High Infection Rates Research Articles

Association Between Vitamin D and COVID-19-Related Outcomes: An Umbrella Review of Meta-Analyses.

COVID-19 remains globally pandemic, and although several meta-analyses have explored the association between vitamin D and COVID-19 relative to clinical outcomes, a unified view has not yet emerged. To summarize the evidence for associations between vitamin D levels and COVID-19-related clinical outcomes and to assess the strength and validity of these associations. PubMed, Embase, Web of Science, Scopus, and the Cochrane Database of Systematic Reviews databases were searched from January 1, 2020, to June 15, 2024. Two reviewers independently extracted data and assessed study quality. Low vitamin D levels increased the risk of infection by 1.26- to 2.18-fold, the risk of severe illness by 1.50- to 5.57-fold, the risk of intensive care unit (ICU) admission by more than 2-fold, and the risk of death by 1.22- to 4.15-fold. In addition, patients with vitamin D deficiency had an average increase in length of hospital stay of 0.54 days compared with patients with high vitamin D levels. Overall, vitamin D supplementation may reduce severity (eg, ICU admissions, need for mechanical ventilation) and shorter length of hospital stay but has a nonsignificant effect on infection and mortality rates. In addition, there were significant differences in vitamin D levels between individuals testing positive for COVID-19 and those testing negative (mean difference [MD] = -3.22 ng mL-1; 95% CI, -5.18 to -1.25), those with severe cases and those with mild cases (MD = -4.60 ng mL-1; 95% CI, -5.49 to -3.71), and nonsurvivors and survivors of COVID-19 infection (MD = -6.59 ng mL-1; 95% CI: -8.94 to -4.24). Low vitamin D levels are associated with higher infection rates, more severe disease, and higher mortality rates among individuals with COVID-19, whereas vitamin D supplementation may reduce patients' disease severity. The beneficial effects on infection rates and mortality remain to be further explored, however, in higher-quality, randomized controlled studies. Nonetheless, caution is warranted because the methodological quality of most meta-analyses and the level of evidence for most outcomes are very low. PROSPERO registration No. CRD42022385036.

Pregnant Women, a Potential Reservoir for Onchocerca volvulus? A Cross Sectional Study in Maridi County, South Sudan

BackgroundOnchocerciasis, a neglected tropical disease (NTD) caused by Onchocerca volvulus, is hyperendemic in many parts of Africa, including South Sudan. Pregnant women may be a parasite reservoir as they are not included in routine ivermectin (IVM) treatments due to unassessed drug safety. In our study we determined the proportion of pregnant women infected with Onchocerca volvulus and assessed the knowledge and practices on IVM use during pregnancy.Methodology/Principal FindingsA hospital-based cross-sectional study was conducted in 2023 at Maridi hospital in Maridi County, an onchocerciasis endemic area in South Sudan. All pregnant or one-week post-partum women willing to participate were interviewed, clinically examined, tested with the Ov16 Bioline rapid diagnostic test (RDT) and skin snipped for O. volvulus detection. A total of 317 women aged between 14 and 44 years participated in the study [median age: 23 years (IQR: 19–29)]. Of 290 women who were tested, 179 (61.7%) were Ov16 RDT positive (SD Bioline). Of the 162 women skin snipped, 51 (31.5%) were positive for O. volvulus microfilarial worm following microscopic examination. The microfilaridemia (skin parasite load) ranged between one microfilaria per skin snip (1mf/ss) and 300 mf/ss with a mean value of value of 12.4 (sd: ± 49.1) mf/ss. Most pregnant women (87.8% (274/312)) knew that it was not advised to take IVM during pregnancy. Out of 309 women, 54 (17.5%) had never taken IVM, and 6.4% (16/251) inadvertently took IVM during pregnancy. Of the 16 women who took IVM during pregnancy, 50% (8/16) knew that they were pregnant. Out of 248 women with children, 9 (3.6%) had children suffering from epilepsy; two of them had two children with epilepsy. No abnormalities were reported in the children of the women who took IVM.ConclusionsOur study is the first to investigate the prevalence and level of O. volvulus infection among pregnant women in onchocerciasis-endemic areas in Africa. Our results showed a high infection rate of O. volvulus among pregnant women, which may pose a risk for adverse materno-foetal outcomes. Pregnant women in South Sudan are a reservoir for parasite transmission. A clinical trial evaluating the potential beneficial effect of treating O. volvulus infected pregnant women with IVM should be considered, as our preliminary results and the literature suggest that IVM intake might not affect the newborn.

P.1 and P.2 SARS-CoV-2 Brazilian variants activate the unfolded protein response with a time and pathway specificity.

COVID-19 is a human respiratory syndrome caused by the infection of the SARS-CoV-2 virus that has a high rate of infection and mortality. Viruses modulate the host machinery by altering cellular mechanisms that favor their replication. One of the mechanisms that viruses exploit is the protein folding and processing of post-translational modifications that occur in the endoplasmic reticulum (ER). When ER function is impaired, there is an accumulation of misfolded proteins leading to endoplasmic reticulum stress (ER stress). To maintain homeostasis, cells trigger an adaptive signaling mechanism called the Unfolded Protein Response (UPR) which helps cells deal with stress, but under severe conditions, can activate the apoptotic cell death mechanism. This study elucidated an activation of a diversity of molecular mechanisms by Brazilian variants of SARS-CoV-2 by a time-resolved and large-scale characterization of SARS-CoV-2-infected cells proteomics and immunoblotting. Furthermore, it was shown that pharmacological UPR modulation could reduce viral release by counteracting the different viral activations of its cellular response. Analysis of human clinical specimens and disease outcomes focusing on ER stress reinforces the importance of UPR modulation as a host regulatory mechanism during viral infection and could point to novel therapeutic targets. SIGNIFICANCE: Since the emergence of SARS-CoV-2 and the consequent COVID-19 pandemic, the rapid emergence of variants of this new coronavirus has been a cause for concern since many of them have significantly higher rates of transmissibility and virulence, being called Variants of Concern (VOC). In this work, we studied the VOCs Gamma (P.1) and Zeta (P.2), also known as Brazilian variants. Constant evidence has reported that there are particularities related to each variant of SARS-CoV-2, with different rates of transmissibility, replication and modulation of host biological processes being observed, in addition to the mutations present in the variants. For this reason, this work focused on infections caused by the Brazilian variants of SARS-CoV-2 in different cell lines, in which we were able to observe that the infections caused by the variants induced endoplasmic reticulum stress in the infected cells and activated the UPR pathways, presenting specific modulations of each variant in this pathway. Furthermore, transcriptome analysis of patients revealed a correlation between ER-related genes and COVID-19 progression. Finally, we observed that the use of UPR modulators in host cells decreased viral release of all variants without affecting cell viability. The data presented in this work complement the observations of other studies that aim to understand the pathogenicity of SARS-CoV-2 VOCs and possible new therapeutic strategies, mainly targeting biological processes related to the endoplasmic reticulum.

Immunological Effects of Electronic Cigarette Use: A Review of Current Evidence.

Electronic cigarettes (EC) have emerged as a popular alternative to traditional tobacco products, but their impact on immune function has raised significant health concerns. This review explores the immunological effects of EC exposure, focusing on innate and adaptive immune responses. Electronic cigarette aerosol (ECA) induces widespread inflammation. These changes compromise immune cell function, impairing neutrophil chemotaxis, phagocytosis, and oxidative burst while increasing macrophage and dendritic cell recruitment and activation. ECA also disrupts epithelial barriers, increasing susceptibility to bacterial and viral infections. Studies show enhanced biofilm formation in bacteria such as Staphylococcus aureus and Streptococcus pneumoniae and impaired antiviral responses against pathogens like influenza A and SARS-CoV-2. Additionally, EC exposure modulates adaptive immunity, affecting T and B cell function and increasing systemic inflammatory markers. The long-term consequences of these immunological disruptions include heightened risks for chronic inflammatory diseases, respiratory infections, and potentially autoimmune conditions. The widespread adoption of EC, particularly among younger users, poses a growing public health challenge. As the popularity of vaping continues to rise, these immunological disruptions could result in increased healthcare burdens in the future, with higher rates of infections, chronic inflammatory diseases, and immune system-related disorders among those who begin using e-cigarettes at a young age. Understanding the full scope of EC-related health risks is essential for informing public health policies and protecting future generations from the potential long-term effects of vaping.

Decarceration and COVID-19 infections in U.S. Immigration and Customs Enforcement detention facilities: a simulation modeling study.

U.S. Immigration and Customs Enforcement (ICE) facilities had high rates of COVID-19 infections and mortality during the global pandemic. We sought to quantify how many COVID-19 infections could have been averted through different decarceration strategies. We developed a set of stochastic simulation models of SARS-CoV-2 transmission in ICE facilities. Employing incremental mixture importance sampling (IMIS), we calibrated them to empirical targets derived from publicly available case time series for ICE facilities, and publicly available facility population censuses prior to vaccine availability (May 6, 2020 to December 31, 2020). The models included infection importation from extra-facility sources. We evaluated reduction of the incarcerated population by 10-90%. People who were decarcerated faced background cumulative risks of infection and detection based on a weighted average of county-level estimates from the covidestim model, which is a Bayesian evidence synthesis model. Without decarceration, the infection rate was 5.05 per 1000 person-days (95% CrI 3.40-6.81) and case rate was 1.53 per 1000 person-days (95% CrI 1.04-2.02). Rates declined linearly when decarceration did not reduce contacts of people remaining in facilities and faster than linearly when it did reduce contacts. At all decarceration levels, rates were substantially higher when contacts were not reduced. Even with 90% decarceration, infection rates for people remaining in facilities were higher than or comparable to otherwise similar free-living people. The decline in COVID-19 infection rates with decarceration was linear or faster than linear depending on how decarceration was implemented. Our findings highlight infection risks associated with incarceration, which compound other health harms of incarceration. Stanford's COVID-19 Emergency Response Fund; the National Institute on Drug Abuse; and the National Institute of Mental Health.

EFEKTIVITAS PERAWATAN LUKA MENGGUNAKAN NACL 0,9% PADA Ny.P IBU POST PARTUM NORMAL PRIMIPARA DENGAN INDIKASI RUPTURE PERINEUM DI DESA KALIGONDANG

On a world scale, the main cause of high maternal mortality is post-partum infection. Of the 500 million incidents of postpartum infections, there are 75,000 deaths, in Purbalingga the incidence of perineal infections will reach 5.7% in 2023. One of the factors is the high rate of postpartum infections, namely low knowledge about infection prevention. One effective management is perineal wound care using NaCl 0.9%. This study aims to determine the effectiveness of wound treatment using 0.9% NaCl in normal primiparous post partum mothers with indications of perineal rupture in Kejobong Village. This research uses a qualitative method with a case study approach. After treating the wound twice for 3 days using 0.9% NaCl, it was found that the wound looked better and there were no signs of infection as indicated by a decrease in the REEDA score from 11 categories of unhealed wounds to 2 categories of moderate wounds. This is supported by cleanliness of the wound area and choosing the right food. Wound treatment using 0.9% NaCl is effective for healing perineal ruptures.

P-1826. Genomic Epidemiology and Clinical Characteristics of Stenotrophomonas maltophilia at an academic medical center

Abstract Background S. maltophilia is an opportunistic pathogen in critically-ill and immunocompromised patients. Distinguishing between colonization and infection is challenging and genomic surveillance data are scarce. This study seeks to define the genomic epidemiology of S. maltophilia and associations between genomic groups (Gg) and clinical outcomes. Methods Consecutive patients with S. maltophilia positive cultures were included from 10/21 – 12/23. Whole genome sequencing (WGS) was performed on the Illumina NextSeq 550 platform. Gg were identified by sequence type (ST). Cases were classified as proven infection, possible infection, or colonized (Table 1). Results Across 204 patients, 21.1%, 57.3%, and 21.6% were classified as proven infection, possible infection, or colonized, respectively (Table 2). The median (IQR) age was 60 (47-68) years, 38% were women, and 18% were solid-organ transplant recipients. The overall 30- and 90-day mortality rates were 19.6% and 28.9%, respectively; 30-day mortality was higher for patients with proven or possible infection (24%) versus colonization (2%; P=0.004). Significant diversity was identified across 470 S. maltophilia isolates sequenced (Figure 1). Using the first isolate from the 204 patients included in the study, 31 known STs were identified. ST5 and ST133 were most common (n=8 each). Isolates were classified into 9 different Cg (Figure 2); an additional 22% were unclassified. Gg6 (S. maltophilia) and GgC (S. muris) accounted for 38% and 10% of all isolates, respectively. Across syndromes, Gg6 was most common, accounting for 34% of proven/possible infections compared to 52% of colonization cases (P=0.03). GgC was more often associated with proven infection than colonization (P=0.05). Mortality rates were highest for Cg4 (43%) and lowest for Cg geniculate (5%).Figure 1.Phylogenetic tree of 470 S. maltophilia isolates collected at the study site Conclusion S. maltophilia genomic groups are highly diverse and associated with varying clinical syndromes. Specific groups like GgC (S. muris) appear to be associated with high infection rates. Across Cg, mortality rates ranged from 5% to 43%, suggesting that differences may exist. These data support further molecular investigations into S. maltophilia Gg to help distinguish colonizing versus infecting isolates. Disclosures Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support Yohei Doi, MD, PhD, bioMerieux: Lecture fees|Entasis: Grant/Research Support|Fujifilm: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|GSK: Advisor/Consultant|KANTO CHEMICAL CO.,INC.: Grant/Research Support|KANTO CHEMICAL CO.,INC.: Patent for genotyping kit|MeijiSeika Pharma: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Lecture fees|Pfizer: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees

P-2240. Metabolomic Approaches to Detect Implant-Associated Infections in Post-Mastectomy Women

Abstract Background This year, approximately 54,000 women with breast cancer will undergo mastectomy followed by implant-based immediate breast reconstruction. This procedure has high infection rates of up to 20% and a diverse microbiology of infection including both gram-positive and gram-negative organisms. Culture-based diagnostic methods after these procedures suffer from poor sensitivity due to antibiotic administration prior to cultures, infection with fastidious organisms, and sequestration of bacteria in implant-associated biofilms. Culture-independent diagnostic methods may serve as an alternative for fast, more accurate diagnosis of these infections. Methods Women undergoing implant-based immediate breast reconstruction were recruited. Seroma fluid was collected from the breast pocket at the time of implant removal due to infectious complications, non-infectious wound complications, or at the time of second stage reconstruction. Samples were analyzed using untargeted liquid chromatography/mass spectrometry (LCMS). Differential Compositional Variation Machine Learning (DiCoVarML) was used to discover metabolic features to differentiate infection status in this population. Results 80 seroma fluid samples taken at time of implant removal were analyzed. Of these, 37 samples were collected at the time of implant removal due to infection, 7 for non-infectious complications, and 36 were collected at the time of second stage reconstruction. After LCMS, 3663 high-quality features were detected in at least ten samples. Features useful in distinguishing infection status were selected using DiCoVarML. Predictive models were able to reliably distinguish infection status, with an area under the receiver operating characteristic curve of ∼0.85. Many features positively correlated with infection are structurally similar to peptides. Conclusion Metabolite-based diagnostic methods appear to be promising tools to diagnose infection in immediate breast reconstruction. Features associated with infection may represent small immune proteins/peptides or degradation products from host or pathogen proteases. Further analysis is ongoing to fully identify metabolites associated with infection. Disclosures Margaret A A. Olsen, PhD, MPH, Pfizer: Advisor/Consultant|Rebyota: Advisor/Consultant

Multicentre adaptive randomised trial of GvHD prophylaxis following unrelated donor stem cell transplantation comparing Thymoglobulin versus calcineurin inhibitor-based or sirolimus-based post-transplant cyclophosphamide (Methods of T cell Depletion, MoTD trial)

IntroductionGraft-versus-host disease (GvHD) remains a major complication of allogeneic stem cell transplantation (allo-SCT), affecting 30–70% of patients (representing 800 new patients per year in the UK). The risk is higher...

Brucella ceti in Common Dolphins (Delphinus delphis) in Portugal—Characterization of First Isolates

This study investigates Brucella ceti infection in marine mammals stranded along the Lisbon and Tagus Valley coast between 2022 and mid-2024, marking the first report of Brucella presence in Portuguese waters. Out of 59 examined marine mammals, B. ceti was isolated in three common dolphins (5.1%), a prevalence rate consistent with previous studies from other coastlines. PCR-based detection indicated a higher infection rate (23.7%), suggesting an underestimation of the prevalence of B. ceti infection in this population. Multi-locus Sequence Typing (MLST) and Multiple-Locus Variable-Number Tandem-Repeat Analysis (MLVA) revealed distinct genetic profiles and close relationships to B. ceti strains from the Atlantic, supporting the hypothesis of specific host-adapted lineages in dolphins. Virulence genes, including those for host interaction (bspE, btpB) and intracellular survival (virB7, vceA), were consistent across isolates, highlighting the pathogenic potential. Additionally, antimicrobial resistance (AMR) genes, such as mprF and efflux proteins (bepC-G), were also identified. These findings underscore the need for further research and surveillance to understand B. ceti transmission, host range, and impacts on Atlantic cetaceans, as well as to develop effective diagnostic and management strategies to mitigate infection risks in marine environments.

Do routine antibiotics change the myelomeningocele infection rate? A case series.

Myelomeningocele (MMC) is the most common type of congenital spinal malformation, typically requiring surgical intervention. While prenatal repair is increasingly favored, postnatal repair remains the standard in many settings. This study aims to evaluate the antibiotics prescribed to neonates with MMC and their correlation with central nervous system (CNS) infection rates following postnatal surgical repair. A retrospective cohort study was conducted, including newborns who underwent postnatal MMC repair between August 2017 and June 2021 at the Children's Hospital of Goiânia. The study examined variables related to the pregnancy and birth periods, as well as anatomical and neurosurgical factors. Neonates were categorized into four groups based on the time interval between birth and surgical repair (within 24, 48, 72h, and beyond 72h) and were evaluated for CNS infection rates. A total of 38 neonates were included, with 24.32% diagnosed with CNS infections post-surgery. Notably, 22.86% of mothers did not receive prenatal care. Cesarean section was the predominant mode of delivery, accounting for 77.78% of cases. The average time from birth to surgery was 67h. At admission, 73.68% of MMC cases presented with a rupture of the MMC membrane, and 78.94% of newborns received intravenous antibiotics. The mean surgical time was 60min, with 78.94% of surgeries performed by experienced surgeons. Timely surgical intervention and the use of prophylactic antibiotics are critical in reducing CNS infection rates in neonates undergoing postnatal MMC repair. Delays in surgery and the lack of antibiotic prophylaxis were associated with higher infection rates, whereas factors such as delivery mode and surgeon experience had less impact on infection outcomes. These findings highlight the need for standardized care protocols and improved prenatal care to optimize neonatal outcomes.

Comparing Outcomes and Infection Risk in Medical, Surgical, and Trauma Intensive Care Patients with Alcohol Use Disorder.

Introduction: Alcohol is the most frequently abused drug in the United States, and alcohol use disorder (AUD) is a common comorbidity in intensive care units (ICUs). Patients and Methods: We performed a retrospective chart review of patients admitted to an ICU between January 2017 and March 2019 at a tertiary hospital serving a large rural population. Patients with diagnoses of AUDs were included. Patients were excluded if they did not require ICU care. Patient demographics, hospital course, infection type, culture results, and mortality were evaluated. We compared medical, surgical, and trauma ICU patient outcomes and infections. Results: In total, 527 patients met inclusion and exclusion criteria. Trauma ICU patients had the least pre-existing comorbidities, and surgical ICU patients had the longest lengths of stay. There was no difference in in-hospital mortality between ICU groups; however, surgical and medical ICU patients had significantly greater rates of in-hospital mortality compared with trauma ICU patients. Infections were common across all ICU types, occurring in 40% of patients. There was no difference in infection rate between ICU types. In multi-variable analysis controlling for age, gender, liver failure, chronic kidney disease, thrombocytopenia, complications, and blood transfusions, infection remained an independent predictor of in-hospital mortality (adjusted odds ratio 3.3, 95% confidence interval 1.7-6.4). Septic shock occurred in 57% of infections and was associated with an increased risk of mortality (38% vs. 2%, p < 0.001). Pneumonia was the most common infection occurring in 28% of the cohort, followed by bacteremia (7%), skin/soft tissue infections (6%), urinary tract infection (5%), intra-abdominal infections (4%), and C. difficile (2%). Conclusions: AUDs in all types of ICU patients are associated with high rates of infections and high morbidity and mortality.

ASSESSING COVID-19 SPREAD AND VACCINATION EFFECTIVENESS IN CHAD THROUGH MEAN KERNEL DENSITY ESTIMATION

This study introduces an innovative approach to assess the impact of COVID-19 vaccination on the spread of the virus in Chad by employing mean kernel density (MKD) estimation for non-parametric analysis. Utilizing epidemiological data collected between January 2021 and June 2023, we explore the correlation between vaccination rates and confirmed cases across various regions of Chad. Our analysis demonstrates that the application of MKD provides a smoother and more accurate visualization of infection trends before and after vaccination campaigns. The results reveal a significant reduction in confirmed cases post-vaccination, particularly in areas with higher vaccination rates. Correlation analysis further highlights the effectiveness of vaccination campaigns, showing a strong association between vaccination rates and the decrease in infections. However, the data also suggest a reactive vaccination strategy in regions with initially high infection rates. This innovative application of mean KDE provides new insights into the dynamics of vaccination efforts and their crucial role in reducing the spread of COVID-19 in Chad.

Evolution of SARS-CoV-2 in white-tailed deer in Pennsylvania 2021-2024.

SARS-CoV-2 continues to transmit and evolve in humans and animals. White-tailed deer (Odocoileus virginianus) have been previously identified as a zoonotic reservoir for SARS-CoV-2 with high rates of infection and probable spillback into humans. Here we report sampling 1,127 white-tailed deer (WTD) in Pennsylvania, and a genomic analysis of viral dynamics spanning 1,017 days between April 2021 and January 2024. To assess viral load and genotypes, RNA was isolated from retropharyngeal lymph nodes and analyzed using RT-qPCR and viral whole genome sequencing. Samples showed a 14.64% positivity rate by RT-qPCR. Analysis showed no association of SARS-CoV-2 prevalence with age, sex, or diagnosis with Chronic Wasting Disease. From the 165 SARS-CoV-2 positive WTD, we recovered 25 whole genome sequences and an additional 17 spike-targeted amplicon sequences. The viral variants identified included 17 Alpha, 11 Delta, and 14 Omicron. Alpha largely stopped circulating in humans around September 2021, but persisted in WTD as recently as March of 2023. Phylodynamic analysis of pooled genomic data from Pennsylvania documents at least 12 SARS-CoV-2 spillovers from humans into WTD, including a recent series of Omicron spillovers. Prevalence was higher in WTD in regions with crop coverage rather than forest, suggesting an association with proximity to humans. Analysis of seasonality showed increased prevalence in winter and spring. Multiple examples of recurrent mutations were identified associated with transmissions, suggesting WTD-specific evolutionary pressures. These data document ongoing infections in white-tailed deer, probable onward transmission in deer, and a remarkable rate of new spillovers from humans.

Infection Rate and Antibiotic Administration for Urban Low-Energy Gunshot Wounds at an Academic Level 1 Trauma Center.

The purpose of this study was to review rates of infection after civilian ballistic fractures and assess the effect of early antibiotic administration (EAA) on infection rates. This was a retrospective cohort study done at an urban Level 1 Trauma Center. Patients ages 16 years and older with ballistic orthopaedic extremity injuries between May 2018 and December 2020 were enrolled. A total of 827 ballistic fractures were identified, and 371 fractures were analyzed after exclusions. The primary outcome measure was the incidence of infection within 90 days postinjury, correlated with the timing of antibiotic administration. Seventy percent of the extremity injuries received EAA (<3 hours of hospital admission) and 30% did not. Infections occurred in 6.9% of patients with EAA and in 7.3% of those without. We found no notable association between EAA and infection on multivariate logistic regression (odds ratio [OR] 1, 95% Confidence Interval [CI] 0.4 to 2.4, P = 0.99). Compartment syndrome (OR 5.4, 95% CI 1.1 to 26.4, P = 0.04) and surgical treatment of fracture (OR 12.9 95% CI 1.7 to 97.9, P = 0.01) were independently associated with higher odds of infection. We found no notable association between vascular injury or visceral injury and infection. Lower extremity fracture location was markedly associated with infection on multivariate logistic regression (OR 2.8; 95% CI 1 to 7.8; P = 0.05) when compared with upper extremity, hand, and foot locations. The highest infection rate was observed in tibial shaft fractures at 22%. Early antibiotic treatment did not markedly reduce infection odds in civilian low-energy ballistic fractures. The study underscores the need for context-specific, evidence-based treatment strategies. III (retrospective cohort study).

The prevalence and immune response to coinfection by avian haemosporidians in wild Eurasian blackbirds Turdus merula.

Coinfection of a host by more than 1 parasite is more common than single infection in wild environments and can have differing impacts, although coinfections have relatively rarely been quantified. Host immune responses to coinfection can contribute to infection costs but are often harder to predict than those associated with single infection, due to the influence of within-host parasite–parasite interactions on infection virulence. To first quantify coinfection in a common bird species, and then to test for immune-related impacts of coinfection, we investigated the prevalence and immune response to avian haemosporidian (genera: Plasmodium, Haemoproteus and Leucocytozoon) coinfection in wild blackbirds. Coinfection status was diagnosed using a 1-step multiplex polymerase chain reaction, immune response was quantified through white blood cell counts and heterophil: lymphocyte ratios, and parasitaemia was quantified for each infected sample. We detected high rates of haemosporidian infection and coinfection, although neither impacted immune activity, despite a significantly higher parasitaemia in individuals experiencing double vs single infection. This suggests that immune-related costs of haemosporidian single and coinfection are low in this system. This could be due to long-term host–parasite coevolution, which has decreased infection virulence, or a consequence of reduced costs associated with chronic infections compared to acute infections. Alternatively, our results may obscure immune-related costs associated with specific combinations of coinfecting haemosporidian genera, species or lineages. Future research should investigate interactions that occur between haemosporidian parasites within hosts, as well as the ways in which these interactions and resulting impacts may vary depending on parasite identity.

Risk Factors for Postoperative Infection in Patients After Pilon Fracture Fixation.

The combination of high energy fractures, extensive soft tissue trauma, and high infection rates in pilon fractures of the distal tibia have long challenged surgeons. Despite the ample evidence, there is no consensus regarding the factors that may influence postoperative infections following surgical management of these fractures. This study aimed to investigate the risk factors for postoperative infections in patients undergoing surgical management for pilon fractures. This retrospective cohort study evaluated demographic variables, smoking status, nutritional status (i.e., pre-and postoperative albumin, pre-and postoperative white blood cell count, use of antibiotics, time to external fixation and ORIF, and hospital length of stay. A multivariate logistic regression model was used to predict risk factors associated with postoperative infection after fixation of a pilon fracture for several independent parameters. A receiver operator characteristic (ROC) curve was constructed, and a threshold was found for the investigated continuous variables, which were significant in the regression analysis. Overall, 416 patients following surgical management for a pilon fracture were identified. A multivariate logistic regression analysis revealed that preoperative albumin, preoperative WBC, and hospital length of stay were associated with postoperative infection following surgical management of pilon fractures. Thresholds determined by the Youden index were 3.05 for preoperative albumin levels, 12.65 for preoperative WBC levels, and 7.1 days for hospital length of stay. Furthermore, older patients were less prone to develop postoperative infection than younger patients. Lower preoperative albumin levels (< 3.05 mg/dL), higher preoperative WBC levels (>12.65 mg/dL), and a longer duration of hospitalization (>7.1 days) were related to an increased risk for postoperative infection after fixation of a pilon fracture.

Prevalence of Extended Spectrum Beta-Lactamase Producing Bacteria in Patients with Wound Infections Attending Tertiary Hospitals in Enugu, Nigeria

Background: The problem of antibiotics usage against bacterial infection is the modifications of such antibiotics by the bacteria thereby rendering them ineffective. Extended spectrum β-lactamase (ESBL) producing bacteria invading wound infections may lead to long term hospitalization, financial burden and limited antibiotics for therapy. The goals of this study were to determine the prevalence of ESBL-producing bacteria colonization of wound infections among individuals with non-healing wounds and the antibiotic susceptibility pattern of the ESBL isolates. Methodology: The study adopted a cross-sectional research design. A total of 266 samples were collected from different wound infections which included diabetic foot ulcers, burn wounds, post-surgical wounds, non-diabetic foot ulcers, pressure ulcers, accident and open cancer wounds that met the inclusion criteria. The patients were consecutively selected. That is, any individual that has a wound and was willing to participate was selected. A structured questionnaire was administered to the patients to obtain information on demographic characteristics, antibiotic usage, and duration of infection, herbal medication, type and site of wound. Identification of bacterial isolates was done using colony/ microscopic morphology, gram stain reaction and standard biochemical tests. Antibiotic susceptibility testing was done using modified Kirby - Bauer disc diffusion method. ESBL detection was done following the recommendations by the Clinical and Laboratory Standard Institute (CLSI) which involves a 2-step approach of initially screening for ESBL producers and phenotypic confirmatory test using a combination disc test method. Molecular screening of the genes encoding for ESBLs was done at the Central Science Laboratory, University of Nigeria, Nsukka. Results: A total of 196 isolates were recovered from the wound swabs. Pseudomonas aeruginosa 56 (28.6%) was the leading organism causing wound infection followed by Staphylococcus aureus 24 (12.2%). The bacteria isolates showed that 157 (80.1%) were gram negatives as against 39 (19.9%) that were gram positive bacteria. Among the gram-negative bacteria isolates, 21.7% (34/157) were confirmed as ESBL producers. The ESBL- producers were Pseudomonas aeruginosa, Esherichia coli, Proteus vulgaris, Proteus mirabilis, Klebsiella oxytoca, Klebsiella pneumonia and Klebsiella granulomatis at frequencies of 41.2%, 20.6%,14.7%,11.8%,5.9%,2.9% and 2.9% respectively. This showed that these isolates have the ability to resist penicillins and cephalosporins of the first, second and third generations. The ESBL-producing bacteria isolated exhibited high degree of multidrug resistance especially to tetracyclines, cefuroxime, ceftriaxone, cefotaxime and ceftazidime. The antibiotics amikacin was sensitive to most of the ESBL-producing bacteria isolated. The assessment of the risk factors showed that none of the variables was statistically significant, though those risk factors were still important in evaluating wound infections. Both hospital and community acquired infections showed no statistical significance (P= 0.072) which means that both had the same degree of pathogenicity. Among the 10 samples screened for ESBLs genes namely bla SHV, bla TEM, bla CTX-M, bla GES, and bla OXA-50, only bla OXA- 50 was detected in 8 out of the ten samples. Thus, the persistent gene circulating in this region is bla OXA-50, which confers high rate of infection and persistence. Conclusion: The presence of ESBL-producing bacteria in wounds remains a challenging issue, as the majority of the patients may suffer from long term infected wounds due to treatment failure.

Identification and molecular characterization of Dirofilaria sp. "hongkongensis" (Rhabditida: Onchocercidae) in wild-caught mosquitoes (Diptera: Culicidae): first report from India.

Dirofilariasis is a globally significant emerging-zoonotic-disease caused by nematode parasites belonging to the genus Dirofilaria (Rhabditida: Onchocercidae) and is transmitted by mosquitoes (Diptera: Culicidae) of the Culicidae family. A recent study on molecular prevalence of Dirofilaria sp. "hongkongensis" To, 2012 (nomen nudum) among the dog population in Kerala indicated a high infection rate. However, no data are currently available on the vectors involved in the transmission of this disease. In this study, an entomological survey was conducted to detect natural infection and to characterize the Dirofilaria parasite from Kani tribal settlements in Thiruvananthapuram, India. A total of 356 mosquitoes were collected, morphologically identified, and analyzed for natural infection of Dirofilaria from 4 different villages in the study area. The species composition of the collected mosquito specimens comprised 10 species belonging to 6 genera, namely Anopheles, Aedes, Armigeres, Culex, Uranotaenia, and Heizmannia. Aedes albopictus (Skuse, 1895) was found to be the predominant species, followed by Armigeres subalbatus Coquillett, 1898. Out of these, 200 female mosquitoes were grouped by species into 31 pools, for genomic DNA extraction. Detection of the nematode parasite was performed using nematode-specific primers via conventional PCR, and the species was subsequently confirmed by sanger sequencing. Natural-infection of Dirofilaria sp. "hongkongensis" was identified in Ae. albopictus and Ar. subalbatus, with a minimum infection rate of 17.6% and 13.3%, respectively. This study represents the first report of natural-infection of Dirofilaria sp. among field-collected mosquitoes in India. These findings underscore the need for robust entomological-surveillance system to prevent potential future outbreaks.

ANALYSIS OF HOSPITAL-ACQUIRED MRSA INFECTIONS IN PUS SAMPLES: A COMPREHENSIVE DISCUSSION

Background: Hospital-acquired infections (HAIs) represent a significant healthcare challenge globally, with Staphylococcus aureus (S. aureus) being a leading cause of skin and soft tissue infections. Methicillin-resistant Staphylococcus aureus (MRSA) poses an even greater threat due to its resistance to commonly used antibiotics. Understanding the prevalence and resistance patterns of MRSA is crucial to developing effective infection control strategies, especially in resource-limited settings like Peshawar, Pakistan. Objective: To determine the frequency of hospital-acquired infections caused by S. aureus in skin abscesses and evaluate the antibiotic resistance patterns of MRSA in patients from District Peshawar. Methods: A total of 525 pus samples were collected from patients with skin abscesses during hospital stays in Peshawar. Samples were processed in a microbiology laboratory using standard protocols, including Gram staining, colony morphology assessment, and biochemical tests to identify S. aureus. Methicillin resistance was confirmed using cefoxitin and oxacillin disc diffusion tests, and the presence of the mecA gene was validated through PCR. Antibiotic susceptibility testing was performed for 14 commonly prescribed antibiotics following Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was conducted using SPSS version 26. Results: Out of 525 pus samples, 100 isolates were confirmed as MRSA. The prevalence of MRSA was higher in males (54%) than females (46%). The highest infection rate was observed in the 21–40 years age group (35%), followed by 1–20 years (27%), 41–60 years (25%), and above 60 years (11%). Resistance was highest to cefoxitin (100%), oxacillin (94%), ciprofloxacin (81%), and amoxicillin (79%). However, isolates showed high susceptibility to vancomycin (93%), linezolid (95%), and teicoplanin (90%). Conclusion: The study highlights the alarming prevalence of MRSA in hospital-acquired skin abscesses in Peshawar, coupled with significant antibiotic resistance. Strengthened infection control measures, antibiotic stewardship programs, and ongoing surveillance are essential to curb the spread of resistant pathogens.