Culture Of Organism Research Articles

Poor quality alcohol hand-rub associated multidrug resistant Klebsiella pnemoniae outbreak in a neonatal unit

Background: Klebsiella pneumoniae represents an important pathogen in hospital acquired infections. Outbreak of sepsis with ESBL producing Klebsiella pneumoniae with fatal outcome was reported in a neonatal unit of a District General Hospital in Sri Lanka. This study is to describe an outbreak of fatal sepsis caused by Klebsiella pneumoniae in 5 neonates, in a neonatal unit during May and June 2015, addressing the range of infection control measures in an outbreak including hand hygiene, in-ward intravenous fluid preparation and administration, under suboptimal infection control conditions. Methods and materials: Collection and culturing of suspected fluid samples, including infusates, humidifier water, prepared intravenous fluids done in stages; culturing the samples collected initially and repeat collection and culturing the fluid samples, after strengthening infection control practices. Observation and correction of infection control procedures according to the infection control manual, strengthening hand hygiene practice, stopping reuse of multi-vials after 24 hours. Inspecting hands of the staff, who prepare infusates, for absence of micro-organisms, after using locally prepared alcohol hand-rub. As the outbreak continued infecting new admission with same organism in blood cultures, quality of the local hand-rub was tested. After replacing local hand-rub with quality assured commercial hand-rub and thorough cleaning of the unit, resampling done. Results: Out of 13 fluid samples of initial cultures, 3 infusates connected to 3 neonates grew Klebsiella pneumoniae, whose blood cultures became positive with the same, subsequently. Awareness programme on hand hygiene, improved staff hand hygiene compliance from 30% to 94%. Samples of infusates taken following corrected infection control practices and strict hand hygiene grew same organism in 3 samples out of 12. Hand prints of staff, following hand-rub usage, grew micro-organisms, including Klebsiella pneumoniae. For local hand-rub preparation, as the starting solution, 70% isopropyl alcohol was used and alcohol percentage of final product was not tested. Samples taken after quality assured hand-rub, did not grow organisms. Conclusion: Poor quality of hand-rub, re-using multi-vials after 24 hours and poor hand hygiene practices have resulted the outbreak. Therefore it is compulsory to look into all the contributing factors and timely correction of them is lifesaving in management of outbreak.

Metapangenomics of the oral microbiome provides insights into habitat adaptation and cultivar diversity

BackgroundThe increasing availability of microbial genomes and environmental shotgun metagenomes provides unprecedented access to the genomic differences within related bacteria. The human oral microbiome with its diverse habitats and abundant, relatively well-characterized microbial inhabitants presents an opportunity to investigate bacterial population structures at an ecosystem scale.ResultsHere, we employ a metapangenomic approach that combines public genomes with Human Microbiome Project (HMP) metagenomes to study the diversity of microbial residents of three oral habitats: tongue dorsum, buccal mucosa, and supragingival plaque. For two exemplar taxa, Haemophilus parainfluenzae and the genus Rothia, metapangenomes reveal distinct genomic groups based on shared genome content. H. parainfluenzae genomes separate into three distinct subgroups with differential abundance between oral habitats. Functional enrichment analyses identify an operon encoding oxaloacetate decarboxylase as diagnostic for the tongue-abundant subgroup. For the genus Rothia, grouping by shared genome content recapitulates species-level taxonomy and habitat preferences. However, while most R. mucilaginosa are restricted to the tongue as expected, two genomes represent a cryptic population of R. mucilaginosa in many buccal mucosa samples. For both H. parainfluenzae and the genus Rothia, we identify not only limitations in the ability of cultivated organisms to represent populations in their native environment, but also specifically which cultivar gene sequences are absent or ubiquitous.ConclusionsOur findings provide insights into population structure and biogeography in the mouth and form specific hypotheses about habitat adaptation. These results illustrate the power of combining metagenomes and pangenomes to investigate the ecology and evolution of bacteria across analytical scales.

Antibiotics in marine aquaculture farms surrounding Laizhou Bay, Bohai Sea: Distribution characteristics considering various culture modes and organism species

This study mainly investigated the distribution characteristics and risk assessment of 14 antibiotics in typical marine aquaculture farms surrounding the Bohai Sea. The effects of various culture modes (outdoor pond culture, recirculating water culture, greenhouse pond culture, raft culture, cage culture and bottom sowing culture), and diverse cultured organism species such as fish (grouper, bass, pike and turbot), mollusk (oyster, scallop, conch and mussel) and sea cucumber on the distribution of antibiotics in different mariculture pond matrices (seawater, sediment/biofilm and organism) were studied. In addition, antibiotic pollution levels in various matrices (water, sediment, organism and feed) from different mariculture areas surrounding the Bohai Sea and the Yellow Sea were compared.The biofilm on the inner wall of greenhouse pond was more capable of accumulating antibiotics than the biofilm attached to the rope for raft culture and net for cage culture, and other culture sediments. The antibiotic concentration level in the culture matrices (water, sediment/biofilm and organism) was the highest under greenhouse pond culture mode, and that under the industrial recirculating water culture mode was the lowest. Antibiotic concentration in culture matrices of fish ponds was higher than that of sea cucumber ponds and mollusk ponds.The levels of antibiotics in water and sediment from marine aquaculture farms in Laizhou (Bohai Sea coast) were higher than those in Haiyang and Jimo (Yellow Sea coast). Enrofloxacin in turbot might cause considerable harm to human health, and the risk of antibiotics in other seafood could be ignored. Antibiotic ecological risks and resistance risks were generally low in water. Fluoroquinolones posed medium to high ecological risks in the natural receiving water around the mariculture farm. Trimethoprim and enrofloxacin showed relatively high antibiotic resistance risks in mariculture water and natural water, which might exert selective pressure on the bacterial community in the environment.

Factors and Causes of Puerperal Sepsis in Kilimanjaro, Tanzania: A Descriptive Study among Postnatal Women who Attended Kilimanjaro Christian Medical Centre.

Background:Puerperal sepsis is the major cause of maternal morbidity and mortality worldwide. About 94% of maternal mortality occur in low and middle-income countries including Tanzania.Objective:To estimate the prevalence, document factors and causes of puerperal sepsis among postnatal women who attended postnatal care in Kilimanjaro Christian Medical Centre Hospital in the year 2015.Methodology:A descriptive cross-sectional study was carried out at Kilimanjaro Christian Medical Centre, Tanzania. A total of 183 medical records of attendance in 2015 were used for the study. Information about the isolated organism in culture was retrieved from the Laboratory Information System.Results:The prevalence of puerperal sepsis was 11.5% (21/183). The most common factors and causes of puerperal sepsis included caesarean section 66.7% (14/21), postpartum haemorrhage 57.1% (12/21), moderate to severe anaemia 61.9% (13/21), prolonged labour 76.2% (16/21) and bacterial infection 90.5% (19/21). The difference was significant at p<.05. The most bacteria species isolated among women with puerperal sepsis was Staphylococcus spp 50.0% (7/14), Escherichia 28.6% (4/14) and Streptococcus spp 21.4% (3/14).Conclusion:Puerperal sepsis is prevalent (11.5%) at Kilimanjaro Christian Medical Centre. Staphylococcus spp was found to be a predominant isolate which causes puerperal sepsis followed by E. coli and Streptococcus spp.

Supplemental carbon sources applied in biofloc technology aquaculture systems: types, effects and future research

AbstractBiofloc technology (BFT) systems have been driven towards increased sustainability in the last decade. BFT depends on maintenance of the optimal carbon‐to‐nitrogen (C/N) ratio through supplementation with organic carbon sources. The types of carbon sources and addition strategies are critical considerations in BFT systems. Thus for the purpose of this review, a thorough search of the literature was conducted to gather relevant information from reliable sources, ranging from reputable journals to books and useful reports in the field of BFT. Keywords used for the literature search include: ‘biofloc technology systems’, ‘carbon sources’, ‘solid carbon sources’, ‘effects of carbons sources’, ‘carbon source addition strategies’, ‘nutritional quality of bioflocs’, ‘carbon sources and water quality’, ‘C/N ratio in BFT’, and ‘carbon sources and bacterial community’. Among the several peer‐reviewed articles, books and technical reports consulted, 147 (dated from 1987 to 2020) were relevant for the preparation of this review. The current review thus examines the subject of supplemental carbon sources in BFT systems and discusses the various effects of their application with respect to the culture organism, microorganisms, water quality and the nutritional quality of flocs. The benefits and challenges associated with the types of carbon sources used in BFTs are also presented. Suggested organic carbon sources and their addition strategies are provided, and further research directions are proposed.

Bitki ve Hayvan Biyoteknolojisi; Hücresel Tarım ve Nano-Teknoloji

Tarımsal biyoteknoloji araştırmacılara, tarımı ve yetiştiriciliği yapılan bütün organizlamarın genetiğini anlama ve manipüle etme imkanı sağlayan bir alandır. Tarımsal biyoteknolojinin başlangıcında fermantasyon gibi yöntemler sık kullanılırken, bugün modern tarımsal biyoteknoloji besinlerin kalitesini, miktarını, içeriğini arttırmaya ve tat gibi farklı özellikleri değiştirmeye imkan sağlamaktadır. Bitki biyoteknolojisi alanındaki çalışmalar çoğunlukla bitkilerde verim ve kaliteyi arttırmanın yanında biyotik ve abiyotik stres faktörlerine karşı dayanıklı bitkiler geliştirmeye odaklanırken, hayvan biyoteknolojisi ise hayvansal ürünlerin kalitesini arttırma, suni dölleme, embriyo transferi, hayvan hastalıklarının daha ucuz ve kolay bir şekilde teşhis ve tedavi yöntemlerinin geliştirilmesi konularını ele almaktadır. Bu çalışmada bitkisel ve hayvansal üretim alanında yeni uygulama alanı bulan hücresel üretim ve nano-biyoteknoloji uygulamaları irdelenmiştir.

Performance of the agarophyte Gracilariopsis tenuifrons in a multi-trophic aquaculture system with Litopenaeus vannamei using water recirculation

This study aimed to evaluate the performance of the red alga Gracilariopsis tenuifrons as a biofilter in a multi-trophic cultivation system with Litopenaeus vannamei, using recirculation by zero water exchange. The species were cultivated for 4 weeks, while measurements were taken of the chemical and physical characteristics of water, the development of the cultivated organisms (biomass and growth rate), and the carbon, nitrogen, and phosphorus content assimilated by the seaweeds. The water enrichment produced by shrimp farming favored the seaweed development, which increased on average by 2.6 % day-1 ± 0.24 (0.4 to 4.08 % day-1). The seaweed species was able to remove up to 35.1% of the ammonium ion and increased its tissue nitrogen by about 4.8 times by the end of the experiment (1.2–4.8%). The shrimp presented an increase in biomass (8.0 to 12.7 g), with an average growth rate of 1.7% day-1 ± 0.1 and a survival of 100% at the end of the experiment. Based on these results, the cultivation of L. vannamei in a recirculating water system using Gp. tenuifrons as a biofilter can be an advantageous alternative, helping to reduce water usage and remove the main metabolites produced by shrimp cultivation.

A Novel Clinical Risk Factor Based Scoring System to Predict the Severity of Acute Graft Versus Host Disease and Steroid Response in Resource Constrained Settings

INTRODUCTION Acute Graft-versus-host disease (aGVHD) is a common complication of allogeneic hematopoietic cell transplantation (HCT), affecting about 50% of transplants. Grading of aGVHD can serve a variety of purposes, including retrospective assessment of peak severity, real-time assessment of severity at prespecified time points, and determination of the need for treatment. But several problems hamper the application of grading systems to predict outcomes among patients with aGVHD: (1) Assignment of a peak GVHD score is done retrospectively; clinicians cannot use the current grading system for peak score in real-time1. (2) The systems do not account for the time to the response after treatment1. (3) Assignment of grade IV GVHD is often used to indicate that GVHD caused a death, irrespective of the severity. In this situation, the grading reflects the outcome and cannot be used to predict the outcome1. Recently serum biomarkers have emerged as an additional potential measurement of acute GVHD severity. The Mount Sinai Acute GVHD International Consortium (MAGIC) Group, has validated MAGIC algorithm probability (MAP) that combines two GI biomarkers (ST2 and REG3α) into a single value. The MAP predicts response to treatment, GVHD severity. But in resource-limited settings, like transplant centers in India lack testing features. In this study we have developed a risk scoring based on clinical and easily available biochemical parameters to predict the severity of aGVHD. AIMS AND OBJECTIVES To predict the aGVHD severity at the onset based on risk factor score. To assess the steroid response in different risk groups MATERIAL AND METHODS The study included patients who underwent allogeneic HCT at Narayana hrudayalaya hospital, between January 2015 and April 2020 and developed acute GVHD within 100 days of transplant. After taking institutional ethics committee approval, data were collected from medical records. Baseline patient characteristics are mentioned in table 1. The following parameters were analyzed as risk factors for the development of severe GVHD (MAGIC grade 3 and 4): 1. Age &amp;gt;18 yrs, 2. MDR organisms in baseline stool culture, 3. HCT comorbidity index &amp;gt;1, 4. Peripheral blood as a source of stem cells, 5. Female to male transplants, 6. Myeloablative regimens, 7. Suboptimal GVHD prophylaxis, 8. CD34 dose &amp;gt; 6 x 106/kg, 9. Grade 3/4 mucositis 10. Early-onset GVHD (within 28 days), 11. Albumin level at the onset of GVHD, 12. Albumin drop from baseline3, and 13. Bloodstream infection. Risk factors with a p-value of &amp;lt;0.05, were given score 2 and score 1 was given to other parameters. The total score ranged from 0 to 17. The study population was divided into 3 groups (Group 1 with score 0-4, Group 2 with score 5-7, Group 3 with score &amp;gt; 8). The following outcomes were assessed in each group; severity of GVHD (Grade I/II vs Grade III/IV) and response to steroids. RESULTS Out of 148 patients, 35.5% of Group 1, 56.5% of Group 2 patients and 85.5% of Group 3 patients developed Grade 3 or 4 GVHD respectively (P-value &amp;lt;0.001). Positive predictive value of score &amp;gt; 8 to predict Grade 3/4 GVHD is 85.4%, negative predictive value is 50.6%, sensitivity is 50.5%, and specificity is 85.5%. From Group 1 and 2, only 30% of patients were steroid non responders, while 55.3% of Group 3 patients are steroid non responders (P-value - 0.04). CONCLUSION Traditional GVHD scoring systems reflect the outcome and cannot be used to predict the outcome. Various biomarker-based scoring systems are helpful in this situation, but in resource-limited settings, it might not be easily feasible. Clinical scoring systems like risk factor-based scoring systems are very helpful, which can predict the severe GVHD at early time points leading to management decisions such as upfront initiation of aggressive treatments and earlier introduction of second-line agents. References Leisenring WM, et al. An acute graft-versus-host disease activity index to predict survival after hematopoietic cell transplantation with myeloablative conditioning regimens. Blood. 2006;108(2):749-55. 2.Rashidi A, et al. Peritransplant Serum Albumin Decline Predicts Subsequent Severe Acute Graft-versus-Host Disease after Mucotoxic Myeloablative Conditioning. Biol Blood Marrow Transplant. 2016;22(6):1137-41. Disclosures No relevant conflicts of interest to declare.

Monitoring of drinking water from the karst springs of the Ljuberadja-Niš water supply system (Serbia)

The Ljuberadja-Nis water supply system is one of the main components of the Nis water supply system. This system consists of a series of natural, karst springs of groundwater (Krupac, Mokra, Divljana, Ljuberadja), with the capacity of 800–1450 L/s. The most important factors in a healthy drinking water supply are the proper choice and protection of water springs. Considering that water composition may sometimes have an adverse effect on consumer health, production processes in some industries and also on facilities and water company equipment, the aim of this paper was to examine water composition and to monitor its quality by analyzing the physical, chemical, and microbiological indicators. Water quality is tested in accordance with the corresponding directives and regulations of national and international authorities. The analysis of drinking water encompassed the appointment of the following parameters (quality indicators): physical parameters: temperature, turbidity, pH value and electrical conductivity of water; chemical parameters: chloride, ammonia, nitrite, nitrate, sulfate, calcium, magnesium, iron, manganese, aluminum and chromium in the form of Cr6+ and Cr3+ ions; microbiological parameters: culturable organisms, total and fecal coliform bacteria, intestinal enterococci, sulfite reducing clostridia, Pseudomonas aeruginosa and Proteus strain. Monitoring has confirmed the hygienic and health adequacy of the water distributed to cosumers.

A perioperative management to reduce rate of urinary tract infection for patient underwent radical cystectomy with ileal conduit diversion

Although radical cystectomy, as the standard surgical treatment for muscle-invasive bladder cancer patients, prolongs survival remarkably, there are postoperative complications associated with urinary diversion. This study aimed to explore the antibiotic prophylaxis, according to culture of single J stent and urine from patients underwent urinary diversion (ileal conduit), its capacity to reduce the rate of urinary tract infection (UTI). A total of 179 patients at Renji Hospital were reviewed in the study between Jan 2016 and June 2019. All patients included in this study were underwent radical cystectomy and ileal conduit. In Jan 2018, we enacted a quality initiative of urologic department to create a modified management. Following this initiative, antibiotic prophylaxis began to be used according to postoperative urine culture and stub of J-stent culture, which were obtained in 3rd days and 7th days after surgery, respectively. All consecutive patients treated with this process were compared with a conventional group. The clinicopathologic features of the two groups were compared using the t test and Chi square test. Multivariable logistic regression analysis was performed to determine the odds of developing 30-day UTI in two groups. 112 and 67 patients underwent the modified and conventional postoperative management, respectively. Two groups were comparable with regard to all demographic, clinical variables. The most common organism in urine culture and stub of J-stent culture was Candida albicans (38.46% and 31.7%). The rate of UTI was significantly lower in the modified group than in the conventional group (4.5% vs 13.4%, P = 0.031). In multivariable analyses, the conventional management was significantly more likely to develop UTI (OR = 4.992, 95% confidence interval [CI] 1.432-17.398 P = 0.012) than modified management. This procedure is associated with a significant decrease in UTI after surgery. During perioperative period, urine/single J stent culture with drug sensitivity test is necessary.

First Report of “Munchausen Syndrome by Proxy Variant” in an Injection Drug User with 12 New Organisms in Blood Cultures 17 Days after Admission to the Hospital

The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the hospital around this time was suspected to have injected a solution of drugs brought from home directly into the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New onset of unexpected symptoms should alert caregivers of the possibility of such abuse.

Predicting antimicrobial susceptibility from the bacterial genome: A new paradigm for one health resistance monitoring

The laboratory identification of antibacterial resistance is a cornerstone of infectious disease medicine. In vitro antimicrobial susceptibility testing has long been based on the growth response of organisms in pure culture to a defined concentration of antimicrobial agents. By comparing individual isolates to wild-type susceptibility patterns, strains with acquired resistance can be identified. Acquired resistance can also be detected genetically. After many decades of research, the inventory of genes underlying antimicrobial resistance is well known for several pathogenic genera including zoonotic enteric organisms such as Salmonella and Campylobacter and continues to grow substantially for others. With the decline in costs for large scale DNA sequencing, it is now practicable to characterize bacteria using whole genome sequencing, including the carriage of resistance genes in individual microorganisms and those present in complex biological samples. With genomics, we can generate comprehensive, detailed information on the bacterium, the mechanisms of antibiotic resistance, clues to its source, and the nature of mobile DNA elements by which resistance spreads. These developments point to a new paradigm for antimicrobial resistance detection and tracking for both clinical and public health purposes.

P43. Validity of routine diagnostic tests for vertebral osteomyelitis/discitis and its influence by the infecting organism

BACKGROUND CONTEXT Spine surgeons rely on multiple tests to correctly diagnose adult vertebral osteomyelitis. Patient temperature, serum C- reactive protein (CRP), erythrocyte sedimentation rate (ESR) and serum polymorphonuclear leukocyte percentage (PMN%) are traditionally used as first-line tests because of their perceived high sensitivity for vertebral osteomyelitis. However, the influence of the infecting organism on the degree of marker elevation remains relatively unaddressed in the spine literature. It is possible each of these markers have a distinct sensitivity based on the infecting organism. PURPOSE The purpose of this study was to determine whether mean serum laboratory marker levels differed based on infecting organism and whether certain organisms are associated with greater elevated values. STUDY DESIGN/SETTING This was a retrospective institutional database review at the University of Missouri-Columbia from 2015-2019. PATIENT SAMPLE A total of 133 patients diagnosed with vertebral osteomyelitis who underwent blood culture, and/or biopsy prior to treatment. OUTCOME MEASURES ESR, CRP, WBC, PMN%, maximum temperature, culture organism. METHODS The mean peak inflammatory marker levels were compared among organisms with student's T test. Demographics, comorbidities and Charleston Comorbidity Index (CCI) were collected and multivariable logistic regression models were utilized. Receiver operating characteristic curve analysis was performed to delineate separate, optimal cut offs for CRP, ESR, WBC, and PMN% for patients with culture positive osteomyelitis. RESULTS Patients diagnosed with osteomyelitis had a max mean temperature of 37.2 C, CRP of 10.8 mg/L, ESR of 72 mm/hr, WBC of 12.1 cells/L, and PMN% of 74.1. A total of 105 patients (79%) had positive cultures. For CRP, Staphylococcus aureus (13.9 mg/L) and antibiotic resistant organisms (methicillin resistant Staphylococcus aureus and vancomycin-resistant Enterococci) (14.3 mg/L) had a higher mean value than culture negative cases (5.65 mg/L). For ESR, antibiotic resistant organisms (72.1 mm/hr) had a higher mean value than culture negative cases (57.9 mm/hr). For WBC, Staphylococcus aureus (14.4 cells/L), antibiotic resistant organisms (13.6 cells/L), and coagulase negative Staphylococcus (11.8 cells/L) had a higher mean value than culture negative cases (8.22 cells/L). For PMN%, Staphylococcus aureus (75.9%), antibiotic resistant organisms (77.2%), coagulase negative Staphylococcus (77.7%), and Streptococcus species (79.7%) had a higher mean peak value than culture negative cases (67.7%). Both Staphylococcus aureus (13.9 mg/L, 72.1 mm/hr, 14.4 cells/L, 75.9%) and antibiotic resistant organisms (14.3 mg/L, 94.0 mm/hr, 13.6 cells/L, 77.2%) had elevated CRP, ESR, WBC, and PMN% compared to fungal organisms (2.56 mg/L, 43.7 mm/hr, 8.17 cells/L, 64.0%). Temperature showed no significant differences in mean values among all organisms. Gram negative, Enterococcus, and fungal organisms did not show significant differences in mean values versus culture negative cases. CONCLUSIONS Serum laboratory markers in the diagnosis of vertebral osteomyelitis appear to be influenced by the infecting organism type. Laboratory values in patients diagnosed with vertebral osteomyelitis with culture negative or low-virulence organisms are lower compared to antibiotic resistant and Staphylococcus aureus organisms. Temperature did not correlate with a diagnosis of osteomyelitis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Efficient open cultivation of cyanidialean red algae in acidified seawater

Microalgae possess high potential for producing pigments, antioxidants, and lipophilic compounds for industrial applications. However, their open pond cultures are often contaminated by other undesirable organisms, including their predators. In addition, the cost of using freshwater is relatively high, which limits the location and scale of cultivation compared with using seawater. It was previously shown that Cyanidium caldarium and Galdieria sulphuraria, but not Cyanidioschyzon merolae grew in media containing NaCl at a concentration equivalent to seawater. We found that the preculture of C. merolae in the presence of a moderate NaCl concentration enabled the cells to grow in the seawater-based medium. The cultivation of cyanidialean red algae in the seawater-based medium did not require additional pH buffering chemicals. In addition, the combination of seawater and acidic conditions reduced the risk of contamination by other organisms in the nonsterile open culture of C. merolae more efficiently than the acidic condition alone.

PATTERN AND BURDEN OF ANTIMICROBIAL RESISTANCE AMONG CAUSATIVE ORGANISMS OF SPONTANEOUS BACTERIAL PERITONITIS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Material and Methods; All the cases (n = 183) of Cirrhosis of liver with ascities, fulfilling inclusion criteria were recruited from Department of Medicine Akhtar Saeed Trust Hospital Lahore and Nishtar Hospital, Multan. All selected patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; High degree of drug resistance was observed among these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli. DOI: 10.7176/JMPB/67-07 Publication date: August 31 st 2020

Underestimating the Levels of Microbiological Contamination on Environmental Surfaces Within NHS Hospitals

<h3>Background</h3> Historically, environmental surfaces were thought to have an insignificant role in healthcare-associated infection transmission; and hospital cleaning was merely aesthetic. Nowadays, cleaning is a crucial activity in managing surface bioburden and preventing pathogen acquisition in patients. Equally important is monitoring of surfaces – current guidelines suggest patients are at greater risk when surfaces exceed 5 colony forming units (CFU) per cm2 for total aerobic counts. Standard nutrient-rich media, used for monitoring surfaces, may fail to culture all microbes present; often discounting dormant or difficult to culture organisms. Research efforts are currently underway, across multiple NHS Trusts, to more accurately quantify the base levels of microbial contamination on critical environmental surfaces. <h3>Methods</h3> Surfaces within close-proximity to patients were periodically swabbed, over two years, for microbial bioburden and cultured using non-specific, improved sensitivity culture media. Samples were categorised according to NHS Trust, date of sampling and distance of surface from the patient. Additional, molecular-based techniques including epifluorescence microscopy and genomic sequencing were employed to further evaluate microbes present. <h3>Results</h3> The presented data shows >60% of samples exceeded the levels defined above for microbial contamination (averaging 380000 CFU/cm2). Our media demonstrated improved recovery rates from surfaces – 36% compared with routine media. Despite procedural variations on cleaning, across the sites, microbiological contamination levels were comparable. Significant differences were discovered for distances between surface and patient; an indirect relationship existed between the distance from a patient and microbe recovery rates. Epifluorescence microscopy of culture-negative samples found populations of viable microbes (estimated <h3>Conclusions</h3> The presentation will discuss the implications of underestimating surface contamination and the applicability of current detection methods, and the need for multi-faceted approaches including molecular-based techniques. The abundance of environmental species discovered here have an unknown impact on patient health and raise questions on the adequacy of hospital cleaning.

Epidemiology of burn-related infections in the largest burn unit in Saudi Arabia.

Objectives:To first describe the epidemiological data of burns, including burn types and burn-related infections, in adult and pediatric patients. Second, to determine the effect of Methicillin-Resistant Staphylococcus aureus (MRSA) on length of hospital stay and, third, to determine if the microbiological profile differs in patients with severe and non-severe burns.Methods:This is a retrospective chart review in which medical records of all burn patients admitted to Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia between January 2016 and January 2017 were reviewed for demographic, microbiological, and burn data using a data-collection sheet. No randomization was necessary as all patients were included. Descriptive and inferential statistics were performed on the collected data.Results:Of 250 patients, 53.6% were pediatric patients and 68.4% were male patients. The most common organism in blood and wound cultures of minor burns was Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus (MRSA) frequency was 82.5%. Length of stay increased in patients with infected burn injuries.Conclusion:The pediatric population had a high frequency of burn injuries, representing an incentive for more focused educational prevention programs in that group. Additionally, burn infections carry significant morbidity, and are associated with longer hospital stay. These data can help implement various prevention programs.

A physical-biological coupled ecosystem model for integrated aquaculture of bivalve and seaweed in sanggou bay

To understand the biological process in an aquaculture dominant coastal system and to provide a tool for further aquaculture management, an ecosystem model has been implemented to study the aquaculture-environmental interaction and the carrying capacity for Sanggou Bay. The model coupled the pelagic system, kelp growth dynamics, oyster energetics, and population dynamics with hourly hydrodynamic and water quality data. The study area was divided into four boxes according to similarities in the hydrological environment and aquaculture layout. Scenario simulations were conducted with different combinations of oyster and kelp seeding densities to examine the environmental impacts and production under different aquaculture layouts. Results showed that the model could capture the main characteristics of observed environmental variables and culture organism growth. Increased seeding density of both oysters and kelp generally leads to increased production with diminished individual growth. Kelp aquaculture plays a leading role in the nutrient cycle in the bay, acting as a large reception tank during the rapid growth period. The model results indicate that there is still potential to increase production for both oyster and kelp in Sanggou bay. The current aquaculture practice seems to have the right balance of carrying capacity, management efforts, and other costs under the existing production procedures. The ecosystem model is a promising tool for further study with sustained observation effort and better boundary conditions.

EPIDEMIOLOGICAL & BACTERIOLOGICAL COMPARATIVE STUDY OF NEONATAL SEPSIS IN AL AZHAR UNIVERSITY HOSPITALS AND MAIN SHAREYANOENATAL INTENSIVE CARE UNITS

Background: Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial pathogen from the blood stream. Diagnosis and management of sepsis are a great challenge facing neonatologists in NICUs. Aim and objectives: The aim of this study is to evaluate and Compare the Epidemiological and Bacteriological Aspects of neonatal sepsis during a period of six months in neonatal Intensive Care units of Al Azhar University Hospitals and Main Shareya NICUs. Subjects and methods: This was A prospective study conducted over a period of six months from 1/7/2018 to 31/12/2018 at NICUs of Al Azhar University Hospitals (Al Hussain &Sayed Galal Hospitals) and Some of Main Shareya NICUs in Grand Cairo, Egypt (Almaza, El-Shohadaa, Istiqamaand 6th October). During the study period, all admitted neonates were recorded, then cases with clinical signs and symptoms of sepsis at the time of admission or who developed sepsis during their hospital stay were assessed (Clinically , Laboratory and Bacteriologically) and included in the study. Results: Out of 1874 of total admitted cases during study period, the incidence of clinically suspected neonatal sepsis among the admitted neonates at the neonatal intensive care units of the included hospitals and Units was 50.3% (942/1874). The sepsis was proved in 410 (43.5%) cases by positive blood culture: 361(44.5%) from Main Shareya and 49 (37.1%) from Azhar hospitals.Regarding demographic characteristics of studied cases, presence of neonatal sepsis is more in (full term, CS, urban residence, male neonates and single) cases, with significant difference between both groups in Post-natal age, Sex and Birth number. Klebsiella is the most organisms in blood cultures in both EOS and LOS of Main Shareya and Azhar cases followed by Staph. Aureus, Proteus, Candida Albicans then E. Coli and finally Strept. Pneumonia .There is no statistically significant difference between types of sepsis regarding to the causative organisms in blood cultures. Death occurs more frequent in EOS than in LOS while improvement is more frequent in LOS. There is no statistically significant difference in Main Shareya and Azhar cases.

Blood culture sampling rate in hospitalised children as a quality indicator for diagnostic stewardship.

Recommendations regarding the optimal number of blood cultures in children are not available. The aim of this article is to describe the correlation between blood culture (BC) rates and laboratory-confirmed bloodstream infection (LCBSI) rates, on different paediatric wards of a tertiary-care centre in Germany. We conducted a retrospective cohort study in a paediatric university hospital, from 1st January to 31st December 2018. All blood cultures collected from neonatal (NICU) and paediatric intensive-care units (PICU), haematology/oncology, and general paediatric wards were included. There were no exclusion criteria. BC taken/1000 patients-days (BC rates/BCR) and LCBSI/1000 patient-days at risk (LCBSI rates) were calculated for each unit. A total of 6040 patients were admitted to the hospital with 3114 of them into wards studied. Of the 3072 BCs collected, 200 (6.5%) were positive. Collection of BCs was performed in 51/77 (66.2%) of admitted patients on NICU, in 151/399 (37.8%) of PICU patients, in 163/755 (21.6%) of haematology/oncology patients, and in 281/1883 (14.9%) of children on general paediatric wards. Gram-positive bacteria were the most commonly detected organisms in blood cultures from all wards with exception of NICU. The BCR in NICU, PICU, haematology/oncology wards, and general wards were 61.6, 196.2, 358.4, and 52.3, respectively. Excluding commensal pathogens and possible contaminations, the LCBSI rates in the same units were 2.4, 5.6, 4.4, and 1.0, respectively. We found different BCR values according the ward studied, being higher in patients with high risk of bloodstream infection such as haematology/oncology patients.