Cause Of Infectious Complications Research Articles

The main causative agents of infectious complications during reconstructive surgery using allomaterials in patients with breast cancer

Introduction: Surgical site infections (SSI) are one of the key problems in surgical practice. Despite the achievements of modern medicine, ongoing preventive measures, the incidence of wound infection remains quite high. This is especially relevant for oncoplastic surgery, since in most cases the installation of foreign materials (expanders, implants, meshes) is required to achieve a satisfactory cosmetic result.The purpose of the study: to identify the most common cause of infectious complications after reconstructive operations on the mammary gland using endoprostheses.Materials and methods: In a retrospective review of 526 consecutive implant-based breast reconstructions at a single institution from June 2020 to June 2022 was conducted. The frequency of development of infectious complications was assessed, as well as the taxonomic structure of the main pathogens that were isolated in the department of oncomammology in 2020–2022.Results: The incidence of infectious complications that led to the loss of the endoprosthesis during reconstructive surgery on the mammary gland was 6.7 %. The main causative agents of SSI leading to the loss of implants and the need for reoperations were Corynebacterium striatum (35.2 %) and Staphylococcus aureus (27.2 %). The spectrum of the most common pathogens that led to the loss of implants corresponded to the flora most often detected during bacterial culture in the department. The probability of implant loss was higher in the group of patients who underwent chemotherapy (14 of 197, 7.1 %) or chemoradiotherapy (14 of 188, 7.4 %) compared with patients who did not receive specific anticancer treatment (7 of 141, 4.9 %). However, taking patients who did not receive drug or radiation treatment as a reference group, statistical significance could not be achieved (p = 0.56 in the chemotherapy group and p = 0.49 in the chemoradiotherapy group).Conclusions: Our own experience has shown that, despite the current preventive measures, the frequency of infectious complications remains quite high. In the etiological structure of SSI pathogens, microorganisms of the genera Staphylococcus and Corynebacterium predominate. The use of broad-spectrum antibiotics in perioperative prophylaxis did not guarantee the absence of SSI in the postoperative period. An analysis of the sensitivity of isolated pathogens to antibacterial drugs, an assessment of the effectiveness of various antibiotic regimens in the future may allow us to develop an optimal antibiotic prophylaxis scheme for infectious complications during breast reconstructive surgery, therefore, further prospective studies in this direction are needed.

Comparative evaluation of test systems for determining premature rupture of membranes

Introduction. Preterm premature rupture of the membranes (PPROM) is one of the most common pregnancy complications. PPROM as а cause of infectious complications poses the greatest danger with increasing duration of period without amniotic fluid (i.e., watchful waiting) in full-term pregnancy.Aim. Comparative evaluation of test systems for the diagnosis of premature rupture of the membranes (PROM) based on the determination of the pH of the vaginal contents, the detection of placental alpha macroglobulin-1 (PAMG) or insulin-like growth factor-binding protein 1 (IGFBP-1).Materials and methods. The study included 52 patients at 22–41 weeks of gestation in whom, according to the clinical examination, it is impossible to exclude/confirm PROM. All women were examined for the detection of PROM using test systems: nitrazine pH test, immunochromatographic test for the detection of IGFBP-1 or PAMG-1. The sensitivity, specificity, accuracy, predictive value of positive and negative results were calculated.Results. As a result of the study, premature rupture of the membranes was confirmed in 25 cases, and this diagnosis was excluded in 27 cases. In three observations, additional observation and examination were required due to the questionable interpretation of the result due to a test error. Sensitivity and specificity were 64.0 and 66.7% for the nitrazine test, 95.8 and 92.3% for IGFBP-1, and 95.8 and 96.3% for PAMG-1.Conclusion. The nitrazine test has low sensitivity and specificity, therefore, for the diagnosis of PROM, test systems based on the determination of PAMG-1 and IGFBP-1 should be used, which improves the quality of diagnosis, reduces the risk of complications and ensures the timely start of a set of measures appropriate to the clinical situation. A negative test result avoids unnecessary hospitalization and unnecessary interventions, which is important both from a medical and economic point of view.

Antibiotic resistance of pathogens causing community-acquired urinary tract infections in pregnant women with diabetes mellitus

BACKGROUND: Urinary tract infections are among the most common infectious diseases in women and are the most frequent cause of infectious complications of pregnancy, especially in pregnant women with type 1 diabetes mellitus. For adequate treatment of urinary tract infections in pregnant women with type 1 diabetes mellitus, it is requisite to regularly monitor antimicrobial resistance of uropathogens in order to update empirical schemes of antibacterial therapy.
 AIM: The aim of this study was to determine the spectrum of uropathogens and the activity of antibacterial drugs against pathogens of community-acquired urinary tract infections in pregnant women with type 1 diabetes mellitus or without diabetes mellitus.
 MATERIALS AND METHODS: We analyzed 91 strains obtained from pregnant women with or without type 1 diabetes mellitus. The sensitivity of microorganisms to all antibacterial drugs was evaluated by the disk diffusion method.
 RESULTS: In the group of pregnant women with type 1 diabetes mellitus in the etiological structure of uropathogens, enterobacteria accounted for 84.8%, Escherichia coli (71.7%) and Klebsiella spp. (13.0%) being the most common. In the group of pregnant women without diabetes mellitus in the structure of uropathogens, enterobacteria accounted for 75.6%, while E. coli was the causative agent of urinary tract infections in 62.2% of women and Klebsiella spp. in 11.1%. Gram-positive uropathogens were isolated much less frequently. In the group of pregnant women with type 1 diabetes mellitus, piperacillin/tazobactam, carbapenems, nitrofurantoin, and amikacin (100%), as well as fosfomycin and gentamicin (97%), had the maximum antibacterial activity against E. coli. The sensitivity of E. coli to various cephalosporins varied in the range of 84.990.9%. In the group of pregnant women without diabetes mellitus and with urinary tract infections, the highest E. coli sensitivity rates were observed for piperacillin/tazobactam, carbapenems, fosfomycin, nitrofurantoin, gentamicin, and amikacin (100%). E. coli sensitivity to second and third generation cephalosporins varied in the range of 75.082.1%, and it was 96.4% to cefepime. Ampicillin and amoxicillin/clavulanate demonstrated the least activity against E. coli in the two study groups. The rate of extended spectrum beta-lactamase production by uropathogenic enterobacteria in pregnant women with type 1 diabetes mellitus was 15.8% of the strains, and in pregnant women without diabetes mellitus, it was 18.1%.
 CONCLUSIONS: There were no significant differences in the activity of antibacterial drugs against the pathogens of community-acquired urinary tract infections in pregnant women with or without diabetes mellitus.

Skin Antiseptics for Atopic Dermatitis: Dissecting Facts From Fiction

Staphylococcus aureus (S. aureus) is a known trigger and cause of infectious complications in atopic dermatitis (AD). Various antiseptics have been used in an attempt to decrease the burden of S. aureus in AD. In this Commentary, we present the evidence for and against some of the commonly-used antiseptics in clinical and research settings. These agents remain attractive as an adjunct therapy for AD due to their relative low cost and potential benefits of reducing S. aureus. Though a number of studies have evaluated the use of dilute bleach, its mechanisms remain controversial. A higher concentration of bleach than the commonly-used 0.005% is likely needed for its anti-S. aureus effect. Silver-coated textiles have demonstrated anti-S. aureus effects in various studies, however, their efficacy and side effects in AD remain to be confirmed. Other antiseptics including chlorhexidine, triclosan and triclocarban are also discussed. Variables that may affect the outcomes of these studies include length of use, concurrent application of moisturizers and anti-inflammatory medications.

Infectious complications of the respiratory tract and lungs in patients with post-COVID syndrome

BACKGROUND. The mechanism of development of post-COVID syndrome is not fully understood. Long-term retention of complaints in patients is associated with long-term persistence of the virus, hyperinflammatory response of the body, as well as with the peculiarities of the patient’s cellular and humoral immunity. Secondary infectious complications in the post-COVID period are due not only to the ability of the SARS-CoV-2 virus to damage erythrocytes and attack the red bone marrow in the acute phase of the disease. It has been proven that the SARS-CoV-2 virus leads to the disappearance of white pulp cells in the spleen, the tissue where cells of the immune response, in particular T- and B-lymphocytes responsible for infectious immunity, mature.
 OBJECTIVE. To investigate the frequency of secondary infectious complications of the respiratory tract and lungs in patients with post-COVID syndrome who underwent inpatient treatment.
 MATERIALS AND METHODS. Clinical, laboratory and radiological data of 90 patients with post-COVID syndrome who were undergoing inpatient treatment in the clinical departments of the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine”. The diagnosis of coronavirus disease (COVID-19) was established in accordance with the current national protocol for the treatment. Computed tomography (CT) of the chest organs was performed on the Aquilion TSX-101A scanner (Toshiba, Japan).
 RESULTS AND DISCUSSION. Complications of COVID-19 were determined according to the clinical and functional, laboratory examination and CT scan of the chest. Some patients had two or more complications at the same time. Patients with post-COVID syndrome were most often hospitalized for progression or slight positive dynamics of the pathological process of the respiratory tract and lungs, disappearing lung syndrome, fibrotic changes in the lungs, exacerbation of bronchoobstructive lung diseases and infectious complications. The latter were observed most often – in 53,3 % of patients. Fungal and bacterial complications occurred secondarily, mainly in patients with disappearing lung syndrome, in places where cystlike cavities were formed. The most common concomitant diseases in patients with post-COVID syndrome were cardiovascular diseases and diabetes.
 CONCLUSIONS. The proportion of infectious complications of the respiratory tract and lungs in patients with post-COVID syndrome, who are indicated for inpatient treatment in the pulmonology department, is 53.3 %. The most frequent causes of infectious complications of the respiratory tract and lungs in patients with post-COVID syndrome are the reactivation of the Epstein – Barr virus infection – in 30.0 %, which in 2.2 % of patients is combined with the reactivation of the hepatitis C virus, and bacterial infections – in 15.6 %. Aspergillosis and mucormycosis occur in 1.1 and 3.3 % of patients respectively.

TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF BULLET AND MINE EXPLOSIVE INJURIES OF EXTREMITIES

The aim of the study. To provide an analysis of the development of purulent-inflammatory complications in gunshot wounds and mine-explosive trauma and to develop tactics for the treatment of infectious complications at the stage of specialized medical care.
 Materials and methods. An analysis of the treatment of 57 patients with purulent-inflammatory complications of the limbs after gunshot bullet wounds and mine-explosive trauma was conducted. Of them, 34 (59.6%) military personnel and 23 (40.4%) civilians were treated in the bone-purulent surgery department. 44 (77.1%) of the patients had a mine-explosive injury, and 13 (22.9%) had bullet wounds.
 Research results. It was revealed that the cause of infectious complications was severe trauma, and in some cases irrational both general and local treatment during the evacuation stages. The therapy was not aimed primarily at the elimination of signs of traumatic shock, anemia, and detoxification of the body. In most of the victims, the initial surgical treatment of wounds was performed poorly and insufficiently, repositioning and stable fixation of fractures was not performed. As a result of the treatment, 2 (3.5%) patients with severe mine-explosive injuries of the lower limbs, pelvis and spine died, 6 (10.5%) victims underwent limb amputation at the level of the middle third of the thigh. The rest of the patients from the first day of hospitalization received complex treatment aimed at eliminating the purulent-inflammatory process of the extremities. In 41 (71.9%) fractures were fixed with external fixation devices. After elimination of the inflammatory process, all patients were transferred to outpatient treatment in a military hospital or at their place of residence.
 Conclusion. Modern combat trauma of the limbs in the course of treatment is complicated by severe purulent-inflammatory processes in 35% of cases. According to the clinical course, gunshot wounds differ significantly from mine-explosive injuries. One of the formidable infectious complications is gunshot osteomyelitis, the course of which exhausts the body and leads to sepsis and death. Stabilization of fractures against the background of purulent-inflammatory processes should be performed with external fixation devices.

POS-189 Urinary tract infection in renal transplant recipients:Experience of a single departement

Urinary tract infection (UI), is the most common cause of infectious complications in kidney transplant recipients.These infections remain suspect due to their impact on graft survival and therefore on the morbidity and mortality of this population .These can occur at any time but with the highest incidence in the first 3–6months after transplantationour aims were as follow: 1. Assess the prevalence of UI in kidney transplant recipients. 2. Identify the risk factors for UI in kidney post transplantation.3. Study the microbiological profile and therapeutic attitudes of these UIs This is a descriptive and analytical retrospective study, carried out between January 2017 and November 2019 at the renal transplant unit in the nephrology department of Fattouma Bourguiba Hospital in Monastir. we included all kidney transplant patients hospitalized during this period During this period 360 patients were hospitalized, IU was diagnosed in 32 patients. The average age of our population was 35.5 ± 9.6 years with a sex ratio of 1. The prevalence of IU in kidney transplant recipients was estimated at 8.8%. The graft acute pyelonephritis was the most frequent presentation. The most incriminated germs were the bacillus gram negative (BGN) represented mainly by Klebsielle pneumonae (47.7%). The most prescribed antibiotics were carbapenemes in 34% of cases followed by third generation cephalosporin (C3G) mainly cefotaxime (21.5%). The only UI risk factor found in our study with a statistically significant p was ureteric vesic reflux complicating a kidney transplant. View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) Several other risk factors have been identified in the literature not objectived in our study, their recognition is important to identify kidney transplant recipients who are more likely to develop urinary tract infections and to minimize the risk with personalized care. for example, adequate screening and prophylaxis.

Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review).

Infectious complications are the most common cause of death in patients with severe burns. To date, there is no generally accepted method for preventing such complications in burn injury. One of the possible prevention options is selective intestinal decontamination (SID). This method is based on the enteral administration of non-absorbable antimicrobial agents. The preventive effect of SID involves inhibition of intestinal microflora translocation through the mucous membranes, inasmuch as studies demonstrate that endogenous opportunistic microorganisms are a common cause of infectious complications in various critical conditions.The SID method was originally developed in the Netherlands for patients suffering from mechanical injury. Antimicrobial drugs were selected based on their high activity in relation to the main endogenous opportunistic pathogens and minimal activity against normal intestinal microflora components. The combination of polymyxin (B or E), tobramycin, and amphotericin B with intravenous cefotaxime was chosen as the first SID regimen. Other regimens were proposed afterwards, and the application field of the method was expanded. In particular, it became the method of choice for prevention of infectious complications in patients with severe burn injury.Clinical studies demonstrate efficacy of some SID regimens for preventing infectious complications in patients with thermal injury. Concomitant administration of SID and systemic preventive antibiotics and addition of oropharyngeal decontamination increases the method efficacy. SID is generally well-tolerated, but some studies show an increased risk of diarrhea with this preventive option. In addition, SID increases the risk of developing antibiotic resistance like any other antibiotic regimens.

Live Monitoring and Analysis of Fungal Growth, Viability, and Mycelial Morphology Using the IncuCyte NeuroTrack Processing Module.

Efficient live-imaging methods are pivotal to understand fungal morphogenesis, especially as it relates to interactions with host immune cells and mechanisms of antifungal drugs. Due to the notable similarities in growth patterns of neuronal cells and mycelial networks, we sought to repurpose the NeuroTrack (NT) processing module of the IncuCyte time-lapse microscopy system as a tool to quantify mycelial growth and branching of pathogenic fungi. We showed the robustness of NT analysis to study Candida albicans and five different molds and confirmed established characteristics of mycelial growth kinetics. We also documented high intra- and interassay reproducibility of the NT module for a spectrum of spore inocula and culture periods. Using GFP-expressing Aspergillus fumigatus and Rhizopus arrhizus, the feasibility of fluorescence-based NT analysis was validated. In addition, we performed proof-of-concept experiments of NT analysis for several translational applications such as studying the morphogenesis of a filamentation-defective C. albicans mutant, the effects of different classes of antifungals (polyenes, azoles, and echinocandins), and coculture with host immune cells. High accuracy was found, even at high immune cell-to-fungus ratios or in the presence of fungal debris. For antifungal efficacy studies, addition of a cytotoxicity dye further refined IncuCyte-based analysis, facilitating real-time determination of fungistatic and fungicidal activity in a single assay. Complementing conventional MIC-based assays, NT analysis is an appealing method to study fungal morphogenesis and viability in the context of antifungal compound screening and evaluation of novel immune therapeutics.IMPORTANCE Pathogenic fungi remain a major cause of infectious complications in immunocompromised patients. Microscopic techniques are crucial for our understanding of fungal biology, host-pathogen interaction, and the pleiotropic effects of antifungal drugs on fungal cell growth and morphogenesis. Taking advantage of the morphological similarities of neuronal cell networks and mycelial growth patterns, we employed the IncuCyte time-lapse microscopy system and its NeuroTrack image analysis software package to study growth and branching of a variety of pathogenic yeasts and molds. Using optimized image processing definitions, we validated IncuCyte NeuroTrack analysis as a reliable and efficient tool for translational applications such as antifungal efficacy evaluation and coculture with host immune effector cells. Hence, the IncuCyte system and its NeuroTrack module provide an appealing platform for efficient in vitro studies of antifungal compounds and immunotherapeutic strategies in medical mycology.

Adenovirus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including pneumonitis, colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus surveillance testing should not be performed in asymptomatic recipients. Serial quantitative PCR might play a role in the decision to initiate or assess response to therapy in a symptomatic patient. The initial and most important components of therapy remain supportive care and decrease in immunosuppression. The use of antiviral therapy is not supported by prospective randomized clinical trials. However, intravenous cidofovir is considered the standard practice for treatment of severe, progressive, or disseminated adenovirus disease in most transplant centers. Intravenous immunoglobulin may be beneficial, primarily in a select group of patients with hypogammaglobulinemia. Future approaches to treatment of adenovirus disease may include administration of adenovirus-specific T-cell therapy.

Gut Microbiome in Critical Illness (Review)

Radical changes in the composition, diversity and metabolic activity of gut microbiome in critically ill patients most probably affect adversely the outcome of treatment. Microbiota dysfunction may be a predictor and presumably the main cause of infectious complications and sepsis. Clinicists use objective scales for evaluation of patient condition severity including specific parameters of disorders of organs and systems; however, microbiota function is not considered specific and, hence, not evaluated. Technical capabilities of the recent decade have allowed characterizing the intestinal microbiota and that helped understanding the ongoing processes. The authors have analyzed data about the role of intestinal microbiota as a metabolic 'reactor' during critical states, possible complications related to misbalance of 'harmful' and 'beneficial' bacteria, and examined potential of a targeted therapy aimed directly at correction of intestinal microbiota. Search for papers was carried out using Scopus and Web of Science databases 2001 to 2018 years: (Gut Microbiota) AND (Critically ill OR Intensive care unit), key words taken for the search were: intestinal microbiota, metabolism, sepsis, antibiotics, critically ill patients, multiple organ failure. A number of questions in understanding of the interaction between gut microbiome and host remain open. It is necessary to take into account interference of microbial metabolism while assessing metabolome of patients with sepsis. Among low-molecular compounds found in blood of sepsis patients, special attention should be paid to molecules that can be classified as ‘common metabolites’ of humans and bacteria, for example, degradation products of aromatic compounds, which many-fold rise in blood of septic patients. It is necessary to take into consideration and experimentally model changes in the human internal environment, which occur during radical transformation of microbiome in critically ill patients. Such approach brings in new prospects for objective monitoring of diseases by evaluating metabolic profile at a particular moment of time based on integral indices reflecting the status of microbiome/metabolome system, which will supply new targets for therapeutic intervention in future.

Burden of cytomegalovirus reactivation post kidney transplant with antithymocyte globulin use in Thailand: A retrospective cohort study

Background: Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections . Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. Methods: We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients’ characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Results: Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation ( P = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization ( P = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting ( P = 0.021) and total cost ( P = 0.035) than in those without CMV reactivation. Conclusions: Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.

Burden of cytomegalovirus reactivation post kidney transplant with antithymocyte globulin use in Thailand: A retrospective cohort study.

Background: Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections . Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. Methods: We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients' characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Results: Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation ( P = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization ( P = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting ( P = 0.021) and total cost ( P = 0.035) than in those without CMV reactivation. Conclusions: Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.

Oral Vancomycin Prophylaxis Is Highly Effective in Preventing Clostridium difficile Infection in Allogeneic Hematopoietic Cell Transplant Recipients.

Clostridium difficile infection (CDI) is a leading cause of infectious complications in allogeneic hematopoietic cell transplant recipients (alloHCT). We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients. We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin, as compared to no prophylaxis, in 145 consecutive adult alloHCT recipients at the University of Pennsylvania between April 2015 and November 2016. Patients received oral vancomycin 125 mg twice daily, starting on admission and continuing until discharge. The primary outcome of interest was the association between oral vancomycin prophylaxis and CDI diagnosis. Secondary outcomes included graft-versus-host disease (GVHD) and relapse. There were no cases of CDI in patients that received prophylaxis (0/90, 0%), whereas 11/55 (20%) patients who did not receive prophylaxis developed CDI (P < .001). Oral vancomycin prophylaxis was not associated with a higher risk of acute, grades 2-4 GVHD (subhazard ratio [sHR] 1.59; 95% confidence interval [CI] 0.88-2.89; P = .12), acute, grades 3-4 GVHD (sHR 0.65; 95% CI 0.25-1.66; P = .36), or acute, grades 2-4 gastrointestinal GVHD (sHR 1.95; 95% CI 0.93-4.07; P = .08) at day 180 post-transplant. No associations between oral vancomycin and relapse or survival were observed. Prophylaxis with oral vancomycin is highly effective in preventing CDI in alloHCT recipients without increasing the risk of graft-versus-host disease or disease relapse. Further evaluation via a prospective study is warranted.

Comparison of the preventive effect of urethral cleaning versus disinfection for catheter-associated urinary tract infections in adults: A network meta-analysis

BackgroundCatheter-associated urinary tract infections (CAUTIs) are the main cause of infectious complications in patients with indwelling urinary catheters (IDCs). However, the best cleaning methods for the prevention of CAUTIs have not been evaluated clearly in previous studies. MethodsAn electronic database search was performed, from inception to December 2017. Randomized controlled trials and quasi-experimental trials using different methods of urethral cleaning versus disinfection to prevent CAUTIs were considered. The study selection and data collection were performed independently by two reviewers. The risk of bias assessment was performed using the Cochrane risk of bias scale. The primary outcome was the incidence rates of CAUTIs. A network meta-analysis was conducted to compare the effect among the different methods of urethral cleaning versus disinfection to prevent CAUTIs. ResultsThirty-three studies (6490 patients) with seven different methods of urethral cleaning versus disinfection were eligible for inclusion, and the data were summarized in the network meta-analysis. No evidence of heterogeneity (P>0.05) was observed among the studies. The network meta-analysis showed that there was no difference in the incidence of CAUTIs when comparing the different urethral cleaning methods versus disinfection (P>0.05 for all). However, chlorhexidine ranked first in the results of the Bayesian analysis and is recommended for preventing CAUTIs. ConclusionsCurrent evidence suggests that there are no significant differences among different urethral cleaning versus disinfection methods with regard to CAUTI incidence rates.

Acinetobacter baumannii Gastrointestinal Colonization Is Facilitated by Secretory IgA Which Is Reductively Dissociated by Bacterial Thioredoxin A.

ABSTRACTMultidrug-resistant Acinetobacter baumannii is among the most common causes of infectious complications associated with combat-related trauma in military personnel serving overseas. However, little is currently known about its pathogenesis. While the gastrointestinal (GI) tract has been found to be a major reservoir for A. baumannii, as well as to potentially contribute to development of multidrug resistance, no studies have addressed the mechanisms involved in gut colonization. In this study, we address this critical gap in knowledge by first assessing the interaction between secretory IgA (SIgA), the principal humoral immune defense on mucosal surfaces, and the A. baumannii clinical isolate Ci79. Surprisingly, SIgA appeared to enhance A. baumannii GI tract colonization, in a process mediated by bacterial thioredoxin A (TrxA), as evidenced by reduction of bacterial attachment in the presence of TrxA inhibitors. Additionally, a trxA targeted deletion mutant (ΔtrxA) showed reduced bacterial burdens within the GI tract 24 h after oral challenge by in vivo live imaging, along with loss of thiol-reductase activity. Surprisingly, not only was GI tract colonization greatly reduced but the associated 50% lethal dose (LD50) of the ΔtrxA mutant was increased nearly 100-fold in an intraperitoneal sepsis model. These data suggest that TrxA not only mediates A. baumannii GI tract colonization but also may contribute to pathogenesis in A. baumannii sepsis following escape from the GI tract under conditions when the intestinal barrier is compromised, as occurs with cases of severe shock and trauma.

Acute Graft-Versus-Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Introduction Acute GVHD is one of the most common serious complications of allogeneic HSCT and remains a leading cause of mortality in HSCT recipients all over the world. Various publications showed the association of acute GVHD with higher risk of infectious complications. There is lack of data on risk factors for developing an episode of infection and spectrum of infections in patients with acute GVHD after allogeneic HSCT. Objective to determine the risk factors and spectrum of infectious complications in patients with acute GVHD after allogeneic HSCT. Methods An ambispective observational study was performed to evaluate the risk factors and characteristics of infectious complications in adult patients having acute GVHD after HSCT. Proven case of infection (bacterial, viral or fungal) was taken as a primary outcome in the study. There were totally 68 adult patients with II-IV grades of acute GVHD after allogeneic HSCT included in the study. As a covariates included in multivariate analysis were taken: procedure of MCSs transplantation; type of allogeneic HSCT (related/non-related), main disease progression, absolute neutrophil count (ANC) on the first day of infectious complication, GVHD-involved organs. Results Microbiological data concerning the causes of infectious complications in patients with acute GVHD has shown the major impact of viral infections (CMV) and invasive pulmonary aspergillosis. There were no bloodstream infections caused by Candida spp. registered in the study. Bacterial infections were mostly presented by bloodstream infections (caused by K. pneumoniae, E. faecalis, E. coli) and pneumonia. Progression of main disease (OR 5.52; 95% CI 1.21-25.06; p=0.0270) was found to be an independent risk factor for development of invasive pulmonary aspergillosis and bacterial infectious complications. Patients with hematopoietic stem cell transplant from unrelated donor remain in a group with high risk for bacterial infections in case of developing acute GVHD (OR 3.50; 95% CI 1.12-10.97; p=0.0316). The procedure of MSCs transplantation as a potential treatment of GVHD showed no influence on risk of invasive aspergillosis (OR 3.25; 95% CI 0.64-16.47; p=0.1536) or CMV-reactivation (reciprocal OR 0.42; 95% CI 0.12-1.49; p=0.1802) in the study. Conclusion Among the most frequent infections in acute GVHD we have described CMV, invasive aspergillosis and bacterial infections. Among risk factors for infectious complications in patients with acute GVHD are progression of main disease and neutropenia below 500 cells/mm3 (for aspergillosis) and unrelated HSCT in the past history and progression of main disease (for bacterial bloodstream infections and pneumonia). MSCs transplantation as a treatment strategy for acute GVHD has shown no statistically significant association with risk of infectious complications in a performed multivariate analysis.

Local experience of real-time PCR implementation into microbiological monitoring programs

Objective. To study level and structure of microbial colonization in cancer patients before admission to a surgery department using molecular methods. Materials and Methods. The presence of DNA of methicillin-resistant Staphylococcus aureus, methicillinresistant coagulase-negative staphylococci, Candida albicans/C. glabrata/C. krusei, Acinetobacter baumannii in the clinical specimens and the presence of antimicrobial resistance genes in cultures were detected by multiplex real-time PCR. A total of 741 clinical samples and 313 cultures were studied. Results. The high level of microbial colonization, including microorganisms with antibiotic resistance genes, was found in cancer patients. Methicillin-resistant staphylococci, A. baumannii and Candida spp. were detected in 56.6%, 20% and 24.8% of cancer patients, respectively. Of patients infected with A. baumannii, 35.9% had OXA-carbapenemase genes. A. baumannii producing blaOXA40 was the most common cause of infectious complications. Conclusions. Molecular methods can be used effectively not only for the diagnosis of infectious diseases, but also in microbiological monitoring programs.

Infectious complications of surgical treatment in long bone methaepiphyseal fractures

In recent decades, metalosteosynthesis has been used to treat fractures of bones, the indications to which are rapidly expand­ing, which is promoted by the spread of AO’s development. Along with this, there is a significant number of complications of metalosteosynthesis, first of all, infection. It is generally be­lieved that complications in the use of internationally recog­nized AO technologies are associated only with the low profes­sional training of surgeons, which is difficult to accept complete­ly.Objective: to conduct a retrospective analysis of the causes of infectious complications after metalosteosynthesis fractures of distal metaepiphises of long bones and on its basis to deter­mine tactical and technological measures to reduce their num­ber.Methods: the clinical material of the department of bone infection «Kharkiv City Multiprofile Hospital № 18» was used. The study group included 78 patients with infectious complica­tions after osteosynthesis of fractures of distal metaepiphises of long bones.Results: the interaction between infection compli­cations and the chosen tactics of surgical treatment was traced. Among the most likely causes of infectious complications after metalosteosynthesis fractures of the pilon type are either tacti­cal or preoperative planning errors. In the case of open and high-energy injury, distal metaepiphises of long bones is recommended to give preference to extra-osseous methods of osteo­synthesis.Conclusions: for the prevention of i infectious compli­cations, advanced understanding of AO technologies in the light of the biological principles of osteosynthesis, careful preoperative planning, technological support of operations, training of surgeons, expanded use of methods of extra-focal fixation with open and high-energy injury is necessary.

Cytomegalovirus Infection in Pediatric Haploidentical Hematopoietic Stem Cell Transplantation at a Single Center

Introduction : Clinical aspects and risk factors of Cytomegalovirus (CMV) reactivation and diseases are an emerging interest in recent investigation fields of hematopoietic stem cell transplantation (HSCT). Several risk factors and clinical manifestations of CMV infection have been reported in numbers of previous reports. Monitoring of viral replication and timely given antiviral agents have resulted in a decreased incidence of CMV-related death recently. However, CMV in still a major cause of infectious complications after HSCT. Specially in haploidentical HSCT setting, clinical manifestations and associated risk factors have been rarely reported. This study is conducted to identify risk factors and clinical aspects of CMV reactivation and disease in pediatric haploidentical HSCT.Methods : We retrospectively reviewed the medical records of 92 pediatric patients who underwent haploidentical HSCT using ex vivo T cell-depleted grafts at Asan Medical Center between December, 2004 and June, 2016. After haploidentical HSCT, all recipients were monitored for CMV infection by CMV pp65 antigen and/or CMV-PCR. Both recipient and donor were screened for CMV serology before the HSCT. During the study period, methodologic changes in ex vivo T cell depletion and CMV prophylaxis policy have been modulated with the course of time. During the 1st study period (Group I, n=19), CD3+ T cell was depleted without CMV prophylaxis while ganciclovir for CMV prophylaxis was given with CD3+ T cell depletion during the 2nd period (Group II, n=16). The T cells expressing alpha-beta T cell receptor (TCRαβ) was depleted during the 3rd period (Group III, n=57) with ganciclovir prophylaxis.Results : Of the 92 patients, 49 (53.3%) developed CMV reactivation after haploidentical HSCT. CMV reactivation significantly reduced in group II and III compared to group I (84±8.4% vs 46±5.9%; p<0.001). Patients with chronic graft-versus-host-disease (GVHD) also experienced more reactivation (p=0.041). In the multivariate analysis, difference of study group was the only variable predicted the occurrence of CMV reactivation (Group I vs Group III; hazard ratio, 3.728; 95% confidence interval (CI), 1.910-7.278). CMV disease was developed in 16/92 (17.4%) patients during the study period (16/49, 32.7% among CMV reactivation patients). The peak CMV pp65 antigen level, peak CMV DNA-PCR level, and duration of CMV antigenemia were significantly higher in patients with CMV disease (p=0.024, p=0.009, p=0.046, respectively). In univariate analysis, the peak CMV pp65 antigen level (p=0.020), and duration of CMV antigenemia (p=0.05) were associated with increased occurrence of CMV disease. In multivariate analysis, CMV disease significantly increased in patients with high CMV pp65 antigenemia greater than 40/200,000 cells (hazard ratio, 3.568; 95% CI 1.062-12.594). CMV diseases included retinitis in 12 (75%), pneumonitis in 3 (25%), gastritis, colitis, and encephalitis in 1 (8.3%) each, respectively. Of the 16 patients, 3 patients (2 pneumonitis, 1 encephalitis) died of CMV disease.Conclusions : Our study demonstrated that ganciclovir prophylaxis has effectively reduced the occurrence of CMV reactivation in ex vivo T cell depleted haploidentical HSCT. In addition, close monitoring of CMV pp65 antigen and timely preemptive management is important to prevent CMV related death. DisclosuresNo relevant conflicts of interest to declare.