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The oral cavity houses a large number of microorganisms that are potential pathogens, such as cytome-galovirus, hepatitis B virus (HBV), hepatitis C virus, herpes simplex virus types 1 and 2, human immuno-deficiency virus, mycobacterium tuberculosis and currently with the appearance of the SARS COV-2 that causes covid-19, the dental community must take stricter measures in its protection protocols against diseases. To evaluate its germicidal efficacy, ultraviolet light was applied with different exposure times on the alginate dental impressions, immediately after having taken the impression, which when it came into contact with the oral cavity of the patient is contaminated. As a result, a decrease in size and quantity of the bacterial colonies was observed in most of the samples in which the UV LED light was applied at 10 and 15 minutes of exposure. Some samples showed less bacterial growth even after 5 minutes of exposure. All this confirms its germicidal capacity thanks to its 245 nm ultraviolet spectrum that affects the DNA and RNA chain of microorganisms since it is the wavelength of maximum absorption of its molecule, eliminating its reproductive and survival capacity. The advantages it offers such as its small size, easy to handle and install, that it does not require constant maintenance, low acquisition cost;its constant high intensity light that does not generate any increase in temperature, makes it an excellent disinfectant auxiliary that can be incorporated into dental clinics.Copyright © 2023, Ediciones Avances S.L.. All rights reserved.
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Background and Aims: The covid-19 pandemic has reversed years of progress in the fight to end tuberculosis. So, the discovery of new drugs as antituberculosis is very much needed. Our previous studies have shown that the extract of Centella asiatica is able to inhibit the growth of Mycobacterium tuberculosis in vitro and requires further research. The aims of this study is to prove the effect of Centella asiatica inhibit Mycobacterium tuberculosis in rat model tuberculosis. Method(s): The protocol in this study was approved by the veterinary ethics committee of Airlangga University. The rat tuberculosis model was induced by intrathecal injection of a suspension of Mycobacterium tuberculosis strain H37 Rv. Twenty-eight tuberculosis rat were randomly divided into four groups. Groups 1,2, and 3 were treated with ethanol extract of Centella asiatica at 375 mg/kgBW, 750 mg/kgBW and 1500 mg/kgBW, and the fourth group was the control group. Centella asiatica extract is administered orally via an intragastric feeding tube for two weeks, once daily At the end of the experimental period, rats were sacrificed by cervical decapitation. The left lung tissue was taken aseptically and cultured on Middlebrook 7H10. Result(s): The results showed that there was no bacterial growth on the culture media in the group that received Centella asiatica extract at a dose of 750 and 1500 mg/kg BW. Conclusion(s): The conclusion in this study, that Centella asiatica extract inhibit the growth of Mycobacterium tuberculosis at doses of 750 and 1500 mg/kg BW. We thank the Directorate of Research and Community Services, the Directorate General of Higher Education, and Ministry of Education and Culture in Indonesia for the financial supportCopyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
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Mask-wearing during the ongoing COVID-19 pandemic has been associated with an increased occurrence of a form of acne mechanica, popularly termed 'maskne. However, our understanding of this entity is limited. Hence we aimed to study the role of changes in the skin microbiome in mask induced acne and its response to standard acne treatment regimens. This was a prospective observational study. Adult patients having new-onset of lesions suggestive of acne within 6 weeks of regularly wearing mask or exacerbation of pre-existing acne were recruited. Disease severity was assessed using the 'Global Acne Severity Grading System (GAGS). Sample collection was done from pustules or comedones. Treatment was given according to American Academy of Dermatology Guidelines and follow up was done till 12 weeks. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) v.25. Total 50 patients were recruited in the study. 56% patients were female and 44% were male. 60% patients had a history of similar lesions in the past. 56% patients used surgical mask, 34 % used N-95 mask and 18 % used cloth mask. The average duration of use for mask per day was 6.78 +/- 2.65. Cheeks were the most commonly involved site and 62% of patients had mild GAGS. The severity of acne was significantly higher in patients using N-95 mask ( p<0.05) but not associated with duration of mask use, history of mask re-use and use of moisturizers. 70% cases did not require systemic treatment. KOH was negative in all cases. Gram stain showed gram positive cocci and rods in 22% and 14 % cases respectively. Aerobic culture showed Staphylococcus aureus growth in 30% cases and Anaerobic culture showed Cutibacterum acnes growth in 20% cases. In our study we found that maskne presented with a milder variant of acne which in majority of cases responded well to topical treatment standardized for acne vulgaris and had a microbiome profile similar to acne vulgaris.Copyright © 2023
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Herbal plant extracts or purified phytocomponents have been extensively used to treat several diseases since ancient times. The Indian Ayurvedic system and Chinese traditional medicines have documented the medicinal properties of important herbs. In Ayurveda, the polyherbal formulation is known to exhibit better therapeutic efficacy compared to a single herb. This review focuses on six key ayurvedic herbal plants namely, Tinospora cordifolia, Withania somnifera, Glycyrrhiza glabra/Licorice, Zingiber officinale, Emblica officinalis and Ocimum sanctum. These plants possess specific phytocomponents that aid them in fighting infections and keeping body healthy and stress-free. Plants were selected due to their reported antimicrobial and anti-inflammatory effects in several diseases and effectiveness in controlling viral pathogenesis. An ad-vanced literature search was carried out using Pubmed and google scholar. Result(s): These medicinal plants are known to exhibit several protective features against various diseases or infections. Here we have particularly emphasized on antioxidant, anti-inflammatory, anti-microbial and immunomodulatory properties which are common in these six plants. Recent literature analysis has revealed Ashwagandha to be protective for Covid-19 too. The formulation from such herbs can exhibit synergism and hence better effectiveness against infection and related dis-eases. The importance of these medicinal herbs becomes highly prominent as it maintains the har-monious balance by way of boosting the immunity in a human body. Further, greater mechanistic analyses are required to prove their efficacy in fighting infectious diseases like Covid-19. It opens the arena for in-depth research of identifying and isolating the active components from these herbs and evaluating their potency to inhibit viral infections as polyherbal formulations.Copyright © 2023 Bentham Science Publishers.
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Background: Honey has been used medicinally in folk medicine since the dawn of civili-zation. It is a necessary component of medicine and food in a wide variety of cultures. It has been used in Unani Medicine for centuries to treat a variety of ailments. Objective(s): This review article aims to explore the medicinal characteristics of honey in view of Unani and modern concepts, highlight its potential in the treatment of the ailments stated in Unani medical literature, and also explore the relevant evidence-based phytochemistry, pharmacological, and clinical data. Method(s): The authors searched classical texts exhaustively for information on the temperament (Mizaj), pharmacological activities, mechanism of action, and therapeutic benefits of honey. Addition-ally, a comprehensive search of internet databases was conducted to compile all available information on the physicochemical, phytochemical, and pharmacological properties of this compound. Result(s): Evidence suggests that honey contains about 180 different types of various compounds, including carbohydrates, proteins, enzymes, flavonoids, and other chemical substances. In Unani classical literature, it exerts important pharmacological actions besides its immense nutritional signifi-cance. Unani physicians advocated many tested/experimented prescriptions and formulations, which still have their relevance in the amelioration of various diseases. Conclusion(s): This analysis concludes that honey has been successfully utilized in Unani medicine for centuries to treat a variety of maladies and is a potential natural source of remedy for a variety of medical disorders. Future research on honey should include a combination of Unani and modern principles.Copyright © 2023 Bentham Science Publishers.
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Background Bacterial pericarditis represents < 1 % of all cases of pericarditis in the United States. Most cases of bacterial pericarditis are from contiguous spread from underlying pneumonia or mediastinitis. We present a case of pneumococcal pericarditis in a patient with untreated pneumonia. Case A 54-year-old male with a past medical history of recent COVID-19 pneumonia presented with worsening dyspnea for the past 3 weeks. Vitals were T 99.3, BP 122/93, HR 159 BPM, O2 sat 94% on 3 L NC. ECG demonstrated atrial flutter with 2:1 block. CT scan demonstrated a pericardial effusion and bilateral pleural effusions. Decision-making In the ED, he became hypotensive and bedside echo demonstrated large pericardial effusion with RV collapse. Emergent pericardiocentesis produced 750 cc of purulent fluid. Streptococcus pneumoniae was isolated from the initial fluid aspirate. Right thoracostomy tube was placed with pleural fluid gram stain and culture without bacterial growth. Due to continued purulent drainage from the pericardial drain, repeat CT scan demonstrated persistent pericardial effusion and loculated right sided pleural effusion. He underwent video-assisted thoracoscopic surgery with pericardial wash out and window. He improved and was discharged with 6 weeks of Ceftriaxone. Conclusion Purulent pericarditis is typically a fulminant disease associated with high mortality and rapid progression. Prompt identification and management is critical for patient survival. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background: Multisystem inflammatory syndrome in children (MIS-C), causing high morbidity and mortality, is the hyperinflammatory response following COVID-19 infection (CI). According to the MISC management guideline, Anakinra (anti-IL1) is the preferable agent among other biologic agents: Infliximab, Tocilizumab (TCZ), and baricitinib if the patient is refractory to intravenous immunoglobulin (IVIG) and systemic corticosteroid (CS). However, these are not available in a number of countries, including Thailand. Our case represents refractory MIS-C in a systemic juvenile idiopathic arthritis (SJIA) patient responding well to TCZ. Method(s): Diagnostic investigations, including basic and immunological blood tests, and echocardiography assessment, were conducted. Result(s): A 12-year- old boy has been diagnosed with SJIA since he was 2 years old, according to the presentation of prolonged fever, hepatomegaly, and evanescent rash. CS, cyclosporin-a, and TCZ have been prescribed, and he has been in clinical remission off medication for two years. He experienced acute fever, rash, shortness of breath, nausea and vomiting for few days. Physical examination revealed a febrile boy with respiratory failure, compensated shock, and a generalized persistent maculopapular rash. The other was unremarkable. MIS-C was one of the possible diagnoses according to fever accompanied by more than two systems involved and his previous CI four weeks prior. Laboratory investigation revealed an elevated inflammatory response (Figure 1). The echocardiography was done by an experienced cardiologist with concern for myocardial dysfunction in MIS-C and showed a significant poor ejection fraction of the left ventricle of 42% under dobutamine, milrinone, and norepinephrine. Broad spectrum antibiotics and IVIG (1 g/kg/dose for two days) were initiated. After hemoculture did not report bacteria growth, pulse intravenous methylprednisolone (IVMP) 1000 mg for 3 days was given for the MIS-C treatment. After initial aggressive treatment with IVIG and pulse IVMP, the patient still has a high grade fever with laboratory revealed ongoing elevated inflammatory markers. The other possible causes of fever, such as infection and active SJIA were suspected. Immunological profiles returned with positive SAR-COV2 IgG, negative SAR-COV2 IgM, which confirmed the diagnosis of MIS-C with refractory to IVIG and CS. After multidisciplinary team discussion, TCZ was given. He had neither fever, dyspnea, nor heart failure. His clinical condition gradually improves together with laboratory parameters (Figure 1). Conclusion(s): In conclusion, our case demonstrated TCZ as a potential therapeutic agent in refractory MIS-C patients living in countries with limited access to anti-IL1 agents. The multidisciplinary care team together with prompt management is advisable to the best benefit of the patient. (Figure Presented).
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Background: Urogynaecological problems are the gynae related disorders of urinary system which affect women during pregnancy and postpartum period. Covid-19 also had an impact on these disorders. Objective(s): The main objective of this study is to find out how urogynaecological problems occur in pregnancy and postpartum period and how these problems were managed during covid 19. Study Design: Cross-sectional study Place and Duration: Gynaecology and Obstetrics department of Al-Nafees Medical College and Hospital, Islamabad, from 5th February 2020 to 6th August 2021. Method(s): We included 220 pregnant women in our study. Their age, body mass index, gestational age, mode of delivery, fetal age at the time of delivery were measured. Prevalence of urogynaecological problems in pregnant women was also noted. Among these 220 females, 50 females got infected with covid. We compared their complications with complications of pregnant women who weren't infected with covid. Result(s): Body mass index of pregnant women with urogynaecological problems was 22 to 36 kg/m2. 12 to 14 kg weight increased during pregnancy. Gestational age at delivery was 38 to 42 weeks. Fetal weight was 2 to 4 kg at the time of birth. 62% women had vaginal mode of delivery while 38% had cesarian. Prevalence of urinary tract infections was 7%, stress urinary incontinence was 18 to 70%, uterine prolapse was 5 to 8% in pregnant women. 45% pregnant women had increased micturition frequency. Their were also some chances of formation of renal stones during pregnancy. Pregnant women who got infected with covid -19 had to face several other complications as well. These complications were managed with hygiene behaviour, balanced diet, exercise and medications. Conclusion(s): Urogynaecological problems are commonly found in pregnant women due to enlargement of kidneys and increased GFR during pregnancy. During pregnancy, uterus size increases which leads to compression of ureters and increased bacterial growth. Increased growth of bacteria causes urinary tract infections. Vaginal mode of delivery increases the risk of uterine prolapse. Covid-19 also had an impact on urogynaecological problems. These problems were managed during pandemic by avoiding direct contact. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Aim. To study the prevalence of the small intestinal bacterial overgrowth syndrome in patients with irritable bowel syndrome with diarrhea who have had COVID-19 infection. Materials and methods. 60 patients with irritable bowel syndrome with diarrhea were examined. In 30 patients, irritable bowel syndrome was diagnosed after COVID-19 infection (main group). The comparison group consisted of 30 patients with classical stress-induced irritable bowel syndrome. The small intestinal bacterial overgrowth syndrome was diagnosed using a hydrogen breath test with lactulose loading in all patients. Results. In main group the small intestinal bacterial overgrowth syndrome was diagnosed in 93.3 % patients, which was statistically significantly higher (p < 0.01) relative to the comparison group - 60.0 % patients Conclusion. Irritable bowel syndrome in patients who have undergone COVID-19 occurs against the background of the small intestinal bacterial overgrowth syndrome development. © 2022 Russian Journal of Gastroenterology, Hepatology, Coloproctology
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Background The evaluation of coronavirus disease 2019 (COVID-19) patients with respiratory secondary bacterial infection, and the causative pathogens, is crucial for the treatment plan of those patients and to ensure the effective needed treatment with antibiotics and to decrease its abuse. Aim To clarify the incidence of bacterial infection in patients with COVID-19 and sensitivity to antibiotics. Patients and methods Samples of sputum were collected from 120 patients with confirmed COVID-19 by clinical, laboratory, radiological signs of pneumonia, or PCR, the severity of COVID-19 was classified as moderate and severe. The moderate type included patients with pneumonia without hypoxemia. The severe type was characterized by (a) dyspnea (respiratory rate >=30/min), (b) blood oxygen saturation less than or equal to 93%, and (c) PaO2 /FiO2 ratio less than 300 or lung infiltrates more than 50%. If one of the above items was met, it was classified as severe. Then, all cases were sent for screening of the presence of secondary bacterial infections by quantitative sputum bacterial culture and sensitivity. Positive cases of bacterial infection were classified into patients with early bacterial infection less than 15 days from COVID-19 infection and patients with late bacterial infections after more than 15 days of COVID-19 infection. Results In total, 40 (33.3%) cases out of 120 cases of COVID-19 showed bacterial growth, while 80 (66.7%) cases were negative for bacterial secondary infection. The most common organisms isolated were Klebsiella pneumoniae 12 cases, streptococci 10 cases, MERSA eight cases, Escherichia coli five cases and mixed infection by E. coli, Klebsiella, and Candida in five cases, Staphylococcus aureus was the same rate in early and late infections, all streptococci were early infection, and more cases of K. pneumoniae were late infection nine cases out of 13, where E. coli was early infection four cases out of five. All mixed infections were late. Conclusion Hidden secondary bacterial infection should be screened in COVID-19 patients. Early bacterial infections and moderate COVID-19 pneumonia are mainly caused by Gram-positive bacteria, but late bacterial infections and severe COVID-19 pneumonia are mainly caused by Gram-negative bacteria. Copyright © 2022 Indian Journal of Anaesthesia Published by Wolters Kluwer - Medknow.
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INTRODUCTION: Legionella is an important cause of community acquired pneumonia. Here we describe a case with strong clinical suspicion of Legionella pneumonia despite negative urine antigen but confirmed by polymerase chain reaction (PCR) test on a lower respiratory sample. DESCRIPTION: A 52-year-old male, nonsmoker with unremarkable past medical history presented with a 4-day history of fever, nonproductive cough, and malaise, after returning from a trip to Italy. He underwent Computed Tomography Angiography (CTA) chest which revealed bilateral lung infiltrates at Urgent Care. Both Rapid Ag and PCR test for SARS CoV-2 were negative. He was vaccinated against SARS-CoV2. On hospital admission his oxygen saturation was 85% on room air. Lab work revealed white blood cell (WBC) 22.5, Hemoglobin 12.8, Platelets 397 with 96% neutrophils. His Sodium was 135 mmol/L (135- 146), CRP 433.2 mg/L (normal < 5). Respiratory PCR was negative for Influenza A, B, RSV. Urine Pneumococcal and Legionella Ag were negative. He was started on Ceftriaxone and Azithromycin. He developed rapidly progressing respiratory failure leading to intubation, prone positioning, inhaled Prostacyclin due to significant hypoxia (P/F ratio 57). His antibiotics were changed to high dose Levofloxacin (750 mg IV Q Day) because of strong suspicion of Legionella. He underwent bronchoscopy with BAL and the PCR came back positive for Legionella. The patient was extubated in 48 hours and discharged home after a 10-day course of Levaquin. The BAL sample was sent to Centers for Disease Control and Prevention (CDC) which identified Legionella species as serotype 1. DISCUSSION: Legionella are gram negative facultative intracellular bacteria with soil and water as reservoirs. Legionella grows poorly on routine culture media. Urine antigen (Ag) testing has a sensitivity of 75% and detects Legionella pneumophilia serotype 1, the dominant cause (80% of cases) but does not detect the other 30 Legionella species that have been isolated from humans. A lower respiratory PCR detects other serotypes and perhaps is more sensitive than urine Ag in detecting serotype 1. If clinical suspicion of Legionella is high PCR must be performed on a lower respiratory sample and one must not solely rely on a negative Urinary Ag test.
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Background. P. aeruginosa is a cause of hospital-acquired and ventilatorassociated pneumonia. Hypermutator P. aeruginosa strains have been described in patients with cystic fibrosis and chronic respiratory infections but are rare in patients with acute P. aeruginosa infection. This case describes a hypermutator strain of P. aeruginosa found in a patient with COVID-19-associated acute respiratory distress syndrome (ARDS). Methods. Serial respiratory and blood cultures were collected. Short-read sequencing libraries were prepared using the Illumina Nextera XT kit, and wholegenome sequencing was performed using the Illumina NextSeq platform. Long-read sequencing libraries were prepared from unsheared genomic DNA using ligation sequencing kit SQK-LSK109 and sequenced on the Oxford MinION platform. Single nucleotide variants were identified by aligning reads from each isolate to the complete genome of the first available clinical isolate. Hypermutator assays were performed by measuring the mutation frequency rate for rifampin resistance. Antibiotic minimal inhibitory concentrations (MICs) were performed. Growth curves were performed with a starting OD600 of 0.1 with measurements taken every 30 minutes for 24 hours. Results. Seventeen respiratory and five blood isolates were obtained throughout 62 days of hospitalization. Fourteen of the 22 isolates exhibited hypermutator phenotypes by rifampin resistance assays, which demonstrated rapid accumulation of mutations. All five bloodstream isolates were hypermutators. MIC testing noted increased resistance to aminoglycosides, fluoroquinolones, and aztreonam in the hypermutator isolates. All bloodstream isolates descended from a single progenitor noted on whole-genome sequencing. Each hypermutator strain contained a mutation in the mismatch repair gene mutL, previously associated with the hypermutator phenotype. Genetic Tree of Patient Isolates The genetic tree highlights hypermutator versus non-hypermutator single nucleotide variants Conclusion. This case was notable for multiple isolates of hypermutator P. aeruginosa that persisted over weeks. The patient's COVID-19 infection and acute respiratory distress syndrome may have facilitated persistence of the P. aeruginosa lineage, allowing a hypermutator lineage to emerge.
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Background. COVID-19 associated pulmonary aspergillosis (CAPA) is a known complication of COVID-19 which carries a high mortality rate. While there are proposed diagnostic criteria, CAPA remains likely underdiagnosed. Our objectives are to evaluate markers of disease severity, bacterial coinfections, and outcome measures in order to assess the clinical impact of CAPA in patients admitted with COVID-19. Methods. A retrospective chart review was performed on all adult patients admitted to a single-center, tertiary hospital from March 1, 2020 to May 1, 2022 with a positive COVID-19 PCR and probable or proven CAPA based on ECMM/ ISHAM consensus criteria. Admission data, ICU status, time to CAPA diagnosis, respiratory cultures, and 90-day mortality were identified. Results. 14 patients met criteria for probable CAPA. 10 of 14 patients (71.4%) were immediately admitted to the ICU. By day 14, 13 patients (92.9%) were intubated. The average time from admission to CAPA diagnosis was 31.3 days. 12 patients were diagnosed by BAL galactomannan, while 2 patients were diagnosed by growth on respiratory culture. 12 patients (85.7%) also had bacterial growth on respiratory cultures. The most common pathogen was Staphylococcus aureus, which was seen in 6 patients. All-cause mortality was 42.8%, or 6 of 14 patients, at day 90. In patients with a CAPA diagnosis, the average length of ICU stay was 36.4 days and average total hospital length of stay was 43.6 days, compared to 6.3 and 12.5 days, respectively, for all patients admitted with COVID-19 disease. Conclusion. CAPA is a rare complication of COVID-19 but had substantial negative impacts on affected patients. The late onset of CAPA may be a result from longer hospitalizations and increased healthcare-associated infections. The association of CAPA with bacterial coinfections is consistent with literature on other viral infections such as influenza predisposing to secondary pneumonias. As the majority of cases were diagnosed by galactomannan rather than culture, providers should have a low threshold for testing in patients with protracted hospitalization for COVID-19. This case series emphasizes the poor outcomes associated with CAPA and its burden on already strained hospital resources, highlighting the need for improved disease awareness and further study.
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Background. Antibiotic overuse has been well described among hospitalized adults with COVID-19 but similar evaluations in children are lacking. We sought to quantify bacterial infection rates and antibiotic utilization among critically ill children hospitalized with COVID-19 to identify opportunities to optimize care. Methods. We performed a single center retrospective cohort study of all children hospitalized with symptomatic COVID-19 in a pediatric intensive care unit between May 16, 2020 and February 11, 2022 at a tertiary care children's hospital in the Southeastern U.S. We performed medical record review to demographic and clinical characteristics. This study was approved by the institutional IRB with a waiver of consent. Results. During the study period there were 92 subjects hospitalized in the intensive care unit with COVID-19. Demographic and clinical characteristics of the cohort are summarized in the Table. Median age was 12.4 years, median length of stay was 6 days, 32% of subjects required mechanical ventilation and 5% died. The vast majority of children had one or more comorbidities and only 1 subject was fully vaccinated against SARS-CoV-2. Thirteen (14%) subjects had bacterial growth from any clinical specimen. Eight subjects had respiratory cultures that may have represented airway colonization;when these were excluded, 5 (5%) subjects had either urinary tract or bloodstream infections. Two of the bloodstream infections were caused by drug-resistant organisms and were hospital-acquired. Despite the low number of subjects with bacterial infections, 45% received antibiotics for >3 days. The antibiotic days of therapy per subject varied widely and ranged from 0 to 61 days. Conclusion. In this cohort of nearly 100 critically ill children with COVID-19, the rate of culture-confirmed bacterial infection ranged from 5-14% yet nearly half of patients received antibiotics. Limitations include the single center and retrospective study design and the fact that bacterial pneumonia may not be cultureconfirmed. Despite these limitations, this work suggests that children with COVID-19 rarely have bacterial co-infections and are often prescribed unnecessary antibiotics.
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Background. Hospitalized COVID-19 patients with severe pneumonia are commonly treated for secondary bacterial pneumonia. The Biofire pneumonia panel, a rapid molecular diagnostic tool with 18 bacterial, 8 viral and 7 resistance gene targets, was made available to critical care and infectious disease clinicians in May 2020 at our institution. We sought to describe its utilization and influence on antibiotic use in patients hospitalized with COVID-19 lower respiratory tract infection (LRTI). Methods. Eligible patients with COVID-19 LRTI (positive PCR test and abnormal chest imaging) had sputum or bronchoalveolar lavage pneumonia panel (PNP) paired with a respiratory tract culture between May 4 and Dec. 8, 2020, were included. Demographics, comorbidities, clinical data including microbiologic testing, PNP indication( s), and antibiotic use after testing were ed through chart review. Descriptive statistics were utilized. Results. Characteristics of 133 patients are provided in Table 1. Median age was 61 years, 93 (70%)weremale, 93 (70%)weremechanically ventilated, and 68 (51%) died within 30 days on PNP testing. PNP results, including culture results are listed in Table 2. No target was identified in 63 (47%) patients. Staphylococcus aureus was the most common bacterial isolate identified (MSSA in 32 [24%], MRSA in 8 [6%]) with culture growth in 21 specimens. More than 1 target was identified in 29 patients (22%). Empiric antibiotics and subsequent modifications within 24h hours of pneumonia panel are provided in Table 3. Vancomycin and cefepime were most frequently prescribed. Antibioticmodifications were made in 71/133 patients. Cessation of the anti-MRSA agent occurred in 39/72 (54%) of eligible patients and the anti-Pseudomonal agent in 21/78 (27%). Conclusion. The PNP is a useful tool to evaluate secondary bacterial pneumonia in critically ill COVID-19 patients and may assist clinicians and antimicrobial stewardship programs in expedited antibiotic discontinuation or de-escalation particularly where rates of secondary bacterial infection are low, such as COVID-19 LRTI. (Table Presented).
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Background. Hospitals have been experiencing an increasing number of acutely ill patients as well as those requiring prolonged hospitalizations, further worsened by the COVID-19 pandemic. This has resulted in increased orders for blood cultures. Once collected, the culture bottles require an incubation period, typically 5 days. The BD BACTEC Fx, a blood culture incubation automated system, holds blood culture bottles until growth is demonstrated or for 5 days, whichever occurs first. New bottles are placed in the apparatus along with older bottles awaiting growth. Capacity is reached when the machine cannot accommodate new bottles due to limited space.When this occurs,manual plating of blood cultures on agar plates is required. Manual plating adds additional responsibility to already overwhelmed microbiology labs. Methods. Following the institutional review board (IRB) approval, data were collected retrospectively at a 765-bed tertiary care center. Data was obtained from positive blood cultures from July 2017 to June 2020. We stratified positive blood cultures based on the day of positivity, from day one to day five. The charts were reviewed for positive blood culture results on day four and day five to evaluate for clinical significance. Clinical significance was determined by an Infectious Disease subspecialty team. Blood culture bottles that were positive on day 4 and day 5 in 1 bottle out of 2 bottles with coagulase-negative species of Staphylococcus, Corynebacterium spp, or Propionibacterium acnes were considered a contaminant and did not warrant further chart review. Results. On a retrospective review of data from July 2017 to June 2020, the total number of blood cultures obtained was 120,320. Among them, 7,558 blood cultures were positive. 94% were positive on day 1, 4% positive on day 2, 2% positive on day 3, 1% positive on day 4 and < 1% positive on day 5. Positive blood cultures on day 5 did not have any clinical significance, according to the chart review. Conclusion. Our study demonstrated that four days of incubation is sufficient for the BD BACTEC Fx automated blood culture incubation system without compromising clinical significance. Implementation of a 4-day incubation period will help with reducing saturation of slots and will improve readiness to accommodate more blood culture bottles.
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Background: Reusable humidifiers are often colonised by microbes, the aerosols generated from which are hypothesised to transmit respiratory infections-jeopardising patient safety. Material(s) and Method(s): In this time-bound cross-sectional study, 10 ml of water was collected in sterile containers from humidifiers installed in selected wards/critical care units/intensive care units and from the source used to refill these humidifiers. These samples were subjected to KOH and gram staining followed by inoculation on blood, MacConkey and Sabouraud dextrose agar and brain heart infusion broth in the aerobic environment at 37degreeC. Observations were recorded as per standard guidelines and compared against blood and respiratory cultures of patients. Result(s): Despite an average of 8.23 days of exposure to oxygen humidified by contaminated water, n = 28 (of n = 39) blood samples reported no growth (NG) and n = 12 reported nonpathogenic organisms (NPO). Among n = 18 available respiratory samples, n = 1 reported Escherichia coli, which was not cultured from the same humidifier indicative of some other source. n = 1 reported NG, n = 6 reported NPO and n = 10 reported normal throat flora. No fungal elements were reported from any humidifier, source, or patient samples. The source-humidifier pathogen pair did not match for any humidifier. Conclusion(s): Sterile patient cultures, despite prolonged exposure to oxygen humidified with contaminated water, indicate that humidifier contaminants did not infect patients. The disparity between the source or patient cultures and humidifier contaminants may be attributed to compromised universal precautions due to the exhaustion of health-care professionals during COVID-19. Furthermore, the type of water used to refill (Distilled/RO/Tap water) had no effect on the microbial contamination of humidifiers. Copyright © 2022 Journal of Patient Safety & Infection Control Published by Wolters Kluwer - Medknow.
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Objective: Patients infected with severe acute respiratory syndrome-coronavirus-2 may progress with severe clinical symptoms and patients may be hospitalized in intensive care for a long time. In patients with long-term intensive care hospitalization, secondary infections develop as a result of the pathophysiology of the disease and the treatments used. The aim of this study is to investigate the incidence of secondary infections in patients with coronavirus disease-2019 (COVID-19) and to identify common pathogen groups. Material(s) and Method(s): Four hundred and sixty one patients with a diagnosis of COVID-19 who were followed up in the intensive care unit at Afy-onkarahisar Health Sciences University Faculty of Medicine Hospital between 20 March 2020 and 31 May 2021 were included in the study. Demographic data, co-morbidities, clinical features, laboratory data and culture growth data of the patients were recorded retrospectively. Re-sults: Nosocomial secondary infections were detected in 132 (28.6%) of 461 patients. Acinetobacter baumannii 39/53 (73.5%) growth was observed in the majority of the lower respiratory tract sample cultures. There was 28/49 (57.1%) Staphylococcus aureus growth in blood cul-tures, and 21/42 (50%) candida spp. growth in urine cultures. Conclu-sion: In this study, we found that the incidence of infection secondary to COVID-19 pneumonia was high. In addition, it was determined that the secondary infection rate was high in patients with PaO2/FiO2<200. Copyright © 2022 by Turkiye Klinikleri.
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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.
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SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Actinomyces is a Gram-positive anaerobic and micro aerophilic filamentous bacillus that normally colonize the human mouth and digestive and urogenital tracts. They most commonly cause cervical and abdominopelvic infections and rarely pulmonary actinomycosis. CASE PRESENTATION: 67-year-old female with past medical history of recurrent DVT with IVC filter placement, non- ischemic cardiomyopathy, atrial fibrillation, 40 pack year history, recent COVID19 infection, lung nodules & COPD presented with complaint of coughing up blood associated with chest pain for the past 2 days. She had a low-grade fever with stable vitals with preliminary labs showing she was anemic and had reactive leukocytosis. She was recommended to hold oral anticoagulation and follow-up outpatient during when her symptoms worsened. On admission she was started on tranexamic acid nebulization for hemostasis and underwent CTA chest which showed no evidence for pulmonary embolism but commented on a right lower lobe perihilar 12.5 mm mass which has increased in size compared to previous scans. Patient underwent bronchoscopy which showed generalized edema of the tracheobronchial tree with bleeding from superior segment of the right lower lobe bronchus with no visualization of mass. PET scan showed hyper-metabolic lung mass with concerns for malignancy. CT guided biopsy of nodule was done and was not staining for malignant cells, acid fast bacilli with no fungal or bacterial growth. Blood cultures and Karius Digital cultures were also negative. She began expectorating blood clots despite being on treatment and cardiothoracic surgery was consulted. A partial lobectomy with lysis of adhesions of the right lower lobe was done. Specimen sent to pathology showed no evidence for malignancy but instead elicited a contained pulmonary abscess containing filamentous bacteria with parenchymal inflammation with areas of chronic hemorrhagic fibrosing pleuritis and hilar thrombi. She was diagnosed with pulmonary actinomycosis and started on IV 24,000,000 IU penicillin. She underwent a panoramic dental x-ray which was read as suboptimal dentition with multiple missing teeth and did not identify a source. Patient symptoms resolved post lobectomy and since discharged on long course of antibiotics. She continued to have no more episodes of hemoptysis. DISCUSSION: Hemoptysis as a symptom of pulmonary actinomycosis is a rather rare presentation. Actinomycosis causes cavities, nodules, and pleural effusions. It is commonly mistaken for chronic suppurative lung disease and sometimes malignancy. Isolation and identification occur only a minority of cases with a high culture failure rate due to previous antibiotic therapy, inadequate incubation time or culture conditions. CONCLUSIONS: Due to it's variable presentation pulmonary actinomyces has a large overlap with other diseases but must be considered in the differential of unexplained hemoptysis. Reference #1: Hemoptysis secondary to actinomycosis: A rare presentation. PMID: 24778485 PMCID: PMC3999682 DOI: 10.4103/0970-2113.129864 DISCLOSURES: No relevant relationships by Victoria Famuyide No relevant relationships by rukhsaar khanam