Antibiotic therapy of Acinetobacter baumannii bloodstream infection in COVID-19 patients

Secondary bacterial infection is one of the important risk factors for the development of severe course and death in COVID-19. The rational choice of antibacterial therapy is based on the data of microbiological monitoring of pathogens of healthcare-associated infections. The aim of the study is to determine the main options for antibiotic therapy of Acinetobacter baumannii bloodstream infection in COVID-19 patients. Material and methods. A retrospective, single-centre, uncontrolled study of the incidence of A. baumannii bacteremia in COVID-19 patients treated at the City Clinical Hospital No. 52 in Moscow from October 2020 to September 2021 was performed. For each strain of A. baumannii sensitivity to the main antibacterial agents was determined. Genetic determinants of antibiotic resistance were studied by real-time multiplex polymerase chain reaction. The main therapeutic options for A. baumannii bloodstream infection were analyzed. Results and discussion. Bloodstream infections were diagnosed in 4.7% of hospitalized patients with COVID-19 (758/16 047). Gram-negative bacteria were the causative agents of bloodstream infections in 76% of cases. A. baumannii were isolated from the blood of 143 patients (0.89%). Detection of the pathogen in the blood of COVID-19 patients was associated with severe and extremely severe course of the disease. Most of the strains (93%) were isolated in the intensive care unit. The A. baumannii strains studied were carbapenem-resistant (CRAb) and phenotypically belonged to the XDR class. According to a PCR study, A. baumannii strains were producers of oxacillinases OXA-23, OXA-40, and OXA-51. Conclusion. The circulation of A. baumannii CRAb in intensive care units makes empiric therapy based on carbapenems irrational and ineffective. For the etiotropic therapy of A. baumannii bloodstream infection it is recommended to use combined antibiotic therapy regimens with the inclusion of polymyxin B and sulbactam.Copyright © Eco-Vector, 2022.

SARS-CoV-2 Positive Patients and the Associated Risk Factors During the Third Wave: A Study in a Tertiary Care Hospital of Punjab

Background: SARS-CoV-2 has a high mutation rate, resulting in the emergence of multiple variants in a shorter time frame, starting with Wuhan strain during first wave, then Delta during second wave and Omicron during third wave. World faced distressing spread of novel corona virus. The reason for this study was to look at the third flood of SARS-CoV-2, clinical highlights and risk factors in northern India. Method(s): This study involved 1,43,983 individuals for testing the presence of SARS-CoV-2 infection during January 2022 by RT-PCR. The epidemiological record was collected as per the guidelines of ICMR from the patient forms. Result(s): A total of 12.24% individuals were found positive with mean age of 29+/-10 years. Large portion of positive population (63.87%) was asymptomatic. Among the positive population, higher positivity rate was observed in males (57.51%) with age band of 21-40 years (51.17%). Significant association (p value = <0.00001) was found between positivity rate with age, gender and status (symptomatic/ asymptomatic). SARS-CoV-2 was shown to be more prevalent in Patiala, (49.66%) district followed by Ludhiana (24.24%), Sangrur (10.06%), Mansa (7.06%), Shaheed Bhagat Singh Nagar (6.90%) and Malerkotla (2.08%) during second and third week of January 2022. Hypertension and bronchial asthma were the most well-known comorbidities found in the current study. Conclusion(s): In totality, current study showed positivity rate of 12.24% from large population size for SARS CoV-2 from period of 1st January 2022 to 31 January 2022. Current findings include younger age group (21-40 years), high percent of asymptomatic individuals, less disease severity and a little need of hospitalization.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Detection of causative agents of bacterial pneumonia in hospitalized hajj and umrah cases by multiplex real-time polymerase chain reaction.

Background and Objectives: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is commonly detected in pneumonia patients who travel from the Middle East regions. Besides MERS-CoV, many other pathogenic agents cause pneumonia. Detection of such organisms must be done swiftly, especially in case of the negative MERS-CoV samples. The aim of this study was to identify the pathogenic agents that might account for bacterial pneumonia, from Hajj and Umrah pneumonia cases. Materials and Methods: We conducted a cross-sectional study, 38 pneumonia clinical samples from suffering of Hajj and Umrah in 2017 with negative MERS-CoV were selected. The laboratory testing was done at National Reference Laboratory in Jakarta and performed by multiplex real-time PCR using a FTD respiratory pathogens. Results: Haemophilus influenzae (26.4%) was the most frequent bacteria detected. Other causative agents of bacterial pneumonia identified were Moraxella catarrhalis (20.8%), Klebsiella pneumoniae (13.2%), Streptococcus pneumoniae (9.4%), and Staphylococcus aureus (5.7%). From 38 samples showed that 25 (65.79%) samples were positive with bacteria, including five samples with coinfection. The coinfection were combinations among S. aureus and S. pneumoniae (1/20), S. pneumoniae and K. pneumoniae (1/20), S. pneumoniae and M. catarrhalis (2/20), S. pneumoniae and H. influenzae (2/20), K. pneumoniae and H. influenzae (5/20), and M. catarrhalis and H. influenzae (5/20). Conclusion: Haemophilus influenzae is the most recurrent bacteria to be identified in samples of pneumonia of hajj and umrah cases.

Respiratory Syncytial Virus Co-infection in the Era of COVID-19 Pandemic

Background:Respiratory syncytial virus (RSV), a known viral pathogen of paediatric age group is now an emerging cause of severe respiratory illness in adults. In the current pandemic, a new strain of Corona virus named SARS CoV -2, has emerged as the causative agent. Both these viral infections have similar clinical presentation and needs to be differenti- ated for appropriate management. Methods:In this cross-sectional study, nasopharyngeal swab samples from individuals with severe acute respiratory infections were tested for SARS CoV-2 and RSV A and B by multiplex real time polymerase chain reaction (PCR). Results:We analysed 100 consecutive samples collected from patients of SARI and the same were subjected to RT-PCR. SARS CoV2 was detected in 35% samples whereas 22% patients were found positive for RSV. 5% samples showed co-infection of RSV and SARS CoV2. RSV B (19%) found to be more prevalent than RSV A (2%). 17% symp- tomatic patients were detected with RSV but not SARS CoV2. [Formula presented] Conclusions:RSV infection in adults should not be under rated. The study highlights the importance of identifying other respiratory pathogens for specific management during current COVID-19 pandemic

COVID-19: Multiorgan Dissemination of SARS-CoV-2 Is Driven by Pulmonary Factors.

Multi-organ failure is one of the common causes of fatal outcome in COVID-19 patients. However, the pathogenetic association of the SARS-CoV-2 viral load (VL) level with fatal dysfunctions of the lungs, liver, kidneys, heart, spleen and brain, as well as with the risk of death in COVID-19 patients remains poorly understood. SARS-CoV-2 VL in the lungs, heart, liver, kidneys, brain, spleen and lymph nodes have been measured by RT qPCR using the following formula: NSARS-CoV-2/NABL1 × 100. Dissemination of SARS-CoV-2 in 30.5% of cases was mono-organ, and in 63.9% of cases, it was multi-organ. The average SARS-CoV-2 VL in the exudative phase of diffuse alveolar damage (DAD) was 60 times higher than in the proliferative phase. The SARS-CoV-2 VL in the lungs ranged from 0 to 250,281 copies. The "pulmonary factors" of SARS-CoV-2 multi-organ dissemination are the high level of SARS-CoV-2 VL (≥4909) and the exudative phase of DAD. The frequency of SARS-CoV-2 dissemination to lymph nodes was 86.9%, heart-56.5%, spleen-52.2%, liver-47.8%, kidney-26%, and brain-13%. We found no link between the SARS-CoV-2 VL level in the liver, kidneys, and heart and the serum level of CPK, LDH, ALP, ALT, AST and Cr of COVID-19 patients. Isolated detection of SARS-CoV-2 RNA in the myocardium of COVID-19 patients who died from heart failure is possible. The pathogenesis of COVID-19-associated multi-organ failure requires further research in a larger cohort of patients.

Viral Load and Patterns of SARS-CoV-2 Dissemination to the Lungs, Mediastinal Lymph Nodes, and Spleen of Patients with COVID-19 Associated Lymphopenia.

Lymphopenia is a frequent hematological manifestation, associated with a severe course of COVID-19, with an insufficiently understood pathogenesis. We present molecular genetic immunohistochemical, and electron microscopic data on SARS-CoV-2 dissemination and viral load (VL) in lungs, mediastinum lymph nodes, and the spleen of 36 patients who died from COVID-19. Lymphopenia <1 × 109/L was observed in 23 of 36 (63.8%) patients. In 12 of 36 cases (33%) SARS-CoV-2 was found in lung tissues only with a median VL of 239 copies (range 18-1952) SARS-CoV-2 cDNA per 100 copies of ABL1. Histomorphological changes corresponding to bronchopneumonia and the proliferative phase of DAD were observed in these cases. SARS-CoV-2 dissemination into the lungs, lymph nodes, and spleen was detected in 23 of 36 patients (58.4%) and was associated with the exudative phase of DAD in most of these cases. The median VL in the lungs was 12,116 copies (range 810-250281), lymph nodes-832 copies (range 96-11586), and spleen-71.5 copies (range 0-2899). SARS-CoV-2 in all cases belonged to the 19A strain. A immunohistochemical study revealed SARS-CoV-2 proteins in pneumocytes, alveolar macrophages, and bronchiolar epithelial cells in lung tissue, sinus histiocytes of lymph nodes, as well as cells of the Billroth pulp cords and spleen capsule. SARS-CoV-2 particles were detected by transmission electron microscopy in the cytoplasm of the endothelial cell, macrophages, and lymphocytes. The infection of lymphocytes with SARS-CoV-2 that we discovered for the first time may indicate a possible link between lymphopenia and SARS-CoV-2-mediated cytotoxic effect.