 evades antibodies Cell-culture experiments have shown that SARS-CoV-2 can hide from the immune system and spread through cell-to-cell transmission by limiting the release of viral particles that can be inactivated by antibodies. Zika pathogenesis Pyruvic acid, a compound in the glucose metabolism pathway and a readily available supplement, may protect babies from neurological disorders and other birth defects caused by the Zika virus if taken by pregnant women. Scientists have discovered a critical gene change that turns the Zika virus from its weakened form into a mildly pathologenic form called M-F37L.
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According to the Centers for Disease Control and Prevention, the animals known to have been infected with SARS-CoV-2 include otters, mink, white-tailed deer, dogs, ferrets, and felids, including domestic cats, lions, pumas, and tigers. Diagnostic samples taken from one tiger confirmed infection with SARS-CoV-2, and public health officials postulated that the source was exposure to a zoo employee positive for the virus. A 2014 literature review in PLoS One documents myriad cases in which humans transmitted influenza A virus, Mycobacterium tuberculosis, methicillin-resistant Staphylococcus aureus, and other pathogens to animals and stated that “transmission occurred in every continent except Antarctica therefore indicating a worldwide disease threat.” November 21, 2021 The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.
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Objective: To identify antimicrobial susceptibility pattern of multidrug resistant bacteria causing secondary infections in COVID-19 patients in ICU's of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Pak Emirates Military Hospital, Rawalpindi, from Apr to Jul 2020. Methodology: This study included blood samples and endotracheal aspirates from 114 critically ill COVID-19 patients. Peripheral blood specimens were collected from the patients with secondary bacterial blood stream infections and endotracheal aspirates were collected from patients with ventilator associated pneumonia for culture and sensitivity. The results were interpreted according to Clinical and Laboratory Standard Institute (CLSI) 2020. Results: A total of 114 COVID-19 patients were admitted in ICU during that time period. Fourteen (12.28%) were female and 100 (87.71%) were male, age distribution was between 36-82 years. Sixty six paired blood samples were sent to the microbiology lab out of which 51 (77.2%) showed bacterial growth while 15 (22.7%) samples were negative. Out of 50 endotracheal aspirates, 42 showed bacterial growth (84%) and 8 samples did not show any significant bacterial growth (16%). Most of the endotracheal aspirates showed growth of >1 bacterial isolates. The most common gram-negative organisms were Acinetobacter baumannii (n=54) and Klebsiella Pneumoniae (n=26) and most common gram-positive organism isolated was Enterococcus faecium (n=9). All isolated organisms were multidrug resistant. Conclusion: Poor antimicrobial stewardship particularly in critical care units resulted in secondary bacterial infections in COVID-19 patients. The pathogens isolated were multidrug resistant including Acinetobacter baumannii, Klebsiella Pneumoniae and Enterococcus faecium.