Nosocomial infections and their control strategies

Phloroglucinol-Based Carbon Quantum Dots/Polyurethane Composite Films: How Structure of Carbon Quantum Dots Affects Antibacterial and Antibiofouling Efficiency of Composite Films

Nowadays, bacteria resistance to many antibiotics is a huge problem, especially in clinics and other parts of the healthcare system. This critical health issue requires a dynamic approach to produce new types of antibacterial coatings to combat various pathogen microbes. In this research, we prepared a new type of carbon quantum dots based on phloroglucinol using the bottom-up method. Polyurethane composite films were produced using the swell-encapsulation-shrink method. Detailed electrostatic force and viscoelastic microscopy of carbon quantum dots revealed inhomogeneous structure characterized by electron-rich/soft and electron-poor/hard regions. The uncommon photoluminescence spectrum of carbon quantum dots core had a multipeak structure. Several tests confirmed that carbon quantum dots and composite films produced singlet oxygen. Antibacterial and antibiofouling efficiency of composite films was tested on eight bacteria strains and three bacteria biofilms.

Aluminum oxide, cobalt aluminum oxide, and aluminum-doped zinc oxide nanoparticles as an effective antimicrobial agent against pathogens

Since the clock of antimicrobial resistance was set, modern medicine has shed light on a new cornerstone in technology to overcome the worldwide dread of the post-antimicrobial era. Research organizations are exploring the use of nanotechnology to modify metallic crystals from macro to nanoscale size, demonstrating significant interest in the field of antimicrobials. Herein, the antimicrobial activities of aluminum oxide (Al2O3), cobalt aluminum oxide (CoAl2O4), and aluminum doped zinc oxide (Zn0.9Al0.1O) nanoparticles were examined against some nosocomial pathogens. The study confirmed the formation and characterization of Al2O3, CoAl2O4, and Zn0.9Al0.1O nanoparticles using various techniques, revealing the generation of pure nanoscale nanoparticles. With inhibition zones ranging from 9 to 14 mm and minimum inhibitory concentrations varying from 4 mg/mL to 16 mg/mL, the produced nanoparticles showed strong antibacterial activity against Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Meanwhile, the bactericidal concentrations ranged from 8 mg/mL to 40 mg/mL. In culture, Zn0.9Al0.1O NPs demonstrated a unique ability to inhibit the development of nosocomial infections with high bactericidal activity (8 mg/mL). Transmission electron microscope images revealed changes in cell shape, bacterial cell wall morphology, cytoplasmic membrane, and protoplasm due to the introduction of tested nanoparticles. These results pave the way for the use of these easily bacterial wall-piercing nanoparticles in combination with potent antibiotics to overcome the majority of bacterial strains' resistance.

Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review

Background

Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission.

Method

An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis.

Results

About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs.

Conclusion

Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.

Ultrathin TiS2@N,S-Doped Carbon Hybrid Nanosheets as Highly Efficient Photoresponsive Antibacterial Agents

Nanobactericides are employed as a promising class of nanomaterials for eradicating microbial infections, considering the rapid resistance risks of conventional antibiotics. Herein, we present a pioneering approach, reporting the synthesis of two-dimensional titanium disulfide nanosheets coated by nitrogen/sulfur-codoped carbon nanosheets (2D-TiS2@NSCLAA hybrid NSs) using a rapid l-ascorbic acid-assisted sulfurization of Ti3C2Tx-MXene to achieve efficient alternative bactericides. The as-developed materials were systematically characterized using a suite of different spectroscopy and microscopy techniques, in which the X-ray diffraction/Raman spectroscopy/X-ray photoelectron spectroscopy data confirm the existence of TiS2 and C, while the morphological investigation reveals single- to few-layered TiS2 NSs confined by N,S-doped C, suggesting the successful synthesis of the ultrathin hybrid NSs. From in vitro evaluation, the resultant product demonstrates impressive bactericidal potential against both Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli bacteria, achieving a substantial decrease in the bacterial viability under a 1.2 J dose of visible-light irradiation at the lowest concentration of 5 μg·mL-1 compared to Ti3C2Tx (15 μg·mL-1), TiS2-C (10 μg·mL-1), and standard antibiotic ciprofloxacin (15 μg·mL-1), respectively. The enhanced degradation efficiency is attributed to the ultrathin TiS2 NSs encapsulated within heteroatom N,S-doped C, facilitating effective photogenerated charge-carrier separation that generates multiple reactive oxygen species (ROS) and induced physical stress as well as piercing action due to its ultrathin structure, resulting in multimechanistic cytotoxicity and damage to bacterial cells. Furthermore, the obtained results from molecular docking studies conducted via computational simulation (in silico) of the as-synthesized materials against selected proteins (β-lactamasE. coli/DNA-GyrasE. coli) are well-consistent with the in vitro antibacterial results, providing strong and consistent validation. Thus, this sophisticated study presents a simple and effective synthesis technique for the structural engineering of metal sulfide-based hybrids as functionalized synthetic bactericides.

Cubeb (Piper cubeba L.): nutritional value, phytochemical profiling and dermacosmeceutical properties

Introduction

Cubeb, Piper cubeba L., has been used for centuries in traditional medicine and culinary practices, with a wide range of biological and pharmacological activities.

Objective

Herein, we determined the phytochemical profile, mineral, fatty acids, and amino acid contents of P. cubeba berries and assessed the dermacosmeceutical properties of their water extract and essential oil (EO). These included assessing their antioxidant and antibacterial activities as well as their in vitro inhibitory activities against tyrosinase and elastase enzymes. In addition, molecular docking and molecular dynamics studies were performed on the major identified compounds of the EO.

Results and discussion

A total of forty-three compounds belonging to organic acids, phenolic acids and flavonoids were found in the water extract, while 36 volatile compounds were identified in the EO with Z-isoeugenol, dihydroeugenol, β-pinene, E-caryophyllene, and 1,8-cineole as major constituents. The berries were found to be rich in sodium and iron, have moderate zinc content along with low contents of total nitrogen, phosphorus, and potassium. Amino acid analysis revealed a considerable concentration of isoleucine and phenylalanine, whereas 11,14,17-eicosatrienoic acid and linoleic acid were identified as the major fatty acids. In the DPPH and FRAP assays, the water extract elicited considerable antioxidant activity compared to the reference compounds. Enzyme inhibitory assays revealed that the EO had a potential to inhibit tyrosinase and elastase enzymes with IC50 values of 340.56 and 86.04 μg/mL, respectively. The water extract and EO completely inhibited the bacterial growth at MIC of 50 mg/mL and 20%, respectively. At sub-MIC concentrations, the extract and the EO substantially reduced the biofilm formation by up to 26.63 and 77.77%, respectively, as well as the swimming and swarming motilities in a dose-dependent manner. Molecular docking and molecular dynamics showed that the five main components of P. cubeba EO could be the major contributors to the elastase and tyrosinase inhibitory effect.

Conclusion

This study emphasizes the promising potential of P. cubeba as a valuable source of natural compounds that can be utilized for the development of innovative pharmaceuticals, dietary supplements, and dermacosmeceutical agents.

Fabrication of antimicrobial cationic hydrogels driven by physically and chemically crosslinking for wound healing

The wound therapy based on antibiotic delivery inevitably leads to the emergence of drug resistance. Hydrogel biomaterials with inherent antibacterial activities have emerged as promising candidates for addressing this issue. However, developing an inherently antibacterial hydrogel through simple and facile strategies to promote localized wound infection healing remains a challenge. In this study, we successfully constructed antimicrobial cationic hydrogels with self-healing and injectable properties through physically and chemically dual-crosslinked networks. The networks were formed by the copolymers poly[(di(ethylene glycol) methyl ether methacrylate)-co-(4-formylphenyl methacrylate)-co-(2-(methacryloyloxy)ethyl]trimethylammonium chloride solution)] (PDFM) and poly[(di(ethylene glycol) methyl ether methacrylate)-co-(2-aminoethyl methacrylate hydrochloride)-co-(2-(((6-(6-methyl-4[1H]pyrimidionylureido) hexyl)carbamoyl)oxy)ethyl methacrylate)] (PDAU). The hydrogel systems effectively facilitate the regeneration and healing of infected wounds through the contact bactericidal feature of quaternary ammonium cations. The presence of Schiff base bonds in the injectable hydrogels imparts remarkable pH responsiveness and self-healing properties. In vitro experiments verified their intrinsic antibacterial activities along with their favorable cytocompatibility and hemocompatibility in both in vitro and in vivo. In addition, the hydrogel significantly accelerated the healing of bacterially infected in a full-thickness skin wound. This facilely prepared dual-crosslinked hydrogel, without antibiotics loading, holds significant prospects for treating infected wounds.

Antimicrobial Antioxidant Polymer Films with Green Silver Nanoparticles from Symphyti radix

Antimicrobial natural polymer film with silver nanoparticles (AgNPs) biosynthesized using aqueous plant root extracts as reducing capping agents and for film formatting show extensive applicability for pathogenic microorganism problems. The formation of AgNPs was confirmed by transmission electron microscopy (TEM) and scanning electron microscopy-energy-dispersive spectroscopy (SEM-EDS) techniques. The antimicrobial activity of biofilm with green AgNPs was analysed by inhibiting the growth of Gram-negative and Gram-positive bacteria culture using the Kirby-Bauer disk diffusion susceptibility test. Total phenolic content and antioxidant activity were slightly higher in aqueous extracts of Sym. Radix than in Sym. Radix/AgNPs. The antimicrobial effect of polymer film/AgNPs against selected test bacteria cultures was substantially more robust than with pure film. Pictures of AgNPs obtained by TEM revealed the presence of spherical-shaped nano-objects with an average size 27.45 nm. SEM-EDS studies confirmed the uniform distribution of metal nanoparticles throughout the biopolymeric matrix. Morphological studies of the surface showed that the obtained surface of the films was even, without holes or other relief irregularities. These apparent Symphyti radix polymer film/AgNPs' biological functions could provide a platform for fighting pathogenic bacteria in the era of multi-drug resistance.

Toolbox of Characterized Genetic Parts for Staphylococcus aureus

Staphylococcus aureus is an important clinical bacterium prevalent in human-associated microbiomes and the cause of many diseases. However, S. aureus has been intractable to synthetic biology approaches due to limited characterized genetic parts for this nonmodel Gram-positive bacterium. Moreover, genetic manipulation of S. aureus has relied on cumbersome and inefficient cloning strategies. Here, we report the first standardized genetic parts toolbox for S. aureus, which includes characterized promoters, ribosome binding sites, terminators, and plasmid replicons from a variety of bacteria for precise control of gene expression. We established a standard relative expression unit (REU) for S. aureus using a plasmid reference and characterized genetic parts in standardized REUs using S. aureus ATCC 12600. We constructed promoter and terminator part plasmids that are compatible with an efficient Type IIS DNA assembly strategy to effectively build multipart DNA constructs. A library of 24 constitutive promoters was built and characterized in S. aureus, which showed a 380-fold activity range. This promoter library was also assayed in Bacillus subtilis (122-fold activity range) to demonstrate the transferability of the constitutive promoters between these Gram-positive bacteria. By applying an iterative design-build-test-learn cycle, we demonstrated the use of our toolbox for the rational design and engineering of a tetracycline sensor in S. aureus using the PXyl-TetO aTc-inducible promoter that achieved 25.8-fold induction. This toolbox greatly expands the growing number of genetic parts for Gram-positive bacteria and will allow researchers to leverage synthetic biology approaches to study and engineer cellular processes in S. aureus.

Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom: Systematic Review

BACKGROUND

Nosocomial infections are infections incubating or not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear, particularly for the hospitalized population of the United Kingdom.

OBJECTIVE

The aim of this systematic literature review was to explore the risk factors of nosocomial infections in hospitalized adult patients in the United Kingdom.

METHODS

A comprehensive keyword search was conducted through the PubMed, Medline, and EBSCO CINAHL Plus databases. The keywords included "risk factors" or "contributing factors" or "predisposing factors" or "cause" or "vulnerability factors" and "nosocomial infections" or "hospital-acquired infections" and "hospitalized patients" or "inpatients" or "patients" or "hospitalized." Additional articles were obtained through reference harvesting of selected articles. The search was limited to the United Kingdom with papers written in English, without limiting for age and gender to minimize bias. The above process retrieved 377 articles, which were further screened using inclusion and exclusion criteria following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The retained 9 studies were subjected to critical appraisal using the Critical Appraisal Skills Programme (cohort and case-control studies) and Appraisal Tool for Cross-Sectional Studies (cross-sectional studies) checklists. Finally, 6 eligible publications were identified and used to collect the study findings. A thematic analysis technique was used to analyze data extracted on risk factors of nosocomial infections in hospitalized patients in the United Kingdom.

RESULTS

The risk factors for nosocomial infections that emerged from the reviewed studies included older age, intrahospital transfers, cross-infection, longer hospital stay, readmissions, prior colonization with opportunistic organisms, comorbidities, and prior intake of antibiotics and urinary catheters. Nosocomial infections were associated with more extended hospital stays, presenting with increased morbidity and mortality. Measures for controlling nosocomial infections included the use of single-patient rooms, well-equipped wards, prior screening of staff and patients, adequate sick leave for staff, improved swallowing techniques and nutritional intake for patients, improved oral hygiene, avoiding unnecessary indwelling plastics, use of suprapubic catheters, aseptic techniques during patient care, and prophylactic use.

CONCLUSIONS

There is a need for further studies to aid in implementing nosocomial infection prevention and control.

Radiology Department: A Potential Source of Multidrug-Resistant Microorganisms: A Cross-Sectional Study at Tertiary Hospital, Palestine

Introduction

Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical field has been considerable, but not so much in the radiology department.

Aim

This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. Materials and Method. In this study, 160 swab samples were collected from the radiology department during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms as well as from US and plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter were calculated after swabbing a 100 cm2 surface.

Results

Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. A noticeable increase in the contamination was noticed in June compared to May, and this was consistent with the increase in the number of isolated patients in the hospital, the workload in the radiology department, and the number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR Gram-negative bacteria such as extended-spectrum beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-producing Enterobacterales (CPE). On the other hand, methicillin-resistant Staphylococcus (MRS), vancomycin-resistant Staphylococcus (VRS), and vancomycin-resistant Enterococcus (VRE) were detected.

Conclusion

All of the radiology department equipment and sites could be a source of bacterial infection including MDR, so the obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients.

Targeted metagenomic assessment reflects critical colonization in battlefield injuries

IMPORTANCE

Microbial contamination in combat wounds can lead to opportunistic infections and adverse outcomes. However, current microbiological detection has a limited ability to capture microbial functional genes. This work describes the application of targeted metagenomic sequencing to profile wound bioburden and capture relevant wound-associated signatures for clinical utility. Ultimately, the ability to detect such signatures will help guide clinical decisions regarding wound care and management and aid in the prediction of wound outcomes.

Superomniphobic and Photoactive Surface Presents Antimicrobial Properties by Repelling and Killing Pathogens

Healthcare-acquired infections place a significant burden on the cost and quality of patient care in hospitals. Reducing contamination on surfaces within healthcare environments is critical for halting the spread of these infections. Herein, we report a bifunctional─repel and kill─surface developed using photoactive TiO2 nanoparticles integrated into a hierarchical scaffold (OmniKill). To quantify the repellency of OmniKill, we developed a touch-based assay, capable of simulating the transfer of individual pathogens, multiple pathogens, or pathogen-latent fecal matter from hands to surfaces. OmniKill repels bacterial pathogens by at least 2.77-log (99.8%). The photoactive material within OmniKill further reduces the viability of transferred pathogens on the surface by an additional 2.43-log (99.6%) after 1 h of light exposure. The antipathogenic effects─repel and kill─remain robust under complex biological contaminates such as feces. These findings show the potential use of OmniKill in reducing the physical transmission of bacterial pathogens in healthcare settings.

Molecular Typing of Multidrug-Resistant Acinetobacter baumannii Isolates from Clinical Specimens by ERIC-PCR and MLVA

Acinetobacter baumannii, a Gram-negative and oxidase-negative bacterium, is a major cause of nosocomial infections, leading to high mortality rates in hospitalized patients. The use of 2 prominent molecular typing methods (i.e., enterobacterial repetitive intergenic consensus-polymerase chain reaction [ERIC-PCR] and multiple-locus variable-number tandem repeat [VNTR] analysis [MLVA]) for genotyping A. baumannii isolates has proven to be an effective approach in assessing the clonal relation of these isolates and managing their outbreaks. A total of 100 A. baumannii isolates were collected from immunocompromised patients hospitalized in the intensive care unit (ICU) of a hospital in Zanjan City, Iran. Their antibiotic resistance ability (especially aminoglycoside resistance) was studied by disc diffusion tests. The genetic typing of A. baumannii was studied using ERIC-PCR and MLVA methods. All isolates were resistant to 3 or more antibiotics and regarded as multidrug-resistant (MDR). Additionally, 32% of the isolates were resistant to all antibiotics tested, and 91% were extensively drug-resistant (XDR). The increased rate of aminoglycoside-resistant A. baumannii in ICU patients, with an increased incidence of aminoglycoside-modifying enzymes of aac (6')-Ib, ant (3″)-I, and aph (2″)-Id. ERIC-PCR has likewise shown an increased level of diversity in A. baumannii isolates. According to the ERIC-PCR patterns, isolates were classified as 4 clusters, while according to the MLVA patterns, isolates were classified as 9 distinct clusters. ERIC-PCR and MLVA assays serve as useful genotyping methods to assess the genetic variety or clonal relatedness of A. baumannii isolates.

Sterilizing orthodontic appliances: A systematic review and meta-analysis on the available methods

Infection control is essential to protect both the doctor and the patient by preventing the spread of infectious diseases. There is no exception in the field of dentistry, particularly in orthodontics, where numerous appliances are used for a variety of functions and also because the mouth cavity has the highest concentration of bacteria of any body part. Through this systematic review, we aimed to assess the various methods of sterilization employed in an orthodontic setting. Using relevant keywords, reference searches, and citation searches, the databases such as PubMed, MEDLINE, Web of Science, Cochrane, and Scopus were all searched; a total of 206 documents were found, of which 113 were initially selected. The remaining 23 distinct papers were initially made available after 90 publications that were identical to or similar to one another were eliminated. The final selection was made from eight documents that met all inclusion and exclusion requirements. The existing methods of sterilization were found to be competent in dealing with the microorganisms found in a typical orthodontic setting. The chemical method of sterilization was the norm in most of the studies that we assessed, with glutaraldehyde and peracetic acid (PAA) being the most commonly employed compounds for disinfection. PROSPERO Registration Number: CRD42022380831.

The Art of War with Pseudomonas aeruginosa: Targeting Mex Efflux Pumps Directly to Strategically Enhance Antipseudomonal Drug Efficacy

Pseudomonas aeruginosa (P. aeruginosa) poses a grave clinical challenge due to its multidrug resistance (MDR) phenotype, leading to severe and life-threatening infections. This bacterium exhibits both intrinsic resistance to various antipseudomonal agents and acquired resistance against nearly all available antibiotics, contributing to its MDR phenotype. Multiple mechanisms, including enzyme production, loss of outer membrane proteins, target mutations, and multidrug efflux systems, contribute to its antimicrobial resistance. The clinical importance of addressing MDR in P. aeruginosa is paramount, and one pivotal determinant is the resistance-nodulation-division (RND) family of drug/proton antiporters, notably the Mex efflux pumps. These pumps function as crucial defenders, reinforcing the emergence of extensively drug-resistant (XDR) and pandrug-resistant (PDR) strains, which underscores the urgency of the situation. Overcoming this challenge necessitates the exploration and development of potent efflux pump inhibitors (EPIs) to restore the efficacy of existing antipseudomonal drugs. By effectively countering or bypassing efflux activities, EPIs hold tremendous potential for restoring the antibacterial activity against P. aeruginosa and other Gram-negative pathogens. This review focuses on concurrent MDR, highlighting the clinical significance of efflux pumps, particularly the Mex efflux pumps, in driving MDR. It explores promising EPIs and delves into the structural characteristics of the MexB subunit and its substrate binding sites.

Molecularly Imprinted Polymer-Based Electrochemical Sensors for the Diagnosis of Infectious Diseases

The appearance of biological molecules, so-called biomarkers in body fluids at abnormal concentrations, is considered a good tool for detecting disease. Biomarkers are usually looked for in the most common body fluids, such as blood, nasopharyngeal fluids, urine, tears, sweat, etc. Even with significant advances in diagnostic technology, many patients with suspected infections receive empiric antimicrobial therapy rather than appropriate treatment, which is driven by rapid identification of the infectious agent, leading to increased antimicrobial resistance. To positively impact healthcare, new tests are needed that are pathogen-specific, easy to use, and produce results quickly. Molecularly imprinted polymer (MIP)-based biosensors can achieve these general goals and have enormous potential for disease detection. This article aimed to overview recent articles dedicated to electrochemical sensors modified with MIP to detect protein-based biomarkers of certain infectious diseases in human beings, particularly the biomarkers of infectious diseases, such as HIV-1, COVID-19, Dengue virus, and others. Some biomarkers, such as C-reactive protein (CRP) found in blood tests, are not specific for a particular disease but are used to identify any inflammation process in the body and are also under consideration in this review. Other biomarkers are specific to a particular disease, e.g., SARS-CoV-2-S spike glycoprotein. This article analyzes the development of electrochemical sensors using molecular imprinting technology and the used materials' influence. The research methods, the application of different electrodes, the influence of the polymers, and the established detection limits are reviewed and compared.

Textiles as fomites in the healthcare system

Nosocomial infections or healthcare-associated infections (HAIs) are acquired under medical care in healthcare facilities. In hospital environments, the transmission of infectious diseases through textiles such as white coats, bed linen, curtains, and towels are well documented. Textile hygiene and infection control measures have become more important in recent years due to the growing concerns about textiles as fomites in healthcare settings. However, systematic research in this area is lacking; the factors contributing to the transmission of infections through textiles needs to be better understood. The review aims to critically explore textiles as contaminants in healthcare systems, and to identify potential risks they may pose to patients and healthcare workers. It delineates different factors affecting bacterial adherence on fabrics, such as surface properties of bacteria and fabrics, and environmental factors. It also identifies areas that require further research to reduce the risk of HAIs and improve textile hygiene practices. Finally, the review elaborates on the strategies currently employed, and those that can be employed to limit the spread of nosocomial infections through fabrics. Implementing textile hygiene practices effectively in healthcare facilities requires a thorough analysis of factors affecting fabric-microbiome interactions, followed by designing newer fabrics that discourage pathogen load. KEY POINTS: • Healthcare textiles act as a potential reservoir of nosocomial pathogens • Survival of pathogens is affected by surface properties of fabric and bacteria • Guidelines required for fabrics that discourage microbial load, for hospital use.

Antimicrobial Resistance Profile of Pseudomonas aeruginosa from Different Clinical Samples in Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Pseudomonas aeruginosa is one of the leading causes of hospital-acquired infections and the most common antimicrobial-resistant pathogens. It is associated with a variety of infections. This study aimed to determine the prevalence of P. aeruginosa and its antimicrobial resistance profile from different clinical specimens at Debre Tabor Comprehensive Referral Hospital (DTCRH).

Methods

A cross-sectional study was conducted from May to July 2022 at DTCRH. Socio-demographic and clinical data were collected using a structured questionnaire. Clinical samples (blood, wound swab, urine, and sputum) were collected from 348 study participants and processed following the standard bacteriological techniques. Antibiotic susceptibility testing was done by the Kirby-Bauer disc diffusion method. Data were entered and analyzed using SPSS version 25 statistical software. Descriptive statistics was used to present the findings of the study.

Results

The prevalence of P.aeruginosa was 74(19.3%). The detection of the isolates was different based on the type of samples that ranged from 0% to 54.5% from sputum and wound swabs, respectively. P.aeruginosa showed resistance against gentamicin at 62.2%, ceftazidime 51.4%, cefepime 50%, amikacin 29.7%, imipenem 28.4% and ciprofloxacin 14.9%. The level of multi-drug resistance (MDR) was 45.9%, and the suspicious extreme-drug resistance (XDR) rate was 9.5%. Being inpatient and wound swab samples were factors associated with the detection of P.aeruginosa from clinical samples.

Conclusion

The antibiotic resistance profile of P. aeruginosa isolates in the present study area was found to be alarming. Actions to minimize the effect of antimicrobial resistance should be strengthened, and further large-scale study should be conducted to find out the main reasons behind antibiotic resistance of P.aeruginosa and other clinically relevant isolates.

Prevalence of Vancomycin-resistant enterococci (VRE) in Egypt (2010-2022): a systematic review and meta-analysis

BACKGROUND

Vancomycin-resistant Enterococci (VRE) represent a critical medical and public health concerns due to their association with serious nosocomial infections and a high risk of mortality. We aimed to reveal the pooled prevalence of VRE and antimicrobial resistance profiles among enterococci clinical isolates in Egypt.

METHODS

A PubMed, Scopus, Google Scholar, and Web of Science literature search was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Only published studies documenting the prevalence of VRE between 2010 and 2022 were included. Using the random effects model and the 95% confidence intervals, the pooled estimate of VRE was calculated by MedCalc Version 20.113. Cochran's Q and I² tests were used to evaluate the degree of heterogeneity, and publication bias was examined by visually examining the funnel plot and its associated tests (Begg's and Egger's tests).

RESULTS

The pooled prevalence of VRE among enterococci clinical isolates in Egypt was estimated to be 26% (95% CI 16.9 to 36.3). E. faecalis had a greater pooled prevalence than E. faecium, with 61.22% (95% CI 53.65 to 68.53) and 32.47% (95% CI 27 to 38.2), respectively. The VanA gene is more frequent than the VanB gene among VRE, with a pooled prevalence of 63.3% (95% CI 52.1 to 73.7) and 17.95% (95% CI 7.8 to 31), respectively. The pooled resistance rate of linezolid was substantially lower than that of ampicillin and high-level gentamicin (HLG) 5.54% (95% CI 2.33 to 10%), 65.7% (95% CI 50.8 to 79.2%), and 61.1% (95% CI 47.4 to 73.9), respectively.

CONCLUSION

The prevalence of VRE is alarmingly high in Egypt. It is imperative that antimicrobial stewardship activities and infection control programs are strictly adhered to and implemented to prevent further escalation of the problem.

Antimicrobial Drug Resistance in Poultry Production: Current Status and Innovative Strategies for Bacterial Control

The world population’s significant increase has promoted a higher consumption of poultry products, which must meet the specified demand while maintaining their quality and safety. It is well known that conventional antimicrobials (antibiotics) have been used in livestock production, including poultry, as a preventive measure against or for the treatment of infectious bacterial diseases. Unfortunately, the use and misuse of these compounds has led to the development and dissemination of antimicrobial drug resistance, which is currently a serious public health concern. Multidrug-resistant bacteria are on the rise, being responsible for serious infections in humans and animals; hence, the goal of this review is to discuss the consequences of antimicrobial drug resistance in poultry production, focusing on the current status of this agroeconomic sector. Novel bacterial control strategies under investigation for application in this industry are also described. These innovative approaches include antimicrobial peptides, bacteriophages, probiotics and nanoparticles. Challenges related to the application of these methods are also discussed.

Bioinspired nanoflakes with antifouling and mechano-bactericidal capacity

Pathogenic bacteria contamination ubiquitously occurs on high-contact surfaces in hospitals and has long been a threat to public health, inducing severe nosocomial infections that cause multiple organ dysfunction and increased hospital mortality. Recently, nanostructured surfaces with mechano-bactericidal properties have shown potential for modifying material surfaces to fight against the spread of pathogenic microorganisms without the risk of triggering antibacterial resistance. Nevertheless, these surfaces are readily contaminated by bacterial attachment or inanimate pollutants like solid dust or common fluids, which has greatly weakened their antibacterial capabilities. In this work, we discovered that the nonwetting Amorpha fruticosa leaf surfaces are equipped with mechano-bactericidal capacity by means of their randomly-arranged nanoflakes. Inspired by this discovery, we reported an artificial superhydrophobic surface with similar nanofeatures and superior antibacterial abilities. Compared to conventional bactericidal surfaces, this bioinspired antibacterial surface was synergistically accompanied by antifouling performances, which significantly prevent either initial bacterial attachment or inanimate pollutants like dust covering and fluid contaminants. Overall, the bioinspired antifouling nanoflakes surface holds promise as the design of next-generation high-touch surface modification that effectively reduces the transmission of nosocomial infections.

Analysis of Whole-Genome Sequences of Pathogenic Gram-Positive and Gram-Negative Isolates from the Same Hospital Environment to Investigate Common Evolutionary Trends Associated with Horizontal Gene Exchange, Mutations and DNA Methylation Patterning

Hospital-acquired infections are a generally recognized problem for healthcare professionals. Clinical variants of Gram-negative and Gram-positive pathogens are characterized with enhanced antibiotic resistance and virulence due to mutations and the horizontal acquisition of respective genetic determinants. In this study, two Escherichia coli, two Klebsiella pneumoniae, three Pseudomonas aeruginosa, two Staphylococcus aureus, one Staphylococcus epidermidis and one Streptococcus pneumoniae showing broad spectra of antibiotic resistance were isolated from patients suffering from nosocomial infections in a local hospital in Almaty, Kazakhstan. The aim of the study was to compare general and species-specific pathways of the development of virulence and antibiotic resistance through opportunistic pathogens causing hospital-acquired infections. The whole-genome PacBio sequencing of the isolates allowed for the genotyping and identification of antibiotic resistance and virulence genetic determinants located in the chromosomes, plasmids and genomic islands. It was concluded that long-read sequencing is a useful tool for monitoring the epidemiological situation in hospitals. Marker antibiotic resistance mutations common for different microorganisms were identified, which were acquired due to antibiotic-selective pressure in the same clinical environment. The genotyping and identification of strain-specific DNA methylation motifs were found to be promising in estimating the risks associated with hospital infection outbreaks and monitoring the distribution and evolution of nosocomial pathogens.

Characterization, antibacterial, antioxidant, antidiabetic, and anti-inflammatory activities of green synthesized silver nanoparticles using Phragmanthera austroarabica A. G. Mill and J. A. Nyberg extract

Introduction

Diabetes mellitus is a chronic metabolic disorder that exhibited great expansion all over the world. It is becoming an epidemic disease adding a major burden to the health care system, particularly in developing countries.

Methods

The plant under investigation in the current study Phragmanthera austroarabica A. G. Mill and J. A. Nyberg is traditionally used in Saudi Arabia for the treatment of diabetes mellitus. The methanolic extract (200 mg/kg) of the plant and pure gallic acid (40 mg/kg), a major metabolite of the plant, as well as their silver nanoparticle formulae (AgNPs) were evaluated for their antidiabetic activity.

Results and Discussion

The results showed a decrease in body fat, obesity, an improvement in lipid profiles, normalization of hyperglycemia, insulin resistance, and hyperinsulinemia, and an improvement in liver tissue structure and function. However, the results obtained from AgNPs for both extract and the pure gallic acid were better in most measured parameters. Additionally, the activity of both the crude extract of the plant and its AgNPs were evaluated against a number of gram-positive, gram-negative bacteria and fungi. Although the activity of the crude extract ranged from moderate to weak or even non-active, the AgNPs of the plant extract clearly enhanced the antimicrobial activity. AgNPs of the extract demonstrated remarkable activity, especially against the Gram-negative pathogens Proteus vulgaris (MIC 2.5 μg/ml) and Pseudomonas aeruginosa (MIC 5 μg/ml). Furthermore, a promising antimicrobial activity was shown against the Gram-positive pathogen Streptococcus mutants (MIC 1.25 μg/ml).

Incidence and determinants of nosocomial infection among hospital admitted adult chronic disease patients in University of Gondar Comprehensive Specialized Hospital, North-West Ethiopia, 2016-2020

Background

Nosocomial infections are major public health problem which affects more than 100 million patients each year globally. This leads to prolonged hospital stays, a high mortality rate, and a vast financial burden to the healthcare system as well as the patients. This study aimed to find out the incidence of nosocomial infections and determinant factors among admitted adult chronic illness patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods

An institutional-based retrospective follow-up study design was employed among 597 respondents. The secondary data was collected from April 15 to May 15, 2021. A computer-generated random sampling technique was used to select a total of 599 patients using Open-epi software. Structured checklists were used to collect data. For data entry and analysis Epi-Data version 4.6 and STATA 16 were used respectively. To identify statistically significant variables Cox-regressions (univariable and multivariable) were performed. To declare statistically significant variables based on p < 0.05 in the multivariable Cox-regression model, adjusted hazard ratio with 95% CI was used.

Results

A total of 597(99.6%) adult chronic illness patients were included in the study. Of these, 53 (8.88%) participants developed nosocomial infections and the incidence rate of nosocomial infection was 6.6 per 1,000 person-days observation. In this study, not taking antibiotics (AHR = 2.74, 95% CI: 1.49, 5.04), using mechanical ventilation (AHR = 2.67, 95% CI: 1.36, 5.26), being on urinary catheter (AHR = 4.62, 95% CI: 2.22, 9.65), being on intravenous catheter (AHR = 3.42, 95% CI: 1.22, 9.61) and length of hospital stay >20 days (AHR = 2.66, 95% CI: 1.43, 4.94) were significantly associated with nosocomial infections.

Conclusions

The findings have indicated that the incidence of nosocomial infection was low. No taking antibiotics, intravenous insertion, mechanical ventilation, length of hospital stay, and urinary catheterization were the predictors for the development of nosocomial infection. Therefore, we recommend that the healthcare providers need to give emphasis on infection prevention and control in the institution on these factors that have a significant effect on nosocomial infection.

Impact of the Accreditation Program of the Saudi Central Board for Accreditation of Healthcare Institutions on the Safety Dimension of the Institute of Medicine Quality

Background

Although hospital accreditation is recognized as a tool for improving healthcare, there are inconsistent results regarding its impact on healthcare quality. In Saudi Arabia, it is mandatory for all Ministry of Health (MOH) hospitals to be accredited by the Central Board for Accreditation of Healthcare Institutions (CBAHI).

Purpose

This study measured the impact of the CBAHI accreditation program on the Institute of Medicine's (IOM) safety dimension in Madinah.

Methods

A cross-sectional study was conducted using retrospective data gathered from a review of hospital records over 60 months (ie, 12 months before, 36 during, and 12 post-accreditation). The data were analyzed using piecewise (segmented) regression analysis.

Results

The three indicators (ie: incident reports, medication errors, and nosocomial infection) were continuously improved compared to the data before accreditation, as a results of implementing the CBAHI accreditation program. Therefore, the CBAHI had a significantly positively impacts on MOH hospitals' safety dimension.

Conclusion

Complying with the CBAHI standards can help reduce the rates of incident reports, medication errors, nosocomial infections, and post-admission mortality. This study provides insight for MOH hospitals and opportunities to expand the accreditation program to improve the quality of healthcare services.

Investigating healthcare worker mobility and patient contacts within a UK hospital during the COVID-19 pandemic

BACKGROUND

Insights into behaviours relevant to the transmission of infections are extremely valuable for epidemiological investigations. Healthcare worker (HCW) mobility and patient contacts within the hospital can contribute to nosocomial outbreaks, yet data on these behaviours are often limited.

METHODS

Using electronic medical records and door access logs from a London teaching hospital during the COVID-19 pandemic, we derive indicators for HCW mobility and patient contacts at an aggregate level. We assess the spatial-temporal variations in HCW behaviour and, to demonstrate the utility of these behavioural markers, investigate changes in the indirect connectivity of patients (resulting from shared contacts with HCWs) and spatial connectivity of floors (owing to the movements of HCWs).

RESULTS

Fluctuations in HCW mobility and patient contacts were identified during the pandemic, with the most prominent changes in behaviour on floors handling the majority of COVID-19 patients. The connectivity between floors was disrupted by the pandemic and, while this stabilised after the first wave, the interconnectivity of COVID-19 and non-COVID-19 wards always featured. Daily rates of indirect contact between patients provided evidence for reactive staff cohorting in response to the number of COVID-19 patients in the hospital.

CONCLUSIONS

Routinely collected electronic records in the healthcare environment provide a means to rapidly assess and investigate behaviour change in the HCW population, and can support evidence based infection prevention and control activities. Integrating frameworks like ours into routine practice will empower decision makers and improve pandemic preparedness by providing tools to help curtail nosocomial outbreaks of communicable diseases.

The Study of Nanosized Silicate-Substituted Hydroxyapatites Co-Doped with Sr2+ and Zn2+ Ions Related to Their Influence on Biological Activities

Nanosized silicate-substituted hydroxyapatites, characterized by the general formula Ca_9.8-x-nSr_nZn_x(PO₄)_6-y(SiO₄)_y(OH)₂ (where: n = 0.2 [mol%]; x = 0.5-3.5 [mol%]; y = 4-5 [mol%]), co-doped with Zn²⁺ and Sr²⁺ ions, were synthesized with the help of a microwave-assisted hydrothermal technique. The structural properties were determined using XRD (X-ray powder diffraction) and Fourier-transformed infrared spectroscopy (FT-IR). The morphology, size and shape of biomaterials were detected using scanning electron microscopy techniques (SEM). The reference strains of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were used to assess bacterial survivability and the impact on biofilm formation in the presence of nanosilicate-substituted strontium-hydroxyapatites. Safety evaluation was also performed using the standard cytotoxicity test (MTT) and hemolysis assay. Moreover, the mutagenic potential of the materials was assessed (Ames test). The obtained results suggest the dose-dependent antibacterial activity of nanomaterials, especially observed for samples doped with 3.5 mol% Zn²⁺ ions. Moreover, the modification with five SiO₄ groups enhanced the antibacterial effect; however, a rise in the toxicity was observed as well. No harmful activity was detected in the hemolysis assay as well as in the mutagenic assay (Ames test).

Development of an infectious disease prevention behavior model for public health center workers in a rural area of Indonesia

The Infection Prevention Behavior (IPB) for health personnel at the Surade Public Health Center has not reached the target. The purpose of this study was to develop the IPB model for health personnel which is suitable to be applied in rural areas in Indonesia. The model was developed through a literature review from online journal database in the last 10 years. The model was tested using a cross-sectional design by the Structural Equation Model Partial Least Square (SEM-PLS). Six selected variables had direct and indirect influences on the IPB of health personnel. They were supervision (27.50%), facilities (9.87%), training (10.44%), compensation (16.97%), work climate (10.78%), and work motivation (8.15%). The model was valid and significant. The Q2 showed 95.7% which mean 95.7% of the components in the model could be applied to other Public Health Centers in the rural area. The development of IPB models for health personnel which wass measured from the direct and indirect effects of six variables proved valid and significant to help achievement Public Health Center reach the target of protecting health workers from infectious diseases.

Healthcare-Associated Infections (HAIs): Challenges and Measures Taken by the Radiology Department to Control Infection Transmission

Infections contracted during healthcare delivery in a hospital or ambulatory setting are collectively referred to as healthcare-associated infections (HAIs). Healthcare workers and patients alike are vulnerable to serious problems as a result of the risk of HAIs. In the healthcare system, HAIs are considered among the most common and serious health problems. However, the occurrence of HAIs differs between different types of clinical departments within the hospital. Recently, the risk of HAIs has been increasing in radiology departments globally due to the central role of radiology in guiding clinical decisions for the diagnosis, treatment, and monitoring of different diseases from almost all medical specialties. The radiology department is particularly vulnerable to HAIs because it serves as a transit hub for infected patients, non-infected patients, and healthcare workers. Furthermore, as the number of patients referred to radiology and the length of patient contact time has increased, thanks to modern imaging techniques such as computed tomography and magnetic resonance imaging, the risk of HAIs has also increased significantly. With the increasing use of interventional radiological procedures, patients and healthcare workers face a potentially greater risk of contracting HAIs due to the invasive nature of such procedures. Although not exhaustive, we attempted through a literature search to provide a general overview of infection prevention and control practices, address HAIs in the radiology departments, and highlight the challenges and measures taken to control infection transmission in the radiology departments.

Functional Characterization, Mechanism, and Mode of Action of Putative Streptomycin Adenylyltransferase from Serratia marcescens

Nosocomial infections are serious threats to the entire world in healthcare settings. The major causative agents of nosocomial infections are bacterial pathogens, among which Enterobacteriaceae family member Serratia marcescens plays a crucial role. It is a gram-negative opportunistic pathogen, predominantly affecting patients in intensive-care units. The presence of intrinsic genes in S. marcescens led to the development of resistance to antibiotics for survival. Complete scanning of the proteome, including hypothetical and partially annotated proteins, paves the way for a better understanding of potential drug targets. The targeted protein expressed in E. coli BL21 (DE3) pLysS cells has shown complete resistance to aminoglycoside antibiotic streptomycin (>256 MCG). The recombinant protein was purified using affinity and size-exclusion chromatography and characterized using SDS-PAGE, western blotting, and MALDI-TOF analysis. Free phosphate bound to malachite green was detected at 620 nm, evident of the conversion of adenosine triphosphate to adenosine monophosphate during the adenylation process. Similarly, in the chromatographic assay, adenylated streptomycin absorbed at 260 nm in AKTA (FPLC), confirming the enzyme-catalyzed adenylation of streptomycin. Further, the adenylated product of streptomycin was confirmed through HPLC and mass spectrometry analysis. In conclusion, our characterization studies identified the partially annotated hypothetical protein as streptomycin adenylyltransferase.

Manganese Dioxide Nanoparticles Prepared by Laser Ablation as Materials with Interesting Electronic, Electrochemical, and Disinfecting Properties in Both Colloidal Suspensions and Deposited on Fluorine-Doped Tin Oxide

Nanoparticles (NPs) of α-MnO₂ have high applicability in photoelectrochemical, heterogeneous photocatalysis, optical switching, and disinfection processes. To widen this panorama about MnO₂ NPs, the formation of this material by laser ablation and deposition by dip-coating on fluorine-doped tin oxide (FTO), were considered in this study. The optical, spectroscopic, electrochemical characterization, and the evaluation of the antimicrobial activity, plus the photocatalytic response, were measured herein in colloidal media and deposited. For the deposition of NPs on FTO sheet, an anode is produced with a pseudocapacitive behavior, and 2.82 eV of band gap (GAP) in comparison with colloidal NPs for a value of 3.84 eV. Both colloidal suspension and deposited NPs have intrinsic antibacterial activity against two representative microorganisms (E. coli and S. aureus), and this biological activity was significantly enhanced in the presence of UVA light, indicating photocatalytic activity of the material. Thus, both the colloidal suspension and deposited NPs can act as disinfecting agents themselves or via light activation. However, an antibacterial behavior different for E. coli and S. aureus was observed, in function of the aggregation state, obtaining total E. coli disinfection at 30 min for deposited samples on FTO.

Microbiology and Clinical Outcome of Hospital-Acquired Respiratory Infections in an Italian Teaching Hospital: A Retrospective Study

The burden, microbial etiology and clinical impact of hospital-acquired respiratory infections (HARIs) were determined at an Italian teaching hospital over a 12-month period. For this purpose, overall ordinary hospitalizations ≥ 2 days of subjects over 18 years old with discharge from 1 January 2018 to 31 December 2018 were examined by cross-referencing demographic and clinical data from hospital discharge forms with microbiological data from the computer system of the Microbiology Unit. We identified 329 individuals with HARIs (96 females and 233 males; median age 70 years, range 18−93), who represented ¼ of the total hospital-acquired infections (HAIs) in the period. The inpatient setting was medical and surgical in similar proportions (169 vs. 160, respectively) and the mean hospital stay was 38.9 ± 33.6 days. One hundred and forty patients (42.6% of the total sample) were suffering from one or more chronic diseases. A total of 581 microorganisms (82 antibiotic-resistant and 499 non-resistant) were detected in HARI patients. The most common isolated species were Staphylococcus aureus (16.7%), Klebsiella pneumoniae (13.3%), Pseudomonas spp. (12.6%) and Acinetobacter baumannii (10.5%), followed by Enterobacter spp. (5.3%), Escherichia coli (5.2%) and Enterococcus spp. (4.8%). One hundred and sixty-seven individuals (49.0% of the total) had polymicrobial infections. One hundred thirty-one patients (39.8% of the total) underwent endotracheal intubation and mechanical ventilation and 62.6% of them died, compared to 17.7% of the non-intubated patients. Multivariable analysis confirmed a positive correlation between death and increased age (p = 0.05), surgical MDC (p = 0.007), number of microorganisms over the sample mean (p = 0.001), the presence of chronic diseases (p = 0.046), and intubation and mechanical ventilation (p < 0.0001). A positive correlation between intubation and antibiotic-resistant organisms (p = 0.003) was also found. HARIs are still a major public health problem and require constant surveillance due to their severe clinical outcome.

Plasma-induced nanostructured metallic silver surfaces: study of bacteriophobic effect to avoid bacterial adhesion on medical devices

Biofilm formation in medical devices represents one of the major problems for the healthcare system, especially those that occur on implantable silicone-based devices. To provide a general solution to avoid biofilm formation in the first stages of development, this work studied how nanostructured metallic silver coatings hinder bacteria-surface interaction by preventing bacteria adhesion. The three studied silver nanostructures (“Sharp blades”, “Thick blades” and “Leaves”) combined superhydrophobic behavior with a physical impediment of the coating nanostructure that produced a bacteriophobic effect avoiding the adhesion mechanism of different bacterial strains. These silver nanostructures are immobilized on stretchable substrates through a polymeric thin film of plasma–polymerized penta-fluorophenyl methacrylate. The control over the nanostructures and therefore its bacteriophobic—bactericidal effect depends on the plasma polymerization conditions of the polymer. The characterization of this bacteriophobic effect through FE-SEM microscopy, live/dead cell staining, and direct bacterial adhesion counts, provided a complete mapping of how bacteria interact with the surface in each scenario. Results revealed that the bacterial adhesion was reduced by up to six orders of magnitude in comparison with uncoated surfaces thereby constituting an effective strategy to avoid the formation of biofilm on medical materials.

Metabolic phenotyping of acquired ampicillin resistance using microbial volatiles from Escherichia coli cultures

AIMS

This study sought to assess the volatile organic compound (VOC) profiles of ampicillin-resistant and -susceptible Escherichia coli to evaluate whether VOC analysis may be utilized to identify resistant phenotypes.

METHODS AND RESULTS

An E. coli BL21 (DE3) strain and its pET16b plasmid transformed ampicillin-resistant counterpart were cultured for 6 h in drug-free, low- and high-concentrations of ampicillin. Headspace analysis was undertaken using thermal desorption-gas chromatography-mass spectrometry. Results revealed distinct VOC profiles with ampicillin-resistant bacteria distinguishable from their susceptible counterparts using as few as six compounds. A minimum of 30 compounds (fold change >2, p ≤ 0.05) were differentially expressed between the strains across all set-ups. Furthermore, three compounds (indole, acetoin and 3-methyl-1-butanol) were observed to be significantly more abundant (fold change >2, p ≤ 0.05) in the resistant strain compared to the susceptible strain both in the presence and in the absence of drug stress.

CONCLUSIONS

Results indicate that E. coli with acquired ampicillin resistance exhibit an altered VOC profile compared to their susceptible counterpart both in the presence and in the absence of antibiotic stress. This suggests that there are fundamental differences between the metabolisms of ampicillin-resistant and -susceptible E. coli which may be detected by means of VOC analysis.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our findings suggest that VOC profiles may be utilized to differentiate between resistant and susceptible bacteria using just six compounds. Consequently, the development of machine-learning models using VOC signatures shows considerable diagnostic applicability for the rapid and accurate detection of antimicrobial resistance.

Novel D-form of hybrid peptide (D-AP19) rapidly kills Acinetobacter baumannii while tolerating proteolytic enzymes

Antimicrobial peptides (AMPs) are being developed as potent alternative treatments to conventional antibiotics which are unlikely to induce bacterial resistance. They can be designed and modified to possess several druggable properties. We report herein a novel hybrid peptide of modified aurein (A3) and cathelicidin (P7), or A3P7, by a flipping technique. It exhibited potent antibacterial activity against both Gram-negative and -positive pathogenic bacteria but had moderate hemolytic activity. To reduce the sequence length and toxicity, C-terminal truncation was serially performed and eight truncated derivatives (AP12-AP19) were obtained. They had significantly less hemolytic activity while preserving antibacterial activity. Secondary structures of the candidate peptides in environments simulating bacterial membranes (30 mM SDS and 50% TFE), determined by CD spectroscopy, showed α-helical structures consistent with predicted in silico 3D structural models. Among the peptides, AP19 demonstrated the best combination of broad-spectrum antibacterial activity (including toward Acinetobacter baumannii) and minimal hemolytic and cytotoxic activities. A D-form peptide (D-AP19), in which all L-enantiomers were substituted with the D-enantiomers, maintained antibacterial activity in the presence of pepsin, trypsin, proteinase K and human plasma. Both isomers exhibited potent antibacterial activity against multi-drug (MDR) and extensively-drug resistant (XDR) clinical isolates of A. baumannii comparable to the traditional antibiotic, meropenem. D-AP19 displayed rapid killing via membrane disruption and leakage of intracellular contents. Additionally, it showed a low tendency to induce bacterial resistance. Our work suggested that D-AP19 could be further optimized and developed as a novel compound potentially for fighting against MDR or XDR A. baumannii.

Nanotoxoid vaccination protects against opportunistic bacterial infections arising from immunodeficiency

The rise in nosocomial infections caused by multidrug-resistant pathogens is a major public health concern. Patients taking immunosuppressants or chemotherapeutics are naturally more susceptible to infections. Thus, strategies for protecting immunodeficient individuals from infections are of great importance. Here, we investigate the effectiveness of a biomimetic nanotoxoid vaccine in defending animals with immunodeficiency against Pseudomonas aeruginosa. The nanotoxoids use a macrophage membrane coating to sequester and safely present bacterial virulence factors that would otherwise be too toxic to administer. Vaccination with the nanoformulation results in rapid and long-lasting immunity, protecting against lethal infections despite severe immunodeficiency. The nanovaccine can be administered through multiple routes and is effective in both pneumonia and septicemia models of infection. Mechanistically, protection is mediated by neutrophils and pathogen-specific antibodies. Overall, nanotoxoid vaccination is an attractive strategy to protect vulnerable patients and could help to mitigate the threat posed by antibiotic-resistant superbugs.

Silver Nanoparticles and Its Mechanistic Insight for Chronic Wound Healing: Review on Recent Progress

Wounds are structural and functional disruptions of skin that occur because of trauma, surgery, acute illness, or chronic disease conditions. Chronic wounds are caused by a breakdown in the finely coordinated cascade of events that occurs during healing. Wound healing is a long process that split into at least three continuous and overlapping processes: an inflammatory response, a proliferative phase, and finally the tissue remodeling. Therefore, these processes are extensively studied to develop novel therapeutics in order to achieve maximum recovery with minimum scarring. Several growth hormones and cytokines secreted at the site of lesions tightly regulates the healing processes. The traditional approach for wound management has been represented by topical treatments. Metal nanoparticles (e.g., silver, gold and zinc) are increasingly being employed in dermatology due to their favorable effects on healing, as well as in treating and preventing secondary bacterial infections. In the current review, a brief introduction on traditional would healing approach is provided, followed by focus on the potential of wound dressing therapeutic techniques functionalized with Ag-NPs.

Synergistic Antibacterial Activity of Green Synthesized Silver Nanomaterials with Colistin Antibiotic against Multidrug-Resistant Bacterial Pathogens

The high frequency of nosocomial bacterial infections caused by multidrug-resistant pathogens contributes to significant morbidity and mortality worldwide. As a result, finding effective antibacterial agents is of critical importance. Hence, the aim of the present study was to greenly synthesize silver nanoparticles (AgNPs) utilizing Salvia officinalis aqueous leaf extract. The biogenic AgNPs were characterized utilizing different physicochemical techniques such as energy-dispersive X-ray spectroscopy (EDX), ultraviolet-visible spectrophotometry (UV-Vis), X-ray diffraction analysis (XRD), transmission electron microscopy (TEM), and Fourier transform infrared spectroscopy (FT-IR) analysis. Additionally, the synergistic antimicrobial effectiveness of the biosynthesized AgNPs with colistin antibiotic against multidrug-resistant bacterial strains was evaluated utilizing the standard disk diffusion assay. The bioformulated AgNPs revealed significant physicochemical features, such as a small particle size of 17.615 ± 1.24 nm and net zeta potential value of −16.2 mV. The elemental mapping of AgNPs revealed that silver was the main element, recording a relative mass percent of 83.16%, followed by carbon (9.51%), oxygen (5.80%), silicon (0.87%), and chloride (0.67%). The disc diffusion assay revealed that AgNPs showed antibacterial potency against different tested bacterial pathogens, recording the highest efficiency against the Escherichia coli strain with an inhibitory zone diameter of 37.86 ± 0.21 mm at an AgNPs concentration of 100 µg/disk. In addition, the antibacterial activity of AgNPs was significantly higher than that of colistin (p ≤ 0.05) against the multidrug resistant bacterial strain namely, Acinetobacter baumannii. The biosynthesized AgNPs revealed synergistic antibacterial activity with colistin antibiotic, demonstrating the highest synergistic percent against the A. baumannii strain (85.57%) followed by Enterobacter cloacae (53.63%), E. coli (35.76%), Klebsiella pneumoniae (35.19%), Salmonella typhimurium (33.06%), and Pseudomonas aeruginosa (13.75%). In conclusion, the biogenic AgNPs revealed unique physicochemical characteristics and significant antibacterial activities against different multidrug-resistant bacterial pathogens. Consequently, the potent synergistic effect of the AgNPs–colistin combination highlights the potential of utilizing this combination for fabrication of highly effective antibacterial coatings in intensive care units for successful control of the spread of nosocomial bacterial infections.

Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd

Microbiological diagnostics is of great importance in limiting the spread of nosocomial infections. The information on etiological agents of infections and their susceptibility to antibiotics enables a quick response in the case of a suspected epidemic outbreak. The aim of this study is to analyze the incidence of nosocomial urinary tract infections among patients hospitalized in hospital wards over a period of 2 years and to determine the predominant etiological agent depending on the method of clinical specimen collection. Data from the Mazovian Specialist Hospital (MSH) in Radom constitute the material for the preparation of this study. Urine was collected using two methods. The first one was the method of collecting urine from the central stream, while the second method was urine collected from patients with a urinary catheter in place. The statistical calculations were conducted using the statistical software. Based on hospital data, it was shown that 5,870 urine tests were performed during the period under review, of which 2,070 were positive. The number of positive results in 2021 decreased by 2.84% compared to that in 2020. On the basis of the statistical analysis, differences in the occurrence of multiple strains were observed between catheter-based and midstream urine collection. Differences were observed especially for Acinetobacter baumannii, Candida albicans, Escherichia coli, and Pseudomonas aeruginosa. A. baumannii, C. albicans, and P. aeruginosa were significantly more frequently found in urine samples collected through the catheter than from the midstream. Furthermore, E. coli (51.56%) and Enterococcus species (25.46%) were more frequent when collected from the middle stream than when urine was collected through a catheter. However, for the strain K. pneumoniae, the results were comparable when urine was collected from catheterized patients (13.83%) and from midstream (13.35%). Urinary tract infection among hospitalized patients of the Mazovian Specialist Hospital in Radom was diagnosed quite frequently. In 2021, 32 more urine cultures were performed than in 2020. In the analyzed period, among all ordered urine cultures, 35.27% of samples were positive.

Layer-By-Layer Self-Assembled Dip Coating for Antifouling Functionalized Finishing of Cotton Textile

The fouling of surfaces such as textiles is a major health challenge, and there is a continuous effort to develop materials and processes to overcome it. In consideration of this, this study regards the development of antifouling functional nanoencapsulated finishing for the cotton textile fabric by employing a layer-by-layer dip coating technique. Antifouling textile finishing was formulated by inducing the nanoencapsulation of the antifouling functional group inside the hydrophobic polymeric shell. Cotton fabric was taken as a substrate to incorporate antibacterial functionality by alternatively fabricating multilayers of antifouling polymeric formulation (APF) and polyelectrolyte solution. The surface morphology of nanoencapsulated finished textile fabric was characterized through scanning electron microscopy to confirm the uniform distribution of nanoparticles on the cotton textile fabric. Optical profilometry and atomic force microscopy studies indicated increased surface roughness in the coated textile substrate as compared to the uncoated textile. The surface thickness of the fabricated textile increased with the number of deposited bilayers on the textile substrate. Surface hydrophobicity increased with number of coating bilayers with θ values of x for single layer, up to y for 20 bilayers. The antibacterial activity of the uncoated and layer-by-layer coated finished textile was also evaluated. It was significant and exhibited a significant zone of inhibition against microbial strains Gram-positive S. aureus and Gram-negative E. coli. The bilayer coating exhibited water repellency, hydrophobicity, and antibacterial activity. Thus, the fabricated textile could be highly useful for many industrial and biomedical applications.

Multidrug-resistant enteric bacteria in Nigeria and potential use of bacteriophages as biocontrol

Enteric bacterial pathogens have been implicated in many cases of gastroenteritis in Nigeria, a West African country. This situation is worsened by some reports of the high prevalence of multidrug-resistant enteric bacteria. To better prepare for situations in which even antibiotics of last resort would fail to treat infections caused by these pathogens, attention should be paid to alternative antimicrobial strategies. Here, we summarize existing reports of multidrug-resistant enteric bacterial infections in Nigeria, and importantly present the use of bacteriophages (viruses of bacteria) as an attractive antimicrobial alternative to combat these pathogens. It is hoped that this review will encourage research into the use of lytic bacteriophages against multidrug-resistant enteric bacteria in Nigeria.

Occurrence of bacteria belonging to the genus Enterococcus and Staphylococcus on inanimate surfaces of selected hospital facilities and their nosocomial significance

OBJECTIVES

This work aimed to determine the representation and resistance of bacteria belonging to the genus Staphylococcus and Enterococcus on inanimate surfaces of two selected workplaces of the University Hospital of L. Pasteur in Košice (UHLP) and to investigate their importance in the hospital environment. The men's ward of the Department of Internal Medicine (DIM) and the Department of Anaesthesiology and Intensive Care (DAIC) were chosen.

METHODS

Using sterile sampling kits, a total of 182 swabs were collected from the inanimate surfaces of both UHLP workplaces. The swabs were then transported to a microbiological laboratory and inoculated onto sterile culture media (blood agar containing 5% ram erythrocytes). After culturing (24-48 hours, in a thermostat at constant temperature 37 °C), bacterial colonies were identified by mass spectrometry on a MALDI TOF MS. Bacteria belonging to the genera Staphylococcus and Enterococcus were subsequently separated from the spectrum of identified bacteria. Nosocomial significant strains of staphylococci (Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus aureus) and all isolated enterococci were subjected to susceptibility testing for selected antibiotics using the disk diffusion method - E-tests.

RESULTS

Several members of the genus Staphylococcus were identified from the inanimate surfaces of both workplaces. These were mainly coagulase-negative strains - Staphylococcus epidermidis (45), Staphylococcus capitis (34), Staphylococcus haemolyticus (20), Staphylococcus hominis (45), Staphylococcus pasteuri (2), Staphylococcus sroph (1), Staphylococcus simulans (3), and Staphylococcus warneri (4). Staphylococcus aureus strains were also identified (2). Nosocomial significant isolates were tested for susceptibility to the antibiotics cefoxitin (FOX) and oxacillin (OXA). Two members of the genus Enterococcus - Enterococcus faecium (7) and Enterococcus faecalis (8) were isolated. All strains were subject to vancomycin susceptibility testing using the disk method.

CONCLUSION

Mutations in AR or SRD5A2 Genes: Clinical Findings, Endocrine Pitfalls, and Genetic Features of Children with 46,XY DSD

OBJECTIVE

Androgen insensivity syndrome (AIS) and 5α-reductase deficiency (5α-RD) present with indistinguishable phenotypes among the 46,XY disorders of sexual development (DSD) that usually necessitate molecular analyses for the definitive diagnosis in the prepubertal period. The aim was to evaluate the clinical, hormonal and genetic findings of 46,XY DSD patients who were diagnosed as AIS or 5α-RD.

METHODS

Patients diagnosed as AIS or 5α-RD according to clinical and hormonal evaluations were investigated. Sequence variants of steroid 5-α-reductase type 2 were analyzed in cases with testosterone/dihydrotestosterone (T/DHT) ratio of ≥20, whereas the androgen receptor (AR) gene was screened when the ratio was <20. Stepwise analysis of other associated genes were screened in cases with no causative variant found in initial analysis. For statistical comparisons, the group was divided into three main groups and subgroups according to their genetic diagnosis and T/DHT ratios.

RESULTS

A total of 128 DSD patients from 125 non-related families were enrolled. Birth weight SDS and gestational weeks were significantly higher in 5α-RD group than in AIS and undiagnosed groups. Completely female phenotype was higher in all subgroups of both AIS and 5α-RD patients than in the undiagnosed subgroups. In those patients with stimulated T/DHT <20 in the prepubertal period, stimulated T/DHT ratio was significantly lower in AIS than in the undiagnosed group, and higher in 5α-RD. Phenotype associated variants were detected in 24% (n=18 AIS, n=14 5α-RD) of the patients, revealing four novel AR variants (c.94G>T, p.Glu32*, c.330G>C, p.Leu110=; c.2084C>T, p.Pro695Leu, c.2585_2592delAGCTCCTG, p.(Lys862Argfs*16), of these c.330G>C with silent status remained undefined in terms of its causative effects.

CONCLUSION

T/DHT ratio is an important hormonal criterion, but in some cases, T/DHT ratio may lead to diagnostic confusion. Molecular diagnosis is important for the robust diagnosis of 46,XY DSD patients. Four novel AR variants were identified in our study.

EF-hand protein, EfhP, specifically binds Ca2+ and mediates Ca2+ regulation of virulence in a human pathogen Pseudomonas aeruginosa

Calcium (Ca2+) is well known as a second messenger in eukaryotes, where Ca2+ signaling controls life-sustaining cellular processes. Although bacteria produce the components required for Ca2+ signaling, little is known about the mechanisms of bacterial Ca2+ signaling. Previously, we have identified a putative Ca2+-binding protein EfhP (PA4107) with two canonical EF-hand motifs and reported that EfhP mediates Ca2+ regulation of virulence factors production and infectivity in Pseudomonas aeruginosa, a human pathogen causing life-threatening infections. Here, we show that EfhP selectively binds Ca2+ with 13.7 µM affinity, and that mutations at the +X and -Z positions within each or both EF-hand motifs abolished Ca2+ binding. We also show that the hydrophobicity of EfhP increased in a Ca2+-dependent manner, however no such response was detected in the mutated proteins. 15 N-NMR showed Ca2+-dependent chemical shifts in EfhP confirming Ca2+-binding triggered structural rearrangements in the protein. Deletion of efhP impaired P. aeruginosa survival in macrophages and virulence in vivo. Disabling EfhP Ca2+ binding abolished Ca2+ induction of pyocyanin production in vitro. These data confirm that EfhP selectively binds Ca2+, which triggers its structural changes required for the Ca2+ regulation of P. aeruginosa virulence, thus establishing the role of EfhP as a Ca2+ sensor.

Mec-Positive Staphylococcus Healthcare-Associated Infections Presenting High Transmission Risks for Antimicrobial-Resistant Strains in an Equine Hospital

Healthcare-associated infections caused by Staphylococcus, particularly Staphylococcus aureus, represent a high risk for human and animal health. Staphylococcus can be easily transmitted through direct contact with individual carriers or fomites, such as medical and non-medical equipment. The risk increases if S. aureus strains carry antibiotic resistance genes and show a phenotypic multidrug resistance behavior. The aim of the study was to identify and characterize methicillin resistant coagulase-positive staphylococci (MRSA) and coagulase-negative staphylococci (MRCoNS) in equine patients and environmental sources in an equine hospital to evaluate the genetic presence of multidrug resistance and to understand the dissemination risks within the hospital setting. We explored 978 samples for MRSA and MRCoNS using Oxacillin Screen Agar in an equine hospital for racehorses in Chile, which included monthly samples (n = 61–70) from equine patients (246) and hospital environments (732) in a one-year period. All isolates were PCR-assessed for the presence of methicillin resistance gene mecA and/or mecC. Additionally, we explored the epidemiological relatedness by Pulsed Field Gel Electrophoresis (PFGE) in MRSA isolates. Phenotypic antibiotic resistance was evaluated using the Kirby-Bauer disk diffusion method. We estimated the unadjusted and adjusted risk of acquiring drug-resistant Staphylococcus strains by employing logistic regression analyses. We identified 16 MRSA isolates and 36 MRCoNS isolates. For MRSA, we detected mecA and mecC in 100% and 87.5 % of the isolates, respectively. For MRCoNS, mecA was detected among 94% of the isolates and mecC among 86%. MRSA and MRCoNS were isolated from eight and 13 equine patients, respectively, either from colonized areas or compromised wounds. MRSA strains showed six different pulse types (i.e., A1–A3, B1–B2, C) isolated from different highly transited areas of the hospital, suggesting potential transmission risks for other patients and hospital staff. The risk of acquiring drug-resistant Staphylococcus species is considerably greater for patients from the surgery, equipment, and exterior areas posing higher transmission risks. Tackling antimicrobial resistance (AMR) using a One Health perspective should be advocated, including a wider control over antimicrobial consumption and reducing the exposure to AMR reservoirs in animals, to avoid cross-transmission of AMR Staphylococcus within equine hospitals.

Linezolid-Resistant Enterococcus spp. Isolates from Foods of Animal Origin-The Genetic Basis of Acquired Resistance

Enterococci are important opportunistic pathogens with the capacity to acquire and spread antibiotic resistance. At present, linezolid-resistant enterococci (LRE) pose a great challenge. Linezolid is considered as a last resort antibiotic in the treatment of enterococcal infections, so it is important to monitor the occurrence of LRE in various environments. The aim of this study was to define the genetic mechanisms of linezolid resistance in enterococci (E. faecalis, E. faecium, E. hirae, E. casseliflavus) isolated from foods of animal origin (n = 104). Linezolid resistance (LR) was shown by 26.9% of isolates. All of them displayed linezolid MICs of 8–32 µg/mL, and 96.4% of them were multidrug multidrug-resistant. The most common acquired linezolid resistance gene in LR isolates was poxtA (64%), followed by optrA (28%) and cfr (12%). According to the authors’ knowledge, this research is the first to indicate the presence of the cfr gene among isolates from food. In 28.6% of the isolates, the point mutation G2576T in the V domain of the 23S rRNA was responsible for linezolid resistance. All isolates harbored the wild-type rplC, rplD and rplV genes. The obtained results indicate that linezolid resistance among enterococci in animal-derived food may result from various genetic mechanisms. The most worrying is that this resistance is encoded on mobile genetic elements, so there is a risk of its rapid transmission, even despite the lack of selective pressure resulting from the use of antibiotics.