Safety and Treatment Outcomes of Infants and Children Treated With Daptomycin: Six-Year Experience From a Pediatric Academic Medical Center

Daptomycin is a common treatment for serious infections caused by gram-positive bacteria in adult patients; however, data regarding its safety and efficacy in the pediatric population are limited. This was a retrospective chart review of adverse reactions and treatment outcomes associated with daptomycin use in children <13 years old who received at least 1 dose of daptomycin. At least 1 dose of daptomycin was received by 147 patients. Seventy-two patients received daptomycin for 5 or more days. New-onset loose stools on daptomycin initiation were reported for 14 (9.5%) patients, elevations in creatine kinase in 3 (2%) patients, and elevated aspartate transaminase and alanine transaminase in 13 (8.8%) and 9 (6.1%) patients, respectively. Two patients (1.4%) had daptomycin discontinued due to specific concerns for adverse drug reactions. Daptomycin was found to be safe and effective in this pediatric cohort that included young children and infants with a variety of types and severities of infections.

Intra-abdominal nocardiosis and scedosporiosis in a dog: case report and literature review

A 2-y-old, intact female, mixed-breed dog was presented to the veterinary hospital with abdominal distension, anemia, and lethargy following a chronic history of nonspecific gastrointestinal signs. CBC and serum biochemistry revealed moderate nonregenerative anemia with neutrophilia, hypoalbuminemia, hyperglobulinemia, hypoglycemia, decreased urea and creatinine, and hypercholesterolemia. Abdominal radiographs and ultrasound revealed a large heterogeneous mesenteric mass and ascites. Abdominocentesis confirmed septic peritonitis with filamentous bacteria. Fine-needle aspiration of the mass yielded pyogranulomatous inflammation and hyphae. An exploratory laparotomy revealed a large cranial abdominal mass with granulomas present throughout the abdominal cavity. Due to the poor prognosis and disseminated disease, the owner elected euthanasia. Postmortem and histologic examinations detected intralesional mycetomas and bacterial colonies within the mesenteric masses. 16S ribosomal RNA gene PCR and sequencing using formalin-fixed, paraffin-embedded sections identified Nocardia yamanashiensis, Nocardioides cavernae, and Nocardioides zeicaulis. Fungal culture, PCR, and sequencing confirmed Scedosporium apiospermum. Our report highlights the importance of molecular methods in conjunction with culture and histologic findings for diagnosing coinfections caused by infrequent etiologic agents. Additionally, we provide a comprehensive literature review of Scedosporium apiospermum infections in dogs.

Transcytosable and Ultrasound-Activated Liposome Enables Deep Penetration of Biofilm for Surgical Site Infection Management

Biofilm-associated surgical site infection (BSSI) is a common and grievous postoperative complication lacking effective remedies, mainly due to the poor drug accumulation and penetration in the biofilms featured by dense extracellular polymeric substances (EPSs). Here, it is found that the vascular cell adhesion molecule-1 (VCAM1) is highly overexpressed in the vascular cells of BSSI. It is proposed that the combination of VCAM1-mediated transcytosis and ultrasonic cavitation can consecutively overcome the biological barriers of vascular endothelial cells and EPS for biofilm eradication. To demonstrate the feasibility, a VCAM1-targeted and ultrasound (US)-activated liposome (LPCOTML) loaded with a reactive-oxygen-species (ROS)-responsive lipoid prodrug of oleoyl meropenem, sonosensitizer of lipoid Ce6, and perfluoropentane is developed. LPCOTML can recognize the receptors on vascular cells, and initiate receptor-mediated transcytosis for transendothelial transport into the BSSI periphery. LPCOTML subsequently transforms from nanoparticle into microbubble via liquid-gas phase transition under US irradiation, triggering strong ultrasonic cavitation to blow up the EPS and deeply penetrate the biofilms. The sonosensitizer Ce6 induces ROS production under US irradiation and triggers the release of meropenem to induce potent antibacterial effect in a BSSI model. This study presents an effective strategy to tackle the biological barriers in BSSI via combining receptor-mediated transcytosis and ultrasonic cavitation.

The Role and Limitations of Artificial Intelligence in Combating Infectious Disease Outbreaks

Artificial intelligence (AI) has emerged as a transformative tool in the management of pandemics, significantly enhancing disease prediction, diagnostics, drug discovery, and vaccine development. This manuscript explores AI's multifaceted applications during infectious disease outbreaks, from predictive modeling and outbreak forecasting to the acceleration of vaccine development and antimicrobial resistance detection. AI-driven technologies, including deep learning and reinforcement learning, have shown remarkable effectiveness in improving diagnostic accuracy, streamlining drug discovery processes, and providing real-time decision-making support for healthcare providers. However, despite its substantial contributions, the deployment of AI in pandemic management faces key limitations, including concerns about data privacy, model transparency, and the need for constant updates to adapt to emerging pathogens. The integration of AI with human expertise is essential to optimize global health outcomes and address these challenges. This review highlights both the potential and the obstacles to fully leveraging AI in pandemic response, proposing pathways for overcoming current limitations and maximizing AI's impact on future outbreaks.

Antibiotics in decompensated liver disease - who, when and for how long?

INTRODUCTION

Bacterial infections are a leading cause of hospitalization and mortality in patients with decompensated cirrhosis. Antibiotic prophylaxis in cirrhotic patients has demonstrated significant short-term reductions in bacterial infections in randomized controlled trials, but at the cost of drug resistance and with uncertain survival benefits.

AREAS COVERED

This review examines antibiotic use in cirrhosis, focusing on patients most likely to benefit from antibiotic prophylaxis, management strategies for infections through risk-based antibiotic selection and timely treatment initiation, challenges posed by the emergence of multidrug-resistant organisms, and principles of antimicrobial stewardship.

EXPERT OPINION

The efficacy of prophylaxis has decreased over time, and current registry data have questioned its use, emphasizing the need for better risk-based individualized strategies. When bacterial infections occur, the efficacy of antimicrobial therapies depends heavily on local epidemiological patterns and individual patient risk factors, necessitating tailored antibiotic selection based on regional resistance data and specific clinical scenarios. Nosocomial infections, colonization with multidrug-resistant organisms, and prior exposure to systemic antibiotics are key risk factors that should guide empirical therapy selection. Until evidence-based algorithms are available, clinicians should continue to adopt individualized approaches, guided by available evidence, local specificities, and antimicrobial stewardship principles to optimize patient outcomes.

A systematic review on malaria and dengue vaccines for the effective management of these mosquito borne diseases: Improving public health

Insect vector-borne diseases (VBDs) pose significant global health challenges, particularly in tropical and subtropical regions. The WHO has launched the "Global Vector Control Response (GVCR) 2017-2030" to address these diseases, emphasizing a comprehensive approach to vector control. This systematic review investigates the potential of malaria and dengue vaccines in controlling mosquito-borne VBDs, aiming to alleviate disease burdens and enhance public health. Following PRISMA 2020 guidelines, the review incorporated 39 new studies out of 934 identified records. It encompasses various studies assessing malaria and dengue vaccines, emphasizing the significance of vaccination as a preventive measure. The findings indicate variations in vaccine efficacy, duration of protection, and safety considerations for each disease, influencing public health strategies. The review underscores the urgent need for vaccines to combat the increasing burden of VBDs like malaria and dengue, advocating for ongoing research and investment in vaccine development.

Plant Compounds Inhibit the Growth of W12 Cervical Precancer Cells Containing Episomal or Integrant HPV DNA; Tanshinone IIA Synergizes with Curcumin in Cervical Cancer Cells

This study explores the effects of plant compounds on human papillomavirus (HPV)-induced W12 cervical precancer cells and bioelectric signaling. The aim is to identify effective phytochemicals, both individually and in combination, that can prevent and treat HPV infection and HPV associated cervical cancer. Phytochemicals were tested using growth inhibition, combination, gene expression, RT PCR, and molecular docking assays. W12 cells, derived from a cervical precancerous lesion, contain either episomal or integrated HPV16 DNA. Several compounds, including digoxin, tanshinone IIA, dihydromethysticin and carrageenan, as well as fractions of turmeric, ginger and pomegranate inhibited the growth of W12 precancer and cervical cancer cells. Curcumin and tanshinone IIA were the most active and relatively nontoxic compounds. RT-PCR analysis showed that tanshinone IIA activated the expression of p53, while repressing the expression of HPV16 E1, E2, E4, E6, and E7 viral transcripts in W12 (type 1 and 2) integrant cells. In addition, curcumin synergized with tanshinone IIA in HeLa cells. Molecular docking studies suggested tanshinone IIA and curcumin bind to the Na+/K+-ATPase ion channel, with curcumin binding with higher affinity. Our findings highlight the potential of these multifaceted phytochemicals to prevent and treat HPV-induced cervical cancer, offering a promising approach for combinatorial therapeutic intervention.

Perception of antibiotic use and antibiotic resistance among faculty and staff in a medical school: insights from a mixed mode survey in Bahrain

BACKGROUND

Understanding awareness of antibiotics is crucial in identifying the attitudes of people which could subsequently help shape campaigns and policies addressing this problem. The study aimed to explore awareness of antibiotics use and antibiotic resistance among faculty and staff at the medical institution.

METHODOLOGY

All the study participants (faculty & staff) were asked to complete the survey. The survey consisted of questions ranging from knowledge and use of antibiotics to knowledge about antibiotic resistance. Ninety participants responded for the quantitative survey. After the questionnaire administration, in-depth interviews were conducted with subgroups of faculty, technicians, and administrative staff. The researchers employed a purposive sampling strategy. Around 43 participants volunteered to participate in this interview.

RESULTS

The results showed that 92% of participants reported taking antibiotics, with the majority receiving them from licensed medical providers, while a smaller respondent (12.6%) self-medicated. The concept of "antibiotic resistance" was the most widely recognized, with 47.78% of participants indicating awareness, typically gained from healthcare personnel. The in-depth interviews revealed that the faculty group had the strongest basic knowledge about antibiotics and resistance. When it comes to consequences of ABR, participants mentioned the risk of repeated infection and spread of stronger strains of bacteria that might be difficult to treat soon. The most important suggestion provided by most participants was that the antibiotics should be taken only with a doctor's prescription and consumed for appropriate duration as suggested by the doctor.

CONCLUSIONS

Although the study revealed a strong understanding of antibiotics, awareness regarding antibiotic resistance remained low. The findings emphasize the importance of enhancing communication skills among health professionals and implementing stewardship programs to promote safe antibiotic use and raise awareness about antibiotic resistance.

Pulmonary mucormycosis in an immunocompetent young female: a case report and literature review

Mucormycosis is considered a rare but highly lethal fungal infection, often occurring in patients with poorly controlled diabetes or immunosuppression. Pulmonary mucormycosis progresses rapidly and is often associated with pulmonary infarction and hemoptysis. In this case report, we presented a young, immunocompetent female patient with newly diagnosed diabetes who was diagnosed early with Rhizopus delemar infection through metagenomic next-generation sequencing. Despite early diagnosis, the infection progressed rapidly, invading the tracheal cartilage and upper mediastinal soft tissue, ultimately leading to the patient's unfortunate demise.

Physician's perception and practices on antimicrobial resistance in a tertiary care hospital in Bangladesh: a cross-sectional study

BACKGROUND

Antimicrobial resistance (AMR) is a global health and development concern. Antimicrobial misuse and overuse are key contributors to the emergence of drug-resistant infections.

OBJECTIVE

The current study aimed to determine the level of perception and practices of physicians regarding AMR in a tertiary-level hospital.

DESIGN

Cross-sectional study.

SETTING

A tertiary care hospital in Dhaka, Bangladesh.

PARTICIPANTS

The study included 360 physicians who worked for more than 6 months in different departments of the hospital.

PRIMARY AND SECONDARY OUTCOME MEASURES

Perceptions of AMR among physicians and secondary outcome measures were to find out the practices of physicians regarding AMR. The current study used 8 defined responses and 6 multiple-choice questions for scoring physicians' perception of AMR and 12 items to score physicians' self-reported practice regarding AMR. After converting these scores into percentages, the median split method was used to categorise them into poor and good categories.

RESULTS

Among 360 physicians, 51% were male, the median (IQR) age was 30 (27.0-34.0) years and 46% had private practices. More than half (52%) had a poor perception of AMR but had good practice (57%) with no significant association between perception and practice. The perception of AMR was significantly associated with age (p=0.048), years in practice (p=0.011) and AMR training (p=0.030). Physicians with private practice had 1.71 times higher odds of having a good perception of AMR (95% CI 2.07 to 2.75, p=0.026) and 2.44 times higher odds of having good practice (95% CI 1.51 to 3.94, p<0.001). The odds of having a good perception of AMR increase 1.20 times with a 1-year increase in years of practice (95% CI 1.01 to 1.44, p=0.042).

CONCLUSION

The study revealed that most physicians had poor perception but good practice regarding AMR. Both poor perception and good practice were associated with private practice. To increase good practice and perception regarding AMR, efforts need to be made to establish an AMR education programme for practicing physicians as soon as possible. Moreover, medical audits and continuous quality improvement (such as programmes for antimicrobial stewardship) should be legislated, and monitoring prescribing behaviour and formulating policies accordingly are the way forward in combating AMR.

White Coats at a Crossroads: Hygiene, Infection Risk, and Patient Trust in Healthcare Attire-An Umbrella Review with Quantitative Synthesis and Stress, Weaknesses, Opportunities, and Threats Analysis

White coats, traditionally symbols of physicians' hygiene and professionalism, are now scrutinized for potential infection risks during patient interactions. This review investigates whether wearing white coats is linked to microbial contamination, infection transmission, and patient expectations. An umbrella review of peer-reviewed studies and guidelines was conducted, with searches in PubMed/Medline and Scopus using terms related to medical attire, infection control, patient perceptions, and discrimination. Ten records were included, and a bibliometric analysis was performed with VOS Viewer. Bias appraisal was conducted using the JBI Bias Assessment Toolset, and a SWOT analysis was developed to support evidence-based decision-making. Findings indicate that white coats may harbor pathogens such as Staphylococcus aureus, Gram-positive cocci, Gram-negative rods, and MRSA. To mitigate contamination risks, it is recommended that physicians roll up coat sleeves during examinations and that the coats receive daily laundering in healthcare settings. However, evidence supporting a coatless policy is yet to be published. Patients tend to expect physicians to wear identifiable attire, like white coats or scrubs for surgeons. Recent research in this field shifts the focus from infection control to the impact of attire on patient trust and physician-patient relationships.

Respiratory Flora Intervention: A New Strategy for the Prevention and Treatment of Occupationally Related Respiratory Allergy in Healthcare Workers

Occupational allergic respiratory disease in healthcare workers due to occupational exposure has received widespread attention. At the same time, evidence of altered respiratory flora associated with the development of allergy has been found in relevant epidemiologic studies. It is of concern that the composition of nasopharyngeal flora in healthcare workers differs significantly from that of non-healthcare workers due to occupational factors, with a particularly high prevalence of carriage of pathogenic and drug-resistant bacteria. Recent studies have found that interventions with upper respiratory tract probiotics can significantly reduce the incidence of respiratory allergies and infections. We searched PubMed and other databases to describe the burden of allergic respiratory disease and altered respiratory flora in healthcare workers in this narrative review, and we summarize the mechanisms and current state of clinical research on the use of flora interventions to ameliorate respiratory allergy, with the aim of providing a new direction for protecting the respiratory health of healthcare workers.

Prevalence of Antimicrobial Resistance Among the WHO's AWaRe Classified Antibiotics Used to Treat Urinary Tract Infections in Diabetic Women

Background and Objectives: Diabetes is linked to a higher risk of urinary tract infections (UTIs) in women, often leading to recurrent antibiotic treatments. Frequent antibiotic use for UTIs can contribute to antimicrobial resistance (AMR), a critical public health threat that increases treatment failure. This study investigated the prevalence of AMR and its associated factors among women with UTIs, comparing those with and without diabetes. Results: The study population had a mean age of 52 years (SD = 23) for the women without diabetes and 68 years (SD = 14) for those with diabetes. Resistance was highest for cefazolin and levofloxacin in the Access and Watch antibiotic groups, while ciprofloxacin was the most frequently prescribed antibiotic. AMR prevalence was 35.7% among the women with diabetes and 21.3% among those without. After adjustment, AMR was significantly associated with both uncomplicated diabetes (OR 1.14, 95% CI 1.08-1.21) and complicated diabetes (OR 1.54, 95% CI 1.45-1.64), as well as with higher numbers of prescribed antibiotics (OR 277.39, 95% CI 253.79-303.17). Methods: Using a cross-sectional cohort from the Physionet database, we analyzed data on 116,902 female participants treated for UTIs, including their antibiotic exposure, diabetes status, comorbidities, and hospital admission details. Antimicrobials were classified per the WHO's AWaRe criteria. The primary outcome was AMR identified in urine cultures, and the association with diabetes status was evaluated using multivariable logistic regression. Conclusions: Our findings highlight the need for focused antimicrobial stewardship in women with diabetes to reduce the AMR rates in this vulnerable group.

Laboratory detection of carbapenemases among Gram-negative organisms

SUMMARYThe carbapenems remain some of the most effective options available for treating patients with serious infections due to Gram-negative bacteria. Carbapenemases are enzymes that hydrolyze carbapenems and are the primary method driving carbapenem resistance globally. Detection of carbapenemases is required for patient management, the rapid implementation of infection prevention and control (IP&C) protocols, and for epidemiologic purposes. Therefore, clinical and public health microbiology laboratories must be able to detect and report carbapenemases among predominant Gram-negative organisms from both cultured isolates and direct from clinical specimens for treatment and surveillance purposes. There is not a "one size fits all" laboratory approach for the detection of bacteria with carbapenemases, and institutions need to determine what fits best with the goals of their antimicrobial stewardship and IP&C programs. Luckily, there are several options and approaches available for clinical laboratories to choose methods that best suits their individual needs. A laboratory approach to detect carbapenemases among bacterial isolates consists of two steps, namely a screening process (e.g., not susceptible to ertapenem, meropenem, and/or imipenem), followed by a confirmation test (i.e., phenotypic, genotypic or proteomic methods) for the presence of a carbapenemase. Direct from specimen testing for the most common carbapenemases generally involves detection via rapid, molecular approaches. The aim of this article is to provide brief overviews on Gram-negative bacteria carbapenem-resistant definitions, types of carbapenemases, global epidemiology, and then describe in detail the laboratory methods for the detection of carbapenemases among Gram-negative bacteria. We will specifically focus on the Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii complex.

The Genomic and Biologic Landscapes of Breast Cancer and Racial Differences

Breast cancer is a significant health challenge worldwide and is the most frequently diagnosed cancer among women globally. This review provides a comprehensive overview of breast cancer biology, genomics, and microbial dysbiosis, focusing on its various subtypes and racial differences. Breast cancer is primarily classified into carcinomas and sarcomas, with carcinomas constituting most cases. Epidemiology and breast cancer risk factors are important for public health intervention. Staging and grading, based on the TNM and Nottingham grading systems, respectively, are crucial to determining the clinical outcome and treatment decisions. Histopathological subtypes include in situ and invasive carcinomas, such as invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC). The review explores molecular subtypes, including Luminal A, Luminal B, Basal-like (Triple Negative), and HER2-enriched, and delves into breast cancer's histological and molecular progression patterns. Recent research findings related to nuclear and mitochondrial genetic alterations, epigenetic reprogramming, and the role of microbiome dysbiosis in breast cancer and racial differences are also reported. The review also provides an update on breast cancer's current diagnostics and treatment modalities.

Emerging Role of Gut Microbiota in Breast Cancer Development and Its Implications in Treatment

Background: The human digestive system contains approximately 100 trillion bacteria. The gut microbiota is an emerging field of research that is associated with specific biological processes in many diseases, including cardiovascular disease, obesity, diabetes, brain disease, rheumatoid arthritis, and cancer. Emerging evidence indicates that the gut microbiota affects the response to anticancer therapies by modulating the host immune system. Recent studies have explained a high correlation between the gut microbiota and breast cancer: dysbiosis in breast cancer may regulate the systemic inflammatory response, hormone metabolism, immune response, and the tumor microenvironment. Some of the gut bacteria are related to estrogen metabolism, which may increase or decrease the risk of breast cancer by changing the number of hormones. Further, the gut microbiota has been seen to modulate the immune system in respect of its ability to protect against and treat cancers, with a specific focus on hormone receptor-positive breast cancer. Probiotics and other therapies claiming to control the gut microbiome by bacterial means might be useful in the prevention, or even in the treatment, of breast cancer. Conclusions: The present review underlines the various aspects of gut microbiota in breast cancer risk and its clinical application, warranting research on individualized microbiome-modulated therapeutic approaches to breast cancer treatment.

Efficacy of colistin-based combinations against pandrug-resistant whole-genome-sequenced Klebsiella pneumoniae isolated from hospitalized patients in Egypt: an in vitro/vivo comparative study

BACKGROUND

Colistin resistance significantly constrains available treatment options and results in the emergence of pandrug-resistant (PDR) strains. Treating PDR infections is a major public health issue. A promising solution lies in using colistin-based combinations. Despite the availability of in vitro data evaluating these combinations, the in vivo studies remain limited.

RESULTS

Thirty colistin-resistant Klebsiella pneumoniae (ColRKp) isolates were collected from hospitalized patients. Colistin resistance was detected using broth microdilution, and antimicrobial susceptibility was tested using the Kirby-Bauer method against 18 antibiotics. Extremely high resistance levels were detected, with 17% of the isolates being PDR. Virulence profiling, assessed using Anthony capsule staining, the string test, and the crystal violet assay, indicated the predominance of non-biofilm formers and non-hypermucoid strains. The isolates were screened for mcr genes using polymerase chain reaction. Whole-genome sequencing (WGS) and bioinformatics analysis were performed to characterize the genomes of PDR isolates. No plasmid-borne mcr genes were detected, and WGS analysis revealed that PDR isolates belonged to the high-risk clones: ST14 (n = 1), ST147 (n = 2), and ST383 (n = 2). They carried genes encoding extended-spectrum β-lactamases and carbapenemases, blaCTX-M-15 and blaNDM-5, on conjugative IncHI1B/IncFIB plasmids, illustrating the convergence of virulence and resistance genes. The most common mechanism of colistin resistance involved alterations in mgrB. Furthermore, deleterious amino acid substitutions were also detected within PhoQ, PmrC, CrrB, ArnB, and ArnT. Seven colistin-containing combinations were compared using the checkerboard experiment. Synergy was observed when combining colistin with tigecycline, doxycycline, levofloxacin, ciprofloxacin, sulfamethoxazole/trimethoprim, imipenem, or meropenem. The efficacy of colistin combined with either doxycycline or levofloxacin was assessed in vitro using a resistance modulation assay, and in vivo, using a murine infection model. In vitro, doxycycline and levofloxacin reversed colistin resistance in 80% and 73.3% of the population, respectively. In vivo, the colistin + doxycycline combination demonstrated superiority over colistin + levofloxacin, rescuing 80% of infected animals, and reducing bacterial bioburden in the liver and kidneys while preserving nearly intact lung histology.

CONCLUSIONS

This study represents the first comparative in vitro and in vivo investigation of the efficacy of colistin + doxycycline and colistin + levofloxacin combinations in clinical PDR ColRKp isolates characterized at a genomic level.

Antimicrobials in Orthopedic Infections: Overview of Clinical Perspective and Microbial Resistance

Orthopedic infections are challenging pathologies that impose a heavy burden on patients and the healthcare system. Antimicrobial therapy is a critical component of the successful management of orthopedic infections, but its effectiveness depends on patient-, surgery-, drug-, and hospital-related factors. The dramatic increase in the emergence of multidrug-resistant microbial strains necessitates new clinical approaches in order to prevent or limit this phenomenon and to ensure a favorable therapeutic outcome. The present paper reviews the currently available antimicrobial strategies in the management of orthopedic infections, highlighting their clinical use related to the occurrence of microbial resistance. Some approaches for reducing antibiotic resistance emergence in orthopedics are also presented. The use of antibiotics tailored to the microorganism's sensitivity profile, patient factors, and pharmacokinetic profile in terms of monotherapy or combinations, the understanding of microbial pathogenicity and resistance patterns, strict control measures in healthcare facilities, the development of new antimicrobial therapies (drugs, devices, technologies), and patient education for improving compliance and tolerance are some of the most important tools for overcoming microbial resistance.

The World Health Organization Access, Watch, and Reserve classification of antibiotics: an awareness survey among pharmacy professionals in a sub-Saharan country, Zambia

Background

Antimicrobial stewardship programs are very essential in addressing the problem of drug-resistant infections. The WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics is essential in monitoring the rational use of antibiotics. Therefore, this study evaluated the awareness of the WHO AWaRe classification of antibiotics among pharmacy professionals in Zambia.

Materials and methods

This cross-sectional study was conducted among 239 pharmacy professionals practicing in both private and public facilities in Zambia. A questionnaire was used to collect data which was subsequently analyzed using IBM SPSS version 23.0.

Results

Of the 239 participants, 63% were male and most were pharmacists employed in the public sector. This study found that 58% of the pharmacy professionals were aware of the AWaRe classification of antibiotics. Consequently, only 36% of the participants agreed that they implemented the AWaRe framework of antibiotics in their healthcare facilities. Most of the participants (74%) agreed that implementing the AWaRe tool can promote the rational use of antibiotics and 98% of the participants were willing to learn more about the AWaRe tool through training or meetings.

Conclusion

This study found a low awareness of the WHO AWaRe classification of antibiotics among pharmacy professionals. Our study further revealed that very few pharmacy professionals agreed that they had implemented the WHO AWaRe tool in their healthcare facilities. Hence, there is a need to strengthen antimicrobial stewardship programs by implementing the AWaRe framework and other recommended guidelines for monitoring the rational use of antibiotics.

Genetically engineered mouse models of FK506-binding protein 5

FK506 binding protein 51 (FKBP51) is a molecular chaperone that influences stress response. In addition to having an integral role in the regulation of steroid hormone receptors, including glucocorticoid receptor, FKBP51 has been linked with several biological processes including metabolism and neuronal health. Genetic and epigenetic alterations in the gene that encodes FKBP51, FKBP5, are associated with increased susceptibility to multiple neuropsychiatric disorders, which has fueled much of the research on this protein. Because of the complexity of these processes, animal models have been important in understanding the role of FKBP51. This review examines each of the current mouse models of FKBP5, which include whole animal knockout, conditional knockout, overexpression, and humanized mouse models. The generation of each model and observational details are discussed, including behavioral phenotypes, molecular changes, and electrophysiological alterations basally and following various challenges. While much has been learned through these models, there are still many aspects of FKBP51 biology that remain opaque and future studies are needed to help illuminate these current gaps in knowledge. Overall, FKBP5 continues to be an exciting potential target for stress-related disorders.

Validity of urinary catheter specimens for diagnosis of urinary tract infection in patients with short-term catheterization

Current guidelines recommend urine culture after catheter replacement to diagnose catheter-associated urinary tract infections (CA-UTI) in patients with long-term catheters, but it's unclear if this applies to short-term catheterizations. We studied 52 patients with catheters for less than 28 days, showing symptoms of CA-UTI. We collected urine from the catheter port initially and from the new catheter within 2 hours of replacement. Positive culture rates were 36.5 % before and 28.8 % after replacement. Significant differences in urine culture results were observed in 32.7 % of cases postreplacement (P = .0184), increasing to 78.9 % after excluding negative pre-replacement cultures (P = 0.0003). Duration of catheterization didn't affect urine bacteriology changes post-replacement. This suggests that urine bacteriology often differs after catheter replacement in short-term catheterizations.

Intestinal Colonization of Multidrug-Resistant Organisms: Identification and Antibiotic Susceptibility Patterns of Bacteria Isolated From Healthy Human Fecal Specimens

Introduction Intestinal carriage of multidrug-resistant organisms (MDROs) in healthy populations could amplify resistant bacteria, which may increase the risk of infections by these bacteria in the community and in the hospital. This study investigated the prevalence of colonization of multidrug-resistant (MDR) bacteria in the intestines of healthy individuals in South India. Methods A prospective study was conducted for six months at a tertiary care teaching hospital. Two hundred and fifty-five fecal samples collected from healthy individuals were processed according to standard microbiological guidelines. The bacteria (n=291) isolated from the samples were identified and evaluated using phenotypic detection methods for the presence of extended-spectrum beta-lactamase (ESBL), AmpC β-lactamase, carbapenemase, methicillin resistance, and vancomycin resistance. Results The prevalence of intestinal carriage of MDR bacteria in healthy populations was 57.04% (166/291). Klebsiella (81.92%; 68/83) was the most resistant bacterial isolate among the tested organisms. ESBL, AmpC β-lactamase, carbapenemase, and methicillin resistance rates were 34.70% (101/291), 12.37% (36/291), 7.90% (23/291), and 2.06% (6/291), respectively. Both ESBL and AmpC β-lactamase co-producing strains were 3.78% (11/291). Vancomycin resistance was not revealed among the sampled isolates. Conclusion The study revealed a high carriage rate of MDROs colonized in the intestines of healthy adults in the community. These results highlight the importance of identifying resistant pathogens through regular surveillance thereby understanding their epidemiology.

Q fever diagnosed using metagenomic next-generation sequencing in Guangdong Province, China

Q fever is a zoonotic disease caused by infection with Coxiella burnetii (C. burnetii). Due to its atypical symptoms and the absence of specific detection methods, Q fever is underdiagnosed commonly. Herein, we report a case of Q fever confirmed by metagenomic next-generation sequencing (mNGS) in March 2024 in Guangdong Province, China. The patient initially experienced fever and was admitted to hospital six days later. Despite a series of laboratory tests conducted at the hospital, the pathogen remained undetermined. Ten days after admission, mNGS revealed that the patient was infected with C. burnetii. The patient subsequently underwent treatment with doxycycline and recovered well. Epidemiological investigation revealed that the patient had been exposed to sheep infected with C. burnetii without any protective measures in Jiangxi Province, China. Based on the comprehensive results of mNGS, exposure history, clinical manifestations and treatment response, the patient was confirmed as a Q fever case. As a neglected and underestimated illness, Q fever necessitates an elevation in awareness among medical staff and the public. The public should be encouraged to take personal protective measures when exposed to livestock. Further research is needed to explore the rational application of mNGS in the diagnosis of uncommon and unknown diseases.

Hair Cortisol/DHEA-S Ratios in Healthcare Workers and Their Patients During the COVID-19 Pandemic: A Case Study

BACKGROUND

Unlike psychological distress, which has been extensively studied during the COVID-19 pandemic, the impact of the pandemic on stress hormones has been overlooked. The aim of this study is to examine the hair cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratios as markers of HPA axis dysregulation in healthcare workers and their patients.

METHODS

A total of 200 healthcare workers and 161 "patients" patients with special healthcare needs due to chronic illness or motor disabilities were included in this study. The hormone concentrations were measured using a radioimmunoassay.

RESULTS

Our results show that the patients had significantly higher cortisol/DHEA-S ratios than the workers. A high cortisol/DHEA-S ratio in the patients reflects higher cortisol concentrations (p < 0.001) and lower DHEA-S (p < 0.05) concentrations compared to those of the healthcare workers, suggesting that they may be exposed to a greater degree of stress and a decrease in their ability to cope with their disease. The cut-off value of the hair cortisol/DHEA-S ratio in our study for detecting people with needs that require special consideration and attention was 1.46 (p ≤ 0.01).

CONCLUSIONS

Assessing the hair cortisol/DHEA-S ratios in both healthcare workers and the patients allowed us to identify a non-homeostatic condition that could lead to disease and to understand psychophysical well-being during the COVID-19 pandemic. They also play a crucial role in preventive and personalized medicine.

Tea-derived exosome-like nanoparticles prevent irritable bowel syndrome induced by water avoidance stress in rat model

BACKGROUND AND AIM

Exosome-like nanoparticles (ELNs) have emerged as crucial mediators of intercellular communication, evaluated as potential bioactive nutraceutical biomolecules. We hypothesized that oral ELNs have some therapeutic effect on irritable bowel syndrome (IBS).

METHODS

In our study, ELNs from tea (Camellia sinensis) leaves were extracted by differential centrifugation. We investigated the role of ELNs by assessing visceral hypersensitivity, body weight, bowel habits, tight junctions, and corticotropin-releasing hormone (CRH) in rats subjected to water avoidance stress (WAS) to mimic IBS with and without ELNs (1 mg/kg per day) for 10 days.

RESULTS

The average diameter of ELNs from LCC, FD and MZ tea tree were 165 ± 107, 168 ± 94, and 168 ± 108 nm, the concentration of ELNs were 1.2 × 1013, 1 × 1013, and 1.5 × 1013 particles/mL, respectively. ELNs can be taken up by intestinal epithelial cells. In WAS rats, ELNs significantly restored weight, recovered tight junctions, decreased CRH, and CRH receptor 1 expression levels and inhibited abdominal hypersensitivity in comparison to positive control.

CONCLUSIONS

Oral tea-derived ELN improves symptoms of IBS by potentially modulating the CRH pathway.

Microbiota of the Mammary Gland in Wistar Rats with Chemically Induced Breast Cancer after Treatment

We conducted a comparative study of the mammary gland microbiota in female Wistar rats and the microbiota associated with breast cancer (BC) induced by the administration of N-methyl-N-nitrosourea, after surgical treatment, photodynamic therapy (PDT), and chemotherapy (CT). Selective nutrient media and a smear-fingerprint technique were used to study the microbiota. Staphylococcus, Streptococcus, and Lactobacillus were found in the mammary glands of intact rats. The mean number of Staphylococcus CFU increased statistically significantly in all groups of rats with induced BC, compared to intact animals: by 8 times in the BC without treatment group, by 15% in BC+surgery, by 10 times in BC+PDT, by 4 times in BC+PDT+CT, and by 13 times in BC+CT. The number of Streptococcus CFU also increased in all experimental groups: by 15.5 times in the BC without treatment group, by 4 times in BC+surgery, by 2.6 times in BC+PDT, by 4.5 times in BC+PDT+CT, and by 3.5 times in BC+CT. The number of Lactobacillus CFU significantly increased only in the BC+PDT group (by 2.5 times). The development of the microbiota in the tumor allows evaluating the impact of various types of therapy on the growth of opportunistic microorganisms. The results suggest that doxorubicin combined with PDT has the most potent effect on changes to the tumor microbiota.

Caught Between Stewardship and Resistance: How to Treat Acute Complicated Diverticulitis in Areas of Low Antimicrobial Susceptibility?

Antimicrobial resistance is one of the main threats to public health, with multidrug-resistant (MDR) pathogens on the rise across continents. Although treatment guidelines generally recommend antimicrobial therapy for acute complicated diverticulitis, they do not specify treatment pathways according to local or national resistance profiles. There is sparse data regarding specific pathogens involved in Hinchey II-IV patients who undergo surgery. This study seeks to address these issues and determine how often and what types of MDR bacteria occur in patients undergoing emergency surgery. We prospectively enrolled patients admitted between 2020-2023 and who underwent emergency surgery for complicated acute diverticulitis. We analysed the inflammatory response parameters at admission, the type of surgery employed for source control, identified pathogens in the peritoneal samples, their antimicrobial susceptibility, the efficacy of antimicrobial empiric therapy, and mortality. Gram-negative bacteria were identified most often, with Escherichia coli being mostly MDR (43.9%) or extended-spectrum beta-lactamase producing (ESBL +ve) (24.4%), while most strains of Klebsiella pneumoniae were extended-spectrum beta-lactamase positive (ESBL +ve) (80%) and MDR (80%). Of the Enterococcus spp., 57.14% were vancomycin-resistant (VRE) strains. Patients with Hinchey III/IV were significantly more associated with MDR. Patients with multiple pathogens were significantly associated with ESBL+/VRE strains. Age, leucocytosis, and procalcitonin levels at admission were good indicators for mortality prediction, which occurred in four cases. In an age when antibiotic stewardship is advisable especially in emergency settings, the treatment should be tailored according to local profiles of MDR to ensure adequate outcomes for patients.

Antiviral combination treatment strategies for SARS-CoV-2 infection in immunocompromised patients

PURPOSE OF REVIEW

The purpose of this review is to report the available evidence regarding the use of combination regimens of antivirals and/or antibody-based therapy in the treatment of SARS-CoV-2 in immunocompromised patients.

RECENT FINDINGS

Literature search identified 24 articles, excluding single case reports, which included mainly patients with hematological malignancies and/or B-cell depletion. Data were divided based on the timing and reason for administration of combination treatment, that is, early treatment to prevent progression to severe COVID-19 and treatment of prolonged or relapsed infection. We described the treated populations, treatment duration and composition of combination treatment. We briefly addressed new treatment options and we proposed an algorithm for the management of COVID-19 infection in patients affected by hematological malignancies.

SUMMARY

Combination treatment seems an effective (73-100%) and well tolerated (<5% reported bradycardia, hepatotoxicity, neutropenia) strategy for treating prolonged/relapsed SARS-CoV-2 infections in the immunocompromised host, although its optimal composition and duration cannot be defined based on the currently available evidence. The role of combination treatment as an early treatment strategy for immunocompromised patients at a high risk of progression to severe disease/persistent shedding requires further evidence from comparison with monotherapy, even though high efficacy was reported for combinations of antivirals plus mAbs in case of previous viral variants.

Knowledge, Attitude, and Practice Towards Antibiotics Use Among Medical Sector Final-Year Students in Egypt

Introduction

Medical sector students must be well-educated and competent to spread public awareness of antibiotics among the public to combat antibiotic resistance. This study aimed to assess the knowledge, attitude, and practice (KAP) of students regarding antibiotic use and resistance in Egypt.

Methodology

A cross-sectional questionnaire was specially designed and self-administered by final-year students (medicine (MS), pharmacy (PS), dentistry (DS), and nursing (NS)) during the last semester at nine universities.

Results

Among 1250 recruited students, with an 89% response rate, PS and MS showed the highest knowledge level, whereas NS scored the lowest. The study revealed some misconceptions and malpractices among students. Two-thirds of PS and NS, half of DS, and a third of MS believed antibiotics treat sore throats. Sixty percent of NS and DS were unaware that vancomycin treats methicillin-resistant Staphylococcus aureus. Over half of MS and NS and a third of DS and PS lacked knowledge of amoxicillin safety during pregnancy and breastfeeding. The prevalence of antibiotics self-medication (ABSM) was highest among PS (30%), followed by NS (27%) and DS (25%), while MS reported the lowest rate (16.6%). One-third of students preferred to use newer and more expensive antibiotics. Seven percent of the students used the local guidelines, 12% used the international guidelines as sources of information, and only 8% received relevant formal training.

Conclusions

The study found misconceptions and injudicious antibiotic use among medical sector students. Effective educational interventions and relevant training are needed to enhance their KAP on rational antibiotic use to minimize antibiotic resistance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02117-6.

Evaluating the Usefulness of Population-Wide COVID-19 Testing in the Omicron Era: Insights from a German Model

BACKGROUND

The Omicron variant of SARS-CoV-2, which has become dominant worldwide since late 2021, presents a unique challenge due to its high rate of asymptomatic transmission. This study evaluates the efficacy and value of population-wide testing, including self-testing, in the context of COVID-19, particularly under the Omicron variant, using data from Germany.

METHODS

A decision-analytical model and secondary data was used for assessing the impact of systematic screening and testing for COVID-19. Various scenarios were taken into consideration including seasonal patterns of COVID-19 transmission and the potential for annual waves. The model assessed the clinical benefits of testing against the backdrop of vaccine effectiveness, transmission rates, and the potential to prevent severe clinical events, including death, ICU admission, and long COVID syndrome.

RESULTS

The study found that the value of mass testing and self-testing for private use was highly contingent on the transmission rate and the scenario of COVID-19 waves (seasonal vs. continuous). For winter waves, a very high incidence rate was required to justify testing, while for continuous waves, testing could be valuable for those in contact with individuals in their last decade of life. The analysis highlighted the limitations of mass testing when community transmission rates were low and the potential value of testing in high-risk contacts or amidst new outbreaks.

CONCLUSION

The findings suggest that the resumption of testing during winter waves is unlikely to provide significant clinical benefits given the current understanding of Omicron's transmission and immunity waning. This study underscores the need for a nuanced approach to COVID-19 testing policies, considering both the epidemiological context and the practical implications of testing strategies.

Two cases of fungemia due to Lomentospora prolificans in haematological patients with different outcome

Lomentospora prolificans is an uncommon cause of invasive fungal disease, but it is associated with high mortality because it is difficult to treat. Most of severe cases are produced in immunossupressed patients, especially in those with neutropenia and/or hematological malignancies. Resistance to the majority of antifungal agents can be still observed. Here we report two cases of L. prolificans fungemia with different outcome, since in one of these patients treatment with one of the new antifungals could be applied. Both patients were treated with different antifungal drugs, but only the second one survived due to therapy with fosmanogepix®. The current treatment is still based on a combination of conventional antifungal drugs, although in much cases this strategy is not sufficient. The introduction of new promising antifungal agents such as fosmanogepix® and olorofim® may open new perspectives in the treatment of invasive infections caused by L. prolificans, as in our patient.

Current understanding of infection of the ventricles and its complications

INTRODUCTION

Ventriculitis, characterized by inflammation of the ventricles in the brain, frequently occurs as a complication of neurosurgical interventions such as the insertion of cerebrospinal fluid (CSF) shunts or external ventricular drains. It can also present as a community-acquired pathology, broadening its clinical significance and complicating diagnosis and treatment. This condition presents significant challenges, primarily due to its association with various medical devices and the predisposing conditions of patients which enhance infection risks.

AREAS COVERED

The review comprehensively explores the etiology, risk factors, diagnostic methodologies, and treatment options for ventriculitis. A thorough literature search was conducted, focusing on recent studies, meta-analyses, and clinical reports that discuss the incidence rates, the effectiveness of different management strategies, and the impact of device-related and community-acquired infections. Particular attention is given to the role of CSF drains and shunts, biofilms, and the prophylactic measures employed in clinical settings to mitigate infection risks.

EXPERT OPINION

Despite advances in medical technology and infection control protocols, ventriculitis remains a severe complication in both neurosurgical and community settings. The review highlights the need for continued research into innovative diagnostic tools and more effective infection control strategies.

Murine typhus: a re-emerging rickettsial zoonotic disease

Murine typhus, caused by Rickettsia typhi, is re-emerging in many parts of the world. The disease is also called endemic typhus to differentiate from epidemic typhus (caused by Rickettsia prowazekii), and sometimes also named flea-borne typhus. Occasionally, literature sources will include Rickettsia felis as a causative agent of flea-borne typhus, but illnesses caused by R. felis are actually flea-borne spotted fever. Murine typhus occurs in warm, coastal areas worldwide. In the United States, most cases are reported from California, Texas, and Hawaii. Murine typhus is usually a self-limited febrile illness but about one-quarter of patients suffer organ complications. The disease is only infrequently fatal. Regarding disease ecology, the historical paradigm is that rats (Rattus rattus and R. norvegicus) are reservoirs of R. typhi worldwide, with rat fleas (Xenopsylla cheopis) as primary vectors. More recently, researchers have proposed an alternative suburban murine typhus transmission cycle involving opossums, cat fleas, cats, and dogs in Texas, California, and rural Mexico. Because cat fleas feed on a variety of mammals, there may be other avenues for R. typhi transmission, including stray or feral cats bringing cat fleas and other infected fleas into proximity with humans and possible aerosolization of infected flea feces. Additional fleas, ticks, lice, and mites may play a role in various areas throughout the world, but a striking lack of fundamental research on this topic makes drawing conclusions difficult. This review provides an overview of the history, epidemiology, diagnosis, and treatment of murine typhus, with special emphasis on its disease ecology.

Metabolic and Regulatory Pathways Involved in the Anticancer Activity of Perillyl Alcohol: A Scoping Review of In Vitro Studies

BACKGROUND/OBJECTIVES

Perillyl alcohol (POH), a plant-derived compound, has demonstrated anti-tumor activity across various human cancers. Understanding the regulatory pathways through which POH exerts its effects is crucial for identifying new therapeutic opportunities and exploring potential drug repositioning strategies. Therefore, this scoping review aims to provide a comprehensive overview of the metabolic and regulatory pathways involved in the anticancer effects of POH, based on in vitro evidence.

METHODS

Following the PRISMA-ScR 2018 guidelines, a systematic search was conducted in the PUBMED, Web of Science, and Scopus databases.

RESULTS

A total of 39 studies were included, revealing that POH exerts its biological effects by modulating several pathways, including the regulation of cyclins, CDKs, and p21, thereby affecting cell cycle progression. It inhibits growth and promotes cell death by attenuating AKT phosphorylation, reducing PARP-1 activity, increasing caspase activity and the FAS receptor and its ligand FASL. Additionally, POH reduces ERK phosphorylation, inhibits RAS protein isoprenylation, and decreases Na/K-ATPase activity.

CONCLUSIONS

In conclusion, this review delineates the key regulatory pathways responsible for mediating the biological effects of POH in cancer.

Raising the bar in ulcerative colitis management

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by growing incidence and prevalence around the world in the last few decades. The range of available existing treatment and strategies for its management is being implemented. Given the introduction of newly developed molecules and the lack of specific guidelines, drug positioning may represent a tough clinical challenge. UC management is mostly medical, and it has been shifting toward a more personalized approach with the aim to create a tailored strategy depending on the patient's profile. A treat-to target strategy seems to be the best approach to reach disease control as it allows to carry out therapeutic choices based on objective and specific parameters: histological, ultrasonographic, and molecular targets may add to the already used clinical, endoscopic, and biochemical targets. In addition, dual-targeted therapy has emerged as an attractive therapeutic strategy for patients not achieving remission. This review aims to provide an overview of the available strategies to raise the bar in UC.

A Novel Variant of KPC-179 Conferring Ceftazidime-Avibactam Resistance in a Carbapenem-Resistant Klebsiella pneumoniae Isolate

Objective

Ceftazidime-avibactam (CZA) is a novel β-lactam/β-lactamase inhibitor with activity against carbapenem-resistant Klebsiella pneumoniae (CRKP) that produce Klebsiella pneumoniae carbapenemase (KPC). In this study, we report the first cases of CZA resistance to develop during treatment of CRKP infections and identify the resistance mechanism.

Methods

APB/EDTA and NG-Test CARBA5 were used to detect the production of carbapenemase, whole-genome sequencing (WGS) and conjugation experiment were used to identify potential resistance mechanisms of CZA-susceptible (HX1032) and -resistant (HX1192) K. pneumoniae isolates.

Results

HX1192 K. pneumoniae was not recognized by APB/EDTA and NG-Test CARBA5 phenotypic assays, WGS revealed it carrying a novel KPC variant, KPC-179, molecular analysis highlighted a G394A mutation, and an ATC insertion at 543 in the blaKPC-2 gene, resulting in an A133T substitution and insertion of the amino acid S at Ambler position 183 in the protein sequence. Remarkably, this mutation restored susceptibility of imipenem (MIC = 0.25 mg/L).

Conclusion

Our study highlights the importance of monitoring susceptibility during CZA treatment and accurately detecting KPC variants.

Causal effects of genetically determined circulating metabolites on endometriosis: A Mendelian randomization study

Endometriosis (EMs) is a common gynecological disease accompanied by metabolic disturbances. However, the causality between metabolites and the risk of EMs remains unclear. We conducted a 2-sample Mendelian randomization (MR) analysis using the publicly available genome-wide association study (GWAS) of 486 circulating metabolites and EMs. The inverse variance weighted (IVW) was mainly used for assessing causality. MR-Egger intercept, MR-PRESSO Global, leave-one-out, and Cochran Q test analyses were used for sensitivity analyses. A total of 25 causal metabolites related to EMs have been identified, including 13 known and 12 unknown ones. Among the known metabolites, caffeine (OR = 0.86, 95% CI: 0.76-0.98, P = .026), cortisol (OR = 0.64, 95% CI: 0.41-0.99, P = .047), glycocholate (OR = 0.67, 95% CI: 0.51-0.87, P = .003), adrenate 22:4n6 (OR = 0.52, 95% CI: 0.35-0.77, P = .001), and ergothioneine (OR = 0.62, 95% CI: 0.47-0.81, P = .000) were protective factors for EMs, while mannose (OR = 1.43, 95% CI: 1.01-2.03, P = .044), 4-acetamidobutanoate (OR = 1.92, 95% CI: 1.27-2.89, P = .002), 1-linoleoylglycerol (OR = 1.36, 95% CI: 1.10-1.68, P = .005), bilirubin (Z, Z) (OR = 1.15, 95% CI: 1.01-1.31, P = .032), threonate (OR = 1.42, 95% CI: 1.14-1.77, P = .002), bilirubin (E, E) (OR = 1.18, 95% CI: 1.01-1.38, P = .039), erythronate (OR = 1.59, 95% CI: 1.01-2.52, P = .047), and dimethylarginine (SDMA + ADMA) (OR = 2.07, 95% CI: 1.19-3.62, P = .010) were risk factors for EMs. Additionally, there was no evidence of heterogeneity or pleiotropy of the known metabolites. Leave-one-out analysis indicated that the MR findings were robust. Our findings provide valuable circulating biomarkers as well as therapeutic targets for the screening, prevention, and treatment of EMs.

Role of Preoperative Multiple-Drug-Resistant Bacteria Intestinal Colonization in Cardiac Surgery: A Retrospective Study

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity.

The Rising Threat of Mucormycosis: Oman's Experience Before and During the COVID-19 Pandemic

Mucormycosis is a rare, severe fungal infection mainly affecting immunocompromised individuals. Because of limited data on its epidemiology in Oman, we present this national, multicentric, retrospective review that includes all cases of proven mucormycosis between 2006 and 2022 in Oman. There were 51 cases of mucormycosis reported in Oman. The annual incidence of mucormycosis was 0.38-0.69 cases per million population before COVID-19. During the pandemic, the incidence rose significantly to 1.76 in 2020, 5.31 in 2021, then decreased to 0.87 per million population in 2022. Diabetes was observed in 82.4% (n = 42) of the cases, COVID-19 in 47.1% (n = 24), and other chronic diseases in 72.6%. The use of steroids was reported in 33.3% (n = 17) and many patients (64.7%, n = 33) had multiple risk factors. The overall mortality rate was 41.2% (n = 21) and most deaths occurred within a month of diagnosis. Mortality rate among patients diagnosed with COVID-19 was 58.3% (14/24). Survival analysis showed a statistically significant association between COVID-19 status and patient survival (p = 0.024). Annual incidence of mucormycosis in Oman rose during the pandemic. This study highlights the epidemiological features of mucormycosis and emphasizes the importance of its inclusion in the national notifiable communicable diseases priority list as well as the importance of enhancing diagnostic capacities to detect and improve patient outcomes.

Typhus group Rickettsia community-acquired bacterial central nervous system infections: We must think outside the box!

Typhus group rickettsiosis (TGR), caused by Rickettsia typhi and Rickettsia prowazekii, are globally distributed vector-borne diseases with increasing cases. Diagnosis is usually clinical, confirmed by seroconversion of IgG antibodies. Human infection occurs in diverse geographic areas with some developing CNS infection characterized by fever, headache, meningismus, and/or focal signs - usually beyond the first week of initial symptomatology. Seizures and other CNS manifestations have been observed. When untreated, infection may result in neurologic sequelae and even death. This study presents a systematic review of all documented cases of Rickettsia typhi meningoencephalitis published since 2015 with the addition of five cases of TGR in South Coastal Texas, USA. This review followed the guidelines outlined in PRISMA. A schematic explanation of the pathophysiology is offered. CSF may present with high opening pressure, mild to moderate pleocytosis, mildly elevated protein levels, and low csf/serum glucose ratio, or normal findings. Meningeal enhancement, intracranial hypertension, and focal abnormalities have been described in imaging studies, but can be normal. Treatment with doxycycline leads to prompt resolution of symptoms. Failure to initiate early empiric treatment can lead to serious consequences. The study recommends routine testing for TGR in patients from endemic areas with classical symptoms when other diagnoses are inconclusive or in cases with atypical presentations. The authors advocate for incorporating empiric treatment for murine typhus into community-acquired bacterial meningitis guidelines in endemic areas; and stress the importance of enhancing laboratory diagnostic capabilities in public health entities world-wide. Further studies of community acquired mengingoencephalitis caused by TGR are highly encouraged.

Why do undergraduate medical students choose medical humanities? A cross-sectional study at an Italian University

BACKGROUND

Medical humanities can contribute positively to clinical practice and medical education. Therefore, in many countries, medical schools have been progressively incorporating medical humanities into their curriculum. In Italy, only a few medical schools offer a variety of medical humanities courses, often as elective. What induces Italian medical students to take a medical humanities course has not yet been explored. The aim of this study is to fill this gap by investigating whether academic performance, sociodemographic and psychological variables may influence student motivation.

METHODS

We conducted a cross-sectional study in a medical school and collected data from 260 medical students, from the 3rd to the 6th year of the degree course. The students who chose to take a course in Medical Humanities were compared with those who chose not to take such a course, analysing numeric variables (age, grade point average, psychometric scores) and categorical variables (gender, nationality, educational level, living conditions). Motivations were investigated by open-ended questions and categorized prior to analyses.

RESULTS

The two subgroups showed no significant differences in sociodemographic characteristics, except for age, which was lower for the students who chose to take a medical humanities course (p < 0.001). Among the psychometric scores, only the anxiety score differed significantly between the groups, being lower for the students who chose a medical humanities course (p < 0.05). Regarding academic performance, the number of examinations passed was similar between the groups, while the average grade was lower for the students taking the course (p < 0.01). Interest in the humanities and their educational potential were the main reasons for choosing to take a course in medical humanities (76.2%). Concurrent commitments and lack of time were the major obstacles to this choice (39%).

CONCLUSIONS

Age, anxiety levels and academic performance seem to be inversely associated with the choice to take a medical humanities course. Considering the workload due to curricular activities when planning elective courses could increase student participation.

Role of rectal colonization by third-generation cephalosporin-resistant Enterobacterales on the risk of surgical site infection after hepato-pancreato-biliary surgery

The impact of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) rectal colonization in the development of subsequent infection after surgery is controversial. In particular, there is a lack of data in the context of hepato-pancreato-biliary (HPB) surgery. The objective of this study was to assess the prevalence of 3GCR-E intestinal carriage among patients undergoing elective HPB resection surgery and its impact on the incidence and etiology of surgical site infections (SSIs). This retrospective cohort study (January 2016-December 2022) was performed at Valme University Hospital (Seville, Spain). The inclusion criteria included (i) 18 years of age or older, (ii) undergoing elective HPB resection surgery, and (iii) availability of a periprocedural surveillance rectal swab culture to detect 3GCR-E. The prevalence of 3GCR-E intestinal carriage at elective HPB resection surgery was assessed, as well as SSI incidence at 30 days and possible associated factors. Two hundred nine patients were included. Eleven (5.3%) patients were colonized by 3GCR-E at baseline. According to 3GCR-E carriage status, 6 (55%) of the carriers developed SSI, whereas this occurred in 50 (25%) of non-carriers (P = 0.033). Likewise, the rates of SSI caused specifically by 3GCR-E were 83% (5 of 6) in 3GCR-E carriers and 6% (3 of 50) in non-carriers (P < 0.001). After multivariate analyses, 3GCR-E colonization at the time of surgery was identified as an independent predictor for developing SSI (adjusted odds ratio 4.63, 95% confidence interval: 1.177-18.232, P = 0.028). Despite a low prevalence of 3GCR-E intestinal carriage at surgery, 3GCR-E rectal colonization is associated with a higher risk of SSI among patients undergoing elective HPB resection surgery, with most SSIs being caused by the colonizing bacteria.

IMPORTANCE

In this Spanish retrospective cohort study, previous 3GCR-E rectal colonization was associated with a higher risk of SSI after hepato-pancreato-biliary resection surgeries. Most of SSIs were caused by the colonizing bacteria, suggesting a rationale for adapted perioperative antibiotic prophylaxis in known 3GCR-E colonized patients.

Incidence, Risk Factors, Short-term Outcomes, and Microbiome of Ventilator-associated Pneumonia in Very-low-birth-weight Infants: Experience at a Single Level III Neonatal Intensive Care Unit

BACKGROUND

Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in neonates on invasive mechanical ventilation, resulting in high morbidity and mortality. The objective of this study is to determine the incidence, risk factors, short-term outcomes and microbiome associated with VAP in very-low-birth-weight (VLBW) infants born at <32 weeks of gestational age (GA).

METHODS

Retrospective study of intubated VLBW infants born at <32 weeks of GA admitted to the Los Angeles General Medical Center neonatal intensive care unit from July 2015 to July 2021 who had routine tracheal aspirate cultures obtained. Neonates were retrospectively classified into 3 groups, confirmed VAP, suspected VAP and no VAP, for comparison of risk factors, outcomes and airway microbial colonization.

RESULTS

Eighty-seven infants met inclusion criteria with a mean GA of 26.1 ± 1 weeks and mean birth weight of 812 ± 281 g. The incidence of VAP was 7.8 per 1000 ventilator days, and the most common causative organisms were Gram-positive organisms (39%), predominantly coagulase-negative Staphylococcus . Duration of postnatal dexamethasone exposure predicted VAP compared to no VAP (coefficient, 0.31; 95% CI 0.03-0.59; P = 0.03) after adjusting for duration of intubation, surfactant use and antenatal steroid exposure. Infants with VAP had higher rate of grade 2/3 bronchopulmonary dysplasia ( P = 0.03) and longer hospital stay ( P = 0.04).

CONCLUSIONS

VAP occurs at a high rate in VLBW infants who are exposed to prolonged dexamethasone use. It is predominantly caused by Gram-positive organisms.

Treatment Outcomes and Associated Factors of Intravenous Colistin for Nosocomial Infections in Pediatric Patients: A Retrospective Study in a University Hospital in Thailand

BACKGROUND

This study aimed to investigate the efficacy and safety of intravenous colistin in pediatric patients with nosocomial Gram-negative bacteria infections and to determine factors associated with treatment outcomes.

METHODS

This retrospective study recruited patients <18 years of age receiving intravenous colistin between January 2014 and December 2018. Clinical data and treatment outcomes were reviewed, and factors associated with treatment outcomes were assessed.

RESULTS

This study included 178 patients with a median age of 3.4 years (range, 0.1-17.8). The mean ± SD dose of colistin prescribed to patients without renal impairment was 5.1 ± 0.6 mg/kg/day. The clinical response rate was 70.8% in patients receiving colistin for specific treatment. Infection-related mortality and crude mortality were 17.5% and 19.7%, respectively. The nephrotoxicity rate was 29.8%; approximately 70% of the episodes occurred between the 3rd and 7th day of treatment. The presence of at least 2 organ dysfunctions [adjusted hazard ratio (aHR): 7.17; 95% CI: 1.64-31.40], septic shock (aHR: 2.69; 95% CI: 1.36-5.32) and receiving chemotherapy/immunosuppressants (aHR: 2.68; 95% CI: 1.36-5.25) were observed to be associated with clinical failure. The factors observed to be associated with nephrotoxicity included hypoalbuminemia (aHR: 2.93; 95% CI: 1.26-6.78), receiving amphotericin B (aHR: 2.29; 95% CI: 1.16-4.52), vancomycin (aHR: 3.36; 95% CI: 1.50-7.56) and vasopressors (aHR: 2.57; 95% CI: 1.27-5.21).

CONCLUSION

Colistin is generally effective in the treatment of nosocomial Gram-negative bacteria infections in pediatric patients. Close monitoring of renal function should be considered, especially in high-risk patients. Optimal dosage regimens for pediatric populations to promote more favorable clinical outcomes and minimize nephrotoxicity require further investigation.

Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India

BACKGROUND

Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.

METHODS

A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.

RESULTS

The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004).

CONCLUSIONS

The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.