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The objective of this study was to describe the prevalence, characteristics, and risk factors of coronavirus disease-2019 (COVID-19) infection among health care workers (HCWs) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. A prospective cross-sectional study of HCWs confirmed to have COVID-19 infection from March 1, 2020 to December 31, 2022. A total of 746 HCWs were diagnosed with COVID-19. Patients' age ranged from 22 to 60 years with a mean ± standard deviation of 37.4 ± 8.7 years. The infection was community-acquired in 584 (78.3%) HCWs. The vast majority (82.6%) of the infected HCWs had no comorbidities. Nurses (400/746 or 53.6%) represented the largest professional group, followed by physicians (128/746 or 17.2%), administrative staff (125/746 or 16.8%), respiratory therapists (54/746 or 7.2%), and physiotherapists (39/746 or 5.2%). Symptoms included fever (64.1%), cough (55.6%), sore throat (44.6%), headache (22.9%), runny nose (19.6%), shortness of breath (19.0%), fatigue (12.7%), body aches (11.4%), diarrhea (10.9%), vomiting (4.4%), and abdominal pain (2.8%). Most (647 or 86.7%) patients were managed as outpatients. Four (0.5%) HCWs died. HCWs face a dual risk of SARS-CoV-2 infection, both from community exposure and within the hospital setting. Comprehensive infection control strategies are needed to protect HCWs both inside and outside the hospital environment. • 78.3% of COVID-19 infections among healthcare workers (HCWs) were community-acquired. • The vast majority (82.6%) of the infected HCWs had no comorbidities. • Nurses (53.6%) represented the largest professional group, followed by physicians (17.2%). • Most (86.7%) patients were managed as outpatients and 4 (0.5%) patients died. • HCWs face a dual risk of infection, both from community and hospital exposures. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has declared antimicrobial resistance (AMR) as one of the top ten public health threats faced by humanity. Carbapenems are currently the last option β-lactam antibiotics for treatment of both hospital and community acquired infections. The rapid rise and spread of carbapenem resistant organisms (CRO) is a global concern highlighting the need for early detection and isolation of patients. A total of 226 non- repeat, carbapenem resistant Gram-negative isolates were subjected to carbapenemase detection. Three phenotypic methods like Modified Hodge Test (MHT), RAPIDEC® CARBA NP kit (bioMérieux, France) and Chromogenic agar were used and a cartridge based molecular method Xpert® Carba-R (Cepheid) was used on all the study samples for detection of carbapenemases. The results of MHT, RAPIDEC® CARBA NP and CHROMagar were same for both Enterobacteriaceae and Non Fermenters (except for CHROMagar, which is applicable only for Enterobacteriaceae). Xpert® Carba R could not detect genes in all the phenotypically positive organisms for carbapenemase production. However, there was no statistically significant difference between the three phenotypic tests and Xpert® Carba R used for the detection of carbapenem resistance. Preserving the last resort antimicrobials is the need of the hour, as there are few therapeutic options for treating infections caused by carbapenem-resistant bacteria. Early detection, followed by strict implementation of infection prevention and control strategies to stall the dissemination of such organisms is the best way and needs to be implemented on a war footing. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP. Methods: This cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups. Results: Among the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P < 0.001). A significant positive correlation was observed between RDW_CV and MPV (r = 0.636, P < 0.001). Mean RDW and MPV values were significantly elevated in children needing ICU admission and those with pleural effusion (P < 0.001). The RDW_CV cutoff was 13.75, with 97.4% sensitivity and 80.4% specificity. The MPV cutoff was 8.25, with 78.9% sensitivity and 69.6% specificity. Conclusion: Elevated RDW_CV and MPV levels are associated with severe CAP in hospitalized children, providing valuable prognostic insights. RDW_CV is a more precise prognostic indicator than MPV, demonstrating superior predictive value in CAP management. [ABSTRACT FROM AUTHOR]

Background: Globally, extended-spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales are major causes of hospital-acquired infections and there are increasing concerns about their role in community-acquired infections. Objective: We aimed to investigate the prevalence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and Carbapenemase-producing-Carbapenemresistant-Enterobacterales (CP-CRE) and associated factors in community settings in Gulele sub city, Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted among 261 healthy individuals. Stool samples were collected and processed using standard microbiological methods. Antimicrobial susceptibility and phenotypic ESBL and carbapenemase tests were performed. Antibiotic resistance genes were detected by Polymerase Chain Reaction (PCR). Results: The colonization rate of ESBL-PE and CP-CRE were 31.4% (82/261, 95% CI: 25.91–37.48) and 0.8% (2/261, 95% CI: 0.13–3.1), respectively by phenotypic method. Molecular detection of genes for ESBL-PE was 27.9% (73/261, 95% CI:22.7–33.9), and for CP-CRE was 0.8% (2/261, 95% CI: 0.13–3.1). The most prevalent genes were blaTEM [76.7% (56/73)] and blaCTX-M [45.2% (33/73)]. Previous antibiotic use (AOR:2.04, 95%CI: 1.35–4.41, P:0.041) and age between 42 and 53 years old (AOR:3.00, 95%CI:1.12–7.48, P:0.019) were significantly associated with ESBL-PE colonization. Conclusion: Intestinal colonization by ESBL-PE harboring the associated antibiotic resistance genes was substantially high but with low CP-CRE. Continued surveillance of community-level carriage of antimicrobial resistance Enterobacterales is warranted. [ABSTRACT FROM AUTHOR]

Background One of the most prevalent long-term kidney disorders in high-blood-pressure patients is nephrolithiasis. This study involves collecting urine and renal stones from patients with urinary tract infection (UTI) to analyze how hospitalized patients with UTI contract community infections. The samples were collected at the Sulaimaniyah Surgical Teaching Hospital urology and extracorporeal shock wave lithotripsy (ESWL) staff. It is understood that UTIs contribute to the formation of kidney stones. Methods Screened and cultured urine requires careful collection, transport, and interpretation. Urine samples were collected from the patients with UTI at the Sulaimaniyah teaching hospital for culturing. Urine cultures containing pyuria and bacteria indicate UTIs. Microorganisms were studied, inoculated on blood, MacConkey, and mannitol salt agar, and biochemically identified. A bacterial and microbiological examination of kidney stones was conducted at the Sulaymaniyah Surgical Teaching Hospital's ESWL and urology departments. Clean renal stone samples with ethanol for 1 minute, crush using sterile tongs, then culture in 37°C thioglycolate broth for 48 hours. Specimens inoculated on blood, MacConkey, and mannitol salt agars resulted in isolation of staphylococci, streptococci, and Staphylococcus spp. Results In this study, 17 of 48 samples showed microbial growth. Each of Enterococcus and Micrococcus spp. comprised 12.5% of eight renal intact stone samples. Three of 14 renal intact stone samples showed microbial growth with 7 and 14% for Enterococcus and Escherichia coli , respectively. From eight urine samples before and after ESWL procedure, E. coli isolation incidents doubled from 12.5 to 25%, while Staphylococcus spp. remained the same at 12.5%. Out of 10 UTI urine samples, 20% Staphylococcus spp., E. coli , and 10% Pseudomonas spp. were isolated. Conclusion This study related renal stones to E. coli , enterococci, Micrococcus luteus , and staphylococci. After ESWL, the urine samples revealed E. coli growth, whereas comparable urine samples before ESWL did not. Thus, urinary infections can cause kidney stones. Eighteen of 48 kidney stone samples tested positive for E. coli , 22 for staphylococci, 11 for enterococci, 5 for Pseudomonas , 5 for Proteus , and 5 for micrococci. [ABSTRACT FROM AUTHOR]

The misuse and overtreatment of antibiotics in hospitalized patients with community-acquired pneumonia (CAP) can cause multi-drug resistance and worsen clinical outcomes. We aimed to analyze the trends and appropriateness of antibiotic changes in hospitalized patients with CAP and their impact on clinical outcomes. This retrospective study enrolled patients with CAP, aged > 18 years, admitted from January 2017 to December 2021 at Seoul National University Bundang Hospital, South Korea. We examined the pathogens identified, antibiotics prescribed, and the appropriateness of antibiotic changes as reviewed by infectious disease specialists. Antibiotic appropriateness was assessed based on adherence to the 2019 ATS/IDSA guidelines and the 2018 Korean national guidelines for CAP, targeting appropriate pathogens, proper route, dosage, and duration of therapy. Outcomes measured included time to clinical stability (TCS), length of hospital stay, duration of antibiotic treatment, and in-hospital mortality. The study included 436 patients with a mean age of 72.11 years, of whom 35.1% were male. The average duration of antibiotic treatment was 13.5 days. More than 55% of patients experienced at least one antibiotic change, and 21.7% had consecutive changes. Throughout their hospital stay, 273 patients (62.6%) received appropriate antibiotic treatment, while 163 patients (37.4%) received at least one inappropriate antibiotic prescription. Those who received at least one inappropriate prescription experienced longer antibiotic treatment durations and extended hospital stays, despite having similar TCS. In conclusion, inappropriate antibiotic prescribing in hospitalized patients with CAP is associated with prolonged antibiotic treatment and increased length of stay. Emphasizing the appropriate initial antibiotic selection may help mitigate these negative effects. [ABSTRACT FROM AUTHOR]

Background Gram-negative bloodstream infections (GNBSIs) more commonly occur in children with comorbidities and are increasingly associated with antimicrobial resistance. There are few large studies of GNBSIs in children that relate the clinical presentation, pathogen characteristics, and outcomes. Methods A 3-year prospective study of GNBSIs in children aged <18 years was conducted in 5 Australian children's hospitals between 2019 and 2021. The clinical characteristics, disease severity, and outcomes were recorded. Causative pathogens underwent antibiotic susceptibility testing and whole genome sequencing. Results There were 931 GNBSI episodes involving 818 children. Median age was 3 years (interquartile range, 0.6–8.5). A total of 576/931 episodes (62%) were community onset, though 661/931 (71%) occurred in children with comorbidities and a central venous catheter was present in 558/931 (60%). Central venous catheter (145/931) and urinary tract (149/931) were the most common sources (16% each). One hundred of 931 (11%) children required intensive care unit admission and a further 11% (105/931) developed GNBSIs in intensive care unit. A total of 659/927 (71%) isolates were Enterobacterales, of which 22% (138/630) were third-generation cephalosporin resistant (3GCR). Extended spectrum beta-lactamase genes were confirmed in 65/138 (47%) 3GCR Enterobacterales. Most common extended spectrum beta-lactamase genes were bla CTX-M-15 (34/94, 36%) and bla SHV-12 (10/94, 11%). There were 48 deaths overall and 30-day in-hospital mortality was 3% (32/931). Infections with 3GCR Enterobacterales were independently associated with higher mortality (adjusted odds ratio, 3.2; 95% confidence interval, 1.6–6.4). Conclusions GNBSIs in children are frequently healthcare associated and affect children younger than age 5 years. Infections with 3GCR Enterobacterales were associated with worse outcomes. These findings will inform optimal management guidelines and help prioritize future antimicrobial clinical trials. [ABSTRACT FROM AUTHOR]

Background We aimed to test the hypothesis that development of metastatic infection represents a distinct clinical endpoint from death due to Staphylococcus aureus bacteremia (SAB). Methods We conducted a retrospective observational study of adults with SAB between 20 December 2019 and 23 August st2022 (n = 464). Simple logistic regression, odds ratios, and z -scores were used to compare host, clinical, and microbiologic features. Results Co-occurrence of attributable mortality and metastatic infection was infrequent. Charlson Comorbidity Index and age were strongly associated with attributable mortality, but not metastatic infection. We compared patients with fatal SAB (without clinically-apparent metastatic complications, 14.4% of cohort), metastatic SAB (without attributable mortality, 22.2%), neither complication (56.7%), and overlapping fatal/metastatic SAB (6.7%). Compared to SAB without complications, fatal SAB was specifically associated with older age and multi-morbidity. Metastatic SAB was specifically associated with community acquisition, persistent fever, persistent bacteremia, and recurrence. Endocarditis was over-represented in the fatal/metastatic SAB overlap group, which shared patient characteristics with fatal SAB. In contrast to other (predominantly musculoskeletal) metastatic complications, endocarditis was associated with increased mortality, with death occurring in older multi-morbid patients later after SAB onset. Conclusions Patients with SAB experience distinct clinical endpoints: (i) early death, associated with multi-morbidity and age; (ii) metastatic (predominantly musculoskeletal) SAB; (iii) endocarditis, associated with late death occurring in older people with multi-morbidity, and (iv) bacteraemia without complications. These distinctions could be important for selecting appropriate outcomes in clinical trials: different interventions might be required to reduce mortality versus improve clinical response in patients with metastatic SAB. [ABSTRACT FROM AUTHOR]

Objective Respiratory syncytial virus (RSV) is the most common viral respiratory infection in infants. This study aimed to establish the potential changes in the clinical course of RSV in the neonatal period with the onset of the coronavirus disease 2019(COVID-19) pandemic. Study Design During the observational study period, newborns diagnosed with community-acquired RSV infection and admitted to the neonatal intensive care unit (NICU) were evaluated. RSV-infected neonates before the COVID-19 pandemic were classified as Group 1 , those during the strict isolation period as Group 2 , and RSV-infected newborns after the removal of restrictions were classified as Group 3. Results A total of 208 community-acquired RSV-infected neonates were analyzed. The median age at admission to the NICU was 26 days, and the mean gestational week was 37.2 ± 2.7. The ratio of hospitalized babies with RSV infection to all hospitalized newborns rose after the pandemic significantly (1.9, 1.6, and 5.2%; p < 0.001). Following the pandemic, there was an increase in full-term, early-term, and late-preterm cases. Nevertheless, no change was observed in the number of preterm cases (p > 0.05). There was also a statistically significant increase in the need for intubation, noninvasive ventilation (NIV), supplemental oxygen, inhaled bronchodilator drugs, and length of hospital stay in Group 3 after the pandemic (p < 0.001). All these parameters related to more severe RSV infection when the precautions were removed, while there was a milder disease with restrictions during the pandemic in Group 2 (p < 0.001). However, none died due to RSV infection during the study because of timely supportive care. Conclusion Following the COVID-19 pandemic, the frequency and severity of RSV infection in newborns have increased, and it can result in a serious clinical picture even in full-term babies with no comorbidities. Attention to strict contact precautions, particularly in newborns, who are a more vulnerable population after the pandemic, may play an important role in any future outbreak. Key Points The course of neonatal RSV infection has changed after the pandemic. A statistically significant increase was observed in the need of intubation in newborns with RSV. The strict precautions during the pandemic also helped to prevent the transmission of RSV. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, 79 million people live in soil transmitted helminths endemic areas. The Ethiopia established a National goal to eradicate STH transmission by 2025. To meet that goal, it is imperative that data is acquired on community helminth infection risk. This study examined the prevalence of STH and risk factors for infection in vegetable farmers working on Akaki River Bank, Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted between November 7, 2022, and June 2023. A stratified random sampling was used to select farming households. Two hundred and sixteen farmers were enrolled in the study. Data on socio-demographic, WASH, wastewater irrigation related factors were collected by trained data collectors using a structured questionnaire. Kato-Katz concentration was utilized to detect STH. The data were entered using EpiData 3.1 and analyzed with Stata 14.0, using p-values less than 0.05 to identify significant factors. Logistic regression was used to identify independent risk factors for infection. Results: The prevalence of STH was 22.2% (95% CI = 13.6-27.9%), with Ascaris lumbricoides being the most common (11.1%), followed by hookworm (7.4%), and Trichuris trichiura (3.7%). Low income levels (AOR = 1.85, 95% CI = 1.25–5.99), lack of handwashing before eating (AOR = 2.25, 95% CI = 1.58 − 11.3), absence of fingernails cleanliness (AOR = 1.97, 95% CI = 1.74–39.5), not wearing shoes at work (AOR = 3.4, 95% CI = 2.98–82.2), touching the face with dirty hands (AOR = 2.9, 95% CI = 0.68–28.2), washing vegetables with irrigation wastewater (AOR = 2.1, 95% CI = 1.95–45.2), and not wearing protective clothing during farming activities (AOR = 2.99, 95% CI = 1.58 − 22.4) were the significant risk factors for infection with STH. Conclusion: Of the farming communities examined in this study, one of the five was found to be infected with soil transmitted helminth. This research has shown clear risk factors for STH infection including: lack of personal hygiene practices, insufficient sanitation access, and limited use of protective equipment. To achieve the national goal, there is a need for farming communities to understand preventative risks of infection, improve WASH (Water access, sanitation and hygine) practices, WASH access, protective equipment, and health education. [ABSTRACT FROM AUTHOR]

Objective COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed post-COVID syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life, and fatigue of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared with usual medical care for people with PCS with persistent respiratory symptoms. Methods The study will be a multi-site randomized controlled trial with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group of 4 weeks, twice-weekly pulmonary telerehabilitation or a control group of usual medical care. Participants in the control group will be invited to cross-over into the intervention group after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; Chronic Obstructive Pulmonary Disease Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up. Impact Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short-duration pulmonary telerehabilitation program, if effective compared with usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus stands as a prominent cause for both nosocominal and community acquired infections across the globe. Clindamycin, a member of MLSB family, has emerged as the preferred choice for treating Staphylococcus aureus infections. However, one critical consideration in administering Clindamycin is the potential development of inducible Clindamycin resistance, posing a significant risk of clinical treatment failure. Aim: The study was aimed to determine the occurence of inducible Clindamycin resistance among Staphylococcus aureus isolates in our geographic region. Method: The hospital based cross sectional study was conducted over a period of one year from January 2023 to December 2023. A total of 672 Staphylococcus aureus isolates were identified by conventional methods and subjected to antimicrobial susceptibility test by Kirby Bauer disk diffusion method and Erythromycin resistant isolates were tested for D test. Result: Out of 672 Staphylococcus aureus isolates, 517 were MRSA and 155 were MSSA. Erythromycin resistance was seen in 395 (58.77%) isolates. D test revealed inducible clindamycin resistance in 45 (6.69%) isolates, constitutive clindamycin resistance in 91 (13.54%) isolates and MS phenotype in 259 (38.54%) isolates. Inducible clindamycin resistance was more in MRSA (7.73%) isolates compared to MSSA (3.22%) isolates. Conclusion: D test is a simple and cost-effective test that should be performed as routine laboratory test and will help in guiding the clinicians regarding judicious use of Clindamycin. [ABSTRACT FROM AUTHOR]

Context: Staphylococcus aureus (S. aureus) is an opportunistic pathogen. It can cause various infections in humans and animals. The threat of antibiotic resistance in S. aureus has risen over the years and the treatment costs have also spiralled up. Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to all β-lactam antimicrobials, and these strains contribute to both hospital-acquired and community-acquired infections. Aim: This study aimed to determine the prevalence rate of methicillin-resistant Staphylococcus aureus in HA-MRSA and CA-MRSA. Methods: MRSA were subjected to antibiotic susceptibility testing, and oxacillin discs and cefoxitin discs were used to detect them. Results: Out of 150 Staphylococcus aureus isolates, 45 were MRSA. Of the 45 confirmed MRSA isolates, 18(40%) were HA-MRSA and 27 (60%) were CA-MRSA. Conclusion: causes of nosocomial pathogens are responsible for causing various human infections that may range from minor skin diseases to life-threatening infections. In the present era of antibiotic resistance, the emergence of multi-drug-resistant organisms is becoming more common. Therefore, early detection is most important for treating, preventing and controlling such organisms. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections (IAIs) are one of the important contributors to sepsis in intensive care units. The emergence of antibiotic resistance and the diversification of etiological agents make it challenging to determine the optimal empirical therapy. This study attempts to know the etiological agents, their antibiotic susceptibility patterns, and the risk factors associated with IAIs in different settings. This prospective cross-sectional study was conducted in a tertiary care facility from January 2023 to June 2023. Adult and paediatric patients having primary IAI or developed infections during their hospital stay were included in this study. Specimen like peritoneal swabs or fluid from intra-abdominal drains placed for more than 24 hours were excluded. Matrix-assisted Laser Desorption/Ionization Time-Of-Flight was used to identify the etiological agents. VITEK®2 system was used to perform the antimicrobial susceptibility. Associated risk factors were documented. A total of 86 cases were analysed. The majority of the patients had complicated IAIs (95.3%), and 65.12 % acquired the infection in the community (CAIAI). The vast number of cases presented with intra-abdominal abscesses (46.5%). Diabetes and hepatic disorders were the frequent underlying comorbid conditions associated with CA-IAIs. Prolonged hospital stay and the presence of concomitant conditions like malignancy and chronic renal failure significantly influenced the occurrence of hospital-acquired infections (HA-IAIs). E. coli was the frequently isolated Gram-negative pathogen both in the community and hospital settings. Whereas among Gram-positives, Enterococcus predominated and was commonly isolated from HA-IAIs. Enterobacterales were highly susceptible to meropenem and piperacillin-tazobactam. E. coli and Klebsiella were the frequent extendedspectrum beta-lactamase producers and showed the least susceptibility towards cephalosporins and fluoroquinolones. Multidrug-resistant organisms (MDROs) (p=.013), including carbapenem-resistant strains (p=.048), were significantly isolated from hospital-acquired IAIs. The high prevalence of IAIs with MDROs in hospital settings emphasizes the importance of developing hospital-based antibiotic policy, infection control measures, and judicious use of antibiotics. [ABSTRACT FROM AUTHOR]

Methicillin resistant Staphylococcus aureus (MRSA) is a known human pathogen capable of causing community and hospital acquired infections worldwide. Treatment options available for MRSA infections are limited, with vancomycin being one of the most common drugs used. It is described in the literature that vancomycin can be ineffective against MRSA isolates with MIC values between 1-2 mg/litre. This slow and steady shift of vancomycin MIC values towards higher side over a period of time is known as "MIC creep". The present retrospective study was carried out over five year period from January 2019 to June 2023. Staphylococcus aureus isolates from all clinical samples isolated during study period were included in the study. MIC50, MIC90, geometric mean MIC values were determined and analysed using Microsoft Excel. In the present study, the prevalence of MRSA was high (79.6%) in pus and tissue samples followed by blood sample (9.7%). Most of the MRSA isolates (55.80%) in present study exhibited vancomycin MIC of 1 µg/ml, there is no increasing trend of MIC values over a five year period. MIC creep is a slow and steady process which is multifactorial in origin. Regular monitoring of vancomycin MIC trend is advisable as vancomycin is the first-line treatment for culture proven severe infection with MRSA. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance in Escherichia coli presents a global challenge associated with nosocomial infections and increased mortality rates. Understanding resistance profiles is crucial for guiding treatment strategies and ensuring effective antibiotic use. This study aimed to investigate the prevalence and in vitro resistance of E. coli to community-acquired and nosocomial infections. Various clinical samples from 700 patients were cultured on MacConkey's medium and blood agar. The disk diffusion method was used to determine the antibiotic susceptibility profile of the E. coli isolates following the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Urine, pus, seminal fluid, vaginal swabs, and other body fluids were among the clinical samples analyzed. Of the 112 E. coli isolates, 48.2% were from inpatients and 51.8% were from outpatients, with the majority (66%) isolated from urine samples. Higher resistance levels were observed in the urinary isolates than that in the previously recorded data from the same institutions. Notably, isolates exhibited high resistance to penicillin (98.2%), ampicillin (97.3%), first-generation cephalosporins (90.2%), erythromycin (72.2%), and roxithromycin (95.4%), whereas lower resistance was noted against piperacillin-tazobactam (25.0%), nitrofurantoin (12.5%), and imipenem (9.8%). The overall multidrug resistance rate was 62.5%, with higher rates observed in nosocomial infections (70%) compared to community-acquired isolates (55.6%). However, this difference was not statistically significant (p>0.05). This study underscores the prevalence of E. coli isolates (27.0%) and highlights the concerning level of resistance, particularly to older antibiotics. These findings emphasize the importance of judicious antibiotic use and ongoing surveillance. [ABSTRACT FROM AUTHOR]

A total of sixty-two isolates were tested to assess the presence of the irp2 gene in different isolates of Klebsiella pneumoniae. The isolates discussed in this study were obtained from patients who had acquired illnesses either within the hospital premises or in the surrounding vicinity. These isolates were sourced from three hospitals located in Baghdad, namely Al-Imam Ali, Al-Zaafaranya, and Ibin-Albady hospitals. One interesting thing about Klebsiella pneumoniae is that it makes siderophores, especially yersiniabactin. This is because of a gene that controls this trait. The application of DNA sequencing methodologies has facilitated the identification of the irp2 gene in 44% of Klebsiella pneumoniae. According to amino acid sequences and differentiation of nucleotide, the current work reports findings on the identification of the K. pneumoniae irp2 gene isolates collected from patients in Iraq. This event represents the initial recorded occurrence of such detection. The presence of this gene is considered an unconventional human pathogen. The aim is to explore the correlation between genetic analysis and the diagnosis of genetic variation by examining isolates documented in the global GenBank database (LC791754.1, LC791755.1, LC791756.1, LC791757.1, LC791758.1, LC791759.1, LC791760.1). Additionally, it seeks to provide insights into the magnitude of genetic variation observed within these isolates. [ABSTRACT FROM AUTHOR]

Background: The efficacy of combination empiric antibiotic therapy for all intensive care unit (ICU) patients with community-acquired sepsis is a subject of ongoing debate in the era of increasing antibiotic resistance. This study was conducted to evaluate the patterns of antibiotic usage and microbial resistance in sepsis patients admitted to the ICU with both hemodynamically stable (HS) and unstable states and to analyze their clinical outcomes. Methods: In this observational study, patients aged 18 years and above who received antibiotics upon admission and had a culture report were included. These patients were categorized into the following groups: HS and hemodynamically unstable (HU), single or combined antibiotics group (more than one antibiotic used empirically to cover one or more groups of organisms), culture-positive and culture-negative group. The microbiological isolates were grouped according to their identified resistance patterns. The outcome parameters involved assessing the differences in empiric antibiotics use upon admission and microbial resistance with hemodynamic stability and investigating any associations with ICU and hospital outcomes. Results: The study included a total of 2675 patients, of which 70.3% were in the HS group, and 29.7% in the HU group. The use of combination antibiotics was significantly higher (p < 0.0001) across all groups. Carbapenems were used more frequently in the single antibiotic group (p < 0.001). The culture was positive in 27.8% (n = 747) of patients. A significantly higher number of patients in the HU group (p < 0.001) were found to have carbapenem-resistant and multidrug-resistant organisms. The ICU and hospital mortality rates were significantly higher in the HU group (p < 0.001), the culture-positive group with resistance (p < 0.001), and the HS patients who received combination antibiotics. Conclusion: The usage of combination antibiotics, coupled with the presence of resistant organisms, emerged as an important variable in predicting ICU and hospital mortality rates in cases of community-acquired sepsis. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of coinfections and/or secondary infections on antibiotic use in patients hospitalized with coronavirus disease 2019 (COVID-19). Days of therapy per 100 bed days (DOT) in a COVID-19 ward were compared between 2022 (Omicron period) and 2021 (pre-Omicron period). Antibiotics were categorized as antibiotics predominantly used for community-acquired infections (CAIs) and antibiotics predominantly used for health care-associated infections (HAIs). Bacterial and/or fungal infections which were proved or assumed on admission were defined as coinfections. Secondary infections were defined as infections that occurred following COVID-19. Patients with COVID-19 during the Omicron period were older and had more comorbidities. Coinfections were more common in the Omicron period than in the pre-Omicron period (44.4% [100/225] versus 0.8% [2/257], respectively, p < 0.001), and the mean DOT of antibiotics for CAIs was significantly increased in the Omicron period (from 3.60 to 17.84, p < 0.001). Secondary infection rate tended to be higher in the Omicron period (p = 0.097). Mean DOT of antibiotics for HAIs were appeared to be lower in the COVID-19 ward than in the general ward (pre-Omicron, 3.33 versus 6.37, respectively; Omicron, 3.84 versus 5.22, respectively). No multidrug-resistant gram-negative organisms were isolated in the COVID-19 ward. Antibiotic use for CAIs was limited in the pre-Omicron period but increased in the Omicron period because of a high coinfection rate on admission. With the antimicrobial stewardship, excessive use of antibiotics for HAIs was avoided in the COVID-19 ward during both periods. [ABSTRACT FROM AUTHOR]

Abstract Background Community-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP. Methods This cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups. Results Among the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P

Abstract The misuse and overtreatment of antibiotics in hospitalized patients with community-acquired pneumonia (CAP) can cause multi-drug resistance and worsen clinical outcomes. We aimed to analyze the trends and appropriateness of antibiotic changes in hospitalized patients with CAP and their impact on clinical outcomes. This retrospective study enrolled patients with CAP, aged > 18 years, admitted from January 2017 to December 2021 at Seoul National University Bundang Hospital, South Korea. We examined the pathogens identified, antibiotics prescribed, and the appropriateness of antibiotic changes as reviewed by infectious disease specialists. Antibiotic appropriateness was assessed based on adherence to the 2019 ATS/IDSA guidelines and the 2018 Korean national guidelines for CAP, targeting appropriate pathogens, proper route, dosage, and duration of therapy. Outcomes measured included time to clinical stability (TCS), length of hospital stay, duration of antibiotic treatment, and in-hospital mortality. The study included 436 patients with a mean age of 72.11 years, of whom 35.1% were male. The average duration of antibiotic treatment was 13.5 days. More than 55% of patients experienced at least one antibiotic change, and 21.7% had consecutive changes. Throughout their hospital stay, 273 patients (62.6%) received appropriate antibiotic treatment, while 163 patients (37.4%) received at least one inappropriate antibiotic prescription. Those who received at least one inappropriate prescription experienced longer antibiotic treatment durations and extended hospital stays, despite having similar TCS. In conclusion, inappropriate antibiotic prescribing in hospitalized patients with CAP is associated with prolonged antibiotic treatment and increased length of stay. Emphasizing the appropriate initial antibiotic selection may help mitigate these negative effects.

Antimicrobial resistance in Escherichia coli presents a global challenge associated with nosocomial infections and increased mortality rates. Understanding resistance profiles is crucial for guiding treatment strategies and ensuring effective antibiotic use. This study aimed to investigate the prevalence and in vitro resistance of E. coli to community-acquired and nosocomial infections. Various clinical samples from 700 patients were cultured on MacConkey’s medium and blood agar. The disk diffusion method was used to determine the antibiotic susceptibility profile of the E. coli isolates following the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Urine, pus, seminal fluid, vaginal swabs, and other body fluids were among the clinical samples analyzed. Of the 112 E. coli isolates, 48.2% were from inpatients and 51.8% were from outpatients, with the majority (66%) isolated from urine samples. Higher resistance levels were observed in the urinary isolates than that in the previously recorded data from the same institutions. Notably, isolates exhibited high resistance to penicillin (98.2%), ampicillin (97.3%), first-generation cephalosporins (90.2%), erythromycin (72.2%), and roxithromycin (95.4%), whereas lower resistance was noted against piperacillin-tazobactam (25.0%), nitrofurantoin (12.5%), and imipenem (9.8%). The overall multidrug resistance rate was 62.5%, with higher rates observed in nosocomial infections (70%) compared to community-acquired isolates (55.6%). However, this difference was not statistically significant (p>0.05). This study underscores the prevalence of E. coli isolates (27.0%) and highlights the concerning level of resistance, particularly to older antibiotics. These findings emphasize the importance of judicious antibiotic use and ongoing surveillance.

Abstract Background Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians’ assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist’s assessments as reference standard. Methods This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations. Results All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians’ CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82). Conclusion This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy.

The article discusses the use of ChatGPT, an artificial intelligence language model, in the field of medicine, specifically in providing information about community-acquired pneumonia (CAP). ChatGPT is capable of generating human-like responses to natural language inputs and has been found to produce quality and empathetic responses to patient questions about CAP. However, the accuracy and reliability of ChatGPT-generated responses are not verified or authenticated, as it does not provide references to support the information provided. The article recommends further research to quantify the accuracy of ChatGPT-generated responses and suggests collaboration among physicians to develop a new AI software that can generate cross-referenced and verified responses to patient queries. [Extracted from the article]

Background Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. Methods We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. Results A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI].59–.92; P =.008). There was no association between outcome and ear surgery. Conclusions Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain. [ABSTRACT FROM AUTHOR]

Background: Multi-drug resistant Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections, with high morbidity and mortality. Treatment of such infections is particularly problematic; hence, it is complicated by antibiotic resistance, and there is currently no reliable vaccine. Furthermore, it is well known that S. aureus produces an exceptionally large number of virulence factors that worsen infection. Consequently, the urgent need for anti-virulent agents that inhibit biofilm formation and virulence factors has gained momentum. Therefore, we focused our attention on an already-approved antibiotic and explored whether changing the dosage would still result in the intended anti-virulence effect. Methods: In the present study, we determined the antibiotic resistance patterns and the MICs of oxacillin against 70 MDR S. aureus isolates. We also investigated the effect of sub-MICs of oxacillin (at 1/4 and 1/8 MICs) on biofilm formation using the crystal violet assay, the phenol-sulphuric acid method, and confocal laser scanning microscopy (CLSM). We examined the effect of sub-MICs on virulence factors and bacterial morphology using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and electron microscopy, respectively. Moreover, we studied the effect of sub-MICs of oxacillin (OX) in-vivo using a wound infection model. Results: Oxacillin at 1/2 MIC showed a significant decrease in bacterial viability, while 1/4 and 1/8 MICs had negligible effects on treated bacterial isolates. Treatment of MDR isolates with 1/4 or 1/8 MICs of oxacillin significantly reduced biofilm formation (64% and 40%, respectively). The treated MDR S. aureus with sub-MICs of OX exhibited a dramatic reduction in several virulence factors, including protease, hemolysin, coagulase, and toxic shock syndrome toxin-1 (TSST-1) production. The sub-MICs of OX significantly decreased (P < 0.05) the gene expression of biofilm and virulence-associated genes such as agrA, icaA, coa, and tst. Furthermore, oxacillin at sub-MICs dramatically accelerated wound healing, according to the recorded scoring of histological parameters. Conclusion: The treatment of MDR S. aureus with sub-MICs of oxacillin can help in combating the bacterial resistance and may be considered a promising approach to attenuating the severity of S. aureus infections due to the unique anti-biofilm and anti-virulence activities. [ABSTRACT FROM AUTHOR]

Background: Without increasing radiation exposure, ultralow-dose computed tomography (CT) of the chest provides improved diagnostic accuracy of radiological pneumonia diagnosis compared to a chest radiograph. Yet, radiologist resources to rapidly report the chest CTs are limited. This study aimed to assess the diagnostic accuracy of emergency clinicians' assessments of chest ultralow-dose CTs for community-acquired pneumonia using a radiologist's assessments as reference standard. Methods: This was a cross-sectional diagnostic accuracy study. Ten emergency department clinicians (five junior clinicians, five consultants) assessed chest ultralow-dose CTs from acutely hospitalised patients suspected of having community-acquired pneumonia. Before assessments, the clinicians attended a focused training course on assessing ultralow-dose CTs for pneumonia. The reference standard was the assessment by an experienced emergency department radiologist. Primary outcome was the presence or absence of pulmonary opacities consistent with community-acquired pneumonia. Sensitivity, specificity, and predictive values were calculated using generalised estimating equations. Results: All clinicians assessed 128 ultralow-dose CTs. The prevalence of findings consistent with community-acquired pneumonia was 56%. Seventy-eight percent of the clinicians' CT assessments matched the reference assessment. Diagnostic accuracy estimates were: sensitivity = 83% (95%CI: 77–88), specificity = 70% (95%CI: 59–81), positive predictive value = 80% (95%CI: 74–84), negative predictive value = 78% (95%CI: 73–82). Conclusion: This study found that clinicians could assess chest ultralow-dose CTs for community-acquired pneumonia with high diagnostic accuracy. A higher level of clinical experience was not associated with better diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background: Community-acquired infections (CAIs) are a major concern for public health due to their prevalence and potential to develop antibiotic resistance. Understanding the resistance patterns can guide clinical practice and antibiotic stewardship. Methods: This cross-sectional study analyzed antibiotic resistance in 160 patients with CAIs. Samples were collected, cultured, and subjected to antibiotic susceptibility tests using standardized methods. Results: The study identified significant resistance to commonly used antibiotics, highlighting a concerning trend in the treatment efficacy of CAIs. Conclusion: The rising antibiotic resistance in CAIs underscores the urgent need for enhanced surveillance, rational antibiotic use, and comprehensive public health strategies to mitigate this issue. [ABSTRACT FROM AUTHOR]

Aims Hypervirulent Klebsiella pneumoniae (hvKp) causes invasive community-acquired infections in healthy individuals, and hypermucoviscosity (HMV) is the main phenotype associated with hvKp. This study investigates the impact of microaerobic environment availability on the mucoviscosity of K. pneumoniae. Methods and results By culturing 25 clinical strains under microaerobic and aerobic environments, we observed a notable reduction in mucoviscosity in microaerobic environments. RNA sequencing and qRT-PCR revealed downregulated expressions of capsule synthesis genes (galf, orf2, wzi, wza, wzb, wzc, wcaj, manC, manB , and ugd) and regulatory genes (rmpA, rmpD , and rmpC) under microaerobic conditions. Transmission electron microscopy and Indian ink staining analysis were performed, revealing that the capsular thickness of K. pneumoniae decreased by half in microaerobic conditions compared to aerobic conditions. Deletion of rmpD and rmpC caused the loss of the HMV phenotype in both aerobic and microaerobic conditions. However, compared to wild-type strain in microaerobic condition, only rmpD overexpression strain, and not rmpC overexpression strain, displayed a significant increase in capsule thickness in microaerobic conditions. Conclusions Microaerobic conditions can suppress the mucoviscosity of K. pneumoniae , but this suppression can be overcome by altering the expression of rmpD , indicating a specific function for rmpD in the oxygen environmental adaptation of K. pneumoniae. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusions Apart from direct portal pressure reduction, non‐selective beta‐blockers (NSBB) modulate inflammatory response, which could be beneficial in patients with acute decompensation (AD). We therefore aimed to evaluate the effect of NSBB on 28‐day mortality and markers of systemic inflammation in a propensity score‐matched (PSM) cohort of AD patients requiring intensive care unit (ICU) admission.Patients were recruited from registry of AD patients requiring ICU admission. Out of total 445 patients, 108 patients on NSBB before admission (NSBB use group) were PSM for age, gender, pre‐admission Child–Turcotte–Pugh score and history of previous decompensation to 108 patients not on NSBB (non‐NSBB use group) which served as the control group. ICU parameters, markers of systemic inflammation and 28‐day mortality were compared by standard statistical tests.After PSM, no difference was observed in aetiology of cirrhosis, or precipitating event for AD between the groups. Pre‐admission creatinine, bilirubin, international normalised ratio and haemoglobin were similar between the groups, whereas pre‐admission white cell count (WCC) and neutrophil to lymphocyte ratio (NLR) was lower in NSBB‐group. On admission to ICU, NSBB group had lower heart rate (p = 0.006), platelets (p = 0.012), WCC (p = 0.006), NLR (p = 0.039) and C‐reactive protein (p = 0.007). Significantly more community acquired bacterial infections (p = 0.006), renal failure (p = 0.033) and higher grades of acute‐on‐chronic liver failure (ACLF; p = 0.012) were observed in non‐NSBB group. Significantly lower 28‐day (p = 0.001) and 90‐day (p = 0.002) mortality was seen in NSBB group. Univariate and multivariable analysis for 28‐day mortality showed that while ACLF at presentation and community acquired bacterial infection were independent negative predictors, prior NSBB use was positive predictors of survival.Prior use of NSBB is associated with improved 28‐ and 90‐day mortality in critically ill cirrhosis patients with AD which is mediated probably by blunting of the inflammatory response. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine, at the phenotypic and molecular levels, resistance and virulence markers in Candida spp. isolated from community-acquired infections in Bucharest outpatients during 2021, and to demonstrate the efficiency of alternative solutions against them based on silver nanoparticles (AgNPs). Methods: A total of 62 Candida spp. strains were isolated from dermatomycoses and identified using chromogenic culture media and MALDI-TOF MS, and then investigated for their antimicrobial resistance and virulence markers (VMs), as well as for metabolic enzymes using enzymatic tests for the expression of soluble virulence factors, their biofilm formation and adherence capacity on HeLa cells, and PCR assays for the detection of virulence markers and the antimicrobial activity of alternative solutions based on AgNPs. Results: Of the total of 62 strains, 45.16% were Candida parapsilosis; 29.03% Candida albicans; 9.67% Candida guilliermondii; 3.22% Candida lusitaniae, Candia pararugosa, and Candida tropicalis; and 1.66% Candida kefyr, Candida famata, Candida haemulonii, and Candida metapsilosis. Aesculin hydrolysis, caseinase, and amylase production were detected in the analyzed strains. The strains exhibited different indices of adherence to HeLa cells and were positive in decreasing frequency order for the LIP1, HWP1, and ALS1,3 genes (C. tropicalis/C. albicans). An inhibitory effect on microbial growth, adherence capacity, and on the production of virulence factors was obtained using AgNPs. Conclusions: The obtained results in C. albicans and Candida non-albicans circulating in Bucharest outpatients were characterized by moderate-to-high potential to produce VMs, necessitating epidemiological surveillance measures to minimize the chances of severe invasive infections. [ABSTRACT FROM AUTHOR]

A study conducted in Djibouti, East Africa, has found the presence of a dangerous strain of bacteria called hypervirulent carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) in both humans and fish. This strain is resistant to last-resort antibiotics and exhibits multidrug-resistance phenotypes. The study suggests that these bacteria may be spreading in the environment, emphasizing the need for further research and measures to prevent their spread. The study also found that the CR-hvKP isolates carried hybrid resistance/virulence plasmids, containing both antimicrobial resistance genes and virulence genes. This indicates the emergence and possible dissemination of CR-hvKP in Africa and raises concerns about the contamination of surface waters by these bacteria. [Extracted from the article]

Sepsis is among the most frequent diagnoses on admission to the intensive care unit (ICU). A systemic inflammatory response, activated by uncontrolled infection, fosters hypoperfusion and multiorgan failure and often leads to septic shock and mortality. These infections arise from a specific anatomic source, and how the infection foci influence the outcomes is unknown. All patients admitted to the ICU of Hospital de Vila Franca de Xira, between 1 January 2017 and 31 June 2023, were screened for sepsis and categorized according to their infection foci. During the study period, 1296 patients (32.2%) had sepsis on admission. Their mean age was 67.5 ± 15.3 and 58.1% were male; 73.0% had community-acquired infections. The lung was the main focus of infection. Septic shock was present in 37.9% of the patients and was associated with hospital mortality. Severe imbalances were noted in its incidence, and there was lower mortality in lung infections. The hospital-acquired infections had a slightly higher mortality but, after adjustment, this difference was non-significant. Patients with secondary bacteremia had a worse prognosis (one-year adjusted hazard ratio of 1.36, 95% confidence interval 1.06–1.74, p = 0.015), especially those with an isolated non-fermenting Gram-negative infection. Lung, skin, and skin structure infections and peritonitis had a worse prognosis, whilst urinary, biliary tract, and other intra-abdominal infections had a better one-year outcome. [ABSTRACT FROM AUTHOR]

Purpose: Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The purpose of the study was to measure the associations of specific exposures (deprivation, ethnicity, and clinical characteristics) with incident sepsis and case fatality. Methods: Two research databases in England were used including anonymized patient-level records from primary care linked to hospital admission, death certificate, and small-area deprivation. Sepsis cases aged 65–100 years were matched to up to six controls. Predictors for sepsis (including 60 clinical conditions) were evaluated using logistic and random forest models; case fatality rates were analyzed using logistic models. Results: 108,317 community-acquired sepsis cases were analyzed. Severe frailty was strongly associated with the risk of developing sepsis (crude odds ratio [OR] 14.93; 95% confidence interval [CI] 14.37–15.52). The quintile with most deprived patients showed an increased sepsis risk (crude OR 1.48; 95% CI 1.45–1.51) compared to least deprived quintile. Strong predictors for sepsis included antibiotic exposure in prior 2 months, being house bound, having cancer, learning disability, and diabetes mellitus. Severely frail patients had a case fatality rate of 42.0% compared to 24.0% in non-frail patients (adjusted OR 1.53; 95% CI 1.41–1.65). Sepsis cases with recent prior antibiotic exposure died less frequently compared to non-users (adjusted OR 0.7; 95% CI 0.72–0.76). Case fatality strongly decreased over calendar time. Conclusion: Given the variety of predictors and their level of associations for developing sepsis, there is a need for prediction models for risk of developing sepsis that can help to target preventative antibiotic therapy. [ABSTRACT FROM AUTHOR]

Bloodstream infections (BSIs) can be primary or secondary, with significant associated morbidity and mortality. Primary bloodstream infections (BSIs) are defined as infections where no clear infection source is identified, while secondary BSIs originate from a localized infection site. This study aims to compare patterns, outcomes, and medical costs between primary and secondary BSIs and identify associated factors. Conducted at the University Hospital of Patras, Greece, from May 2016 to May 2018, this single-center retrospective cohort study included 201 patients with confirmed BSIs based on positive blood cultures. Data on patient characteristics, clinical outcomes, hospitalization costs, and laboratory parameters were analyzed using appropriate statistical methods. Primary BSIs occurred in 22.89% (46 patients), while secondary BSIs occurred in 77.11% (155 patients). Primary BSI patients were younger and predominantly nosocomial, whereas secondary BSI was mostly community-acquired. Clinical severity scores (SOFA, APACHE II, SAPS, and qPitt) were significantly higher in primary compared to secondary BSI. The median hospital stay was longer for primary BSI (21 vs. 12 days, p < 0.001). Although not statistically significant, mortality rates were higher in primary BSI (43.24% vs. 26.09%). Total care costs were significantly higher for primary BSI (EUR 4388.3 vs. EUR 2530.25, p = 0.016), driven by longer hospital stays and increased antibiotic costs. This study underscores the distinct clinical and economic challenges of primary versus secondary BSI and emphasizes the need for prompt diagnosis and tailored antimicrobial therapy. Further research should focus on developing specific management guidelines for primary BSI and exploring interventions to reduce BSI burden across healthcare settings. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. Methods: This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. Results: Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% – 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. Conclusion: The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsThere is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence.Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021.From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm3. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6–1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4–1·3).In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis. [ABSTRACT FROM AUTHOR]

Healthcare associated infections (HAIs) are costly but preventable. A limited understanding of the effects of environmental cleaning on the riskiest HAI associated pathogens is a current challenge in HAI prevention. This project aimed to quantify the effects of terminal hospital cleaning practices on HAI pathogens via environmental sampling in three hospitals located throughout the United States. Surfaces were swabbed from 36 occupied patient rooms with a laboratory-confirmed, hospital- or community-acquired infection of at least one of the four pathogens of interest (i.e., Acinetobacter baumannii (A. baumannii), methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus faecalis/faecium (VRE), and Clostridioides difficile (C. difficile)). Six nonporous, high touch surfaces (i.e., chair handrail, bed handrail, nurse call button, desk surface, bathroom counter near the sink, and a grab bar near the toilet) were sampled in each room for Adenosine Triphosphate (ATP) and the four pathogens of interest before and after terminal cleaning. The four pathogens of interest were detected on surfaces before and after terminal cleaning, but their levels were generally reduced. Overall, C. difficile was confirmed on the desk (n = 2), while MRSA (n = 24) and VRE (n = 25) were confirmed on all surface types before terminal cleaning. After cleaning, only MRSA (n = 6) on bed handrail, chair handrail, and nurse call button and VRE (n = 5) on bathroom sink, bed handrail, nurse call button, toilet grab bar, and C. difficile (n = 1) were confirmed. At 2 of the 3 hospitals, pathogens were generally reduced by >99% during terminal cleaning. One hospital showed that VRE increased after terminal cleaning, MRSA was reduced by 73% on the nurse call button, and VRE was reduced by only 50% on the bathroom sink. ATP detections did not correlate with any pathogen concentration. This study highlights the importance of terminal cleaning and indicates room for improvement in cleaning practices to reduce surface contamination throughout hospital rooms. [ABSTRACT FROM AUTHOR]

The monocyte distribution width (MDW) has emerged as a promising biomarker for accurate and early identification of patients with potentially life-threatening infections. Here we tested the diagnostic performance of MDW in adult patients requiring hospital admission for community-acquired infections and sepsis, evaluated sources of heterogeneity in the estimates of diagnostic accuracy, and assessed the meaning of MDW in a patient population presenting to the emergency department (ED) for acute non-infectious conditions. 1925 consecutive patients were categorized into three groups: non-infection (n = 1507), infection (n = 316), and sepsis/septic shock (n = 102). Diagnostic performance for infection or sepsis of MDW alone or in combination with components of SOFA was tested using AUC of ROC curves, sensitivity, and specificity. The relationship between MDW and different pathogens as well as the impact of non-infectious conditions on MDW values were explored. For the prediction of infection, the AUC/ROC of MDW (0.84) was nearly overlapping that of procalcitonin (0.83), and C-reactive protein (0.89). Statistical optimal cut-off value for MDW was 21 for predicting infection (sensitivity 73%, specificity 82%) and 22 for predicting sepsis (sensitivity 79%, specificity 83%). The best threshold to rule out infection was MDW ≤ 17 (NPV 96.9, 95% CI 88.3–100.0), and ≤ 18 (NPV 99.5, 95% CI 98.3–100.0) to rule out sepsis. The combination of MDW with markers of organ dysfunction (creatinine, bilirubin, platelets) substantially improved the AUC (0.96 (95% CI 0.94–0.97); specificity and sensitivity of 88% and 94%, respectively). In conclusion, MDW has a good diagnostic performance in diagnosing infection and sepsis in patients presenting in ED. Its use as an infection marker even increases when combined with other markers of organ dysfunction. Understanding the impact of interactions of non-infectious conditions and comorbidities on MDW and its diagnostic accuracy requires further elucidation. [ABSTRACT FROM AUTHOR]

Background: Staphylococcus aureus, a commensal bacterium, colonizes the skin and mucous membranes of approximately 30% of the human population. Apart from conventional resistance mechanisms, one of the pathogenic features of S. aureus is its ability to survive in a biofilm state on both biotic and abiotic surfaces. Due to this characteristic, S. aureus is a major cause of human infections, with Methicillin-Resistant Staphylococcus aureus (MRSA) being a significant contributor to both community-acquired and hospital-acquired infections. Results: Analyzing non-repetitive clinical isolates of MRSA collected from seven provinces and cities in China between 2014 and 2020, it was observed that 53.2% of the MRSA isolates exhibited varying degrees of ability to produce biofilm. The biofilm positivity rate was notably high in MRSA isolates from Guangdong, Jiangxi, and Hubei. The predominant MRSA strains collected in this study were of sequence types ST59, ST5, and ST239, with the biofilm-producing capability mainly distributed among moderate and weak biofilm producers within these ST types. Notably, certain sequence types, such as ST88, exhibited a high prevalence of strong biofilm-producing strains. The study found that SCCmec IV was the predominant type among biofilm-positive MRSA, followed by SCCmec II. Comparing strains with weak and strong biofilm production capabilities, the positive rates of the sdrD and sdrE were higher in strong biofilm producers. The genetic determinants ebp, icaA, icaB, icaC, icaD, icaR, and sdrE were associated with strong biofilm production in MRSA. Additionally, biofilm-negative MRSA isolates showed higher sensitivity rates to cefalotin (94.8%), daptomycin (94.5%), mupirocin (86.5%), teicoplanin (94.5%), fusidic acid (81.0%), and dalbavancin (94.5%) compared to biofilm-positive MRSA isolates. The biofilm positivity rate was consistently above 50% in all collected specimen types. Conclusions: MRSA strains with biofilm production capability warrant increased vigilance. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae (K. pneumoniae) is a major cause of nosocomial and community-acquired infections (CAIs). Understanding the antibiotic susceptibility of this bacterium is essential for selecting the most effective antibiotic for associated infections. Objectives: We investigated the sensitivity of K. pneumonia (KP) isolates obtained from inpatients in Isfahan, Iran. Methods: Organism identification and antibiotic susceptibility testing were conducted using standard tests. Stratification was performed based on extended spectrum beta-lactamase (ESBL) production and the source of infection acquisition (community versus hospital). Results: A total of 437 KP isolates were investigated, of which 5.5% were pan drug resistant (PDR), 56.8% were extensively drug resistant (XDR), and 18% were ESBL producers. The isolates were most susceptible to colistin (100%), aminoglycosides (62.8%), and carbapenems (55%). Nosocomial isolates showed lower sensitivity to most of the examined antibiotics. Conclusions: The high prevalence of PDR and XDR KP strains in hospitalized patients is a major problem in the studied area. [ABSTRACT FROM AUTHOR]

Early recognition of bloodstream infection (BSI) in infants can be difficult, as symptoms may be non-specific, and culture can take up to 48 h. As a result, many infants receive unneeded antibiotic treatment while awaiting the culture results. In this study, we aimed to develop a model that can reliably identify infants who do not have positive blood cultures (and, by extension, BSI) based on the full blood count (FBC) and C-reactive protein (CRP) values. Several models (i.e. multivariable logistic regression, linear discriminant analysis, K nearest neighbors, support vector machine, random forest model and decision tree) were trained using FBC and CRP values of 2693 infants aged 7 to 60 days with suspected BSI between 2005 and 2022 in a tertiary paediatric hospital in Dublin, Ireland. All models tested showed similar sensitivities (range 47% – 62%) and specificities (range 85%-95%). A trained decision tree and random forest model were applied to the full dataset and to a dataset containing infants with suspected BSI in 2023 and showed good segregation of a low-risk and high-risk group. Negative predictive values for these two models were high for the full dataset (> 99%) and for the 2023 dataset (> 97%), while positive predictive values were low in both dataset (4%–20%). Conclusion: We identified several models that can predict positive blood cultures in infants with suspected BSI aged 7 to 60 days. Application of these models could prevent administration of antimicrobial treatment and burdensome diagnostics in infants who do not need them. What is Known: • Bloodstream infection (BSI) in infants cause non-specific symptoms and may be difficult to diagnose. • Results of blood cultures can take up to 48 hours. What is New: • Machine learning models can contribute to clinical decision making on BSI in infants while blood culture results are not yet known. [ABSTRACT FROM AUTHOR]

Objectives MRSA is a major cause of hospital-acquired and community-acquired infections. Treatment options for MRSA are limited because of the rapid development of β-lactam resistance. Combining antibiotics offers an affordable, time-saving, viable and efficient approach for developing novel antimicrobial therapies. Both amoxicillin and cefdinir are oral β-lactams with indications for a wide range of bacterial infections and mild side effects. This study aimed to investigate the in vitro and in vivo efficacy of combining these two β-lactams against MRSA strains. Methods Fourteen representative prevalent MRSA strains with diverse sequence types (STs) were tested with a combination of amoxicillin and cefdinir, using chequerboard and time–kill assays. The Galleria mellonella larvae infection model was used to evaluate the in vivo efficacy of this dual combination against the community-acquired MRSA (CA-MRSA) strain USA300 and the hospital-acquired MRSA (HA-MRSA) strain COL. Results The chequerboard assay revealed a synergistic activity of the dual amoxicillin/cefdinir combination against all tested MRSA strains, with fractional inhibitory concentration index (FICI) values below 0.5 and at least a 4-fold reduction in the MICs of both antibiotics. Time–kill assays demonstrated synergistic bactericidal activity of this dual combination against the MRSA strain USA300 and strain COL. Moreover, in vivo studies showed that the administration of amoxicillin/cefdinir combination to G. mellonella larvae infected with MRSA strains significantly improved the survival rate up to 82%, which was comparable to the efficacy of vancomycin. Conclusions In vitro and in vivo studies indicate that the dual combination of amoxicillin/cefdinir demonstrates a synergistic bactericidal efficacy against MRSA strains of various STs. Further research is needed to explore its potential as a treatment option for MRSA infections. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the factors affecting patients' prognoses based on the community acquired-bloodstream infection patient data from 2017 to 2021. Patients and Methods: The data of 940 patients were retrieved, having at least one positive bilateral blood culture within 48 hours of hospitalization, and grouped into survivor and non-survivor groups. The clinical characteristics, laboratory results, causative pathogen and other indicators were collected and compared, and risk factors were identified by applying Cox proportional hazard regression model to the data. Results: Community acquired-bloodstream infection is most commonly caused by Escherichia coli, Klebsiella species and Staphylococcus hominis. Among the total of 940 selected patients, 52 (5.5%) died during hospitalization. The demographic parameters like age and gender, clinical protocols like maintenance hemodialysis, glucocorticoid use during hospitalization, catheter placement, procaicitonin, total protein, albumin, creatinine, uric acid contents and Sequential Organ Failure Assessment scores were significantly different between the survivor and non-survivor groups. The survival analysis results revealed that age (HR=1.02, 95% CI: 1.00– 1.05, P=0.002), glucocorticoid use during hospitalization (HR=3.69, 95% CI: 1.62– 8.37, P=0.021) and Sequential Organ Failure Assessment score (HR=1.10, 95% CI: 1.03– 1.18, P=0.004) might be the risk factors affecting 30-day mortality in patients with community acquired-bloodstream infection. Conclusion: The identified risk factors may help guide clinical treatment protocol for patients with community acquired-bloodstream infection, providing more effective treatment strategy selection with improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a leading cause of death and serious illness that requires early recognition and therapeutic management to improve survival. The quick-SOFA score helps in its recognition, but its diagnostic performance is insufficient. To develop a score that can rapidly identify a community acquired septic situation at risk of clinical complications in patients consulting the emergency department (ED). Methods: We conducted a monocentric, prospective cohort study in the emergency department of a university hospital between March 2016 and August 2018 (NCT03280992). All patients admitted to the emergency department for a suspicion of a community-acquired infection were included. Predictor variables of progression to septic shock or death within the first 90 days were selected using backward stepwise multivariable logistic regression to develop a clinical score. Receiver operating characteristic (ROC) curves were constructed to determine the discriminating power of the area under the curve (AUC). We also determined the threshold of our score that optimized the performance required for a sepsis-worsening score. We have compared our score with the NEWS-2 and qSOFA scores. Results: Among the 21,826 patients admitted to the ED, 796 patients were suspected of having community-acquired infection and 461 met the sepsis criteria; therefore, these patients were included in the analysis. The median [interquartile range] age was 72 [54–84] years, 248 (54%) were males, and 244 (53%) had respiratory symptoms. The clinical score ranged from 0 to 90 and included 8 variables with an area under the ROC curve of 0.85 (confidence interval [CI] 95% 0.81–0.89). A cut-off of 26 yields a sensitivity of 88% (CI 95% 0.79–0.93), a specificity of 62% (CI 95% 57–67), and a negative predictive value of 95% (CI 95% 91–97). The area under the ROC curve for our score was 0.85 (95% CI, 0.81–0.89) versus 0.73 (95% CI, 0.68–0.78) for qSOFA and 0.66 (95% CI, 0.60–0.72) for NEWS-2. Conclusions: Our study provides an accurate clinical score for identifying septic patients consulting the ED early at risk of worsening disease. This score could be implemented at admission. [ABSTRACT FROM AUTHOR]

Background People who inject drugs (PWID) are at increased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB), but little is known about clinical outcomes of CA-SAB in PWID compared with the wider population of patients with CA-SAB. Methods Three national datasets were linked to provide clinical and mortality data on patients hospitalized with CA-SAB in England between 1 January 2017 and 31 December 2020. PWID were identified using the International Classification of Diseases, Tenth Revision code for "mental health and behavioral disorder due to opioid use" (F11). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for associations of PWID with 30-day all-cause mortality and 90-day hospital readmission. Results In 10 045 cases of CA-SAB, 1612 (16.0%) were PWID. Overall, 796 (7.9%) patients died within 30 days of CA-SAB admission and 1189 (11.8%) patients were readmitted to hospital within 90 days of CA-SAB. In those without infective endocarditis, there was strong evidence of lower odds of mortality among PWID compared with non-PWID (aOR, 0.47 [95% confidence interval {CI}:.33–.68]; P <.001), whereas there was no association in CA-SAB case fatality with endocarditis (aOR, 1.40 [95% CI:.87–2.25]; P =.163). PWID were less likely to be readmitted within 90 days of CA-SAB (aOR, 0.79 [95% CI:.65–.95]; P =.011). Conclusions In this large cohort study of patients with CA-SAB in England, PWID had lower odds of death in the absence of endocarditis and lower odds of readmission within 90 days compared to non-PWID patients. This study highlights the overrepresentation of PWID among patients with CA-SAB nationally. [ABSTRACT FROM AUTHOR]