Characteristics and influencing factors for Stenotrophomonas maltophilia infection in a tertiary general hospital of Sanya city and drug resistance from 2016 to 2020

OBJECTIVE: To investigate the characteristics and influencing factors for Stenotrophomonas maltophilia (SMA) infection in Sanya and analyze the drug resistance so as to provide guidance for prevention and control of infection in medical institutions. METHODS: The hospitalization data were collected from the patients with SMA infection who were hospitalized in three tertiary general hospitals of Sanya from 2016 to 2020. The characteristics of SMA infection and influencing factors for respiratory tract and non-respiratory tract SMA infection were retrospectively analyzed, and the result of drug susceptibility testing was observed. RESULTS: A total of 753 case times of patients had SMA infection, including 606 (80.48%) case times of respiratory tract infection and 147 (19.52%) case times of non-respiratory tract infection. The isolation rate was the highest in respiratory medicine department (16.73%), followed by critical care medicine department (15.67%) and neurosurgery department (12.35%). The percentages of the patients with advanced age, complications with hypertension and pulmonary diseases, tracheotomy were the higher in the respiratory tract infection group than in the non-respiratory tract infection group (P < 0.05);while the percentages of the patients with malignant tumors, bacteremia, surgery, urinary tract intubation, low immunity and use of antibiotics and immunosuppressants were the higher in the non-respiratory tract infection group than in the respiratory tract infection group (P < 0.05). The result of drug susceptibility testing showed that the drug resistance rate of the SMA strains to sulfamethoxazole-trimethoprim was only 2.39%, while the drug resistance rate to ceftazidime was as high as 74.50%. CONCLUSION: The major influencing factors for the respiratory tract SMA infection include pulmonary diseases, hypertension, advanced age and tracheotomy;the influencing factors for the non-respiratory tract SMA infection include malignant tumors, low immunity, long-term excessive use of immunosuppressants and broad-spectrum antibiotics, bacteremia, surgery and urinary tract intubation. The SMA strains isolated from the city are highly sensitive to sulfamethoxazole-trimethoprim but are highly resistant to ceftazidime and chloramphenicol. It is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing.

Pharmaceuticals as Emerging Pollutants in the Reclaimed Wastewater Used in Irrigation and Their Effects on Plants, Soils, and Groundwater

Pharmaceuticals and personal care products (PPCPs) were investigated in five wastewater treatment plants (WWTPs), groundwater, irrigated soils, and plants in Amman and Al-Balqa governorates in Jordan. PPCPs were extracted from water samples by solid-phase extraction (SPE) and analyzed by high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC–MS/MS). Carbamazepine, ciprofloxacin, ceftiofur, diclofenac, erythromycin, lincomycin, ofloxacin, pyrimthamine, spiramycin, sulfamethoxazole, sulfapyridine, testosterone, trimethoprim, and thiamphenicol were detected in all raw wastewaters in μg/L, whereas 45 PPCPs were below the detection limits (<0.02 μg/L) in all samples. Na`ur and Abu Nuseir WWTPs showed high PPCPs removal efficiencies in comparison with AL-Baqa`a, Salt, and Fuhais-Mahis WWTPs. Boqorreya spring showed signs of contamination by Salt WWTP effluents as a result of mixing. Irrigation with effluents showed higher carbamazepine concentrations in soils at the top soil layers (0 to 20 cm) in all farms than its concentrations at the root zone (20 to 40 cm) by using drip irrigation system with various plants. In plants, carbamazepine concentration was only detected in high concentration level in mint leaves. In the same farm, diclofenac concentration was detected only in olives and not in twigs and leaves, indicating a high rate of plant uptake especially during the olive’s growth period. Furthermore, plant fruits, leaves, and stems left on the farm after harvesting are generally consumed by cattle, which means entering the food chain of humans.

Long-Term Study of Antibiotic Presence in Ebro River Basin (Spain): Identification of the Emission Sources

Water monitoring is key to determining the presence of potentially hazardous substances related to urban activities and intensive farming. This research aimed to perform a long-term (four years) quantitative monitoring of selected antibiotics (azithromycin, enrofloxacin, trimethoprim and sulfadiazine) both in rivers and wastewaters belonging to the Ebro River basin (North of Spain). The target antibiotics were chosen on the basis of a preliminary multispecies screening. The analysis of the antibiotics was carried out by LC-MS/MS on wastewater-treatment plant (WWTP) effluent, effluents of a slaughterhouse and hospital, rivers downstream and upstream of these WWTPs, and rivers close to extensive farming areas. The ANOVA test was performed to study the significant differences between the points exposed to concrete emission sources and antibiotic concentration. The monitoring, carried out from 2018 to 2020, has been essential to illustrating the presence of the most abundant antibiotics that were detected in the Ebro River basin. Enrofloxacin has appeared in river waters in significant concentrations, especially near intensive farming, meanwhile azithromycin has been frequently detected in wastewaters.

Stenotrophomonas maltophilia Bacteremia Associated With Severe COVID-19: Successful Treatment With Appropriate Antimicrobial Therapy.

Stenotrophomonas maltophilia, an opportunistic pathogen, can cause bacteremia in immunocompromised and debilitated patients. A 50-year-old man with severe coronavirus disease 2019 (COVID-19) was admitted to our hospital's intensive care unit where he underwent extracorporeal membrane oxygenation and ventilatory support. On day 25, he developed S. maltophilia bacteremia originating from an indwelling central venous catheter. After confirming susceptibility, trimethoprim-sulfamethoxazole (80 mg/400 mg) was administered thrice daily. Following improvement, he was weaned from ventilation, recovered sufficiently, and was discharged on day 53. To the best of our knowledge, this is the first report of a patient recovering after antimicrobial treatment for S. maltophilia bacteremia associated with severe COVID-19.

POS-497 SUCCESSFUL BARIATRIC SURGERY FOLLOWING SECOND RENAL TRANSPLNATATION. AND OTHER COMPLICATIONS DURING THE JOURNEY

Introduction: Obesity is highly prevalent among patients with renal transplants. It is associated with increased risk of overall mortality, obesity-related complications such as diabetes, increased renal graft loss rates and shortened graft survival. Roux en Y gastric bypass in contrast to other non malabsorptive procedures, may affect the pharmacokinetics of certain drugs, which is of particular importance for immunosuppressant drugs required by patients post-transplant to avoid graft rejection. Methods: 43-year-old female known case of IgA nephropathy biopsy proven in 2000, progressed to end stage renal disease (ESRD) and was initiated on hemodialysis. She underwent live unrelated renal transplantation. Creatinine was 79 micromole/L and eGFR 85ml/min/1.73 m2. Her maintenance immunosuppression included azathioprine 50 mg daily, cyclosporine 75 mg bid and prednisolone 5 mg daily. She had two successful pregnancies post renal transplantations. She developed post renal transplant diabetes in 2013 and uncontrolled hypertension. She had persistent microscopic hematuria. Her creatinine peaked up to 275 micromol/L, her allograft kidney biopsy showed histopathologic features for mild acute T-cell mediated rejection (probably modified slightly by anti-rejection treatment). Grade 1A by Banff working grading. C4d stain is negative with background of focal proliferative and sclerosing glomerulonephritis with associated IgA deposits, consistent with IgA nephropathy ("M1, E1, S1, T0" Oxford classification). Her rejection was treated with pulse IV steroids, azathioprine was changed to mycophenolate and dose of cyclosporine was increased to 100 mg bid. Her creatinine came down to 105 micromol/L. Her post transplantation course involved purpuric rash, joint pain, abdominal pain, h/o HSP biopsy proven with elevated ESR and CRP most likely this is HSP again associated with medication exposure, possible the fibrate. Results: She lost follow up in our clinic and showed up after 5 years with uremic symptoms and creatinine of 1,063micromol/L and was initiated on hemodialysis in 2019. She had second live unrelated renal transplantation, she received 3 sessions of plasma exchange and IVIG prior to transplantation and was maintained on tacrolimus, mycophenolate and prednisolone. Her creatinine was 88 micromol/L. She had Laparoscopic sleeve gastrectomy and Dermo lipectomy of abdominal wall 2 months following her transplantation and lost 22 kgs since then, her BMI was 32 kg/m2 dropped to 24 kg/m2 in 6 months duration. The patient suffered from recurrent multi drug resistant E.Coli urinary tract infection treated with IV ertapenem and continued on trimethoprim sulpha- methoxazole prophylaxis for 6 months. She is still using insulin in smaller doses and her blood sugar is within acceptable ranges. She recently suffered from covid 19 pneumonia requiring home quarantine during which her creatinine went up to 106 micromol/L but settled down to baseline of 88 micromol/L during further follow up. Conclusions: Limited evidence suggests that bariatric surgery is safe and feasible for selected obese patients post-renal transplant. It is associated with good, if variable, short-term excess weight loss and resolution of co-morbidities. More studies should address long term complications in renal trnasplant patient population. No conflict of interest

Multifocal pyomyositis in decompesated DM and SARS-COV-2 pneumonia: A diagnostic challenge

Background: Pyomysitis is a bacterial infection of skeletal muscle characterized by intramuscular abscess formation that arises in endemic areas (tropical) or in patients with immunocompromised condition such as HIV or Diabetes Mellitus. Staphylococcus aureus is the most common culprit, with rising proportion of MRSA. Description of the case: A 35-year-old man with history of diabetes mellitus in poor control was admitted to our ward with ketoacidotic state, fever, repiratory insufficiency and diffuse myalgia. After the prompt correction of DKA, Chest X-ray reveald bilateral interstitial pneumonia and nasopharyngeal swab for CoViD-19 resulted positive. He started dexamethasone, remdesivir and noninvasive ventilation with improvement of gas exchanges. A MRI revealed an intramuscular abscess on left paravertebral muscle and bedside ultrosound showed multiple muscolar abscesses (right rectus femoris, right gastrocnemius, left teres minor and left semitendinosus). Ultrasound assisted drainage was performed and liquid culture yielded MSSA, thus antibiogram guided treatment with linezolid plus sulphametoxazole/trimetroprim was started. Follow-up PET at two weeks demonstrated a dramatic reduction in the inflammations. Conclusions: Pyomyositis is a potentially severe but uncommon complication of poorly controlled diabetes that could be difficult to detect in the setting of a concomitant viral illness. Bedside ultrasound has a unique role in the diagnosis, in the surgical drainage and in the follow-up. The cornerstone of optimal antimicrobic therapy is antibiogram-guided due to the rising proportion of MRSA.

MANORAA: A machine learning platform to guide protein-ligand design by anchors and influential distances.

The MANORAA platform uses structure-based approaches to provide information on drug design originally derived from mapping tens of thousands of amino acids on a grid. In-depth analyses of the pockets, frequently occurring atoms, influential distances, and active-site boundaries are used for the analysis of active sites. The algorithms derived provide model equations that can predict whether changes in distances, such as contraction or expansion, will result in improved binding affinity. The algorithm is confirmed using kinetic studies of dihydrofolate reductase (DHFR), together with two DHFR-TS crystal structures. Empirical analyses of 881 crystal structures involving 180 ligands are used to interpret protein-ligand binding affinities. MANORAA links to major biological databases for web-based analysis of drug design. The frequency of atoms inside the main protease structures, including those from SARS-CoV-2, shows how the rigid part of the ligand can be used as a probe for molecular design (http://manoraa.org).

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Combination therapy of zinc and trimethoprim inhibits infection of influenza A virus in chick embryo.

BACKGROUND: Respiratory RNA viruses including influenza virus have been a cause of health and economic hardships. These viruses depend on its host for replication and infection. Influenza virus infection is lethal to the chick embryo. We examined whether a combination of trimethoprim and zinc (Tri-Z), that acts on the host, can reduce the lethal effect of influenza A virus in chick embryo model. METHOD: Influenza virus was isolated from patients and propagated in eggs. We determined viral load that infects 50% of eggs (50% egg lethal dose, ELD50). We introduced 10 ELD50 into embryonated eggs and repeated the experiments using 100 ELD50. A mixture of zinc oxide (Zn) and trimethoprim (TMP) (weight/weight ratios ranged from 0.01 to 0.3, Zn/TMP with increment of 0.1) was tested for embryo survival of the infection (n = 12 per ratio, in triplicates). Embryo survival was determined by candling eggs daily for 7 days. Controls of Zn, TMP, saline or convalescent serum were conducted in parallel. The effect of Tri-Z on virus binding to its cell surface receptor was evaluated in a hemagglutination inhibition (HAI) assay using chicken red cells. Tri-Z was prepared to concentration of 10 mg TMP and 1.8 mg Zn per ml, then serial dilutions were made. HAI effect was expressed as scores where ++++ = no effect; 0 = complete HAI effect. RESULTS: TMP, Zn or saline separately had no effect on embryo survival, none of the embryos survived influenza virus infection. All embryos treated with convalescent serum survived. Tri-Z, at ratio range of 0.15-0.2 (optimal ratio of 0.18) Zn/TMP, enabled embryos to survive influenza virus despite increasing viral load (> 80% survival at optimal ratio). At concentration of 15 µg/ml of optimal ratio, Tri-Z had total HAI effect (scored 0). However, at clinical concentration of 5 µg/ml, Tri-Z had partial HAI effect (+ +). CONCLUSION: Acting on host cells, Tri-Z at optimal ratio can reduce the lethal effect of influenza A virus in chick embryo. Tri-Z has HAI effect. These findings suggest that combination of trimethoprim and zinc at optimal ratio can be provided as treatment for influenza and possibly other respiratory RNA viruses infection in man.