Bacterial Superinfection Research Articles

Stroke - Challenge in Patients with COPD, Chronic Pulmonary Heart and COVID-19 Infection

Abstract Chronic obstructive pulmonary disease (COPD) is the respiratory condition with the highest prevalence, with over 10% of individuals over the age of 40 presenting with this disease .(1) The COVID-19 infection has significantly increased morbidity and mortality among COPD patients, as well as the rate of complications within this pathology. COVID-19 infection is a systemic inflammatory condition, with primary pulmonary involvement, but also with secondary gastrointestinal, cardiovascular, endocrinological, hepatic, renal, and, not least, neurological effects .(2) The degree of pulmonary involvement and bacterial superinfection have increased the risk of thromboembolic complications: stroke, atrial fibrillation (FiA), and death.

Necrotic ulcers caused by Loxosceles rufescens bites: a report of seven patients and scanning electron microscopy of the spider.

Loxosceles rufescens is a spider that may bite humans. To describe the clinical manifestations and treatment of patients with bites caused by L. rufescens, and present scanning electron microscopy of the spider. Twelve patients are described, seven with a confirmed aetiological diagnosis as a sample of the spider was captured. In one case, scanning electron microscopy of the spider was performed. Seven patients presented with a single necrotic ulcer of varying morphology, with a purulent-necrotic bed, located on the neck (one patient), buttock (one patient), thigh (one patient), legs (three patients) and foot (one patient). All patients complained of burning and pain. No systemic symptoms were observed. All patients were treated with sodium hypochlorite solution packs, an equine catalase gel, and polyhexamethylene biguanide cream. Oral analgesics were added. In one patient, oral prednisone was prescribed. Two patients with bacterial superinfections were treated with i.v. piperacillin/tazobactam or i.m. ceftriaxone. All patients recovered within eight weeks, however, a scar developed in five of six patients. The sequence of cutaneous manifestations due to L. rufescens bites is typical. At first, erythema and oedema forms, followed by a vesicle, blister or pustule and, finally, an eschar and scar. Systemic symptoms and signs are rare. To consider this spider as an aetiological agent of necrotic ulcers, it is necessary to capture a sample of the spider, dead or alive, which should then be identified by an expert. Corticosteroids, antibiotics and analgesics are frequently used. Surgery is often necessary.

CRP/Neopterin Ratio and Neuropsychiatric Symptoms in Patients with Different Forms of Pneumonia: Results of a Pilot Study.

Pneumonia is one of the most common infectious diseases, mostly caused by viruses or bacteria. In response to bacteria or viruses which are different but which also are partly overlapping, innate and adaptive immune responses are induced, which can be quantified using the determination of specific biomarkers. Among these, C-reactive protein (CRP) has been established as a marker of innate immune function, whereas Neopterin, which is mainly produced upon stimulation with interferon-gamma, reflects cellular immune activation. We investigated inflammation markers in patients with microbiologically confirmed viral or bacterial pneumonia, and studied the potential of CRP, Neopterin, and the CRP/Neopterin ratio to distinguish between viral and bacterial pathogenesis. Furthermore, we examined, how often neuropsychiatric symptoms occur in patients suffering from different kinds of pneumonia. A total of 194 patients diagnosed with either coronavirus disease 2019 (COVID-19) (n = 63), bacterial pneumonia (n = 58), Influenza infection (n = 10), Influenza and a bacterial superinfection (n = 9), and COVID-19 patients with a bacterial superinfection (n = 54) were included in our pilot study. Clinical as well as laboratory parameters were determined shortly after admission. We found significantly higher CRP/Neopterin ratios in patients with bacterial pneumonia (median: 0.34) and lower CRP/Neopterin ratios in patients hospitalized with COVID-19 infection (median: 0.03; p < 0.001). Both in men and in women, the CRP/Neopterin ratio was able to distinguish between viral and bacterial pathogens, but also was able to detect bacterial super-infection (BSI) in subjects with initial viral pneumonia (p < 0.001). Patients with BSI presented with significantly lower CRP/Neopterin ratios (median 0.08) than patients with bacterial infection only (median 0.34; p < 0.001). Interestingly, COVID-19 patients had a decreased physical functioning (as reflected in the ECOG score) and a higher frequency of fatigue (84.1%) and neurological symptoms (54.8%) than patients with pneumonia, due to other underlying pathogens. Patients that reported fatigue during viral and bacterial pneumonia presented with lower CRP concentrations than patients without it. The CRP/Neopterin ratio is useful to differentiate between viral and bacterial pathogenesis. The occurrence of neuropsychiatric symptoms in pneumonia appears to depend on the kind of pathogen causing the infection. Lower CRP concentrations at admission appear to be related to fatigue during acute viral and bacterial infection.

Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.

The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.

#799 M1-M2 macrophages in postmortem biopsies from patients with acute kidney injury with COVID-19 compared to pulmonary bacterial sepsis

Abstract Background and Aims AKI associated with COVID19 is highly prevalent; there is controversy if it is similar to AKI in sepsis of bacterial origin. Macrophage differentiation M1-M2 is a predictor of outcomes. Macrophage expression in kidney tissue is not known in patients with severe COVID19 compared to sepsis of bacterial origin. We compare the tissue expression of macrophage differentiation markers M1-M2, through the expression of CD163, CD68, INOS in postmortem biopsies from patients with C19-LRA and S-AKI. Method Observational, comparative, analytical study. Results 49 subjects were analyzed, 39(COVID-19) and 10(pulmonary sepsis of bacterial origin). No significant baseline differences. The degree of AKI had no difference between groups, but in COVID-19 there were severe grades 2-3, compared to bacterial sepsis p = 0.89. Histopathologically there were no differences with the degree of LTA and IFTA. NTI was more frequent in bacterial sepsis vs COVID-19 100%/12.8% (p &amp;lt; 0.001). When comparing macrophage expression we found that the expression of M1(INOS) was not different, the expression of M2(CD163) was higher in patients with bacterial Sepsis with 100% corresponding to severe grade vs 28.2% in patients with COVID19 p&amp;gt;0.001. The classification between degrees of AKI were statistically positive for patients with COVID19 and CD163 with r2: 0.26 and CD68 with r2: 0.36 with p 0.01 and 0.02 respectively. The classification with NTI was positive in COVID19 and bacterial sepsis with an r2: 0.34 for CD163, r2: 0.11 for CD68 p &amp;lt; 0.001. Regarding IFTA in COVID-19 and bacterial sepsis, r2: 0.12 for CD163, r2: 0.11 for CD68 (p 0.01 and 0.03 respectively). Steroid use was negatively correlated on the COVID19 with bacterial sobreinfectión + the bacterial sepsis group with the marker CD163 with r2: 0.23 p = 0.005. The association between moderate and severe positivity for CD68+ and NTI had an OR of 15.5 (CI 3.21-64.6) p = 0.001. Conclusion The 2 groups had a similar severity, AKI in COVID19 was more severe compared to bacterial Sepsis, histologically there were no differences in AKI, but there was a marked difference in the presence of NTI, this being more frequent in the bacterial sepsis group. Findings different from those reported in other bibliographies where the degree of acute kidney injury was higher in COVID19. When comparing the dominant macrophage phenotype, iNOS(M1) had no difference between the groups, on the contrary CD163(M2) was different, with severe staining in all cases with bacterial sepsis, similar to what was seen with NTI and lower degrees of clinical severity of LRA. When evaluating the correlations we found a moderate correlation between the presence of NTI and CD163(M2), mild for NTI and CD68(M0). Finding suggestive of the macrophage role especially low M2 in the context of NTI, it is important to note that those with CD163 had lower degrees of acute kidney injury, more reported as KDIGO1, which is reproducible taking into account other studies in which the CD163(M2) was associated with higher degrees of repair, while their depletion was associated with greater severity of kidney injury. With respect to the treatment established, there was a slight correlation between the use of steroids in the population with bacterial superinfection with CD163(M2), in a recent study it was shown that the use of steroids could induce the repopulation of CD163.

Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit?

Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022-2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.

Clinical characteristics and outcomes of respiratory syncytial virus-associated ARF in immunocompetent patients: A seven-year experience at a tertiary hospital in France

Respiratory syncytial virus (RSV) is widely recognized as a cause of acute respiratory failure in infants and immunocompromised patients. However, RSV can also contribute to acute respiratory failure in adults, particularly among the elderly population. The objective of this study was to analyze the clinical characteristics and outcomes of immunocompetent adults hospitalized for RSV infection. This retrospective study included all immunocompetent adult patients consecutively admitted to a tertiary care hospital with RSV-related acute respiratory failure over a seven-year period (2016-2023). Diagnosis of RSV infection was made through nasal swabs or pulmonary samples, with multiplex reverse transcription polymerase chain reaction (RT-PCR). Patients were eligible for inclusion if they required supplemental oxygen therapy for at least 48h. One hundred and four patients met the inclusion criteria. Median age [IQR] was 77 years [67-85]. Ninety-seven patients had at least one comorbidity (97/104, 93%). At the time of RSV diagnosis, 67 patients (67/104, 64%) experienced acute decompensation of a pre-existing chronic comorbidity. Antibiotics were started in 80% (77/104) of patients; however, only 16 patients had a confirmed diagnosis of bacterial superinfection. Twenty-six patients needed ventilatory support (26/104, 25%) and 21 were admitted to the intensive care unit (21/104, 20%). The median duration of oxygen therapy [IQR] was 6 days [3-9], while the median hospital length of stay [IQR] was 11 days [6-15]. The overall mortality rate within 1 month of hospital admission was 13% (14/104). The sole variables associated with one-month mortality were age and maximum oxygen flow during hospitalization. RSV-associated acute respiratory failure affected elderly individuals with multiple comorbidities and was associated with prolonged hospitalization and a high mortality rate.

Assessment of the Seroprevalence of Varicella zoster Virus in Young Adults Aged 15 – 35 Years Old in Mashhad, Iran

Background: Varicella zoster virus (VZV) is highly contagious and can lead to two distinct diseases. Initially, it causes chickenpox, a primary infection common among children worldwide, characterized by itchy, red blisters that cover the body. After this initial outbreak, the virus can lie dormant in nerve tissues and may reactivate later in life as herpes zoster, commonly known as shingles, which presents as a painful rash. While chickenpox is generally mild and resolves on its own, it can cause severe complications, especially in vulnerable groups such as immunocompromised individuals or adults. These complications can range from bacterial superinfections and pneumonia to encephalitis. In rare cases, it may lead to life-threatening conditions like necrotizing fasciitis or toxic shock syndrome, highlighting the potential severity of what is often considered a childhood illness. Objectives: One of the main risk factors for varicella-zoster infection is the absence of immunity. Individuals who have not been vaccinated against or previously infected with the VZV are at risk of contracting chickenpox when exposed. Additionally, close contact with infected individuals increases the likelihood of transmission. People with chronic conditions or those undergoing immunosuppressive therapy are particularly vulnerable to severe complications from varicella-zoster infections. Therefore, this study was conducted to assess the seroepidemiology of antibodies against varicella zoster in the young adult population in Mashhad. Methods: This cross-sectional study was conducted in 2018 on men and women aged 15 to 35 years in Mashhad, northeast Iran. Random cluster sampling was utilized. Individuals undergoing treatment for rare diseases were excluded from the study. The enzyme-linked immunoassay (ELISA) technique was employed to assess the presence of IgG antibodies against varicella zoster in 724 serum samples. Data analysis was performed using SPSS 20, and the significance level was set at 0.05. Results: Overall, among the 724 participants aged 15 - 35 years old in Mashhad, the frequency of anti-varicella IgG seropositivity was 85.9%. Our results indicated significant associations between age (P = 0.001) and occupational status (P = 0.02) with varicella-zoster seroprevalence. Conclusions: We observed a high frequency of anti-varicella zoster IgG seroprevalence among young adults in Mashhad. Infants, pregnant women, and individuals with weakened immune systems are more likely to develop severe forms of chickenpox or experience complications from shingles, including pneumonia and encephalitis. Given the severe health problems caused by the varicella virus and its high prevalence in Mashhad, we recommend incorporating the varicella vaccine into the public vaccination program. Additionally, further examination of the burden of herpes zoster, including its impact on quality of life and healthcare utilization, can guide interventions to mitigate the consequences of this condition.

Airway epithelial CD47 plays a critical role in inducing influenza virus-mediated bacterial super-infection.

Respiratory viral infection increases host susceptibility to secondary bacterial infections, yet the precise dynamics within airway epithelia remain elusive. Here, we elucidate the pivotal role of CD47 in the airway epithelium during bacterial super-infection. We demonstrated that upon influenza virus infection, CD47 expression was upregulated and localized on the apical surface of ciliated cells within primary human nasal or bronchial epithelial cells. This induced CD47 exposure provided attachment sites for Staphylococcus aureus, thereby compromising the epithelial barrier integrity. Through bacterial adhesion assays and in vitro pull-down assays, we identified fibronectin-binding proteins (FnBP) of S. aureus as a key component that binds to CD47. Furthermore, we found that ciliated cell-specific CD47 deficiency or neutralizing antibody-mediated CD47 inactivation enhanced in vivo survival rates. These findings suggest that interfering with the interaction between airway epithelial CD47 and pathogenic bacterial FnBP holds promise for alleviating the adverse effects of super-infection.

Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study.

Introduction Despite the constant development of medicine and the increasing accessibility to medical specialists, in the first quarter of the 21st century, odontogenic abscesses remain one of the leading causes of emergency hospitalization in maxillofacial surgery clinics. Because of the serious and lethal complications that this type of suppurative infection can lead to if not treated promptly, there is a need for constant updating of the knowledge of its origin, which is precisely what is addressed in this original article. Materials and methods It reports on a retrospective study conducted over a five-year period (2018-2023), during which 705 patients aged 18 years and older with a confirmed diagnosis of odontogenic soft tissue abscess of the head and neck underwent emergency surgery. Results The average age of the patients studied was 41 years, with the oldest being an 82-year-old woman. The proportion of males in the study population was higher - 54.18%. Young patients (18-44 years) were the most affected, with a total of 364 patients (213 males and 151 females), while the proportion of old people (75 years of age and older) was the lowest, with a total of 15 patients, including seven males and eight females. The first molars of both jaws (16, 26, 36 and 46) were the cause of the suppurative bacterial infection in the highest number among our study patients - 208 out of 705 (29.5%). Central incisors (teeth 11, 21, 31 and 41) were the least frequent direct cause of odontogenic infection, accounting for only 17 cases out of 705 (2.41%). Discussion The most logical reason for the decrease in the number of patients with odontogenic abscesses with increasing age is tooth loss in older individuals. Our study confirmed the knowledge that the first mandibular molars are the most common teeth leading to the formation of purulent exudate in the adjacent mandibular soft tissues. However, in contrast to the well-known fact for the maxilla that canines are the most frequent etiologic factor for the occurrence of odontogenic abscesses, we conclude that again the first molars (teeth 16 and 26) outnumber the other teeth of the maxillary dentition, with canines outnumbering only incisors. The teeth of the lower jaw are the cause of more than twice as many exudative infections as those of the upper jaw - the ratio between them is 2.54:1. Conclusions Knowledge of odontogenic abscesses - their demographic distribution, frequency and etiology, their diagnosis and treatment - is the basis for the prediction and treatment outcome of these diseases, mainly affecting young people. Their treatment is both surgical in order to evacuate the suppurative focus, and antibacterial.

Pulmonary Cavitation as a Complication of COVID-19: Case Series and a Brief Review of the Literature

The COVID-19 pandemic has led to an unprecedented surge in respiratory illness cases worldwide. Although uncommon, pulmonary cavitation has been reported as a potential complication of COVID-19. This case series report describes four cases of COVID-19 patients with lung cavities, highlighting the various causes and clinical manifestations of this complication, and a review of the literature on the presence of lung cavities in COVID-19 patients. In two cases, the cavities were most likely due to secondary bacterial superinfections, with one case being complicated by multi-drug-resistant bacteria. Another case developed cavities secondary to a fungal infection, while the third case was directly caused by SARS-CoV-2 invasion in the lungs. The presence of cavities with or without air-fluid level or pneumothorax in COVID-19 patients should be considered as a potential complication of this infection, especially in those with respiratory symptoms. Physicians should remain vigilant for the development of pulmonary cavitation in COVID-19 patients, particularly those receiving high doses of steroids. Additionally, spontaneous pneumothorax should be considered an alarming sign in COVID-19 patients.

Pregnant women with COVID-19 ARDS on the intensive care unit

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of aGerman university hospital between March and November 2021. The cohort included 9 patients with amean age of 30.3 years (range 26-40years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had aPaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, atotal of 47prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia amore viable alternative, especially in severe disease.

Perioperative Antibiotic Prophylaxis.

Postoperative surgical site infections (SSI) account for almost 25% of all nosocomial infections in Germany and are a source of increased morbidity and mortality. This review is based on pertinent publications retrieved by a selective search in PubMed and on national and international guidelines. The individual risk factors for SSI must be assessed before any surgical procedure. A body-mass index above 30 kg/m2 is associated with an unadjusted risk ratio of 1.35 [1.28; 1.41] for SSI, which rises to 3.29 [2.99; 3.62] if the patient is also immunosuppressed. The risk of SSI is also significantly higher with certain types of procedure. Perioperative antibiotic prophylaxis (PAP) is clearly indicated for operations that carry a high risk of SSI (e.g., colorectal surgery) and for those that involve the implantation of alloplastic material (e.g., hip endoprostheses). PAP can usually be administered with basic antibiotics such as cefazoline. The basic principles of PAP are that it should be given by the anesthesia team in the interval from 60 minutes preoperatively up to shortly before the incision, and that its administration should only be for a short period of time, usually as a single shot. Continuing PAP onward into the postoperative period leads to increased toxicity, bacterial superinfections, and antibiotic resistance. The evidence shows that perioperative antibiotic prophylaxis is a component of a bundle of measures that can help prevent SSI. Strict indications and adherence to the basic principles of PAP are essential for therapeutic success.

The significance of monitoring respiratory sample cultures and polymerase chain reaction tests for detecting bacterial pathogens in severely and critically ill patients with COVID-19.

Bacterial superinfection is one of the most common and potentially lethal complications in severely and critically ill patients with COVID-19. To determine the colonisation time frame and the spectrum of potential bacterial pathogens in respiratory samples from patients with severe and critical COVID-19, using routine culture and polymerase chain reaction (PCR) tests. A prospective observational study was conducted on patients aged ≥18 years with confirmed severe and critical COVID-19 who were admitted to or transferred to the intensive care unit (ICU). Respiratory samples were collected for microbial culture and PCR testing within the first 2 days after ICU admission/transfer, between days 3 and 6, and after 7 days of ICU stay. A total of 82 patients, with a median (interquartile range) age of 74.5 (67.3 - 81.0) years and a median Charlson comorbidity index of 4 (3 - 5), were enrolled in the study. Colonisation with any pathogen was observed in 67% of patients, after a median of 4 (2 - 6) days in the ICU. On days 0 - 2 of the ICU stay, micro-organisms were detected in 18% of patients, with Klebsiella pneumoniae (without acquired antibiotic resistance) and methicillin-susceptible Staphylococcus aureus being most frequently identified. Later, A. baumannii and carbapenem-resistant K. pneumoniae became the predominant micro-organisms, identified in nearly half of the patients. In 74% of the samples, the results of microbial culture and PCR tests were identical. In 17%, PCR revealed bacterial pathogens not identified by culture. Our study confirms that colonisation of the respiratory tract occurs early in the course of ICU stay. Superinfections are predominantly caused by multidrug-resistant Gram-negative bacteria. What the study adds. This real-world study provides valuable insights into the significance of microbiological monitoring of critically ill COVID-19 patients. It confirms that bacterial colonisation of the respiratory tract occurs early in the course of ICU stay, with nosocomial superinfections caused predominantly by multidrug-resistant Gram-negative pathogens. Polymerase chain reaction (PCR) testing can assist in ruling out colonisation and in early detection of potential bacterial superinfections.Implications of the findings. Bacterial superinfections present a major challenge in critically ill COVID-19 patients, owing to their high prevalence and mortality rates. Their early detection, determination of causative agents, and antibiotic susceptibility profiling are therefore of paramont importance. PCR testing of clinical specimens appears to be a valuable supplement to respiratory culture, enhancing the precision of diagnosis of lower respiratory tract infections.

Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission.

Objective: To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. Methods: For this predefined secondary analysis of a larger cohort previously described, all consecutive COVID-19 adult patients admitted between March and December 2020 to the ICU of a referral, university hospital in Northern Italy were screened, and clinical severity scores were calculated upon admission. A blood sample for copeptin, MR-proADM and MR-proANP was collected within 48 h (T1), on day 3 (T3) and 7 (T7). Outcomes considered were ICU and in-hospital mortality, bacterial superinfection, recourse to renal replacement therapy (RRT) or veno-venous extracorporeal membrane oxygenation, need for invasive mechanical ventilation (IMV) and pronation. Results: Sixty-eight patients were enrolled, and in-hospital mortality was 69.1%. ICU mortality was predicted by MR-proANP measured at T1 (HR 1.005, 95% CI 1.001-1.010, p = 0.049), although significance was lost if the analysis was adjusted for procalcitonin and steroid treatment (p = 0.056). Non-survivors showed higher MR-proADM levels than survivors at all time points, and an increase in the ratio between values at baseline and at T7 > 4.9% resulted in a more than four-fold greater risk of in-hospital mortality (HR 4.417, p < 0.001). Finally, when considering patients with any reduction in glomerular filtration, an early copeptin level > 23.4 pmol/L correlated with a more than five-fold higher risk of requiring RRT during hospitalization (HR 5.305, p = 0.044). Conclusion: Timely evaluation of MR-proADM, MR-proANP and copeptin, as well as changes in the former over time, might predict mortality and other adverse outcomes in ICU patients suffering from severe COVID-19.

A case of co-infection with head lice and varicella in a child: considerations for rational management

A case of co-infection with head lice and varicella in a child: considerations for rational management

GM-CSF shields IAV-infected mice from bacterial superinfection

GM-CSF shields IAV-infected mice from bacterial superinfection

Inflammasome regulation during bacterial and fungal superinfection in cystic fibrosis

Inflammasome regulation during bacterial and fungal superinfection in cystic fibrosis

Pulmonary Involvement during Varicella in a Patient with Sickle Cell Disease: Diagnosis and Treatment

Introduction: Pulmonary involvement during chickenpox is one of the most serious complications. However, it can be difficult to distinguish between varicella pneumonia, bacterial superinfection and an acute chest syndrome. We report a case of varicella complicated by pneumonia in a young adult with sickle cell disease.&#x0D; Observation: It was a 24-year-old woman with sickle cell disease. Examination on admission revealed generalized skin lesions of varying ages, associated with scratching lesions. On day 3 of hospitalization, she presented an acute respiratory distress associated with fever (40°C). Thoracic CT angiography revealed diffuse pulmonary nodules and micronodules in both lung fields. Blood culture isolated Staphylococcus spp. The patient was put on oxygen therapy combined with antiviral treatment and antibiotic therapy. The course was marked by symptoms regression, with disappearance of respiratory distress on day 2 and apyrexia on day 3 of treatment. The follow-up chest CT scan carried out at month 4, came back normal.&#x0D; Conclusion: Although pneumonia is one of the most common complications of varicella, it can be difficult to diagnose in patients with sickle cell disease, considering the frequency of pulmonary involvement of various etiologies

Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound-A Prospective Observational Study.

This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.