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Nan Fang Yi Ke Da Xue Xue Bao = Journal... May 2024To investigate the characteristics of infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI.
OBJECTIVE
To investigate the characteristics of infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI.
METHODS
Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December, 2020. . was isolated by anaerobic culture, and qRT-PCR was used to detect the expressions of toxin A () and B () genes and the binary toxin genes ( and ). Multilocus sequence typing (MLST) was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing. Etest strips were used to determine the drug resistance profiles of the isolated strains, and the risk factors of CDI in the patients were analyzed.
RESULTS
CDI was detected in 25 (8.17%) out of the 306 patients. All the patients tested positive for and but negative for the binary toxin genes. Seven noncontaminated . strains with 5 ST types were isolated, including 3 ST54 strains and one strain of ST129, ST98, ST53, and ST631 types each, all belonging to clade 1 and sensitive to metronidazole and vancomycin. Hospitalization within the past 6 months (= 3.675; 95% : 1.405-9.612), use of PPIs (=7.107; 95% : 2.575-19.613), antibiotics for ≥1 week (=7.306; 95% : 2.274-23.472), non-steroidal anti-inflammatory drugs (=4.754; 95% : 1.504-15.031) in the past month, and gastrointestinal disorders (=5.050; 95% : 1.826-13.968) were all risk factors for CDI in the patients hospitalized for diarrhea.
CONCLUSION
The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals, but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.
Topics: Humans; Diarrhea; Clostridioides difficile; Risk Factors; Clostridium Infections; China; Hospitals, University; Multilocus Sequence Typing; Bacterial Toxins; Feces; Anti-Bacterial Agents; Hospitalization; Bacterial Proteins; Enterotoxins; Male; Female; Middle Aged
PubMed: 38862459
DOI: 10.12122/j.issn.1673-4254.2024.05.23 -
Acta Ortopedica Mexicana 2024intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized...
INTRODUCTION
intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA).
MATERIAL AND METHODS
a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII).
RESULTS
in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII.
CONCLUSIONS
IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.
Topics: Humans; Vancomycin; Retrospective Studies; Arthroplasty, Replacement, Knee; Male; Female; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Middle Aged; Prosthesis-Related Infections; Cefazolin; Methicillin-Resistant Staphylococcus aureus; Infusions, Intraosseous; Aged, 80 and over; Staphylococcal Infections
PubMed: 38862147
DOI: 10.35366/115812 -
Turkish Journal of Ophthalmology Jun 2024A 78-year-old man with a history of lung cancer, chemotherapy, radiotherapy, and coronavirus disease 2019 infection experienced visual deterioration of two-weeks’...
A 78-year-old man with a history of lung cancer, chemotherapy, radiotherapy, and coronavirus disease 2019 infection experienced visual deterioration of two-weeks’ duration in his right eye. There was multifocal, yellowish-white retinitis foci, vascular engorgement, and scattered intraretinal hemorrhages extending from posterior pole to retinal periphery in the right eye, whereas the left eye was normal. Intravitreal vancomycin, ceftazidime, clindamycin, and dexamethasone were given for endogenous endophthalmitis initially. Vitreous culture confirmed the presence of Aspergillus lentulus, and he was treated with intravitreal amphotericin-B and voriconazole injections together with systemic amphotericin-B, voriconazole, posaconazole, and micafungin therapy. During follow-up, vitreoretinal surgery was performed because of rhegmatogenous retinal detachment, and he received one additional cycle of chemotherapy due to recurrence of the cancer. Although the retina was attached, enucleation was eventually required due to painful red eye. Atypical squamous cells beneath the neurosensory retina suggesting metastasis were noted on histopathological examination. Timely ocular examination is crucial for any immunocompromised patient having ocular symptoms. High level of suspicion for a fungal etiology is a must in these patients.
Topics: Humans; Endophthalmitis; Male; Aged; Eye Infections, Fungal; Immunocompromised Host; Lung Neoplasms; Aspergillosis; Aspergillus; Antifungal Agents; COVID-19; Vitreous Body; Intravitreal Injections; SARS-CoV-2
PubMed: 38860516
DOI: 10.4274/tjo.galenos.2024.44045 -
Cureus May 2024Introduction Bacteria tend to persist on mobile phones for longer durations causing hospital-acquired infections. This is primarily because mobile phones have become an...
Introduction Bacteria tend to persist on mobile phones for longer durations causing hospital-acquired infections. This is primarily because mobile phones have become an extended hand to healthcare workers due to their unavoidable utilization and the lack of sanitization after use in wards. Methods A questionnaire was used to assess the usage and disinfection practices of mobile phones among medical students regularly attending the wards of a teaching hospital. Culture was done to assess the presence of bacteria and their resistance to antibiotics. Three sterile cotton swabs were performed for each mobile phone. If growth was present, then a culture smear was made, and the type of bacteria was assessed. Participants received subsequent education on the disinfection of phones according to standard disinfection protocol. The main objective of the study was to determine the presence of bacteria on students' mobile phones and its resistance to antibiotics. Results A total of 103 medical students took part in the study, which included 51 males and 52 females. It was found that all the students used their mobile phones at all times in wards and 43% of them carried their phones to washrooms. Out of all the students surveyed, only 23% of students had regularly disinfected their phones. Bacteria were present on all mobile phones sampled. Among these, 98.05% had Gram-positive bacteria, 82.52% had Gram-negative bacilli, 33.98% had Bacillaceae, and 8.73% had vancomycin-resistant enterococcus (VRE). Among participants who did not disinfect their phones, 95.89% and 97.59% had methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA), respectively. Conclusion Following standard disinfection protocols is the need of the hour to reduce hospital-acquired infections.
PubMed: 38860100
DOI: 10.7759/cureus.60060 -
Environmental Health Insights 2024The emergence and spread of antibiotic resistance (ABR) have been a public health challenge globally. The burden is even higher in low-income countries where there is a...
The emergence and spread of antibiotic resistance (ABR) have been a public health challenge globally. The burden is even higher in low-income countries where there is a lack of appropriate healthcare systems, and inappropriate antibiotic disposal practices and utilization. Due to poor solid waste disposal practices in developing nations, municipal solid waste dumpsite (MSWDS) can be a reservoir for ABR bacteria. However, only a few studies demonstrated the prevalence of ABR in non-clinical environments such as MSWDS. This study assessed the prevalence of ABR bacteria at Bahir Dar City MSWDS, to understand the public health risks related to poor solid waste disposal systems. Nine soil samples were collected from the dumpsite. Bacteria were isolated, identified and tested for ABR. Seventy-one distinct colonies were isolated from all samples and identified into 10 bacterial genera based on morphological features and biochemical tests. For ABR tests, gentamicin (GN, 10 μg), streptomycin (ST, 30 μg), tetracycline (TE, 30 μg), ciprofloxacin (CIP, 5 μg), nalidixic acid (NAA, 30 μg), sulfonamide (SA, 250 μg), chloramphenicol (C, 30 μg), erythromycin (E, 15 μg), vancomycin (V, 30 μg), and amoxicillin (AMX, 25 μg) were used. The most frequently isolated bacteria were (23%) followed by species (17%). Ten isolates related to spp. were excluded from the antibiotic sensitivity test as there is no standard regarding this genus in the Clinical and Laboratory Standards Institute. The overall antibiotic résistance rate was 95.08%, and most isolates were found to be resistant to amoxicillin (100%), nalidixic acid (75.5%), and vancomycin (75%). Substantial proportions of the isolates were also resistant to tetracycline (55.35%), streptomycin (54.5%), and sulfonamide (50%). The overall multidrug resistance (MDR) rate was 36.06%. This high level of ABR calls for urgent intervention in waste management systems and regular surveillance programs.
PubMed: 38859927
DOI: 10.1177/11786302241260508 -
Infection and Drug Resistance 2024Methicillin-resistant (MRSA) enteritis is a condition in which MRSA grows abnormally in the intestine after administration of antimicrobial agents, resulting in...
BACKGROUND
Methicillin-resistant (MRSA) enteritis is a condition in which MRSA grows abnormally in the intestine after administration of antimicrobial agents, resulting in enteritis. Patients with MRSA detected in stool culture tests are often diagnosed with MSRA enteritis. However, uncertainty remains in the diagnostic criteria; therefore, we conducted epidemiological studies to define these cases.
PATIENTS AND METHODS
Patients who tested positive for MRSA by stool culture using selective media 48 h after admission to Kochi Medical School Hospital between April 1, 2012, and December 31, 2022, and did not meet the exclusion criteria were included. We defined MRSA enteritis (Group A) as cases that were responsive to treatment with vancomycin hydrochloride powder, had a Bristol Stool Scale of ≥ 5, and a stool frequency of at least three times per day; all others were MRSA carriers (Group B). Multivariate analysis was performed to risk factors associated with MRSA enteritis.
RESULTS
Groups A and B included 18 (25.4%) and 53 (74.6%) patients, respectively. Multivariate logistic regression analysis showed that a white blood cell count of > 10000/µL (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.12-26.9), MRSA count of ≥ 2+ in stool cultures (OR, 8.91; 95% CI, 1.79-44.3), and meropenem administration within 1 month of stool specimen submission (OR, 7.47; 95% CI, 1.66-33.6) were risk factors of MRSA enteritis.
CONCLUSION
The case definitions reviewed for MRSA enteritis may be useful as diagnostic criteria.
PubMed: 38854779
DOI: 10.2147/IDR.S459708 -
Water Research Aug 2024Since stormwater conveys a variety of contaminants into water bodies, green infrastructure (GI) is increasingly being adopted as an on-site treatment solution in...
Since stormwater conveys a variety of contaminants into water bodies, green infrastructure (GI) is increasingly being adopted as an on-site treatment solution in addition to controlling peak flows. The purpose of this study was to identify differences in microbial water quality of stormwater in watersheds retrofitted with GI vs. those without GI. Considering stormwater is recently recognized as a contributor to the antibiotic resistance (AR) threat, another goal of this study was to characterize changes in the microbiome and collection of AR genes (resistome) of urban stormwater with season, rainfall characteristics, and fecal contamination. MinION long-read sequencing was used to analyze stormwater microbiome and resistome from watersheds with and without GI in Columbus, Ohio, United States, over 18 months. We characterized fecal contamination in stormwater via culturing Escherichia coli and with molecular microbial source tracking (MST) to identify sources of fecal contamination. Overall, season and storm event (rainfall) characteristics had the strongest relationships with changes in the stormwater microbiome and resistome. We found no significant differences in microbial water quality or the microbiome of stormwater in watersheds with and without GI implemented. However, there were differences between the communities of microorganisms hosting antibiotic resistance genes (ARGs) in stormwater from watersheds with and without GI, indicating the potential sensitivity of AR bacteria to treatment. Stormwater was contaminated with high concentrations of human-associated fecal bacterial genes, and the ARG host bacterial community had considerable similarities to human feces/wastewater. We also identified 15 potential pathogens hosting ARGs in these stormwater resistome, including vancomycin-resistant Enterococcus faecium (VRE) and multidrug-resistant Pseudomonas aeruginosa. In summary, urban stormwater is highly contaminated and has a great potential to spread AR and microbial hazards to nearby environments. This study presents the most comprehensive analysis of stormwater microbiome and resistome to date, which is crucial to understanding the potential microbial risk from this matrix. This information can be used to guide future public health policy, stormwater reuse programs, and urban runoff treatment initiatives.
Topics: Microbiota; Water Microbiology; Rain; Ohio; Feces; Escherichia coli; Drug Resistance, Microbial; Water Quality
PubMed: 38852387
DOI: 10.1016/j.watres.2024.121873 -
The Journal of Infection Jun 2024
PubMed: 38848967
DOI: 10.1016/j.jinf.2024.106191 -
Euro Surveillance : Bulletin Europeen... Jun 2024BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment...
BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment options are limited. Vancomycin-variable enterococci (VVE) harbour the gene complex but are phenotypically vancomycin-susceptible.AimThe aim was to describe clonal shifts for VRE and VVE in Denmark between 2015 and 2022 and to investigate genotypic linezolid resistance among the VRE and VVE.MethodsFrom 2015 to 2022, 4,090 Danish clinical VRE and VVE isolates were whole genome sequenced. We extracted vancomycin resistance genes and sequence types (STs) from the sequencing data and performed core genome multilocus sequence typing (cgMLST) analysis for . All isolates were tested for the presence of mutations or genes encoding linezolid resistance.ResultsIn total 99% of the VRE and VVE isolates were From 2015 through 2019, 91.1% of the VRE and VVE were . During 2020, to the number of increased to 254 of 509 VRE and VVE isolates. Between 2015 and 2022, seven clusters dominated: ST80-CT14 , ST117-CT24 , ST203-CT859 ST1421-CT1134 (VVE cluster) ST80-CT1064 , ST117-CT36 and ST80-CT2406 We detected 35 linezolid vancomycin-resistant and eight linezolid-resistant VVEfm.ConclusionFrom 2015 to 2022, the numbers of VRE and VVE increased. The spread of the VVE cluster ST1421-CT1134 in Denmark is a concern, especially since VVE diagnostics are challenging. The finding of LVRE, although in small numbers, ia also a concern, as treatment options are limited.
Topics: Vancomycin-Resistant Enterococci; Enterococcus faecium; Humans; Denmark; Gram-Positive Bacterial Infections; Anti-Bacterial Agents; Bacterial Proteins; Carbon-Oxygen Ligases; Linezolid; Multilocus Sequence Typing; Microbial Sensitivity Tests; Vancomycin Resistance; Whole Genome Sequencing; Vancomycin; Genotype
PubMed: 38847117
DOI: 10.2807/1560-7917.ES.2024.29.23.2300633 -
Frontiers in Immunology 2024bacteremia (SAB) is a life-threatening infection particularly involving methicillin-resistant (MRSA). In contrast to resolving MRSA bacteremia (RB), persistent MRSA...
INTRODUCTION
bacteremia (SAB) is a life-threatening infection particularly involving methicillin-resistant (MRSA). In contrast to resolving MRSA bacteremia (RB), persistent MRSA bacteremia (PB) blood cultures remain positive despite appropriate antibiotic treatment. Host immune responses distinguishing PB vs. RB outcomes are poorly understood. Here, integrated transcriptomic, IL-10 cytokine levels, and genomic analyses sought to identify signatures differentiating PB vs. RB outcomes.
METHODS
Whole-blood transcriptomes of propensity-matched PB (n=28) versus RB (n=30) patients treated with vancomycin were compared in one independent training patient cohort. Gene expression (GE) modules were analyzed and prioritized relative to host IL-10 cytokine levels and DNA methyltransferase-3A () genotype.
RESULTS
Differential expression of T and B lymphocyte gene expression early in MRSA bacteremia discriminated RB from PB outcomes. Significant increases in effector T and B cell signaling pathways correlated with RB, lower IL-10 cytokine levels and heterozygous A/C genotype. Importantly, a second PB and RB patient cohort analyzed in a masked manner demonstrated high predictive accuracy of differential signatures.
DISCUSSION
Collectively, the present findings indicate that human PB involves dysregulated immunity characterized by impaired T and B cell responses associated with excessive IL-10 expression in context of the A/A genotype. These findings reveal distinct immunologic programs in PB vs. RB outcomes, enable future studies to define mechanisms by which host and/or pathogen drive differential signatures and may accelerate prediction of PB outcomes. Such prognostic assessment of host risk could significantly enhance early anti-infective interventions to avert PB and improve patient outcomes.
Topics: Humans; Bacteremia; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Male; Female; Middle Aged; Gene Expression Profiling; Transcriptome; Aged; Interleukin-10; DNA Methyltransferase 3A; Anti-Bacterial Agents; Adult
PubMed: 38846955
DOI: 10.3389/fimmu.2024.1373553