Carbapenem- and colistin-resistant Enterobacterales in intensive care unit patients in Mediterranean countries, 2019.

Introduction: The colonization of patients by carbapenemase-producing Enterobacterales (CPE) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units (ICUs). Our study aimed to comprehensively assess CPE prevalence among ICU patients across the Mediterranean region pre-COVID-19, conducting a multicenter prevalence study in the first quarter of 2019. Methods: We collected clinical data and rectal or fecal samples from 256 ICU patients for CPE testing. Additionally, we performed whole-genome sequencing on 40 representative CPE strains to document their molecular characteristics. Results: Among the 256 patients, CPE was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant CPE strains, affecting three ICUs. Genetic analysis revealed highly diverse E. coli and K. pneumoniae strains, predominantly from international high-risk clones. Notably, blaOXA-48 and blaNDM-1 were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased CPE carriage (p < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated. Discussion: Our study provides CPE prevalence in Mediterranean ICUs and reaffirms established CPE presence in this setting but also provides updates on the molecular diversity of CPE strains. These findings highlight the imperative of reinforcing infection control measures in the participating ICUs to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.

The impact of silver nanoparticles integration on biofilm formation and mechanical properties of glass ionomer cement.

OBJECTIVES: To study the effect of silver nanoparticles incorporation to glass ionomer cement (GIC) on the Staphylococcus aureus biofilm in terms of bacterial growth and evaluate the incorporating effect on hardness and compressive strength. METHODS: Silver nanopowder was added in concentration 0, 1, 3, and 5 wt% to the conventional powder of GIC Fuji IX GP and then the powder is added to the liquid and mixed together with the recommended Powder/liquid ratio of 3.6:1 g. One hundred and twenty disc and cylindrical-shaped specimens were prepared using teflon molds. The specimens were put in tissue culture plate wells contained S. aureus in brain-heart infusion broth. The plate was incubated at 37°C for 24 h. Specimens were then washed, fixed, dehydrated, and air dried. The spatial distribution of biofilm was examined via scanning electron microscope. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also evaluated. After setting, the specimens were stored in distilled water for 24 h before testing for microhardness and compressive strength. RESULTS: Scanning electron photomicrographs of biofilm formed on the control GIC, showed a consistent biofilm with a thick sheet of cells, whereas those formed were less dense at 3 wt% and below the detection limit at 5 wt% silver nanoparticles. MIC and MBC of S. aureus were 25 and 50 µg/mL, respectively. The microhardness and compressive strength values of tested groups showed a nonsignificant decrease from the control group, P = .58 and .82, respectively. CONCLUSION: Incorporation of silver nanoparticles with GIC can limit S. aureus biofilm formation with an insignificant effect on mechanical properties and noticeable influence on its coloration, which restrict its usage in areas where esthetic is not of major concern. CLINICAL SIGNIFICANCE: As the modification of GIC with silver nanoparticles improved the antibiofilm properties without altering its mechanical properties, it could be used as a restoration of root carious lesion mainly in nonesthetic areas, a base under composite restorations in deep posterior cavities and as a core material in caries susceptible patients.

Serum soluble toll-like receptor 2: a novel biomarker for systemic lupus erythematosus disease activity and lupus-related cardiovascular dysfunction.

AIM: To assess the serum levels of soluble toll-like receptor (sTLR2) as an endogenous negative regulator of TLR2 signaling in systemic lupus erythematosus (SLE) patients, to investigate the correlation between sTLR2 and SLE disease activity index (SELDAI), SLE-related cardiovascular risk factors and ventricular dysfunction and to evaluate the effect of different therapeutic regimens on serum sTLR2 levels. METHODS: Ninety-six SLE patients, along with 30 healthy controls, were enrolled in the study. Echocardiography measurements were performed. Serum levels of (sTLR2) were measured using enzyme-linked immunosorbent assay (ELISA). Serum lipid profiles, uric acid and creatinine were also detected. RESULTS: Mean serum levels of sTLR2 in SLE patients was 3.98 ± 4.4 ng/mL, which was significantly decreased as compared with that of the control group (11.3 ± 4.9 ng/mL; P < 0.0001). sTLR2 was negatively correlated with SELDAI, low-density lipoprotein (LDL) and left ventricular diastolic dysfunction. sTLR2 levels were increased in patients receiving hydroxychloroquine, statins and corticosteroids. CONCLUSION: Serum sTLR2 can attenuate disease activity and negatively impact left ventricular diastolic dysfunction and hypercholersterelemia in SLE patients. Statins, corticosteroids and chloroquine increase sTLR2 levels.