Portal Of Entry Research Articles

“A robust and simple catheter connector assembly for long-term self-administration experiments”

Intravenous self-administration in rats is used widely to study the reinforcing effects of drugs and serves as the gold standard for assessing their use and misuse potential. One challenge that researchers often encounter when scaling up experiments is balancing the cost, time investment to construct, and robustness of each implanted catheter. These catheters include multiple components such as surgical meshing and a variety of entry ports designed to facilitate the connection of the rat to a catheter port tethering system. Other considerations include maintaining the catheters free of blockage during the extent of the drug self-administration experiment. These large-scale studies provide ample opportunity for the catheter system to fail. The failure and replacement of commercially purchased catheters leads to ballooning expenses, and the failure of in-lab manufactured catheters requires the manufacture of reserves, also increasing costs, as these handmade products are inherently more variable. We have developed a catheter system that combines a commercially available implantable back-mounted entry connector system with inexpensive medical items such as surgical mesh, sutures, and an air-tight back flow prevention system to bolster the overall success of self-administration experiments.•Method to bolster commercially available jugular catheter components for long-lasting self-administration experiments.•Reduces the overall cost per unit of self-administration experiments.•Easily assembled by laboratory students and staff.

Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke

BackgroundPerforming endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling.ObjectiveTo test the hypothesis that specific immune players are molecular contributors...

Laparoscopic entry in obese patients: Jain point

Objectives: The study aims to analyze the safety of a novel entry port, the Jain Point for first blind laparoscopic entry port in obese patients, which is non umbilical in position, located in mid abdomen, applicable in patients with or without previous surgery. Methods: The study was conducted at an advanced laparoscopy center between January 2011 to December 2023. Total 9715 patients underwent laparoscopy and out of these, 1362 were selected and categorized as per WHO criteria for obesity. The selection criteria were solely based on BMI. All first blind entries were made by Jain point. The entry related complications were compared with other conventional techniques. Results: In the study period, 1362 obese patients were operated. Time spent in establishing the pneumoperitoneum and trocar entry was comparable to other conventional approaches with a short learning curve. Major complications in the form of MRV (major retroperitoneal vessel) injury was not noted in our series. No injury to stomach and any other viscera noted. Minor complications in the form of prepertioneal insufflation and omental emphysema in 2.7% and failed entry were noted in 1% cases. All surgeries were completed laparoscopically and majority of patients were discharged in 24 to 48 hours. Conclusions: Keeping in context the safety of non umbilical entry ports, this study proposes Jain Point a, lateral, non-umbilical, primary blind entry port, as a viable option in obese patients, with or without previous surgeries.

A comparative study of the bacterial diversity and composition of nursery piglets’ oral fluid, feces, and housing environment

The oral cavity is the portal of entry for many microorganisms that affect swine, and the swine oral fluid has been used as a specimen for the diagnosis of several infectious diseases. The oral microbiota has been shown to play important roles in humans, such as protection against non-indigenous bacteria. In swine, studies that have investigated the microbial composition of the oral cavity of pigs are scarce. This study aimed to characterize the oral fluid microbiota of weaned pigs from five commercial farms in Brazil and compare it to their respective fecal and environmental microbiotas. Bacterial compositions were determined by 16S rRNA gene sequencing and analyzed in R Studio. Oral fluid samples were significantly less diverse (alpha diversity) than pen floor and fecal samples (P < 0.01). Alpha diversity changed among farms in oral fluid and pen floor samples, but no differences were observed in fecal samples. Permutational ANOVA revealed that beta diversity was significantly different among sample types (P = 0.001) and farms (P = 0.001), with separation of sample types (feces, pen floor, and oral fluid) on the principal coordinates analysis. Most counts obtained from oral fluid samples were classified as Firmicutes (80.4%) and Proteobacteria (7.7%). The genera Streptococcus, members of the Pasteurellaceae family, and Veillonella were differentially abundant in oral fluid samples when compared to fecal samples, in which Streptococcus was identified as a core genus that was strongly correlated (SparCC) with other taxa. Firmicutes and Bacteroidota were the most relatively abundant phyla identified in fecal and pen floor samples, and Prevotella_9 was the most classified genus. No differentially abundant taxa were identified when comparing fecal samples and pen floor samples. We concluded that under the conditions of our study, the oral fluid microbiota of weaned piglets is different (beta diversity) and less diverse (alpha diversity) than the fecal and environmental microbiotas. Several differentially abundant taxa were identified in the oral fluid samples, and some have been described as important colonizers of the oral cavity in human microbiome studies. Further understanding of the relationship between the oral fluid microbiota and swine is necessary and would create opportunities for the development of innovative solutions that target the microbiota to improve swine health and production.

Deployment of vaccine cold chain equipment in resource-limited settings: lessons from the Gavi Cold Chain Optimization Platform in Cameroon.

Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon. This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon. Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0-395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning. Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program.

DENTIST’S ROLE IN COLLABORATIVE MANAGEMENT OF TETANUS PATIENT

Tetanus was a life-threatening infection causing muscle contractions. The need for qualified collaborative management was crucial due to the potential for poor prognosis and complications. Dentists can contribute significantly to the treatment, as the mouth can be one of the entry points for tetanus-causing bacteria. A 45-year-old male tetanus inpatient was referred from the Intensive Care Unit to the Oral Medicine Unit at Universitas Indonesia Hospital to evaluate the possible source of oral focus infection. A boil was on his back, suspected to be the main port of entry for tetanus bacteria. The definitive diagnosis was Tetanus of moderate to severe severity (Philips score 24, Dakar score 1, Ablett score 2). Extra oral examination shows lip inflammation. An intra-oral examination cannot be done optimally despite his trismus. The oral foci of infection found were chronic gingivitis and pulp necrosis on 47 48, in addition to the diagnosis of cheilitis simplex. Since the comprehensive management of the foci of infection could only be done in an outpatient setting, the nurse was instructed to clean the intra-oral using sterile gauze moistened with NaCl 0.9% solution to improve the patient's oral hygiene (OH). Comprehensive management includes periodically visiting to maintain OH, administering muscle relaxants, antibiotics, and analgesics, and administering Tetanus toxoid vaccination. The patient was recovered. Management of tetanus cases needs a multidisciplinary approach. Dentists are pivotal in identifying oral infection sources and ensuring its management. A dentist's role in the collaborative management of tetanus patients might significantly contribute to the patient's prognosis.

Spectrum of Thoracic Imaging Findings in the Setting of Substance Abuse.

Substance abuse continues to be prevalent nationwide and can lead to a myriad of chest pathologies. Imaging findings are vast and can include nodules, masses, ground-glass opacities, airspace disease, and cysts. Radiologists with awareness of these manifestations can assist in early identification of disease in situations where information is unable to be obtained from the patient. This review focuses on thoracic imaging findings associated with various forms of substance abuse, which are organized by portal of entry into the thorax: inhalation, ingestion, and injection.

Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy.

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.

Single port endoscopic thoracic sympathectomy with holmium laser for treating palmar hyperhidrosis at Thai Binh Provincial General Hospital

Introduction: thoracoscopic sympathectomy for treating palmar hyperhidrosis often uses 2 ports. Research to evaluate the results of the method using 1 port &lt; 5mm with Holmium Laser fiber.&#x0D; Object and Method: Description, prospective.&#x0D; Within 2 months from June 2023 to July 2023, 47 patients underwent single port endoscopic thoracic surgery using holmium laser to transect the sympathetic ganglia at T3 level for patients with palm sweating (26 patients) and T3-T4 level for patients with palm and axillary sweating (21 patients). The male-to-female ratio was 44.7% to 55.3%, with an average age of 18 ± 7.4 years (minimum age of 11 years, maximum age of 52 years). Surgical method: A single entry port trocar 14Fr located at the 3rd intercostal space, the posterior border of the pectoralis major muscle between the anterior and midaxillary lines, using a 12Fr endoscopic lens with integrated tunnel for Holmium Laser fiber. Patients were monitored and evaluated for early post-operative results: technical failure requiring the placement of a second port, complications during and after surgery and the degree of improvement in palmar hyperhidrosis, the rate of compensatory hyperhidrosis after 1 month and the patient's quality of life after surgery.&#x0D; Results:&#x0D; There were no technical failures. The time for transecting the sympathetic ganglion (one side) with Holmium Laser was 78 ± 40.76 seconds. All patients had dry hands after surgery, with two out of forty-seven patients having excessively dry hands. There were no complications during or after surgery, and no patients developed Horner’s syndrome. The average time to discharge after surgery was 30 ± 11.4 hours. Fourteen out of forty-seven patients had compensatory sweating after one month postoperatively at an acceptable level.&#x0D; Conclusion: The method of using a port &lt; 5mm with an endoscopic lens integrated with a Holmium Laser fiber tunnel is safe, effective, less traumatic and highly aesthetic.

Combination Insecticide Treatments with Methoprene and Pyrethrin for Control of Khapra Beetle Larvae on Different Commodities.

Trogoderma granarium Everts, the khapra beetle, is a serious pest of stored products throughout the world. Larvae pose a significant threat to stored products because they feed on >100 different commodities, possess the ability to enter facultative diapause, and are difficult to detect. Control methods for T. granarium include fumigation, contact insecticides, trapping, and insecticide-incorporated packaging. The objective of this study was to determine the residual efficacy of two insecticide formulations (methoprene + deltamethrin + piperonyl butoxide synergist Gravista® and methoprene + deltamethrin, DiaconIGR®Plus). These insecticides were evaluated on three stored product commodities, corn, wheat, and brown rice, by exposing T. granarium larvae during a 12-month testing period. Both formulations significantly reduced adult emergence on corn and wheat for 12 months and on brown rice for up to 6 months. Adult emergence was highest at month 12 for corn (8.41%), and brown rice (85.88%), and month 9 for wheat (39.52%), treated with DiaconIGR®Plus or Gravista®, respectively. A biological index used to measure the development of exposed larvae on the treated grain from the larval stage (low values) to adult emergence (high values) was lower (fewer adults) on corn and wheat compared to controls. Despite differences in formulations, each of these grain protectants could be utilized by stored commodity managers to protect commodities during storage and transportation for T. granarium when and if this pest is detected at USA ports of entry.

Clinical and Bacteriological Specificities of Escherichia coli Bloodstream Infections From Biliary Portal of Entries.

Escherichia coli is frequently responsible for bloodstream infections (BSIs). Among digestive BSIs, biliary infections appear to be less severe. Respective roles of host factors, bacterial determinants (phylogroups, virulence, and antibiotic resistance), and portal of entry on outcome are unknown. Clinical characteristics and prognosis of 770 episodes of E coli BSI were analyzed and isolates sequenced (Illumina technology) comparing phylogroups, multilocus sequence type, virulence, and resistance gene content. BSI isolates were compared with 362 commensal E coli from healthy subjects. Among 770 episodes, 135 were biliary, 156 nonbiliary digestive, and 479 urinary. Compared to urinary infections, BSIs of digestive origin occurred significantly more in men, comorbid, and immunocompromised patients. Digestive portal of entry was significantly associated with septic shock and death. Among digestive infections, patients with biliary infections were less likely to die (P = .032), despite comparable initial severity. Biliary E coli resembled commensals (phylogroup distribution, sequence type, and few virulence-associated genes) whereas nonbiliary digestive and urinary strains carried many virulence-associated genes. Escherichia coli strains responsible for biliary infections exhibit commensal characteristics and are associated with lower mortality rates, despite similar initial severity, than other digestive BSIs. Biliary drainage in addition to antibiotics in the management of biliary infections may explain improved outcome.

Cross-pathogenicity of Phytophthora palmivora associated with bud rot disease of oil palm and development of biomarkers for detection.

Phytophthora palmivora has caused disease in many crops including oil palm in the South America region. The pathogen has had a significant economic impact on oil palm cultivation in Colombia, and therefore poses a threat to oil palm cultivation in other regions of the World, especially in Southeast Asia, the largest producer of the crop. This study aimed to look at the ability of isolates from Malaysia, Colombia, and other regions to cross-infect Malaysian oil palm, durian, and cocoa and to develop specific biomarkers and assays for identification, detection, and diagnosis of P. palmivora as a key component for the oil palm biosecurity continuum in order to contain the disease especially at the ports of entry. We have developed specific molecular biomarkers to identify and detect Phytophthora palmivora using polymerase chain reaction (PCR) and real-time loop mediated isothermal amplification (rt-LAMP) in various sample types such as soil and plants. The limit of detection (DNA template, pure culture assay) for the PCR assay is 5.94 × 10-2 ng µl-1 and for rt-LAMP is 9.28 × 10-4 ng µl-1. Diagnosis using rt-LAMP can be achieved within 30min of incubation. In addition, PCR primer pair AV3F/AV3R developed successfully distinguished the Colombian and Malaysian P. palmivora isolates.

Invasive Bacterial Infections of the Musculoskeletal and Central Nervous System during Pig Rearing: Detection Frequencies of Different Pathogens and Specific Streptococcus suis Genotypes.

Locomotor and central nervous system disorders occur during pig rearing, but there is no systematic recording of the different causative agents in Germany. Joint and meningeal swabs, kidneys, lungs, and eight different lymph nodes per pig were cultured, and isolated pathogens were identified using polymerase chain reactions (PCRs). The cps and pathotype of Streptococcus suis (S. suis) isolates were determined using multiplex-PCR. S. suis was the most important pathogen in the infected joints (70.8%) and meningeal swabs (85.4%) and was most frequently detected in both sites in suckling and weaning piglets. To elucidate the possible portal of entry of S. suis, eight different lymph nodes from 201 pigs were examined in a prospective study. S. suis was detected in all examined lymph nodes (n = 1569), including the mesenteric lymph nodes (15.8%; n = 121/765), with cps 9 (37.2%; n = 147) and cps 2 (24.3%; n = 96) being the most dominating cps types. In piglets with a systemic S. suis infection, different lymph nodes are frequently infected with the invasive S. suis strain, which does not help clarify the portal of entry for S. suis.

Pica and Autism/Pica in Developmental Disability – Ports of Entry

Introduction: GI symptoms and disease in neurodivergent individuals who engage in pica are consistently higher than in comparable groups who do not ingest non-food substances. Such statistics serve as a red flag, not only for immediate medical consideration, but also as a baseline against which the impact of long-term interventions for pica and correlated GI issues can be measured. Organic treatment approaches offer effective alternatives to common behavior modification approaches.

Health effects and user perceptions of the US Customs and Border Patrol One™ mobile application: A qualitative analysis among asylum seekers at the Mexico-US border

BackgroundThe number of migrants at the Mexico-US border has increased to historic levels, and frequently changing immigration policy impacts this population as they await entry into the US. This study evaluated the usability and health effects of the Customs and Border Protection (CBP) One™ mobile application among asylum seekers near the US port of entry in Reynosa, Mexico. MethodsWe conducted semi-structured qualitative interviews with 20 asylum seekers in Reynosa, Mexico, in February 2023. Our objective was to explore the subjective experiences of migrants, usability of CBP One™, and presence of perceived health effects from using the application. Interviews were conducted until saturation occurred, transcribed verbatim into Word, coded in NVivo using a validated, team-based coding methodology, and analyzed according to internal domains, external domains, and health effects regarding CBP One™. ResultsTwenty participants originated from eight countries throughout Latin America and the Caribbean. In total, 18 subthemes were identified among internal, external, and effects domains. Internal themes included a confusing application interface (80%), technical malfunction (60%), and perceived racial bias from the photo-capture features (15%). External themes challenging CBP One™ use included unavailable appointment slots (80%), inequity and inaccessibility (35%), and inadequate internet (25%). Most perceived effects were negative (85%), including worsening mental health effects (40%), exacerbation of pre-existing physical conditions (35%), and forgoing health expenditures to pay for internet (25%). ConclusionsOur findings suggest that asylum seekers at the Reynosa port of entry perceive CBP One™ negatively, with detrimental effects towards their mental and physical health. This study highlights how immigration policy can influence health and suggests that more creative and humane approaches are needed for people seeking asylum at the Mexico-US border.

Challenges in The Management of Ocular Syphilis in Human Immunodeficiency Virus Patient: A Case Report

Background: The incidence rate of syphilis has been increasing in recent years. Ocular syphilis can manifest at any stage of syphilis, either with or without Human Immunodeficiency Virus (HIV) co-infection. Case Illustration: A 52-year-old man presented with a complaint of blurred vision persisting for the past 6 months. Visual examination revealed NLP (no light perception) in the right eye and 6/30 in the left eye. Syphilis serology testing was positive. Patient were diagnosed with latent syphilis with ocular syphilis, along with stage I HIV infection. Patient were treated with benzathine penicillin also with antiretroviral therapy for the HIV infection. Conclusion: Syphilis and HIV often occur together and can influence each other. Syphilitic ulcers can serve as the port of entry for HIV infection. In HIV-infected individuals with syphilis, the symptoms of syphilis can be varied due to the immunocompromised state. Benzathine penicillin G is a first-line therapy for ocular syphilis.

Fungicide Sensitivity of Trichoderma atroviride and the Application of this Biocontrol Fungus to Protect Grapevine Sucker Wounds

It is known that Trichoderma spp. can protect winter pruning wounds effectively against infection by trunk disease pathogens. Another port of entry for trunk disease pathogens is spring sucker wounds. Trichoderma spp. hold the potential to be applied to grapevine sucker wounds to prevent infection by trunk disease pathogens. During spring, fungicides are regularly applied to control grapevine foliar and fruit diseases. The effect of these fungicides on T. atroviride is unknown. The efficacy of a T. atroviride-based commercial product, Eco-77®, was tested on sucker wounds in a vineyard against the trunk pathogens Phaeomoniella chlamydospora and Diaporthe ampelina. Sucker wounds were made on one-year-old wood of Cabernet Sauvignon vines. The wounds were spray-treated with Eco-77® immediately after suckering, and 24 hours later the sucker wounds were inoculated with spore suspensions of either P. chlamydospora or D. ampelina. After five months, isolations were made from the sucker wounds. Trichoderma atroviride reduced the incidence of P. chlamydospora by 66.65%. Even though the incidence of D. ampelina was reduced by 15.37%, it was not significantly different from the control treatment. In vitro sensitivity studies were utilised to investigate the effect of fungicides applied during spring against other diseases (downy and powdery mildew, Botrytis rot and Phomopsis cane and leaf spot) on Trichoderma spp. The inhibition of mycelial growth and conidial germination of T. atroviride (UST1 and Eco-77®) were screened for 16 fungicides. Potato dextrose agar and broth was amended to obtain 0, 0.25, 0.5, 1 and 2 times the recommended dosages of the respective fungicides. Trichoderma spp. isolates were the least sensitive to the systemic fungicides boscalid, metrafenone and trifloxystrobin, as well as to the contact fungicides quinoxyfen and meptyldinocap for mycelial inhibition. These fungicides gave less than 50% mycelial inhibition at all the tested dosages. For the conidial germination assay, boscalid, penconazole and trifloxystrobin (systemic fungicides) gave less than 50% conidial germination inhibition of Trichoderma spp. Spiroxamine and pyrimethanil gave the highest mean percentage inhibition for both mycelial inhibition and conidial germination. The findings of this study show that T. atroviride can potentially be used to protect sucker wounds against P. chlamydospora. Furthermore, fungicides applied to grapevines during springtime can influence the conidial germination and mycelial growth of T. atroviride (UST1 and Eco-77®) to varying degrees. When applying Trichoderma spp. in spring, care needs to be taken in the timing of application of fungicides so as not to inhibit the growth of the biocontrol fungus.

Knowledge and attitudes of healthcare personnel about vaccination of migrant and refugee children and adolescents

BackgroundThe number of migrants to Greece has increased considerably the last decade. This study assessed the knowledge and attitudes of healthcare personnel (HCP) toward vaccination of newly-arrived children and adolescents in the Aegean islands, a major port of entry of migrants and refugees to Europe. MethodsThe study was conducted from September 2020 to January 2021. All (166) HCP employed in the public health sector of the Aegean islands were invited to participate. A structured questionnaire was used to collect demographic data and data about their knowledge and attitudes toward vaccinations for migrant and refugees. ResultsA total of 120 HCP participated (72 % response rate), including 54 (45 %) physicians, 43 nurses (35.8 %), and 23 health visitors (19.2 %). Sixty-seven (55.8 %) HCP were aware of the national vaccination guidelines. Health visitors had higher rates of knowledge about the national vaccination guidelines, compared with nurses and physicians (87% versus 44,2% and 51,9%; p-value-0.001). Overall, 73 (60.8 %) HCP were aware of vaccinations during the first examination upon arrival. Primary-healthcare physicians were more likely to be aware about the time of vaccine administration compared with hospital-based physicians (74 % versus 50 %; p-value = 0.006). Out of 120 HCP, 45 % knew that vaccination guidelines apply to all newly-arrived migrant and refugees and 65 % that vaccinations are free-of-charge. Overall, 67.5 % of participants supported no serology testing before vaccination, 21.8 % were against free-of-charge vaccinations, and 55 % recommended only priority vaccinations. ConclusionsThere is a need to increase HCP’ awareness and knowledge through training programs and tailored protocols focusing on vaccinations for newly-arrived migrant and refugee children and adolescents in order to promote effective vaccination of this vulnerable population.

The pulmonary effects of nickel-containing nanoparticles: Cytotoxicity, genotoxicity, carcinogenicity, and their underlying mechanisms.

With the exponential growth of the nanotechnology field, the global nanotechnology market is on an upward track with fast-growing jobs. Nickel (Ni)-containing nanoparticles (NPs), an important class of transition metal nanoparticles, have been extensively used in industrial and biomedical fields due to their unique nanostructural, physical, and chemical properties. Millions of people have been/are going to be exposed to Ni-containing NPs in occupational and non-occupational settings. Therefore, there are increasing concerns over the hazardous effects of Ni-containing NPs on health and the environment. The respiratory tract is a major portal of entry for Ni-containing NPs; thus, the adverse effects of Ni-containing NPs on the respiratory system, especially the lungs, have been a focus of scientific study. This review summarized previous studies, published before December 1, 2023, on cytotoxic, genotoxic, and carcinogenic effects of Ni-containing NPs on humans, lung cells in vitro, and rodent lungs in vivo, and the potential underlying mechanisms were also included. In addition, whether these adverse effects were induced by NPs themselves or Ni ions released from the NPs was also discussed. The extra-pulmonary effects of Ni-containing NPs were briefly mentioned. This review will provide us with a comprehensive view of the pulmonary effects of Ni-containing NPs and their underlying mechanisms, which will shed light on our future studies, including the urgency and necessity to produce engineering Ni-containing NPs with controlled and reduced toxicity, and also provide the scientific basis for developing nanoparticle exposure limits and policies.

Clinical and Microbiological Characteristics of Bacteremia Caused by Carbapenemase-producing Enterobacterales in Minami Ibaraki Area, Japan.

Although recent propagation of carbapenemase-producing Enterobacterales (CPE) has become a problem worldwide, the picture of CPE infection in Japan has not fully been elucidated. In this study, we examined clinical and microbiological characteristics of invasive CPE infection occurring at 8 hospitals in Minami Ibaraki Area between July 2001 to June 2017. Of 7294 Enterobacterales strains isolated from independent cases of bacteremia and/or meningitis, 10 (0.14%) were CPE (8 Enterobacter cloacae-complex, 1 Escherichia coli, and 1 Edwardsiella tarda）, all of which had the blaIMP-1 gene and susceptible to gentamicin and trimethoprim/sulfamethoxazole. These strains were isolated from 7 adult and 2 infant bacteremia (1 infant patient developed CPE bacteremia twice) after 2007. The most common portal of entry was intravenous catheters. All of the adult patients were recovered, while the infant patients eventually died. Genomic analyses showed that the 8 E. cloacae-complex strains were classified into 5 groups, each of which was exclusively detected in specific facilities at intervals of up to 3 years, suggesting persistent colonization in the facilities. This study showed that invasive CPE infection in the area was rare, caused by IMP-1-type CPE having susceptibility to various antibiotics, and nonfatal among adult patients.