Clinical Infection Research Articles

Clinical Coxiella burnetii infection in sable and roan antelope in South Africa.

Various zoonotic microorganisms cause reproductive problems such as abortions and stillbirths, leading to economic losses on farms, particularly within livestock. In South Africa, bovine brucellosis is endemic in cattle, and from 2013-2018, outbreaks ofBrucella melitensisoccurred in sable.Coxiella burnetii, the agent responsible for the zoonotic disease known as Q-fever and/or coxiellosis, also causes reproductive problems and infects multiple domestic animal species worldwide, including humans. However, little is known of this disease in wildlife. With the expansion of the wildlife industry in South Africa, diseases like brucellosis and coxiellosis can significantly impact herd breeding success because of challenges in identifying, managing and treating diseases in wildlife populations. This study investigated samples obtained from aborted sable and roan antelope, initially suspected to be brucellosis, from game farms in South Africa using serology tests and ruminant VetMAX™ polymerase chain reaction (PCR) abortion kit. The presence ofC. burnetiiwas confirmed with PCR in a sable abortion case, while samples from both sable and roan were seropositive forC. burnetiiindirect enzyme-linked immunosorbent assay (iELISA). This study represents the initial report ofC. burnetiiinfection in sable and roan antelope in South Africa. Epidemiological investigations are crucial to assess the risk ofC. burnetiiin sable and roan populations, as well as wildlife and livestock in general, across South Africa. This is important in intensive farming practices, particularly as Q-fever, being a zoonotic disease, poses a particular threat to the health of veterinarians and farm workers as well as domestic animals.Contribution:A report of clinicalC. burnetiiinfection in the wildlife industry contributes towards the limited knowledge of this zoonotic disease in South Africa.

Visible light-responsive vitamin B2 functionalized ZnO with dual-mechanism bactericidal effects for perishable agrofood preservation

Recent advances in functionalized micro-nanostructures have enlightened promising non-thermal-dependent antibacterial strategies with broad applications in preventing agrofood spoilage, clinical infections, and environmental pollution caused by pathogens. These advances highlight the need for precise design of efficient and multi-mode bactericides. Herein, photosensitive vitamin B2 (VB2) was exploited to functionalize semiconductors with limited visible-light response and intrinsic antibacterial activity, while ZnO served as a paradigm for the fabrication of VB2-functionalized zinc oxide (VB2-ZnO) with persistent antibacterial effects. The enhanced visible photocatalytic activity and the released Zn2+ in VB2-ZnO contribute to potent antibacterial and anti-biofilm effects by disrupting bacterial structures and inducing oxidative stress. Furthermore, the successful fabrication of composite films incorporating VB2-ZnO and natural locust bean gum (LBG) exhibited improved physicochemical properties and persistent antibacterial effects, resulting in the shelf-life extension of perishable berries. This work pioneers a novel approach to functionalizing semiconductor photocatalysts with VB2 photosensitizer, offering novel solutions for ensuring agrofood safety through multi-mechanism antibacterial materials.

Mutation of the envelope stress-responsive protein CpxA capable of regulating the antimicrobial resistance and virulence of bacteria

CpxA is a key member of the envelope stress-responsive Cpx two-component system ubiquitous in Gram-negative bacteria. It is responsible for signal sensing and has dual activities of phosphatase and kinase. CpxA has been revealed to participate in the regulation of physiological processes such as virulence and antimicrobial resistance of bacteria. In recent years, the development of novel antimicrobials targeting CpxA has attracted much attention. Drugs developed based on inhibition of the phosphatase activity of CpxA have shown effectiveness in the treatment of urinary tract infections caused by Escherichia coli. This review introduces the structure and functional domains of CpxA and the activation of Cpx pathways by CpxA. Furthermore, it summarizes the roles of CpxA in the development of antimicrobial resistance and the regulation of bacterial virulence and reviews the latest progress in the development of new antimicrobials targeting this protein. It is expected to assist in the exploration of CpxA-targeting anti-infection strategies for severely antimicrobial-resistant bacteria whose clinical infections are of urgent need to be controlled.

Clinical Significance and Microbiological Characteristics of Staphylococcus lugdunensis in Cutaneous Infections.

Background/Objectives:Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) commonly found on human skin. Unlike other CoNS, S. lugdunensis has a notable potential to cause severe infections comparable to Staphylococcus aureus. This study aimed to characterize the clinical and microbiological profile of patients with S. lugdunensis skin infections at a single center. Methods: We conducted a retrospective analysis of patient records from the Dermatology Department of the University Hospital of Heraklion, Greece, covering the period from January 2014 to January 2024. Patients' clinical presentations, demographics, infection sites, comorbidities, prior infections, antimicrobial treatments, and therapeutic responses were examined. Specimens were collected, transported, and processed according to standardized microbiological protocols. Bacterial identification and antibiotic susceptibility testing were performed using the Vitek 2 automated system and MALDI-TOF MS, with results interpreted according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: A total of 123 skin specimens positive for S. lugdunensis were analyzed. The cohort comprised 62 males (50.4%) and 61 females (49.6%), with a mean age of 40.24 ± 20.14 years. Most specimens were collected from pus (84%), primarily from below the waist (66.7%). Hidradenitis suppurativa (26%) was the most common condition associated with S. lugdunensis, followed by folliculitis, abscesses, ulcers, cellulitis, and acne. Co-infections with other bacteria were noted in 49.6% of cases, and 25.2% of infections were nosocomially acquired. The majority of patients (65%) received systemic antibiotics, predominantly amoxicillin/clavulanic acid, cefuroxime axetil, and doxycycline, with a cure rate of 100%. All isolates were susceptible to several antibiotics, though resistance to penicillin (28.5%) and clindamycin (36%) was observed. Conclusions:S. lugdunensis is a significant pathogen in skin infections, capable of causing severe disease. The high cure rate demonstrates the effectiveness of appropriate antibiotic therapy. Continued monitoring and antimicrobial stewardship are essential to manage resistance and ensure effective treatment.

Wastewater and clinical surveillance of respiratory viral pathogens on a university campus

Areas of dense population congregation are prone to experience respiratory virus outbreaks. We monitored wastewater and clinic patients for the presence of respiratory viruses on a large, public university campus. Campus sewer systems were monitored in 16 locations for the presence of viruses using next generation sequencing over 22 weeks in 2023. During this period, we detected a surge in human adenovirus (HAdV) levels in wastewater. Hence, we initiated clinical surveillance at an on-campus clinic from patients presenting with acute respiratory infection. From whole genome sequencing of 123 throat and/or nasal swabs collected, we identified an outbreak of HAdV, specifically of HAdV-E4 and HAdV-B7 genotypes overlapping in time. The temporal dynamics and proportions of HAdV genotypes found in wastewater were corroborated in clinical infections. We tracked specific single nucleotide polymorphisms (SNPs) found in clinical virus sequences and showed that they arose in wastewater signals concordant with the time of clinical presentation, linking community transmission of HAdV to the outbreak. This study demonstrates how wastewater-based epidemiology can be integrated with surveillance at ambulatory healthcare settings to monitor areas prone to respiratory virus outbreaks and provide public health guidance.

Campylobacteriosis: genotypic characteristics of the pathogen and immunological status of patients

Introduction. Campylobacteriosis is among the leading causes of acute gastrointestinal infections. The severity of campylobacteriosis and the development of long-term complications may be influenced by the genotype of the pathogen, whose biological properties can affect immune response parameters. The aim of the study was to identify common genotypes of epidemic clones of Campylobacter pathogens and to investigate characteristics of the immune response and severity of the disease. Materials and methods. The study included 203 patients aged from 1 month to 17 years with campylobacteriosis who underwent treatment at the clinic of the Federal State Budgetary Institution "DNKCIB FMBA" in 2019–2021. The diagnosis was confirmed using polymerase chain reaction method. Patient samples were also analyzed using culture-based methods. Total DNA was extracted using the QIAamp DNA Mini Kit. Genetic determinants encoding virulence factors and MLST typing were performed using the ResFinder program. The immune status of patients was assessed on days 1 and 7 of the illness. Immunological investigation included measurement of serum immunoglobulin concentrations (IgA, IgM, IgG), C-reactive protein, and cytokines (IL-1β, IL-1, IL-2, IL-4, IL-5, IL-6, IL- 7, IL-8, IL-10, TNF-α, and IFN-γ). Results. When analyzing the frequency of detection of Campylobacter sequence types in children with clinical intestinal infections, it was found that the profile of isolated isolates is most similar to those from countries of North America (USA and Canada), Northern Europe (Great Britain, Holland ) and Scandinavia (Denmark, Sweden, Finland). Identification of a pathogen with the flgE+, cdtA+, cdtC+ genotype was accompanied by a statistically significant increase in the level of IL-8 and a decrease in the content of IgA in the peripheral blood serum, which reflected the low efficiency of the immune response during infection with Campylobacter and predetermined the severe course of the infectious process during the disease.

Molecular Genetic Analysis of Perioperative Colonization by Infection-Related Microorganisms in Patients Receiving Intraoral Microvascular Grafts.

Background/Objectives: In oral and maxillofacial surgery, the reconstruction of defects often involves the transfer of skin tissue into the oral cavity utilizing microvascular grafts. This study investigates postoperative changes in microbial colonization following intraoral microvascular transplantation, as well as potential influencing factors. Methods: In 37 patients undergoing intraoral reconstructions, pre- and postoperative swabs were taken from the donor and recipient regions to quantify the seven selected marker bacteria using TaqMan PCRs. Patient-specific factors and clinical data were also recorded. Results: The infection-associated Acinetobacter baumannii tended to decrease postoperatively, while the infectious pathogens Pseudomonas aeruginosa, Enterococcus faecalis and the family of Enterobacteriaceae showed a postoperative increase without being directly associated with a clinical infection. Streptococcus mitis showed a significant postoperative decrease on buccal mucosa and increase on the graft surface (oral dysbiosis) and was significantly reduced or displaced by other bacteria (e.g., Mycoplasma salivarium, positive selection) when treated with ampicillin/sulbactam. Conclusions: The cutaneous microbiome of the graft adapts to the local intraoral environment. Postoperative shifts in oral bacterial colonization and an increase in infection-relevant bacteria were observed. These perioperative changes in colonization are also influenced by the administration of ampicillin/sulbactam. Consequently, single doses of antibiotics appear to be more beneficial compared to longer-term preventive use.

The course of Rotavirus A (RVA) infection in young racing pigeons during the racing season

BackgroundPigeon Rotavirus A (RVA) infection has been confirmed in pigeons in the last decade as a cause of Young Pigeon Disease (YPD). Although YPD has been known for many years to date, no studies have been conducted to track the spread of RVA infection in pigeons during the racing season. The presented research aims to determine the course of RVA infection during the flights of young racing pigeons in the summer season, in one of the districts in the Mazovian Voivodeship in Poland.ResultsFaecal samples of pigeons collected from transport baskets in vehicles transporting pigeons to the starting point were tested. The quantitative RT-PCR (qRT-PCR) was used to detect the genetic material of RVA. Samples taken during 6 flights were analysed. The study showed a percentage increase in infections up to the fourth flight of pigeons, and then their decrease. With Cq values below 20, breeders did not participate in the next flight and/or reported disease in the flock. With positive Cq values of 20 to 30, clinical signs of disease were not reported. Of the 76 breeders participating in the races, at least one positive result was found in 46 (60.5%). Including the occurrence of the disease during the racing season was reported by 11 breeders (14.4%). The main clinical signs in sick pigeons were vomiting, diarrhea and stowed crop. The tested pigeons were not vaccinated against RVA.ConclusionsDuring training and racing of pigeons, it is not possible to avoid exposing them to pathogens, including RVA, regardless of whether pigeons from different breeders are placed in the same baskets or are in separate baskets. However, after four flights the number of new cases of the disease decreases which indicates the development of immunity. The qRT-PCR test is useful in the diagnosis and differentiation of clinical (Cq below 20) and subclinical RVA infections in racing pigeons.

The impact of electrical stimulation at the back-shu acupoint with an extrinsic diaphragmatic pacing mode on respiratory function and extubation success rate in tracheostomized stroke patients: An observational study.

To observe of the effect of electrical stimulation at the back-shu acupoint with extrinsic diaphragmatic pacing (EDP) mode on respiratory function and extubation success rate in tracheostomized stroke patients. A total of 200 patients who underwent tracheostomy after a stroke from January 2022 to February 2023 were included in this study. They were divided into 2 groups based on whether electroacupuncture was used: the EDP + electroacupuncture group and the EDP group. We assessed the differences in cough reflex scores and clinical lung infection scores between the 2 groups, and measured levels of blood gas analysis indicators, diaphragmatic function, lung function, maximum inspiratory pressure, and maximum expiratory pressure in both groups. The total effective rate in the EDP + electroacupuncture group was 91.00% (91/100), which was higher than the EDP group's 80.00% (80/100) (P < .05). After treatment, both groups showed a decrease in clinical lung infection scores and cough reflex scores compared to before treatment, with the EDP + electroacupuncture group having lower scores than the EDP group (P < .05). After treatment, the pH value, arterial oxygen pressure, and oxygenation index all increased compared to before treatment, with the EDP + electroacupuncture group showing higher values than the EDP group (P < .05). After treatment, both groups showed a decrease in arterial carbon dioxide pressure compared to before treatment, with the EDP + electroacupuncture group having lower PaCO2 levels than the EDP group (P < .05). After treatment, both groups showed an increase in forced vital capacity as a percentage of predicted value (FVC%), diaphragm thickness, diaphragm mobility, maximum inspiratory pressure, maximum expiratory pressure, forced expiratory volume in the first second as a percentage of predicted value (FEV1%), and diaphragm contraction speed compared to before treatment. Additionally, the EDP + electroacupuncture group had higher values in these parameters compared to the EDP group (P < .05). The EDP + electroacupuncture group had a shorter average extubation time and a higher extubation success rate compared to the EDP group (P < .05). The combination of EDP mode and electroacupuncture at the back-shu acupoint appears to be effective in improving lung function and diaphragmatic function in tracheostomized stroke patients. It also leads to a shorter extubation time and higher extubation success rates.

Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm.

Data on short courses of antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients are limited. The aim of the study was to describe and compare the frequency of bacteremia relapse, 30-day overall and infection-related mortality, Clostridiodes difficile infection and length of hospital stay since bacteremia among those who received antibiotic therapy for 7 or 14days. This is a multicenter, prospective, observational cohort study in adult high-risk neutropenic patients with hematologic malignancies or hematopoietic stem cell transplant and monomicrobial Enterobacterales bacteremia. They received appropriate empirical antibiotic therapy, had a clinical response within 7days, and infection source control. Clinical, epidemiological and outcomes variables were compared based on 7 or 14days of AT. Two hundred patients were included (100, 7-day antibiotic therapy; 100, 14-day antibiotic therapy). Escherichia coli was the pathogen most frequently isolated (47.5%), followed by Klebsiella sp. (40.5%). Among those patients that received 7-day vs. 14-day antibiotic course, a clinical source of bacteremia was found in 54% vs. 57% (p = 0.66), multidrug-resistant Enterobacterales isolates in 28% vs. 30% (p = 0.75), and 40% vs. 47% (p = 0.31) received combined empirical antibiotic therapy. Overall mortality was 3% vs. 1% (p = 0.62), in no case related to infection; bacteremia relapse was 7% vs. 2% (p = 0.17), and length of hospital stay since bacteremia had a median of 9days (IQR: 7-15) vs. 14days (IQR: 13-22) (p = < 0.001). These data suggest that seven-day antibiotic therapy might be adequate for patients with high-risk neutropenia and Enterobacterales bacteremia, who receive appropriate empirical therapy, with clinical response and infection source control.

When less is more: the art of communicating clinical microbiology results.

The clinical microbiology laboratory is capable of identifying microorganisms in clinical specimens faster and more accurately than ever before. At face value, this should enable patient care providers to make better-informed decisions and target antimicrobial therapies to deliver individualized care. Ironically, more complete and specific reporting of microorganisms isolated from specimens may result in overtreatment based on the presence of a pathogen, even in the absence of clear signs of clinical infection. This conundrum calls into question the role of the laboratory in contributing to care through selective or "exception" reporting whereby some results are selectively withheld when there is a low probability that laboratory findings correlate with the clinical infection. In a recent article published in the Journal of Clinical Microbiology, Bloomfield et al. (J Clin Microbiol 62:e00342-24, 2024, https://doi.org/10.1128/jcm.00342-24) examine the impact and safety of an exception reporting strategy applied to wound swab specimens. Canonical pathogens associated with skin and soft tissue infections including S. aureus and beta-hemolytic streptococci are withheld from the laboratory report if certain patient criteria are met that would put them at low risk of adverse outcomes if untreated, or if treated with guideline-recommended empiric therapy. Their central finding was an approximately 50% reduction in post-laboratory report antibiotic initiation without adverse events or increased 30-day admission rate (indicative of infection-related complications, e.g., disseminated disease). While effectively achieving their goal, the premise of exception reporting and other modified reporting strategies raises questions about the potential risk of underreporting and how to ensure that the message is being interpreted, and acted upon, by care providers as was intended by the laboratory.

Serratia marcescens Burden in a Neonatal Intensive Care Unit: Colonization Rate, Clinical Infections and Strain Relatedness

Background: Serratia marcescens (S. marcescens) is an environmentally associated organism known for causing healthcare associated infections and outbreaks in neonatal intensive care units (NICUs). The colonization or infection rates in NICU settings remain uncertain. This study aims to evaluate the rate of baseline colonization and clinical infection and relatedness of S. marcescens isolates. Methods: Prospective surveillance of rectal colonization and clinical infection of S. marcescens was conducted on patients admitted to the NICU at Mount Sinai Hospital in Toronto, Ontario, from March 1, 2023, to September 30, 2023. The NICU is a 57 bed unit with all private rooms. Monthly point prevalence assessments by rectal screening were performed, alongside active surveillance for clinical infections associated with S. marcesens. Isolates from screening or clinical samples underwent assessment for relatedness using pulse field gel electrophoresis (PFGE). Results: Over the 7 month study period, 12 different patients (5.4%) were colonized/infected with S. marcescens. Among these, 10 patients (4.5%) were identified through rectal screening (316 rectal swabs were collected from 224 patients) and two patients (0.9%) exhibited positive clinical specimens (urine and endotracheal aspirate) in association with pyelonephritis and ventilator-associated pneumonia, respectively. Of the two clinical cases, one case showed a negative preceding rectal swab and the other detected through a clinical sample before the point prevalence date. The age at which a positive S. marcescens swab or positive clinical specimen was identified ranged from 4 to 66 days (median=18 days, IQR 5-38.8) (Figure 1). Sixty seven infants had repeated screening. Three out of 67 (4.5%) were colonized with S. marcescens, the timing and sequence of positive and negative testing are presented in Figure 2. Females demonstrated a higher positivity rate compared to males [9.1% (9/99) vs 2.4% (3/125), p=0.04, respectively]. PFGE analysis of all 12 (100%) isolates revealed a polyclonal pattern. Most cases were detected from March to May in 9/12 cases (75%). Ten different strains were identified. Notably, two strains demonstrated clusters of two cases each, one during March and the other during May (Figure 3). No mortality was reported among the cases. Conclusions: The study highlights the polyclonal nature of S. marcesens and raises questions about the utility of point prevalence in anticipating clinical cases or patient-to-patient transmission, especially in patients with clinical infection where there were no preceding positive screening tests.

Investigation of Biofilm Formation, Anti-Quorum Sensing Activity and Antimicrobial Resistance in Corynebacterium Species Isolated from Clinical Samples

An increasing number of different clinical infections caused by Corynebacteria have been reported in the last decade. The aim of this study was to evaluate the antibiotic resistance rates, biofilm formation capacities and to investigate the ''anti-quorum-sensing (anti-QS)'' activities of corynebacteria, which were divided into three groups according to the type of growth in culture (pure, with another pathogenic bacterium and polymicrobial growth). In total 240 Corynebacterium spp. isolates from different clinical specimens sent to the medical microbiology laboratories of Düzce University Faculty of Medicine Hospital and Başakşehir Çam and Sakura City Hospital between June 2021 and June 2022 were classified into three groups: pure, isolated with another pathogen and polymicrobial, according to their growth patterns in culture. Bacteria were identified by matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) Biotyper (Bruker, Germany) at an external centre. Antibiotic susceptibilities were determined by disc diffusion method and for vancomycin broth microdilution method was used. Results were interpreted according to EUCAST recommendations. The biofilm-forming properties of the isolates were determined quantitatively. Bioactive components of 17 isolates with strong biofilm formation were extracted and anti-QS activity was determined by agar diffusion method using Chromobacterium violaceum ATCC 12472 strain and then violacein pigment production was measured quantitatively. Of the 240 Corynebacterium spp. isolates, 138 (58%) were pure, 52 (22%) were isolated with another pathogen and 50 (20%) were part of a polymicrobial infection. Of the isolates, 140 were identified as C.striatum, 34 as C.amycolatum and 24 as Corynebacterium afermentans. When the antibiotic resistance rates of the Corynebacterium isolates were analysed according to the groups, the resistance rates to rifampicin and tetracycline antibiotics were found to be statistically significantly lower in the polymicrobial group than in the other groups. The resistance rates to penicillin, clindamycin, ciprofloxacin, moxifloxacin, rifampicin, tetracycline and linezolid were 96.7%, 88.3%, 86.3%, 73.8%, 62.5%, 59.2% and 0.8%, respectively. While all isolates were susceptible to vancomycin, linezolid resistance was detected in two C.afermentans isolates. When the biofilm formation ability was analysed, it was observed that 87 (36.3%) isolates formed biofilm. The biofilm formation rate of the isolates in the polymicrobial growth group was lower than the other two groups. The anti-QS activity of 17 isolates with strong biofilm formation was investigated and none of the Corynebacterium extracts tested were found to have anti-QS activity (inhibition of violacein pigment production without inhibiting bacterial growth) in the QS study with C.violaceum, whereas five isolate extracts had antibacterial activity (inhibition of bacterial growth). Four of the bacterial extracts with antimicrobial activity belonged to C.amycolatum and one to C.afermentans. In conclusion, when both antibiotic resistance rates and biofilm formation rates were analysed, the corynebacteria growing in culture with another pathogen showed similar characteristics to the corynebacteria growing as a pure culture. Therefore, it was thought that corynebacteria growing with another pathogen should not be ignored. In addition, the antimicrobial effects of some corynebacterial extracts suggested that more QS studies should be carried out with microbiota bacteria.

Evaluation of Inoculating Sterile Pericardial Fluid into Blood Culture Bottles

Background: There is limited data regarding the benefits of direct inoculation of sterile pericardial fluid into blood culture bottles. We discovered widespread adoption of this practice at our institution during pericardiocenteses and became concerned about over-capturing of skin flora contaminants. We aimed to understand how organisms detected in pericardial fluid inoculated into blood culture bottles were interpreted clinically. Methods: We investigated a cluster of four patients with coagulase-negative Staphylococcus (CoNS) isolated in pericardial fluid inoculated blood culture bottles (PF-BCxBs) over a 2-week period; three of these patients had recent cardiac surgery and were initially flagged as potential SSIs. We further expanded to a retrospective review and identified 28 patients with ≥1 organism isolated from PF-BCxBs from 7/2021 to 6/2023. Clinical, microbiological, and pharmacy data were abstracted. The primary outcome was the proportion of patients with a clinically diagnosed infection. Results: Investigation into the initial cluster revealed a pseudo-outbreak - three of four patients had no clinical evidence of infection (CoNS was deemed a contaminant); one was treated for a potential infection. All patients had concomitant negative routine fluid cultures. Discussions with the cardiology teams revealed areas for improvement in the process for inoculating fluid into blood culture bottles. From the two-year review, 18% (5/28) of patients were clinically diagnosed with an infection (two Staphylococcus aureus; two CoNS; one Candida rugosa). Of the patients without Staphylococcus aureus, all three had a concomitant negative routine fluid culture, were receiving antibiotics prior to pericardiocentesis, and had white blood cell counts (WBC) &gt;12 K/uL. The remaining 82% (23/28) of patients were deemed not to have an infection. Of these 23 patient without infection, organisms isolated were 16 CoNS (70%) and seven Cutibacterium species (30%). None of these patients had a fever, one (4%) was receiving pre-pericardiocentesis antibiotics, and three (9%) had WBC &gt;12 K/uL. 70% (16/23) of these patients were started on antibiotics after gram-stain results; all were eventually discontinued (mean antibiotic days = 2, range 1-5 days). 83% (19/23) of these patients had a concomitant negative routine fluid culture. Conclusion: The majority of patients with an organism isolated from PF-BCxBs had either CoNS or Cutibacterium species and were deemed not to have a clinical infection. Within the small cohort limitations, clinical utility of blood culture bottle inoculation seems highest for patients with pre-procedural concern for infection. IPC teams should be aware of the non-pathogenic skin flora frequency and potential implication on SSI surveillance.

Investigation and control of an outbreak of methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in a level IV NICU

Background: Neonatal intensive care units (NICU) outbreaks caused by methicillin-susceptible Staphylococcus aureus (MSSA) are less commonly reported than outbreaks caused by methicillin-resistant S. aureus. We report an unusual outbreak of MSSA skin and soft tissue infections (SSTIs) in a level IV NICU investigated by whole genome sequencing (WGS) and molecular typing. Methods: An investigation was initiated in a 56-single-bed NICU after four patients developed MSSA SSTIs in Week 1. Case-patients had positive MSSA cultures identified by clinical cultures or surveillance sampling (bilateral nares, axillae, umbilicus, and groin), and antibiotic susceptibility testing was performed. WGS and assessment of isolate relatedness through mutation event analysis and multi-locus sequence typing (MLST) was performed by the NYS DOH. Demographic and isolate characteristics were compared using Wilcoxon rank sum test, Fisher’s exact test and Pearson’s Chi-squared test, as appropriate. Results: From Week 2 to Week 32, 9 rounds of surveillance for MSSA colonization were conducted. In all, 30 case-patients had MSSA colonization and 16 infants developed infections including impetigo (n=7), pustules (n=5), staphylococcal scalded skin syndrome (SSSS, n=2), abscess (n=1), and bacteremia (n=1). All SSTI cases presented on infants’ faces, all of whom were on non-invasive respiratory support. MLST identified 4 distinct types including MLST 121 (n=12), MLST 398 (n=10), MLST 30 (n=6), and MLST 15 (n=6). Eight isolates were unrelated to other isolates. MLST 398 and MLST 30 included isolates not closely related (&gt;9 mutation events). The 12 MLST 121 isolates were closely related (≤9 mutational events between all isolates), harbored the mupA gene, and were mupirocin-resistant (MIC&gt;1024 ug/ml). Clinical infection and mupirocin resistance were associated with MLST 121 (Table 1). Multiple infection control measures were implemented, including increased availability of alcohol-based hand sanitizers, introducing bare-below-the-elbows practice for staff, contact precautions for case-patients, decolonization with mupirocin and chlorhexidine baths, environmental cleaning/disinfection, and removing excess equipment and supplies. No new cases of mupirocin-resistant or MLST 121 SSTIs occurred after Week 25. Conclusion: We report a MSSA outbreak associated with multiple MLST types and a predominant mupirocin-resistant strain. This report highlights the ability of molecular typing to characterize strains causing infections versus colonization and the potential loss of mupirocin as a control measure when outbreaks are caused by mupirocin-resistant strains. WGS analysis allows for increased discrimination of mutation events allowing for improved resolution of case relatedness compared to other typing methods. Successful control of this outbreak was achieved with a multitude of infection prevention and control.

Medical complications among acute leukaemia patients receiving inward induction chemotherapy at haematooncology section of the National Cancer Institute, Sri Lanka

Introduction: Acute leukaemias are complicated with numerous disease and treatment related medical complications. Infection is one of the major complications and is related to chemotherapy associated-neutropaenia. This study aims to identify medical complications in acute leukaemia patients during the induction chemotherapy period. Results: Medical complications were observed in patients receiving induction chemotherapy N=50. Infections and electrolyte disturbances were the most frequently observed complications (74% each) followed by chemotherapy induced neutropaenia (38%), alteration of liver functions (32%), steroid induced hyperglycaemia (28%) and bleeding (16%). Thrombosis and tumour lysis were detected at lesser frequencies (4% each). Among infections, the majority showed evidence of blood stream infection (27%) followed by pulmonary infections (24.3%). Gram negative organisms were the most frequently identified pathogen. Among the electrolyte disturbances, hypokalaemia (48%), hyponatraemia (48%), and hypocalcaemia (44%) were more prevalent. Mean duration from initiation of chemotherapy to neutrophil nadir was 10.05 days.Conclusions: Patients with acute leukaemia encounter a multitude of disease and treatment related medical complications during induction chemotherapy. Infection is the most common complication with higher rates of bacteraemia and gram-negative sepsis. This is likely to be a result of treatment related neutropaenia. However, further focused studies on neutropaenic sepsis during induction chemotherapy are recommended. Clinical vigilance, strict and improved infection control strategies are necessary to improve the outcome of these patients.

Antifungal Properties of Dracaena cinnabari Resin Extracts Against Candida albicans

Background: Candida albicans is the most prevalent fungal pathogen in humans, capable of causing a range of clinical infections from mucocutaneous conditions like oral thrush to life-threatening systemic diseases. While Candida species are typically part of the normal oral flora in about 75% of the global population, the rising resistance to antifungal drugs has become a significant concern. This highlights the urgent need to explore alternative antimicrobial agents, including natural phytochemicals derived from plants, as potential substitutes for synthetic chemicals to address the growing issue of antifungal resistance. Methods: This study aimed to evaluate the antifungal properties of Dracaena cinnabari resin extracts (methanol and water) against Candida albicans. The antifungal activity was assessed using the direct contact agar diffusion test, while the minimal inhibitory concentration (MIC) of the extracts was determined through the broth dilution method. Results: The antifungal susceptibility tests demonstrated that C. albicans was susceptible to both methanol and water extracts of D. cinnabari resin, with zones of inhibition measuring 32.2 ± 0.8 mm and 29.0 ± 1.1 mm, respectively. The MIC values ranged between 2.50 and 5.00 mg/mL for both extracts. Conclusion: The antifungal effectiveness of D. cinnabari resin extracts was comparable to that of the miconazole control, showing significant potential as a natural treatment option against Candida albicans. These findings suggest that Dracaena cinnabari resin could play a valuable role in the treatment and management of candidiasis, particularly oral candidiasis.

Bacteriophage therapy- a refurbished age-old potential strategy to treat antibiotic and multidrug resistant bacterial infections in future.

The worldwide prevalence of antimicrobial resistance coupled with the unavailability of newer antibiotics, has brought the sharp focus back among the scientific community, towards the discovery of novel alternative therapeutics to tackle the menace. Consequently, in the current post-antibiotic era, 'Bacteriophage Therapy' has emerged as one of the most promising option to address this problem. Bacteriophages, actually discovered long back, has shown greater potential to kill various bacterial pathogens, including the resistant clinical ones. Some of the other advantages for the use of bacteriophage therapy to treat infectious diseases include, wider availability of these microorganisms in nature, host-specific action, absence of any significant side-effects in humans and most often also exhibiting a broader anti-bacterial potential. In the recent times, the potential of phage therapy has been demonstrated in various treatments, clinical trials and infection models across the globe, where even antibiotics have completely failed. To address the global threat of AMR, WHO and UN have jointly illustrated "One Health" approach, recently extending the context to bacteriophage therapy. Many pharmaceutical companies have also recently started employing bacteriophages for developing different kinds of formulations for catering to medical and other industries. It has even shown great effect as combinatorial therapy along with antibiotics, to treat or manage various critical antibiotic resistant clinical infections. This continuously expanding potential of the bacteriophages holds great promise in the future, in the fight against the rising threat of AMR globally.

Case-control study to identify the causative agents of ophthalmia and conjunctivitis in goats in Savannakhet province of Lao PDR

Pinkeye is a highly contagious disease of goats with different aetiologies. Surveys in Lao PDR have identified eye lesions typical of pinkeye as a common condition, however, this has not been confirmed diagnostically, and the responsible pathogens have not been identified. A matched case-control study was implemented in 70 goat holdings from Savannakhet province, Lao PDR, to detect agents causing pinkeye and conduct phylogenetic analysis of the identified pathogens. Fifty eye swabs from goats with infected eyes (cases) and 50 paired samples from unaffected cohorts (controls) were collected from 25 holdings. Samples were tested using quantitative PCR assays targeting known pinkeye pathogens at the genus and species levels. The prevalence of pathogens in case and control goats was as follows: Mycoplasma conjunctivae (94% and 74% respectively, P = 0.006, OR = 5.5), Chlamydia pecorum (4%, 10%), Moraxella ovis (30%, 30%), Moraxella bovis (0%, 0%) and Moraxella bovoculi (0%, 0%). M. conjunctivae was present in a high proportion of goats in both groups revealing that Lao goats are carriers of M. conjunctivae. However, the mean log10 genome copy number/µL of DNA extract was significantly higher in case goats than control goats (P < 0.05). Thus, M. conjunctivae is likely the principal causative agent of pinkeye in Lao goats with carrier status converting to clinical infection following corneal damage or other causative factors. M. conjunctivae detected in samples from different goats and districts showed low genetic diversity. Identifying the causes of pinkeye in Lao goats will assist in designing appropriate treatment and control strategies.

Responding to COVID-19 on the outer islands of Tuvalu.

Coronavirus disease (COVID-19) reached Tuvalu's shores in November 2022, making Tuvalu one of the last countries in the world to experience community transmission of the disease. With minimal capacity to deliver critical care and a small health workforce that had been further depleted by COVID-19 infection, response priorities rapidly shifted to the outer islands. The outer islands are accessible only by boat, with travel taking from 6 to 24 hours. The return of high school students to their home islands for the Christmas holidays had the potential to place further pressure on the islands' medical facilities. A multiorganizational collaboration between the Australian and Fijian governments, the Pacific Community, the Tuvalu Ministry of Social Welfare and Gender Affairs (MoHSWGA) and the World Health Organization facilitated the deployment of two teams to the outer islands to provide support. The team worked with public health and clinical staff to provide technical support for clinical management, infection prevention and control, laboratory, risk communication, community engagement and logistics. The outer islands' response to the pandemic significantly benefited the island communities, the MoHSWGA and the team members who deployed. The key lessons identified relate to the need to strengthen the health workforce and supply chain.