Development Of Infections In Patients Research Articles

Risk factors and skin colonization/recolonization – a matter in the development of sternal wound infection after cardiac surgery

Abstract Cardiac surgeries are classified as “clean procedures” as they do not involve access to any space populated by the patient’s microbiota. Nevertheless, the development of sternal wound infection (SWI) can sometimes occur. The aim of the study was to analyze risk factors of SWI, efficacy of antiseptics procedures, skin microbiota colonization/recolonization, and their impact on infection development in patients undergoing cardiac surgery. Of 500 patients who had undergone cardiac surgery through a median sternotomy, perioperative swabs of standardized surgical cut area were taken at three-time points: ‘1’-after admission to treatment rooms, ‘2’-before incision; ‘3’-before chest reconstruction. Material was cultured and grown bacterial colonies were counted. Out of the total population, 23 patients developed SWI and 11 had suspicion of SWI while 466 were without SWI. Risk factors which had statistically significant impact of infection development were high body mass index (BMI) and use of cardiopulmonary bypass (CPB) during operation. The most common SWI-pathogens were coagulase-negative staphylococci (CoNS) and Gram-negative bacilli. From the perioperative period, CoNS and Staphylococcus aureus were isolated. When simultaneous positive cultures in ‘swab-1 and -3’ were observed (respectively, ≥87 and ≥17 bacterial colonies), the risk of complications was higher (patients with SWI – 69.57%; without SWI – 6.71%). Regarding point ‘3’, significant differences were noted in the general level of grown colonies. About 3 times more bacterial colonies were grown in the group with healing problems and SWI. SWI development is multifactorial. The rate of skin microbiota recolonization during surgery may suggests that being more colonized in the surgical incision area was more susceptible to local complications.

Profiling risk factors for separation of infection complications in patients with gastrointestinal and nodal diffuse large B-cell lymphoma

ObjectiveTo identify risk factors for infection complications in patients with gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) and nodal DLBCL (N-DLBCL) during treatment, respectively.MethodsTotal 51 GI-DLBCL patients and 80 N-DLBCL patients were included after retrieving clinical data from a single medical center in the past ten years. Logistic regression analysis was utilized to analyze patients’ data, including baseline demographics, treatments and laboratory values, to determine independent risk factors of infection in these patients.ResultsTotal 28 of 51 patients (54.9%) in the GI-DLBCL group and 52 of 80 patients (65%) in the N-DLBCL group were observed infection events during treatment. A multivariate logistic regression model revealed that Ann-arbor stage IV (P = 0.034; odds ratio [OR]: 10.635; 95% confidence interval [CI]: 1.152-142.712), extra-nodal lesions ≥ 2 (P = 0.041; OR: 23.116; 95%CI: 1.144-466.949) and high serum lactate dehydrogenase (LDH) at the time of diagnosis (LDH > 252U/L; P = 0.033; OR: 6.058; 95%CI: 1.159–31.659) were independent risk factors for the development of infection in patients with GI-DLBCL after systemic treatment. In the N-DLBCL group, high serum C-reactive protein (CRP) (P = 0.027; OR: 1.104; 95%CI: 1.011–1.204) and a low platelet count (P = 0.041; OR: 0.991; 95%CI: 0.982-1.000) at routine blood tests just before infection occurred were identified as significant risk factors related to infection events during treatment.ConclusionsDiscordant independent risk factors induced infection may be present during the treatment in patients with GI-DLBCL and N-DLBCL. Close monitoring these risk factors is likely an effective strategy to prevent microbial infections in these patients.

The conductive gel for hospital use as a culture medium for the genus Burkholderia

The Burkholderia genus is a group of gram-negative bacteria that inhabit soil, water, plant and animal tissues; within this genus are B. pseudomallei, B. cepacia, and B. contaminants, which can cause multiple infections. The objective is to describe a prospective series and study whether the use of hospital gel contributed to the development of infection in patients. Methods: Descriptive and prospective study of the series with positive cultures for the genus Burkholderia from 2019 to 2023 in a hospital in Colombia. Results: 27 cases with isolation of Burkholderia, 74.07% Burkholderia cepacea and 25.93% Burkholderia pseudomallei, 68.85% male and 31.15% female, 78.57% from urban areas and 21 43% rural, 62.96% had a history of chronic diseases. The mean hours of culture positivity was 40.64 hours (SD ± 23.19), 14.81% presented pneumonia, 7.40% soft tissue infections, 55.55% sepsis and 22.24 % others, the mean hospital stay was 7.92 days, 100% underwent diagnostic procedures using hospital gel, B. Cepacea and B. pseudomallei growth was obtained in the gel and identification by molecular tests reported Burkholderia contaminants, the mortality of this study was 22.22%. Conclusion: The random culture carried out on the gel in different areas of the hospital obtained growth of Burkholderia, for which procedures and possible solutions are reconsidered to avoid the growth of this germ in this medium and the diagnostic strengthening in the laboratory. 81% presented pneumonia, 7.40% soft tissue infections, 55.55% sepsis and 22.24% others, the mean hospital stay was 7.92 days, 100% underwent diagnostic procedures with the use of gel hospital, B. Cepacea and B. pseudomallei growth was obtained in the gel and the identification by molecular tests reported Burkholderia contaminants, the mortality of this study was 22.22%.

Systemic Immune Profile Predicts the Development of Infections in Patients with Spinal Cord Injuries.

Patients with spinal cord injury (SCI) frequently develop infections that may affect quality of life, be life-threatening, and impair their neurological recovery in the acute and subacute injury phases. Therefore, identifying patients with SCI at risk for developing infections in this stage is of utmost importance. We determined the systemic levels of immune cell populations, cytokines, chemokines, and growth factors in 81 patients with traumatic SCI at 4 weeks after injury and compared them with those of 26 age-matched healthy control subjects. Patients who developed infections between 4 and 16 weeks after injury exhibited higher numbers of neutrophils and eosinophils, as well as lower numbers of lymphocytes and eotaxin-1 (CCL11) levels. Accordingly, lasso logistic regression showed that incomplete lesions (American Spinal Injury Association Impairment Scale [AIS] C and D grades), the levels of eotaxin-1, and the number of lymphocytes, basophils, and monocytes are predictive of lower odds for infections. On the other hand, the number of neutrophils and eosinophils as well as, in a lesser extent, the levels of IP-10 (CXCL10), MCP-1 (CCL2), BDNF [brain-derived neurotrophic factor], and vascular endothelial growth factor [VEGF]-A, are predictors of increased susceptibility for developing infections. Overall, our results point to systemic immune disbalance after SCI as predictors of infection in a period when infections may greatly interfere with neurological and functional recovery and suggest new pathways and players to further explore novel therapeutic strategies.

Gram-negative multidrug-resistant organisms were dominant in neurorehabilitation ward patients in a general hospital in southwest China

This study aimed to investigate the prevalence of and risk factors for multidrug-resistant organism (MDRO) infection in the rehabilitation ward of a general hospital in Southwest China. We analyzed rehabilitation patients with nosocomial infections caused by MDROs from June 2016 to June 2020. MDRO infection pathogens and associated antibiotic resistance were calculated. Possible risk factors for MDRO-related infection in the neurorehabilitation ward were analyzed using chi-square, and logistic regression. A total of 112 strains of MDRO were found positive from 96 patients. The MDRO test-positive rate was 16.70% (96/575). Ninety-five MDRO strains were detected in sputum, of which 84.82% (95/112) were gram-negative bacteria. Acinetobacter baumannii (A. Baumannii), Pseudomonas aeruginosa (P. aeruginosa), and Klebsiella pneumonia (K. pneumonia) were the most frequently isolated MDRO strains. The logistic regression model and multifactorial analysis showed that long-term (≥ 7 days) antibiotic use (OR 6.901), history of tracheotomy (OR 4.458), and a low albumin level (< 40 g/L) (OR 2.749) were independent risk factors for the development of MDRO infection in patients in the rehabilitation ward (all P < 0.05). Gram-negative MRDOs were dominant in rehabilitation ward patients. Low albumin, history of a tracheostomy, and long-term use of antibiotics were independent risk factors for MRDO infection and are worthy of attention.

Infection profile of patients with extracorporeal membrane oxygenation in paediatric cardiac surgery ICU.

We investigated the risk of increased nosocomial infections and the associated pathogens in patients who underwent paediatric cardiovascular surgery and were put on extracorporeal membrane oxygenation support. We studied the duration of extracorporeal membrane oxygenation use and other variables that may be associated with increased nosocomial infection risk. Patients who were treated with an extracorporeal membrane oxygenation in paediatric cardiovascular surgery ICU between 2010 and 2020 were included in this retrospective study. We analysed the site of infection and microbiological profile of infections occurring in these patients according to CDC and National Healthcare Safety Network criteria. The onset of infection development in patients after extracorporeal membrane oxygenation was found to be median 8 (3-15, 25-75 IQR) days in the whole group, and median 11 (3-16, 25-75 IQR) days in those who developed infection without being put on extracorporeal membrane oxygenation. When patients were divided into those with and without infection, duration of ICU was found to be 19 (16-28, IQR 25-75) days in patients with infection vs. 8 (2-16, IQR 25-75; p: <0.001) days in patients without infection. Duration of extracorporeal membrane oxygenation support was found to be 14 (10-25, IQR 25-75) days in patients with infection versus 5 (2-10, IQR 25-75; p: <0.001) days in patients without infection and total hospital stay was 26 (18-33, IQR 25-75) days in patients with infection versus 8 (2-23, IQR 25-75) days in those without infection. A total of 24 patients out of the 70 patients experienced 32 infectious episodes during extracorporeal membrane oxygenation support. Culture-positive infections were detected at a single site in 19 patients, and multiple sites in 5 patients. We propose that prolonged extracorporeal membrane oxygenation support is associated with an increased risk of infection. Although extracorporeal membrane oxygenation is a life-saving treatment method, prolonged extracorporeal membrane oxygenation may increase the development of infectious complications and the associated mortality and morbidity of the patient.

Interventions for treating catheter-related bloodstream infections in people receiving maintenance haemodialysis.

Patients with kidney failure require vascular access to receive maintenance haemodialysis (HD), which can be achieved by an arteriovenous fistula or a central venous catheter (CVC). CVC use is related to frequent complications such as venous stenosis and infection. Venous stenosis occurs mainly due to trauma caused by the entrance of the catheter into the venous lumen and repeated contact with the vein wall. A biofilm, a colony of irreversible adherent and self-sufficient micro-organisms embedded in a self-produced matrix of exopolysaccharides, is associated with the development of infections in patients with indwelling catheters.Despite its clinical relevance, the treatment of catheter-related bloodstream infections (CRBSIs) in patients receiving maintenance HD remains controversial, especially regarding catheter management. Antibiotic lock solutions may sterilise the catheter, treat the infection and prevent unnecessary catheter procedures. However, such treatment may also lead to antibiotic resistance or even clinical worsening in certain more virulent pathogens. Catheter removal and delayed replacement may remove the source of infection, improving infectious outcomes, but this approach may also increase vascular access stenosis, thrombosis or both, or even central vein access failure. Catheter guidewire exchange attempts to remove the source of infection while maintaining access to the same vein and, therefore, may improve clinical outcomes and preserve central veins for future access. To assess the benefits and harms of different interventions for CRBSI treatment in patients receiving maintenance HD through a permanent CVC, such as systemic antibiotics alone or systemic antibiotics combined with either lock solutions or catheter guidewire exchange or catheter replacement. We searched the Cochrane Kidney and Transplant Register of Studies up to 21 December 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. We included all randomised controlled trials (RCTs) and quasi-RCTs evaluating the management of CRBSI in permanent CVCs in people receiving maintenance HD. Two authors independently selected studies for inclusion, assessed their risk of bias, and performed data extraction. Results were expressed as risk ratios (RR) or hazard ratios (HR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with their 95% confidence intervals (CI). The certainty of the evidence was assessed using GRADE. We identified two RCTs and one quasi-RCT that enrolled 760 participants addressing the treatment of CRBSIs in people (children and adults) receiving maintenance HD through CVC. No two studies compared the same interventions. The quasi-RCT compared two different lock solutions (tissue plasminogen activator (TPA) and heparin) with concurrent systemic antibiotics. One RCT compared systemic antibiotics alone and in association with an ethanol lock solution, and the other compared systemic antibiotics with different catheter management strategies (guidewire exchange versus removal and replacement). The overall certainty of the evidence was downgraded due to the small number of participants, high risk of bias in many domains, especially randomisation, allocation, and other sources of bias, and missing outcome data. It is uncertain whether an ethanol lock solution used with concurrent systemic antibiotics improved CRBSI eradication compared to systemic antibiotics alone (RR 1.61, 95% CI 1.16 to 2.23) because the certainty of this evidence is very low. There were no reported differences between the effects of TPA and heparin lock solutions on cure rates (RR 0.92, 95% CI 0.74 to 1.15) or between catheter guidewire exchange versus catheter removal with delayed replacement, expressed as catheter infection-free survival (HR 0.88, 95% CI 0.43 to 1.79). To date, no results are available comparing other interventions. Outcomes such as venous stenosis and/or thrombosis, antibiotic resistance, death, and adverse events were not reported. Currently, there is no available high certainty evidence to support one treatment over another for CRBSIs. The benefit of using ethanol lock treatment in combination with systemic antibiotics compared to systemic antibiotics alone for CRBSIs in patients receiving maintenance HD remains uncertain due to the very low certainty of the evidence. Hence, further RCTs to identify the benefits and harms of CRBSI treatment options are needed. Future studies should unify CRBSI and cure definitions and improve methodological design.

Infection is not rare in patients with idiopathic inflammatory myopathies.

To assess the prevalence and characteristics of infections in patients with idiopathic inflammatory myopathies (IIM) and analyse risk factors for infection using clinical presentation and biochemical findings of IIM. Retrospective review of the medical records of patients with IIM followed up in a single medical centre from January 2008 to January 2018. Of the 779 patients with IIM, 215 (27.6%) suffered from infections. The prevalence of infection in dermatomyositis (DM) (29.8%) was more than polymyositis (PM) (18.5%). The lung was the most common infection site (66.5%). Multivariate analyses demonstrated that methylprednisolone pulse (MP) (OR=3.22; 95% CI=1.60 - 6.48; p=0.001), age of onset >50 years (OR=1.02; 95% CI=1.00 - 1.03; p=0.011), anti-melanoma differentiation-associated gene 5 (MDA5) antibody (OR=1.93; 95% CI=1.20 - 3.11; p=0.007), lymphocyte count <1200/mm3 (OR=2.85; 95% CI=1.89 - 4.30; p<0.001), and interstitial lung diseases (ILD) (OR=2.03; 95% CI=1.30 - 3.71; p=0.002) are independent risk factors for infection. Survival analysis demonstrated that the three-year survival rate in the infection group was lower than the no-infection group (75.3% vs. 94.7%, p < 0.001). Among hospitalised individuals with IIM, infection is frequent and the leading cause of mortality. The anti-MDA5 antibody, lymphopenia, ILD, old age, and treatment with MP are contributing factors in the development of infections in patients with IIM.

Does the pre-operative neutrophil-lymphocyte ratio have a predictive value in detecting infection in type 3 open tibia diaphysis fractures?

This retrospective study was aimed to investigate whether the pre-operative neutrophil-lymphocyte (N/L) ratio has a predictive value in terms of evaluating the development of infection in patients with type 3 open fractures of the tibia diaphysis. A total of 72 patients with type 3 open tibia fractures who consulted to the emergency service at the Necmettin Er-bakan University Meram Faculty of Medicine, during the period between 2015 and 2020 were retrospectively examined. A total of 39 patients who underwent external fixator in the first treatment were included in the study. The information pertaining to the patients such as the patient demographic data, type of injury, wound cultures, and N/L rates during the pre-operative period were recorded. Patients were divided into two groups based on the presence of infection: Group 1 (12 patients) consisted of patients who had infec-tion, and Group 2 (27 patients) consisted of patients who had no infection. 34 (87.2%) of the patients were male and 5 (12.8%) were women. The mean age of these patients was 43.18±18.67 (19-80). Infection was detected in 12 (30.8%) out of 39 patients. Of these patients, 9 (75%) were monomicrobial, and 3 (25%) were polymicrobial. The most common mechanism of the injury was gunshot injury in 16 (41%) of all patients. However, there was no sig-nificant difference between the groups in terms of mechanism of injury (p=0.445). When all patients were examined in terms of N/L rates and presence of infection, there was no significant difference between Group 1 and Group 2 (p=0.976). Although N/L ratio of the blood in the pre-operative period has a predictive value for chronic diseases, we believe that it has no predictive value for detecting infection in patients with type 3 acute open tibia fractures.

Risk Prediction of Nosocomial and Posthospital Discharge Infections in Alcohol-Associated Hepatitis.

Alcohol‐associated hepatitis (AAH) is a severe form of liver injury with mortality as high as 30%‐40% at 90 days. As a result of altered immune function in AAH, bacterial infections are common and are associated with poor outcomes. However, determining the risk and subsequent development of infection in patients with AAH remain challenging. We performed a retrospective study of consecutive patients admitted with a diagnosis of AAH at two independent tertiary centers from 1998 to 2018 (test cohort, n = 286) who developed infections following hospitalization. The diagnosis of AAH was confirmed by manual chart review according to the recent National Institute on Alcohol Abuse and Alcoholism definition. Infections were categorized by location and time of diagnosis as hospital‐acquired infection (48 hours after admission until discharge) and posthospital infections (up to 6 months following discharge). The cohort was 66% men, and the median age was 48 (21‐83) years. Corticosteroids were used in 32% of all patients with AAH. The overall infection rate was 24%. Of those with infections, 46% were hospital acquired and 54% were acquired after hospitalization. Variables found to be significant risk factors for bacterial infection included the presence of ascites on admission (hazard ratio [HR], 2.06), corticosteroid administration (HR, 1.70), Model for End‐Stage Liver Disease (MELD) >23 (HR, 2.61), and white blood cell (WBC) count on admission per point (HR, 1.02). Conclusion: In this multicenter cohort study of patients hospitalized with AAH, MELD score, ascites, WBC count, and use of corticosteroids were identified as significant predictors of the development of bacterial infection. We created a novel predictive equation that may be used to aid in the identification of patients with AAH at high risk of infection.

Repeated intracranial empyema following cranioplasty in a patient with atopic dermatitis: a case report

BackgroundAtopic dermatitis is a chronic inflammatory skin disease associated with pruritus. Skin affected by atopic dermatitis not only shows a high percentage of Staphylococcus aureus colonization, but corneal barrier dysfunction is also known to occur. It is considered a risk factor for bacterial infections in various areas of the body. However, the relationship between atopic dermatitis and bacterial infection following neurological surgery has not yet been reported. Here, we present a case of atopic dermatitis in which the surgical site became infected twice and finally resolved only after the atopic dermatitis was treated.Case presentationA 50-year-old Japanese woman with atopic dermatitis underwent cerebral aneurysm clipping to prevent impending rupture. Postoperatively, she developed repeated epidural empyema following titanium cranioplasty. As a result of atopic dermatitis treatment with oral antiallergy medicines and external heparinoids, postoperative infection was suppressed by using an absorbable plastic plate for cranioplasty. The patient’s postoperative course was uneventful for 16 months.ConclusionsAtopic dermatitis is likely to cause surgical-site infection in neurosurgical procedures, and the use of a metal implant could promote the development of surgical-site infection in patients with dermatitis.

Effect of preoperative pneumococcal immunization on the incidence of respiratory infection in the postoperative period of cardiac surgery

Objective: To analyze whether the incidence of respiratory infections in the postoperative period of cardiac surgery is lower in patients immunized with the 13-valent pneumococcal conjugate vaccine. To study the main risk factors related to the development of infections in patients undergoing cardiac surgery. Methodology: 40 patients were included in the study, randomized 1: 1 to receive pneumococcal vaccine or placebo, 14 days before undergoing elective cardiac surgery. The incidence of infections in the 30 postoperative days was compared between groups. Results: There were 6 respiratory infections in the vaccine group and 2 in the placebo group (p=0.2024) and one death in the placebo group and none in the vaccine group (p=0.3173). Chronic obstructive pulmonary disease (p=0.003), diabetes mellitus (p=0.047) and peripheral arterial disease (p=0.0001) were listed as risk factors for the development of infections, which generated an increase in hospital stay (95% CI : 1.33- 7.13; p =0.0147) and ICU stay in the postoperative period (95% CI: 1.87- 33.45; p=0.0025). Conclusion: The application of pneumococcal vaccine 13v did not influence the development of postoperative pulmonary infections. Chronic obstructive pulmonary disease, diabetes mellitus and peripheral arterial disease were identified as risk factors for the development of infections, increasing the length of total hospital stay and time in the ICU.

Prevalence, Risk Factors, Treatment Outcome and Molecular Epidemiology of Gastrointestinal Carbapenem-Resistant &lt;i&gt;Klebsiella Pneumoniae&lt;/i&gt; from Infections in China

Background: Carbapenem-resistant K. pneumoniae (CRKP) is the leading cause of hospital infections. The prevalence of CRKP in human and the risk factors that predispose occurrence of CRKP infections need to be determined. Methods: We conducted a retrospective, cross-sectional study of K. pneumoniae strains collected in a hospital in Zhejiang Province, China, from Jan 2014 to Dec 2017. The strains were characterized by antimicrobial susceptibility tests and whole genome sequencing. Then we investigated risk factors of CRKP infections and depicted the likely disease outcomes. Findings: 804 patients tested positive for intestinal CRKP or carbapenem susceptible strains (CSKP) in total. Ninety-seven patients were positive for both intestinal and extra-intestinal CRKP and had significantly (P<0.001) higher percentage of death (12.4%) and discharge against medical advice (DAMA) (27.8%) than those who only harbored intestinal CRKP and intestinal CSKP strains. The virulence factor Yersiniabactin-9 could increase the risk of death and DAMA by 4.6 times (95% CI: 1.8-11.7). Statistically significant risk factors associated with intestinal CRKP infections included the use of urinary catheter (OR=4.8, 95% CI 1.7-13.5), artificial lung ventilation (OR=4.1, 95% CI 2.3-7.3) during the hospitalization and exposure to tigecycline (OR=1.5, 95% CI 1.0-2.3) three months prior to hospital admission. The prevalence rates of human intestinal ST11-K64 CRKP strains has been increasing in the past few years. Interpretation: These data confirm that K. pneumoniae colonization in human gut is a significant risk factor for intestinal infection. Screening for K. pneumoniae colonization upon hospital admission could limit the risk of development of infection in patients and transmission to others in the same ward. Funding: This work was supported by the National Natural Science Foundation of China (No. 81772250, 81861138052) and Research Impact Fund of Hong Kong Research Grants Council (No. 8790002). Declaration of Interest: The authors have declared that no competing interest exists. Ethical Approval: Ethical approval (No. 2020-319) was given by SAHZU.

Risk factors for surgical site infection in thoracic and lumbosacral spine surgery: retrospective study results

Objective. To specify risk factors for the development of surgical site infection in patients operated on for injuries and degenerative diseases of the thoracic and lumbosacral spine through the posterior median approach. Material and Methods. The study included formalized case histories of 415 patients (207 men, 208 women) who were operated on for degenerative diseases (n = 385) or unstable injuries (n = 30) of the spine. The average age of patients was 47 ± 18 years. Out of them, 230 patients had concomitant chronic diseases requiring constant drug treatment. Before statistical processing, the data obtained in the study were classified according to a generally accepted method to determine the possibility of using different statistical methods when comparing groups. The patients were divided into two groups: Group I included patients with pyoinflammatory complications, and Group II – without pyoinflammatory complications. Results. It was revealed that the following factors significantly affect the development of postoperative wound suppuration: the use of metal fixation, external drainage of the wound for more than four days, the use of monocoagulation from the level of subcutaneous fat, the installation of a retractor for a period of more than 1 hour, blood loss of more than 300 ml, leaving absorbable hemostatic materials in the wound, suturing of muscles in the area of laminectomy, and applying intradermal (cosmetic) sutures. Patient age, preoperative bed day number, skin isolation technique (or lack thereof), duration of surgery, and surgeon experience do not affect the risk of the surgical site infection. Conclusion. Despite the fact that most of the identified risk factors for postoperative wound suppuration are reduced to more complex and prolonged intervention which is more difficult for a patient to tolerate, some of the identified risk factors are potentially removable.

A study on steroids and immunosuppressants as risk factors for infections in SLE patients

Introduction: Systemic lupus Erythematosus (SLE) patients are inherently at risk for infections. Steroids and other immunosuppressants used for treating SLE patients further increase the chances of infections. This study was done to find the association of immunosuppressants with the risk of development of infections in patients with SLE. Materials and Methods: Appropriate samples were collected from 110 SLE patients with various infections and processed in Microbiology laboratory. Treatment history was also collected from the patients and analysis was done on infections in these patients. Results: Daily prednisolone dosage 20 mg was associated with increased risk of infection with p value of p value Conclusion: Since there is strong association between higher dose of steroids and Cyclophosphamide therapy with risk of infections in SLE patients, judicious use of these drugs is recommended.

Microbiome in the setting of burn patients: implications for infections and clinical outcomes.

Burn damage can lead to a state of immune dysregulation that facilitates the development of infections in patients. The most deleterious impact of this dysfunction is the loss of the skin’s natural protective barrier. Furthermore, the risk of infection is exacerbated by protracted hospitalization, urinary catheters, endotracheal intubation, inhalation injury, arterial lines and central venous access, among other mainstays of burn care. Currently, infections comprise the leading cause of mortality after major burn injuries, which highlights the improvements observed over the last 50 years in the care provided to burn victims. The need to implement the empirical selection of antibiotic therapy to treat multidrug-resistant bacteria may concomitantly lead to an overall pervasiveness of difficult-to-treat pathogens in burn centres, as well as the propagation of antimicrobial resistance and the ultimate dysregulation of a healthy microbiome. While preliminary studies are examining the variability and evolution of human and mice microbiota, both during the early and late phase burn injury, one must consider that abnormal microbiome conditions could influence the systemic inflammatory response. A better understanding of the changes in the post-burn microbiome might be useful to interpret the provenance and subsequent development of infections, as well as to come up with inferences on the prognosis of burn patients. This review aims to summarise the current findings describing the microbiological changes in different organs and systems of burn patients and how these alterations affect the risks of infections, complications, and, ultimately, healing.

Obesity and infection. Another comorbidity?

A literature review is devoted to the problem of comorbidity of obesity (Ob) and infections. At present, extensive material has been accumulated about the increased propensity of patients with Ob to various infections (respiratory, urinary, viral, nosocomial, postoperative). One of the pathogenetic mechanisms of infection development in patients with Ob is dysfunction of cellular and humoral immunity, induced by adipose tissue production of cytokines (adipokines), which have an immunomodulating effect in various directions. Further research is needed in the field of epidemiology, mechanisms of development and course of infections in patients with Ob, as well as developing tactics for conducting this category of patients (diagnosis, antibiotic therapy, preoperative preparation, etc.).

Pulmonary artery catheter epidemiology of risk in pre-heart-transplant recipients.

Central-line-associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre-heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC. Retrospective cohort study. This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota. 61 pre-heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs. At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic's Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models. Among pre-heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98-9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355). The rate of CLABSI with PAC is high. Prolonged PAC use in the pre-heart-transplant population should be revisited.

Contaminação de enxertos de tendões flexores na reconstrução do ligamento cruzado anterior: comparação de duas técnicas de retirada

ObjectiveTo evaluate the contamination rate of hamstring tendon autograft by comparing two different techniques, and to verify whether intraoperative contamination is associated with clinical infection development in patients submitted to reconstruction of the anterior cruciate ligament. MethodsOne hundred and ten hamstring tendons autograft anterior cruciate ligament reconstructions were performed and divided into two groups: 1 – hamstring tendon retraction technique and 2 ‐ technique maintaining the tibial insertion of the hamstring tendon. During the preparation, two grafts fragments were sent for culturing; the harvesting time, preparation time, and total surgery time were measured. Twenty‐four hours after the surgery, the C‐reactive protein was assayed. Clinical outpatient follow‐up was performed up to 180 days postoperatively. ResultsAlthough there were two postoperative infections, there was no graft contamination or difference between the groups in relation to the graft preparation time and the 24‐hour post‐operative C‐reactive protein. The classic technique presented longer graft harvesting time (p = 0.038) and there was no statistical difference between the two groups regarding the degree of contamination and consequent clinical infection, although two patients in group 2 had infection with negative perioperative cultures. ConclusionBased on the results obtained, there was no association between graft contamination and the time or technique of its preparation. In addition, there was also no association between intraoperative contamination and development of clinical infection, nor was there any sign of an association between the early alteration of C‐reactive protein and the onset of infection.

Infectious complications in a child with acute lymphoblastic leukemia (case study)

Acute lymphoblastic leukemia (ALL) is the most common malignant condition in children, with a prevalence of 25% and a survival rate of approximately 85%. The patients with acute lymphoblastic leukemia are susceptible to infections (bacterial, viral, fungal, often severe, recurring) due to a com­pro­mised immune system. Infectious diseases are the main cause of morbidity and mortality in children’s can­cer. Neutropenia has been documented as a major risk fac­tor in the development of infections in patients with on­co­lo­gical diseases receiving chemotherapy. The mortality rate associated with infection is up to 10 times higher in low-income countries than in high-income countries. The pre­ven­tion, recognition and early management of infectious complications remain a challenge. Staphylococcus aureus is the most common cause of infection in cancer patients.