Inoculation Pneumonia Caused by Coagulase Negative Staphylococcus

Staphylococcus aureus and Coagulase-Negative Staphylococci from Bloodstream Infections: Frequency of Occurrence and Antimicrobial Resistance, 2018-2021

BACKGROUND

The abuse of antibiotics during the SARS-CoV-2 pandemic might have disrupted efforts to curb the further development and spread of the antimicrobial resistance of Staphylococcus aureus infection and Staphylococcus spp. coagulase-negative (CoNS) agents of nosocomial bloodstream infections (NBSIs). The purpose of our work was to study the resistance patterns of Staphylococcus aureus and CoNS through the analysis of blood cultures in hospitalized SARS-CoV-2-positive and SARS-CoV-2-negative patients (pts.).

MATERIALS AND METHODS

During the period January 2018-June 2021, a retrospective case-control study was performed on blood cultures positive for Staphylococcus spp. detected in 177 adult pts. (≥18 years old) hospitalized for >48 hours at Sant'Elia Hospital, Caltanissetta.

RESULTS

Staphylococcus aureus was isolated in 33.9% of blood culture samples, and among CoNS, the most frequent strains were Staphylococcus capitis (18.6%) and Staphylococcus hominis (18.1%). Patients aged ≥ 65 years, with a greater number of males, comprised the SARS-CoV-2-negative pts. (71.8% vs. 52.2%, p = 0.0154). Among the SARS-CoV-2-positive patients, the significant resistance of Staphylococcus aureus was only observed for erythromycin (57.1%). The oxacillin resistance of Staphylococcus capitis was higher in SARS-CoV-2-positive than in negative pts. (90% and 78.3%, respectively). Comparing the two groups, we found an increase in resistance in SARS-CoV-2-negative patients for the following antibiotics: gentamicin for Staphylococcus aureus (p = 0.007), clindamycin and erythromycin (p = 0.012) for Staphylococcus hominis and oxacillin and rifampicin for Staphylococcus haemoliticus (p = 0.012).

CONCLUSIONS

Our study confirms the relevance of oxacillin-resistant Staphylococcus aureus in being responsible for bloodstream infection and draws attention to highly oxacillin-resistant CoNS such as Staphylococcus capitis. The presence of resistant strains of CoNS in hospitals can be worrying, as it limits treatment options and worsens outcomes. The Infection Control Committee (ICC) recommends new treatment strategies to decrease colonization and infections. As part of the implementation of a bloodstream infection prevention program, the authors encourage the introduction of a report on the antimicrobial resistance of hospital bacteremia due to CoNS.

Clinical and etiological characteristics of pneumonia in children with a poor outcome of infectious diseases

Purpose: to study the clinical and etiological features of pneumonia in children with a poor outcome of infectious diseases.

Materials and methods. The retrospective analysis of clinical, anamnestic, laboratory, instrumental data of 46 children who died from infectious diseases during the period from December 2009 to November 2019 was carried out, of which 26 patients had pneumonia at autopsy. The etiology of pneumonia was determined in vivo and postmortem using cultural, molecular genetic, serological methods and immunohistocytochemical examination of lung tissue. Pneumonia was classified into primary and secondary.

Results. In patients with pneumonia in the structure of generalized infections (n=26) secondary forms prevailed (septic – 14 cases, ventilator-associated (VAP) – 5, aspiration – 2); primary pneumonia was detected in 5 children. Clinical polymorphism and frequent absence of typical symptoms of pneumonia (cough, shortness of breath, auscultatory and percussion changes) were shown, that led to intravital underdiagnosis of pneumonia in 31% of patients. The probable etiology of pneumonia was detected in vivo and postmortem in 58% and 98% of cases respectively. S. pneumoniae (40%) and H. influenzae type b (40%) were main pathogens in primary pneumonia, N. meningitidis (36%) and S. pneumoniae (29%) – in septic pneumonia, commensals of naso- and oropharynx (S. salivarius) – in aspiration pneumonia, nosocomial bacteria (S. aureus and coagulase-negative staphylococci) – in VAP. In children with HIV infection, pneumonia was associated with opportunistic pathogens (P. jirovecii, C. neoformans). In 87% of cases polymicrobial associations were found in lower airways, that makes it difficult to identify the main causative agent of pneumonia.

Conclusions. Most of symptoms of pediatric pneumonia in the structure of generalized infections are nonspecific. Post-mortem study improves the etiological verification of pneumonia and allow to suggest the most pathogenetically and thanatogenetically significant pathogen.

The Emergence of a Multidrug-Resistant and Pathogenic ST42 Lineage of Staphylococcus haemolyticus from a Hospital in China

Staphylococcus haemolyticus is an opportunistic pathogen associated with hospital-acquired infections. However, the genetic diversity of S. haemolyticus among the patients and the hospital environment is largely unknown. Here, we isolated 311 S. haemolyticus strains from different sampling sites of patients and hospital environment. Genomic analysis showed that ST42 is an emerging clone widely disseminated in the hospital. S. haemolyticus ST42 strains exhibited decreased susceptibilities for multiple antibiotics compared with other STs and carried significantly more antibiotic resistance genes (ARGs). Furthermore, ST42 strains harbored more virulence genes per isolate than in other STs, and the capsular biosynthesis genes capDEFG were more prevalent in ST42 strains. Using the Galleria mellonella infection model, we demonstrated that ST42 strains are highly virulent compared with non-ST42 strains. Taken together, our data identified an emerging ST42 clone of S. haemolyticus with aggregated ARGs and virulence determinants in the hospital, representing a significant health threat in terms of both disease and treatment. IMPORTANCES. haemolyticus is an emerging opportunistic pathogen with a high burden of antimicrobial resistance. We performed molecular epidemiological analysis of S. haemolyticus that was isolated from a hospital, and found that the phylogenetic lineages are diverse accompanied by a dominant epidemic clonal lineage ST42. We demonstrated that S. haemolyticus ST42 strains have been disseminated among patients and the hospital environment. The data provide mechanistic insight and indicate that S. haemolyticus ST42 strains are multidrug-resistance and virulent clones via accumulating more ARGs and virulence genes.

Preclinical efficacy and clinical safety of clinical-grade nebulized allogenic adipose mesenchymal stromal cells-derived extracellular vesicles

Mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) turn out to be a promising source of cell-free therapy. Here, we investigated the biodistribution and effect of nebulized human adipose-derived MSC-EVs (haMSC-EVs) in the preclinical lung injury model and explored the safety of nebulized haMSC-EVs in healthy volunteers. DiR-labelled haMSC-EVs were used to explore the distribution of nebulized haMSC-EVs in the murine model. Pseudomonas aeruginosa-induced murine lung injury model was established, and survival rate, as well as WBC counts, histology, IL-6, TNF-α and IL-10 levels in bronchoalveolar lavage fluid (BALF) were measured to explore the optimal therapeutic dose of haMSC-EVs through the nebulized route. Twenty-four healthy volunteers were involved and received the haMSC-EVs once, ranging from 2 × 108 particles to 16 × 108 particles (MEXVT study, NCT04313647). Nebulizing haMSC-EVs improved survival rate to 80% at 96 h in P. aeruginosa-induced murine lung injury model by decreasing lung inflammation and histological severity. All volunteers tolerated the haMSC-EVs nebulization well, and no serious adverse events were observed from starting nebulization to the 7th day after nebulization. These findings suggest that nebulized haMSC-EVs could be a promising therapeutic strategy, offering preliminary evidence to promote the future clinical applications of nebulized haMSC-EVs in lung injury diseases.

Ants (Hymenoptera: Formicidae) as Potential Mechanical Vectors of Pathogenic Bacteria in a Public Hospital in the Eastern Amazon, Brazil

Studies related to ants found in hospital environments have aroused interest in their role as mechanical vectors of pathogenic microorganisms. The objective of the current research was to determine the species composition and bacterial contamination of ant species found in a public hospital in the eastern Amazonian region. Ants were captured using bait containing honey and sterilized sardines in 15 locations within the Macapá Emergency Hospital, Amapá. Ants were identified morphologically using specific keys. Bacteria were first inoculed in a Brain Heart Infusion broth and then plated on 5% Agar with blood or MacConkey media. Bacterial species were identified through biochemical procedures. In total, 9,687 ants were collected, with 69.8% from the dry season and 30.2% from the rainy season. Nine species of ants were identified belonging to three subfamilies: the Monomorium pharaonis (Linnaeus 1758) being the most common, comprising 39.2% of the total specimens. Only one ant species was found in each bait, facilitating microbiological analyses. In total, 92 bacteria isolates were identified comprising 12 species. Pseudomonas aeruginosa Schroeter 1872 (Pseudomonadales: Pseudomonadaceae) was pathogenic bacteria, most frequently isolated, comprising 10.9% of the positive samples. The most contaminated ant in the study was M. pharaonis with 38.3%. It was the dominant ant species in this hospital environment. Its wide prevalence, forage day and night of this vector in hospital facilitated bacterial contamination. The presence of bacteria on ants may be associated with the dissemination of pathogens which cause hospital infections, making pest control a necessity in these institutions.