ABSTRACT
In recent years, the emergence of carbapenem-resistant strains has been increasing worldwide, including in Romania. Rapid tests for post-mortem examinations have been researched and currently have several applications. In the present study, we aimed to test the performance of O.K.N.V.I. RESIST-5 tests on impure post-mortem biological samples compared with a standard of pure cultures. When a death occurs during hospitalization and the issue of malpractice arises, the medico-legal practice would benefit from rapid tests applicable to post-mortem samples. Thus, detection and differentiation of the five targeted carbapenemases, namely oxacilinase-48, Klebsiella pneumoniae carbapenemase, New Delhi metallo-ß-lactamase, Verona integron-encoded metallo-ß-lactamase and imipenemase, could be useful in guiding sampling for third-party microbiological assessment and could also be an asset from an epidemiological standpoint. The present prospective and observational pilot study included medico-legal autopsy cases performed at Mina Minovici National Institute of Legal Medicine (Romania) between June and July 2022. A total of two sets of O.K.N.V.I. RESIST-5 tests were performed: Test I, which was performed on-site from biological samples obtained during autopsy; and Test II, which was performed on pure cultures after sample inoculation and incubation. Total of 39 O.K.N.V.I. RESIST-5 rapid tests were performed on 19 biological samples, at least one sample per case. The O.K.N.V.I. RESIST-5 tests performed on-site showed an overall sensitivity of 92.3% with a 100% specificity. The results obtained through rapid tests using post-mortem impure samples were comparable to the results obtained from sample cultures with good sensitivity and specificity. Through post-mortem screening for carbapenem resistance, it would be possible to narrow down the number of cases that require further bacteriological assessment.
ABSTRACT
Introduction: Healthcare-associated infections are a major concern for healthcare systems around the world. Microorganisms developing resistance to potent antibiotics are an urgent threat to public health. Methods: The present study is a retrospective, single-center study performed at the Mina Minovici National Institute of Legal Medicine, Bucharest, Romania, over a period of ten years (2011-2020). Autopsies for deaths occurring in the hospital setting for which postmortem bacteriological examination was solicited were screened and the recovered data consisted of demographics, hospital stay duration, autopsy data, and postmortem microbiology. Results: In the 516 autopsies recovered we found that carbapenemase-producing Enterobacteriaceae (CPE) isolates from postmortem bacteriology results increased in 2019. Positive postmortem microbiology results were associated with histological infection in over 80% of cases. Positive results for healthcare-related pathogens were associated with prolonged hospital stay. In our data vancomycin-resistant enterococci were isolated from 2015. Conclusions: Postmortem bacteriology results from medico-legal autopsies mirror antimicrobial resistance trends from hospital settings with several limitations due to the scarcity of solicitations.
ABSTRACT
The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS-guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre-operative EUS-guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS-guided loco-regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS-guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.
