Frequent Infectious Diseases Research Articles

Effect of Ganduqing on common cold: A protocol for systematic review and meta-analysis based on existing evidence.

Background:The common cold is an infectious viral disease of the upper respiratory tract that has become the most frequent infectious disease in humans. Currently there is no cure for the common cold, and treatment typically focuses on alleviating symptoms. Although antiviral treatment is an important focus of current research, more than 200 viral strains have been associated with the common cold, making antiviral drug interventions difficult. Ganduqing is a Chinese medicinal preparation composed of Astragalus and Shegan. Several randomized controlled trials have been conducted to evaluate treatment of the common cold, but their effectiveness and safety have not been scientifically evaluated. In this study, we will systematically examine the efficacy and safety of Ganduqing in patients with common cold.Methods:The following electronic databases will be systematically and comprehensively searched: Cochrane Library, EMBASE, PubMed, Science Network, China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database and Chinese Journal Database, for randomized controlled trials that used Ganduqing for treating the common cold through June 2020. The primary outcomes were signs and symptoms of the common cold, including cough, sore throat, fever, nasal congestion and runny nose. Secondary outcomes included changes in the percentage of neutrophils and lymphocytes, and recurrence. Study selection, data extraction and quality assessment will be independently conducted by 2 researchers. Meta-analyses incorporating data derived from the literature will conduct using Review Manager (RevMan) v.5.3 and Stata 14 software. The Grading of Recommendations, Assessment, Development and Evaluations framework will be used to assess the quality of evidence derived from the meta-analyses.Results:This systematic review and meta-analysis aims to provide an evidence of Ganduqing for the common cold and will be disseminated through publications in peer-reviewed journals and/or presentations at scientific conferences.Conclusions:This systematic review will provide evidence for the efficacy and safety of Ganduqing in treating common colds.Trial registration number:INPLASY202060073

PATHOGENETIC ASPECTS OF INFERTILITY IN WOMEN OF REPRODUCTIVE AGE WITH OVARIAN VARICOCELE

To date, the problem of reduced fertility is quite relevant. At the same time, it should be noted that the effectiveness of infertility treatment, even with the use of the latest techniques, tools and drugs does not exceed 35-40%. This can be explained by insufficient study of a number of causes that lead to impaired fertility.One of these little-known and poorly studied factors is pelvic venous plethora, in particular varicose veins of the ovaries. While anatomically similar disease in men - varicocele - is given great importance, in women, even the very existence of this pathology is controversial among some authors.All studies were conducted in compliance with the basic bioethical norms and requirements of the Declaration of Helsinki. 117 women of reproductive age (21 - 42 years) with infertility of functional genesis were examined.According to the results of the analysis, the clinical and anamnestic features of women with infertility and ovaric varicocele are increased proportion of patients with intellectual differentiation and psycho-emotional and physical stress, high frequency of infectious diseases with acyclic uterine bleeding, dysmenorrhea and premenstrual. Changes in the anatomical and functional state of the pelvic organs and venous system in women with infertility and ovarian varicocele have been established. It was found that the hormonal profile of women with infertility and ovarian varicocele is characterized by a decrease in estradiol and progesterone. A pathogenetically sound algorithm for the diagnosis and treatment of women with infertility and ovarian varicocele has been developed, which is based on clinical data and the results of instrumental methods of examination.

Tedizolid (torezolid) for the treatment of complicated skin and skin structure infections

ABSTRACT Introduction Acute bacterial skin and skin structure infections (ABSSSI) are among the most frequent infectious diseases. Recently, several new antibiotics with activity against MRSA have been approved. Tedizolid, a second-generation oxazolidinone approved for ABSSSI offers theoretical advantages over first-generation oxazolidinones. Areas covered A comprehensive online search of Medline, ClinicalTrials.gov, and conference presentations was made, selecting articles between January 2000 and April 2020. In this review, the authors discuss the chemical and microbiological properties of tedizolid, summarize its efficacy, safety, and potential role in the treatment of ABSSSI as well as the potential for future indications. Expert opinion Tedizolid has proven to be non-inferior compared to linezolid for the treatment of ABSSSI in two registrational phase III clinical trials, being well tolerated. Tedizolid exhibits antibacterial activity against the most important ABSSSI pathogens (including multidrug-resistant strains of MRSA), as well as mycobacteria and Nocardia. It appears to have a safe profile, including decreased myelotoxicity and no significant drug interactions. Preliminary studies with longer duration of therapy seem to confirm these potential benefits. Overall, tedizolid expands the newly acquired armamentarium to treat ABSSSI. The role of tedizolid for other indications is under investigation and has yet to be determined.

Synthesis and molecular docking study of 6-chloropyrazine-2-carboxylic acid derivatives

One of the most lethal and frequent infectious diseases worldwide is tuberculosis. Multi and extensively tuberculosis drug-resistant constitutes a serious problem and emphasizes the need for novel anti-tubercular agents. Accordingly, various pyrazine-2-carboxamides were synthesized and evaluated as potential anti-tuberculosis agents. The synthesis involved reaction of pyrazinoic acids with thionyl chloride to yield acyl chlorides which on treatment with various anilines gave various pyrazine-2-carboxamides. Based on structure-activity relationships extracted from previously published, this paper reported the synthesis and molecular docking study of 6-chloropyrazine-2-carboxamides. Synthesis involved reaction of 6-chloropyrazinoic acid with 2,4,6-trichlorobenzoyl chloride instead of thionyl chloride which listed under the Chemical Weapons Convention as it may use for the production of chemical weapons. Structure identification of 6-chloropyrazine-2-carboxamides was carried out by 1H NMR, 13C NMR, FTIR, and high-resolution mass spectroscopy. It is predicted that 6-chloro-N-octylpyrazine-2-carboxamide has better bioactivity against Mycobacterium tuberculosis, based on molecular docking study.

Origin and transmission of Feline coronavirus type I in domestic cats from Northern Italy: a phylogeographic approach

Feline coronavirus (FCoV) is responsible, along with an inadequate immune response of the host, for Feline infectious peritonitis (FIP), one of the most frequent and deadly infectious feline disease worldwide. This study analyzed the genetic characteristics of the spike (S) gene of 33 FCoVs circulating in Northern Italy between 2011 and 2015 in cats with or without FIP. In order to reconstruct the most probable places of origin and dispersion of FCoV among Italian cats, a phylogeographic approach was performed based on 106 FCoV S gene partial sequences from cats, including the 33 novel Italian sequences and 73 retrieved from public databases. Only FCoV type I was found in the Italian cats. The estimated mean evolutionary rate of FCoV was 2.4 × 10-2 subs/site/year (95% HPD: 1.3-3.7 × 10-2), confirming the high genetic variability in the circulating strains. All the isolates clustered in a unique highly significant clade that likely originated from USA between the 1950s and the 1970s, confirming the first descriptions of the disease in American cats. Our results suggest that from USA the virus likely entered Germany and thereafter spread to other European countries. Phylogeography showed that sequences segregated mainly by geographical origin. In the 2010s Italian sequences clustered in different subclades, confirming that different strains cocirculate in Italy. Further studies on archival samples and other genetic regions of FCoV are suggested in order to confirm the present results and to reconstruct a more in-depth detailed virus dispersion pattern for the definition of possible control measures.

Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study.

Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany. From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe. Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.

Cross–Sectional Descriptive Study: Risk Factors of Urinary Tract infection in hospitalized Patients Under the age of 5 in hospital humanitario Pablo Jaramillo, Cuenca 2014 - 2015

BACKGROUND: Urinary tract infection is the colonization and microbial replication along the urinary tract, it is a frequent cause for seeking medical attention. Its clinical presentation is often nonspecific and represents a risk of permanent kidney damage, which is higher as younger is the patient. The aim of this study was to determine the prevalence of known risk factors for urinary tract infection in hospitalized patients under the age of 5 years and older than a month of age. METhODS: A descriptive cross-sectional study was carried out in 68 patients with diagnosis of urinary tract infection (confirmed by urine culture), hospitalized at the Pediatrics department of Hospital Hu-manitario Pablo Jaramillo from January 2014 to December 2015. We measured the prevalence of the known risk factors for urinary tract infection. Data was collected in a form with the information obtained from the medical records and analyzed in SPSS V 20. Possible associations between the variables was evaluated with the Chi square test. RESUlTS: 67.6% of the sample were women and 32.4% were men. The age group with the highest prevalence of UTI was the group under 12 months (80.9%), with a higher frequency in females in all age groups. Among the risk factors, the maternal background of urinary infection represented 13.3%. Ve-sico-ureteral reflux represented 7.2% and hydronephrosis 8.8%. Phimosis was predominant in children under 12 months (11.7% of the total sample). The prolonged use of the diaper corresponded to 36.7 %. 5.9% of the patients with UTI presented constipation. CONClUSiON: UTIs are a frequent infectious disease in children under 5, with different distribution ac-cording to age and sex. The age group more frequently affected was the group under 12 months of age, and it was higher on women. Prolonged used of diaper (higher than 8 hours) was the most frequent risk factor in this study, and we found statistical significant association between this two variables. KEyWORDS: URINARY TRACT INFECTIONS, RISK FACTORS, CHILD, HOSPITALIZED, HYDRONEPHROSIS, PHYMOSIS, DIAPERS.

Cardiovascular Events in Adults With Community Acquired Pneumonia

Background: Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for significant morbidity and mortality world wide. Poor outcome in CAP patients is directly related to pneumonia also to comorbidities both during hospitalization and long term after discharge.
 Objective: To determine the incidence of major cardiac complications in CAP patients.
 Materials and Methods: This observational study was conducted in Medicine Department, Gazi Medical College and Hospital (GMCAH) Khulna from January 2016 to March 2019. We studied patients with association of CAP and ACE on admission or Patients with CAP on admission, developing ACE after 48 to 72 hours of hospital stay. Patients who were admitted with ACE but developed a CAP after 48 to 72 hours of admission and Patients with severe sepsis with a concomitant elevated troponin were excluded from the study.
 Results: Out of 1406 patients with CAP, 12.4% presented with cardiovascular events and 87.6% without cardiovascular events. In cardiovascular events, 79.3% patient had heart failure, 17.8% had cardiac arrhythmia and 2.9% had myocardial infarction. Subjects with hyperlipidemia had 2.10 fold more cardiac events than subjects without hyperlipidemia. A Subject with (PSI) <80 vs >80 had 3.16 (95% CI 1.18 to 8.47) times increase in odds having cardiovascular events. Hyperlipidemia and PSI were significantly associated with cardiovascular events.
 Conclusion: Major cardiac complications occur in a substantial proportion of patients with CAP. Physicians and patients need to appreciate the significance of this association for timely recognition and management of these events. Strategies aimed at preventing pneumonia in high-risk population need to be optimized.
 KYAMC Journal Vol. 10, No.-4, January 2020, Page 191-195

Knowledge, Attitudes, and Practices towards Infectious Diseases Related to Travel of Community Pharmacists in Italy.

Pharmacists should be educated about travel medicine, since they could influence their own choices and those of the individuals they encounter. This study aims to investigate the knowledge, attitudes, and behaviors towards infectious diseases related to travel among community pharmacists in Italy. The data was collected from September 2018 to September 2019 using semi-structured telephone interviews. Only 1.8% answered correctly to all seven questions regarding the infectious diseases related to travel. Community pharmacists who had heard about travel medicine and those who had received information were more likely to have good knowledge. More than two-thirds of the respondents believed that it is important to provide information to the public about travel medicine. Pharmacists who worked a higher number of hours per week, were more knowledgeable about the more frequent infectious diseases related to travel, believed that travel medicine was a pharmacist competency, believed that they could give advice to the public, and had received information from scientific journals and educational activities were more likely to have this positive attitude. More than two-thirds often/always informed the public about the importance of having travel health center counseling. Pharmacists who had heard about travel medicine and those who believed that they could give advice to the public were more likely to inform. Interventions are needed to improve knowledge in order that community pharmacists can play an active role in counseling the public.

Antimicrobial Resistance in Uropathogenic Escherichia coli Strains Isolated from Beasat Hospital in Sanandaj, West of Iran

Background and Objectives: Urinary tract infection (UTI) is one of the most frequent infectious diseases which is caused by Gram-negative bacteria especially Escherichia coli. Multiple resistance to antimicrobial agents are increasing quickly in E. coli isolates and may complicate therapeutic strategies for UTI. The propose of this study was to determine the antibiotic resistance patterns and the multidrug-resistance (MDR) phenotypes in uropathogenic E. coli (UPEC).
 Materials and Methods: A total of 153 UPEC isolates were collected from both hospitalized patients (95 isolates) and outpatients (58 isolates) from March to October 2018. In order to determine the MDR among UPEC isolates, we have tested 15 antimicrobial agents on Muller Hinton agar by the disk diffusion method.
 Results: The percentage of MDR isolates (resistant to at least three drug classes such as fluoroquinolones, penicillins and cephalosporins) was 55.5% in the hospitalized patients and the outpatients. Antibiotic resistance to ampicillin, ceftazidime, nalidixic acid and trimethoprim/ sulfamethoxazole was higher than 60%. Meropenem, Imipenem and norfloxacin indicated markedly greater activity (93.3%, 80% and 85.6%, respectively) than other antimicrobial agents.
 Conclusions: Urinary tract infection due to MDR E. coli may be difficult to treat empirically due to high resistance to commonly used antibiotics, so, empirical antibiotic treatment should be reviewed periodically at local studies.

Markov State Modelling of Disease Courses and Mortality Risks of Patients with Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP) is one of the most frequent infectious diseases worldwide, with high lethality. Risk evaluation is well established at hospital admission, and re-evaluation is advised for patients at higher risk. However, severe disease courses may develop from all levels of severity. We propose a stochastic continuous-time Markov model describing daily development of time courses of CAP severity. Disease states were defined based on the Sequential Organ Failure Assessment (SOFA) score. Model calibration was based on longitudinal data from 2838 patients with a primary diagnosis of CAP from four clinical studies (PROGRESS, MAXSEP, SISPCT, VISEP). We categorized CAP severity into five disease states and estimated transition probabilities for CAP progression between these states and corresponding sojourn times. Good agreement between model predictions and clinical data was observed. Time courses of mortality were correctly predicted for up to 28 days, including validation with patient data not used for model calibration. We conclude that CAP disease course follows a Markov process, suggesting the necessity of daily monitoring and re-evaluation of patient’s risk. Our model can be used for regular updates of risk assessments of patients and could improve the design of clinical trials by estimating transition rates for different risk groups.

Epidemiology of urological infections: a global burden.

Urinary tract infections (UTIs) are among the most frequent infections in clinical practice worldwide. Their frequency and burden must be higher than available data suggest because they are not among mandatory diseases to be notified. Although there are many different proposals for classifying UTIs, classifications based on acquisition settings and complication status are more widely used. These include community- acquired UTIs (CAUTIs) or healthcare-associated UTIs (HAUTIs) and uncomplicated or complicated UTIs. As the most frequently seen infectious disease, CAUTIs affect more than 150 million people annually. Complicated UTIs in particular constitute a huge burden on healthcare systems as a frequent reason for hospitalization. The prevalence of HAUTIs ranges between 1.4% and 5.1%, and the majority of them are catheter-related UTIs. Community-onset HAUTIs have gained importance in recent years. As frequent infectious diseases, UTIs create clinical and economic burdens on healthcare systems, and they also affect quality of life determinants.

Development and validation of a novel UPLC-MS/MS method for quantification of delafloxacin in plasma and aqueous humour for pharmacokinetic analyses

Acute bacterial skin and skin structure infections are one of the most frequent infectious disease requiring hospitalization for treatment. Delafloxacin is a clinically approved fluoroquinolone antibiotic for the treatment of ABSSSIs. In spite of being marketed since 2017, there is no published analytical method for quantification of delafloxacin in biological samples. Herein, a selective and sensitive UPLC-MS/MS method was developed and validated for quantitative analysis of delafloxacin in rat plasma and rabbit aqueous humour samples. The liquid liquid extraction (using ethyl acetate) was used for analyte extraction form rat plasma, whereas protein precipitation (acetonitrile) was used for aqueous humour samples preparations. An Acquity UPLC BEH C18 column was used for chromatographic separation of delafloxacin and internal standard (rivaroxaban). The mobile phase composition of acetonitrile (containing 0.1% formic acid) and 10 mM ammonium acetate in ratio of 60:40 were used for sample elution at 300 µL/min flow rate. The electrospray ionization operated in positive mode was used for sample ionization and detection of analyte and internal standard were performed by multiple reaction monitoring (MRM) mode. The MRM transitions were set to 441.14 > 379.09 and 436.89 > 144.87 for delafloxacin and internal standard, respectively. The method was validated as per USFDA guideline for bioanalytical method and all the evaluated parameters were within the acceptable ranges. The developed method in plasma was successfully used to analyze samples in pharmacokinetic study of newly developed stearic acid-chitosan solid lipid nanoparticles formulation of delafloxacin in rat.

Risques professionnels chez les pathologistes : résultats d’une enquête française

The profession of pathologist exposes to various risks, notably infectious, physical and chemical. The objective of this study was to make an inventory of these occupational risks to which pathologists are subjected and to evaluate the pathologies that they presented. A particular attention was given to microscopic and screen work as they can induce musculoskeletal or ophthalmic disorders, and stress-related psychological disorders. An anonymous online questionnaire containing 54 questions had been sent by mail to pathologists via the French Society of Pathology and the Syndicate of French Pathologists. Five hundred and twelve pathologists responded to the survey. Thirty-eight percent reported musculoskeletal disorders in the last 6 months. Visual disturbances concerned 73.4% of respondents. In the last 12 months, 33.3% of pathologists had been injured or had had mucosal projections during macroscopic or autopsy specimens. The frequency of infectious diseases was low (6.2%) as well as that of cancers (3.9%). Psychological disorders such as depression or burnout were reported by 16.7% of respondents. Pathologists seemed happy at work and had a good overall lifestyle. Few doctors had medical follow-up and few had benefited from ergonomic advice and training on the risks of chemicals. The results of this study showed the interest of a medical surveillance adapted to the pathologies presented by the pathologists. Educational and preventive measures should be introduced early in the career, focusing on ergonomics and learning about chemical and biological hazards.

Multiplex PCR-Based Newborn Screening for Severe T and B-Cell Lymphopenia: The first Pilot Study in Turkey.

Objectives:Severe combined immunodeficiency disease (SCID), non-SCID T-cell lymphopenia, and other primary immunodeficiency diseases with T-cell and B-cell lymphopenia have low the T-cell-receptor-excision circles (TRECs) and κ-deleting-recombination-excision circles (KRECs) levels that can be measured in dried blood spots (DBS) of the newborn. The incidence of SCID and non-SCID T-cell lymphopenia in Western societies has been reported by TREC screening of newborns as 1: 58,000 and 1: 7300, respectively. Since there is no similar study in our country, we aimed to perform the first pilot study of TREC and KREC screening of newborn for SCID and non-SCID T-cell lymphopenia in Turkey.Methods:The heel blood samples of newborns born between 1st October 2015 and 31st December 2016 at two major hospitals in our city were included in this study. TREC and KREC copies were determined by a multiplex quantitative PCR-based method from newborn DBS. Cutoff levels were used as 7 copies per DBS for TRECs and KRECs, 1000 copies for ACTB (internal control). Failed samples or abnormal results in measurements were tested the second time. An immunologist evaluated data of newborns with low TREC and KREC copies clinically and through the laboratory.Results:A total of 1960 DBS were tested. The results of 1856 newborns were evaluated. The low TRECs and/or KRECs levels were detected in 71 newborns (3.8 %). The low TRECs rate was 1.1 %. Preterm newborns have lower levels of TRECs and KRECs than term newborns (both p <0.0001). As a result of immunological research, we did not detect any SCID, but we detected 2 newborns with non-SCID T-cell lymphopenia (1:928). These 2 newborns were found to have frequent and severe infectious diseases or hypogammaglobulinemia in their clinical follow-up, although they did not have absolute lymphopenia.Conclusion:Non-SCID T-cell lymphopenia is common in our country than in western societies. TRECs and KRECs assay should be considered for routine NBS programs in our country. Studies involving more newborns should be conducted to detect SCID.

Differential diagnosis of COVID-19 in symptomatic patients at the University Hospital Center Mohammed VI, Marrakesh

Introductioncoronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China. Clinical spectrum of this disease has nonspecific symptoms shared by many other frequent infectious diseases of the respiratory tract and other respiratory tract diseases. This study explains the importance of differential diagnosis between COVID-19 and other lung diseases.Methodswe analyzed in this study, the demographic features, clinical presentations, laboratory data and radiologic findings of the COVID-19 patients in comparison to those with other respiratory infections or diseases.Resultsthe mean age of all patients was 38.04 years; 35 patients were later confirmed to be positive for SARS-CoV-2 infection. The most common symptoms reported by both groups included nonproductive cough and myalgia. Two of the non-COVID-19 patients were having below 92% oxygen saturation and low systolic blood pressure. The patients shared relatively similar laboratory findings except 3% of the non-COVID-19 patients who had lympho-neutropenia and 22.6% had high levels of C-reactive protein. Pulmonary tuberculosis and autoimmune disease respiratory disorder were suspected in 2 of the non-COVID-19 patients respectively.Conclusionwe emphasize the importance of good screening protocols, rapid detection of SARS-CoV-2 and other most common respiratory pathogens, which may help for a better control of COVID-19 spread and avoid delayed care of other lung diseases.

Impact of 13Valent Vaccine for Prevention of Pneumococcal Diseases in Children and Adults at Risk: Possible Scenarios in Campania Region.

Pneumonias are the most frequent infectious diseases, characterized by a high prevalence especially among children and adults at risk. The socio-economic impact caused by Streptococcus pneumoniae is evaluated in terms of morbidity, death rate and hospitalizations. The aim of the study was to demonstrate the potential economic advantages by implementation of an active anti-pneumococcal 13-valent vaccine strategy in Campania region (Southern Italy) in two different categories of subjects, children (aged 0-12), and adults (aged 50- 79) at risk (hypertension, nephropathies, COPD and heart diseases). Vaccination costs were compared with costs necessary to treat avoidable diseases in the presence and absence of a vaccination program. Offering anti-pneumococcal 13-valent vaccine to the paediatric population was quantified as saving one million euros for Italian national health service in two years. In addition, offering anti-pneumococcal vaccine to adults at risk would generate a return of around 29 million euros. In both cases, offering anti-pneumococcal 13-valent vaccine was proven to be a helpful political health strategy, not only in consideration of a reduction of cases but also in view of the favourable economic impacts.

2007. Impact of Combining Rapid Diagnostics with an Interpretation Guide on Vancomycin Usage for Contaminant Blood Cultures Growing Coagulase-Negative Staphylococci (CoNS)

BackgroundContaminant blood cultures can lead to unnecessary antibiotic use, longer admissions and increased costs. Rapid diagnostics, like the BioFire® FilmArray® Blood Culture Identification (BCID) Panel, can potentially lessen these harms. BioFire BCID was implemented at VA Greater Los Angeles in 7/2017. When providers review BCID results, they are also directed to an interpretation guide developed by our antimicrobial stewardship program. This study aimed to determine the impact of BioFire BCID with this interpretation guide on unnecessary vancomycin use for contaminant blood cultures growing CoNS.MethodsThis was a retrospective cohort study on adult inpatients with contaminant blood cultures positive for CoNS. We evaluated cases before BCID (April 2016–July 2017) and after BCID (July 7/2017–December 2018) implementation. Cases with patients who died or were discharged prior to preliminary results, polymicrobial cultures, no empiric vancomycin use, or where vancomycin was indicated were excluded. We defined a “case” as anytime a provider concurrently ordered blood cultures and empiric antibiotics. Our primary outcome was the duration of unnecessary vancomycin. Secondary outcomes were time to discontinuation/modification of any empiric antibiotic, length of stay (LOS), LOS in ICU and 30-day mortality.ResultsA total of 99 cases were included (N = 45 pre-BCID; N = 54 post-BCID). Demographics between the 2 groups were largely similar except the post-BCID group had more patients with end-stage renal disease (ESRD) (14 vs. 4, P = 0.037) and more frequent infectious disease (ID) consultation (21 vs. 8, P = 0.027). The post-BCID group had shorter mean duration of unnecessary vancomycin (53.0 hours vs. 38.1 hours, P = 0.0029). After controlling for ESRD and ID involvement, the mean duration of unnecessary vancomycin was not significantly different between the 2 groups (P = 0.30 and P = 0.49, respectively). There was no difference in time to modification/discontinuation of any empiric antibiotic (44.6 hr vs. 35.0 hr, P = 0.36). There was no difference in mean LOS, mean LOS in ICU, or 30-day mortality.ConclusionShorter duration of unnecessary vancomycin for CoNS bacteremia after BCID implementation and provision of an interpretation guide may have been driven in part by more frequent ID consultation.Disclosures All authors: No reported disclosures.

ImmGen report: sexual dimorphism in the immune system transcriptome

Sexual dimorphism in the mammalian immune system is manifested as more frequent and severe infectious diseases in males and, on the other hand, higher rates of autoimmune disease in females, yet insights underlying those differences are still lacking. Here we characterize sex differences in the immune system by RNA and ATAC sequence profiling of untreated and interferon-induced immune cell types in male and female mice. We detect very few differentially expressed genes between male and female immune cells except in macrophages from three different tissues. Accordingly, very few genomic regions display differences in accessibility between sexes. Transcriptional sexual dimorphism in macrophages is mediated by genes of innate immune pathways, and increases after interferon stimulation. Thus, the stronger immune response of females may be due to more activated innate immune pathways prior to pathogen invasion.

Identification and phylogenetic analysis of oral Veillonella species isolated from the saliva of Japanese children.

Background: As the most frequent infectious disease among children worldwide, dental caries have a strong relationship with oral hygiene status, specifically in the development of infection. However, the study regarding the identification and distribution of oral Veillonella are limited. The oral Veillonella community may affected by the differences in geographical location, age, diet, lifestyle, socio-economic status and oral hygiene status. Here, we studied the oral hygiene status by examining the composition and proportion of oral Veillonella species in saliva of Japanese children. Methods: Microbial samples collected from 15 Japanese children divided into three oral hygiene groups were cultured under anaerobic conditions after homogenization and dilution, and inoculated onto brain heart infusion and selective medium Veillonella agar. Genomic DNA was extracted from each isolate. Veillonella species were detected by one-step PCR using rpoB species-specific primers. To analyse the phylogenetic properties of the unknown Veillonella strains, PCR amplification and sequence analysis of rpoB were conducted for 10 representative strains. Results: Although V. rogosae was found as the predominant species among all groups, its prevalence was significantly lower in the children with poor oral hygiene than in those with good oral hygiene. V. parvula was the prevalent species in the poor oral hygiene group. Approximately 10% of the isolated Veillonella strains were not classified to any established species; the phylogenetic analysis showed that they were most closely related to V.infantiumConclusions: This study demonstrates that the composition and proportion of oral Veillonella species in the saliva of Japanese children is correlated with different oral hygiene status. Changes in detection ratios of V. parvula and V. rogosae can be useful indicators of oral hygiene status. Furthermore, new strains closely related to V. infantium were isolated from the saliva of Japanese children.