Obesity as a Determinant of Staphylococcus aureus Colonization Among Inmates in Maximum-Security Prisons in New York State

Burden of diabetes in correctional facilities: A global systematic review and meta-analysis

Background

Diabetes mellitus presents significant public health challenges worldwide. While its prevalence and management in the general population have been extensively studied, comprehensive research on diabetes among incarcerated individuals is lacking. This study aims to conduct a systematic review and meta-analysis to determine the prevalence of diabetes within the prison population.

Methods

The systematic review included studies reporting on the prevalence of diabetes in prison populations. Searches were conducted in PubMed, Web of Science, and EMBASE from 2000 to November 4, 2023, with an update on December 15, 2023. Nested Knowledge web software was utilized for screening and data extraction. Quality assessment was conducted using the JBI tool. A meta-analysis was performed using a random-effects model in R software version 4.3.

Results

Thirty-three studies were included, encompassing 807,617 participants, with 67,291 reported as patients with diabetes. The pooled prevalence of diabetes in prison populations was found to be 7.1% (95% CI: 4.9% to 10.1%), exhibiting high heterogeneity (I2 = 100%). Subgroup analysis revealed significant geographical variability: the United States had a prevalence of 9% (95% CI: 4 %to 17 %), Italy 5% (95% CI: 0% to 40 %), Iran 10% (95% CI: 7 % to 15 %), and Egypt 21% (95% CI: 14% to 28 %). Notable variations in prevalence were also observed in countries like France, Australia, Taiwan, India, the UK, Spain, Brazil, and Sub-Saharan Africa. An LFK index of -3.3 indicated the presence of publication bias.

Conclusion

The study reveals that diabetes mellitus is a significant health concern in prisons, with a prevalence of 7.1%, comparable to that in the general population. The marked variability across studies indicates the challenges of diabetes management in correctional settings. These findings highlight the need for tailored healthcare strategies, considering prisons' unique challenges and risk factors.

Time-restricted feeding mediated modulation of microbiota leads to changes in muscle physiology in Drosophila obesity models

Recent research has highlighted the essential role of the microbiome in maintaining skeletal muscle physiology. The microbiota influences muscle health by regulating lipid metabolism, protein synthesis, and insulin sensitivity. However, metabolic disturbances such as obesity can lead to dysbiosis, impairing muscle function. Time-restricted feeding (TRF) has been shown to mitigate obesity-related muscle dysfunction, but its effects on restoring healthy microbiomes remain poorly understood. This study utilizes 16S microbiome analysis and bacterial supplementation to investigate the bacterial communities influenced by TRF that may benefit skeletal muscle physiology. In wild-type and obese Drosophila models (axenic models devoid of natural microbial communities), the absence of microbiota influence muscle performance and metabolism differently. Specifically, axenic wild-type Drosophila exhibited reduced muscle performance, higher glucose levels, insulin resistance, ectopic lipid accumulation, and decreased ATP levels. Interestingly, in obese Drosophila (induced by a high-fat diet or predisposed obesity mutant Sk2), the absence of microbiota improved muscle performance, lowered glucose levels, reduced insulin resistance, and increased ATP levels. TRF was found to modulate microbiota composition, notably increasing Acetobacter pasteurianus (AP) and decreasing Staphylococcus aureus (SA) in both obesity models. Supplementation with AP improved muscle performance and reduced glucose and insulin resistance, while SA supplementation had the opposite effect. This study provides novel insights into the complex interactions between TRF, microbiota, and skeletal muscle physiology in different Drosophila models.

Factors Affecting Recurrent Staphylococcus aureus Bacteremia Among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study

Introduction Staphylococcus aureus bacteremia (SAB) poses a significant health risk, particularly among adults over 65 years old, due to age-related vulnerabilities and comorbidities. Recurrent SAB is associated with increased morbidity, prolonged hospitalizations, and higher healthcare costs, necessitating the identification of risk factors that contribute to these recurrent infections. Methods A retrospective cohort study was conducted at a rural community hospital to identify factors associated with recurrent SAB in older patients. Data were extracted from electronic medical records of patients diagnosed with SAB between April 2016 and December 2023. Multivariate logistic regression was employed to analyze the relationship between recurrent SAB and potential risk factors, including age, sex, BMI, dependency on Japanese long-term health insurance, and comorbidities. Results Among 99 patients with SAB, 36 (36.4%) experienced recurrence. Higher BMI was significantly associated with recurrent SAB (OR: 1.15, 95% CI: 1.01-1.31, p = 0.036), while dependency on long-term care was associated with a lower risk of recurrence (OR: 0.20, 95% CI: 0.06-0.64, p = 0.007). Age and sex did not show significant associations with recurrence. Conclusion This study identified higher BMI as a risk factor for recurrent SAB in older patients, while dependency on long-term care was protective. These findings highlight the need for targeted management strategies for patients with higher BMI to prevent recurrent SAB. Further research is needed to explore these associations and confirm their relevance in other clinical settings.

A microbial causal mediation analytic tool for health disparity and applications in body mass index

BACKGROUND

Emerging evidence suggests the potential mediating role of microbiome in health disparities. However, no analytic framework can be directly used to analyze microbiome as a mediator between health disparity and clinical outcome, due to the non-manipulable nature of the exposure and the unique structure of microbiome data, including high dimensionality, sparsity, and compositionality.

METHODS

Considering the modifiable and quantitative features of the microbiome, we propose a microbial causal mediation model framework, SparseMCMM_HD, to uncover the mediating role of microbiome in health disparities, by depicting a plausible path from a non-manipulable exposure (e.g., ethnicity or region) to the outcome through the microbiome. The proposed SparseMCMM_HD rigorously defines and quantifies the manipulable disparity measure that would be eliminated by equalizing microbiome profiles between comparison and reference groups and innovatively and successfully extends the existing microbial mediation methods, which are originally proposed under potential outcome or counterfactual outcome study design, to address health disparities.

RESULTS

Through three body mass index (BMI) studies selected from the curatedMetagenomicData 3.4.2 package and the American gut project: China vs. USA, China vs. UK, and Asian or Pacific Islander (API) vs. Caucasian, we exhibit the utility of the proposed SparseMCMM_HD framework for investigating the microbiome's contributions in health disparities. Specifically, BMI exhibits disparities and microbial community diversities are significantly distinctive between reference and comparison groups in all three applications. By employing SparseMCMM_HD, we illustrate that microbiome plays a crucial role in explaining the disparities in BMI between ethnicities or regions. 20.63%, 33.09%, and 25.71% of the overall disparity in BMI in China-USA, China-UK, and API-Caucasian comparisons, respectively, would be eliminated if the between-group microbiome profiles were equalized; and 15, 18, and 16 species are identified to play the mediating role respectively.

CONCLUSIONS

The proposed SparseMCMM_HD is an effective and validated tool to elucidate the mediating role of microbiome in health disparity. Three BMI applications shed light on the utility of microbiome in reducing BMI disparity by manipulating microbial profiles. Video Abstract.

Obesity Epidemic in U.S. Prison Populations: A Meta-Analysis and Review of the Literature

Limited existing evidence and health provider perceptions suggest that prevalence of obesity among incarcerated people residing in U.S. correctional institutions is high. Evaluating evidence of obesity and weight change during incarceration will allow for the determination of whether people are subject to weight gain during incarceration. A systematic review of three online databases, gray literature, and reference lists of articles of interest was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A meta-analysis to obtain pooled prevalence estimates of obesity among U.S. incarcerated people was then completed. A total of 11 studies met our inclusion criteria. Results show the estimated pooled prevalence of obesity in incarcerated men (30.0%) was less than the national average. The estimated pooled prevalence of obesity in females (39.8%) was similar to the national average.

Beyond energy balance regulation: The underestimated role of adipose tissues in host defense against pathogens

Although the adipose tissue (AT) is a central metabolic organ in the regulation of whole-body energy homeostasis, it is also an important endocrine and immunological organ. As an endocrine organ, AT secretes a variety of bioactive peptides known as adipokines - some of which have inflammatory and immunoregulatory properties. As an immunological organ, AT contains a broad spectrum of innate and adaptive immune cells that have mostly been studied in the context of obesity. However, overwhelming evidence supports the notion that AT is a genuine immunological effector site, which contains all cell subsets required to induce and generate specific and effective immune responses against pathogens. Indeed, AT was reported to be an immune reservoir in the host's response to infection, and a site of parasitic, bacterial and viral infections. In addition, besides AT's immune cells, preadipocytes and adipocytes were shown to express innate immune receptors, and adipocytes were reported as antigen-presenting cells to regulate T-cell-mediated adaptive immunity. Here we review the current knowledge on the role of AT and AT's immune system in host defense against pathogens. First, we will summarize the main characteristics of AT: type, distribution, function, and extraordinary plasticity. Second, we will describe the intimate contact AT has with lymph nodes and vessels, and AT immune cell composition. Finally, we will present a comprehensive and up-to-date overview of the current research on the contribution of AT to host defense against pathogens, including the respiratory viruses influenza and SARS-CoV-2.

A microbial causal mediation analytic tool for health disparity and applications in body mass index

Background: Emerging evidence suggests the potential mediating role of microbiome in health disparities. However, no analytic framework is available to analyze microbiome as a mediator between health disparity and clinical outcome, due to the unique structure of microbiome data, including high dimensionality, sparsity, and compositionality. Methods: Considering the modifiable and quantitative features of microbiome, we propose a microbial causal mediation model framework, SparseMCMM_HD, to uncover the mediating role of microbiome in health disparities, by depicting a plausible path from a non-manipulable exposure (e.g. race or region) to a continuous outcome through microbiome. The proposed SparseMCMM_HD rigorously defines and quantifies the manipulable disparity measure that would be eliminated by equalizing microbiome profiles between comparison and reference groups. Moreover, two tests checking the impact of microbiome on health disparity are proposed. Results: Through three body mass index (BMI) studies selected from the curatedMetagenomicData 3.4.2 package and the American gut project: China vs. USA, China vs. UK, and Asian or Pacific Islander (API) vs. Caucasian, we exhibit the utility of the proposed SparseMCMM_HD framework for investigating microbiome’s contributions in health disparities. Specifically, BMI exhibits disparities and microbial community diversities are significantly distinctive between the reference and comparison groups in all three applications. By employing SparseMCMM_HD, we illustrate that microbiome plays a crucial role in explaining the disparities in BMI between races or regions. 11.99%, 12.90%, and 7.4% of the overall disparity in BMI in China-USA, China-UK, and API-Caucasian comparisons, respectively, would be eliminated if the between-group microbiome profiles were equalized; and 15, 21, and 12 species are identified to play the mediating role respectively. Conclusions: The proposed SparseMCMM_HD is an effective and validated tool to elucidate the mediating role of microbiome in health disparity. Three BMI applications shed light on the utility of microbiome in reducing BMI disparity by manipulating microbial profiles.

A Case Report of Sepsis Post Cardiac Catheterization

Percutaneous coronary intervention (PCI) and cardiac catheterization are clean procedures done under aseptic precautions, but studies have shown transient bacteremia following the process, mostly involving Staphylococcus. This has many complications, from localized wounds at arterial access sites to endocarditis, mycotic aneurysm, and sepsis, and are associated with high mortality. These may require surgical intervention and prolonged antibiotic use. The risk of acquiring these infections is higher in femoral catheterization than in radial access. This risk also increases in patients with congestive cardiac failure, age 60 and above, and those with diabetes and obesity. Procedural hazards include multiple punctures and leaving the sheath for future access due to the needle tract's colonization. We present a case of sepsis presenting two days after PCI using single puncture radial access and a rapid downhill course.

Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: A multinational matched case-control study

OBJECTIVES

We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI), and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions.

METHODS

We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; also, predictive scores were developed and validated in an external cohort.

RESULTS

In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): BMI >30 kg/m² (3.0; 1.9-4.8), resident in a long-term care facility (2.8; 1.05-7.5), fracture as reason for arthroplasty (2.7; 1.4-5.03), skin disorders (2.5; 0.9-7.04), previous surgery in the index joint (2.4; 1.3-4.4), male sex (1.9; 1.2-2.9) and ASA score 3-4 (1.8; 1.2-2.9). The AUROC curve was 0.73 (95% CI 0.68-0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1-16.2), wound drainage for >72h after arthroplasty (4.5; 1.9-19.4) and use of metal bearing material vs. ceramic (1.9; 1.1-3.3). The AUROC curve was 0.78 (95% CI 0.72-0.83). The predictive scores developed were validated in the external cohort.

CONCLUSIONS

Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.

Obesity Reshapes the Microbial Population Structure along the Gut-Liver-Lung Axis in Mice

The microbiome is emerging as a major player in tissue homeostasis in health and disease. Gut microbiome dysbiosis correlates with several autoimmune and metabolic diseases, while high-fat diets and ensuing obesity are known to affect the complexity and diversity of the microbiome, thus modulating pathophysiology. Moreover, the existence of a gut-liver microbial axis has been proposed, which may extend to the lung. In this context, we systematically compared the microbiomes of the gut, liver, and lung of mice fed a high-fat diet to those of littermates fed a matched control diet. We carried out deep sequencing of seven hypervariable regions of the 16S rRNA microbial gene to examine microbial diversity in the tissues of interest. Comparison of the local microbiomes indicated that lung tissue has the least diverse microbiome under healthy conditions, while microbial diversity in the healthy liver clustered closer to the gut. Obesity increased microbial complexity in all three tissues, with lung microbial diversity being the most modified. Obesity promoted the expansion of Firmicutes along the gut-liver-lung axis, highlighting staphylococcus as a possible pathologic link between obesity and systemic pathophysiology, especially in the lungs.

Incidence and outcomes of infective endocarditis following transcatheter aortic valve implantation

INTRODUCTION

Prosthetic valve infective endocarditis is a feared and potentially catastrophic complication of valvular intervention. Transcatheter aortic valve implantation has transformed the modern management of aortic stenosis and vastly altered the demographics of those patients undergoing valve replacement.

AREAS COVERED

As a relatively nascent development, what TAVI means for the epidemiology of infective endocarditis, how to identify those patients undergoing the procedure at greatest risk, and how best to prevent and manage the condition remains the subject of fervent research activity. In this review, we appraise relevant contemporary data discussing the incidence, microbiological profiles, associated risk factors and clinical outcomes of infective endocarditis after TAVI.

EXPERT OPINION

Present outcomes are poor, with exceedingly high in-hospital and long-term mortality. Evidence to support surgical management in this patient group is lacking. Prevention is therefore paramount and a logical focus for future research attention.

Lysozyme is a component of the innate immune system linked to obesity associated-chronic low-grade inflammation and altered glucose tolerance

BACKGROUND & AIMS

Several proteins of the innate immune system are known to be deregulated with insulin resistance. We here aimed to investigate the relationship among circulating lysozyme (both plasma concentration and activity) and obesity-associated metabolic disturbances.

METHODS

Plasma lysozyme concentration was determined cross-sectionally in a discovery (Cohort 1, n = 137) and in a replication cohort (Cohort 2, n = 181), in which plasma lysozyme activity was also analyzed. Plasma lysozyme was also evaluated longitudinally in participants from the replication cohort (n = 93). Leukocyte lysozyme expression (LYZ mRNA) were also investigated in an independent cohort (Cohort 3, n = 76), and adipose tissue (AT) LYZ mRNA (n = 25) and plasma peptidoglycan levels (n = 61) in subcohorts from discovery cohort.

RESULTS

Translocation of peptidoglycan (as inferred from its increased circulating levels) was linked to plasma lysozyme, hyperinsulinemia and dyslipidemia in obese subjects. In both discovery and replication cohorts, plasma lysozyme levels and activity were significantly increased in obesity in direct association with obesity-associated metabolic disturbances and inflammatory parameters, being circulating lysozyme negatively correlated with fasting glucose, HbA1c and insulin resistance (HOMA-IR) in obese subjects. Of note, total cholesterol (p < 0.0001) and LDL cholesterol (p = 0.003) contributed independently to age-, gender- and BMI adjusted plasma lysozyme activity. Longitudinally, changes in HbA1c levels and serum LDL cholesterol were negatively associated with circulating lysozyme antimicrobial activity. On the contrary, the change in glucose infusion rate during the clamp (insulin sensitivity) was positively associated with lysozyme concentration.

CONCLUSIONS

Increased plasma lysozyme levels and activity are found in obese subjects. The longitudinal findings suggest that plasma lysozyme might be protective on the development of obesity-associated metabolic disturbances.

Methicillin-resistant Staphylococcus aureus in Metabolic Syndrome Patients at the Mbouda Hospitals, West Region of Cameroon

Background

Studies have revealed an increased risk of contracting Staphylococcus aureus infections in patients suffering from metabolic diseases. Methicillin-resistant Staphylococcus aureus (MRSA) in metabolic syndrome subjects is less reported in the medical literature. This study aimed at isolating and establishing the distribution of antibiotic-resistant Staphylococcus aureus from faecal samples in metabolic syndrome subjects from Mbouda Hospitals, West Region of Cameroon.

Methods

A cross-sectional study was conducted from May 2016 to May 2018 in 114 participants in whom Staphylococcus aureus was detected. Thirty (30) participants were suffering from metabolic syndrome and 84 did not suffer from this pathology. Staphylococcus aureus isolation was based on culture and confirmed by polymerase chain reaction (PCR) of the nuc gene. The Kirby-Bauer disk diffusion method was used for drug susceptibility assay. Molecular detection of the mecA gene by PCR was performed to screen MRSA.

Results

 From the 114 Staphylococcus aureus isolates, the prevalence of the mecA gene confirming MRSA was 79.82%, higher than that of methicillin-sensitive Staphylococcus aureus (MSSA) (20.17%). The frequency of MRSA was higher in participants with metabolic syndrome (80.00%) compared to non-metabolic syndrome (79.76%) participants without significant difference (p=0.977). The antimicrobial susceptibility test revealed that the amikacin susceptibility profile was significantly different in metabolic and non-metabolic syndrome participants (p=0.037, chi-square=6.59). Regarding metabolic syndrome status, 72.62% of isolates were multidrug-resistant in non-metabolic syndrome participants versus 63.33% in metabolic syndrome participants.

Conclusion

This study suggests that metabolic syndrome patients harbour MRSA strains in their intestines even as the difference was not statistically significant with non-metabolic syndrome participants. The need for appropriate antimicrobial use to halt or at least limit the spread of resistance is suggested in the care of metabolic syndrome patients and the entire population.

Postoperative Complications Associated With Metabolic Syndrome Following Adult Spinal Deformity Surgery

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

The objective of this study was to examine the effect of metabolic syndrome on 30-day postoperative complications following corrective surgery for the adult spinal deformity (ASD).

SUMMARY OF BACKGROUND DATA

Metabolic syndrome has been shown to increase the risk of cardiovascular morbidity and mortality. Few studies have examined the effect of metabolic syndrome on patients with ASD undergoing surgery.

MATERIALS AND METHODS

We performed a retrospective cohort study of patients who underwent spinal fusion for ASD. Patients were divided into 2 groups based on the presence or absence of metabolic syndrome, which was defined as a combination of hypertension, diabetes mellitus, and obesity. Baseline patient characteristics and operative variables were compared between the 2 groups. We also compared the incidence of 30-day postoperative complications between the 2 groups. A multivariable regression analysis was then performed to identify 30-day postoperative complications that were independently associated with metabolic syndrome.

RESULTS

A total of 6696 patients were included with 8.3% (n=553) having metabolic syndrome. Patients with metabolic syndrome were more likely to have renal comorbidity (P=0.042), bleeding disorder (P=0.011), American Society of Anesthesiology classification ≥3 (P<0.001), and undergo a long fusion (P=0.009). Patients with metabolic syndrome had higher rates of 30-day mortality (P=0.042), superficial surgical site infection (P=0.006), sepsis (P=0.003), cardiac complications (P<0.001), pulmonary complications (P=0.003), pulmonary embolism (P=0.050), prolonged hospitalization (P=0.010), nonhome discharge (P=0.007), and reoperation (P=0.003). Metabolic syndrome was an independent risk factor for cardiac complications [odds ratio (OR)=4.2; 95% confidence interval (CI): 1.7-10.2; P=0.001], superficial surgical site infection (OR=2.8; 95% CI: 1.4-5.7; P=0.004), sepsis (OR=2.2, 95% CI: 1.2-3.9; P=0.009), reoperation (OR=1.7; 95% CI: 1.2-2.5; P=0.006), pulmonary complications (OR=1.7; 95% CI: 1.1-2.5; P=0.017), and prolonged hospitalization (OR=1.4; 95% CI: 1.0-1.9; P=0.039).

CONCLUSIONS

Recognition and awareness of the relationship between metabolic syndrome and postoperative complications following ASD surgery is important for preoperative optimization and perioperative care.

Obesity and Weight Change in Two United Kingdom Male Prisons

Prisoners' weight and waist circumference were measured 6 and 12 months after imprisonment. Variables known to be associated with differences in lifestyle behaviors and obesity were considered as covariates in the study. A total of 367 prisoners were recruited into the study at baseline, with 116 of these having dropped out of the study from the 6-month to the 12-month follow-up. The obesity prevalence rate increased 50% from baseline (16%) to the 6-month follow-up (24%). Obesity prevalence rates then declined 4-fold from the 6-month (24%) to the 12-month follow-up (6%). While time in prison was associated with an increase in body mass index, this effect was influenced by intrinsic prisoner characteristics, extrinsic factors, and the prison regime.

Infective endocarditis after transcatheter aortic valve implantation: a nationwide study

AIMS

Transcatheter aortic valve implantation (TAVI), now a common procedure to treat high-risk patients with severe aortic stenosis, has rapidly been expanding into younger and lower-risk populations, creating a need to better understand long-term outcome after TAVI. The aim of the present investigation was to determine the incidence, risk factors for, clinical presentation of, and outcome after prosthetic valve endocarditis (PVE) in patients treated with TAVI in a nationwide study.

METHODS AND RESULTS

Three registries were used: a national TAVI registry, a national diagnosis registry, and a national infective endocarditis registry. Combining these registries made it possible to perform a nationwide, all-comers study with independent and validated reporting of PVE in 4336 patients between 2008 and mid-2018. The risk for PVE after TAVI was 1.4% (95% confidence interval 1.0-1.8%) the first year and 0.8% (0.6-1.1%) per year thereafter. One-year survival after PVE diagnosis was 58% (49-68%), and 5-year survival was 29% (17-41%). Body surface area, estimated glomerular filtration rate <30 mL/min/1.73 m2, critical pre-operative state, mean pre-procedural valve gradient, amount of contrast dye used, transapical access, and atrial fibrillation were identified as independent risk factors for PVE. Staphylococcus aureus was more common in early (<1 year) PVE. Infection with S. aureus, root abscess, late PVE, and non-community acquisition was associated with higher 6-month mortality.

CONCLUSION

The incidence of PVE was similar to that of surgical bioprostheses. Compromised renal function was a strong risk factor for developing PVE. In the context of PVE, TAVI seems to be a safe option for patients.

CLINICAL TRIAL REGISTRATION

NCT03768180 (http://clinicaltrials.gov/).

Dysbiosis of Skin Microbiota in Psoriatic Patients: Co-occurrence of Fungal and Bacterial Communities

Psoriasis is a chronic inflammatory skin disease, whose pathogenesis involves dysregulated interplay among immune cells, keratinocytes and environmental triggers, including microbiota. Bacterial and fungal dysbiosis has been recently associated with several chronic immune-mediated diseases including psoriasis. In this comprehensive study, we investigated how different sampling sites and methods reflect the uncovered skin microbiota composition. After establishing the most suitable approach, we further examined correlations between bacteria and fungi on the psoriatic skin. We compared microbiota composition determined in the same sample by sequencing two distinct hypervariable regions of the 16S rRNA gene. We showed that using the V3V4 region led to higher species richness and evenness than using the V1V2 region. In particular, genera, such as Staphylococcus and Micrococcus were more abundant when using the V3V4 region, while Planococcaceae, on the other hand, were detected only by the V1V2 region. We performed a detailed analysis of skin microbiota composition of psoriatic lesions, unaffected psoriatic skin, and healthy control skin from the back and elbow. Only a few discriminative features were uncovered, mostly specific for the sampling site or method (swab, scraping, or biopsy). Swabs from psoriatic lesions on the back and the elbow were associated with increased abundance of Brevibacterium and Kocuria palustris and Gordonia, respectively. In the same samples from psoriatic lesions, we found a significantly higher abundance of the fungus Malassezia restricta on the back, while Malassezia sympodialis dominated the elbow mycobiota. In psoriatic elbow skin, we found significant correlation between occurrence of Kocuria, Lactobacillus, and Streptococcus with Saccharomyces, which was not observed in healthy skin. For the first time, we showed here a psoriasis-specific correlation between fungal and bacterial species, suggesting a link between competition for niche occupancy and psoriasis. However, it still remains to be elucidated whether observed microbial shift and specific inter-kingdom relationship pattern are of primary etiological significance or secondary to the disease.

School environmental contamination of methicillin-sensitive Staphylococcus aureus as an independent risk factor for nasal colonization in schoolchildren: An observational, cross-sectional study

Objective

We aim to assess the similarities of proportional, phenotypic, and molecular characteristics between the school environment and schoolchildren on methicillin-sensitive S. aureus (MSSA) isolates.

Methods

A cross-sectional study was conducted between March 2016 and August 2016 in eight elementary schools in Guangzhou, China. Nasal swabs from students and environmental swabs from school environments were collected. Univariate and multivariate logistic regression analyses under a multistage stratified cluster cross-sectional survey design were performed to access the prevalence relationship and influencing factors, respectively. Phenotypic and molecular characterizations of MSSA isolates were conducted using the Kirby-Bauer disk diffusion method and polymerase chain reaction assays, respectively.

Results

In total, 1705 schoolchildren and 1240 environmental samples from 40 classes in eight elementary schools obtained between March and August 2016 were include in this study. The rates of MSSA prevalence among schoolchildren and the environment were 11.44% (195/1705) and 4.60% (57/1240), respectively. The odds ratios and 95% confidence intervals (CIs) on the prevalence of MSSA isolates were 1.11 (95% CI, 1.05–1.29; P = 0.010) and 1.04 (95% CI, 1.01–1.07; P = 0.003) for the school or class environment and students, respectively. Similar phenotypic and molecular characteristics were identified between schoolchildren and the environment. A cause and effect relationship could not be established because the study design was cross-sectional.

Conclusions

Because of the cross-sectional design, we can reveal the association between school environment and schoolchildren on MSSA, but it is not a cause and effect relationship.

Chronic Health Conditions Among Incoming Canadian Federally Sentenced Women

Over a 13-month period, health data on all consecutive incoming Canadian federally sentenced women offenders were collected and analyzed ( N = 280). The most common health conditions cited were back pain, head injury, hepatitis C virus (HCV), and asthma. Rates of chronic health problems were generally similar to those of their male offender counterparts, with the notable exception of HCV, which was higher for women. Aboriginal women offenders had particularly high rates of HCV. The study provides valuable information on the self-reported physical health status of federally sentenced women offenders that can be used as a benchmark to examine health trends over time.

Neutrophil killing of Staphylococcus aureus in diabetes, obesity and metabolic syndrome: a prospective cellular surveillance study

BACKGROUND

Obesity, metabolic syndrome (MetS), and diabetes are frequent in surgical populations and can enhance susceptibility to postoperative surgical site infections. Reduced neutrophil function has been linked with diabetes and risk of Staphylococcus aureus infection. Therefore, neutrophil function in diabetic and obese subjects (± MetS) was assessed in this prospective serological and cellular surveillance study to determine whether vaccines administered to protect against infections after surgery could be effective in these populations.

METHODS

Neutrophil function (chemotaxis, phagocytosis, and opsonophagocytic killing of S. aureus) was assessed in subjects classified according to diabetes status, body mass index, and presence/absence of MetS. Neutrophils were characterized within functional subsets by flow cytometry. A serologic assay was used to measure baseline antibody presence to each antigen in SA4Ag: capsular polysaccharide (CP) type 5, CP8, recombinant mutant Clumping factor A (rmClfA), and recombinant Manganese transport protein C (rMntC).

RESULTS

Neutrophil function was similar for comorbid and healthy cohorts, with no significant between-group differences in cell counts, migration, phagocytosis ability, neutrophil subset proportions, and S. aureus killing ability when neutrophils were isolated 3-6 months apart (Visit 1 [n = 90] and Visit 2 [n = 70]) and assessed. Median pre-existing antibody titers to CP5, CP8, and rmClfA were comparable for all cohorts (insufficient subjects with rMntC titers for determination).

CONCLUSIONS

MetS, diabetes, and obesity do not impact in vitro neutrophil function with regard to S. aureus killing, suggesting that if an effective S. aureus vaccine is developed it may be effective in individuals with these comorbidities.

Drug Use Is Associated With Purulent Skin and Soft Tissue Infections in a Large Urban Jail: 2011-2015

Background

Skin and soft tissue infections (SSTIs) are a common problem in jails in the United States. This study aimed to identify factors associated with purulent SSTIs in the New York City jail system.

Methods

We conducted a case-control study of purulent SSTIs at the New York City jail. Cases were matched to controls by visit date to the jail’s urgent care clinic. Bivariate and multivariable analyses were conducted using conditional logistic regression.

Results

From April 2011 to April 2015, 1010 cases of SSTIs were identified and matched to 1010 controls. In multivariable analyses, report upon entry to jail of current injection drug use (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.77–4.31), current snorting of drugs (OR, 1.50; 95% CI, 1.12–2.00), current heroin use (OR, 1.53; 95% CI, 1.08–2.17), current cocaine use (OR, 1.76; 95% CI, 1.18–2.65), and antibiotic use within the previous 6 months (OR, 4.05; 95% CI, 2.98–5.49) were significantly associated with SSTI diagnosis.

Conclusions

Skin and soft tissue infections were strongly associated with a history of drug use at jail entry. Targeting intravenous drug use may be a preventive strategy for SSTIs in this population. Strategies such as harm reduction programs may be investigated.

Sex differences in the risk factors for Staphylococcus aureus throat carriage

BACKGROUND

Male gender and adiposity are considered to be risk factors for Staphylococcus aureus carriage. We tested whether colonization is related to free testosterone (fT) level and adiposity, measured with body mass index (BMI) and body fat percentage (BFP), in healthy adults.

METHODS

Blood sample and throat swabs were taken twice (at 4-week intervals) from healthy men and women aged 18-36 years. fT level, height, weight, and BFP were measured. Participants were classified as persistent carriers, intermittent carriers (excluded from the analyses), and noncarriers. The final sample was 152 participants: 85 men and 67 women.

RESULTS

BFP, but not BMI, correlated positively with S aureus colonization (P = .02) in men. BMI became a significant predictor of carriage only when comparing groups within and above norms (P = .04). There was no relationship for BMI nor BFP in women. Higher fT level was related to persistent carriage (P = .02) in women, there was no relationship for fT level in men.

CONCLUSION

Risk factors for S aureus carriage are sex dependent. Within-sex variation in colonization is related to fT level in women, whereas in men it is related to the amount of body fat.

Prior Staphylococcus Aureus Nasal Colonization: A Risk Factor for Surgical Site Infections Following Decolonization

INTRODUCTION

Staphylococcus aureus (S aureus) decolonization regimens are being used to mitigate the risk of surgical site infection (SSI). However, their efficacy is controversial, with mixed results reported in the literature.

METHODS

Before undergoing primary total knee arthroplasty (TKA), total hip arthroplasty (THA), or spinal fusion, 13,828 consecutive patients were screened for nasal S aureus and underwent a preoperative decolonization regimen. Infection rates of colonized and noncolonized patients were compared using unadjusted logistic regression. An adjusted regression analysis was performed to determine independent risk factors for SSI.

RESULTS

The rate of SSI in colonized patients was 4.35% compared with only 2.39% in noncolonized patients. In our TKA cohort, unadjusted logistic regression identified S aureus colonization to be a significant risk factor for SSI (odds ratio [OR], 2.9; P < 0.001). After controlling for other potential confounders including age, body mass index, tobacco use, and American Society of Anesthesiologists score, an SSI was 3.8 times more likely to develop in patients colonized with S aureus (OR, 3.8; P = 0.0025). The THA and spine colonized patients trended toward higher risk in both unadjusted and adjusted models; however, the results were not statistically significant.

DISCUSSION

The results of our study suggest that decolonization may not be fully protective against SSI. The risk of infection after decolonization is not lowered to the baseline of a noncolonized patient.

LEVEL OF EVIDENCE

Level IV.

Gut Microbiota: A Contributing Factor to Obesity

Obesity, a global epidemic of the modern era, is a risk factor for cardiovascular diseases (CVD) and diabetes. The pervasiveness of obesity and overweight in both developed as well as developing populations is on the rise and placing a huge burden on health and economic resources. Consequently, research to control this emerging epidemic is of utmost importance. Recently, host interactions with their resident gut microbiota (GM) have been reported to be involved in the pathogenesis of many metabolic diseases, including obesity, diabetes, and CVD. Around 10(14) microorganisms reside within the lower human intestine and many of these 10(14) microorganisms have developed mutualistic or commensal associations with the host and actively involved in many physiological processes of the host. However, dysbiosis (altered gut microbial composition) with other predisposing genetic and environmental factors, may contribute to host metabolic disorders resulting in many ailments. Therefore, delineating the role of GM as a contributing factor to obesity is the main objective of this review. Obesity research, as a field is expanding rapidly due to major advances in nutrigenomics, metabolomics, RNA silencing, epigenetics, and other disciplines that may result in the emergence of new technologies and methods to better interpret causal relationships between microbiota and obesity.

Intermittent nasal carriage with Staphylococcus aureus within a menstrual cycle: Results from a prospective cohort of healthy carriers

Female sex hormones have been related to nasal Staphylococcus aureus carriage in healthy individuals; however, whether nasal staphylococcal carriage varies by menstrual cycle phase remains unknown.We sampled anterior nares of female healthcare workers twice per week for 6 consecutive menstrual cycles. We used mixed-effects Poisson regression models to determine whether intermittent carriage was associated with cycle phases in a given individual. We also performed recurrent event survival analysis to identify host factors linked to incident carriage status.Overall, we collected 754 nasal swabs over 89 consecutive person-cycles from 14 intermittent carriers. In 84 ovulation-defined menstrual cycles (715 swabs), the period prevalence of staphylococcal carriage was 58.7%, 63.1%, and 64.9% in the follicular, periovulatory, and luteal phases, respectively; these differences were not statistically significant after multivariable adjustment and correction for within-person correlation (adjusted relative risk [RR]-periovulatory 0.92, P: 0.30; luteal 1.00, P: 0.98).Using survival analysis, we identified several host factors that were associated with incident loss, gain of colonization, or both. For example, as compared to women aged 20 to 30 years, those aged 30 to 40 years were less likely to losing carriage (hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.09, 0.80) but were as likely to regaining carriage (HR: 0.53, 95% CI: 0.21, 1.34). In comparison, being underweight (body mass index [BMI] <18.5) was significantly associated with a higher risk for regaining (HR: 1.95, 95% CI: 1.34, 1.51) and losing (HR: 1.57, 95% CI: 1.16, 2.12) colonization, indicating the alternating tendency for status changes. Personal hygiene behaviors, such as nostril cleansing habit and methods, differentially affected carriers' risk for losing or regaining staphylococcal colonization.Using an intensive sampling scheme, we found that nasal staphylococcal carriage could vary substantially over time in healthy carriers. Yet, such dynamic intraperson changes in carriage status did not depend on menstrual cycle phases but were associated with host age, BMI, and personal hygiene behavior.