Changes In Bacteriology Research Articles

Effective removal of iron, nutrients, micropollutants, and faecal bacteria in constructed wetlands cotreating mine water and sewage treatment plant effluent.

Regulators in England and Wales have set new targets under the Environment Act 2021 for freshwater quality by 2038 that include halving the length of rivers polluted by harmful metals from abandoned mines and reducing phosphorus loadings from treated wastewater by 80%. In this context, an intriguing win-win opportunity exists in the removal of iron from abandoned mines and phosphate from small sewage treatment plants by coprecipitation in constructed wetlands (CWs). We investigated such a CW located at Lamesley, Northeast England, which cotreats abandoned coal mine and secondary-treated sewage treatment plant effluents. We assessed the removal of nutrients, heavy metals, organic micropollutants, and faecal coliforms by the CW, and characterized changes in the water bacteriology comprehensively using environmental DNA. The CW effectively removed ammonium-nitrogen, phosphorus, iron, and faecal coliforms by an average of 86, 74, 98, and 75%, respectively, to levels below or insignificantly different from those in the receiving river. The CW also effectively removed micropollutants such as acetaminophen, caffeine, and sulpiride by 70-100%. Molecular microbiology methods showed successful conversion of sewage and mine water microbiomes into a freshwater microbiome. Overall, the CW significantly reduced impacts on the rural water environment with minimal operational requirements.

The development of surgical risk score and evaluation of necrotizing soft tissue infection in 161 Naja atra envenomed patients.

BackgroundNaja atra bites cause wound necrosis, secondary infection, and necrotizing soft tissue infection (NSTI) requiring repetitive surgeries. Little information is known about the predictors for surgery after these bites.Materials and methodsWe retrospectively evaluated 161 patients envenomed by N. atra, 80 of whom underwent surgery because of wound necrosis and infection. We compared the patients’ variables between surgical and non-surgical groups. To construct a surgical risk score, we converted the regression coefficients of the significant factors in the multivariate logistic regression into integers. We also examined the deep tissue cultures and pathological findings of the debrided tissue.ResultsA lower limb as the bite site, a ≥3 swelling grade, bullae or blister formation, gastrointestinal (GI) effects, and fever were significantly associated with surgery in the multivariate logistic regression analysis. The surgical risk scores for these variables were 1, 1, 2, 1, and 2, respectively. At a ≥3-point cutoff value, the model has 71.8% sensitivity and 88.5% specificity for predicting surgery, with an area under the receiver operating characteristic curve of 0.88. The histopathological examinations of the debrided tissues supported the diagnosis of snakebite-induced NSTI. Twelve bacterial species were isolated during the initial surgery and eleven during subsequent surgeries.Discussion and conclusionsFrom the clinical perspective, swelling, bullae or blister formation, GI effects, and fever appeared quickly after the bite and before surgery. The predictive value of these factors for surgery was acceptable, with a ≥3-point risk score. The common laboratory parameters did not always predict the outcomes of N. atra bites without proper wound examination. Our study supported the diagnosis of NSTI and demonstrated the changes in bacteriology during the surgeries, which can have therapeutic implications for N. atra bites.

Febrile Infant Hospitalizations: When Is the Right Time to Discharge?

Early in their training, pediatricians come to grips with a scary fact about young febrile infants <3 months of age: they can be sick without looking sick.1–3 Until the early 1990s, both well- and ill-appearing young febrile infants were managed conservatively, with the same cookbook strategy: hospitalization for 48 to 72 hours on empirical parenteral antibiotics as urine, blood, and spinal fluid cultures marinated.4,5 Pediatric house staff became proficient at spinal taps but also learned that most infants had cultures that tested negative. This “rule out sepsis” recipe clearly subjected many infants to the risks and costs of unnecessary hospitalization and treatment.6 At least 2 questions ensued: which infants could be spared hospitalization? And, if an infant was hospitalized, when could she or he be safely discharged? With regard to the first question, in 2012, the US Agency for Healthcare Research and Quality published a comprehensive review of the myriad of approaches to this conundrum,7 and most are familiar with the current state of affairs.8 First, pediatric trainees still learn the algorithms developed decades ago in Boston,9 Milwaukee,10 Philadelphia,11 and Rochester,12 which teased out a subpopulation of “low-risk” febrile infants who might safely be spared tests, antibiotics, and/or hospitalization. In other studies, authors supported intramuscular ceftriaxone and close follow-up as an alternative to hospitalization for selected infants 28 to 90 days of age.13 Second, despite changes in bacteriology, such as the virtual disappearance of Listeria and Haemophilus influenzae , and the impressive reduction in group B streptococcal and pneumococcal infections,14,15 the overall ball park rates of serious bacterial infection in young febrile infants remain stubbornly unchanged: 5% to 10% have a …

Acute Otitis Media in the 21st Century: What Now?

* Abbreviations: AAP — : American Academy of Pediatrics AOM — : acute otitis media PCV — : pneumococcal conjugate vaccine Acute otitis media (AOM) is, by far, the most common indication for antibiotic prescribing to children.1 Thus, understanding the epidemiology of AOM is important to optimize clinical outcomes and promote judicious antibiotic use. In this issue of Pediatrics , Kaur et al2 offer a community-based glimpse into 21st century AOM. Notably, the authors summarize the current bacteriology of AOM in the patients of Legacy Pediatrics, a research-oriented primary care practice in Rochester, New York. It is gratifying to note that research from individual practice settings is alive and well. Pichichero and co-workers3–5 have been tracking changes in bacteriology of AOM at Legacy Pediatrics since 2007. He previously published work with similar methodology6 on patients … Address correspondence to Richard C. Wasserman, MD, MPH, Department of Pediatrics, Larner College of Medicine, One South Prospect St, Burlington, VT 05401. E-mail: richard.wasserman{at}med.uvm.edu

Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder.

Retrospective analysis. The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. SSI is an undesired complication of orthopedic spine surgical procedures. It poses a significant risk to the patient, as well as a financial toll on the health care system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 g of intrawound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed-effects logistic regression in a univariate fashion. Risk factors with P values of 0.05 or less in univariate analysis were included together in a multivariate mixed-effects logistic regression model. SSI rates were reduced by 50% after the intervention; χ analysis comparing the SSI rates between the pre- and postintervention periods yielded a P value of 0.042. Rates of methicillin-resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multibacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (odds ratio [OR] = 0.93), anemia (OR = 30.73), prior operation (OR = 27.45), and vertebral fracture (OR = 22.22). The combination of Betadine wound irrigation and intrawound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols. 4.

Oral doxycycline for the treatment of chronic leg ulceration

This pilot study investigated oral doxycycline as an adjunct to compression therapy for non-healing venous leg ulcers. Ten patients received doxycycline 20 mg twice daily (low-dose doxycycline) and ten patients received doxycycline 100 mg twice daily (high-dose doxycycline). Utilising a pre-test post-test study design, ulcer area was measured and wound fluid was collected before and after 4 weeks of treatment. In the high-dose doxycycline group, the reduction in median ulcer area was 48% (p = 0.1) and there was a significant reduction in wound fluid total matrix metalloprotease-1 (p = 0.02). These effects were not observed with low-dose doxycycline. There were no significant changes in wound fluid tumour necrosis factor-α or quantitative bacteriology following treatment with low-dose or high-dose doxycycline. There was no significant relationship between change in ulcer area and matrix metalloprotease-1, -8 or -9 activities in wound fluid at the end of treatment. Median wound fluid doxycycline concentrations after 4 weeks of treatment were 0.2 mg/L(0.45 lM) and 2.3 mg/L (5.18 lM) [DOSAGE ERROR CORRECTED] in the low-dose and high-dose groups, respectively, which are lower than that previously shown to inhibit matrix metalloproteases and tumour necrosis factor-α. Our study suggests that doxycycline 100 mg twice daily may improve the healing rate of recalcitrant leg ulcers, however the mechanism remains unclear.

Bacterial, SCFA and gas profiles of a range of food ingredients following in vitro fermentation by human colonic microbiota

It is now apparent that there is a strong link between health and nutrition and this can be seen clearly when we talk of obesity. The food industry is trying to capitalise on this by adapting high sugar/fat foods to become healthier alternatives. In confectionery food ingredients can be used for a range of purposes including sucrose replacement. Many of these ingredients may also evade digestion in the upper gut and be fermented by the gut microbiota upon entering the colon. This study was designed to screen a range of ingredients and their activities on the gut microbiota. In this study we screened a range of these ingredients in triplicate batch culture fermentations with known prebiotics as controls. Changes in bacteriology were monitored using FISH. SCFA were measured by GC and gas production was assessed during anaerobic batch fermentations. Bacterial enumeration showed significant increases ( P ≤ 0.05) in bifidobacteria and lactobacilli with polydextrose and most polyols with no significant increases in Clostridium histolyticum/perfringens. SCFA and gas formation indicated that the substrates added to the fermenters were being utilised by the gut microbiota. It therefore appears these ingredients exert some prebiotic activity in vitro. Further studies, particularly in human volunteers, are necessary.

Changes in bacteriology of discharging ears

A bacteriological study on 161 consecutive out-patients presenting with otorrhoea was performed prospectively at a local teaching hospital in Taiwan between August 2000 and June 2001. A total of 177 isolates were recovered. Staphylococcus aureus was found in 77 (43.5 per cent) isolates, and non-Staphylococcus aureus in 100 (56.5 per cent) isolates. Pseudomas sp was found to be the most common pathogen (28.8 per cent) in the non-Staphylococcus aureus group. Staphylococcus aureus had become more common than Pseudomonas aeruginosa in acute otitis externa, granular myringitis, and chronic otitis media in Taiwan. Methicillin-resistant Staphylococcus aureus (MRSA) was also an increasing problem in all three disease entities. The prevalence of community-acquired MRSA infections in discharging ears was found to be 13.7 per cent (22/161). MRSAs were highly susceptible to vancomycin, teicoplanin, fusidic acid, and minocycline. More studies should be done to determine the susceptibility of MRSA to ofloxacin in the future.

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Tratamento cirúrgico da endocardite infecciosa na fase aguda: experiência de três anos

O tratamento cirurgico da endocardite na fase aguda vem-se impondo como o mais efetivo, em muitas circunstâncias clinicas. As continuas modificacoes nos aspectos clinicos, diagnosticos e bacteriologicos desta afeccao tornam necessaria permanente avaliacao dos resultados, nas situacoes concretas de atuacao dos diversos grupos clinico-cirurgicos. A definicao de normas de conduta ante esta grave afeccao tem-nos preocupado, ultimamente, por sua crescente participacao em nossa pratica clinica-cirurgica. De novembro de 1983 a novembro de 1986, 6,7% das substituicoes valvares por nosso grupo cirurgico deveram-se a endocardite (32 de 4,77 pacientes). A sede do processo infeccioso teve a seguinte distribuicao: mitral 6 casos, aortica 12 casos (um obito), mitral e aortica 6 casos (dois obitos) protese aortica 4 casos (tres obitos), protese mitral 2 casos (um obito) mitral, aortica e tricuspide 1 caso (um obito) e parede do ventriculo esquerdo 1 caso. A idade variou entre 10 e 56 anos. Sete pacientes eram do sexo feminino e 24 do masculino. Todos os pacientes eram brancos. A analise dos achados anatomo-patologicos permitiu determinacao de tres grupos: no Grupo A, tivemos 11 operacoes por lesoes valvares simples, consistentes basicamente de vegetacoes infectadas. Todos os pacientes sobreviveram e obtiveram alta hospitalar. Nos 15 pacientes do Grupo B, havia acometimento multivalvar, ou lesoes complicadas por mutilacoes valvares extensas e/ou comunicacoes entre câmaras cardiacas; 5 pacientes faleceram. No Grupo C, houve 5 operacoes por infeccoes em proteses, ocorrendo 4 obitos. O prognostico favoravel dos pacientes operados com lesoes simples e o alto risco daqueles em que havia destruicao tissular mais extensa e daqueles em que a endocardite se instalou em proteses, nos levam a defender o tratamento cirurgico precoce das infeccoes valvares, em todos os casos em que nao haja rapida resposta ao tratamento antibiotico.

Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis.

The aim was to determine whether changes in enteric bacteriology, absorption, morphology, and emptying occur after ileal pouch-anal anastomosis for ulcerative colitis, and to relate any changes to the clinical result. Twenty patients were studied 26 +/- 2 months (mean +/- s.e.m.) after operation. Eight patients had a good result, six a poor result, and six a history of recurrent pouch ileitis. Anaerobic and aerobic overgrowth occurred in the jejunum of patients with a poor result, but not in those with a good result or with pouch ileitis. In contrast, ileal pouch bacterial overgrowth occurred in all patients regardless of the clinical result. Patients with jejunal overgrowth had increased 24 h stool volume and stool nitrogen, but other patients did not. The larger the stool volume, the greater the anaerobic overgrowth. Pouch biopsies showed chronic inflammation in all patients, while 45 per cent had colonic metaplasia. Neither the inflammation nor the metaplasia correlated with the clinical result, nor did the clinical result correlate with the efficiency of pouch emptying. In conclusion, jejunal bacterial overgrowth after ileal pouch-anal anastomosis was associated with an increased stool output, azotorrhoea, and a poor clinical result. A distinguishing bacterial, absorptive, morphological, or emptying abnormality was not found in patients with a history of recurrent pouch ileitis.

Effects of contraceptive vaginal ring treatment on vaginal bacteriology and cytology

The presence of aerobic and anaerobic bacteria, yeasts and mycoplasma/ureaplasma was investigated in seventeen women before and after six months use of a contraceptive vaginal ring releasing levo-Norgestrel and estradiol and in 16 women using an oral contraceptive containing levo-Norgestrel and ethinylestradiol. Apart from an increase in yeasts in both groups, no significant changes in the vaginal bacteriology could be found.Vaginal smears were examined before and during treatment for up to two years in a group of 120 women participating in a clinical trial of the contraceptive vaginal ring. No changes in the squamous epithelium or cylinder cells were found. The amount of leucocytes increased in the smears.The results indicate that use of the contraceptive vaginal ring does not affect the bacterial ecology of the vagina. The increase in leucocytes indicates a weak inflammatory reaction which might explain the increase in vaginal discharge often observed by women using the contraceptive vaginal ring.

Effects of poly of and sucrose candies on plaque, gingivitis and lactobacillus index scores: Observations on Helsinki school children

The purpose of this study was to determine whether partial substitution of xylitol and soibitol for sucrose could produce changes in plaque formation, gingivitis and oral bacteriology in children. The subjects consisted of 55 volunteer schoolchildren aged 14 to 16, divided into the following groups: 1) Polyol Group (26 children), 2) No-Sweets Group (8), 3) Sucrose Group (21).During the two weeks of the study, the Polyol Group consumed chewing gum and pastilles containing xylitol and sorbitol, mainly after meals. The No-Sweets Group was instructed to consume no sweets during the study. The Sucrose Group chewed gum and ate sweets same as before the study. The variables measured were the visible plaque index (VPI), gingival bleeding index (GBI) and lactobacillus index (Dentocult®). The scores for these indices were determined at the beginning and end of the study. The results for the Polyol and No-Sweets groups were similar; both the xylitol-sorbitol mixture and abstention from sweets reduced the VPI and GBI scores substantially. In the Sucrose Group, the VPI and GBI scores remained practically unchanged. Changes in the Dentocult index were difficult to assess due to high variability, though significant differences were observed between treatment groups, polyol utilization and total abstention from sweets leading to similarly decreased scores. The results may be due to differences between the microbiological and biochemical effects of sucrose and the polyol mixture, which resulted in reductions in plaque, gingival bleeding and lactobacilli.

Tropical Sprue and Malnutrition in West Bengal : I. Intestinal Microflora and Absorption

Small bowel bacterial flora and absorptive function were studied in three groups of subjects; namely, patients with tropical sprue (15), patients with malnutrition without malabsorption (7), and normal individuals (13). Except for fat and B12 malabsorption, the tropical sprue and malnourished cases could not be differentiated by biochemical studies. Low serum folate, megaloblastic anemia, and reduced serum albumin were seen as frequently in both groups. Bacterial overgrowth of the upper small bowel was noted in all of the sprue cases; in five patients colonic bacteria were present in the stomach. The most consistent finding was an increase in numbers of coliforms. Four of seven malnourished patients also had coliforms in the upper bowel, but the concentrations were less than 104/ml. In normal individuals, coliforms could not be cultured from the stomach, duodenum, or jejunum. Bacterial populations in the small bowel declined during therapy in seven of nine sprue cases and one malnourished subject. Of six sprue patients treated with antibiotics, four showed dramatic improvement of fat and B12 absorption and decreased small bowel bacterial concentrations within 48 hr; resistant bacteria and antibiotic toxicity were responsible for the delayed response in two patients. Minimal abnormalities of the small bowel microflora were seen in two sprue patients in whom improvement in absorption could not be well correlated with changes in bacteriology. Thus, bacterial overgrowth of the small bowel was present in tropical sprue and to a lesser extent, in malnutrition, but the bacteria were interfering with absorption in 80% of the sprue cases and were acting as commensals in the malnourished individuals.