A Case of X-Linked Moesin-Associated Immune Deficiency in a Pediatric Patient

Background: X-Linked Moesin-Associated Immune Deficiency (X-MAID) is a rare severe combined immunodeficiency (SCID) subtype that can present at any age due to its variability. Depending on severity, patients demonstrate failure to thrive, recurrent bacterial and viral infections, and increased susceptibility to varicella zoster. It has been characterized by marked lymphopenia with hypogammaglobulinemia and impaired T-cell migration and proliferation. Case Presentation: This is a report of a Cuban 7-year-old male with poor weight gain and facial dysmorphia. He had a history of recurrent bacterial gastrointestinal infections and pneumonia beginning at 4 months of age. He additionally had 4-6 upper respiratory tract and ear infections annually. While still living in Cuba, he was admitted for a profound EBV infection in the setting of significant leukopenia. A bone marrow biopsy confirmed no malignancy. After he moved to the United States, his laboratory work-up revealed marked leukopenia with low absolute neutrophil and lymphocyte count with low T and B cells, very low immunoglobulin levels IgG, IgA, and IgM, and poor vaccination responses to streptococcus pneumonia, varicella zoster, and SARS-CoV-2. Genetic testing revealed a missense pathogenic variant c.511C>T (p.Arg171Trp) in the moesin (MSN) gene associated with X-MAID. He was managed with Bactrim and acyclovir prophylaxis, and immunoglobulin replacement therapy, and considered for hematopoietic stem cell transplantation. Discussion(s): Diagnosis of X-MAID should be considered in patients with recurrent infections and profound lymphopenia. As with SCID, early diagnosis and intervention is of utmost importance to prevent morbidity and mortality. This case demonstrates the importance of genetic testing in identifying this disease as it may prompt an immunologist to consider HSCT if conservative management is suboptimal. In the current literature, HSCT appears promising, but the long-term outcomes have yet to be described.Copyright © 2023 Elsevier Inc.

Colonization, Density, and Antibiotic Resistance of Streptococcus pneumoniae, Haemophilus Influenzae, and Moraxella catarrhalis among PCV13-Vaccinated Infants in the First Six Months of Life in Rochester, New York: A Cohort Study.

BACKGROUND: Streptococcus pneumoniae (Spn), Haemophilus influenzae (Hflu), and Moraxella catarrhalis (Mcat) nasopharyngeal colonization precedes disease pathogenesis and varies among settings and countries. We sought to assess colonization prevalence, density, Spn serotypes, and antibiotic resistance in children in the first 6 months of life in pediatric primary care settings. METHODS: Prospective cohort study in Rochester, NY during 2018-2020. Nasopharyngeal swabs were collected from 101 children at age 1, 2, and 3 weeks, then 1, 2, 4, 6, 9, 12, 15, 18, and 24 months. Spn serotypes were determined by Quellung. Oxacillin resistance for Spn and ß-lactamase production by Hflu and Mcat was tested. All children received PCV13 vaccine according to U.S. recommended schedule. RESULTS: Spn, Hflu, and Mcat colonization was detected in only 5% of infants before age 2 months old. Cumulative prevalence was 34% for Spn, 10% for Hflu, and 53% for Mcat in children ≤6 months of age. Nasopharyngeal bacterial density of Spn, Hflu, and Mcat (x = 2.71 log) in children ≤6 months of age was lower than at 7-24 months of age (x = 3.15 log, p < 0.0001). Predominant serotypes detected ≤6 months of age were 23B (16.7%), 22F (12.9%), 15B/C (11%), and 16F (9.2%). In total, 14.8% of Spn isolates were oxacillin resistant and 66.7% of Hflu isolates were ß-lactamase producing. CONCLUSION: Spn, Hflu, and Mcat nasopharyngeal colonization was uncommon and of low density among children ≤6 months old, especially among children <2 months of age. Non-PCV13 serotypes predominated and a different serotype distribution was observed in ≤6-month olds compared to 7- to 24-month olds.

Opportunistic Respiratory Pathogens in Symptomatic Non- Covid-19 Adults during a Presumptive Influenza Season

Intro: It is hypothesized that metagenomics could contribute to the effective sentinel surveillance of emerging infections to identify plausible cause of respiratory symptoms in the population. Method(s): This study forms part of a longitudinal household cohort study involving the collection of respiratory symptoms and vaccination history in Hong Kong. As a pilot, selected households were provided with swab collection kit for collecting nasopharyngeal and throat samples when there was an influenza-like illness (ILI) during a 4-month presumptive period of the year's winter influenza season. Sequence-Independent Single Primer Amplification (SISPA) and nanopore metagenomic sequencing were performed. After basecalling, demultiplexing, and quality filtering, taxonomic classification was done. Unclassified and host reads were removed and only taxon with over 0.1% abundance were included in the analysis. Finding(s): Between December 2021 and April 2022, of 101 collection kits delivered, 36 (36%) participants returned the samples. Two (6%) had previous COVID-19 diagnosis and almost all (97%) received at least one dose of COVID-19 vaccination. Metagenomics sequencing was performed on 13 samples collected from participants when ILI was present. Of the 1,592,219 reads obtained, 5308 taxa were identified and 136 had over 0.1% abundance, including 128 bacteria, 6 fungi, and 1 virus, which was a bacteriophage. The five most abundant genera of bacteria included Neisseria (19%), Streptococcus (10%), Haemophilus (9%), Veillonella (3%), and Rothia (3%). Haemophilus parainfluenzae was the most abundant species with 97,542 (6%) reads, followed by Neisseria meningitides (5%). Other bacteria identified included Rothia mucilaginosa, Acinetobacter baumannii, Lautropia mirabilis, Veillonella atypica, Streptococcus salivarius, and Streptococcus pneumonia. Inter-participant abundance profile was significantly different (p<0.001). Conclusion(s): The absence of viral infections identified echoed the extremely low proportion (3/21986, or 0.01%) of respiratory specimens testing positive for influenza virus by the government laboratory during the same period. The metagenomic profile could be useful for identifying the likely ILI-causing pathogen.Copyright © 2023

Antibacterial and Phagocytic Properties of a Novel Silver-Interferon Complex

Background: Developing new antibacterial and antiviral drugs are considered a significant issue due to the emergence and spread of resistant strains of microorganisms. The COVID-19 pandemic has dramatically increased the need for new broad-spectrum anti-infective agents. Objective(s): This experimental study aimed to investigate the antibacterial and phagocytic properties of silver-interferon preparation. The combination of properties of complex drugs makes them promising for treating drug-resistant infections and bacterial complications of viral diseases. Method(s): The antibacterial effect of the silver-interferon platform was investigated by agar diffusion and serial dilution methods. The drug's effect on the functional activity of phagocytes was studied on human neutrophils in a Staphylococcus aureus uptake test. Result(s): Investigations have shown that the silver-interferon complex possesses a bactericidal mechanism of action against tested bacterial strains, including Streptococcus pneumonia, Salmonella enteritidis, Staphylococcus aureus, Escherichia coli. Streptococcus pneumonia was the most susceptible bacterial target for the tested complex, with a growth inhibition zone of 12+/-0.6 mm and a minimal bactericidal concentration of 0.08 mg/ml. A slight stimulating action of the drug in relation to the activity of phagocytes was revealed. Conclusion(s): Silver-interferon has proved as a prospective anti-infective drug with a wide range of activities. Copyright © 2022 Bentham Science Publishers.

A HARD PILL TO SWALLOW

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Epiglottitis is an inflammation of the epiglottis which can be life-threatening in the absence of prompt intervention. Although primarily a pediatric condition, streptococcus pneumonia has been identified as a common pathogen in adults. SARS-CoV 2 has been known to affect a multitude of systems including the upper respiratory tract, but rarely the epiglottis. CASE PRESENTATION: A 66-year-old female with a past history of hypertension, and hypothyroidism presented with acute onset pharyngodynia and dysphagia with a feeling of throat closing up due to swelling and difficulty speaking. She had a recent COVID-19 diagnosis and was doing well except for mild fatigue. Upon presentation, she was hemodynamically stable. Physical exam revealed posterior pharyngeal edema without any exudate, mildly edematous uvula, and no stridor. Laboratory data was pristine except for elevated inflammatory markers. Rapid streptococcal test and MRSA swab were negative. Sputum culture showed usual respiratory flora and blood cultures were negative. A neck CT showed diffuse edema without any evidence of abscess. Laryngoscopy performed by the ENT surgeon revealed diffuse edema including epiglottitis. Emergent intubation revealed supra and epiglottis edema sparing the vocal cords. The patient was given Decadron and Benadryl to help with the edema along with clindamycin and subsequently transferred to ICU for further care. She was treated with Ceftriaxone for 7 days due to a chest X-ray finding of pneumonia. As for COVID 19 treatment, she received a course of Remdesivir and Decadron. Decadron was given at an increased interval to reduce edema around the epiglottis. Her ICU course was complicated with hypotension requiring intermittent vasopressor support, and acute kidney injury from ischemic acute tubular necrosis which slowly improved. Repeat CT chest showed bibasilar consolidations with peripheral ground-glass opacities. In view of hospital-acquired pneumonia, she was started on Ertapenem. Her clinical condition improved and she was successfully extubated. She was shifted to the floors from where she was discharged without any further complications. DISCUSSION: There are only two other reported cases of COVID 19 epiglottitis. The patient's advanced age and obesity were non-modifiable risk factors, but the COVID-19 infection played a role. The virus can lead to excessive upregulation of the host inflammatory response through repeat epithelial and endothelial damage leading to a cytokine storm, which may be responsible for this presentation. A great level of attention is to be maintained while attending to these patients given the multitude of systems that can be affected. CONCLUSIONS: COVID-19 is a potential cause of life-threatening acute epiglottitis. Early suspicion and direct visualization of the epiglottis is the key to success for early management. Reference #1: Emberey J, Velala SS, Marshall B, et al. Acute Epiglottitis Due to COVID-19 Infection. Eur J Case Rep Intern Med. 2021;8(3):002280. Published 2021 Mar 3. doi:10.12890/2021_002280 Reference #2: Smith C, Mobarakai O, Sahra S, Twito J, Mobarakai N. Case report: Epiglottitis in the setting of COVID-19. IDCases. 2021;24:e01116. doi: 10.1016/j.idcr.2021.e01116. Epub 2021 Apr 7. PMID: 33842206;PMCID: PMC8025537. DISCLOSURES: No relevant relationships by Arunava Saha

A UNIQUE CASE OF CANDIDA RETINITIS IN THE COVID-19 ERA

CASE: A 56-year-old male with a history of asthma was admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure. He was found to have sepsis secondary to pneumococcal pneumonia superinfected by COVID19. Labs showed elevated inflammatory markers. Chest x-ray initially demonstrated left lower lobe pneumonia but throughout the COVID-19 course, worsened to persistent multifocal pneumonia. The patient was intubated and treated with enoxaparin and a ten-day course of dexamethasone as well as antibiotics due to worsening clinical status. After the COVID-19 course resolved and the patient was extubated, he developed sepsis again - this time secondary to Candidemia. Treatment with intravenous micafungin was initiated and HIV antibodies screening returned negative. The patient began to report subacute visual changes including floating spots and blurry vision in the right eye without any other acute ocular symptoms. Upon ophthalmological exam, there were multiple white retinal lesions without vitreous involvement bilaterally on the macula indicating candida retinitis. Antifungal treatment with micafungin was changed to intravenous voriconazole for greater intraocular penetration. After seven days of intravenous voriconazole, two blood cultures came back negative for Candida. At this point, the patient was medically stable and was discharged on a six- week course of oral voriconazole. IMPACT/DISCUSSION: The COVID-19 pandemic changed the landscape of medicine. Not only have healthcare systems worked hard to treat the COVID-19 infections themselves but also the long-term effects that result from an infection. As treatment guidelines have been developed and honed, steroids appear at the forefront of therapy. However, this does not come without consequences as prolonged use of corticosteroids can dampen the body's immune system. This compounds the ability of COVID-19 pneumonia to result in a severely immunocompromised state that can subsequently expose the body to opportunistic infections. Candida albicans is an organism that exists in all humans in the gastrointestinal and genitourinary systems typically without impact. In severely immunocompromised individuals such as the patient in the case, hospital courses involving ICU care can lead to hematogenous spread of Candida. The candidemia leads to sepsis and may also present with rare clinical pictures such as Candida retinitis. For this reason, candidemia should prompt thorough evaluation of patients with an echocardiogram, abdominal computer tomography, and ophthalmologic exam. CONCLUSION: This case displays the ability of COVID-19 infections to provide an opportunity for rare infectious manifestations such as Candida retinitis. As the pandemic prolongs, proper treatment regimens must be reassessed for future use as these presentations may become more common.

VACCINE-PREVENTABLE HOSPITALISATION IN MENTAL HEALTH SERVICE USERS: A BOOSTER IS NEEDED

Background: COVID-19 has highlighted the essential role of vaccination in preventing illness, modifying illness severity and averting hospital care. Mental health (MH) service users have low vaccination rates for many conditions, but evidence on individual and health system impacts is limited. Methods: The NSW Mental Health Living Longer links population-wide data from NSW hospitals and community MH services. We calculated hospitalisation rates and incidence rate ratios for vaccine-preventable conditions including hepatitis, influenza and pneumococcal pneumonia, comparing MH service users to other NSW residents. Rates were standardised for age and socio-economic disadvantage. Results: Over 12 months there were 14,530 vaccine preventable admissions in NSW, occupying 94,241 bed days. MH service users had a more than fourfold increased risk of admission for vaccine-preventable conditions (adjusted incidence rate ratio = 4.7;95% confidence interval = [4.5, 5.0]), with the highest relative risk in people aged 40-65 years. One-quarter of total excess potentially preventable bed days in MH service users were due to vaccine-preventable conditions, including respiratory illness. MH service users comprised 2.3% of the NSW population but contributed nearly 15% of vaccine-preventable bed days. Additional analyses will be presented examining specific conditions, demographic and clinical subgroups. Conclusion: Low vaccination rates have serious impacts for MH service users. Strategies to overcome barriers and support vaccination uptake could have quick and substantial benefits for individuals and health systems. Supporting uptake of COVID-19 vaccination will be essential to avoid further amplifying health inequalities for people using MH services.

Why do we focus on common cold and bacterial pneumonia

Common cold and influenza are often complicated by pneumococcal pneumonia, but the complication whereas pneumococcal pneumonia complicating COVID-19 is not common. Both influenza and COVID-19 are respiratory viral infections, and their pathogenesis depends on the host immune response. Therefore, clinically, accurate pathogen diagnosis in the early stage of the clinical course for the purpose of formulating an appropriate treatment plan may contribute to improvement of the patient prognosis. Clinical characteristics of COVID-19 in clinical manifestations, epidemiological history, laboratory findings and radiological findings, some of which were different and some of which were similar from influenza or any other common cold. We would like to emphasize the importance of researching the mechanism of pneumonia induced from common cold, influenza, COVID-19 and any other respiratory viral infection.

Antimicrobial Resistance of Secondary Bacterial Infections in Patients Hospitalized with Covid-19

Coronavirus disease 2019 (COVID-19) is an emerging serious global health problem. It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. This study was carried out on 100 samples of sputum from COVID-19 patients. During the laboratory diagnosis, 156 bacterial isolates were obtained from the positive samples . The Gram-positive bacteria isolates included Strptococcus pneumonia 64(40%) Streptococcus pyogenes, 7 (4%), Streptococcus mitis 1 (1%) Streptococcus mutus 1(1%), Streptococcus parasanguinis 1(1%) Staphylococcus eidermidis 10(6%), staphylococcus aureus 4 (2%), Micrococcus lutus,1 (1%). Whereas, Gram-negtive bacteria included Pseudomonas aeruginosa 9 (6%), E coli 10 (6%), Serratia marcescens, 3 (2%), Klebsiella pneumonia 31 (19%), H.influenzae 10 (6%) Acinetobacter baumannii, 4 (2%) .The isolates varied in their response against the antibiotics;and Gram positive bacteria were significantly (p<0.05) more sensitive to the antibiotic then Gram negative. To detect the Streptococcus pneumonia isolates, the house keeping Eno genes was screened. Results showed that all the isolates, had Eno gene (100%). Furthermore, This study was carried out in order to detect tet-L and ermB gene in 10 S.pneumonia isolates . genes were Results showed that all the isolates, numbering 10, had both tetL and ermB genes(100%).

Correlation of COVID-19 Receptors with Neutrophils and Their Role in the Adherence of Co-Infected Bacteria.

The COVID-19 caused by the SARS-CoV-2 virus has an impact on all aspects of patient care. Since the onset of this disease pandemic in 2019, numerous studies have been published which have attempted to identify virus receptors in the upper respiratory tract, such as nasal, oropharynx, and lung and their role in coinfection of bacterial adherence. In this study, the level of m RNA for platelet-activating factor receptor (PAF-R) and angiotensin-converting enzyme 2 receptor (ACE2-R) were detected in the whole blood of COVID-19 patients and controlled by using real-time reverse transcription-polymerase chain reaction technique. The results of the expression level of the PAF-R gene were higher in patients (43 ± 12.5) than in the healthy control (40 ± 2.1). Moreover, the expression level of ACE2-R was significantly (0.0001) increased in patients (27.5±6.2), compared to the control group. In addition, there was an elevation of neutrophils (79.6±17.6%) and PAF-R level (43%) in COVID-19 patients in comparison to the control (40) with a positive correlation between these factors (r=0.8769, P=0.0001). Nasopharyngeal epithelial cells showed a higher adherence rate (86%) to both bacteria isolates (Streptococcus pneumonia and Staphylococcus aureus) in patients than in the control group. Increased expression of PAF-R and ACE2-R genes in COVID-19 patients and co-infected bacteria disease could be the factors for the SARS-CoV-2 virus to enter the cells of the host.

Reemergence of Invasive Pneumococcal Disease in Germany During the Spring and Summer of 2021.

BACKGROUND: The incidence of invasive pneumococcal disease (IPD) decreased worldwide in 2020 and the first quarter of 2021, concurrent with nonpharmaceutical interventions (NPIs) intended to stymie transmission of SARS-CoV-2. In 2021, the stringency of these NPI strategies has varied. We investigated age- and serotype-specific variations in IPD case counts in Germany in 2020-2021. METHODS: IPD cases through 30 November 2021 were stratified by age group, serotype, or geographic location. IPD surveillance data in 2020-2021 were compared with (1) IPD surveillance data from 2015-2019, (2) mobility data during 2020 and 2021, and (3) NPI stringency data in 2020 and 2021. RESULTS: IPD incidence began to return toward baseline among children 0-4 years old in April 2021 and exceeded baseline by June 2021 (a 9% increase over the average monthly values for 2015-2019). Children aged 5-14 years and adults aged 15-34 or ≥80 years showed increases in IPD cases that exceeded baseline values starting in July 2021, with increases also starting in spring 2021. The age distribution and proportion of vaccine-serotype IPD remained comparable to those in previous years, despite lower overall case counts in 2020 and 2021. The percentage change in IPD incidence compared with the previous 5 years was correlated with changes in mobility and with NPI stringency. CONCLUSIONS: IPD levels began to return to and exceed seasonal levels in spring and summer 2021 in Germany, following sharp declines in 2020 that coincided with NPIs related to the coronavirus disease 2019 pandemic. Proportions of vaccine serotypes remained largely consistent throughout 2020-2021.

Decrease in Invasive Pneumococcal Disease in 7 United States Children's Hospitals during the COVID-19 Pandemic

Background. During the 2020 SARS-CoV-2 pandemic, physical distancing and mask use guidelines were implemented resulting in a decline in the number of infections caused by influenza, respiratory syncytial virus and otitis media. A surveillance analysis from England and Taiwan showed a decline in invasive pneumococcal disease (IPD) (Clin Infect Dis. 2021;72: e65-75 and J Infect. 2021;82:296-297). We hypothesized that COVID mitigation efforts resulted in a decrease in incidence of pediatric IPD within the U.S. during 2020 compared to previous years. Methods. We reviewed all cases of IPD among 7 children's hospitals from the U.S. Pediatric Multicenter Pneumococcal Surveillance Group from 2017-2020. IPD was defined by the isolation of Streptococcus pneumoniae from normally sterile sites (eg. blood, cerebrospinal, pleural, synovial or peritoneal fluid). Pneumococcal pneumonia was defined as an abnormal chest radiograph in the presence of a positive blood, pleural fluid or lung culture. Mastoiditis was identified by positive middle ear, subperiosteal abscess or mastoid bone culture. Serotypes were determined by the capsular swelling method. Hospital admission numbers were obtained for incidence calculations. Statistical analyses were performed using STATA11. A p< 0.05 was considered significant. Results. A total of 410 IPD cases were identified. The cumulative incidence of IPD (0-22 years of age) decreased from 99.2/100,000 admissions in 2017-2019 to 53.8/100,000 admissions in 2020 (risk ratio 0.54, CI: 0.40-0.72, p< 0.00001). Pneumococcal bacteremia and pneumonia decreased significantly in 2020 (p< 0.05), and although not statistically significant, there were fewer cases of meningitis and mastoiditis when compared to previous years (p=0.08) (Figure 1). Sex, race, age or presence of comorbidities were not significantly different between groups. Most common serotypes in 2020 were 35B, 3 and 15B/C (Figure 2). Conclusion. The observed decline in IPD cases during the first year of the SARSCoV-2 pandemic is likely associated with mask use and physical distancing limiting transmission of S. pneumoniae via droplets and viral infections frequently preceding IPD. These precautions might be useful in the future to decrease IPD, especially in high-risk patients.

Detection of Pneumococcal Pneumonia during SARS-CoV-2 Infection

Background. Streptococcus pneumoniae (pneumococcus) is a common colonizer of the upper respiratory tract and can progress to cause invasive and mucosal disease. Additionally, infection with pneumococcus can complicate respiratory viral infections (influenza, respiratory syncytial virus, etc.) by exacerbating the initial disease. Limited data exist describing the potential relationship of SARS-CoV-2 infection with pneumococcus and the role of co-infection in influencing COVID-19 severity. Methods. Inpatients and healthcare workers testing positive for SARS-CoV-2 during March-August 2020 were tested for pneumococcus through culture-enrichment of saliva followed by RT-qPCR (to identify carriage) and for inpatients only, serotype-specific urine antigen detection (UAD) assays (to identify pneumococcal pneumonia). A multinomial multivariate regression model was used to examine the relationship between pneumococcal detection and COVID-19 severity. Results. Among the 126 subjects who tested positive for SARS-CoV-2, the median age was 62 years;54.9% of subjects were male;88.89% were inpatients;23.5% had an ICU stay;and 13.5% died. Pneumococcus was detected in 17 subjects (13.5%) by any method, including 5 subjects (4.0%) by RT-qPCR and 12 subjects (13.6%) by UAD. Little to no bacterial growth was observed on 21/235 culture plates. Detection by UAD was associated with both moderate and severe COVID-19 disease while RT-qPCR detection in saliva was not associated with severity. None of the 12 individuals who were UAD-positive died. Conclusion. Pneumococcal pneumonia (as determined by UAD) continues to occur during the ongoing pandemic and may be associated with more serious COVID-19 outcomes. Detection of pneumococcal carriage may be masked by high levels of antibiotic use. Future studies should better characterize the relationship between pneumococcus and SARS-CoV-2 across all disease severity levels.

Evaluation of the Secondary Bacterial Infections of Respiratory Tract in Covid 19 Patients

Background:A novel corona virus known as severe acute respiratory syndrome corona virus 2 was first reported in Wu- han city of China.The spectrum of clinical presentation of COVID 19 is highly variable,infections range from being asymp- tomatic to severe viral pneumonia with respiratory failure often leading to death.some patients found to be additionally infected with a secondary bacterial infection with 50% fatalities due to the COVID 19 caused by untreated or untreata- ble secondary bacterial infection in the lungs.Secondary bacterial infections develop in patients during or after initial infection. Methods:The study was conducted in Microbiology laboratory from the samples received from Government general hospital, Kurnool medical college,Kurnool.Patients were investigated for detection of secondary bacterial infection of respiratory tract using the conventional methods.Cough out sputum was collected and cultured on different media to support the growth of the bacteria. After incubation,formed colonies on the media were identified using gram staining and other biochemical tests.Antimocrobial susceptibility testing then done on isolated organisms according to standard CLSI guidelines. Results:Among 60 samples obtained, commonest organisms isolated are Staphylococcus aurues (35%), Streptococcus pneumonia (23%),Klebsiella (16%),Pseudomonas (8%),Acimetobacter (6%). Antibiotic susceptibility done in order to see multidrug resistant organisms. Conclusions:Secondary bacterial infections play a critical role in the morbidity and mortality rates of patients initially falling ill with pulmonary viral disease. Need for the study is to isolate the organism causing secondary bacterial infec- tion, there antibiotic susceptibility in order to give appropriate treatment, to avoid drug resistance and to improve the quality of life.

Improving the vaccination rates for immunosuppressed patients with inflammatory bowel disease

BACKGROUND: Immunosuppressive therapy (IS) has altered the course of Inflammatory Bowel Disease (IBD). IBD patients are at considerable risk of developing vaccine-preventable illness and are even more susceptible when on treatment. Many of these patients fail to receive appropriate vaccinations for influenza, pneumonia, hepatitis B, Shingles and recently COVID. Our aim was to develop a quality improvement intervention to increase recommended vaccinations in IBD patients on IS. METHODS: A retrospective chart analysis was completed at the Memphis Veteran Affairs Gastroenterology Practice. 55 patients were found to be on immunosuppressive therapy with a biologic and/or immunomodulator. Once identified, these patient's vaccination records were reviewed to see if they were up to date on recommended vaccinations for influenza, pneumonia, hepatitis B, COVID, and Shingles. Patients who were not up to date on their vaccinations were called by a provider (Resident, Fellow, or Nurse Practitioner), and were offered a nurse visit to be given the appropriate vaccinations. After a 6-month intervention period, the data on the 55 patients was recollected and analyzed. RESULTS: Of the patients analyzed, 63% (n=35) had Crohn's disease and 37% (n=20) had Ulcerative Colitis. The most common biologic medication the patients were on was adalimumab (n=24), and the most common immunomodulator was azathioprine (n=17). Prior to the intervention, 22% had received the shingles vaccine, 20% had received the COVID-19 vaccine, 78% had received the hepatitis B vaccine, 69% had received the flu vaccine, 62% had received the pneumococcal 23 vaccine, and 72% had received the pneumococcal 13 vaccine. After the intervention, 65% had received the shingles vaccine, 65% had received the COVID-19 vaccine, 87% had received the hepatitis B vaccine, 85% had received the flu vaccine, 78% had received the pneumococcal 23 vaccine, and 84% had received the pneumococcal 13 vaccine. CONCLUSION: Patients on immunosuppressive therapy remain vulnerable to vaccine-preventable illnesses such as Shingles, Pneumococcal Pneumonia, Influenza, Hepatitis B, and COVID-19. Our quality improvement intervention increased overall vaccination adherence. This project was a proof of concept and in the future, we hope to integrate a warning system into our practice to alert providers when these patients are due for their appropriate vaccinations. It is also a practice that can be adopted by other healthcare providers who treat patients with IS and biologics to improve vaccination uptake.

A retroprospective study of an antimicrobial stewardship program on antimicrobial utilization at a tertiary care medical center in kolkata

The WHO has set Defined Daily Dose which represent the average daily dose of an antibiotic in a standard patient. The DDD mai nly focuses on population-based parameters & assumes that patients as well as hospitals are homogenous entities. DOTs are very useful in order to classify antibiotic days based on patient-level exposure. DOTs merely mean the number of days that a patient is on an antibiotic, irrespective of dose. DOTs signifies that the underlying assumptions about antibiotic dosing was appropriate. Additionally, when patients receive more than one antibiotic, supplementary DOT may be counted. The 300-bed tertiary care medical center serves adults and paediatrics. An all-time Microbiology Consultant and a Clinical Pharmacology trainee used to go for round daily and used to collect data for ASP for the period of 3 months that is April to June,2021. In this study we have compared DOT of some important antibiotics for a specific period of time for both COVID and NON COVID patient. ASP-focused antibiotics were antibiotics routinely evaluated by the ASP team for appropriateness during therapy and the potential to optimize their appropriate use through policies, protocols, formulary restrictions, or clinician education. ASP-focused antibiotics included meropenem, linezolid, pip-taz, poly b, colistin, teicoplanin. In this study we have compared the DDD for 2 specific period of time for better understanding the consumption of those antibiotics. In conclusion, following the initiation of an ASP, significant decreases in utilization, increases in cost savings occurred. In our study we have reduced the consumption and DDD of linezolid which is clinically significant. When it comes to DOTs;We have reduced the DOTs of piptaz and teicoplanin for covid patient And Reduced the DOTs of meropenem and teicoplanin for non-covid patient which is clinically and statistically significant.

Influenza and pneumococcal vaccines in cancer patients on active therapy: A prospective study

Background: Due to immunosuppression, influenza virus and S. pneumoniae infections in cancer patients (pts) are responsible of a 4 times higher morbidity and mortality rates. Inadequate data are available about efficacy, safety, timing and immunogenicity of influenza (I) and pneumococcal (P) vaccine (vax) in pts undergoing active oncologic treatment. Nevertheless, the main Oncology societies recommend I and P vax in cancer pts and their family members (FMs). Materials and Methods: This is a single institution prospective study conducted at L. Sacco Hospital (Milan) between Sept 20 and Apr 21. The aim was to evaluate efficacy and safety of vax. Pts with diagnosis of tumor, age>18ys, in active antineoplastic treatment and FMs age>18ys were included. Each pt received I+P vax on the same day of therapy. Pts were compared with a control group of FMs, with age- and gender-adjusted logistic regression. Monthly monitoring was scheduled to register any Adverse Events (AEs) after injection (local and systemic AEs), episode of Influenza Like Illness (ILI), pneumococcal infection, access to Emergency department (ED) or Hospital admission (HA) and delay of treatment (DT). Results: 194 pts (63y median age, 67.5% female) and 140 FMs (59y median age, 49% female) were enrolled. CANCER: 92% solid and 8% hematological malignancy, 69% metastatic stage. TREATMENTS: 54% =1 previous line of therapy;38% chemotherapy, 31% target, 17% chemo+target, 14% hormone therapy. VAX: 47% pts and 72% FMs received I-vax for first time. I+P-vax were administered in 100% pts and 49% FMs. LOCAL AEs: I-vax: 34% pts and 19.6% FMs (p=0.01), P-vax: 35.7% pts and 20.7% FMs (p=0.11). The most common was pain in site of injection. SISTEMIC AEs: 19.6% pts and 8.5% FMs (p=0.11);the most frequent was fatigue. EFFICACY: ILI were recorded in 8.8% pts (3 had a HA and 1 a DT) and 3.6% FMs (p=0.04). No PI was recorded. Type of therapy, previous treatment and the use of steroid don't significantly impact on vax safety and efficacy. Conclusions: Despite the atypical season, I+P vax are safe and effective in cancer pts. The limited number of ILI events observed could be referred to vax but also to COVID-19 risk prevention and mitigation measures. No differences in efficacy and safety were observed between the 2 groups, except for local I-vax AEs. Moreover, the vax administration in the Oncology department, a wide vaccination coverage was achieved (>70% of cancer pts), reducing the pressure on territorial healthcare system.

The role of pneumococcal urinary antigen in CoViD-19 pneumonia: if you know it, you don't avoid it

Background: CoViD-19 pneumonia has a bacterial co-infection rate about 3-5% at the admission to hospital care. The aim of our study is to assess the utility of pneumococcal urinary antigen (Ag) test in the diagnosis of bacterial pulmonary co-infection in CoViD- 19 pneumonia and its support in the decision about antibiotic therapy. Materials and Methods: We searched in NIH and PubMed for a revision of literature about the characteristics of pneumococcal urinary Ag test and the respiratory co-infection rate in CoViD-19 pneumonia. We analyzed1268 cases of pneumonia admitted at the hospital: 703 CoViD-19 pneumonia and 565 community-acquired pneumonia. We compared positivity test rate in these two groups, the presence of clinical features suggestive for bacterial co-infection and antibiotic treatment rates. Results: There was no statistical significative difference rate of positive test between the two groups (p-value=0,6): 703 CoViD- 19 pneumonia,10,8% (N=76) positive and 89,2% (n=627) negative;565 community-acquired pneumonia, 9,9% (n=56) positive and 90,1% (509) negative. Positive test wasn't always correlated with sign/symptoms of bacterial co-infection;the rate of antibiotic treatment was higher in community-acquired pneumonia group than in CoViD-19 pneumonia one. Conclusions: In conclusion, we support the use of pneumococcal Ag test in CoViD-19 pneumonia patients with sign/symptoms suggestive for bacterial co-infection. A positive test in this subgroup of patients must be considered as diagnostic for pneumococcal pneumonia and antibiotic treatment must be started.

Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality-Perspectives.

Aims and objectives: The pandemic of COVID-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity of COVID-19. H1N1 and Streptococcus pneumonia vaccines are available. The current analysis was performed to analyze the severity of COVID-19 and influenza (H1N1) vaccination in adults ≥ 65. Also, to correlate the lower respiratory tract infections (LRIs), and influenza attributable to the lower respiratory tract infections' incidence with Covid-19 mortality. Evolutionarily influenza is close in resemblance to SARS-CoV-2 viruses and shares some common epitopes and mechanisms. Methods: Recent influenza vaccination data of 34 countries from OECD and other publications were correlated with COVID-19 mortality from worldometer data. LRIs attributable to influenza and streptococcus pneumonia were correlated with COVID-19 mortality. Specifically, influenza-attributable LRI incidence data of various countries (n = 182) was correlated with COVID-19 death by linear regression and receiver operating characteristic (ROC) curve analyzes. In a logistic regression model, population density and influenza LRI incidence were correlated with COVID-19 mortality. Results: There is a correlation between COVID-19-related mortality, morbidity, and case incidence and the status of influenza vaccination, which appears protective. The tendency of correlation is increasingly highlighted as the pandemic is evolving. In countries where influenza immunization is less common, there is a correlation between LRIs and influenza attributable to LRI incidence and COVID-19 severity, which is beneficial. ROC curve showed an area under the curve of 0.86 (CI 0.78 to 0.944, P < 0.0001) to predict COVID-19 mortality >150/million and a decreasing trend of influenza LRI episodes. To predict COVID-19 mortality of >200/million population, the odds ratio for influenza incidence/100,000 was -1.86 (CI -2.75 to -0.96, P < 0.0001). To predict the parameter Covid-19 mortality/influenza LRI episodes*1000>1000, the influenza parameter had an odd's ratio of -3.83 (CI -5.98 to -1.67), and an AUC of 0.94. Conclusion: Influenza (H1N1) vaccination can be used as an interim measure to mitigate the severity of COVID-19 in the general population. In appropriate high-risk circumstances, Streptococcus pneumonia vaccination would also be an adjunct strategy, especially in countries with a lower incidence of LRIs.

Risk factors for symptoms of infection and microbial carriage among French medical students abroad.

OBJECTIVES: To investigate symptoms of infections and their risk factors among French medical students undertaking an internship abroad. METHODS: Clinical follow up, and qPCR-based respiratory, gastrointestinal, and vaginal pathogen carriages were prospectively assessed pre-travel and post-travel, in a cohort of medical students departing from Marseille, France. RESULTS: 293 students were included. 63.5%, 35.8%, and 3.6% of students reported gastrointestinal, respiratory, and vaginal symptoms, respectively. The acquisition rate of Enteroaggregative Escherichia coli and Enteropathogenic E. coli was 40.9% and 18.6%, respectively. A significant increase was observed for rhinovirus and Streptococcus pneumoniae by comparing the prevalence of pathogens in pre-travel and post-travel samples. Gardnerella vaginalis and Atopobium vaginae acquisition rates were 12.9% and 13.9%, respectively. Being female, primarily traveling to Vietnam, and living in basic accommodation conditions were independent risk factors for reporting respiratory symptoms. Students reporting respiratory symptoms were three times more likely to acquire S. pneumoniae. Traveling primarily to north India and Senegal were independent risk factors for diarrhea. CONCLUSION: This study makes it possible to identify the leading infectious diseases linked to travel in a group of French medical students undertaking an internship abroad and the risk factors on which to base targeting students for reinforced pre-travel advice.