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Acute and Critical Care May 2024Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high...
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.
PubMed: 38863352
DOI: 10.4266/acc.2023.01571 -
Journal of Arthropod-borne Diseases Sep 2023Cockroaches play a role in the mechanical transmission of microbial pathogens. This study was designed to determine the isolated bacteria and their susceptibility to...
BACKGROUND
Cockroaches play a role in the mechanical transmission of microbial pathogens. This study was designed to determine the isolated bacteria and their susceptibility to conventional antibiotics from brown-banded cockroach, in Qom province, central Iran.
METHODS
In this cross-sectional study, brown-banded cockroaches were bred in an insectary and caught from hospitals of Qom. The samples were taken from the surface and alimentary canal and then cultured on microbial culture media; next, grown specimens were identified using differential culture media. Finally, after performing diagnostic tests and identifying the bacteria species, their susceptibility to various antibiotics was evaluated.
RESULTS
A total of 120 adult cockroaches from the insectary and hospitals were included in the study. Ten bacterial genera were found; nine were Gram-negative and one was Gram-positive. The genus , , , and were isolated only from the hospital strain. On the other hand, and from both groups and other species such as , and were isolated only from laboratory strains. The highest antibiotic resistance among Gram-positive cocci and Gram-negative bacilli were 100.0% and 98.1% for ampicillin and Ceftazidime, respectively.
CONCLUSION
The results of this study showed that various pathogenic bacteria harbored by brown-banded cockroaches. Moreover, it was found that most of these bacteria belong to the family, which can be pathogenic and thus threaten human health.
PubMed: 38860199
DOI: 10.18502/jad.v17i3.14981 -
Cureus May 2024An uncommon congenital hamartomatous disorder called Proteus syndrome is characterized by multifocal tissue expansion originating from all three germinal layers....
An uncommon congenital hamartomatous disorder called Proteus syndrome is characterized by multifocal tissue expansion originating from all three germinal layers. Diagnosis mainly relies on clinical and radiological criteria. Here, we present a case of a 13-year-old female child exhibiting bony, soft tissue, and vascular abnormalities, along with developmental delay. We conclude by highlighting the importance of imaging studies in conjunction with physical examination, which are characterized by general and specific criteria to diagnose this rare condition until a specific gene test becomes available.
PubMed: 38860105
DOI: 10.7759/cureus.60072 -
Skin Health and Disease Jun 2024Incontinence Associated Dermatitis (IAD) is a type of skin inflammation caused by chronic exposure to urine and/or faeces. Current treatment strategies involve creating...
BACKGROUND
Incontinence Associated Dermatitis (IAD) is a type of skin inflammation caused by chronic exposure to urine and/or faeces. Current treatment strategies involve creating a barrier between the skin and urine/faeces rather than targeting specific irritants. Urease expressing pathogens catalyse the conversion of urea, present in urine, into ammonia. The accumulation of ammonia causes an elevation in skin pH which is believed to activate faecal enzymes which damage skin, and opportunistic pathogens, which lead to secondary infections.
OBJECTIVES
To develop a better, multi-factorial model of IAD pathogenesis, including the effect of urease-expressing bacteria on skin, mechanism of damage of urease and urease-triggered activity of faecal enzymes and secondary pathogens. To study the effect of urease inhibition on preventing IAD skin damage.
METHODS
Five separate studies were made using ex vivo porcine skin and in vivo human skin models. Measurements of the change in skin barrier function were made using skin impedance, trans-epidermal water loss (TEWL), stratum corneum moisture and pH. Skin was exposed to artificial urine, inoculated with various microbes, enzymes and chemicals to examine the influence of: 1) urease-positive 2) ammonia, 3) combination of and a faecal enzyme, trypsin, 4) combination of and opportunistic pathogens, and , 5) inhibition of urease using acetohydroxamic acid (AHA) on barrier function.
RESULTS
The urease-mediated production of ammonia had two principal effects: it elevated skin pH and caused inflammation, leading to significant breakdown in skin (stratum corneum) barrier function. Urease was found to further increase the activity of faecal enzymes and opportunistic pathogens, due to elevated skin pH. The urease inhibitor, AHA, was shown to have significantly reduced damage to skin barrier function, measured as its electrical resistance.
CONCLUSIONS
Targeted therapeutic strategies should be developed to prevent the manifestation of IAD, rather than creating a generic barrier between skin and urine/faeces. Urease has been identified as a crucial component in the manifestation of IAD, due to its role in the production of ammonia. Urease inhibition provides a promising therapeutic target to halt the progression of IAD.
PubMed: 38846694
DOI: 10.1002/ski2.349 -
Indian Dermatology Online Journal 2024International Society for the Study of Vascular Anomalies classification defines Congenital Limb Overgrowth Vascular Syndromes (CLOS) as a subset of vascular syndromes...
International Society for the Study of Vascular Anomalies classification defines Congenital Limb Overgrowth Vascular Syndromes (CLOS) as a subset of vascular syndromes with other abnormalities that present with unilateral limb overgrowth. It includes Klippel-Trenaunay Syndrome, Parkes-Weber Syndrome, CLOVES (Congenital Lipomatous Overgrowth, Vascular Malformations, Epidermal Nevi, Spinal/Skeletal Anomalies/Scoliosis) Syndrome, Proteus Syndrome, PTEN Hamartomatous Syndrome, and Fibroadipose Vascular Anomaly. Due to their rare and complex nature, a multidisciplinary approach to diagnosis and treatment is required. A thorough clinical and radiological workup can go miles in reflecting on the patient's outcome. Here we report five cases of CLOS with their detailed dermato-radiological profiles.
PubMed: 38845672
DOI: 10.4103/idoj.idoj_500_23 -
Alternative Therapies in Health and... Jun 2024This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on...
OBJECTIVE
This meta-analysis aims to investigate the effects of prenatal prophylactic antibiotics on the diversity of intestinal flora in premature infants, with a focus on elucidating the rationale behind this investigation and the potential impact of altered intestinal flora on the health of preterm infants, such as increased susceptibility to infections, impaired nutrient absorption, and compromised immune function.
METHODS
Relevant literature consistent with the effects of prenatal prophylactic antibiotics on intestinal flora diversity in preterm infants was systematically searched and screened from both domestic and foreign databases, including Wanfang Medical Center, CNKNET, VIpp, and PubMed. Meta-analysis was performed using RevMan 5.2 software. Inclusion criteria for the study were: (1) comparison of prophylactic antibiotic use versus non-use, (2) no restrictions on subjects' characteristics, (3) follow-up loss < 20%, (4) institutional approval, (5) publication within the time frame from January 2017 to December 2022, (6) minimal missing data or suppliable by author contact, and (7) no major errors in sequencing or detection. Outcome measures included intestinal flora composition, phylum flora content, abundance index, and Shannon index, comparing antibiotic-treated and non-treated groups. RevMan 5.2 software was used for statistical analysis. Counting data was expressed as risk ratio (RR), and weighted mean difference (WMD) or standard mean difference (SMD) was selected as analysis statistics.
RESULTS
The study encompassed five Chinese literature sources, with one deemed low quality and four high quality. No significant publication bias was observed. Among the included studies, a significant reduction in the intestinal flora abundance index ACE was noted in the treated group compared to the non-treated group (RR: -8.10, 95% CI: -8.81 to -7.40, P < .00001). ACE estimates species richness in a microbial community by considering both abundant and rare species. Higher ACE values indicate greater diversity. Similarly, the Shannon diversity index was lower in the medication group compared to the non-medication group (RR: 0.73, 95% CI: 0.64 to 0.82, P < .00001). Shannon Diversity Index measures species diversity and evenness within a community. Higher values indicate higher diversity, considering both the number of species and their relative abundance. Analysis of Firmicutes content revealed a higher level in the treated group (RR: -6.44, 95% CI: -7.26 to -5.63, P < .00001). Additionally, lower Proteus (RR: 10.96, 95% CI: 9.47 to 12.45, P < .00001) and Klebsiella (RR: 15.96, 95% CI: 15.31 to 16.62, P < .00001) content was observed in the treated group. Conversely, Enterococcus content was higher in the treated group (RR: 2.18, 95% CI: 1.84 to 2.52, P < .00001), along with a higher proportion of Enterococcus (RR: 0.45, 95% CI: 0.27 to 0.76, P = .003). These findings collectively suggest that prophylactic antibiotic use in preterm infants significantly alters the composition of intestinal flora.
CONCLUSION
Our findings suggest that prophylactic antibiotic use in preterm infants leads to a notable reduction in intestinal flora diversity, potentially impacting their health outcomes. Decreased microbial diversity has been linked to gastrointestinal issues, infections, and weakened immune function. These results highlight the importance of cautious antibiotic use in this vulnerable population and the need for further research to better understand and mitigate the potential health implications.
PubMed: 38836722
DOI: No ID Found -
Pakistan Journal of Medical Sciences 2024Our objective was to quantify the number of various bacteria that frequently cause UTI in diabetes patients as well as to gauge their susceptibility and resistance to...
OBJECTIVE
Our objective was to quantify the number of various bacteria that frequently cause UTI in diabetes patients as well as to gauge their susceptibility and resistance to antibiotics.
METHOD
A cross-sectional study was conducted at the Internal Medicine Ward of Lady Reading Hospital, Peshawar, Pakistan from June 2021 to December 2021, Patients with confirmed diabetes were included in the study; however, participants receiving antimicrobial medications for a maximum of 14 days were excluded from the study. Resistance of was asssessed using ciprofloxac, ceftazidime and meropenem.
RESULTS
The findings highlighted the the prevalence of in 38.8% of patients, Candida in 19% of patients, in 11.8% of patients, Pseudomonas in 10%, Klebsiella in 9.5% patients, 6.2% patients and Staphylococcus was found in 5.2% patients. According to the overall sensitivity and resistance of antibiotics in microorganisms, Meropenem showed 89.6% sensitivity and 10.4% resistance. Ciprofloxacin showed 38.9% sensitivity and 61.1% resistance and ceftazidime showed 22.7 sensitivity and 77.3% resistance.
CONCLUSION
UTIs were very common in diabetes patients, and was the most common uropathogen found. Compared to male patients, more female patients had infections. The uropathogens showed a significant degree of resistance to ceftizidime and ciprofloxacin.
PubMed: 38827869
DOI: 10.12669/pjms.40.5.8275 -
Heliyon May 2024The ability of ureolytic bacteria to break down stable urea to alkaline ammonia leads to several environmental and health challenges. Ureolytic bacteria such as and...
Synergistic inhibition of ureolytic activity and growth of suggests cobinding of fluoride and acetohydroxamic acid at the urease active site and provides a novel strategy to combat ureolytic bacteria.
The ability of ureolytic bacteria to break down stable urea to alkaline ammonia leads to several environmental and health challenges. Ureolytic bacteria such as and can become pathogenic and cause persistent infections that can be difficult to treat. Inhibiting urease activity can reduce the growth and pathogenicity of ureolytic bacteria. In the present study, we investigated the synergistic effects of tannic acid (TA) and the urease inhibitors fluoride (F) and acetohydroxamic acid (AHA). The concentration of AHA needed for efficient inhibition of the ureolytic activity of can be significantly reduced if AHA is coapplied with tannic acid and sodium fluoride (NaF). Thus, only 1.20 μmol l AHA in combination with 0.30 mmol l tannic acid and 0.60 mmol l NaF delayed the onset of ureolytic pH increase by 95.8 % and increased the growth lag phase by 124.3 % relative to untreated . At these concentrations, without AHA, TA and NaF increased the onset of the ureolytic pH change by only 37.0 % and the growth lag phase by 52.5 %. The strong inhibition obtained with low concentrations of AHA in triple-compound treatments suggests cobinding of F and AHA at the urease active site and could reduce the side effects of AHA when it is employed as a drug against e.g. urinary tract infections (UTIs) and blocked catheters. This study reports the basis for a promising novel therapeutic strategy to combat infections caused by ureolytic bacteria and the formation of urinary tract stones and crystalline biofilms on catheters.
PubMed: 38826744
DOI: 10.1016/j.heliyon.2024.e31209 -
Lancet (London, England) Jun 2024Coronary computed tomography angiography (CCTA) is the first line investigation for chest pain, and it is used to guide revascularisation. However, the widespread...
BACKGROUND
Coronary computed tomography angiography (CCTA) is the first line investigation for chest pain, and it is used to guide revascularisation. However, the widespread adoption of CCTA has revealed a large group of individuals without obstructive coronary artery disease (CAD), with unclear prognosis and management. Measurement of coronary inflammation from CCTA using the perivascular fat attenuation index (FAI) Score could enable cardiovascular risk prediction and guide the management of individuals without obstructive CAD. The Oxford Risk Factors And Non-invasive imaging (ORFAN) study aimed to evaluate the risk profile and event rates among patients undergoing CCTA as part of routine clinical care in the UK National Health Service (NHS); to test the hypothesis that coronary arterial inflammation drives cardiac mortality or major adverse cardiac events (MACE) in patients with or without CAD; and to externally validate the performance of the previously trained artificial intelligence (AI)-Risk prognostic algorithm and the related AI-Risk classification system in a UK population.
METHODS
This multicentre, longitudinal cohort study included 40 091 consecutive patients undergoing clinically indicated CCTA in eight UK hospitals, who were followed up for MACE (ie, myocardial infarction, new onset heart failure, or cardiac death) for a median of 2·7 years (IQR 1·4-5·3). The prognostic value of FAI Score in the presence and absence of obstructive CAD was evaluated in 3393 consecutive patients from the two hospitals with the longest follow-up (7·7 years [6·4-9·1]). An AI-enhanced cardiac risk prediction algorithm, which integrates FAI Score, coronary plaque metrics, and clinical risk factors, was then evaluated in this population.
FINDINGS
In the 2·7 year median follow-up period, patients without obstructive CAD (32 533 [81·1%] of 40 091) accounted for 2857 (66·3%) of the 4307 total MACE and 1118 (63·7%) of the 1754 total cardiac deaths in the whole of Cohort A. Increased FAI Score in all the three coronary arteries had an additive impact on the risk for cardiac mortality (hazard ratio [HR] 29·8 [95% CI 13·9-63·9], p<0·001) or MACE (12·6 [8·5-18·6], p<0·001) comparing three vessels with an FAI Score in the top versus bottom quartile for each artery. FAI Score in any coronary artery predicted cardiac mortality and MACE independently from cardiovascular risk factors and the presence or extent of CAD. The AI-Risk classification was positively associated with cardiac mortality (6·75 [5·17-8·82], p<0·001, for very high risk vs low or medium risk) and MACE (4·68 [3·93-5·57], p<0·001 for very high risk vs low or medium risk). Finally, the AI-Risk model was well calibrated against true events.
INTERPRETATION
The FAI Score captures inflammatory risk beyond the current clinical risk stratification and CCTA interpretation, particularly among patients without obstructive CAD. The AI-Risk integrates this information in a prognostic algorithm, which could be used as an alternative to traditional risk factor-based risk calculators.
FUNDING
British Heart Foundation, NHS-AI award, Innovate UK, National Institute for Health and Care Research, and the Oxford Biomedical Research Centre.
Topics: Humans; Male; Female; Middle Aged; Computed Tomography Angiography; Aged; Longitudinal Studies; Coronary Artery Disease; Coronary Angiography; United Kingdom; Risk Assessment; Risk Factors; Inflammation; Prognosis; Myocardial Infarction
PubMed: 38823406
DOI: 10.1016/S0140-6736(24)00596-8 -
PloS One 2024Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings....
Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.
BACKGROUND
Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings. Urinary tract infections have a significant health impact on HIV-infected patients. Nowadays, drug-resistant pathogens are widespread poses a serious clinical risk, and causes urinary tract infection. The common agents of bacteria and fungi that cause urinary tract infection are Escherichia coli followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida. albicans. This study aimed to investigate uro-pathogen, multidrug resistance pattern of bacteria, and associated factors of community-acquired urinary tract infection among HIV-positive patients attending antiretroviral therapy in Dessie comprehensive specialized hospital, Northeast Ethiopia from February 1, 2021, to March 30, 2021.
METHODS
An institutional-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital. Socio-demographic and clinical data were collected by using structured questionnaires from HIV patients suspected of community-acquired urinary tract infections. About 10 ml of clean-catch midstream urine was collected and inoculated into Blood agar, MacConkey, and Cysteine lactose electrolyte deficient media. Yeasts were identified by using Gram stain, germ tube test, carbohydrate fermentation, assimilation tests, and chromogenic medium. Gram stain and biochemical tests were performed to identify isolates and an antimicrobial susceptibility pattern was performed on disc diffusion techniques. Data were entered and analyzed using SPSS version 25. Both bivariate and multivariable logistic regression analysis was performed and a P value of < 0.05 with an adjusted odds ratio with their 95% confidence interval (CI) was used as statistically significant associations.
RESULTS
From the total 346 study participants, 92 (26.6%) were culture positive 75 (81.52%) were bacterial and 17 (18.48%) were fungal pathogens. From a total of 75 bacteria isolates 51(68%) were Gram-negative bacteria and the most commonly isolated bacteria were E. coli 16 (21.33%) followed by K. pneumoniae 11(14.67%) and enterococcus species 10(10.87. Of the 17 fungal isolates of fungi, 8(47.1%) were represented by C. tropicalis. Of the isolated bacteria, 61(81.3%) were resistant to three and above classes of antibiotics (drug classes). About 13 (81.3%) of E. coli, 9(81.8%) of K. pneumoniae, 8(80%) of Enterococcus species, 7 (77.8%) of P. aeruginosa, and CoNs 7(87.5%) were the most frequently exhibited three and above classes of antibiotics (multi-drug resistance). Amikacin and gentamicin were effective against Gram-negative Uro-pathogens. Participants aged>44year, female, being daily labor, being farmer, unable to read and write, patients with CD4 count of ≤ 200 cells/mm3 and CD4 count of 201-350 cells/mm3, who had chronic diabetics, patients having a history of hospitalization and who had urgency of urinations were statistically significant association with significant urinary tract infections.
CONCLUSION
The burden of community-acquired urinary tract infections among HIV patients is alarmingly increased. Therefore, behavior change communications might be considered for promoting the health status of HIV patients. Moreover, CD4 level monitoring and therapeutics selection based on microbiological culture are quite advisable for the management of urinary tract infections of HIV patients.
Topics: Humans; Ethiopia; Urinary Tract Infections; Female; Male; HIV Infections; Adult; Community-Acquired Infections; Middle Aged; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Young Adult; Microbial Sensitivity Tests; Anti-Bacterial Agents; Hospitals, Special; Bacteria
PubMed: 38820330
DOI: 10.1371/journal.pone.0296480