Beta-hemolytic Streptococci Research Articles

Development of thermostable Streptokinase by recombinant DNA technology as fibrinolytic agent for different thromboembolic disorders

Edicine is a therapeutic agent in the management of thromboembolic blockade. Streptokinase is presently utilized in clinical mase and is an extracellular protein secreted by certain strains of beta-hemolytic streptococci. It activates plasminogen to produce plasmin, an enzyme that breaks down fibrin clots through specific lysine binding sites.

Knowledge, Attitude, and Practice of House Officers to the Diagnosis and Management of Bacterial Pharyngitis: A Multicenter Cross-Sectional Study.

Pharyngitis is one of the most common clinical presentations in pediatric clinics. Streptococcal pharyngitis reaches a nadir in the early school years, and it is vital to diagnose it earlyto avoid the serious complications that can arise from improper treatment, such as acute rheumatic fever and rheumatic heart disease. This is a cross-sectional multicenter study of medical house officers conducted from January to February 2018. This study surveyed 135 house officers at Khartoum's primary health centers and hospitals. Most of the respondents were males (76/135;56%). Most of the house officers reported seeing patients with throat complaints 1-2 times per week (58/135; 43%). The most common complication was acute rheumatic fever (65/135; 48%). Out of all the criteria of a Group A beta-hemolytic streptococcus (GAS) pharyngitis diagnosis, absence of cough and tender lymph nodes were the least recognized by house officers, i.e. 11.9%(16/135) and 45.2% (61/135), respectively. Only (4/135) 3% knew the full criteria for diagnosing bacterial pharyngitis. Throat culture was the most commonly used lab test to diagnose bacterial pharyngitis (115/135; 85.2%). The majority of participants did not recognize an IM injection of benzathine penicillin G as the first-line management of bacterial pharyngitis (101/135; 74.8%). The participants had moderate knowledge (93/135; 68.9%). Those with poor knowledge also happened to have poor practice (p = 0.009). Those who see more cases per week were also more likely to have good knowledge (p = 0.000). House officers with a moderate attitude constituted about 48.9%(66/135) of the whole sample. The most often prescribed medication was amoxicillin-clavulanic acid for one week (53/135; 39.3%). The practice score was associated with a lower knowledge (p = 0.009). Only 20.7%(28/135) of the participants in our study were adherent to the use of benzathine penicillin G as the first-line management of bacterial pharyngitis. House officers had poor-to-moderate knowledge regarding the diagnosis and management of bacterial pharyngitis, especially in regardto what antibiotic to use. However, their fear of antibiotic resistance was a good behavior.

Respiratory microorganisms in acute pharyngitis patients: Identification, antibiotic prescription patterns and appropriateness, and antibiotic resistance in private primary care, central Malaysia.

Acute pharyngitis (AP) is a common reason for private primary care consultations, thus providing an avenue for widespread antibiotic intake among the community. However, there is limited data on the antibiotic prescription appropriateness and resistance information in the Malaysian private primary care setting, therefore, this study aimed to investigate the prevalence of isolated viruses and bacteria, antibiotic resistance patterns, antibiotic prescription patterns and appropriateness by general practitioners (GPs) and factors affecting antibiotic resistance and antibiotic prescription patterns. To investigate, a cross-sectional study was conducted among 205 patients presenting with AP symptoms at private primary care clinics in central Malaysia from 3rd January 2016 to 30th November 2016. Throat swabs were collected from 205 AP patients for two purposes: (i) the detection of four common respiratory viruses associated with AP via reverse-transcription real-time PCR (qRT-PCR); and (ii) bacterial identification using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Bacterial isolates were then subjected to antibiotic susceptibility screening and McIsaac scoring was calculated post-prescription based on GP selection of criteria. Generalized estimating equations analysis with multiple logistic regression was conducted to identify factors associated with presence of virus and antibiotic prescription. The results showed that 95.1% (195/205) of patients had at least one of the four viruses, with rhinovirus (88.5%) being the most prevalent, followed by adenovirus (74.9%), influenza A virus (4.6%) and enterovirus (2.1%). A total of 862 non-repetitive colonies were isolated from the culture of throat swabs from 205 patients who were positive for bacteria. From a total of 22 genera, Streptococcus constitutes the most prevalent bacteria genus (40.9%), followed by Neisseria (20%), Rothia (13.0%), Staphylococcus (11%) and Klebsiella (4.9%). Only 5 patients carried group A beta-hemolytic streptococci (GABHS). We also report the presence of vancomycin-resistant S. aureus or VRSA (n = 9, 10.1%) among which one isolate is a multidrug-resistant methicillin-resistant S. aureus (MDR-MRSA), while 54.1% (n = 111) were found to carry at least one antibiotic-resistant bacteria species. Application of the McIsaac scoring system indicated that 87.8% (n = 180) of patients should not be prescribed antibiotics as the majority of AP patients in this study had viral pharyngitis. The antibiotic prescription appropriateness by applying post-prescription McIsaac scoring was able to rule out GABHS pharyngitis in this sample with a GABHS culture-positive sensitivity of 40% (n = 2/5) and specificity of 90% (180/200). In conclusion, antibiotic-resistant throat isolates and over-prescription of antibiotics were observed and McIsaac scoring system is effective in guiding GPs to determine occurrences of viral pharyngitis to reduce unnecessary antibiotic prescription.

Screening della colonizzazione vagino-rettale da streptococco di gruppo B in gravidanza

Group B beta-haemolytic streptococcus (GBS) is a bacterium that colonizes the genito-intestinal tract of many women and is one of the main causes of neonatal sepsis if screening and antibiotic prophylaxis are not carried out during pregnancy. The best strategy for identifying colonized women (and therefore subjecting them to intrapartum antibiotic prophylaxis) is based on universal cultural screening with the execution of a vagino-rectal swab at 36-37 weeks of gestational age. In 2007, the prevalence of GBS-colonized pregnant women was on average 15.5% in the Piedmont Region (Italy) laboratories that followed the international culture guidelines, while it was 10.5% in the laboratories that did not follow them. In 2010 the Piedmont Regional Health Department carried out an awareness-raising intervention that led to an increase in the average prevalence of GBS (19.2% in 2018), resulting in a net reduction in false negatives. Accurate identification of the carriers to undergo intrapartum prophylaxis makes it possible to prevent the greatest number of early neonatal infections.

Erythromycin resistance in Group A Beta-hemolytic streptococci

Aim: Streptococcus pyogenes (Group A Beta-hemolytic streptococci, GABHS) is one of the important bacterial pathogens in clinical microbiology. It often causes upper respiratory tract infections such as tonsillitis, pharyngitis, and laryngitis. It also leads to complications such as acute rheumatic fever and post-streptococcal glomerulonephritis. Early diagnosis and treatment of these bacterial infections will prevent suppurative and non-suppurative complications, the transmission of infection to other people, and chronic carriage. Today, the treatment of streptococcal infections relies entirely on chemotherapy. Beta hemolytic group A streptococci and generally other beta-hemolytic streptococci in groups B (GBBHS), C, and G are generally sensitive to many chemotherapeutics, especially Penicillin and Erythromycin. In patients with penicillin allergy, erythromycin, amoxicillin-clavulanate, or oral cephalosporins are used instead of penicillin. However, it has recently been understood that there are strains resistant to Erythromycin in GABHS and are increasing. In this study, the situation in our region of Erythromycin resistance, which is used as an alternative for people allergic to Penicillin in the treatment of streptococcal infections, was investigated.
 Material and Method: In our study, throat swab samples were taken from 150 pharyngitis patients and 94 GABHS were obtained by applying the Bacitracin-SXT test with the culture method, and antibiotic susceptibility tests were performed on these 94 GABHS by Kirby-Bauer agar disc diffusion method. 
 Result: GABHS was found susceptible to Bacitracin and resistant to SXT. GBBHS is resistant to Bacitracin and SXT. other beta-hemolytic streptococci were resistant to Bacitracin and susceptible to SXT.
 Conclusion: In this study, Erythromycin’s resistance was found to be 19.1%. it is observed that Erythromycin resistance has increased over the years when compared to previous studies. Erythromycin should not be used empirically in treatment. An antibiotic susceptibility test should be performed and the antibiotic should be selected according to the results of the antibiogram test.

Isolation of Streptococcus Thoraltensis in A Case of Necrotizing Fasciitis

Our aim of this case report is to add significant epidemiological knowledge regarding the role of Streptococcus thoraltensis in causing human infections, emphasizing the importance of not neglecting the viridans group of streptococci in nonneutropenic patients and also patients with normal cardiac valves. Objectives of our study are to present the clinical features and laboratory findings of a patient diagnosed with Necrotizing fasciitis of perineum in whom S.thoraltesis a viridans streptococcus species was isolated in blood culture . Necrotizing fasciitis is an uncommon bacterial infection of fascial tissue which can progress to cause necrosis followed by sepsis. In microbiological aspects Necrotizing fasciitis is classified as type I and II. Type I is due to polymicrobial infection.Type II is commonly due to group A beta hemolytic Streptococci and Staphylococcus aureus .To the best of our knowledge Streptococcus thoraltensis bacteremia with necrotizing fasciitis has never been reported till now. Only a few cases of S.thoraltensis is reported in literature so far. Here we present a case of a 65-year-old male patient admitted with sepsis and shock. He had a fever, chills for two weeks, and difficulty walking for five days. On examination, there was a scrotal swelling and a swelling of 8x4 cm over the left gluteal region near the anal canal with erythema and tenderness. The computed tomographic scan of the abdomen and pelvis was suggestive of Necrotizing Fasciitis with multiple abscess formation involving perianal region,ischiorectal fossa,root of penis, and scrotum, left anterior abdominal wall with left retroperitoneal and intraperitoneal extension. Laboratory investigations revealed marked neutrophilia and elevated urea and creatinine levels.The patient expired on the same day in spite of prompt supportive treatment. The 2 blood samples drawn from different sites were culture positive for S. thoraltensis . As blood culture results play a very important role in identifying the pathogen in Necrotizing fasciitis S.thoraltensis isolation from two blood cultures throws light on the emerging pathogenic nature of viridans group of streptococci.It emphasizes the importance of treating the viridans group of streptococci and not neglecting it in non-neutropenic patients and patients with normal cardiac valves.

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME: A VICIOUS CIRCLE OF CLOTTING AND BLEEDING

EFFECT OF COLLAGEN INDUCED ARTHRITIS ON ANTISTREPTOLYSIN TEST IN THE WHITE LABORATORY RAT

Rheumatoid arthritis (RA) is a serious health challenge as a disease with serious health consequences andthe potential to result in permanent disability. Most of the authors state that the reason for the occurrence of thedisease and its persistence is multifactorial, but above all it is a genetic predisposition as a result of the disruption ofthe control mechanisms of the immune system. The disease can occur at any age, but it is most common in patientsover sixty years of age who suffer from damage to the joints, resulting in impaired locomotion, reduced workcapacity, unproductive and poor quality of life. Animal models in RA disease research are useful for studying andevaluating the effect of potential antiarthritic drugs. The study of the disease in animal models provides usefulinformation about rheumatoid diseases and RA in humans because of the great similarity in their onset anddevelopment.Our research aimed to see how collagen type-II induced arthritis would cause an effect on the immune system andinter alia on ASTO in Wistar rats of both sexes, on the thirtieth and sixtieth days of immunization. ASTO is alsoused to diagnose RA secondary to streptococcal infections. Wistar rats, healthy seven-week-old male and femaleanimals, bred according to standard conditions for experimental animals at the laboratory animal farm at PMFSkopjewere used for the research. The experimental animals were divided into four groups; control group of maleanimals (n=20), control group of female animals (n=20), experimental group of male animals (n=30), which weretreated with collagen type-II and experimental group of female animals (n=30), which were also treated withcollagen. Analyzes of aliquots were performed on the thirtieth and sixtieth day of the test. We apply the highlypurified collagen type-II according to a defined protocol in the joint of the back right leg. We took blood for analysison the thirtieth and sixtieth day after immunization. The ASTO samples were tested on the computerized andthermostated Mini NEF TM Duinding Fait apparatus. The principle of the method is based on the fact thatpathogenic beta-hemolytic streptococci of group A produce streptolysin O, which stimulate the body to produceantistreptolysin. A titer greater than 1/200 is a positive value. From the studies that were done on the influence ofcollagen induced arthritis type-II on the value of ASTO in both sexes of animals, in both experimental periods, it canbe concluded that they are within the limits of normal values in all groups and in both sexes. All were <59,430IU/ml. In general, these studies of RA performed in animal models provide a good parallel for the course anddevelopment of RA in the human population.

An Application of Real-Time PCR and CDC Protocol May Significantly Reduce the Incidence of Streptococcus agalactiae Infections among Neonates.

Streptococcus agalactiae is an important human opportunistic pathogen, especially infectious for pregnant women and neonates. This pathogen belongs to beta hemolytic Streptococcus spp. representatives and accounts for a significant part of early infections in newborns, including serious life-threatening infections. This research investigated the usefulness of Centers for Disease Control and Prevention (CDC) protocol for S. agalactiae DNA detection in 250 samples of recto-vaginal swabs collected from pregnant women (at 35-37 weeks of gestation) and pre-cultured overnight in liquid medium. With an application of the CDC protocol-based real-time PCR, the cfb gene was detected in 68 (27.2%) samples compared to 41 (16.4%) for the standard culture-based methodology. The applied molecular method presented high sensitivity (100.0%) and specificity (87.1%). Therefore, it allowed for more precise detection of S. agalactiae bacteria, compared to the reference diagnostic method, culture on solid media with the following strain identification. The increased sensitivity of GBS detection may result in a reduced number of infections in newborns and leads to more targeted antimicrobial prophylaxis therapy of GBS infections in pregnant women. In addition, the use of the molecular method allows for a significant reduction in the time needed to obtain a result for GBS detection, and interpretation of the results is relatively simple. Therefore, it enables a faster intervention in case of a necessity of an antibiotic therapy introduction in pregnant women whose GBS status is unknown at the time of delivery.

Limiting the role of antibiotics in children with adenotosilitis

Background In the past, group A beta-haemolytic streptococcus infection consequences were the main goal of empirical antibiotic therapy of sore throat. Antimicrobial stewardship is crucial due to the threats posed by multi-resistant pathogens. The aim of this study : was to investigate the possibility of limiting the role of antibiotic in children with adenotosilitis Methods: This hospital-based, randomised, prospective research involved 120 child who visited OPD of both Pediatrics and Otorhinolaryngology departments, pesented with adenotonsillitis were enrolled . All cases met the eligibility requirements were randomly assigned to two groups: 60 cases in Group A got systemic antibiotics. Group B 60 cases received symptomatic treatment with immune modulator, vit D 2000-5000 IU orally once daily. The cases were selected through 2 months from February 2022 to April 2022. Age :2 years to 9 years. In younger children less than 3 years, dysphagia was expressed by the mothers as difficult swallowing and crying during feeding with drolling of saliva. Results: Regarding baseline symptoms and indicators and after three days, there was no discernible difference between groups A and B. However, after six days of therapy, group B considerably outperformed group A in terms of absent sore throat, dysphagia, and tonsillar hypertrophy.

Lactoferrin versus Long-Acting Penicillin in Reducing Elevated Anti-Streptolysin O Titer in Cases of Tonsillopharyngitis.

BackgroundBeta-Hemolytic streptococci are the most frequent bacteria causing tonsillitis. Lactoferrin may play a role in the treatment of chronic tonsillitis due to its direct antimicrobial activity.ObjectiveTo assess the possible role of lactoferrin in reduction of raised serum Anti-Streptolysin O Titer (ASOT) in cases of chronic tonsillopharyngitis in comparison to long acting penicillin.MethodsThis study included 117 children with tonsillopharyngitis with high ASOT randomly divided into three groups; group 1 treated with lactoferrin, group 2 treated with long acting penicillin and group 3 treated with both drugs. For all patients ASOT was measured after three and six months of starting treatment.ResultsThis study included 60 males and 57 females with the mean age (8.5 ± 2.4). There is statistically significant reduction in ASOT in all groups after three months of treatment. ASOT after 3 months was significantly lower in group1 (370±440) and group 3 (350±450) in comparison to group 2 (420±560) with p value 0.02, 0.004, respectively, with no significant difference in comparing group 1 to group 3 p value 0.4. Also, ASO titre after 6 months was significantly lower in group1 (350±420) and group 3 (340±440) in comparison to group 2 (420±550) with p value 0.02, 0.007, respectively, with no significant difference in comparing group 1 to group 3 p value 0.5. In comparing ASOT at three months and six months of treatment in the three studied groups; it decreased by 2% in group 1, and 1.6% in group 3 and no change in group 2.ConclusionLactoferrin alone or in combination with long acting penicillin is safe and more effective than long acting penicillin alone in reducing ASOT. Treatment for six months with lactoferrin alone or in combination with long acting penicillin could offer a better response.

Benign Acute Childhood Myositis: Our Experience on Clinical Evaluation.

Benign acute childhood myositis (BACM) is a transient condition mainly affecting children of school age characterized by muscle pain, typically localized to the calf muscle with symmetrical lower extremity pain and difficulty in walking. Usually, the symptomatology is preceded by a viral infection including influenza, parainfluenza, rotavirus, and mycoplasma. The case series was conducted in four pediatric hospitals in Catania, Italy, over a 12-year observational period. Clinical examination, laboratory data, course, treatment, and complications of the affected children were extracted from electronic medical records of each hospital. For the case series, 50 children diagnosed with BACM were enrolled: the mean age of affected children was 5.35 years, 86% of were males, and in 56% the affections occurred during the winter. In the affected children, the clinical picture was characterized by previous fever and/or symptoms of inflammation of the upper airways, and followed by pain in the lower extremities up to uncoordinated gait. In 17 cases the etiological agent was isolated, including the influenza virus type B as the most frequent and influenza virus type A, Mycoplasma pneumoniae, beta-hemolytic streptococcus, and herpes simplex virus. Children were treated with supportive therapy. In all the children the muscular symptomatology had a good evolution with progressive marked reduction of pain and of the high level of CKemia. Neither clinical recurrences nor sequelae were reported. BACM shows to have in most of the cases a favorable evolution, a spontaneous remission of symptoms, and a good prognosis. However, the disorder generates parental distress for the acute presentation and the striking muscle dysfunction. It is worthy a rapid and early diagnosis to avoid unnecessary diagnostic investigations and a careful follow-up necessary to exclude persistence of symptoms or creatine kinase elevation.

Prevalence of Group A Beta Hemolytic Streptococcus Related Pharyngitis in Pakistan

Objective: To identify the prevalence of group A beta hemolytic streptococcus related pharyngitis in Pakistan. Study Design: Retrospective Study Place and Duration of Study: Department of ENT and Head & Neck Surgery, Liaquat College of Medicine & Dentistry, Karachi from 1st July 2021 to 31st March 2022. Methodology: One hundred and seventy patients who showed symptoms of pharyngitis were enrolled. Two throat swabs were taken where first was used for rapid group a beta hemolytic streptococcus assessment. In cases of negative testing second swab was placed on 5% of the sheep blood agar plates at a temperature of 35°C with anaerobic conditions for two days. Beta hemolytic streptococcus colonies were checked. On sub-culturing pyrrolidonyl-arylamidase test was applied. A disc of >15mm with inhibited growth around bacitracin was considered as positive for group A β-hemolytic. Result: The present study found that the mean age of the patients was 19.5±4.3 years. There were 51.7% males while 48.2% females in this study. There were 11.17% those who were found positive for group a beta hemolytic streptococcus There was a significant association between rapid test positive and modified Centor scoring assuming that as score increases from 0-3 the risk of group a beta hemolytic streptococcus positive cases also surges. Conclusion: There is a significant prevalence of group A beta hemolytic streptococcus in pharyngitis cases reported from Pakistan. Keywords: Prevalence, Pharyngitis, Group A ß-hemolytic, Streptococcus

A case of Streptococcus canis bacteremia, osteomyelitis, sacroiliitis, myositis, and abscess

BackgroundStreptococcus canis is a group G beta-hemolytic Streptococcus species which normally resides on the skin and mucosal surfaces of dogs. Although it rarely causes infection in humans, our case and review of relevant literature demonstrate that this multi-host pathogen may be responsible for metastatic infection. We present an appropriate management strategy in such cases.Case presentationA previously healthy 26-year-old male presented to the emergency department with a 2-day history of erythema, pain, and swelling of the left ankle and foot, consistent with acute cellulitis. The patient was initially discharged home with a plan to complete a course of IV cefazolin as an outpatient, but later recalled after two sets of blood cultures grew gram positive cocci. Blood cultures speciated as Streptococcus canis. This was performed by identifying beta hemolytic strep on blood agar, then typed as Lancefield group G, followed by MALDI-TOF which distinguished S. canis. History was unremarkable except for a 2-week history of lower back pain precipitated by a wrestling injury. There was no canine bite or scratch wound, although the patient lives with a dog. CT spine was obtained which demonstrated right piriformis myositis and S1 osteomyelitis. MRI additionally demonstrated right erector spinae myositis, right sacroiliitis, and multiple collections in the right posterior paraspinal soft tissues. Transthoracic echocardiogram did not demonstrate valvular vegetations. The S. canis isolate was pan-susceptible and the patient was ultimately discharged home and completed a 8-week course of IV penicillin G. After completion of therapy, his symptoms, repeat imaging, and biochemical markers suggested resolution of infection on follow-up.ConclusionsWe suggest that management of S. canis bacteremia should involve consideration of screening for metastatic infection and infectious diseases consultation. However, despite its potential for systemic involvement, S. canis is often susceptible to narrow spectrum antibiotics, and may be treated with penicillins.

Cloning and expression of native streptokinase in E. coli BL21(DE3)

Streptokinase (SK) is a potent plasminogen activator naturally produced by beta-hemolytic streptococcus bacteria. Streptokinase is one of the most important thrombolytic agents that was frequently employed treatment of myocardial infarction. In this study, we amplified the SK gene isolated from Streptococcus pyogenes. The sequence of SK was recorded in the NCBI database. The Accession number of the SK sequence was LC625519.1. The SK gene was digested by EcoR1 and Hindlll, ligated with the linear pGEM®-3Zf (+) vector, and then introduced into an expression host E. coli BL21(DE3). For the production of the SK protein, we induced by 1mM IPTG. SDS-PAGE was used for the evaluation of the streptokinase synthesis with a molecular weight of around 47 kDa. Using the casein lysis method and the in vitro clot lysis assay, the activity of native SK was assessed. The native SK has clot lysis activity and a clear zone in the casein plate.

QS66. The Safety of Elution of Multiple Antibiotics From Collagen-rich Hydrogel for Topical Treatment of Chronic Wounds

Purpose: Chronic wounds pose a significant challenge to modern healthcare systems, affecting 1-2% of the population in developed countries with costs ranging between $28.1 and $96.8 billion annually. Overtime chronic wounds tend to become colonized or infected with multiple different bacteria resulting in patients being treated with several rounds of systemic oral and IV antibiotics. Subsequently, antibiotic resistance develops, and wounds become harder to treat. Comorbidities, such as diabetes and peripheral vascular disease, also make treatment more challenging. Ideally chronic wounds would be treated topically with customized antimicrobial combinations unique to each patient’s wound.In vivo, we have previously shown that a topical collagen-rich hydrogel (cHG) can provide controlled elution of single antibiotics leading to inhibition of bacterial growth while avoiding cytotoxicity towards host cells in a stented wound model. We hypothesize that the elution of multiple antibiotics from collagen-rich hydrogel will also be well-tolerated in mammalian cells. Methods: Antibiotic Selection: We performed a literature search to determine the antibiograms bacteria isolated from chronic diabetic wounds; the most common microbes were Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., and beta-hemolytic streptococci. This informed our choice of antibiotics. We tested four antibiotic combinations from six antibiotics. While there are 15 two-antibiotic permutations, these combinations provided the most extensive coverage. Collagen hydrogel formation: 2.5% collagen-rich thermoresponsive hydrogel (cHG) was synthesized according to a previously established protocol. After confirmation of composition and gelation, cHG-antibiotic solutions were prepared by determining 100x the minimum inhibitory concentration of each antibiotic and adjusting the final volume of hydrogel to 100 mL per well. The antibiotic concentrations used were 400 ug/mL vancomycin, 400 ug/mL imipenem, 200 ug/mL ciprofloxacin, 500 ug/mL ceftazidime, 1.0 mg/mL gentamicin, and 100 ug/mL clindamycin.Mammalian cell cytotoxicity: Human adipose-derived stem cells (ASCs), mouse ASCs, human fibroblasts (FBs), and mouse FBs were used to study cytotoxicity in both differentiated and undifferentiated mammalian cells. Cells were seeded onto 24-well culture plates at a density of 2 × 104 cells/ml, allowed to attach overnight, and treated with cHG+antibiotic, incubated until 24, 48, and 72-hour time points.A live/dead viability/cytotoxicity assay was used according to the manufacturer’s instructions, and images were analyzed using MATLAB. All experiments were performed in triplicates. Results: We observed no significant cell death in differentiated and undifferentiated cells in both mouse and human cell lines treated with antibiotic-eluting hydrogel with multiple combinations of antibiotics. All cell lines had >90% survival at all timepoints. Conclusion: This study demonstrates that the application of a topical drug-eluting hydrogel with a combination of antibiotics in the hydrogel is safe for use in mammalian cells. This could transform the treatment of chronic diabetic wounds, which are often polymicrobial with unique resistance patterns requiring multiple antibiotics.

A Retrospective Analysis of Intravenous vs Oral Antibiotic Step-Down Therapy for the Treatment of Uncomplicated Streptococcal Bloodstream Infections.

Evidence supporting intravenous-to-oral (IV-to-PO) antibiotic deescalation for uncomplicated streptococcal bloodstream infections (BSIs) are limited. The objective of this study was to compare clinical outcomes of patients treated with IV-only versus IV-to-PO antibiotic therapy for uncomplicated streptococcal BSIs. This was a single-center, retrospective study of patients aged ≥18 years who received treatment for uncomplicated streptococcal BSIs from January 2017 to December 2019. Patients were excluded if they had a polymicrobial BSI, endocarditis, osteomyelitis, septic arthritis, or received antibiotic therapy for >14 days. The primary outcome was clinical failure, defined as persistent bacteremia, recurrence of bacteremia, or mortality at 30 days. Secondary outcomes included length of hospital stay, all-cause readmissions, development of Clostridioides difficile infection, and adverse antibiotic reactions. There were 98 patients who met the inclusion criteria: 51 patients in the IV-to-PO therapy group and 47 patients who received IV-only antibiotics. Streptococcus pneumoniae and beta-hemolytic streptococci were the most common pathogens. Patients received an average of 4.4 days of IV antibiotics before being stepped down to an oral agent. Hospital length of stay (6.3 vs 12.6 days; P < .001) and total antibiotic duration of therapy (11.8 vs 13.9 days; P = .002) were significantly shorter in patients receiving IV-to-PO therapy. There were no clinical failures observed in patients who received IV-to-PO antibiotic therapy. IV-to-PO step-down therapy for uncomplicated streptococcal BSIs was not associated with worse clinical outcomes compared to patients receiving IV-only antibiotic therapy.

Impact of a bloodstream infection stewardship program in hospitalized patients

Bloodstream infections (BSIs) in hospitalized patients represent sentinel events requiring timely and responsive antimicrobial prescribing. These infections represent an attractive but seldom-evaluated stewardship opportunity. Retrospective pre-post study design, with review of patient charts 18 months before and after initiation of a hospital Bloodstream Infection Stewardship Program (BSISP). Pre-intervention, the ward and attending physician were notified of all positive blood cultures. Post-intervention, an infectious disease (ID) pharmacist collaborating with an ID consultant was also notified. Two hundred twenty-six eligible BSIs were identified pre-intervention and 195 post-intervention. The urinary tract was the most common source of infection; most common bloodstream isolates were Escherichia coli, Staphylococcus aureus, beta-hemolytic streptococci, and Klebsiella pneumoniae; 71.7% of infections were community acquired. Empiric therapy was not given in 17.3% of cases and inadequate in 16.4% of patients. Therapy was altered on the basis of Gram stain results ('directed therapy') in 54.6% of episodes and was inadequate in 3.5%. Compared to pre-intervention, the post-intervention cohort received directed therapy on average 4.36 hours earlier (p = 0.003), was more likely to receive appropriate definitive therapy (99.0% post versus 79.1% pre, p <0.001), stepped down to oral therapy earlier (6.0 versus 8.0 days, p = 0.031), and received fewer directed prescriptions (214 per 100 cases post versus 260 per 100 cases pre; p = 0.001), including fewer prescriptions of quinolones and clindamycin. A BSISP could be an effective strategy for improving antimicrobial prescribing in hospitalized patients with a BSI.

Cutaneous bacteriological profile and antibiotic sensitivity pattern in patients with pemphigus attending tertiary care center, Northeast India

Pemphigus is an autoimmune bullous disease. Septicemia is one of the common causes of death which is usually secondary to cutaneous bacterial infection. 1: To study the cutaneous bacteriological profile and the most common cause of bacterial skin infection in pemphigus patients; 2: To find out the antibiotic sensitivity pattern in pemphigus patients of Northeastern part of India.This was a descriptive type of cross-sectional study conducted at Dermatology, Venereology and Leprosy department of Silchar Medical College from January 2021 to December 2021. A total of 33 confirmed inpatient cases of pemphigus was selected via non probability convenient sampling method. Pus for culture was collected, to study the common cause of bacterial skin infections and antibiotic sensitivity pattern in pemphigus patients. Out of 33 patients included in the study, male patients were 22 and female patients were 11. Pemphigus vulgaris was noted in 28 patients, pemphigus foliaceous was found in 4 patients and 1 patient was of pemphigus vegetans. The mean age was found to be 35.6 years and 36.36% patients were diabetics in our study. About 45.4% patient’s pus culture report showed the growth of Staphylococcus aureus, 18.1% showed the growth of Proteus mirabilis, 6.06% showed the growth of nonfermenting gram negative bacilli, 3.03% showed the growth of Klebsiella species and Beta hemolytic streptococci, 9.09% showed the growth of skin commensals and 15.15% showed no growth. Staphylococcus aureus showed 100% sensitivity to linezolid, amikacin and tetracycline; 86.6% resistance was seen for penicillin, 80% resistance was seen for levofloxacin, 60% resistance was seen for clindamycin, 66.6% resistance for cotrimoxazole was seen and 33.3% resistance was seen for azithromycin. Proteus mirabilis showed maximal sensitivity to ciprofloxacin, amikacin, gentamicin, ceftazidime, piperacillin + tazobactam and meropenem. Staphylococcus aureus is the most common organism causing skin infections in pemphigus patients and it has maximal sensitivity to linezolid, amikacin and tetracycline

#13 Dalbavancin Activity against Bacterial Isolates from Pediatric Patients: Results from the International Dalbavancin Evaluation of Activity (IDEA) Program for the United States and Europe (2019-2021)

Abstract Background Dalbavancin is a lipoglycopeptide approved in the United States (US; 2014) and Europe (2015) to treat skin and skin structure infections in adults with a convenient parenteral administration of either a single dose of 1500 mg or a dose of 1000 mg followed by 500 mg a week later. We evaluated dalbavancin in vitro spectrum and potency against Gram-positive isolates from pediatric patients. Method 4,487 consecutive, unique pediatric patient isolates of clinical significance were collected from 32 US and 34 European medical centers and tested for susceptibility to dalbavancin and comparators by broth microdilution. The most common organisms were Staphylococcus aureus (n=2,633), Streptococcus pneumoniae (n=689), and beta-hemolytic streptococci (BHS; n=584). Susceptibility results were analyzed by patient age group: ≤1 years old (yo; n=1,459), 2-5 (1,106), 6-12 (1,164), and 13-17 (758). Results Dalbavancin showed complete activity against S. aureus (100% susceptibility), with a highest MIC value of 0.12 mg/L and consistent activity against all age groups (MIC50/90 of 0.03/0.03 mg/L for the US and Europe as well as the MSSA and MRSA subsets). MRSA rates were higher in the US (32.4% overall) than Europe (14.0%). In the US, MRSA rates were 38.7%, 34.2%, 28.4%, and 25.0% in the ≤1, 2-5, 6-12, and 13-17 yo groups, respectively; whereas, in Europe, it was slightly lower in the 2-5 yo group (11.5%) compared to the other age groups (14.1-14.8%). Ceftaroline was consistently active against S. aureus isolates from all age groups, with susceptibility rates ranging from 99.4% (13-17 yo) to 99.8% (2-5 yo) in the US and from 95.3% (≤1 yo) to 100.0% (2-5 yo) in Europe. Dalbavancin showed consistent activity against S. pneumoniae from all age groups (MIC50/90 of 0.008/0.015 mg/L for all age groups in the US and Europe) with a highest MIC value of 0.06 mg/L (1 isolate). All S. pneumoniae isolates were susceptible to ceftaroline, and susceptibility to ceftriaxone (at ≤1 mg/L; non-meningitis breakpoint) ranged from 92.7% (13-17 yo) to 100.0% (≤1 yo), or 97.8% overall. Dalbavancin was also highly active against BHS (n=584; MIC50/90, 0.008/0.015 mg/L; highest MIC, 0.06 mg/L), coagulase-negative staphylococci (n=240; MIC50/90, 0.03/0.06 mg/L; highest MIC, 0.25 mg/L), Enterococcus faecalis (n=200; MIC50/90, 0.03/0.06 mg/L; highest MIC, 0.06 mg/L), viridans group streptococci (n=102; MIC50/90, 0.008/0.03 mg/L; highest MIC, 0.12 mg/L), and vancomycin-susceptible E. faecium (n=26; MIC50/90, 0.03/0.12 mg/L; highest MIC, 0.25 mg/L), but showed limited activity against vancomycin-resistant E. faecium (VREFM; n=13 [0.3% of the organism collection]; MIC50/90, &amp;gt;2/&amp;gt;2 mg/L). Conclusion Dalbavancin showed potent in vitro activity against a large collection of Gram-positive isolates from pediatric patients, independent of patient age and geographic region (US and Europe). Only 13 of 4,487 (0.3%) isolates exhibited a dalbavancin MIC &amp;gt;0.25 mg/L, all of which were VREFM. These in vitro results support further clinical development of dalbavancin for treatment of Gram-positive infections in children.