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Srisurapanont K, Lerttiendamrong B, Meejun T, Thanakitcharu J, Manothummetha K, Thongkam A, Chuleerarux N, Sanguankeo A, Li LX, Leksuwankun S, Langsiri N, Torvorapanit P, Worasilchai N, Plongla R, Moonla C, Nematollahi S, Kates OS, Permpalung N. Candidemia Following Severe COVID-19 in Hospitalised and Critical Ill Patients: A Systematic Review and Meta-Analysis. Mycoses 2024; 67:e13798. [PMID: 39379339 DOI: 10.1111/myc.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 10/10/2024]
Abstract
RATIONALE The epidemiology and clinical impact of COVID-19-associated candidemia (CAC) remained uncertain, leaving gaps in understanding its prevalence, risk factors and outcomes. METHODS A systematic review and meta-analysis were conducted by searching PubMed, Embase and Scopus for reports of CAC prevalence, risk factors and clinical outcomes up to June 18, 2024. The generalised linear mixed model was employed to determine the prevalence and 95% confidence intervals (CIs). The risk factors and clinical outcomes were compared between patients with and without CAC using the inverse variance method. RESULTS From 81 studies encompassing 29 countries and involving 351,268 patients, the global prevalence of CAC was 4.33% (95% Cl, 3.16%-5.90%) in intensive care unit (ICU) patients. In ICUs, the pooled prevalence of CAC in high-income countries was significantly higher than that of lower-middle-income countries (5.99% [95% Cl, 4.24%-8.40%] vs. 2.23% [95% Cl, 1.06%-4.61%], p = 0.02). Resistant Candida species, including C. auris, C. glabrata (Nakaseomyces glabratus) and C. krusei (Pichia kudriavzveii), constituted 2% of ICU cases. The mortality rate for CAC was 68.40% (95% Cl, 61.86%-74.28%) among ICU patients. Several risk factors were associated with CAC, including antibiotic use, central venous catheter placement, dialysis, mechanical ventilation, tocilizumab, extracorporeal membrane oxygenation and total parenteral nutrition. Notably, the pooled odds ratio of tocilizumab was 2.59 (95% CI, 1.44-4.65). CONCLUSIONS The prevalence of CAC is substantial in the ICU setting, particularly in high-income countries. Several risk factors associated with CAC were identified, including several that are modifiable, offering the opportunity to mitigate the risk of CAC.
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Affiliation(s)
| | | | - Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jaedvara Thanakitcharu
- Panyananthaphikkhu Cholprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Kasama Manothummetha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nipat Chuleerarux
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lucy X Li
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Surachai Leksuwankun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattapong Langsiri
- Panyananthaphikkhu Cholprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Navaporn Worasilchai
- Department of Transfusion Medicine and Clinical Microbiology, Faculty of Allied Health Sciences, and Research Unit of Medical Mycology Diagnosis, Chulalongkorn University, Bangkok, Thailand
| | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Olivia S Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kopp-Derouet A, Diamantis S, Chevret S, Tazi A, Burlacu R, Kevorkian JP, Julla JB, Molina JM, Sellier P. Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics. J Antimicrob Chemother 2024:dkae350. [PMID: 39327031 DOI: 10.1093/jac/dkae350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical. METHODS We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations. RESULTS Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively). CONCLUSIONS We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.
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Affiliation(s)
- A Kopp-Derouet
- Infectious Diseases Department, Hôpitaux Saint-Louis/Lariboisière, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France
- Université de Paris Cité, Paris, France
- Infectious Diseases and Internal Medicine Department, GH SIF, Melun, France
- DYNAMIC Unit, UPEC, Créteil, France
| | - S Diamantis
- Infectious Diseases and Internal Medicine Department, GH SIF, Melun, France
- DYNAMIC Unit, UPEC, Créteil, France
| | - S Chevret
- Department of Biostatistics and Medical Informatics, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - A Tazi
- Department of Respiratory Diseases, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - R Burlacu
- Department of Internal Medicine, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - J P Kevorkian
- Department of Endocrinology, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - J B Julla
- Department of Endocrinology, Hôpitaux Saint-Louis/Lariboisière, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - J M Molina
- Infectious Diseases Department, Hôpitaux Saint-Louis/Lariboisière, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France
- Université de Paris Cité, Paris, France
| | - P Sellier
- Infectious Diseases Department, Hôpitaux Saint-Louis/Lariboisière, APHP, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France
- Université de Paris Cité, Paris, France
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Hanna JJ, Most ZM, Cooper LN, Wakene AD, Radunsky AP, Lehmann CU, Perl TM, Medford RJ. Mortality in hospitalized SARS-CoV-2 patients with contemporaneous bacterial and fungal infections. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e142. [PMID: 39346658 PMCID: PMC11428019 DOI: 10.1017/ash.2024.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 10/01/2024]
Abstract
Background The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2. Methods In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation. Results The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables. Conclusions In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.
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Affiliation(s)
- John J Hanna
- Information Services, ECU Health, Greenville, NC, USA
- Division of Infectious Diseases, Department of Internal Medicine, East Carolina University, Greenville, NC, USA
- Clinical Informatics Center, University of Texas Southwestern, Dallas, TX, USA
| | - Zachary M Most
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lauren N Cooper
- Clinical Informatics Center, University of Texas Southwestern, Dallas, TX, USA
| | - Abdi D Wakene
- Clinical Informatics Center, University of Texas Southwestern, Dallas, TX, USA
| | - Alexander P Radunsky
- Division of Infectious Diseases & Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern, Dallas, TX, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Trish M Perl
- Division of Infectious Diseases & Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Richard J Medford
- Information Services, ECU Health, Greenville, NC, USA
- Division of Infectious Diseases, Department of Internal Medicine, East Carolina University, Greenville, NC, USA
- Clinical Informatics Center, University of Texas Southwestern, Dallas, TX, USA
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Liu S, Yu C, Tu Q, Zhang Q, Fu Z, Huang Y, He C, Yao L. Bacterial co-infection in COVID-19: a call to stay vigilant. PeerJ 2024; 12:e18041. [PMID: 39308818 PMCID: PMC11416760 DOI: 10.7717/peerj.18041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Co-infection with diverse bacteria is commonly seen in patients infected with the novel coronavirus, SARS-CoV-2. This type of co-infection significantly impacts the occurrence and development of novel coronavirus infection. Bacterial co-pathogens are typically identified in the respiratory system and blood culture, which complicates the diagnosis, treatment, and prognosis of COVID-19, and even exacerbates the severity of disease symptoms and increases mortality rates. However, the status and impact of bacterial co-infections during the COVID-19 pandemic have not been properly studied. Recently, the amount of literature on the co-infection of SARS-CoV-2 and bacteria has gradually increased, enabling a comprehensive discussion on this type of co-infection. In this study, we focus on bacterial infections in the respiratory system and blood of patients with COVID-19 because these infection types significantly affect the severity and mortality of COVID-19. Furthermore, the progression of COVID-19 has markedly elevated the antimicrobial resistance among specific bacteria, such as Klebsiella pneumoniae, in clinical settings including intensive care units (ICUs). Grasping these resistance patterns is pivotal for the optimal utilization and stewardship of antibiotics, including fluoroquinolones. Our study offers insights into these aspects and serves as a fundamental basis for devising effective therapeutic strategies. We primarily sourced our articles from PubMed, ScienceDirect, Scopus, and Google Scholar. We queried these databases using specific search terms related to COVID-19 and its co-infections with bacteria or fungi, and selectively chose relevant articles for inclusion in our review.
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Affiliation(s)
- Shengbi Liu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chao Yu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qin Tu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Qianming Zhang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Zuowei Fu
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Yifeng Huang
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Chuan He
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
| | - Lei Yao
- Department of Clinical Laboratory, Guiqian International General Hospital, Guiyang, People’s Republic of China
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Alhuthil RT, Hijazi RM, Alyabes OA, Alsuhaibani MA, Gashgarey DA, Binsalamah IM, Aldahmash MA, Alghamdi SM, Albanyan EA, Aljumaah SA, Al-Hajjar SH. Epidemiology, clinical profiles, and antimicrobial susceptibility of Elizabethkingia meningoseptica infections: Insights from a tertiary care hospital in Saudi Arabia. Saudi Med J 2024; 45:840-847. [PMID: 39074884 PMCID: PMC11288499 DOI: 10.15537/smj.2024.45.8.20240279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/04/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES To investigate the incidence rate, clinical characteristics across different age groups, antimicrobial susceptibility, and outcomes of Elizabethkingia meningoseptica (E. meningoseptica) infections. METHODS A retrospective analysis was carried out to include 66 cases with confirmed E. meningoseptica cultures from sterile samples between January 2014 and June 2022 at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. RESULTS A total of 66 cases were identified, with an incidence rate of 0.3 per 1000 admissions. Most cases were hospital-acquired (80.3%), primarily in critical care areas. All patients had underlying diseases, with respiratory (40.9%) and cardiovascular (39.4%) diseases being the most common. Minocycline showed the highest susceptibility (96.0%), followed by trimethoprim/sulfamethoxazole (77.0%), whereas tobramycin and colistin were fully resistant. The in-hospital mortality rate was 34.8%, whereas the 28-day mortality rate was 22.7%. Clinical characteristics across age groups showed a higher prevalence of cardiovascular disease in pediatrics than in adults, whereas exposure to mechanical ventilation, immunosuppressive therapy, previous infection, anemia, and in-hospital mortality were reported more frequently in adults (p<0.05). CONCLUSION Our study provides valuable insights into E. meningoseptica infection in Saudi Arabia, emphasizing the importance of robust infection control measures. Incidence and mortality rates align with global trends. Variations in clinical characteristics across age groups highlight the importance of tailored treatments based on patient demographics and underlying comorbidities.
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Affiliation(s)
- Raghad T. Alhuthil
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Raghad M. Hijazi
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Ohoud A. Alyabes
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Alsuhaibani
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Deema A. Gashgarey
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Ibrahim M. Binsalamah
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Aldahmash
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Salem M. Alghamdi
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Esam A. Albanyan
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Suliman A. Aljumaah
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
| | - Sami H. Al-Hajjar
- From the Department of Pediatrics (Alhuthil, Alyabes, Alsuhaibani, Gashgarey, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), King Faisal Specialist Hospital & Research Centre, and from the College of Medicine (Hijazi, Alyabes, Alsuhaibani, Binsalamah, Aldahmash, Alghamdi, Albanyan, Aljumaah, Al-Hajjar), Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
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Pérez-Granda MJ, Burillo A, Serrano-Lobo J, Martín-Rabadán P, Muñoz P, Bouza E, Guembe M. Impact of the COVID-19 pandemic on the incidence and the epidemiology of catheter-related bloodstream infection two years later. Heliyon 2024; 10:e34185. [PMID: 39104508 PMCID: PMC11298837 DOI: 10.1016/j.heliyon.2024.e34185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction The COVID-19 pandemic increased catheter-related bloodstream infections (C-RBSI), but its subsequent impact has not been adequately described. Our hospital has already depicted the effects of the COVID-19 pandemic in the first wave. However, we still do not know whether C-RBSI rates and aetiology are similar to those described before the COVID-19 pandemic. We aimed to evaluate the impact of the COVID-19 pandemic on the evolution of C-RBSI in a large tertiary teaching hospital two years later. Material and methods We prospectively collected all confirmed C-RBSI episodes in a clinical microbiology laboratory database by matching blood cultures and catheter tip cultures with the isolation of the same microorganism (s). We compared our C-RBSI incidence rates and aetiology from 2018 to 2023. C-RBSI was defined as bacteremia or fungemia in a patient with clinical manifestations of infection and no other apparent source except the catheter. Results During the study period, we collected 556 C-RBSI episodes. C-RBSI incidence rate per 1000 admissions each year was as follows: 2018: 2.2; 2019: 1.7; 2020: 3.29; 2021: 2.92; 2022: 2.69. and 2023: 2.01. Mainly, C-RBSI episodes occurring in critical care units each year were, respectively: 2018: 57 (54.8 %), 2019: 38 (45.2 %), 2020: 89 (63.6 %), 2021: 69 (60.5 %), 2022: 58 (50.9 %) and 2023 (61.4 %). The distribution of microorganisms showed an increase in Gram-negative episodes after the pandemic. Conclusion Our study shows an increase in the incidence rate of C-RBSI during the COVID-19 pandemic, with a discrete decrease after that. C-RBSI episodes were mainly caused by coagulase-negative Staphylococci but with a rise in Gram-negative bacilli.
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Affiliation(s)
- María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Julia Serrano-Lobo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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El-Maraghy CM, Medhat PM, Hathout RM, Ayad MF, Fares NV. Implementation of green-assessed nanotechnology and quality by design approach for development of optical sensor for determination of tobramycin in ophthalmic formulations and spiked human plasma. BMC Chem 2024; 18:131. [PMID: 39010206 PMCID: PMC11247747 DOI: 10.1186/s13065-024-01234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
A fast eco-friendly colorimetric method was developed for the determination of Tobramycin in drug substance, ophthalmic formulations, and spiked human plasma using silver nanoparticles optical sensor. Even though tobramycin is non-UV-visible absorbing, the developed method is based on measuring the absorbance quenching of silver nanoparticles resulting from the interaction with tobramycin. Different factors affecting the absorbance intensity were studied as; silver nanoparticle concentration, pH, buffer type, and reaction time using quality by design approach. Validation of the proposed method was performed according to ICH guidelines and was found to be accurate, precise, and sensitive. The linearity range of tobramycin was 0.35-4.0 μg/mL. The optical sensor was successfully applied for the determination of Tobramycin in ophthalmic formulations and spiked human plasma without pre-treatment. Additionally, the binding between Tobramycin and PVP- capped silver nanoparticles was studied using molecular docking software. The method was assessed and compared to colorimetric reported methods for the green character using Green Analytical Procedure Index (GAPI) and Analytical GREEnness calculator (AGREE) tools and found to be greener.
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Affiliation(s)
- Christine M El-Maraghy
- Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 6th October City, 11787, Cairo, Egypt.
| | - Passant M Medhat
- Analytical Chemistry Department, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 6th October City, 11787, Cairo, Egypt
| | - Rania M Hathout
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Abbassia, Cairo, 11566, Egypt
| | - Miriam F Ayad
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Abbassia, Cairo, 11566, Egypt
| | - Nermine V Fares
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Ain Shams University, Abbassia, Cairo, 11566, Egypt
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Ntziora F, Giannitsioti E. Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:269-280. [PMID: 39035613 PMCID: PMC11258508 DOI: 10.1016/j.jointm.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 07/23/2024]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms "COVID-19" AND "bloodstream infections" AND "ICU" were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60-70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, Enterococci, Acinetobacter baumannii, and Candida spp. emerged as prominent infecting organisms during the pandemic; along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.
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Affiliation(s)
- Fotinie Ntziora
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Hackman HK, Annison L, Arhin RE, Adjei GO, Otu P, Arthur-Hayford E, Annison S, Borteih BB. Self-medication with antibiotics during the COVID-19 pandemic: A cross-sectional study among adults in Tema, Ghana. PLoS One 2024; 19:e0305602. [PMID: 38917123 PMCID: PMC11198810 DOI: 10.1371/journal.pone.0305602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Antibiotic self-medication is one of the common causes of antibiotic resistance of bacterial organisms. The COVID-19 pandemic introduced a new paradigm shift and significantly influenced healthcare behaviors, including an increase in antibiotic self-medication, which contributes to antibiotic resistance. This study was aimed at determining the prevalence of antibiotic self-medication and the possible associated factors during the peak of the COVID-19 pandemic among adult residents of Tema in Ghana from April to July 2021. METHODS Using a cross-sectional design, 400 adults were randomly selected and surveyed using a researcher-assisted questionnaire. Data were analyzed with IBM® SPSS® Statistics Version 22.0, considering associations significant at a 95% confidence interval (p < 0.05). RESULTS Of the 400 respondents, (76%) 304 had practiced antibiotic self-medication within the previous 12 months during the COVID-19 pandemic. Significant factors associated with antibiotic self-medication included gender, age, marital status, education, occupation, and National Health Insurance Scheme subscription. Convenience and avoiding long hospital queues were primary non-medical reasons for antibiotic self-medication, while previous successful experience, easy access to antibiotics, treating symptoms, prophylaxis, and fear of hospital infection were the medical reasons for antibiotic self-medication. Commonly self-administered antibiotics were azithromycin (34%), amoxicillin/clavulanic acid (22%), and metronidazole (16%) for perceived respiratory tract and gastrointestinal tract infections. CONCLUSIONS The high prevalence of antibiotic self-medication observed during the COVID-19 pandemic underscores the need for enhanced public education and stricter enforcement of regulations governing antibiotic sales. The non-medical and medical factors of convenience, avoiding long hospital queues, previous successful experience, easy access to antibiotics, treating symptoms, prophylaxis, and fear of hospital infection which motivated antibiotic self-medication practices require the implementation of antimicrobial stewardship interventions.
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Affiliation(s)
- Henry Kwadwo Hackman
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Lawrence Annison
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Reuben Essel Arhin
- Department of Science Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - George Osei Adjei
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Phyllis Otu
- Department of Science Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Emele Arthur-Hayford
- Department of Medical Laboratory Technology, Faculty of Applied Sciences, Accra Technical University, Accra, Ghana
| | - Sharon Annison
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Bernard Bortei Borteih
- Department of Animal Research Institute, Council for Scientific and Industrial Research (CSIR), Accra, Ghana
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Negi P, Chadha J, Harjai K, Gondil VS, Kumari S, Raj K. Antimicrobial and Antibiofilm Potential of Green-Synthesized Graphene-Silver Nanocomposite against Multidrug-Resistant Nosocomial Pathogens. Biomedicines 2024; 12:1104. [PMID: 38791065 PMCID: PMC11117616 DOI: 10.3390/biomedicines12051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/01/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Hospital-acquired infections (HAIs) pose a significant risk to global health, impacting millions of individuals globally. These infections have increased rates of morbidity and mortality due to the prevalence of widespread antimicrobial resistance (AMR). Graphene-based nanoparticles (GBNs) are known to possess extensive antimicrobial properties by inflicting damage to the cell membrane, suppressing virulence, and inhibiting microbial biofilms. Developing alternative therapies for HAIs and addressing AMR can be made easier and more affordable by combining nanoparticles with medicinal plants harboring antimicrobial properties. Hence, this study was undertaken to develop a novel graphene-silver nanocomposite via green synthesis using Trillium govanianum plant extract as a reducing agent. The resulting nanocomposite comprised silver nanoparticles embedded in graphene sheets. The antibacterial and antifungal properties of graphene-silver nanocomposites were investigated against several nosocomial pathogens, namely, Candida auris, Candida glabrata, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The nanocomposite displayed broad-range antimicrobial potential against the test pathogens, with minimum inhibitory concentrations (MICs) ranging between 31.25 and 125.0 µg/mL, and biofilm inhibition up to 80-96%. Moreover, nanocomposite-functionalized urinary catheters demonstrated hemocompatibility towards sheep erythrocytes and imparted anti-fouling activity to the biomaterial, while also displaying biocompatibility towards HEK 293 cells. Collectively, this investigation highlights the possible application of green-synthesized GBNs as an effective alternative to conventional antibiotics for combating multidrug-resistant pathogens.
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Affiliation(s)
- Preeti Negi
- Department of Microbiology, Basic Medical Sciences Block 1, South Campus, Panjab University, Sector-25, Chandigarh 160014, India
| | - Jatin Chadha
- Department of Microbiology, Basic Medical Sciences Block 1, South Campus, Panjab University, Sector-25, Chandigarh 160014, India
| | - Kusum Harjai
- Department of Microbiology, Basic Medical Sciences Block 1, South Campus, Panjab University, Sector-25, Chandigarh 160014, India
| | - Vijay Singh Gondil
- Department of Microbiology & Immunology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Seema Kumari
- Department of Microbiology, Basic Medical Sciences Block 1, South Campus, Panjab University, Sector-25, Chandigarh 160014, India
| | - Khem Raj
- Department of Microbiology, Basic Medical Sciences Block 1, South Campus, Panjab University, Sector-25, Chandigarh 160014, India
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11
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Md Lasim A, Mohd Ngesom AM, Nathan S, Abdul Razak F, Abdul Halim M, Mohd-Saleh W, Zainul Abidin K, Mohd-Taib FS. Bacterial community profiles within the water samples of leptospirosis outbreak areas. PeerJ 2024; 12:e17096. [PMID: 38699181 PMCID: PMC11064854 DOI: 10.7717/peerj.17096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/21/2024] [Indexed: 05/05/2024] Open
Abstract
Background Leptospirosis is a water-related zoonotic disease. The disease is primarily transmitted from animals to humans through pathogenic Leptospira bacteria in contaminated water and soil. Rivers have a critical role in Leptospira transmissions, while co-infection potentials with other waterborne bacteria might increase the severity and death risk of the disease. Methods The water samples evaluated in this study were collected from four recreational forest rivers, Sungai Congkak, Sungai Lopo, Hulu Perdik, and Gunung Nuang. The samples were subjected to next-generation sequencing (NGS) for the 16S rRNA and in-depth metagenomic analysis of the bacterial communities. Results The water samples recorded various bacterial diversity. The samples from the Hulu Perdik and Sungai Lopo downstream sampling sites had a more significant diversity, followed by Sungai Congkak. Conversely, the upstream samples from Gunung Nuang exhibited the lowest bacterial diversity. Proteobacteria, Firmicutes, and Acidobacteria were the dominant phyla detected in downstream areas. Potential pathogenic bacteria belonging to the genera Burkholderiales and Serratia were also identified, raising concerns about co-infection possibilities. Nevertheless, Leptospira pathogenic bacteria were absent from all sites, which is attributable to its limited persistence. The bacteria might also be washed to other locations, contributing to the reduced environmental bacterial load. Conclusion The present study established the presence of pathogenic bacteria in the river ecosystems assessed. The findings offer valuable insights for designing strategies for preventing pathogenic bacteria environmental contamination and managing leptospirosis co-infections with other human diseases. Furthermore, closely monitoring water sample compositions with diverse approaches, including sentinel programs, wastewater-based epidemiology, and clinical surveillance, enables disease transmission and outbreak early detections. The data also provides valuable information for suitable treatments and long-term strategies for combating infectious diseases.
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Affiliation(s)
- Asmalia Md Lasim
- Department of Herbal Medicine Research Centre, Insitute for Medical Research, Setia Alam, Malaysia
- Department of Biological Science and Biotechnology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - Sheila Nathan
- Department of Biological Science and Biotechnology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Fatimah Abdul Razak
- Department of Biological Science and Biotechnology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Mardani Abdul Halim
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Wardah Mohd-Saleh
- Department of Herbal Medicine Research Centre, Insitute for Medical Research, Setia Alam, Malaysia
| | - Kamaruddin Zainul Abidin
- Faculty of Applied Science, Universiti Teknologi MARA (UiTM) Cawangan Pahang, Bandar Tun Razak, Pahang, Malaysia
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12
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Ardino C, Sannio F, Poli G, Galati S, Dreassi E, Botta L, Docquier JD, D'Agostino I. An update on antibacterial AlkylGuanidino Ureas: Design of new derivatives, synergism with colistin and data analysis of the whole library. Eur J Med Chem 2024; 270:116362. [PMID: 38574637 DOI: 10.1016/j.ejmech.2024.116362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
Antimicrobial resistance (AMR) represents one of the most challenging global Public Health issues, with an alarmingly increasing rate of attributable mortality. This scenario highlights the urgent need for innovative medicinal strategies showing activity on resistant isolates (especially, carbapenem-resistant Gram-negative bacteria, methicillin-resistant S. aureus, and vancomycin-resistant enterococci) yielding new approaches for the treatment of bacterial infections. We previously reported AlkylGuanidino Ureas (AGUs) with broad-spectrum antibacterial activity and a putative membrane-based mechanism of action. Herein, new tetra- and mono-guanidino derivatives were designed and synthesized to expand the structure-activity relationships (SARs) and, thereby, tested on the same panel of Gram-positive and Gram-negative bacteria. The membrane-active mechanism of selected compounds was then investigated through molecular dynamics (MD) on simulated bacterial membranes. In the end, the newly synthesized series, along with the whole library of compounds (more than 70) developed in the last decade, was tested in combination with subinhibitory concentrations of the last resort antibiotic colistin to assess putative synergistic or additive effects. Moreover, all the AGUs were subjected to cheminformatic and machine learning analyses to gain a deeper knowledge of the key features required for bioactivity.
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Affiliation(s)
- Claudia Ardino
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via Aldo Moro 2, I-53100, Siena, Italy
| | - Filomena Sannio
- Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, I-53100, Siena, Italy
| | - Giulio Poli
- Department of Pharmacy, University of Pisa, via Bonanno Pisano 6, I-56126, Pisa, Italy
| | - Salvatore Galati
- Department of Pharmacy, University of Pisa, via Bonanno Pisano 6, I-56126, Pisa, Italy
| | - Elena Dreassi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via Aldo Moro 2, I-53100, Siena, Italy
| | - Lorenzo Botta
- Lead Discovery Siena s.r.l., Via Vittorio Alfieri 31, I-53019, Castelnuovo Berardenga, Italy; Department of Ecological and Biological Sciences, University of Tuscia, Largo dell'Università snc, I-01100, Viterbo, Italy
| | - Jean-Denis Docquier
- Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, I-53100, Siena, Italy; Lead Discovery Siena s.r.l., Via Vittorio Alfieri 31, I-53019, Castelnuovo Berardenga, Italy
| | - Ilaria D'Agostino
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via Aldo Moro 2, I-53100, Siena, Italy; Department of Pharmacy, University of Pisa, via Bonanno Pisano 6, I-56126, Pisa, Italy.
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Li N, Zhang L, Gao Y, Lai Q, Tang Y, Du X, Chen P, Yue C, Zhao M, Yu K, Kang K. Changes in clinical parameters and inflammatory markers after blood culture collection facilitate early identification of positive culture in adult patients with COVID-19 and clinically suspected bloodstream infection. J Int Med Res 2024; 52:3000605241238134. [PMID: 38630560 PMCID: PMC11025435 DOI: 10.1177/03000605241238134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/22/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE We explored whether changes in clinical parameters and inflammatory markers can facilitate early identification of positive blood culture in adult patients with COVID-19 and clinically suspected bloodstream infection (BSI). METHODS This single-center retrospective study enrolled 20 adult patients with COVID-19 admitted to the intensive care unit who underwent blood culture for clinically suspected BSI (February 2020-November 2021). We divided patients into positive (Pos) and negative blood culture groups. Clinical parameters and inflammatory markers were obtained from medical records between blood culture collection and the first positive or negative result and compared between groups on different days. RESULTS Patients in the positive culture group had significantly older age and higher D-dimer, immunoglobulin 6 (IL-6), and Sequential Organ Failure Assessment score as well as lower albumin (ALB). The area under the receiver operating characteristic curve (AUC) was 0.865 for IL-6, D-dimer and ALB on the first day after blood culture collection; the AUC was 0.979 for IL-6, IL-10, D-dimer, and C-reactive protein on the second day after blood culture collection. CONCLUSION Changes in clinical parameters and inflammatory markers after blood culture collection may facilitate early identification of positive culture in adult patients with COVID-19 and clinically suspected BSI.
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Affiliation(s)
- Nana Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Long Zhang
- Department of Critical Care Medicine, The Shanghai Baoshan Luodian Hospital, Shanghai, China
| | - Yang Gao
- Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
- Institute of Critical Care Medicine, The Sino Russian Medical Research Center of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qiqi Lai
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yujia Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xue Du
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Pengfei Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuangshi Yue
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Mingyan Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
- Institute of Critical Care Medicine, The Sino Russian Medical Research Center of Harbin Medical University, Harbin, Heilongjiang Province, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang Province, China
- Key Laboratory of Cell Transplantation, National Health Commission, Harbin, Heilongjiang Province, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Debaco ISS, Kluck HM, Marx R, da Rosa PRM, Teixeira C. Bacterial coinfections in COVID-19-hospitalized patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230469. [PMID: 38451571 PMCID: PMC10913779 DOI: 10.1590/1806-9282.2023469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18-3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15-2.67); p=0.009), active cancer (RR=1.52 (1.082-2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740-3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24-9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26-2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75-1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established.
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Affiliation(s)
| | - Helena Moreira Kluck
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Rômulo Marx
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Paulo Ricardo Mottin da Rosa
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
- Moinhos de Vento Hospital, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Cassiano Teixeira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Clinical Medicine and Rehabilitation Sciences – Porto Alegre (RS), Brazil
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15
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Pasula S. Hemophilus parainfluenzae Meningitis in an Adult Post-COVID-19 Infection. Cureus 2024; 16:e57076. [PMID: 38681376 PMCID: PMC11052641 DOI: 10.7759/cureus.57076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Hemophilus parainfluenzae is a gram-negative coccobacillus that usually inhabits the respiratory tract. It is a causative agent of meningitis, usually in children. The author presents a case of a 34-year-old woman presented with fever, neck stiffness, and headache, two weeks after the diagnosis of coronavirus disease 2019 (COVID-19) infection. Her CT scan of the head showed sinusitis. CSF analysis showed monocytic pleocytosis. CSF cultures grew Hemophilus parainfluenzae. The patient improved on intravenous antibiotic ceftriaxone 2 grams every 12 hours. This article also provides a brief literature review of Hemophilus parainfluenzae infections associated with COVID-19 infection.
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Affiliation(s)
- Shirisha Pasula
- Infectious Diseases, Northeastern Ohio Infectious Diseases, Youngstown, USA
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16
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Koupaei M, Asadi A, Mahdizade Ari M, Seyyedi ZS, Mohammadi F, Afifi Rad R, Ghanavati R, Rezaei Khozani N, Darbandi A, Masjedian Jazi F. Secondary Klebsiella pneumoniae infection in patients with COVID-19: A systematic review. Diagn Microbiol Infect Dis 2024; 108:116105. [PMID: 38147789 DOI: 10.1016/j.diagmicrobio.2023.116105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 12/28/2023]
Abstract
This study aims to investigate the development of secondary bacterial infection and risk factors associated with it in critical COVID-19 patients, and to identify the most common pathogen groups in them. All the cohort studies were retrieved from Scopus, Google Scholar, Web of Science, and MEDLINE from the inception of COVID-19 to 2022 for the following keywords: 'Klebsiella" AND "COVID-19". The most common comorbidities among the patients with COVID-19 were respiratory disease (33.62%), obesity (28.99%), and heart disease or cardiovascular disease (16.31%). We report 42.91% rate of Klebsiella spp co-infection in ICU admission patients, mostly related to K. pneumonia (26.81%), K. aerogenes (9.4%), and K. oxytoca (6.7%). The overall incidence of bacterial infection in hospitalized COVID-19 patients is estimated at 15.5% and in 32.5% of cases of co-infection patients deceased. The threat of carbapenem-resistant K. pneumoniae infections in patients with COVID-19 is imminent, therefore rational antibiotic therapy based on antibiotic sensitivity test should be implemented.
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Affiliation(s)
- Maryam Koupaei
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Arezoo Asadi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medica Sciences, Tehran, Iran
| | - Marzie Mahdizade Ari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Seyyedi
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Fahime Mohammadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roghayeh Afifi Rad
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nahid Rezaei Khozani
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Atieh Darbandi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Molecular Microbiology Research Center, Shahed University, Tehran, Iran.
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Khan S, Bond SE, Lee-Milner J, Conway BR, Lattyak WJ, Aldeyab MA. Antimicrobial consumption in an acute NHS Trust during the COVID-19 pandemic: intervention time series analysis. JAC Antimicrob Resist 2024; 6:dlae013. [PMID: 38328263 PMCID: PMC10848649 DOI: 10.1093/jacamr/dlae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Objective To determine the impact of the COVID-19 pandemic on antimicrobial consumption and trends of therapeutic drugs for COVID-19 treatments, including corticosteroids, remdesivir and monoclonal antibodies (tocilizumab) from April 2017 to September 2022 in a secondary care NHS Trust in England. Methods A retrospective intervention time series analysis was conducted for April 2017 to September 2022 at the Mid Yorkshire Teaching NHS Trust. Data were retrieved from the pharmacy dispensing system as defined daily doses (DDDs) monthly and reported per 1000 occupied bed days (OBDs). Antimicrobial consumption and COVID-19 treatment options were measured. DDDs were calculated according to the classification of antimicrobials for systemic use (J01) and for other drugs classification. Trends for antimicrobial consumption and other therapeutic drugs for treating COVID-19 were also determined in each wave in England. Results During the pandemic: total antibiotic consumption decreased from 826.4 to 728.2 DDDs per 1000 OBDs (P = 0.0067); piperacillin/tazobactam use increased (P < 0.0001) and ciprofloxacin use decreased (P < 0.0001); there were no changes in Access, Watch, Reserve antibiotic use, and the proportion of antifungal consumption was consistent throughout the study. The use of total antibiotics (P = 0.024), levofloxacin (P = 0.0007), piperacillin/tazobactam (P = 0.0015) and co-amoxiclav (P = 0.0198) increased during wave one. Consumption of COVID-19 treatment drugs was highest during wave two, with 624.3 DDDs per 1000 OBDs for dexamethasone (P = 0.4441), 6.8 DDDs per 1000 OBDs for remdesivir (P < 0.0001) and 35.01 DDDs per 1000 OBDs for tocilizumab (P = 0.2544). Discussion This study determined the consumption of antimicrobials trends before and during the pandemic. The individual wave antimicrobial consumption indicates maximum consumption in the first wave, advocating for antimicrobial stewardship and preparedness for future pandemics.
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Affiliation(s)
- Sidra Khan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - Stuart E Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Jade Lee-Milner
- Pharmacy Department, Mid Yorkshire Teaching NHS Trust, Wakefield, WF1 4DG, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | - William J Lattyak
- Statistical Consulting Department, Scientific Computing Associates Corp., River Forest, IL 60305, USA
| | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
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18
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Wu L, Ye T, Pan X, Hong L, Shi Y. A case of Elizabethkingia meningoseptica septicemia. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 53:126-130. [PMID: 38105675 PMCID: PMC10945492 DOI: 10.3724/zdxbyxb-2023-0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Abstract
A 82-year-old man was admitted to hospital with fever, unresponsiveness, elevated hypersensitive C-reactive protein and neutrophile granulocyte. Ceftriaxone was administrated by intravenous dripping in the emergency room, but the effect was not satisfactory. Following his admission to the ward, cefoperazone sulbactam were given. Elizabethkingia meningoseptica was identified by blood culture and further confirmed by 16S rRNA sequencing. The lumbar puncture showed that cerebrospinal fluid pressure was 80 mmH2O (1 mmH2O=0.0098 kPa) and biochemical results were normal. After 11 days of cefoperazone sulbactam treatment, the patient was discharged with negative blood culture. The hypersensitive C-reactive protein and neutrophile granulocyte had also declined. The patient received levofloxacin tablets for anti-infection treatment for 14 d after discharge. No signs of infection were observed in three months' following up.
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Affiliation(s)
- Lihua Wu
- Department of Infectious disease, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China.
| | - Tinghua Ye
- Clinical Laboratory, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Xinling Pan
- Department of Biological Laboratory, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Li Hong
- Department of Infectious disease, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Yunzhen Shi
- Department of Infectious disease, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China.
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19
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Santos TA, Oliveira JED, Fonseca CDD, Barbosa DA, Belasco AGDS, Miura CRM. Sepsis and COVID-19: outcomes in young adults in intensive care. Rev Bras Enferm 2023; 76:e20230037. [PMID: 38055486 DOI: 10.1590/0034-7167-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/23/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables. METHODS a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records. RESULTS sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis. CONCLUSIONS there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.
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20
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Gangar T, Patra S. Antibiotic persistence and its impact on the environment. 3 Biotech 2023; 13:401. [PMID: 37982084 PMCID: PMC10654327 DOI: 10.1007/s13205-023-03806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
From boon molecules to molecules contributing to rising concern has been the sojourn of antibiotics. The problem of antibiotic contamination has gotten worse due to antibiotics' pervasive use in every aspect of the environment. One such consequence of pollution is the increase in infections with antibiotic resistance. All known antimicrobials being used for human benefit lead to their repetitive and routine release into the environment. The misuse of antibiotics has aggravated the situation to a level that we are short of antibiotics to treat infections as organisms have developed resistance against them. Overconsumption is not just limited to human health care, but also occurs in other areas such as aquaculture, livestock, and veterinary applications for the purpose of improving feed and meat products. Due to their harmful effects on non-target species, the trace level of antibiotics in the aquatic ecosystem presents a significant problem. Since the introduction of antibiotics into the environment is more than their removal, they have been given the status of persistent pollutants. The buildup of antibiotics in the environment threatens aquatic life and may lead to bacterial strains developing resistance. As newer organisms are becoming resistant, there exists a shortage of antibiotics to treat infections. This has presented a very critical problem for the health-care community. Another rising concern is that the development of newer drug molecules as antibiotics is minimal. This review article critically explains the cause and nature of the pollution and the effects of this emerging trend. Also, in the latter sections, why we need newer antibiotics is questioned and discussed.
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Affiliation(s)
- Tarun Gangar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, North Guwahati, Assam 781039 India
| | - Sanjukta Patra
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, North Guwahati, Assam 781039 India
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21
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Khavandegar A, Siami Z, Goudarzi S, Rasooli A, Ettehad Y. Investigation of microbial coinfection in 453 septic COVID-19 patients admitted to hospital; a retrospective study. Future Sci OA 2023; 9:FSO884. [PMID: 37752919 PMCID: PMC10518821 DOI: 10.2144/fsoa-2023-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Aim We evaluated the rate of COVID-19 microbial coinfection in an Iranian population. Methods In this single-center, retrospective observational study, we evaluated 453 septic COVID-19 patients for possible coinfection in an Iranian hospital. Results Overall, 211 (46.57%) cases died due to COVID-19 complications. Positive respiratory secretion and blood cultures were reported in 99 (21.9%) and 19 (4.2%) cases. Klebsiella species were the most commonly isolated microorganisms in respiratory (n = 50, 50.5%) and blood (n = 10, 52.6%) specimens. After adjustment for underlying disorders, positive respiratory microbial cultures significantly increase the odds of developing death, intubation, and ICU admission and negatively impact healthy discharge (P < 0.05). Conclusion Coinfections with bacteria and fungi independently contribute to poor outcomes in septic COVID-19 patients.
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Affiliation(s)
- Armin Khavandegar
- Sina Trauma & Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Siami
- Infectious Disease Department, Alborz University of Medical Sciences, Karaj, Iran
- Department of Infectious Diseases & Tropical Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogand Goudarzi
- Department of Anesthesiology & Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Aziz Rasooli
- Department of Emergency Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Ettehad
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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22
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Suleiman AS, Islam MA, Akter MS, Amin MR, Werkneh AA, Bhattacharya P. A meta-meta-analysis of co-infection, secondary infections, and antimicrobial resistance in COVID-19 patients. J Infect Public Health 2023; 16:1562-1590. [PMID: 37572572 DOI: 10.1016/j.jiph.2023.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023] Open
Abstract
The newly discovered coronavirus SARS-CoV-2 has sparked a worldwide pandemic of COVID-19, which has caused havoc on medical infrastructures, economies, and cultures around the world. Determining the whole scenario is essential since SARS-CoV-2 variants and sub-variants keep appearing after vaccinations and booster doses. The objective of this secondary meta-analysis is to analysis co-infection, secondary infections, and antimicrobial resistance (AMR) in COVID-19 patients. This study used five significant databases to conduct a systematic review and an overlap meta-analysis to evaluate the pooled estimates of co-infections and secondary infections. The summary of the meta-analysis showed an overall co-infection effect of 26.19% (95% confidence intervals CI: 21.39-31.01, I2 =98.78, n = 14 meta-analysis) among patients with COVID-19. A coinfection effect of 11.13% (95% CI: 9.7-12.56, I2 =99.14, n = 11 meta-analysis) for bacteria; 9.69% (95% CI: 1.21-7.90, I2 =98.33) for fungal and 3.48% (95% CI: 2.15-4.81, I2 =95.84) for viruses. A secondary infection effect of 19.03% (95% CI: 9.53-28.54, I2 =85.65) was pooled from 2 meta-analyses (Ave: 82 primary studies). This is the first study that compiles the results of all the previous three years meta-analyses into a single source and offers strong proof of co-infections and secondary infections in COVID-19 patients. Early detection of co-infection and AMR is crucial for COVID-19 patients in order to effective treatment.
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Affiliation(s)
- Adeiza Shuaibu Suleiman
- Department of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria.
| | - Md Aminul Islam
- Advanced Molecular Lab, Department of Microbiology, President Abdul Hamid Medical College, Karimganj, Kishoreganj 2310, Bangladesh; COVID-19 Diagnostic lab, Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh.
| | - Mir Salma Akter
- COVID-19 Diagnostic lab, Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Mohammad Ruhul Amin
- COVID-19 Diagnostic lab, Department of Microbiology, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Adhena Ayaliew Werkneh
- Department of Environmental Health, School of Public Health, College of Health Sciences, Mekelle University, P. O. Box 1871, Mekelle, Ethiopia
| | - Prosun Bhattacharya
- COVID-19 Research @KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE-100 44 Stockholm, Sweden.
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23
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Dar S, Erickson D, Manca C, Lozy T, Shashkina E, Kordalewska M, Mediavilla JR, Chen L, Rojtman A, Kreiswirth BN. The impact of COVID on bacterial sepsis. Eur J Clin Microbiol Infect Dis 2023; 42:1173-1181. [PMID: 37597051 DOI: 10.1007/s10096-023-04655-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To identify the predictors of morbidity and mortality in matched COVID-19 positive and negative patients who were septic with Gram positive or Gram negative infections. METHODS We conducted a retrospective review, from March to October 2020, of matched septic patients at five Hackensack Meridian Health hospitals who had bacteremia with Staphylococcus aureus, Klebsiella pneumoniae or Escherichia coli with and without COVID-19. We extracted patient demographics, comorbidities and clinical outcomes data using ICD-10 codes. Bacterial isolates were compared by whole genome sequencing analysis. Multivariate logistic regression was used to analyze independent predictors of morbidity and mortality. RESULTS A total of 208 patients were grouped by positive bloodstream infection (BSI) with COVID-19 (n = 104) and without COVID-19 (n = 104). Most patients were over age 50 (90% vs. 89%) and Caucasian (78% vs. 86%). Inpatient mortality was higher in patients with COVID-19 for both GP (35% vs. 8%, p < 0.05) and GN (28% vs. 10%, p < 0.05) BSIs. Patients with Gram positive (GP) BSIs had a significant increase in mortality risk (OR 4.5, CI 1.4-14.5, p < 0.05) in contrast to those with Gram negative (GN) infections (OR 0.4, CI 0.4-4.0, p = 0.4). CONCLUSION Concurrent COVID-19 infection is associated with a significant increase in morbidity and mortality in patients with GP and GN BSIs. Patients with S. aureus BSIs with COVID-19 are more likely to develop shock and respiratory failure and have higher rates and odds of mortality than those without COVID-19. These findings provide an essential insight into the care of these patients, especially those co-infected with Staphylococcus aureus.
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Affiliation(s)
- Sophia Dar
- Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
- Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, 11030, USA
| | - Daniel Erickson
- Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | - Claudia Manca
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Tara Lozy
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Elena Shashkina
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Milena Kordalewska
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Jose R Mediavilla
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - Albert Rojtman
- Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Barry N Kreiswirth
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA.
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24
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Plummer AM, Matos YL, Lin HC, Ryman SG, Birg A, Quinn DK, Parada AN, Vakhtin AA. Gut-brain pathogenesis of post-acute COVID-19 neurocognitive symptoms. Front Neurosci 2023; 17:1232480. [PMID: 37841680 PMCID: PMC10568482 DOI: 10.3389/fnins.2023.1232480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Approximately one third of non-hospitalized coronavirus disease of 2019 (COVID-19) patients report chronic symptoms after recovering from the acute stage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some of the most persistent and common complaints of this post-acute COVID-19 syndrome (PACS) are cognitive in nature, described subjectively as "brain fog" and also objectively measured as deficits in executive function, working memory, attention, and processing speed. The mechanisms of these chronic cognitive sequelae are currently not understood. SARS-CoV-2 inflicts damage to cerebral blood vessels and the intestinal wall by binding to angiotensin-converting enzyme 2 (ACE2) receptors and also by evoking production of high levels of systemic cytokines, compromising the brain's neurovascular unit, degrading the intestinal barrier, and potentially increasing the permeability of both to harmful substances. Such substances are hypothesized to be produced in the gut by pathogenic microbiota that, given the profound effects COVID-19 has on the gastrointestinal system, may fourish as a result of intestinal post-COVID-19 dysbiosis. COVID-19 may therefore create a scenario in which neurotoxic and neuroinflammatory substances readily proliferate from the gut lumen and encounter a weakened neurovascular unit, gaining access to the brain and subsequently producing cognitive deficits. Here, we review this proposed PACS pathogenesis along the gut-brain axis, while also identifying specific methodologies that are currently available to experimentally measure each individual component of the model.
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Affiliation(s)
- Allison M. Plummer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yvette L. Matos
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
| | - Henry C. Lin
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Sephira G. Ryman
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Aleksandr Birg
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, United States
- Section of Gastroenterology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM, United States
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Alisha N. Parada
- Division of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Andrei A. Vakhtin
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
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25
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Yang YT, Zhong X, Fahmi A, Watts S, Ashcroft DM, Massey J, Fisher L, MacKenna B, Mehrkar A, Bacon SCJ, Goldacre B, Hand K, van Staa T, Palin V. The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England. Antimicrob Resist Infect Control 2023; 12:102. [PMID: 37717030 PMCID: PMC10504725 DOI: 10.1186/s13756-023-01280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/22/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND There is concern that the COVID-19 pandemic altered the management of common infections in primary care. This study aimed to evaluate infection-coded consultation rates and antibiotic use during the pandemic and how any change may have affected clinical outcomes. METHODS With the approval of NHS England, a retrospective cohort study using the OpenSAFELY platform analysed routinely collected electronic health data from GP practices in England between January 2019 and December 2021. Infection coded consultations and antibiotic prescriptions were used estimate multiple measures over calendar months, including age-sex adjusted prescribing rates, prescribing by infection and antibiotic type, infection consultation rates, coding quality and rate of same-day antibiotic prescribing for COVID-19 infections. Interrupted time series (ITS) estimated the effect of COVID-19 pandemic on infection-coded consultation rates. The impact of the pandemic on non- COVID-19 infection-related hospitalisations was also estimated. RESULTS Records from 24 million patients were included. The rate of infection-related consultations fell for all infections (mean reduction of 39% in 2020 compared to 2019 mean rate), except for UTI which remained stable. Modelling infection-related consultation rates highlighted this with an incidence rate ratio of 0.44 (95% CI 0.36-0.53) for incident consultations and 0.43 (95% CI 0.33-0.54) for prevalent consultations. Lower respiratory tract infections (LRTI) saw the largest reduction of 0.11 (95% CI 0.07-0.17). Antibiotic prescribing rates fell with a mean reduction of 118.4 items per 1000 patients in 2020, returning to pre-pandemic rates by summer 2021. Prescribing for LRTI decreased 20% and URTI increased 15.9%. Over 60% of antibiotics were issued without an associated same-day infection code, which increased during the pandemic. Infection-related hospitalisations reduced (by 62%), with the largest reduction observed for pneumonia infections (72.9%). Same-day antibiotic prescribing for COVID-19 infection increased from 1 to 10.5% between the second and third national lockdowns and rose again during 2022. CONCLUSIONS Changes to consultations and hospital admissions may be driven by reduced transmission of non-COVID-19 infections due to reduced social mixing and lockdowns. Inconsistencies in coding practice emphasises the need for improvement to inform new antibiotic stewardship policies and prevent resistance to novel infections.
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Affiliation(s)
- Ya-Ting Yang
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Ali Fahmi
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Simon Watts
- Health Education England, Manchester, M1 3BN, UK
| | - Darren M Ashcroft
- Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Faculty of Biology, Medicine and Health, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Sebastian C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Kieran Hand
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Victoria Palin
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK.
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, The University of Manchester, Manchester, M13 9WL, UK.
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26
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Chen Z, Zhan Q, Huang L, Wang C. Coinfection and superinfection in ICU critically ill patients with severe COVID-19 pneumonia and influenza pneumonia: are the pictures different? Front Public Health 2023; 11:1195048. [PMID: 37711242 PMCID: PMC10497876 DOI: 10.3389/fpubh.2023.1195048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
Background Similar to influenza, coinfections and superinfections are common and might result in poor prognosis. Our study aimed to compare the characteristics and risks of coinfections and superinfections in severe COVID-19 and influenza virus pneumonia. Methods The data of patients with COVID-19 and influenza admitted to the intensive care unit (ICU) were retrospectively analyzed. The primary outcome was to describe the prevalence and pathogenic distribution of coinfections/ICU-acquired superinfections in the study population. The secondary outcome was to evaluate the independent risk factors for coinfections/ICU-acquired superinfections at ICU admission. Multivariate analysis of survivors and non-survivors was performed to investigate whether coinfections/ICU-acquired superinfections was an independent prognostic factor. Results In the COVID-19 (n = 123) and influenza (n = 145) cohorts, the incidence of coinfections/ICU-acquired superinfections was 33.3%/43.9 and 35.2%/52.4%, respectively. The most common bacteria identified in coinfection cases were Enterococcus faecium, Pseudomonas aeruginosa, and Acinetobacter baumannii (COVID-19 cohort) and A. baumannii, P. aeruginosa, and Klebsiella pneumoniae (influenza cohort). A significant higher proportion of coinfection events was sustained by Aspergillus spp. [(22/123, 17.9% in COVID-19) and (18/145, 12.4% in influenza)]. The COVID-19 group had more cases of ICU-acquired A. baumannii, Corynebacterium striatum and K. pneumoniae. A. baumannii, P. aeruginosa, and K. pneumoniae were the three most prevalent pathogens in the influenza cases with ICU-acquired superinfections. Patients with APACHE II ≥18, CD8+ T cells ≤90/μL, and 50 < age ≤ 70 years were more susceptible to coinfections; while those with CD8+ T cells ≤90/μL, CRP ≥120 mg/L, IL-8 ≥ 20 pg./mL, blood glucose ≥10 mmol/L, hypertension, and smoking might had a higher risk of ICU-acquired superinfections in the COVID-19 group. ICU-acquired superinfection, corticosteroid administration for COVID-19 treatment before ICU admission, and SOFA score ≥ 7 were independent prognostic factors in patients with COVID-19. Conclusion Patients with COVID-19 or influenza had a high incidence of coinfections and ICU-acquired superinfections. The represent agents of coinfection in ICU patients were different from those in the general ward. These high-risk patients should be closely monitored and empirically treated with effective antibiotics according to the pathogen.
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Affiliation(s)
- Ziying Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qingyuan Zhan
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Linna Huang
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, China-Japan Friendship Hospital, Beijing, China
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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27
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Sumardi U, Valentino B, Prasetya D, Debora J, Sugianli AK. The Diagnostic Value of Kinetics of NLR to Identify Secondary Pulmonary Bacterial Infection Among COVID-19 Patients at Single Tertiary Hospital in Indonesia. Int J Gen Med 2023; 16:3281-3289. [PMID: 37546238 PMCID: PMC10404039 DOI: 10.2147/ijgm.s417569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) is a new respiratory tract infection caused by severe acute respiratory syndrome coronavirus-2. The presence of secondary pulmonary bacterial infection (SPBI) made COVID-19 difficult to treat. Neutrophil-lymphocyte count ratio (NLR) is a systemic inflammatory marker used in the diagnosis and prognosis of viral or bacterial infection. At the first 3-5 days after hyperinflammation, it occurs in relation to clinical outcome. Therefore, this study aimed to evaluate the diagnostic value of NLR based on leukocyte kinetics upon admission and after 72 hours among COVID-19 patients with or without SPBI. Patients and Methods This retrospective cross-sectional study analyzed medical records data of admitted patients with COVID-19 according to the International Classification of Disease 10th Revision (ICD-10) between January and December 2021. The list of patients was extracted and followed by a hand search to identify the inclusion or exclusion criteria and stratified into proven and non-proven SPBI based on clinical data. The study distinguished between SPBI by means of a cut-off value (COV) on the first (D1) and third day (D3), assessed using receiver operating characteristics (ROC), as well as determined the magnitude of sensitivity, specificity, and prevalence ratio. Results A screening process was conducted on 2902 COVID-19 patients, of which 236 were included, accounting for 8.1%. Among these patients, 87 (36.9%) were found to have proven SPBI. A considerable difference in NLR value between proven and non-proven SPBI was observed on both D1 (11.1 vs 4.2) and D3 (15.3 vs 5.2), with optimal COV of NLR on D1, D3 was found to be 5.29, 9.47, respectively (p < 0.001). Conclusion NLR on the D1 and D3 distinguished the occurrence of SPBI among COVID-19 patients. The application of NLR assisted in the early determination of bacterial infection and helped in controlling the empirical use of antibiotics.
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Affiliation(s)
- Uun Sumardi
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Bima Valentino
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Dimmy Prasetya
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Josephine Debora
- Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Adhi Kristianto Sugianli
- Department of Clinical Pathology, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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28
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Romanelli F, Stolfa S, Ronga L, Del Prete R, Bavaro DF, Saracino A, Dalfino L, Mosca A. Coinfections in intensive care units. Has anything changed with Covid-19 pandemia? ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023075. [PMID: 37326281 PMCID: PMC10308474 DOI: 10.23750/abm.v94i3.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Since December 2019, the Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), has spread from China, becoming a pandemic. Bacterial and fungal co-infections may lead to increase in COVID-19 severity with a decrease in patients survive. The aim of this work was to evaluate bacterial and fungal co-infections in COVID-19 patients admitted to ICU in comparison with patients recovered in ICU in pre-COVID-19 era in order to understand whether the pandemic had changed the incidence of overinfections in patients admitted to ICU. In fact, the epidemiological data should guide the choice of empirical therapy. METHODS During pandemic, AOUC Policlinico of Bari organized dedicated ICUs for patient with SARS-CoV-2. Blood cultures, urine, and tracheobronchial aspirate were included in the analysis. RESULTS Specimens of 1905 patients were analysed in this work. Comparing clinical isolates prevalence by material and COVID-19 vs. non-COVID-19 patients statistically significant differences were detected for A. baumannii complex, Aspergillus fumigatus, Escherichia coli, Haemophilus influenzae and Serratia marcescens isolated from tracheobronchial aspirates; C. albicans from urine samples, A. baumannii complex, Enterococcus faecalis and Enterococcus faecium isolated from blood culture. CONCLUSIONS Although the organisms isolated in COVID-19 patients are consistent with those frequently associated with healthcare associated infection, our data suggest a particular prevalence in COVID-19 patients of A. baumannii, Stenotrophomonas maltophilia and Aspergillus spp. in the respiratory tract, C. albicans in urine and A. baumannii, E. faecalis and E. faecium in blood cultures.
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Affiliation(s)
- Federica Romanelli
- a:1:{s:5:"en_US";s:115:"1Section of Microbiology, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy";}.
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29
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Khan M, Li L, Haak L, Payen SH, Carine M, Adhikari K, Uppal T, Hartley PD, Vasquez-Gross H, Petereit J, Verma SC, Pagilla K. Significance of wastewater surveillance in detecting the prevalence of SARS-CoV-2 variants and other respiratory viruses in the community - A multi-site evaluation. One Health 2023; 16:100536. [PMID: 37041760 PMCID: PMC10074727 DOI: 10.1016/j.onehlt.2023.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/13/2023] Open
Abstract
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral genome in wastewater has proven to be useful for tracking the trends of virus prevalence within the community. The surveillance also provides precise and early detection of any new and circulating variants, which aids in response to viral outbreaks. Site-specific monitoring of SARS-CoV-2 variants provides valuable information on the prevalence of new or emerging variants in the community. We sequenced the genomic RNA of viruses present in the wastewater samples and analyzed for the prevalence of SARS-CoV-2 variants as well as other respiratory viruses for a period of one year to account for seasonal variations. The samples were collected from the Reno-Sparks metropolitan area on a weekly basis between November 2021 to November 2022. Samples were analyzed to detect the levels of SARS-CoV-2 genomic copies and variants identification. This study confirmed that wastewater monitoring of SARS-CoV-2 variants can be used for community surveillance and early detection of circulating variants and supports wastewater-based epidemiology (WBE) as a complement to clinical respiratory virus testing as a healthcare response effort. Our study showed the persistence of the SARS-CoV-2 virus throughout the year compared to a seasonal presence of other respiratory viruses, implicating SARS-CoV-2's broad genetic diversity and strength to persist and infect susceptible hosts. Through secondary analysis, we further identified antimicrobial resistance (AMR) genes in the same wastewater samples and found WBE to be a feasible tool for community AMR detection and monitoring.
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Affiliation(s)
- Majid Khan
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, MS320, Reno, NV 89557, USA
| | - Lin Li
- Department of Civil and Environmental Engineering, University of Nevada, MS258, Reno, NV 89557, USA
| | - Laura Haak
- Department of Civil and Environmental Engineering, University of Nevada, MS258, Reno, NV 89557, USA
| | - Shannon Harger Payen
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, MS320, Reno, NV 89557, USA
| | - Madeline Carine
- Department of Civil and Environmental Engineering, University of Nevada, MS258, Reno, NV 89557, USA
| | - Kabita Adhikari
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, MS320, Reno, NV 89557, USA
| | - Timsy Uppal
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, MS320, Reno, NV 89557, USA
| | - Paul D. Hartley
- Nevada Genomics Center, University of Nevada, Reno, NV 89557, USA
| | - Hans Vasquez-Gross
- Nevada Bioinformatics Center (RRID:SCR_017802), University of Nevada, Reno, NV 89557, USA
| | - Juli Petereit
- Nevada Bioinformatics Center (RRID:SCR_017802), University of Nevada, Reno, NV 89557, USA
| | - Subhash C. Verma
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, MS320, Reno, NV 89557, USA
| | - Krishna Pagilla
- Department of Civil and Environmental Engineering, University of Nevada, MS258, Reno, NV 89557, USA
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30
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Cortes JA, Valderrama-Rios MC, Nocua-Báez LC, Quitián LM, Lozada FA, Buitrago G. Effect of bloodstream infection on survival in COVID-19 patients admitted to an intensive care unit in Colombia: a matched cohort analysis. Infect Prev Pract 2023; 5:100283. [PMID: 37197192 PMCID: PMC10148245 DOI: 10.1016/j.infpip.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/31/2023] [Indexed: 05/19/2023] Open
Abstract
Aim To determine the impact of bloodstream infection (BSI) and other risk factors for mortality in patients with COVID-19 admitted to the intensive care unit (ICU). Methods A retrospective cohort was carried out at the Hospital Universitario Nacional (HUN) between March 29 and December 19, 2020. Patients with COVID-19 admitted to the Intensive Care Unit (ICU) were paired 1:4 in two groups, one with BSI and the other without, according to hospital stay and the month of admission. The primary outcome was mortality at 28 days. A Cox proportional hazards model was used to estimate differences in mortality risk. Results 456 patients were identified and 320 were included in the final cohort, 18% (n = 59) in the BSI group and 82% (n = 261) in the control group. 125 (39%) patients died, 30 (51%) in the BSI group and 95 (36%) in the control group (P = 0.040). BSI was associated with an increased risk of in-hospital mortality at 28 days, [HR] 1.77 (95% CI: 1.03-3.02; P = 0.037). Invasive mechanical ventilation (IMV) and age were associated with increased mortality risk. Some months of the year of the hospital stay were associated with a reduced risk of mortality. There was no difference in mortality between inappropriate and appropriate empirical antimicrobial use. Conclusion BSI in patients with COVID-19 in ICU increases in-hospital mortality to 28 days. Other risk factors for mortality were IMV and age.
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Affiliation(s)
- Jorge Alberto Cortes
- Department of Internal Medicine, Universidad Nacional de Colombia, Sede Bogotá, Facultad de Medicina, Bogotá, Colombia
- Infectious Diseases Service, Hospital Universitario Nacional, Bogotá, Colombia
| | | | - Laura Cristina Nocua-Báez
- Department of Internal Medicine, Universidad Nacional de Colombia, Sede Bogotá, Facultad de Medicina, Bogotá, Colombia
- Infectious Diseases Service, Hospital Universitario Nacional, Bogotá, Colombia
| | - Lina María Quitián
- Department of Internal Medicine, Universidad Nacional de Colombia, Sede Bogotá, Facultad de Medicina, Bogotá, Colombia
| | - Fabio Alexander Lozada
- Department of Internal Medicine, Universidad Nacional de Colombia, Sede Bogotá, Facultad de Medicina, Bogotá, Colombia
| | - Giancarlo Buitrago
- Research Institute, Universidad Nacional de Colombia, Sede Bogotá, Facultad de Medicina, Bogotá, Colombia
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31
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Amati F, Bindo F, Stainer A, Gramegna A, Mantero M, Nigro M, Bussini L, Bartoletti M, Blasi F, Aliberti S. Identify Drug-Resistant Pathogens in Patients with Community-Acquired Pneumonia. Adv Respir Med 2023; 91:224-238. [PMID: 37366804 PMCID: PMC10295768 DOI: 10.3390/arm91030018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
A substantial increase in broad-spectrum antibiotics as empirical therapy in patients with community-acquired pneumonia (CAP) has occurred over the last 15 years. One of the driving factors leading to that has been some evidence showing an increased incidence of drug-resistant pathogens (DRP) in patients from a community with pneumonia, including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Research has been published attempting to identify DRP in CAP through the implementation of probabilistic approaches in clinical practice. However, recent epidemiological data showed that the incidence of DRP in CAP varies significantly according to local ecology, healthcare systems and countries where the studies were performed. Several studies also questioned whether broad-spectrum antibiotic coverage might improve outcomes in CAP, as it is widely documented that broad-spectrum antibiotics overuse is associated with increased costs, length of hospital stay, drug adverse events and resistance. The aim of this review is to analyze the different approaches used to identify DRP in CAP patients as well as the outcomes and adverse events in patients undergoing broad-spectrum antibiotics.
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Affiliation(s)
- Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesco Bindo
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Marco Mantero
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mattia Nigro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Linda Bussini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, 20089 Milan, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, 20089 Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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32
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Bantun F. Fungal-Bacterial Co-Infections and Super-Infections among Hospitalized COVID-19 Patients: A Systematic Review. J Fungi (Basel) 2023; 9:598. [PMID: 37367534 PMCID: PMC10299597 DOI: 10.3390/jof9060598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 06/28/2023] Open
Abstract
This study systematically reviewed fungal-bacterial co-infections and super-infections among hospitalized COVID-19 patients. A PRISMA systematic search was conducted. On September 2022, Medline, PubMed, Google Scholar, PsychINFO, Wiley Online Library, NATURE, and CINAHL databases were searched for all relevant articles published in English. All articles that exclusively reported the presence of fungal-bacterial co-infections and super-infections among hospitalized COVID-19 patients were included. Seven databases produced 6937 articles as a result of the literature search. Twenty-four articles met the inclusion criteria and were included in the final analysis. The total number of samples across the studies was 10,834, with a total of 1243 (11.5%) patients admitted to the intensive care unit (ICU). Of these patients, 535 underwent mechanical ventilation (4.9%), 2386 (22.0%) were male, and 597 (5.5%) died. Furthermore, hospitalized COVID-19 patients have a somewhat high rate (23.5%) of fungal-bacterial co-infections and super-infections. Moreover, for SARS-CoV-2 patients who have a chest X-ray that suggests a bacterial infection, who require immediate ICU admission, or who have a seriously immunocompromised condition, empiric antibiotic therapy should be taken into consideration. Additionally, the prevalence of co-infections and super-infections among hospitalized COVID-19 patients may have an impact on diagnosis and treatment. It is crucial to check for fungal and bacterial co-infections and super-infections in COVID-19 patients.
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Affiliation(s)
- Farkad Bantun
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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33
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Bhatt S, Pathak R, Punetha VD, Punetha M. Recent advances and mechanism of antimicrobial efficacy of graphene-based materials: a review. JOURNAL OF MATERIALS SCIENCE 2023; 58:7839-7867. [PMID: 37200572 PMCID: PMC10166465 DOI: 10.1007/s10853-023-08534-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Graphene-based materials have undergone substantial investigation in recent years owing to their wide array of physicochemical characteristics. Employment of these materials in the current state, where infectious illnesses caused by microbes have severely damaged human life, has found widespread application in combating fatal infectious diseases. These materials interact with the physicochemical characteristics of the microbial cell and alter or damage them. The current review is dedicated to molecular mechanisms underlying the antimicrobial property of graphene-based materials. Various physical and chemical mechanisms leading to cell membrane stress, mechanical wrapping, photo-thermal ablation as well as oxidative stress exerting antimicrobial effect have also been thoroughly discussed. Furthermore, an overview of the interactions of these materials with membrane lipids, proteins, and nucleic acids has been provided. A thorough understanding of discussed mechanisms and interactions is essential to develop extremely effective antimicrobial nanomaterial for application as an antimicrobial agent. Graphical abstract
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Affiliation(s)
- Shalini Bhatt
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Rakshit Pathak
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Vinay Deep Punetha
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
| | - Mayank Punetha
- 2D Materials and LASER Actuation Laboratory, Centre of Excellence for Research, PP Savani University, NH-8, Kosamba-Surat, Gujarat 394125 India
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Mahoney A, Storek KM, Wuest WM. Structure-Based Design of Promysalin Analogues to Overcome Mechanisms of Bacterial Resistance. ACS OMEGA 2023; 8:12558-12564. [PMID: 37033834 PMCID: PMC10077553 DOI: 10.1021/acsomega.3c00884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The search for antibiotics that function through novel mechanisms of action is ongoing, and recent progress in our lab identified the tricarboxylic acid cycle as a viable option. Promysalin is a secondary metabolite capable of species-specific inhibition of Pseudomonas aeruginosa, a common opportunistic pathogen. Promysalin disrupts primary metabolism in this bacterium by competitively inhibiting succinate dehydrogenase at the ubiquinone binding site. However, the activity of promysalin in cellulo is marred potentially by its chemical instability and/or propensity for efflux. To assess the success of these novel analogues, a novel strain of P. aeruginosa harboring gene deletions of eight efflux pumps and porins was developed and implemented. Herein, we disclose the synthesis and biological investigation of six promysalin analogues to overcome these liabilities and demonstrate that efflux likely plays a significant role in tolerating the effect of the inhibitor.
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Affiliation(s)
- Andrew
R. Mahoney
- Department
of Chemistry, Emory Univers ity, and Emory
Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia 30322, United States
| | - Kelly M. Storek
- Department
of Infectious Diseases, Genentech, Inc. South San Francisco, California 94080, United States
| | - William M. Wuest
- Department
of Chemistry, Emory Univers ity, and Emory
Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia 30322, United States
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35
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Rehman S. A parallel and silent emerging pandemic: Antimicrobial resistance (AMR) amid COVID-19 pandemic. J Infect Public Health 2023; 16:611-617. [PMID: 36857834 PMCID: PMC9942450 DOI: 10.1016/j.jiph.2023.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/12/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
World is in the middle of the pandemic (COVID-19), caused by SARS-COV-2 virus, which is a significant global health crisis after Spanish influenza in the beginning of 20th century. Progressive drastic steps have been enforced to minimize the transmission of the disease. Likewise, in the current years, antimicrobial resistance (AMR) has been referred as one of the potential perils to the global economy and health; however, it is now veiled under the present pandemic. During the current pandemic, AMR to available frontline antibiotics may prove fatal and life threatening to bacterial and fungal infections during routine procedures like elective surgery, C-sections, etc. Currently, a swift elevation in multidrug-resistant organisms (MDROs), like carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Acinetobacter baumannii, Enterobacterales, extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), multi-triazole-resistant Aspergillus fumigatus and pan-echinocandin-resistant Candida glabrata has been seen. Thereupon, the global outbreak of COVID-19 also offers some important ramification for developing antimicrobial drug resistance. This article aims to highlights episodes and aspects of AMR prevalence, impact of management and mismanagement of COVID-19 crisis, hospital settings, community, environment, and travel on the AMR during the current pandemic.
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Affiliation(s)
- Suriya Rehman
- Department of Epidemic Diseases Research, Institute for Research & Medical Consultations, (IRMC), Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
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36
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García-García J, Diez-Echave P, Yuste ME, Chueca N, García F, Cabeza-Barrera J, Fernández-Varón E, Gálvez J, Colmenero M, Rodríguez-Cabezas ME, Rodríguez-Nogales A, Morón R. Gut Microbiota Composition Can Predict Colonization by Multidrug-Resistant Bacteria in SARS-CoV-2 Patients in Intensive Care Unit: A Pilot Study. Antibiotics (Basel) 2023; 12:antibiotics12030498. [PMID: 36978365 PMCID: PMC10044413 DOI: 10.3390/antibiotics12030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
The SARS-CoV-2 infection has increased the number of patients entering Intensive Care Unit (ICU) facilities and antibiotic treatments. Concurrently, the multi-drug resistant bacteria (MDRB) colonization index has risen. Considering that most of these bacteria are derived from gut microbiota, the study of its composition is essential. Additionally, SARS-CoV-2 infection may promote gut dysbiosis, suggesting an effect on microbiota composition. This pilot study aims to determine bacteria biomarkers to predict MDRB colonization risk in SARS-CoV-2 patients in ICUs. Seventeen adult patients with an ICU stay >48 h and who tested positive for SARS-CoV-2 infection were enrolled in this study. Patients were assigned to two groups according to routine MDRB colonization surveillance: non-colonized and colonized. Stool samples were collected when entering ICUs, and microbiota composition was determined through Next Generation Sequencing techniques. Gut microbiota from colonized patients presented significantly lower bacterial diversity compared with non-colonized patients (p < 0.05). Microbiota in colonized subjects showed higher abundance of Anaerococcus, Dialister and Peptoniphilus, while higher levels of Enterococcus, Ochrobactrum and Staphylococcus were found in non-colonized ones. Moreover, LEfSe analysis suggests an initial detection of Dialister propionicifaciens as a biomarker of MDRB colonization risk. This pilot study shows that gut microbiota profile can become a predictor biomarker for MDRB colonization in SARS-CoV-2 patients.
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Affiliation(s)
- Jorge García-García
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
| | - Patricia Diez-Echave
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - María Eugenia Yuste
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | - Natalia Chueca
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERInfec), 18016 Granada, Spain
| | - Federico García
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERInfec), 18016 Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERInfec), 28029 Madrid, Spain
| | - Jose Cabeza-Barrera
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio Farmacia Hospitalaria, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | - Emilio Fernández-Varón
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Julio Gálvez
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Manuel Colmenero
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
- Correspondence: (M.C.); (M.E.R.-C.)
| | - Maria Elena Rodríguez-Cabezas
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Correspondence: (M.C.); (M.E.R.-C.)
| | - Alba Rodríguez-Nogales
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
| | - Rocío Morón
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
- Servicio Farmacia Hospitalaria, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
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Bacterial infections and antibiotic utilization varies by coronavirus disease 19 (COVID-19) severity in hospitalized cancer patients: Analysis from the first phase of the pandemic. Infect Control Hosp Epidemiol 2023; 44:413-419. [PMID: 35616016 PMCID: PMC9203359 DOI: 10.1017/ice.2022.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize bacterial infections and antibiotic utilization in hospitalized cancer patients with coronavirus disease 2019 (COVID-19). DESIGN Retrospective cohort study. SETTING Tertiary cancer center in New York City. PATIENTS Hospitalized cancer patients ≥18 years with COVID-19 between March 1, 2020, and May 31, 2020. METHODS Patients were classified with mild COVID-19 (ie, with room air), moderate COVID-19 (ie, using nasal cannula oxygen), or severe COVID-19 (ie, using high-flow oxygen or mechanical ventilation). The primary outcome was bacterial infection rate within 30 days of COVID-19 onset. Secondary outcomes included the proportion of patients receiving antibiotics and antibiotic length of therapy (LOT). RESULTS Of 358 study patients, 133 had mild COVID-19, 97 had moderate COVID-19, and 128 had severe COVID-19. Of 358 patients, 234 (65%) had a solid tumor. Also, 200 patients (56%) had 245 bacterial infections, of which 67 (27%) were microbiologically confirmed. The proportion of patients with bacterial infection increased with COVID-19 severity: mild (n = 47, 35%) versus moderate (n = 49, 51%) versus severe (n = 104, 81%) (P < .0001). Also, 274 (77%) received antibiotics for a median of 4 days. The median antibiotic LOTs were 7 days with 1 infection and 20 days with multiple infections (P < .0001). Antibiotic durations were 1 day for patients with mild COVID-19, 4 days for patients with moderate COVID-19, and 8 days for patients with severe COVID-19 (P < .0001). CONCLUSIONS Hospitalized cancer patients with COVID-19 had a high rate of bacterial infection. As COVID-19 severity increased, the proportion of patients diagnosed with bacterial infection and given antibiotics increased. In mild COVID-19 cases, antibiotic LOT was short, suggesting that empiric antibiotics can be safely avoided or discontinued in this group.
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Langford BJ, So M, Simeonova M, Leung V, Lo J, Kan T, Raybardhan S, Sapin ME, Mponponsuo K, Farrell A, Leung E, Soucy JPR, Cassini A, MacFadden D, Daneman N, Bertagnolio S. Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis. THE LANCET. MICROBE 2023; 4:e179-e191. [PMID: 36736332 PMCID: PMC9889096 DOI: 10.1016/s2666-5247(22)00355-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/08/2022] [Accepted: 11/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Frequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19. METHODS We did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344). FINDINGS We included 148 studies of 362 976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I2=95%). INTERPRETATION Although infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed. FUNDING WHO.
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Affiliation(s)
- Bradley J Langford
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, ON, Canada; Toronto East Health Network, Toronto, ON, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tiffany Kan
- North York General Hospital, Toronto, ON, Canada
| | | | - Mia E Sapin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Mponponsuo
- University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada
| | | | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, UK
| | - Jean-Paul R Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Derek MacFadden
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Traglia GM, Pasteran F, Escalante J, Nishimura B, Tuttobene MR, Subils T, Nuñez MR, Rivollier MG, Corso A, Tolmasky ME, Ramirez MS. Genomic Comparative Analysis of Two Multi-Drug Resistance (MDR) Acinetobacter baumannii Clinical Strains Assigned to International Clonal Lineage II Recovered Pre- and Post-COVID-19 Pandemic. BIOLOGY 2023; 12:358. [PMID: 36979049 PMCID: PMC10045941 DOI: 10.3390/biology12030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND After the emergence of COVID-19, numerous cases of A. baumannii/SARS-CoV-2 co-infection were reported. Whether the co-infecting A. baumannii strains have distinctive characteristics remains unknown. METHODS AND RESULTS A. baumannii AMA_NO was isolated in 2021 from a patient with COVID-19. AMA166 was isolated from a mini-BAL used on a patient with pneumonia in 2016. Both genomes were similar, but they possessed 337 (AMA_NO) and 93 (AMA166) unique genes that were associated with biofilm formation, flagellar assembly, antibiotic resistance, secretion systems, and other functions. The antibiotic resistance genes were found within mobile genetic elements. While both strains harbored the carbapenemase-coding gene blaOXA-23, only the strain AMA_NO carried blaNDM-1. Representative functions coded for by virulence genes are the synthesis of the outer core of lipooligosaccharide (OCL5), biosynthesis and export of the capsular polysaccharide (KL2 cluster), high-efficiency iron uptake systems (acinetobactin and baumannoferrin), adherence, and quorum sensing. A comparative phylogenetic analysis including 239 additional sequence type (ST) 2 representative genomes showed high similarity to A. baumannii ABBL141. Since the degree of similarity that was observed between A. baumannii AMA_NO and AMA166 is higher than that found among other ST2 strains, we propose that they derive from a unique background based on core-genome phylogeny and comparative genome analysis. CONCLUSIONS Acquisition or shedding of specific genes could increase the ability of A. baumannii to infect patients with COVID-19.
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Affiliation(s)
- German Matias Traglia
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Universidad de la Republica, Montevideo 11200, Uruguay
| | - Fernando Pasteran
- National Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires 1282, Argentina
| | - Jenny Escalante
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA
| | - Brent Nishimura
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA
| | - Marisel R. Tuttobene
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario 2000, Argentina
| | - Tomás Subils
- Instituto de Procesos Biotecnológicos y Químicos de Rosario (IPROBYQ, CONICET-UNR), Rosario 2000, Argentina
| | - Maria Rosa Nuñez
- Laboratorio de Microbiología, Hospital Provincial Neuquén Dr. Castro Rendón, Neuquén 8300, Argentina
| | | | - Alejandra Corso
- National Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires 1282, Argentina
| | - Marcelo E. Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA
| | - Maria Soledad Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA
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Ahava MJ, Kortela E, Forsblom E, Pätäri-Sampo A, Friberg N, Meretoja A, Kivivuori SM, Lappalainen M, Kurkela S, Järvinen A, Jarva H. Low incidence of severe bacterial infections in hospitalised patients with COVID-19: A population-based registry study. Infect Dis (Lond) 2023; 55:132-141. [PMID: 36305894 DOI: 10.1080/23744235.2022.2138963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bacterial infections complicating COVID-19 are rare but present a challenging clinical entity. The aim of this study was to evaluate the incidence, aetiology and outcome of severe laboratory-verified bacterial infections in hospitalised patients with COVID-19. METHODS All laboratory-confirmed patients with COVID-19 admitted to specialised healthcare hospitals in the Capital Province of Finland during the first wave of COVID-19 between 27 February and 21 June 2020 were retrospectively studied. We gathered the blood and respiratory tract culture reports of these patients and analysed their association with 90-day case-fatality using multivariable regression analysis. RESULTS A severe bacterial infection was diagnosed in 40/585 (6.8%) patients with COVID-19. The range of bacteria was diverse, and the most common bacterial findings in respiratory samples were gram-negative, and in blood cultures gram-positive bacteria. Patients with severe bacterial infection had longer hospital stay (mean 31; SD 20 days) compared to patients without (mean 9; SD 9 days; p < 0.001). Case-fatality was higher with bacterial infection (15% vs 11%), but the difference was not statistically significant (OR 1.38 CI95% 0.56-3.41). CONCLUSIONS Severe bacterial infection complicating COVID-19 was a rare occurrence in our cohort. Our results are in line with the current understanding that antibiotic treatment for hospitalised COVID-19 patients should only be reserved for situations where a bacterial infection is strongly suspected. The ever-evolving landscape of the pandemic and recent advances in immunomodulatory treatment of COVID-19 patients underline the need for continuous vigilance concerning the possibility and frequency of nosocomial bacterial infections.
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Affiliation(s)
- M J Ahava
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Kortela
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - E Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Pätäri-Sampo
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - N Friberg
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Meretoja
- General Administration, Helsinki University Hospital, Helsinki, Finland
| | - S-M Kivivuori
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - S Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - H Jarva
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology Department, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Translational Immunology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
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Lee J, Chang E, Jung J, Kim MJ, Chong YP, Kim SH, Lee SO, Choi SH, Kim YS, Bae S. Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19. J Korean Med Sci 2023; 38:e37. [PMID: 36718563 PMCID: PMC9886529 DOI: 10.3346/jkms.2023.38.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METHODS In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. RESULTS Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. CONCLUSION In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.
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Affiliation(s)
- Jiyoung Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Euijin Chang
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Hafiz TA, Albloshi A, Alhumaidan OS, Mubaraki MA, Alyami AS, Alrashoudi R, Alrabiah MA, Alotaibi F. The Epidemiological Pattern, Resistance Characteristics and Clinical Outcome of Enterobacter cloacae: Recent Updates and Impact of COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11030312. [PMID: 36766887 PMCID: PMC9914498 DOI: 10.3390/healthcare11030312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES E. cloacae is an opportunistic organism that causes serious infections, particularly in immuno-compromised and hospitalized patients, along with the emergence of resistance traits. The COVID-19 pandemic has impacted the epidemiological pattern and resistance traits of E. cloacae infections as well as those of other bacteria. The study aims to assess the epidemiological patterns, resistance characteristics and clinical outcomes of E. cloacae in Saudi Arabia and the impact of the COVID-19 pandemic. METHODS King Fahad Medical City in Riyadh provided the data between January 2019 and December 2021 for the retrospective study of 638 isolates of E. cloacae. The clinical outcome of an E. cloacae infection was also determined by collecting and statistically analyzing the clinical records of 153 ICU patients. RESULTS The total percentage of resistant E. cloacae isolates decreased from 48.36% in 2019 to 38% in 2020 and 37.6% in 2021. The overall mortality rate among ICU patients was 40.5%, with an adult age group having a substantial relative risk value of 1.37. CONCLUSION E. cloacae is a prevalent nosocomial infection in which adult age is a significant risk factor for mortality. Moreover, this study emphasizes the importance of comparing E. cloacae resistance trends before and throughout the pandemic period in order to better understand the bacteria's behaviour.
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Affiliation(s)
- Taghreed A. Hafiz
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
- Correspondence:
| | - Alaa Albloshi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ohoud S. Alhumaidan
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Murad A. Mubaraki
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ahmed S. Alyami
- Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Reem Alrashoudi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mona A. Alrabiah
- Microbiology and Immunology Department, King Khaled University Hospital, Riyadh 12372, Saudi Arabia
| | - Fawzia Alotaibi
- Pathology Department, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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Bonazzetti C, Giannella M. The controversial bond between COVID-19 and bacterial superinfections. Clin Microbiol Infect 2023; 29:411-413. [PMID: 36621671 PMCID: PMC9814274 DOI: 10.1016/j.cmi.2022.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Cecilia Bonazzetti
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Kariyappa M, Patel AS, Dhanalakshmi K, Dakshayani B. Rhino-orbito-cerebral invasive fungal sinusitis associated with COVID-19 infection in a malnurished child. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [PMCID: PMC9810516 DOI: 10.1186/s43054-022-00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Abstract
Background
Corona virus disease has been associated with a wide variety of fungal and bacterial co-infections. These secondary infections could be due to the irrational use of antibiotics, immunosuppressive therapy, pre-existing co morbidities, and immune modulator effects of the virus. But here, we report a very rare occurring of rhino-orbito-cerebral invasive fungal sinusitis in a malnourished child and no other co morbidities.
Case presentation
This is a case of a 6-year-old boy with severe thinness and no other co-morbidities, with mild COVID-19 infection, during the course of illness developed rhino-orbito-cerebral invasive fungal sinusitis. The child’s mother had COVID-19 1 week prior to child’s illness. The child then developed fever followed by headache. The child reported to hospital on seventh day of illness and RTPCR for COVID-19, turned positive. The child’s vitals were stable and maintaining saturation. Child was being treated with supplements and symptomatic treatment for fever. On his second day of stay at hospital, he started to develop gradually progressive left-sided peri-orbital swelling. Due to the association of COVID-19 with fungal infection, child was started on AMPHOTERICIN-B and given for 4 days and referred to a higher center for further management. Radiological imaging was suggestive of rhino-sinusitis with orbital cellulitis with meningeal enhancement suggestive of fungal etiology. Debridement was done, child was adequately treated with anti-fungal, and the child showed significant improvement along with radiological clearing.
Conclusion
Invasive fungal infection can occur in association with COVID-19 among malnourished pediatric age groups with no other comorbidities.
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45
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Hu S, You Y, Zhang S, Tang J, Chen C, Wen W, Wang C, Cheng Y, Zhou M, Feng Z, Tan T, Qi G, Wang M, Liu X. Multidrug-resistant infection in COVID-19 patients: A meta-analysis. J Infect 2023; 86:66-117. [PMID: 36347426 PMCID: PMC9637013 DOI: 10.1016/j.jinf.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Siqi Hu
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Yao You
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Shenghui Zhang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Jiake Tang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Chen Chen
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Wen Wen
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Chunyi Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, 311300, China
| | - Mengyun Zhou
- Department of Molecular & Cellular Physiology, Shinshu University School of Medicine, 3900803, Japan
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, China
| | - Tao Tan
- Faculty of Applied Science, Macao Polytechnic University, Macao SAR, 999078, China
| | - Guanming Qi
- Division of Pulmonary, Critical Care and Sleep, Tufts Medical Center, Boston, MA, 02111, USA,Corresponding authors
| | - Mingwei Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China,Corresponding authors
| | - Xiaoyan Liu
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China,Corresponding authors
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Che Yusof R, Norhayati MN, Mohd Azman Y. Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis. PeerJ 2023; 11:e15265. [PMID: 37128208 PMCID: PMC10148641 DOI: 10.7717/peerj.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023] Open
Abstract
Background There were a few studies on bacterial coinfection in hospitalized COVID-19 patients worldwide. This systematic review aimed to provide the pooled prevalence of bacterial coinfection from published studies from 2020 to 2022. Methods Three databases were used to search the studies, and 49 studies from 2,451 identified studies involving 212,605 COVID-19 patients were included in this review. Results The random-effects inverse-variance model determined that the pooled prevalence of bacterial coinfection in hospitalized COVID-19 patients was 26.84% (95% CI [23.85-29.83]). The pooled prevalence of isolated bacteria for Acinetobacter baumannii was 23.25% (95% CI [19.27-27.24]), Escherichia coli was 10.51% (95% CI [8.90-12.12]), Klebsiella pneumoniae was 15.24% (95% CI [7.84-22.64]), Pseudomonas aeruginosa was 11.09% (95% CI [8.92-13.27]) and Staphylococcus aureus (11.59% (95% CI [9.71-13.46])). Meanwhile, the pooled prevalence of antibiotic-resistant bacteria for extended-spectrum beta-lactamases producing Enterobacteriaceae was 15.24% (95% CI [7.84-22.64]) followed by carbapenem-resistant Acinetobacter baumannii (14.55% (95% CI [9.59-19.52%])), carbapenem-resistant Pseudomonas aeruginosa (6.95% (95% CI [2.61-11.29])), methicillin-resistant Staphylococcus aureus (5.05% (95% CI [3.49-6.60])), carbapenem-resistant Enterobacteriaceae (4.95% (95% CI [3.10-6.79])), and vancomycin-resistant Enterococcus (1.26% (95% CI [0.46-2.05])). Conclusion All the prevalences were considered as low. However, effective management and prevention of the infection should be considered since these coinfections have a bad impact on the morbidity and mortality of patients.
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Affiliation(s)
- Ruhana Che Yusof
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yacob Mohd Azman
- Medical Development Division, Ministry of Health, Putrajaya, Malaysia
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47
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Hashmi AW, Ahmad M, Israr MM, Fajar IE, Adnan F. Multi-Drug-Resistant Elizabethkingia meningoseptica: A Rare Cause of Late-Onset Sepsis in a Preterm Neonate. Cureus 2023; 15:e34361. [PMID: 36874723 PMCID: PMC9977078 DOI: 10.7759/cureus.34361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Elizabethkingia meningoseptica is a gram-negative bacillus and is a rare cause of opportunistic infections. Literature shows that this gram-negative bacillus may cause early-onset sepsis in neonates and immunocompromised adults; however, it is a rare cause of late-onset sepsis or meningitis in neonates. We hereby delineate a case of a preterm neonate, born at 35 weeks of gestation, presenting to us on the eleventh day after birth, with fever, tachycardia, and delayed reflexes. The neonate was managed in the neonatal intensive care unit (NICU). Initial laboratory tests, blood, and cerebrospinal fluid (CSF) cultures showed evidence of late-onset sepsis due to multi-drug-resistant E. meningoseptica sensitive to vancomycin and ciprofloxacin. The patient completed the antibiotic therapy and was discharged from the hospital. The patient was followed up at one and two months after discharge in the tele-clinic and was thriving well with no complaints.
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Affiliation(s)
| | | | | | - Ibtesam E Fajar
- Surgery, Al-Nafees Medical College and Hospital, Islamabad, PAK
| | - Farid Adnan
- Pediatrics, Walsall Manor Hospital, The Royal Wolverhampton NHS Trust, Walsall, GBR
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48
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Na YS, Baek AR, Baek MS, Kim WY, Kim JH, Lee BY, Seong GM, Lee SI. Clinical outcomes of and risk factors for secondary infection in patients with severe COVID-19: a multicenter cohort study in South Korea. Korean J Intern Med 2023; 38:68-79. [PMID: 36420564 PMCID: PMC9816674 DOI: 10.3904/kjim.2022.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/AIMS Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. METHODS This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. RESULTS Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). CONCLUSION In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.
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Affiliation(s)
- Yong Sub Na
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju,
Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Bo young Lee
- Division of Allergy and Respiratory Diseases, Soonchunhyang University Hospital, Seoul,
Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju,
Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
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49
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Witt LS, Howard-Anderson JR, Jacob JT, Gottlieb LB. The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review. JAC Antimicrob Resist 2022; 5:dlac130. [PMID: 36601548 PMCID: PMC9798082 DOI: 10.1093/jacamr/dlac130] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) changed healthcare across the world. With this change came an increase in healthcare-associated infections (HAIs) and a concerning concurrent proliferation of MDR organisms (MDROs). In this narrative review, we describe the impact of COVID-19 on HAIs and MDROs, describe potential causes of these changes, and discuss future directions to combat the observed rise in rates of HAIs and MDRO infections.
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Affiliation(s)
- Lucy S Witt
- Corresponding author. E-mail: ; @drwittID, @JessH_A, @jestjac
| | - Jessica R Howard-Anderson
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Jesse T Jacob
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Lindsey B Gottlieb
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
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50
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Ram-Mohan N, Rogers AJ, Blish CA, Nadeau KC, Zudock EJ, Kim D, Quinn JV, Sun L, Liesenfeld O, Yang S. Using a 29-mRNA Host Response Classifier To Detect Bacterial Coinfections and Predict Outcomes in COVID-19 Patients Presenting to the Emergency Department. Microbiol Spectr 2022; 10:e0230522. [PMID: 36250865 PMCID: PMC9769905 DOI: 10.1128/spectrum.02305-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023] Open
Abstract
Clinicians in the emergency department (ED) face challenges in concurrently assessing patients with suspected COVID-19 infection, detecting bacterial coinfection, and determining illness severity since current practices require separate workflows. Here, we explore the accuracy of the IMX-BVN-3/IMX-SEV-3 29 mRNA host response classifiers in simultaneously detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and bacterial coinfections and predicting clinical severity of COVID-19. A total of 161 patients with PCR-confirmed COVID-19 (52.2% female; median age, 50.0 years; 51% hospitalized; 5.6% deaths) were enrolled at the Stanford Hospital ED. RNA was extracted (2.5 mL whole blood in PAXgene blood RNA), and 29 host mRNAs in response to the infection were quantified using Nanostring nCounter. The IMX-BVN-3 classifier identified SARS-CoV-2 infection in 151 patients with a sensitivity of 93.8%. Six of 10 patients undetected by the classifier had positive COVID tests more than 9 days prior to enrollment, and the remaining patients oscillated between positive and negative results in subsequent tests. The classifier also predicted that 6 (3.7%) patients had a bacterial coinfection. Clinical adjudication confirmed that 5/6 (83.3%) of the patients had bacterial infections, i.e., Clostridioides difficile colitis (n = 1), urinary tract infection (n = 1), and clinically diagnosed bacterial infections (n = 3), for a specificity of 99.4%. Two of 101 (2.8%) patients in the IMX-SEV-3 "Low" severity classification and 7/60 (11.7%) in the "Moderate" severity classification died within 30 days of enrollment. IMX-BVN-3/IMX-SEV-3 classifiers accurately identified patients with COVID-19 and bacterial coinfections and predicted patients' risk of death. A point-of-care version of these classifiers, under development, could improve ED patient management, including more accurate treatment decisions and optimized resource utilization. IMPORTANCE We assay the utility of the single-test IMX-BVN-3/IMX-SEV-3 classifiers that require just 2.5 mL of patient blood in concurrently detecting viral and bacterial infections as well as predicting the severity and 30-day outcome from the infection. A point-of-care device, in development, will circumvent the need for blood culturing and drastically reduce the time needed to detect an infection. This will negate the need for empirical use of broad-spectrum antibiotics and allow for antibiotic use stewardship. Additionally, accurate classification of the severity of infection and the prediction of 30-day severe outcomes will allow for appropriate allocation of hospital resources.
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Affiliation(s)
- Nikhil Ram-Mohan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Angela J. Rogers
- Department of Medicine—Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Catherine A. Blish
- Department of Medicine/Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
| | - Kari C. Nadeau
- Department of Medicine—Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Elizabeth J. Zudock
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David Kim
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - James V. Quinn
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lixian Sun
- Inflammatix, Inc., Burlingame, California, USA
| | | | - The Stanford COVID-19 Biobank Study Group
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine—Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine/Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA
- Inflammatix, Inc., Burlingame, California, USA
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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