Clinical outcomes after faecal microbiota transplant by retention enema in both immunocompetent and immunocompromised patients with recurrent Clostridioides difficile infections at an academic medical centre.

BACKGROUND: Recurrent Clostridioides difficile infection (CDI) is one of the most common and challenging infections to treat in healthcare facilities. Faecal microbiota transplantation (FMT) is recommended as a definitive treatment option. METHODS: We performed a retrospective review of 50 patients from January 2015 to December 2019 who underwent FMT for recurrent CDI. Primary outcome was recurrence of CDI within 12-weeks of FMT and secondary outcomes were the need for repeat FMT, serious adverse outcomes related to FMT and all-cause mortality. RESULTS: Fifty charts were reviewed, of which 47 cases comprising 17 immunocompromised patients treated with FMT via retention enema were included in the study. The majority of the patients had ≥3 recurrent CDIs (62%). Nine (19%) patients failed to respond to the first FMT and five underwent repeat FMT within four to 12 weeks. The cure rate was 81% after the first FMT (38/47) and 91% after the second FMT treatment (43/47). Serious adverse events occurred in 2% and all-cause mortality was 2% at 90-day follow up. CONCLUSION: Our study demonstrated the safety and efficacy of FMT administered via retention enema, a simple bedside procedure, for the treatment and prevention of recurrent non-severe and severe CDI with an overall cure rate of 91%.

Sun heated surfaces are an environmental hazard for young children.

AIMS: Children commonly sustain heat contact type burn injuries from sun heated surfaces during the summer months in hot, sunny climates. The aim of this study was to review the causes and outcomes in a series of heat contact type burns sustained by children who touched hot sun heated surfaces. METHODS: A retrospective chart review was performed to identify all children who sustained burn injuries due to naturally heated surfaces and were treated between January 2012 and December 2017 at Children's Hospital Colorado. Demographics of the subjects and clinical data regarding their burn injuries were collected. RESULTS: A total of 58 children were identified over the study period, involving 118 burn wounds. The median age was 17 months (interquartile range = 14-23), and 33 were male (57%). Mean total body surface area (TBSA) was 1.4% (standard deviation = 1). A foot was the most commonly involved area, affecting 36 subjects (62%). The most common causes of these burn injuries were metal thresholds (n = 7, 12%) and metal covers or lids (n = 5, 9%) outside the home. The depth of the burn injury was partial thickness in 57 children (98%). The mean time to heal was 12 ± 6 days, and the majority of injuries occurred in June (n = 28, 48%). CONCLUSION: Heat contact type burn injuries from sun heated surfaces commonly affect children ⩽2 years of age during the summer months, and the majority of these injuries occur around the home environment. They are preventable injuries, and this information should be used for prevention and education materials for parents and healthcare providers, who reside in hot, sunny climates.

First case of vaccine-strain varicella infection as manifestation of HIV in healthcare worker: a case report and review of the literature.

Live-attenuated varicella vaccination is safe in non-immunocompromised populations and is associated with rare non-serious adverse events. A healthcare worker (HCW) developed varicella infection, and exposure investigation led to immunization against varicella in an exposed non-immune HCW. Subsequently, vaccine-strain-induced disseminated varicella and progressive outer retinal necrosis in the exposed HCW resulted in identification of undiagnosed human immunodeficiency virus infection. This article reviews serious adverse events from varicella vaccination, and extreme caution is advised prior to live vaccination of HCWs.

Multidrug-resistant Acinetobacter baumannii: an emerging pathogen among older adults in community hospitals and nursing homes.

BACKGROUND: Drug-resistant Acinetobacter species are problematic in tertiary-care hospitals. We describe the epidemiology, resistance patterns, and outcomes of older adults with Acinetobacter infection in community hospitals. METHODS: We queried the microbiology databases of the Oakwood Healthcare System (4 hospitals with 632, 259, 199, and 168 beds) for clinical Acinetobacter cultures obtained in 2003-2008. Patients aged 60 years who were admitted from home or nursing homes were included. We recorded the initial Acinetobacter isolate and susceptibility to 8 antibiotics. Cultures obtained 48 h after hospitalization were categorized as "nosocomial." Administrative databases provided patients' origins (home or nursing home) and discharge destinations (home, nursing home, long-term acute-care facility, another hospital, or hospice care or death). RESULTS: During the 6-year period, 560 community-dwelling (mean age +/- standard deviation, 74 +/- 8.6 years) and 280 nursing home-dwelling (78 +/- 9.1 years) patients had Acinetobacter isolated. During this period, Acinetobacter prevalence increased 25% (P<.001, by trend test). In comparison of 2003 with 2008, Acinetobacter resistance to imipenem and ampicillin/sulbactam increased (from 1.8% to 33.1%; P<.001), as did "panresistance" (ie, resistance to all 8 antibiotics; increase from 0.0% to 13.6%; P<.001). Although resistance was stable in community-acquired isolates (resistance to approximately 4.2 antibiotics), resistance increased among nursing home-acquired and nosocomial-acquired isolates (from 4.5 to 5.7 and from 5.0 to 6.0 antibiotics, respectively; P<.01). At discharge, only 25% of community-dwelling and 50% of nursing home-dwelling patients returned to their place of origin; the remainder required higher levels of care or died. After adjustment for age, length of stay, and origin, resistance to each additional antibiotic predicted a >20% increased risk for discharge to higher levels of care or death (odds ratio, 1.23; 95% confidence interval, 1.11-1.36). CONCLUSIONS: The prevalence and resistance of Acinetobacter species are increasing in the community. Patients with resistant isolates are selectively discharged to nursing homes and long-term acute-care facilities, introducing resistance to new facilities.

Allergic Contact Dermatitis Due To Parthenium Hysterophorus.

Fifty cases of allergic contact dermatitis from Parthenium hysterophorus have been studied in detail. Clinico-epidemiological features have been described. Patients present with any of the four observed patterns of dermatitis viz. atopic, photosensitivity, seborrhoeic and miscellaneous. Patients were patch tested with 12 extracts of the plants in six solvents producing differing reaction. Limited chemical analysis of the plant extracts yielded various fractions of which three were found to be immunologically active. Chemical nature of parthenin which is a known allergen of this plant has been studied. Possibility of cross sensitivity with other plants is briefed.