Impact of improving infection control and antibiotic stewardship practices on nosocomial infections and antimicrobial resistance in an oncology centre from India

Background: Improving basic infection control (IC) practices, diagnostics and anti-microbial stewardship (AMS) are key tools to handle antimicrobial resistance (AMR). Material(s) and Method(s): This is a retrospective study done over 6 years (2016-2021) in an oncology centre in North India with many on-going interventions to improve IC practices, diagnostics and AMS. This study looked into AMR patterns from clinical isolates, rates of hospital acquired infections (HAI) and clinical outcomes. Result(s): Over all, 98,915 samples were sent for culture from 158,191 admitted patients. Most commonly isolated organism was E. coli (n = 6951;30.1%) followed by Klebsiella pneumoniae (n = 5801;25.1%) and Pseudomonas aeroginosa (n = 3041;13.1%). VRE (Vancomycin resistant Enterococcus) rates fell down from 43.5% in Jan-June 2016 to 12.2% in July-Dec 2021, same was seen in CR (carbapenem resistant) Pseudomonas (23.0%-20.6%, CR Acinetobacter (66.6%-17.02%) and CR E. coli (21.6%-19.4%) over the same study period. Rate of isolation of Candida spp. from non-sterile sites also showed reduction (1.68 per 100 patients to 0.65 per 100 patients). Incidence of health care associated infections also fell from 2.3 to 1.19 per 1000 line days for CLABSI, 2.28 to 1.88 per 1000 catheter days for CAUTI. There was no change in overall mortality rates across the study period. Conclusion(s): This study emphasizes the point that improving compliance to standard IC recommendations and improving diagnostics can help in reducing the burden of antimicrobial resistance.Copyright © 2023 Indian Association of Medical Microbiologists

Primary proximal hypospadias repair in in toilet-trained males is associated with a higher risk of post-operative complications and parental dissatisfaction

Introduction & Objectives: Hypospadias is the most common congenital malformation of the penis. There has been a lot of recent controversy in certain countries as to whether operating on distal hypospadias is warranted, and when this should occur. Proximal hypospadias, however, is much less common, with a putative aetiology within the male programming window of the first trimester. It has an association with differences of sexual development (DSD) when diagnosed alongside cryptorchidism and the operative approach is technically more challenging. The European Association of Urology (EAU) recommends initial repair between 6-18 months of age. Material(s) and Method(s): We prospectively gathered data from 24 consecutive toilet-trained children (3-7 years) who were initially listed for proximal hypospadias repair, but who were delayed as a result of resource limitations and the ongoing supply chain effects of COVID-19. The patients were operated between July 2020 and July 2022 with a mean follow-up of 7 months (3-24months). These were compared with a cohort of 16 patients who underwent proximal hypospadias repair between 12-18 months of age in the same institution. Both single and staged procedures were included. Institutional review board approval was obtained. Patients who had previously been operated on as an infant, or who were diagnosed with a DSD, or had an associated diagnosed neuropsychiatric developmental disorder were excluded. Pre-, peri- and post-operative data were statistically compared. Result(s): Overall, 40 children underwent a total of 75 primary procedures for their proximal hypospadias (7x single stage;31 x 2-stage;2 x 3-stage). All patients had an indwelling catheter placed post-operatively, were on antibiotic prophylaxis and oxybutynin for bladder spasms. Morphine was not used post-operatively in any case. Apart from age, there were no significant demographic or racial differences between these groups. The toilettrained cohort was associated with a higher rate of urethrocutaneous fistulas (58% vs. 31%;p=0.11), catheter/stent trauma (79% vs. 6%;p<0.001), pain (54% vs. 12%;p<0.01), constipation (75% vs. 37%;p=0.02). Both Likert Scales (4 vs. 8) and parental net promoter scores (-25 vs. +68.75) were worse for the toilet trained cohort compared to the infant cohort. There were no differences in glans dehiscence, or residual chordee between both groups. Conclusion(s): Primary proximal hypospadias repair is associated with a higher degree of perioperative complications in toilet-trained kids and lower levels of parental satisfaction. These cases are not deemed to be suitable to be managed conservatively and should be offered treatment within the 6-18 months window adjusted for gestational age as endorsed by the EAU.Copyright © 2023.

An unexpected diagnosis: Good's syndrome

Case report Introduction: Good's syndrome (GS) represents an acquired adult-onset immunodeficiency associated with thymoma. GS affects patients over 40 yrs in form of recurrent infections especially with encapsulated bacteria, opportunistic viral and fungal invasions as a result of combined T/B cell deficiency. The imbalanced immunity may also provoke autoimmune phenomena and tumorigenesis. Case report: We present a 40-year- old male with a newly onset of dull thoracic pain and with no history of previous diseases. Chest CT revealed an anterior mediastinal mass in 2021, without lympadenopathy. A CT-guided core biopsy was suggestive for malignant thymoma, so the patient underwent total thymectomy. Histology indicated a thymoma of the AB type (WHO), and stage I. (Masaoka-Koga);(pT1a pNo). After surgery he was readmitted due to recurrent febrile respiratory tract infections, caused by Gram (-) bacteria or fungi;combination therapy of antibiotics and antifungal drugs was used. With suspicion of GS we determined immunoglobulin levels and the distribution of peripheral lymphocyte subsets. Hypogammaglobulinemia (IgG/A/M), and by flow cytometry markedly reduced peripheral B cells, and an inverse ratio of CD4+/CD8+ T cells were detected, confirming the diagnosis. Blast transformation assay indicated decreased T cell proliferation. Thus, following thymectomy, the patient exhibited severe T/B cell alterations with subsequent recurrent infections. Detailed autoantibody and complement analyses indicated no autoimmune laboratory abnormalities so far. There are still no effective protocols for GS therapy, except of antibiotic prophylaxis, preventive vaccination, and regular immunoglobulin replacement, so IVIG was introduced. As part of the follow-up repeated CT indicated no thymoma recurrence or metastasis. In December 2021 the vaccination refusing patient survived a severe bilateral organizing pneumonia secondary to SARS-CoV2. Conclusion(s): Incidence of the thymic epithelial tumor, thymoma is 0.15-0.33 cases/100.000/year. Depending on histology it could be linked to various immunological abnormalities. Appr. 0.2%-6% of thymomas corresponds to GS. GS, with a still elusive pathogenesis is considered as an uncommon combined immunodeficiency of adults with a variable phenotype and certain similarities to CVID. The prevalence is estimated appr. as 1/500.000. Combination of the high infection susceptibility and concomitant autoimmune diseases could make the diagnosis a challenging task.

Health Care-Associated Infections: Best Practices for Prevention

Health care-associated infections (HAIs) are a significant cause of morbidity and mortality in the United States. Common examples include catheter-associated urinary tract infections, central line-associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and Clostridioides difficile infections. Standardized infection control processes and precautions have been shown to reduce the rate of HAIs, and targeted practices for HAIs have shown further reductions. Patient safety tools have been developed for various HAIs to help guide administrators and are free for public use through the Centers for Disease Control and Prevention STRIVE (States Targeting Reduction in Infections via Engagement) initiative. The Choosing Wisely initiative makes best practice recommendations for physicians to improve quality of care and reduce costs;targeted recommendations were developed to reduce the risk of HAIs. For example, using invasive devices only when indicated and for the shortest time possible reduces the risk of device-related HAIs. The goal of antibiotic stewardship is to reduce C. difficile infections and further development of multidrug-resistant organisms such as vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae. Antibiotic stewardship targets physician behaviors such as reviewing antibiotic therapy choices every 48 to 72 hours, reviewing culture results as soon as available, de-escalating antibiotic therapy when appropriate, and documenting the indications for initiating and continuing antibiotic therapy.Copyright © 2022 American Academy of Family Physicians.

Patient Engagement in Management of Recurrent Urinary Tract Infections

Purpose of Review: Recurrent urinary tract infections (rUTIs) are highly prevalent among women and can be challenging to manage for both clinicians and patients. This review aims to outline and analyze important studies relevant to clinical care and provide patient-centered recommendations. Recent Findings: The current literature supports that the treatment of rUTIs is multifaceted, and improving patient engagement requires clinical strategies that prioritize improving women's quality of life. Culture-directed treatment of recurrent infections to prevent collateral damage from antibiotics is supported by the 2019 Recurrent Uncomplicated Urinary Tract Infections in Women Guidelines published by the American Urological Association, Canadian Urology Association, and Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction. Qualitative studies have identified important considerations for patients such as antibiotic and non-antibiotic treatment options, financial costs, as well as physical and mental health impairments. Summary: Solely treating the physical symptoms caused by recurrent urinary tract infections without discussing prevention strategies and quality of life challenges caused by rUTIs will likely lead to poor patient engagement and satisfaction. Building a medical practice with ancillary physician support to expedite and increase convenience may help meet patient expectations and ease the burden of care identified in prior studies. Physicians should prioritize antibiotic stewardship and be mindful that microbiome research has demonstrated that healthy bladders have been found to have commensal bacteria, which may act as barriers against uropathogens, thus helping prevent urinary tract infections. Copyright © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Expert Group Opinion for Respiratory Infections in Solid Organ Transplant Recipients in South Asia

Respiratory infections are among the most common and serious infections after solid organ transplantation (SOT). Infections within a month after transplant are usually donor-derived or bacterial infections related to surgical infections or ventilator associated. Infections between 1-6 months after SOT are mostly opportunistic due to various viruses, or fungal infections. After 6 months of transplantation usually community acquired infections predominate, however it is not uncommon to find opportunistic fungal and viral infections in this period. The signs and symptoms of these infections are often mitigated in SOT recipients, so a high index of suspicion is required along with microbiological or tissue diagnosis early in the course to timely treat these infections. Thorough screening for common infections and endemic infections is required in donor and recipients before transplantation to reduce the risk of infections in posttransplant period. Finally, a longer duration of treatment and prophylaxis is required for adequately treat these infections and prevent the relapse. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.

Recurrent and De Novo Toxoplasmosis Retinochoroiditis following Coronavirus Disease 2019 Infection or Vaccination.

This study reports three cases of toxoplasmosis retinochoroiditis following coronavirus disease 2019 (COVID-19) infection or vaccination from the national Canadian COVID-19 Eye Registry between December 2020 and September 2021. A 56-year-old male presented 15 days after a positive COVID-19 test with toxoplasmosis retinochoroiditis. He later relapsed 8 days following a first Pfizer-BioNTech vaccine dose. Two patients presented with toxoplasmosis retinochoroiditis following COVID-19 vaccination: A 58-year-old female presenting 4 days following a first Pfizer-BioNTech vaccine dose with anterior uveitis and a posterior pole lesion discovered 3 months later and a 39-year-old female presenting 17 days after a first Moderna vaccine dose. Resolution was achieved with oral clindamycin, oral trimethoprim/sulfamethoxazole, and topical prednisolone acetate 1%. Patients were offered prophylactic trimethoprim/sulfamethoxazole for subsequent doses without relapse. Following COVID-19 infection or vaccination, patients may be at risk for toxoplasmosis retinochoroiditis. Prophylactic antibiotics for future doses may be offered to patients with known ocular toxoplasmosis to prevent recurrence.

PROSPECTIVE MULTICENTRIC STUDY ON INFECTIOUS COMPLICATIONS AND CLINICAL OUTCOME IN 230 UNFIT AML PATIENTS TREATED IN FIRST-LINE WITH HYPOMETHYLATING AGENTS ALONE OR IN COMBINATION WITH VENETOCLAX

Background: The hypomethylating agents (HMAs) are an important therapeutic option for older patients (pts) with AML and have become the backbone for combination regimens (eg, with Venetoclax). However, there are very limited real-life prospective studies regarding clinical outcome of these pts, including infectious complications and infection related mortality (IRM) during treatment. Aims: To investigate the infectious complications and clinical outcome in AML patients treated with HMAs± Venetoclax (V) outside of clinical trials. Methods: The recruitment of this prospective multicentric study (CE-Id-study:2908) has been completed on December 31, 2020. We enrolled 230 AML pts with a median age of 75 years (range 25-94);157 pts (68%) had >2 relevant comorbidities. Of the 230 cases, 132 (57%) received a first-line therapy with a combination of HMAs+V while 98 (43%) were treated with HMAs monotherapy (azacitidine or decitabine). A total of 1550 cycles of HMAs have been administered (680/1550 with HMAs+V). Results: The best response achieved, with HMAs treatment, was: CR in 44% of cases (57,6% with HMAs+V and 25,5% with HMAs alone, P=0,0001), PR in 17% and SD in 14% of cases (ORR 61%;72% in HMAS+V and 46% in HMAs alone, P=0,0007). The microbiological or radiological proven infectious complications (almost one) occurred in 160/230 (70%) of pts, mainly pneumonia (in 42% of pts) and/or bacteremia/sepsis (one or more events in 29% of pts). Febrile neutropenia (one or more episodes) occurred in 38% of pts and 14 cases of Covid-19 (6%) were reported. After a median follow-up of 9 months (1-24) from the start of HMAs therapy, 144 (63%) pts died and 86 (37%) were alive. The 1 yr OS probability was 46% with a median OS of 10,3 months (11 months in HMAs+V and 9 months in HMAs alone;P=ns). The primary causes of death were: progression of AML (42%), Infection (26%-37/144), Infection+AML (24%), other causes (8%). The IRM was 26% and 19/144 (13%) pts died of infectious complication while in CR/PR (16 in HMAs+V group and only 3 in HMAs group;P=0,005). Data on antibiotic prophylaxis, hospitalization, drugdoses modulation, are available and analyzed in this study. Summary/Conclusion: The results of this real-life, multicentric, prospective study, confirm a higher CR rate in pts treated with HMAs+V compared to HMAs alone (P=0,0001). However, we found a high rate of infectious complications and IRM (26%) with a higher infection related deaths in patients in CR/PR who were treated with HMAs+V (P=0,005). Findings from this study highlight the critical relevance of infection prevention in reducing infectious mortality, which adversely impacts the OS of this frail AML population.

General anaesthesia for operative obstetrics

General anaesthesia in obstetrics is reducing. Obstetric surgery is often urgent, requiring effective team communication and a rapid, focused preoperative assessment. Physiological changes of pregnancy increase the incidence of aspiration, desaturation and failed intubation. In addition, the rapidly evolving circumstances add additional stress impacting on performance. Hypotension from aortocaval compression is common and minimized by left lateral tilt or uterine displacement. Rapid sequence induction with tracheal intubation remains gold standard but supraglottic devices are advocated in the event of failed intubation. Awareness remains relatively common and adequate depth of anaesthesia should be maintained and monitored. Complications are more common in obese pregnant patients, whilst women with pre-eclampsia are at particular risk of hypertensive responses to intubation and extubation, intravenous opiates can ameliorate this. Improved multidisciplinary communication on the delivery suite allows for pre-emptive assessment of patients at risk of requiring an operative delivery. With diminishing individual experience of general anaesthesia in obstetrics and delivery suite often being covered by junior doctors, simulation exercises can improve confidence, performance and team working.

Liver enzyme changes following Covid-19 in patients with underlying liver diseases

Objectives: In the recent 2 years,a novel Covid-19 virus played a crucial role in development of severe respiratory and multiple organ failure, including liver.The aim of the study is determine liver injury in patients with underlying liver diseases and evaluate the effect of treatment. Materials and Methods: 137 patients (51% males, 49% females, mean age 34 years ± 6.5 with known liver diseases were admitted to our department for post-COVID control (median time post-infection 34 days ± 1.4). Previously, HBV was diagnoses in 18 (13.5%),mean ALT 31 (52.4-12.6),mean AST 24.8 (52.4-12.6), HCV in 43 (32% mean ALT 57 (195.1-16.9)mean AST 31.3 (61.9-17)), NAFLD/ NASH in 74 ( (54.5%)mean ALT 152.4 (1186 -19.7)mean AST 57.9 (70-19.4)). 22 (32.8%) have received antibiotic prophylaxis only, 25 (37% antiviral treatment (40% favipiravir,60% remdesivir)),9 (13.4%) had both antibiotics and antiviral treatment). Results: Median Elevation of ALT/AST was mostly observed in NASH/NAFLD group with pre-COVID high liver enzymes (median ALT value 42 IU/ml vs 98 IU/ml p<0.005;AST 26 IU/ml vs 84 p<0.005).Mixed treatment with both antibiotics (azithromycin) and Favipirovir was associated with higher elevation of liver enzyme in all groups. NASH/NAFLD patients had the highest elevation of liver enzymes following COVID among chronic liver disease groups. Conclusion: All Post-Covid patients, especially those with NASH/ NAFLD, regardless of the presence or absence of concurrent chronic liver disease, regardless of receiving antibiotics, require monitoring of liver function tests from the beginning of the disease.

Knowledge, Attitude and Perception of Dentists towards Special Care Dentistry in Chennai, India

Aim: The aim of this study was to investigate the Knowledge, attitude and perception of dentists towards special care dentistry. The objective was to evaluate the awareness of special care dentistry and its needs among dentists who were based in Chennai and also to determine the association between age range and willingness to participate in future special care training. Method: The study was designed as an online closed ended questionnaire based study and the dentists (n=101) were contacted via email. The data collected was computerized and analysed statistically using IBM SPSS software. Results: The frequency of the obtained data was depicted for understanding the knowledge, attitude and perception of dentists towards Special Care Dentistry (SCD). Chi-Square test was used for statistical analyses to determine the association between age range (20-30, 31-40, 41-50, and 51-60) and willingness to participate in future special care training courses. The result was statistically significant with chi-square value of 12.234 at p-value 0.007 (p<0.05). The association between age range and category of patients difficult to treat was not statistically significant at p-value 0.98. The association between gender and category of patients difficult to treat was not statistically significant at p-value 0.548. The association between dentist qualification and referral to special care specialists was not statistically significant at p-value 0.318. Conclusion: This study highlights the shortcomings in our dental curriculum as not all dentists had been mandatorily trained in delivering oral health care for special care patients.

Impact of collaborative physician-pharmacist stewardship strategies on prophylactic antibiotic practices: a quasi-experimental study.

BACKGROUND: An effective use of surgical antibiotic prophylaxis (SAP) appears essential to prevent the development of infections linked to surgery while inappropriate and excessive prescriptions of prophylactic antibiotics increase the risk of adverse effects, bacterial resistance and Clostridium difficile infections. In this study, we aimed to analyze SAP practices in an acute secondary hospital in Belgium during the years 2016-2021 in order to evaluate the impacts of combined stewardship interventions, implemented thanks to a physician-pharmacist collaboration. METHODS: A quasi-experimental study on SAP practices was conducted during 5 years (2016-2021) in a Belgian University Hospital. We first performed a retrospective observational transversal study on a baseline group (2016.1-2016.4). Then, we constituted a group of patients (2017.1-2017.4) to test a combined intervention strategy of stewardship which integrated the central role of a pharmacist in antibiotic stewardship team and in the pre-operative delivery of nominative kits of antibiotics adapted to patient factors. After this test, we collected patient data (2018.1-2018.4) to evaluate the sustained effects of stewardship interventions. Furthermore, we evaluated SAP practices (2019.1-2019.4) after the diffusion of a computerized decision support system. Finally, we analyzed SAP practices in the context of the COVID-19 pandemic (2020.1-2020.4 and 2021.1-2021.4). The groups were compared from year to year in terms of compliance to institutional guidelines, as evaluated from seven criteria (χ2 test). RESULTS: In total, 760 surgical interventions were recorded. The observational study within the baseline group showed that true penicillin allergy, certain types of surgery and certain practitioners were associated with non-compliance (p < 0.05). Compared with the baseline group, the compliance was significantly increased in the test group for all seven criteria assessed (p < 0.05). However, the effects were not fully sustained after discontinuation of the active interventions. Following the diffusion of the computerized decision support system, the compliance to guidelines was not significantly improved. Finally, the COVID-19 pandemic did not appear to affect the practices in terms of compliance to guidelines. CONCLUSIONS: This study shows that optimization of SAP practices is achievable within a proactive multidisciplinary approach including real-time pharmaceutical interventions in the operating area and in the care units practicing SAP.

Sustainability in quality improvement project to reduce SSI;Redefining value!

Objective: Sustainability in a QIP is a pivotal domain of quality in healthcare. It induces the need of implementing changes in a QIP which add value to the results. In a secondary level hospital of Qatar, a quality improvement project was proposed to reduce the SSIs from 8.3% in 2013. SSI rates were reduced to 1.47% in 2016. However, it was noted that in women with high risk for wound infection, the SSIs rate increased to 10.71% in the last quarter of 2016. To make the project sustainable, in the second quarter of the year 2017, changes were implemented, and antibiotic prophylaxis was given to high-risk cases and the results were evaluated. Design: Quality Improvement Project (QIP) Methods: PDSA cycle was implemented. All women operated at our hospital by either elective or emergency Cesarean from third quarter of 2017 to 2020 were included. Women who were operated in other facilities with SSIs were excluded. A total of 8372 women were delivered by Cesarean section during the study period. Extended use of antibiotics was implemented for 48 h in patients with high risk of SSI. SSIs rate was considered as the key performance indicator and statistical evaluation (odds' ratio) was carried out using online statistical software. Results: The overall SSIs rate observed after implementation of changes was 1.51%. Significant decrease was noted (3.26% vs. 1.51%) (p < 0.001). In the first quarter of 2017, the SSIs rate was 2.73%. After the completion of 14 quarters of the project in 2020, results were analyzed. In the last two quarters of 2019, a significant decrease in SSIs was noted and the SSIs rate reduced to less than one percent. Due to the COVID-19 pandemic, post-operative wound evaluation was done by telephonic consultation by midwives. During this period the rate of SSIs increased to 2.60% in the last quarter of 2020. However, there was insignificant increase in the annual rate of SSIs (1.8% vs. 1.51%). Face to face appointments were re-started as the cases of COVID-19 decreased in the country in 2021. Conclusion: The project led to a great impact on quality. It reduced the rates of SSRIs significantly. Reduced the duration of hospital stay and the cost of care. It also reduced the re-admissions due to SSIs. This project clearly proves that sustainability improves quality by immediate benefits and motivates changes that redefine value.

Nebulized Amphotericin B in Mechanically Ventilated COVID-19 Patients to Prevent Invasive Pulmonary Aspergillosis: A Retrospective Cohort Study.

Despite high mortality rates of COVID-19-associated pulmonary aspergillosis (CAPA) in the ICU, antifungal prophylaxis remains a subject of debate. We initiated nebulized conventional amphotericin B (c-AmB) as antifungal prophylaxis in COVID-19 patients on invasive mechanical ventilation (IMV). OBJECTIVES: To assess the CAPA incidence in COVID-19 patients on IMV treated with and without nebulized c-AmB as antifungal prophylaxis. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study of consecutive COVID-19 patients admitted to our adult 17-bed ICU in a university-affiliated general hospital in Ede, The Netherlands, between January 25, 2021, and July 9, 2021. Patients not requiring IMV or transferred from or to another ICU were excluded. From April 9, 2021, daily nebulized amphotericin B in all patients on IMV was initiated. MAIN OUTCOMES AND MEASURES: Bronchoscopy with bronchoalveolar lavage (BAL) was performed in case of positive cultures for Aspergillus from the respiratory tract and/or unexplained respiratory deterioration. Incidence of probable and proven CAPA was compared between patients treated with and without nebulized antifungal prophylaxis using Pearson chi-square test. RESULTS: A total of 39 intubated COVID-19 patients could be analyzed, of which 16 were treated with antifungal prophylaxis and 23 were not. Twenty-six patients underwent bronchoscopy with BAL. In patients treated with antifungal prophylaxis, the incidence of probable/proven CAPA was significantly lower when compared with no antifungal prophylaxis (27% vs 67%; p = 0.047). Incidence of tracheobronchial lesions and positive Aspergillus cultures and BAL-galactomannan was significantly lower in patients treated with antifungal prophylaxis (9% vs 47%; p = 0.040, 9% vs 53%; p = 0.044, and 20% vs 60%; p = 0.047, respectively). No treatment-related adverse events and no case of proven CAPA were encountered in patients receiving antifungal prophylaxis. CONCLUSIONS AND RELEVANCE: Nebulization of c-AmB in critically ill COVID-19 patients on IMV is safe and may be considered as antifungal prophylaxis to prevent CAPA. However, a randomized controlled trial to confirm this is warranted.

BLOODSTREAM INFECTIONS IN COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Many COVID-19 studies are about epidemiological and clinical features but information about secondary bacterial infections is limited. The present study was conducted to determine the prevalence and characteristics of bloodstream infections in COVID-19 patients admitted to a tertiary care academic health care organization. All blood samples were obtained from patients with COVID-19 admitted were included in the study. Blood cultures were performed using BD BACTEC ™ FX40, and the diagnosis and bacterial identification and antimicrobial sensitivity was performed by manual method. 2200 patients with COVID-19 were hospitalized during a 6-month study period in which 315 blood cultures were performed. Of these, 24 (7.61%) were positive. The median age of patients with positive blood culture was 38 years and included 13 males and 11 females. Seventeen patients (70.83%) needed intensive care in the ICU. Significant correlations with blood culture positivity have been noted with parameters such as admission to the ICU, availability of accommodation, basic illness and adverse clinical outcomes. Bloodstream infections prevalence in COVID-19 patients is low. However, antibiotic prophylaxis needs to be used with caution, and immediate discontinuation should be made based on clinical judgment.

Compassionate Use of an Anti-C5 Inhibitor, Nomacopan, Positively Influenced the Course and Progression of Disease in Covid-19

Background Originally derived from tick-saliva, nomacopan is a first-in-class dual inhibitor of leukotriene B4 (LTB4) and complement C5. Nomacopan (Coversin) is currently in Phase III development for bullous pemphigoid and HSCT-TMA. In this study, we used nomacopan to treat a small cohort of COVID-19 patients on a compassionate basis. We concurrently present data from a study of biomarkers within a larger cohort of COVID-19 patients, where hyperinflammatory pathways due to complement are highlighted. Methods Patients, healthy-controls and sub-groups recruited to this study are summarised in Figure 1. Betweengroup comparisons in demographic, clinical and biomarker levels were carried out using Kruskal-Wallis and rank-Wilcoxon tests. ROX. SpO2Seven patients (six males and one female) in the CORONET study were treated with nomacopan (1st initial subcutaneous-dose: 45mg of nomacopan (t1/2 = 2.5 hrs), + 2 doses;45 mg, 12-hourly. Subsequently, patients were administered 45mg, od for 12 days. Antibiotic prophylaxis was co-administered. Results ROX indices for patients at enrolment within the CASCADE and CORONET studies were lower than that for normal-healthy individuals, with SpO2 <93%, admitted to ICU or COVID-19 Unit with suspected COVID-19 pneumonia and not on invasive mechanical ventilation on recruitment. Average values for SOFA and NEWS scores were significantly different (p<0.05) between the clinical severities. Values for SOFA and NEWS score were not available for the CORONET study patients.CH50, sC5b-9, C5, C5a, C3, and C3a levels were elevated significantly in CASCADE patients (p<0.05, C.I. 95%).Of the seven patients in the CORONET study, six survived, one (female) died, due to unforeseen circumstances (three days delay to get treatment delivered) from start of symptom onset before starting nomacopan treatment. Conclusion The result of this combined study shows that COVID-19 patients, admitted to hospital with significant symptoms of respiratory difficulty, demonstrated increased circulating levels of components of the complement cascade, potentially linked to lung damage leading to fatality. Interestingly, C5-levels (target of nomacopan) was increased, validating the rationale for anti-C5 treatment of COVID-19 patients. Nomacopan treatment was associated with no noticeable adverse event and without highly elevated as associated with normal C5 and C5a levels. (Figure Presented).

Health Care–Associated Infections: Best Practices for Prevention

Health care–associated infections (HAIs) are a significant cause of morbidity and mortality in the United States. Common examples include catheter-associated urinary tract infections, central line–associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and Clostridioides difficile infections. Standardized infection control processes and precautions have been shown to reduce the rate of HAIs, and targeted practices for HAIs have shown further reductions. Patient safety tools have been developed for various HAIs to help guide administrators and are free for public use through the Centers for Disease Control and Prevention STRIVE (States Targeting Reduction in Infections via Engagement) initiative. The Choosing Wisely initiative makes best practice recommendations for physicians to improve quality of care and reduce costs;targeted recommendations were developed to reduce the risk of HAIs. For example, using invasive devices only when indicated and for the shortest time possible reduces the risk of device-related HAIs. The goal of antibiotic stewardship is to reduce C. difficile infections and further development of multidrug-resistant organisms such as vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae. Antibiotic stewardship targets physician behaviors such as reviewing antibiotic therapy choices every 48 to 72 hours, reviewing culture results as soon as available, de-escalating antibiotic therapy when appropriate, and documenting the indications for initiating and continuing antibiotic therapy.

Incidence of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone.

Surgical site infections (SSIs) are common postoperative complications. Surgical antibiotic prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine the incidence of SSIs and assess whether SAP were administered according to WHO guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional government hospital from November 2019 to October 2020. The analysis included 681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7% among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy patients, respectively. SAP was administered preoperatively in 85% of CS and 70% of herniorrhaphy patients. Postoperative antibiotics were prescribed to 85% of CS and 100% of herniorrhaphy patients. Ampicillin, metronidazole, and amoxicillin were the most commonly used antibiotics. The relatively low rate of SSIs observed in this study is probably due to improved infection prevention and control (IPC) measures following the Ebola outbreak and the current COVID-19 pandemic. A good compliance rate with WHO guidelines for preoperative SAP was observed. However, there was a high use of postoperative antibiotics, which is not in line with WHO guidelines. Recommendations were made to ensure the appropriate administration of SAP and reduce unnecessary use of antibiotics.