Catheter Samples Research Articles

Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial

BackgroundCatheter-associated urinary tract infection (CAUTI) remains the most significant challenge among hospital-acquired infections (HAIs), yet still unresolved. The present study aims to evaluate the preventive effectiveness of JUC Spray Dressing (name of U.S. FDA and CE certifications, while the medical device name in China is Long-acting Antimicrobial Material) alone for CAUTI without combining with antibiotics and to evaluate the impact of bacterial biofilm formation on CAUTI results on the inserted catheters of patients.MethodsIn this multicenter, randomized, double-blind study, we enrolled adults who suffered from acute urinary retention (AUR) and required catheterization in 6 hospitals in China. Participants were randomly allocated 1:1 according to a random number table to receive JUC Spray Dressing (JUC group) or normal saline (placebo group). The catheters were pretreated with JUC Spray Dressing or normal saline respectively before catheterization. Urine samples and catheter samples were collected after catheterization by trial staff for further investigation.ResultsFrom April 2012 to April 2020, we enrolled 264 patients and randomly assigned them to the JUC group (n = 132) and the placebo group (n = 132). Clinical symptoms and urine bacterial cultures showed the incidence of CAUTI of the JUC group was significantly lower than the placebo group (P < 0.01). In addition, another 30 patients were enrolled to evaluate the biofilm formation on catheters after catheter insertion in the patients’ urethra (10 groups, 3 each). The results of scanning electron microscopy (SEM) showed that bacterial biofilm formed on the 5th day in the placebo group, while no bacterial biofilm formed on the 5th day in the JUC group. In addition, no adverse reactions were reported using JUC Spray Dressing.ConclusionContinued indwelling urinary catheters for 5 days resulted in bacterial biofilm formation, and pretreatment of urethral catheters with JUC Spray Dressing can prevent bacterial biofilm formation by forming a physical antimicrobial film, and significantly reduce the incidence of CAUTI. This is the first report of a study on inhibiting bacterial biofilm formation on the catheters in CAUTI patients.

Esophageal oxyhemoglobin saturation as a resuscitative metric in hemorrhagic shock

BackgroundMixed venous saturation (SvO2) is considered the gold standard to assess the adequacy of tissue oxygen delivery (DO2) in shock states. However, SvO2 monitoring is challenging as it requires an...

Synergistic effect of mannan extracted from Saccharomyces cerevisiae with antibiotics against multidrug resistant Escherichia coli

Multidrug-resistant Escherichia coli (MDR-E. coli) presents a formidable healthcare challenge, continuously evolving resistance to conventional antibiotics. The aim of this study focuses on assessing the synergistic effect and enhance the effectiveness of traditional antibiotics of mannan extracted from Saccharomyces cerevisiae on MDR-E. coli. Clinical samples (n=150) were collected from several hospitals in Baghdad for both sexes between August and December 2022, including 73 urine, 10 catheter, 13 wound, and 54 stool samples. Among the total collected samples, 112 E. coli isolates were obtained, with 54 derived from urine, 9 from catheter samples, 6 from wound samples, and 43 from stool samples. Antimicrobial susceptibility test (AST) revealed resistance to imipenem (0%) and amikacin (2%), with sensitivity observed for cefotaxime (25%), gentamicin (29%), ceftriaxone (28%), ciprofloxacin (41%), norfloxacin (34%), trimethoprim-sulfamethoxazole (48%), and tetracycline (35%). Mannan purified from S. cerevisiae demonstrated inhibitory effects on E. coli growth, with Minimum Inhibitory Concentrations (MIC) ranging from 100 to 12.5 mg/mL and Minimum Bactericidal Concentrations (MBC) from 25 to 200 mg/mL. Furthermore, mannan exhibited a synergistic effect with conventional antibiotics, pointedly boosting the efficacy of gentamicin (250%), cefotaxime (160%), ceftriaxone (340%), ciprofloxacin (344.4%), norfloxacin (337.5%), and trimethoprim-sulfamethoxazole (237.5%). This research addresses the public health threat posed by MDR-E. coli, highlighting the potential of S. cerevisiae mannan as a promising solution for inhibiting E. coli and improving antibiotic efficacy.

Multiplex Digital PCR-Based Development and discussion of the Detection of Genetic Association Between Staphylococcus aureus and mecA.

Methicillin-resistant Staphylococcus aureus (MRSA) is a predominant nosocomial infection-causing bacteria. The aim of this study was to develop a novel single-bacteria multiplex digital PCR assays (SMD-PCR), which is capable of simultaneously detecting and discriminating Methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA. This protocol employed TaqMan probes to detect SAOUHSC_00106 and mecA genes, with the latter being linked to methicillin resistance. A total of 72 samples from various specimen types were evaluated. The accuracy rates for the sputum samples, pus samples, swab samples, ear secretion samples, and catheter samples were 94.44%, 100%, 92%, 100%, and 100%, respectively. Our results showed that the clinical practicability of SMD-PCR has applicability to the rapid detection of MRSA without DNA extraction or bacterial culture, and can be utilized for the rapid detection of Staphylococcus aureus and the timely identification of MRSA in clinical samples, thereby providing an advanced platform for the rapid diagnosis of clinical MRSA infection.

Oxidative Stress Reaction to Hypobaric-Hyperoxic Civilian Flight Conditions.

In military flight operations, during flights, fighter pilots constantly work under hyperoxic breathing conditions with supplemental oxygen in varying hypobaric environments. These conditions are suspected to cause oxidative stress to neuronal organ tissues. For civilian flight operations, the Federal Aviation Administration (FAA) also recommends supplemental oxygen for flying under hypobaric conditions equivalent to higher than 3048 m altitude, and has made it mandatory for conditions equivalent to more than 3657 m altitude. We hypothesized that hypobaric-hyperoxic civilian commercial and private flight conditions with supplemental oxygen in a flight simulation in a hypobaric chamber at 2500 m and 4500 m equivalent altitude would cause significant oxidative stress in healthy individuals. Twelve healthy, COVID-19-vaccinated (third portion of vaccination 15 months before study onset) subjects (six male, six female, mean age 35.7 years) from a larger cohort were selected to perform a 3 h flight simulation in a hypobaric chamber with increasing supplemental oxygen levels (35%, 50%, 60%, and 100% fraction of inspired oxygen, FiO2, via venturi valve-equipped face mask), switching back and forth between simulated altitudes of 2500 m and 4500 m. Arterial blood pressure and oxygen saturation were constantly measured via radial catheter and blood samples for blood gases taken from the catheter at each altitude and oxygen level. Additional blood samples from the arterial catheter at baseline and 60% oxygen at both altitudes were centrifuged inside the chamber and the serum was frozen instantly at -21 °C for later analysis of the oxidative stress markers malondialdehyde low-density lipoprotein (M-LDL) and glutathione-peroxidase 1 (GPX1) via the ELISA test. Eleven subjects finished the study without adverse events. Whereas the partial pressure of oxygen (PO2) levels increased in the mean with increasing oxygen levels from baseline 96.2 mm mercury (mmHg) to 160.9 mmHg at 2500 m altitude and 60% FiO2 and 113.2 mmHg at 4500 m altitude and 60% FiO2, there was no significant increase in both oxidative markers from baseline to 60% FiO2 at these simulated altitudes. Some individuals had a slight increase, whereas some showed no increase at all or even a slight decrease. A moderate correlation (Pearson correlation coefficient 0.55) existed between subject age and glutathione peroxidase levels at 60% FiO2 at 4500 m altitude. Supplemental oxygen of 60% FiO2 in a flight simulation, compared to flying in cabin pressure levels equivalent to 2500 m-4500 m altitude, does not lead to a significant increase or decrease in the oxidative stress markers M-LDL and GPX1 in the serum of arterial blood.

Detrimental Effects of Sterilization Types on Single-Use Coronary Angioplasty Catheters for Reuse: An Electron Microscopic Study.

Reuse of medical devices poses risks concerning technical issues and patient safety. In this study, we aimed to examine the structural changes in catheters that occur due to the reuse with the aid of electron microscopy. The effects of hydrogen peroxide (HP) and ethylene oxide (EO) sterilization on four percutaneous transluminal coronary angioplasty (PTCA) catheters and control PTCA catheters were examined by scanning electron microscope (SEM). Each catheter sample was divided into four parts during the SEM examination, and a total of 20 pieces were examined. Catheters were reprocessed through every regular sterilization step and used solely for the study, not in patients. Statistical evaluations of histological scoring made on images obtained from scanning electron microscopic images were made using the GraphPad Prism 8 program. Electron microscopical examination showed that HP sterilization caused more robust and deeper lines compared to EO. These distortions increased directly with the increase in the reprocessing cycle. In EO, no significant damage was detected within five cycles in contrast to HP; however, the harmful effects of EO were seen over five cycles. Unprocessed samples had no damage. Outer and inner deterioration was significantly higher in the EO>5 group and HP>5 group than in the control group. However, the bacterial contamination score in the EO>5 group was higher than the control group. Our findings showed that HP and EO sterilizations caused some deterioration in the inner and outer surfaces of PTCA catheter samples. We recommend reprocessing using EO, the least damaging method, when necessary, and paying attention not to exceed five cycles when necessary.

Challenging the Practice of Utilizing Central Venous Catheter Samples to Guide Tacrolimus Therapeutic Drug Monitoring Results

Challenging the Practice of Utilizing Central Venous Catheter Samples to Guide Tacrolimus Therapeutic Drug Monitoring Results

Toxicokinetics of Zearalenone following Oral Administration in Female Dezhou Donkeys.

Zearalenone (ZEN) is a mycotoxin produced by various Fusarium strains, that is present in food and feed raw materials worldwide, causing toxicity effects in animals and humans. This research aimed to explore the toxicokinetics of ZEN on female Dezhou donkeys following a single oral exposure dosage of 2 mg/kg BW (body weight). The sample collection of donkeys plasma was carried out at 0, 5, 10, 15, 20, 30, 45, 60, 90 min, 2 h, 2.5 h, 3 h, 3.5 h, 4 h, 4.5 h, 6 h, 9 h, 12 h, 24 h, 48 h, 72 h, 96 h and 120 h via intravenous catheter, and fecal and urinary samples were severally collected at 0 h and every 6 h until 120 h. The concentrations of ZEN, α-zearalenol (α-ZOL), β-zearalenol (β-ZOL), α-zearalanol (α-ZAL), β-zearalanol (β-ZAL), zearalanone (ZAN) in plasma, urine, and feces were detected by UPLC-MS/MS. Only ZEN was detected in plasma, and the maximum was 15.34 ± 5.12 µg/L occurred at 0.48 h after gavage. The total plasma clearance (Cl) of ZEN was 95.20 ± 8.01 L·kg·BW-1·h-1. In addition, the volume of distribution (Vd) was up to 216.17 ± 58.71 L/kg. The percentage of total ZEN (ZEN plus the main metabolites) excretion in feces and urine was 2.49% and 2.10%, respectively. In summary, ZEN was fast absorbed and relatively slowly excreted in female donkeys during 120 h after a single gavage, indicating a trend of wider tissue distribution and longer tissue persistence.

Genomic analyses of an Escherichia coli and Klebsiella pneumoniae urinary tract co‐infection using long‐read nanopore sequencing

AbstractEscherichia coli and Klebsiella pneumoniae isolates presenting with the same antimicrobial susceptibility profile were recovered from the same catheter sample of urine (CSU). Both strains were recovered from a patient with a long‐standing indwelling urinary catheter. Each isolate had its DNA extracted following culture. Nanopore long‐read sequencing was used to build the plasmids and chromosomes from each strain to closure to discern the potential horizontal propagation of resistance‐encoding plasmids and the relationship between resistance genes and insertion sequences. Plasmids derived from resistance strains in the urinary microbiota remain poorly characterized. The same 11 antimicrobial resistance (AMR) genes were found in plasmids from each strain. The 185,239‐bp FIB(K) pKBM1, from the K. pneumoniae strain, additionally encoded the five AMR genes: sul2, strA, strB, blaTEM‐1B, and blaCTX‐M‐15. A multimeric array of AMR genes and IS26 insertion sequences were found in the plasmids from both isolates. Both plasmids from each isolate were similar. Horizontal transfer of plasmids, followed by subsequent plasmid rearrangement, is likely to have occurred during infection. Furthermore, the resistance region in the plasmids shared similarity against the internationally prevalent plasmid, pKPN3‐307_typeA, commonly identified in K. pneumoniae ST307. Biofilm formation in catheterized patients may allow close cell contact between strains. Horizontal propagation of resistance genes may occur, leading to polymicrobial infections.

Association of glucose metabolism and insulin resistance with feed efficiency and production traits of finishing beef steers.

Increasing nutrient utilization efficiency is an important component of enhancing the sustainability of beef cattle production. The objective of this experiment was to determine the association of glucose metabolism and insulin resistance with dry matter intake (DMI), average daily gain (ADG), gain:feed ratio (G:F), and residual feed intake (RFI). Steers (n = 54; initial body weight = 518 ± 27.0kg) were subjected to an intravenous glucose tolerance test (IVGTT) where glucose was dosed through a jugular catheter and serial blood samples were collected. Three days after the last group's IVGTT, steers began a 63-d DMI and ADG test. Body weight was measured on days 0, 1, 21, 42, 62, and 63, and DMI was measured using an Insentec Roughage Intake Control system (Hokofarm Group, Emmeloord, the Netherlands). To examine relationships between DMI, ADG, G:F, and RFI with IVGTT measurements, Pearson correlations were calculated using Proc Corr of SAS 9.4 (SAS Inst. Inc., Cary, NC). Additionally, cattle were classified based on DMI, ADG, RFI, and G:F, where the medium classification was set as mean ± 0.5 SD, the low classification was < 0.5 SD from the mean, and the high classification was > 0.5 SD from the mean. No associations between DMI and IVGTT parameters were observed, and no differences were detected when classifying cattle as having low, medium, or high DMI. Peak insulin concentration in response to the IVGTT tended to be correlated with ADG (r = 0.28; P = 0.07), indicating cattle with greater ADG tend to have a greater insulin release in response to glucose. Glucose nadir concentrations tended to be positively correlated with ADG (r = 0.26; P = 0.10). Additionally, the glucose nadir was greater in high-ADG steers (P = 0.003). The association of greater glucose nadir with high-ADG could indicate that high-ADG steers do not clear glucose as efficiently as low-ADG steers, potentially indicating increased insulin resistance. Further, RFI was not correlated with IVGTT measurements, but low RFI steers had a greater peak glucose concentration (P = 0.040) and tended to have a greater glucose area under the curve (P = 0.09). G:F was correlated with glucose area under the curve (r = 0.33; P = 0.050), glucose nadir (r = 0.35; P = 0.011), and insulin time to peak (r = 0.39; P = 0.010). These results indicate that glucose metabolism and insulin signaling are associated with growth and efficiency, but the molecular mechanisms that drive these effects need to be elucidated.

Microbial co-occurrences on catheters from long-term catheterized patients

Catheter-associated urinary tract infections (CAUTIs), a common cause of healthcare-associated infections, are caused by a diverse array of pathogens that are increasingly becoming antibiotic resistant. We analyze the microbial occurrences in catheter and urine samples from 55 human long-term catheterized patients collected over one year. Although most of these patients were prescribed antibiotics over several collection periods, their catheter samples remain colonized by one or more bacterial species. Examination of a total of 366 catheter and urine samples identify 13 positive and 13 negative genus co-occurrences over 12 collection periods, representing associations that occur more or less frequently than expected by chance. We find that for many patients, the microbial species composition between collection periods is similar. In a subset of patients, we find that the most frequently sampled bacteria, Escherichia coli and Enterococcus faecalis, co-localize on catheter samples. Further, co-culture of paired isolates recovered from the same patients reveals that E. coli significantly augments E. faecalis growth in an artificial urine medium, where E. faecalis monoculture grows poorly. These findings suggest novel strategies to collapse polymicrobial CAUTI in long-term catheterized patients by targeting mechanisms that promote positive co-associations.

Abstract 109: Nitric Oxide Added to the ECMO Circuit Improves Neuroprotection and Cardiac Function After Cardiac Arrest

Background: Veno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest. Nitric Oxide (NO) has shown potential for exerting a protective role in ischemia/reperfusion damage in different organs. Aim: This study aims to investigate the cardio and neuroprotective effects of NO administered in the extracorporeal membrane oxygenation (ECMO) circuit after cardiac arrest. Methods: Thirty male SD rats were subjected to 10 minutes of cardiac arrest. They were randomly assigned to receive ECMO or ECMO plus NO (20 ppm) administered in the oxygenator (ECMO+NO). After 1 hour, the animals were weaned from ECMO, hemodynamic analysis using pressure-volume miniaturized catheter, and cardiac and brain samples were collected after two hours. Results: Analysis of cardiac function showed improved systolic cardiac function in the ECMO+NO group compared to standard ECMO (stroke volume: 55 ± 8 vs. 26 ± 9 μl, cardiac index: 9.05 ± 1.41 vs. 4.70 ± 0.81 ml/min/100g, dP/dt max : 6870 ± 290 vs. 5124 ± 205 mmHg/s; p&lt;0.01). The ECMO+NO group also exhibited reduced systemic resistance (total peripheral resistance: 2.14 ± 0.42 vs. 2.95 ± 0.35 mmHg/ml/min/100g; p&lt;0.05) and improved ventricular-arterial coupling (Ees/Ea: 0.96 ± 0.15 vs. 0.53 ± 0.15; p&lt;0.001). Neuroinflammation, assessed by the expression of Iba1, a microglia activation marker, was attenuated in the ECMO+NO group (8.37 ± 0.41% vs. 12.58 ± 0.48%; p &lt; 0.001). The extent of hypoxic brain areas, analyzed by thiol oxidation, was lower in the ECMO+NO group (4.07 ± 0.45% vs. 11.72 ± 1.03%; p&lt;0.01). Conclusions: NO administration in the oxygenator during ECMO after cardiac arrest improves cardiac function and ventricular-arterial coupling and enhances neuroprotection decreasing neuroinflammation and hypoxic areas. NO administration in the ECMO circuit might be a promising therapeutic adjunct during ECLS.

N-acetylcysteine prevents catheter occlusion and inflammation in catheter associated-urinary tract infections by suppressing urease activity.

Proteus mirabilis is a key pathobiont in catheter-associated urinary tract infections (CA-UTIs), which is well known to form crystalline biofilms that occlude catheters. Urease activity alkylates urine through the release of ammonia, consequentially resulting in higher levels of Mg2+ and Ca2+ and formation of crystals. In this study, we showed that N-acetyl cysteine (NAC), a thiol antioxidant, is a potent urease inhibitor that prevents crystalline biofilm formation. To quantify urease activity, Berthelot's method was done on bacterial extracts treated with NAC. We also used an in vitro catheterised glass bladder model to study the effect of NAC treatment on catheter occlusion and biofilm encrustation in P. mirabilis infections. Inductively-coupled plasma mass spectrometry (ICP-MS) was performed on catheter samples to decipher elemental profiles. NAC inhibits urease activity of clinical P. mirabilis isolates at concentrations as low as 1 mM, independent of bacterial killing. The study also showed that NAC is bacteriostatic on P. mirabilis, and inhibited biofilm formation and catheter occlusion in an in vitro. A significant 4-8log10 reduction in viable bacteria was observed in catheters infected in this model. Additionally, biofilms in NAC treated catheters displayed a depletion of calcium, magnesium, or phosphates (>10 fold reduction), thus confirming the absence of any urease activity in the presence of NAC. Interestingly, we also showed that not only is NAC anti-inflammatory in bladder epithelial cells (BECs), but that it mutes its inflammatory response to urease and P. mirabilis infection by reducing the production of IL-6, IL-8 and IL-1b. Using biochemical, microbiological and immunological techniques, this study displays the functionality of NAC in preventing catheter occlusion by inhibiting urease activity. The study also highlights NAC as a strong anti-inflammatory antibiofilm agent that can target both bacterial and host factors in the treatment of CA-UTIs.

COMPARISON OF ANTIBIOTIC SENSITIVITY OF MRSA WITH MSSA AMONG STAPHYLOCOCCUS AUREUS ISOLATES FROM PATIENTS IN THE 48 MILITARY HOSPITAL IN SANA'A CITY, YEMEN

Background and objectives: A number of infectious disorders can be opportunistically brought on by Staphylococcus aureus ( S. aureus), which colonizes human skin and mucous membranes. Methicillin (MRSA) resistance is a frequent occurrence, as are resistances to a number of clinically useful antibiotics. Though MRSA affects healthcare systems and society all throughout the world, it is most severe in underdeveloped countries. The Clinical and Laboratory Standards Institute (CLSI) advises that cumulative antibiotic data for S. aureus be analyzed and reported on an annual basis to help clinicians choose the best preliminary empirical antimicrobial therapy. The most recent report from our center on this subject, however, was more than 7 years ago. Subjects and methods: Well-proven S. aureus data were gathered from inpatient and outpatient clinical samples at the 48th Military Hospital, Sana'a, Yemen, from January 1, 2022, through December 2022, using a retrospective cross-sectional design. Using Kirby-Bauer disk diffusion, antimicrobial susceptibility testing (AST) was carried out. Calculations were made on the rate of antibiotic resistance between MRSA and MSSA as well as the correlation between MRSA. Results: Among the 265 unique isolates, the overall prevalence of MRSA was 37.4%. Inpatients had a greater risk factor for MRSA with an OR of 2.7 (p&lt;0.001). A risk factor was also found with the catheter sample, and devices with an OR=3.7 (p=0.003). Methicillin resistance was predictive of resistance to most antibiotics. Zero resistance rate to linezolid, and vancomycin was observed for the MRSA and MSSA strains. The prevalence of multidrug resistant (MDR) isolates was 60.4%. Significantly higher in MRSA (68.7%) versus 55.4% for MSSA. Conclusion: This study's MRSA prevalence was higher than that of earlier research from the same hospital; it is a progressive issue and much below the desired rates. Additionally, there was notable resistance to erythromycin, imipenem, and clindamycin. Vancomycin and linezolid are currently the top two options for the empiric treatment of MRSA. In order to stop the emergence of MDR species, it is suggested against giving newer antibacterial medications while the older ones are still effective. Peer Review History: Received: 24 June 2023; Revised: 19 July; Accepted: 29 August, Available online: 15 September 2023 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg

Survey the Effect of Educational Intervention Based on Mobile Short Message Service (SMS) on Self-Care in Patients with Type 2 Diabetes Referring to the Diabetes Clinic in Khorram Abad City

Background: The highlighting of possible risk factors for urinary colonization in patients with obstructive urolithiasis that needed double J catheters implanted to preserve renal function. Methods: We performed a descriptive, retrospective study, carried out in the Urology Department of the Bucharest Central Military Hospital, between January 2020 and January 2022 and included 168 patients with urolithiasis who required the insertion of double J catheters. We studied the bacteriological profile, using both urine and JJ catheter samples. Results: We obtained a double J catheter colonization rate of 32% (54 patients) and 29% of urinary colonization (49 patients). The rate of urinary colonization is higher in patients with colonized ureteral catheters regardless of sex, age, and associated comorbidities. At the same time, we noticed an increased rate of urinary colonization in patients associated with diabetes, hypertension, and chronic kidney disease. Conclusions: The prevalence of urinary colonization in patients with double J catheters was 29%. The colonization of the JJ catheters, as well as the association with chronic diseases, such as diabetes, hypertension, and CKD (Chronic Kidney Disease), show an increased risk of urinary colonization.

External ventriculostomy-associated infection reduction after updating a care bundle

BackgroundDespite the clinical benefits of external ventricular drains (EVD), these devices can lead to EVD-related infections (EVDRI). The drainage insertion technique and standardized guidelines can significantly reduce the risk of infection, mainly caused by gram-positive bacteria. However, gram-negative microorganisms are the most frequent causative microorganisms of EVDRI in our hospital. We aimed to determine whether a new bundle of measures for the insertion and maintenance of a drain could reduce the incidence of EVDRI. This cohort study of consecutive patients requiring EVD from 01/01/2015 to 12/31/2018 compared the patients’ characteristics before and after introducing an updated protocol (UP) for EVD insertion and maintenance in 2017.ResultsFrom 204 consecutive patients, 198 requiring EVD insertion were included (54% females, mean age 55 ± 15 years). The before-UP protocol included 87 patients, and the after-UP protocol included 111 patients. Subarachnoid (42%) and intracerebral (24%) hemorrhage were the main diagnoses at admission. The incidence of EVDRI fell from 13.4 to 2.5 episodes per 1000 days of catheter use. Gram-negative bacteria were the most frequent causative microorganisms. Previous craniotomy remained the only independent risk factor for EVDRI. EVDRI patients had increased mechanical ventilation durations, hospital and ICU stays, and percutaneous tracheostomy requirements.ConclusionsA care bundle focusing on fewer catheter sampling and more accurate antiseptic measures can significantly decrease the incidence of EVDRI. After implementing the management protocol, a decreased incidence of infections caused by gram-negative and gram-positive bacteria and reduced ICU and hospital lengths of stay were observed.

Bacteraemia caused by Lactobacillus casei in a patient after cardiac surgery. A case report

BackgroundBacteria of the Lactobacillus family are a part of the physiological flora of the oral cavity, gastrointestinal tract, and urinary tract. We have used them in the food industry as probiotics and supplements. In some settings, rod-shaped lactic acid bacteria may become pathogenic. It may occur in immunocompromised or heart disease patients after cardiac surgery, patients with disturbed intestinal wall permeability, or those treated with broad-spectrum antibiotics.Case presentationWe present rare bacteraemia induced by the probiotic bacterium Lactobacillus casei in a 63-year-old patient after the attempted removal of ICD electrodes, complicated by acute regurgitation of the tricuspid valve. The patient underwent urgent cardiac surgery, the electrode elements were removed, and the tricuspid valve was replaced with a biological prosthesis. After surgery, the patient required intensive, multidisciplinary treatment with mechanical ventilation, continuous renal replacement therapy, broad-spectrum empirical antibiotic therapy, parenteral nutrition, and blood product transfusion because of multiple organ failure. On the 14th day of hospitalisation, the clinical symptoms of septic shock were observed. The microbiological investigation was performed, and Lactobacillus casei was cultured from a dialysis catheter sample. Dedicated antimicrobials were administered, and the patient was discharged home in good overall condition.ConclusionsThe present case shows that the promoted use of probiotics must be cautiously administered to patients in severe conditions, especially when accompanied by reduced immune system efficiency symptoms.

Reducing Microbial Contamination in Hematopoietic Stem Cell Products and Quality Improvement Strategy: Retrospective Analysis of 1996-2021 Data.

Sterility and safety assurance of hematopoietic stem cell (HSC) products is critical in transplantation. Microbial contamination can lead to product disposal and increases the risk of unsuccessful clinical outcomes. Therefore, it is important to implement and maintain good practice guidelines and regulations for the HSC collection and processing unit in each hospital. We aimed to share our experiences and suggest strategies to improve the quality assurance of HSC processing. We retrospectively analyzed microbial culture results of 11,743 HSC products processed over a 25-year period (January 1996 to May 2021). Because of reorganization of the HSC management system in 2008, the 25-year period was divided into periods 1 (January 1996 to December 2007) and 2 (January 2008 to May 2021). We reviewed all culture results of the HSC products and stored aliquot samples and collected culture results for peripheral blood and catheter samples. Of the 11,743 products in total, 35 (0.3%) were contaminated by microorganisms, including 19 (0.5%) of 3,861 products during period 1 and 16 (0.2%) of 7,882 products during period 2. Penicillium was the most commonly identified microorganism (15.8%) during period 1 and coagulase-negative Staphylococcus was the most commonly identified (31.3%) during period 2. HSC product contamination occurred most often during HSC collection and processing. The contamination rate decreased significantly during period 2, when the HSC management system was reorganized. Our results imply that handling HSC products by trained personnel and adopting established protocols, including quality assurance programs, aid in decreasing the contamination risk.

Coronary conductance in the normal development of sheep during the perinatal period.

Birth is associated with substantial shifts in cardiovascular physiology. Little is known about coronary vascular adaptations during this period. We used fetal and neonatal lambs to measure coronary function at late gestation (92% of term) and shortly after birth (5-6 days postnatal age). In each animal we measured unanesthetized myocardial perfusion and oxygen delivery using a circumflex artery flow probe. We used inflatable occluders and adenosine to determine coronary conductance and flow reserve. In a subset of animals, we used myocardial contrast echocardiography (MCE, anesthetized) to assess its utility as a tool for studying changes in regional myocardial perfusion in normal development. Separate age-matched animals were instrumented with aortic and coronary sinus sampling catheters to determine myocardial oxygen extraction (unanesthetized). With an average of 17 days of developmental time separating our neonatal and fetal cohorts we found that heart-to-body weight ratio was significantly greater in neonates than fetuses. In resting animals, we found significant decreases in weight-normalized perfusion of, and oxygen delivery to, neonatal relative to fetal myocardium. Similar results were seen when measuring baseline MCE-derived perfusion. Pressure-flow relationship studies revealed lower baseline and maximal coronary conductance in neonates than fetuses, with similar coronary flow reserve between groups. There was greater oxygen extraction in neonates than fetuses. Combined analysis of oxygen extraction with coronary flow suggested greater oxygen consumption by the fetal than neonatal myocardium. We conclude that, during the immediate perinatal period, cardiac growth outpaces coronary microvascular growth resulting in lower capacity for microvascular perfusion in the early neonate.

PSII-B-12 Association of Glucose Metabolism with Feed Intake, Growth, and Efficiency of Beef Steers

Abstract The objective of this experiment was to determine the association of glucose metabolism and insulin sensitivity with dry matter intake (DMI), average daily gain (ADG), and feed efficiency (G:F) of steers fed a finishing diet. Steers (n = 55; initial body weight 518 ± 26.7 kg) were subjected to an intravenous glucose tolerance test (IVGTT) where glucose was dosed through a jugular catheter and serial blood samples were collected. Three days after the final IVGTT, steers began a 63-d DMI and ADG test. Body weight was measured on d 0, 1, 21, 42, 62, and 63, and DMI was measured using an Insentec Roughage Intake Control system (Insentec, Markenesse, The Netherlands). Peak insulin concentration in response to the IVGTT tended to be correlated with ADG (r = 0.25; P = 0.07) and DMI (r = 0.23; P = 0.09), indicating cattle with greater ADG and DMI tend to require a greater insulin release in response to glucose. Glucose nadir concentrations were correlated with ADG (r = 0.27; P = 0.044) and G:F (r = 0.37; P = 0.005). Additionally, when steers within 0.5 standard deviations of the mean for DMI are classed as displaying high- or low-ADG, glucose nadir was greater in high-ADG steers (P = 0.042). The association of greater glucose nadir with high-ADG could indicate that high-ADG steers do not clear glucose as efficiently as low-ADG steers, potentially indicating reduced insulin sensitivity. Carcass marbling score was negatively correlated with area under the glucose curve (r = -0.38; P = 0.006), glucose clearance rate (r = -0.33; P = 0.016), and glucose nadir concentration (r = -0.40; P = 0.004). These results indicate that glucose metabolism and insulin signaling are associated with growth, efficiency, and carcass quality, but the molecular mechanisms that drive these effects need to be elucidated.