Canadian Journal of Infectious Diseases & Medical Microbiology最新文献

Objectives: Adequate ventilation and air filtration in the operating theatre are essential measures to prevent surgical site infections, which impact on hospital stay, healthcare costs and increased risk of mortality. The aim of the study is to assess how other factors, such as the number of operators and the opening of doors during surgery, affect microbiological airborne contamination. Methods: The data were extrapolated from 105 reports of operational controls conducted in the operating rooms in Siena's Teaching Hospital, Italy, from 2018 to 2021. The number of colonies incubated at 22°C and 36°C, was related by Spearman correlation analysis to the number of operators in the rooms and the number of air changes. The Mann-Whitney test was used to assess the difference between the mean of colonies detected with doors closed and opened. Results: The number of colonies incubated at 22°C was correlated only with air changes (Spearman ρ = -0.441; p < 0.001). In contrast, those incubated at 36°C were correlated with air changes (ρ = -0.394; p < 0.001) and the number of operators (ρ = +0.249; p=0.011). For colonies incubated at 22°C, the mean difference between opened and closed doors was not statistically significant (p=0.575). In contrast, the difference was statistically significant for those incubated at 36°C (p=0.013). In terms of airflow, our study showed a statistically significant difference (p < 0.001) between laminar and turbulent flow rooms for both colonies. Conclusion: Continuous monitoring of airflows, correlated with door opening and closing and the number of operators, can help predict levels of microbiological air contamination and thus prevent surgical infections.

Escherichia coli is a leading cause of both community-acquired and nosocomial infections. In particular, E. coli is responsible for 90% of all uncomplicated urinary tract infections (UTIs) and 65% of complicated UTIs. Among complicated UTIs, those caused by third-generation cephalosporin (3GC)-resistant E. coli strains, expressing extended-spectrum beta-lactamases (ESBLs), are on the rise. These strains show often a multidrug-resistant (MDR) phenotype, limiting the therapeutic options and the increasing incidence of MDR E. coli in Algeria is concerning. This study aims to compare the antibiotic resistance rates and profiles as well as the virulence traits between 3CG-resistant E. coli isolates, collected from Algerian inpatients (IPs) and outpatients (OPs). Our analyses include phenotypic and genotypic resistance factor detection, strains classification by genotyping and phylogrouping, as well as genotypic and phenotypic virulence factor evaluation. Among 42 E. coli isolates, 76.20% caused UTIs. ESBL producers (n = 35) carried all the bla _CTX-M, while bla _TEM was found in 69.04% of isolates. All isolates were MDR, and no significant differences in type and rate of antibiotic resistance were observed between IP- and OP-isolates. OP-isolates demonstrated greater virulence, exhibiting higher motility and biofilm production, compared to IP-isolates. Moreover, pathogenic Phylogroup B2 was prevalent among OP-isolates, while IP-isolates belonged predominantly to Phylogroup A. Our data suggest a uniform spreading of antibiotic-resistant genes within hospitals and communities. However, hospital environment selects for less virulent strains with increasing level of resistance; differently, communities host more virulent strains. This study highlights the urgent need to implement the surveillance of 3CG-resistant E. coli and to adopt the One Health approach to monitor the antimicrobial resistance (AMR) in the country.

The global HIV/AIDS pandemic remains a profound public health challenge, with substantial impacts on mortality and morbidity worldwide. In Ghana, where HIV prevalence persists, understanding disease progression among patients receiving antiretroviral therapy (ART) is crucial. This study, conducted in the Ashanti Region, employs a 5-state continuous-time Markov multistate model to analyze HIV progression based on CD4 cell counts, employing tuberculosis (TB) coinfection as a covariate. A retrospective cohort of 416 patients from St. Martins Catholic Hospital between 2000 and 2019 was studied. Transition intensities, sojourn time and probabilities between CD4 states, and the impact of TB coinfection were evaluated. The results showed that patients with CD4 counts ≥ 500 cells/mm³ spent more time before transitioning to lower CD4 levels, indicating the effectiveness of ART in controlling the disease at this level. However, the transition from 200-350 cells/mm³ to death was more likely than recovery to CD4 counts ≥ 500 cells/mm³, indicating the increased risk of mortality once CD4 counts drop significantly. TB coinfection did not significantly alter these transition probabilities, which may be due to the effective management of both HIV and TB in this cohort, emphasizing the need for integrated care strategies. This study emphasizes the importance of tailored interventions to manage HIV/AIDS effectively, particularly in regions with high disease burden. It is recommended that initiating treatment quickly can help maintain higher CD4 counts and improve survival.

Cervical cancer (CC) is a public health concern related to the human papillomavirus (HPV) persistent infection. Minichromosome maintenance 2 (MCM2) has been postulated as a surrogate marker for HPV infection. Thymopoietin (TMPO) is a nuclear protein regulated by E2F such as MCM2 or p16. TMPO can give rise to six different isoforms. Herein, both the mRNA and protein levels of TMPO isoforms were analyzed in cervical cells. TMPO expression was selected and analyzed through in silico in several databases from the healthy cervix and cervical lesions. TMPO RNA expression was evaluated in cervical samples and cell lines by RT-PCR and protein expression by Western-blot and immunohistochemistry assays. TMPO and MCM2 immunostaining were evaluated in cervical smears. The clinical-pathological correlation analysis was performed using Kruskal-Wallis or Χ ² tests. TMPO is overexpressed in 74% of CC cells and all CC cell lines. Moreover, negative immunostaining was observed in normal cervical tissue, compared to strong expression for cervical lesions. Interestingly, TMPO-α, -β, -δ, -ε, and -γ are expressed in all cervical cells and tissues, but a differential expression for α, -β, and -γ isoforms among the cervical cells was observed as overexpressed when HPV is present. Also, the immunostaining of both MCM2 and TMPO was quite similar, but TMPO expression was more sensitive and specific than MCM2 protein. The present study has revealed that TMPO protein expression could be a potential molecular marker for cervical transformed cells, highlighting the TMPO-α, -β, and -γ isoforms as a promising molecular marker of HPV infection.

Introduction: Febrile neutropenia (FN) is defined by an absolute neutrophil count (ANC) less than or equal to 500 cells per microliter with a concurrent single oral body temperature of more than or equal to 38.3° C (orally) or more than 38.0° C maintained over one hour. There are different published guidelines for the management of FN. The primary objective of this study is to assess the management of FN in terms of choice, dose, and duration of empirical antimicrobial therapy and postculture results in our tertiary medical center. Methods: This is a retrospective review of medical records for patients admitted to the institution with a diagnosis of FN between 2018 and 2023. An electronic review of the medical records of all adult patients admitted with the diagnosis of FN was conducted through the platform of the medical records. A set of criteria for the evaluation of therapy was developed based on standard local and international guidelines. Results: The study included 280 patients who fit the inclusion/exclusion criteria. Around half of the patients did not have a focus of infection (48.9%). The overall treatment regimen was appropriate in only 32.1% of the patient cases which includes an appropriate choice, dose, and duration of therapy. The choice of the antimicrobial(s) was inappropriate in 49.3% of the patient cases. The dosing regimen and treatment duration were inappropriate in 36.5% and 19.3% of the patient cases, respectively. Conclusion: This study evaluated the appropriate management of FN at our medical center including the appropriate choice, dose, and duration of the antimicrobials used. The overall management of FN was inappropriate in two thirds of the patient cases (67.9%) when evaluated according to the assessment criteria. The choice, dose, and duration of treatment needs improvement for optimization of therapy and improvement of patient outcomes.

Background and Aims: Coronavirus disease 2019 (COVID-19), an emerging life-threatening viral disease, has rapidly spread worldwide, exerting a detrimental impact on public health. We aimed to devise an innovative platform based on the loop-mediated isothermal amplification (LAMP) method, having priorities over real-time PCR (RT-PCR) in terms of sensitivity, specificity, and low running costs. Methods: To develop a novel assay, a new primer set plus four primer sets were designed targeting the N gene of the COVID-19 agent, resulting in the sensitivity reinforcement. The limit of detection (LOD) of the developed approach was determined and compared to those of the standard RT-LAMP and RT-PCR. Two hundred confirmed positive and negative samples initially tested by RT-PCR were recruited to assess the nested-RT-LAMP assay. Furthermore, for the one-step nested-RT-LAMP assay, positive samples were tested directly without the need for RNA extraction. Results: The LOD of nested-RT-LAMP, LAMP, and RT-PCR were 5, 15, and 15 copies/μL, respectively. The findings of the investigation illustrated 100% sensitivity and 98% specificity for both LAMP assays. Moreover, respectively, 94% and 97% sensitivity and specificity were determined regarding the one-step nested-RT-LAMP assay. Conclusion: We offered a novel approach with more sensitivity compared to RT-PCR and common RT-LAMP, not only being a simple, accurate, cost-effective alternative diagnostic tool for RT-PCR but also being able to detect asymptomatic or mildly symptomatic patients more accurately in 2 h by naked eyes.

The COVID-19 pandemic created an unprecedented public health crisis, driven by its rapid global spread and the urgent need for worldwide collaborative interventions to contain it. This urgency spurred the search for therapeutic agents to prevent or manage the infection. Among these, various types of antivirals emerged as a prominent treatment option, supported by a wealth of observational studies and randomized controlled trials. The results from such studies conflict, with some concluding efficacy and others the lack thereof, with variability also occurring depending on the severity of COVID-19 in the studied population. In addition, many agents have been explored using randomized controlled trials-the gold standard in evaluating the efficacy of an intervention-to only a limited degree, with most of the evidence behind their use concluded using observational studies. Thus, the sheer volume of data has made it challenging to resolve inconsistencies and determine true efficacy. Furthermore, there is a paucity in the literature regarding the use of antivirals in the pediatric population infected with COVID-19, with their use being extrapolated from the results of studies done on adult patients. As such, additional trials are needed to solidify the effectiveness of antivirals in managing COVID-19, particularly in the underexplored and especially vulnerable pediatric cardiac patients. Therefore, utilizing the results from randomized controlled trials, this narrative review evaluates the rationale behind the use of antivirals, summarizes the findings from the literature, and concludes with a focused discussion on their application in pediatric cardiac patients.

Quercetin (QC), a flavonoid abundant in fruits and vegetables, has garnered attention for its potential therapeutic properties. In this study, we investigated the antibiofilm and antiquorum sensing (QS) activities of QC against Gram-negative bacteria both in vitro and in silico. The findings of this study demonstrate MIC values of 125 μg/mL for Chromobacterium violaceum, 250 μg/mL for Pseudomonas aeruginosa, and 500 μg/mL for Serratia marcescens, indicating its antibacterial potential abilities. QS-mediated production of violacein and prodigiosin was significantly inhibited in a dose-dependent manner at sub-MIC concentrations. Additionally, a dose-dependent reduction in the virulence factors of P. aeruginosa, including production of pyocyanin, pyoverdine, and rhamnolipid, was noted with QC. Biofilm formation decreased by 66.40%, 59.28%, and 63.70% at the highest sub-MIC for C. violaceum, P. aeruginosa, and S. marcescens, respectively. Furthermore, swimming motility and exopolysaccharide (EPS) production were also reduced in the presence of QC. Additionally, molecular docking and molecular dynamics simulations elucidate the binding interactions between QC and key molecular targets (LasI, LasR, PilY1, LasA, PilT, CviR, CviR', PqsR, RhlR, and PigG) involved in biofilm formation and QS pathways. Our results indicated that the antibiofilm and anti-QS sensing activities of QC may be attributed to its ability to interfere with critical signaling molecules and regulatory proteins. Overall, this study highlights QC as a promising natural compound for combating biofilm-associated infections caused by Gram-negative bacteria. The multifaceted antimicrobial mechanisms of QC underscore its potential as a therapeutic agent for the treatment of biofilm-related infections, providing the way for further exploration, and development of QC-based strategies in antimicrobial therapy.

Background: Antimicrobial-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) species pathogens pose a threat to global health by limiting available treatments, escalating the burden of disease, and raising mortality rates. This study investigated the prevalence of ESKAPE pathogens in different infections in a Nepalese hospital and studied their antibiotic resistance pattern. Methodology: The study was performed from September 2022 to February 2023 at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. ESKAPE pathogens were isolated in accordance with standard procedures and subjected to antimicrobial susceptibility testing (AST). Identification was done via biochemical testing. The rates of multidrug resistance (MDR), production of extended-spectrum beta-lactamase (ESBL), and methicillin resistance were studied and statistically compared in terms of the type of pathogen, infection, and hospital admission. Result: Altogether, 7429 different clinical samples were cultured and ESKAPE pathogens were isolated from 503/1564 (32.1%) positive samples. The prevalence of these pathogens was significantly higher in admitted patients (p < 0.001). Higher rates of isolation were from urine and sputum samples. Klebsiella pneumoniae was the most prevalent organism while Enterobacter was the least. A total of 52.3% and 7.4% of the isolates were MDR and ESBL producers, respectively. A significant proportion of MDR isolates were from patients admitted to the Intensive Care Unit (ICU). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 36.8%. AST revealed comparatively lower resistance of Gram-negative rods to tigecycline, polymyxin B, and colistin sulfate. Likewise, lower resistance rates to vancomycin and teicoplanin were observed in S. aureus. Conclusion: In various clinical samples, we discovered that ESKAPE pathogens were more prevalent. In order to escape the ESKAPE's torment of antibiotic resistance, our findings urge the urgent implementation of sensible antibiotic use, training healthcare professionals in antibiotic stewardship, developing effective infection control strategies, and conducting effective surveillance.

Background: With emerging antibiotic resistance, many patients on peritoneal dialysis require newer antibiotic treatment such as daptomycin. Inadequate clinical information exists across different peritoneal dialysis solutions, including icodextrin, for the stability of intraperitoneal daptomycin. To guide the clinical practice of intraperitoneal daptomycin treatment, we need to establish the stability of daptomycin at dextrose concentration higher than 1.5% and icodextrin, as well as the duration of stability. Methods: We tested the stability of daptomycin in three types of peritoneal dialysis bags (UltraBag dextrose 2.5%, UltraBag icodextrin 7.5%, and Stay-Safe Balance 2.3%). Daptomycin was reconstituted with water for injection (50 mg/mL), followed by administration to peritoneal dialysis bags to obtain the final daptomycin concentrations of 70 μg/mL (equivalent to 140 mg/2L, the maintenance level) and 245 μg/mL (equivalent to 490 mg/2L, the loading level). The bags were then placed at ambient temperature (25°C) followed by withdrawing 5 mL samples at 0, 4, 8, 12, 24, and 48 h for UltraBag dextrose 2.5% and UltraBag icodextrin 7.5% and 0, 4, 8, 12, and 24 h for Stay-Safe Balance 2.3%. The concentrations of daptomycin in the collected samples were quantified by high-performance liquid chromatography with diode array detector (HPLC-DAD). Results: Under ambient condition, daptomycin was stable at maintenance level in UltraBag dextrose 2.5% for 48 h and in UltraBag icodextrin 7.5% or Stay-Safe Balance 2.3% for 24 h. For loading level, daptomycin was stable in UltraBag dextrose 2.5% and Stay-Safe Balance 2.3% for 12 h and in UltraBag icodextrin 7.5% for 48 h. Conclusions: Current stability results support and guide the use of intraperitoneal daptomycin in different dialysis solutions. Patients with peritonitis requiring icodextrin exchange and assisted preparation of daptomycin can benefit from nurses who provide daily home visit based on our stability results.