High Risk Of Infection Research Articles

Prevalence, Risk Factors, and Result Features in the Detection of Latent Tuberculosis Infection in Thai Healthcare Workers Using QuantiFERON-TB Gold Plus.

Introduction Latent tuberculosis infection (LTBI) is an enormous reservoir for tuberculosis (TB), and healthcare workers (HCWs) are at high risk for TB infection. QuantiFERON-TB Gold Plus (QFT-Plus) is an alternative to the tuberculin skin test for LTBI detection, but data on its application and LTBI detected by QFT-Plus in high TB burden countries are limited. This study aimed to determine the prevalence of LTBI and its risk factors, and to investigate the QFT-Plus results in Thai HCWs. Methods A cross-sectional analytical study was conducted among HCWs at a secondary care hospital in Health Region 5, Thailand. Eligible HCWs were enrolled and underwent QFT-Plus testing. Interferon-gamma (IFN-γ) values in tubes were analysed. The prevalence and associated risk factors for LTBI were assessed based on laboratory and sociodemographic data. Logistic regression analyses were applied to calculate odds ratios (OR, aOR) reported with 95% confidence intervals (CI). Results Of the 269 participants enrolled, their median age was 42 years and 93.31% (n = 251/269) were female. The majority (n = 178/269, 66.17%) were nurses or nurse assistants and 42.75% (n = 115/269) worked in the inpatient medical wards. Overall, the QFT-Plus results showed 110 (40.89%) positive with good agreement (93.68%; κ 0.87) and high correlation (Spearman's ρ 0.91) of IFN-γ concentrations in the two antigen tubes. A true difference inIFN-γ values for predicting a recent infection was found about 7.81% (n = 21/269). By univariate and multivariate analyses, the participants' age > 40 years (OR = 3.21, 95% CI: 1.84-5.64%; aOR = 2.05, 95% CI: 1.07-3.96%), and employment duration > 10 years (OR = 3.19, 95% CI: 1.66-6.37%; aOR = 2.34, 95% CI: 1.05-5.21%) were significantly associated with the increased risk of LTBI (p-value < 0.05). Conclusions The prevalence of LTBI among these HCWs was high, and the increased risk factors for LTBI according to QFT-Plus positivity were age over 40 years and working time in the hospital for more than 10 years. It is important to screen HCWs in this setting for LTBI, particularly those with long employment durations and older ages. The high prevalence of LTBI suggests that LTBI management, such as regular screening and treatment, should be considered together with strengthening preventive measures, especially in high-risk groups.

#237 Carbapenemase producing Enterobacteriaceae rectal colonization in dialysis patients: a large monocentric retrospective analysis

Abstract Background and Aims Carbapenemase-producing Enterobacteriaceae (CPE) represent a growing global public health concern due to their increasing prevalence and resistance to carbapenems. Dialysis patients are particularly vulnerable to infections that represent the second cause of death in dialysis’ cohorts. Considering the immunosuppression, dialysis patients constitute a highly immunocompromised population and represent a unique setting similar to intensive care, hematology, or transplant recipients. Several studies have already been conducted in these populations, demonstrating the high infectious risk, increased mortality and morbidity burdened by CPE. Our study aims to analyze a large dialysis population and assess if there is an increased risk of mortality, sepsis, and/or hospitalizations within this cohort. Considering the frequency of evaluations for these patients, we have also decided to evaluate the treatments to which these patients are subjected, their antibiotic exposure, the number of hospitalizations and specific infections, while seeking predisposing or protective factors within this specific patient group. Method Our work is a retrospective, single-center cohort study that analyzes patients on HD and PD who were followed by the Nephrology and Dialysis Department of the Ravenna Hospital from 01/01/2015 to 31/12/2021 (674 patients). We analyzed demographic data (Date of birth, gender, blood type), comorbidities (Diabetes, hypertension), dialysis data (type of dialysis technique, dialytic age), blood tests (hemoglobin, white blood cells, platelets, albumin, ALT, lipase, C-reactive protein), serology and markers (HBV, HCV, HIV, EBV, CMV, Quantiferon, Helicobacter pylori colonization, SARS-COV2), therapies (antihypertensives, proton pump inhibitors, calcium-based phosphorus binders, non-calcium-based phosphorus binders, potassium binders, iron therapy, erythropoietin-stimulating agents), antibiotics (cephalosporins, penicillins, fluoroquinolones, macrolides, aminoglycosides, carbapenems, tetracyclines, vancomycin, linezolid, cefepime/avibactam), hospitalizations, colonization or lack thereof by CPE bacteria, infections (urinary tract infections and pneumonias) or sepsis and responsible microorganisms, survival. We exclude patients who had stomas or those who received chemotherapy or immunotherapy for a period longer than 3 months. Results Overall we considered for our analysis 528 patients and 51 presented CPE positive rectal swab during the period of observation. In our population CPE colonized patients present a higher risk to develop pneumonias (HR 2.048, p = 0.003). 178 patients presented 497 episodes of sepsis, 451 episodes in the non CPE colonized and 46 episodes in the CPE colonized (HR 2.057, p-value 0.001). Considering CPE-induced sepsis, a substantial difference was observed between the two groups. The colonized patient group had 7 (15.2%) cases of CPE sepsis, while the non-colonized group did not have any (0%). The result shows statistical significance, although the limited number of infections does not allow for definitive conclusions on this matter. Concerning the re-hospitalization rate we evidenced a significative difference between the two groups, displaying an involvement of CPE colonization (HR1.367, p-value = 0.038). Conclusion Our study highlighted that a colonization by CPE lead to a greater number of episodes of all bacterial sepsis, of CPE sepsis, of pneumonias and of re-hospitalizations. Colonization by CPE conferm an increased risk of CPE sepsis, and therefore, future research should focus on determining whether it is worthwhile to treat hyperpyrexia in colonized CPE dialysis patients as if it were CPE-related sepsis. This is a significant question that can guide our clinical practice.

Charcot Neuro-Osteoarthropathy With Superimposed Osteomyelitis in a Nondiabetic Patient, as a Consequence of Cancer Chemotherapy: A MR-Monitored Case Report.

Charcot neuro-osteoarthropathy (CNO) is a manifestation of peripheral neuropathy as a chronic complication of diabetes mellitus but, less frequently, can be associated to other conditions such as alcoholism or neurotoxic therapies. An increasingly emerging cause of CNO is the use of oncological drugs which can cause neuropathic damage. The use of these therapies dramatically increased in recent years. CNO leads to a progressive degeneration of the foot's joints and to bone destruction and resorption which ends in deformities. These alterations in the foot's anatomy determine a high risk of ulceration, infection, and osteomyelitis. The superimposition of osteomyelitis on CNO increases the risk of major amputation, already high in patients suffering either from only CNO or osteomyelitis alone. We report the case of a 61-year old nondiabetic woman affected by CNO as a consequence of antiblastic therapy for breast cancer and the subsequent overlap of osteomyelitis, confirmed by magnetic resonance imaging. This case underlines how it is necessary to consider CNO as a possible complication of antiblastic therapy in the view of the severe consequences of missing its diagnosis.

Clinical features and risk factors for pyogenic liver abscess caused by multidrug-resistant organisms: A retrospective study

ABSTRACT The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06–1.68), hospitalization (aOR: 10.34, 95% CI: 1.86–60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66–71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29–261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.

Awareness of fish-borne zoonoses and prevalence of Contracaecum in Oreochromis niloticus and Lates niloticus collected from Lake Chamo, Arba Minch, Ethiopia.

Many fish species can harbour a wide range of pathogenic agents in their tissues. Of many pathogens, the parasitic nematode of genus Contracaecum, which resides in the tissues of fish species, can results in fish-borne infections in humans. This study was planned to assess consumers' awareness of fish-borne zoonoses in the fishing sites of Lake Chamo, Arba Minch, Ethiopia. The study was also aimed at demonstrating the zoonotic nematode, Contracaecum parasites in the Oreochromis niloticus and Lates niloticus fishes collected from Lake Chamo, Arba Minch, Ethiopia. Assessment of awareness about fish-borne zoonoses was conducted in randomly selected participants (n = 162) using face-to-face interviews via a structured and semi-structured questionnaire. Besides, 70 fishes (O. niloticus = 35 and L. niloticus = 35) were examined for the presence of larva of Contracaecum and other anisakid genera through standard dissection, pepsin-hydrochloric acid digestion and microscopic observation. Consumers have inadequate awareness about fish-borne zoonoses based on the answers they provided to the questions. The majority of respondents (82%) consume raw fish in the area. Of these, a significantly higher proportion were male (p < 0.001), completed their elementary or high school (p = 0.004), Orthodox Christian (p = 0.044), fishermen (p < 0.001) and participants without previous information about fish-borne zoonoses (p < 0.001). Overall, of examined fishes (n = 70), n = 15 (21.4%, 95% CI, 12.8-33.2) were infected with Contracaecum larva. A significant (p = 0.028) higher infection prevalence was noted in L. niloticus (34.3%, 95% CI, 19.7-52.3) compared to O. niloticus (8.6%, 95% CI, 2.2-24.2). A unit gram addition in the total weight of fish would significantly raise the risk of Contracaecum infection by 1% (p < 0.001). The presence of Contracaecum, a zoonotic nematode in the fishes, which are often preferred by consumers for raw dishes, designates a high risk of possible fish-borne infections in the area. Thus, providing education and training for fishermen, visitors of the area, and local people who visit the area for fish consumption, it is inevitably important to minimize the risk. Furthermore, health workers should suspect fish-borne infections, such as anisakidosis in patients who have a history of raw fish consumption in Arba Minch, Ethiopia.

Factors underlying the high occupational risk of healthcare personnel for COVID-19 infection.

To verify the rate of COVID-19 infection among healthcare personnel at high and low risk of COVID-19 infection and identify the underlying risk factors. This cross-sectional study was conducted between December 1, 2020 and February 28, 2021. Associations were verified between the levels of risk (high or low) of occupational COVID-19 infection and participant characteristics using the World Health Organization risk assessment questionnaire and adjusted using logistic regression models in single and multiple approaches. Of the 486 participants, 57.4% were classified as having a high occupational risk for SARS-CoV-2 infection, with a diagnosis rate of 12.1%. The factors identified in the multivariate analysis for high occupational risk were age up to 29 years (odds ratio [OR] = 2.7, 95% confidence interval [95%CI] = 1.63-4.47), monthly family income greater than eight times the basic salary (OR= 1.8, 95%CI= 1.07-3.16), and healthcare personnel who did not participate in initial training to work in the area of patients with COVID-19 infection (OR= 2.39, 95%CI= 1.53-3.75). Encouraging training for occupational infection prevention is very important to reduce the impact of infectious diseases on healthcare personnel, especially young health professionals. COVID-19 infection among healthcare personnel has impacted the workforce in hospitals. Knowledge of the risk factors for COVID-19 infection is important for disease prevention measures. Failure to train healthcare personnel is an important risk factor for acquiring COVID-19.

LIMITATIONS IN THE USE OF SUBCUTANEOUS DEFIBRILLATOR IN PATIENTS WITH LOW BODY MASS INDEX

Abstract Introduction Subcutaneous defibrillator is an effective and widely used tool in clinical practice but the presence of large fluctuations in the body mass index and the reduction of subcutaneous tissue may limit its application to all patients. Case Report In 2014, a 51–year–old woman underwent implantation of a dual–chamber transvenous defibrillator with left subclavian vein approach in secondary prevention for long Qt syndrome (LQT3). About 6 years after implantation she presented a ventricular lead breakage due to subclavian crush syndrome and was subjected to multiple inappropriate shocks due to lead failure. For this reason, the transvenous defibrillator was replaced with a single–chamber pacemaker for atrial stimulation and a subcutaneous defibrillator was implanted (Fig.1). In the following years the patient lost 14 kg and in the first months of 2022 she complained of the onset of stabbing pain in the precordial region near the upper face of the left sixth rib on the midclavicular line (Fig.2). Over the months, this symptomatology has become increasingly limiting and poorly responsive to normal analgesics but only to opiates; furthermore the pain has also occurred after a few weeks at the left parasternal level along the course of the distal portion of the subcutaneous catheter. For this reason, after discussing the case with the patient, we proceeded to implant a new transvenous lead via left subclavian vein and upgrade to a dual–chamber defibrillator. Subsequently, in the same operating session, the subcutaneous defibrillator was removed, finding only a modest traction resistance of the catheter in the parasternal area, resolved with the use of a 10 French introducer used as a sheet to debride the course of the same from the fibrotic adhesions (Fig .3). In the days following the procedure, the patient reported a progressive total disappearance of the pain symptoms. Reassessed after one year, the patient reports subjective well–being with total absence of chest pain and good quality of life. Conclusions The subcutaneous defibrillator represents an important resource for the management of the main ventricular arrhythmias, especially in patients with a high risk of infection and with a long life expectancy. The presence of a stable amount of subcutaneous tissue is a necessary condition to guarantee the tolerance of the lead over time and to avoid chronic pain situations that can lead to its removal.

CHRONIC INFECTION AND SEVERE MITRAL REGURGITATION: A TRICKY CASE REPORT

Abstract Background Techniques of mitral valve repair has improved in the last decades. Percutaneous approach is now a reliable and safe therapy in those patients with high surgical risk. Of note, the presence of implanted prothesis may increase the risk of endocarditis, especially in those patients experiencing recurrent infection. Case Summary We describe a case of a 75–year–old with medical history of chronic lymphedema. It was characterized by periodical episode (yearly) of cellulitis, with a rapid onset of fever (38.5–39° C), lasting for a few days after paracetamol therapy. Patients had severe mitral valve regurgitation due to prolapse of the posterior leaflet (P2). In December 2022, he had percutaneous edge–to–edge mitral valve. Three months later the patient was admitted to the emergency department of our hospital due to fever without any specific symptoms. The patient was well compensated, normal blood pressure, heart rate and oxygen saturation. He had emocolture which revealed the presence of Staphilococcus lugdunensis. Transesophageal echocardiogram confirmed the presence endocarditis, showing a huge (10x12 mm) vegetation at the level of mitral device (Fig 1 and 2). Patients was then referred to cardiac surgery for urgent mitral valve replacement with mitral bioprothesis (Fig 3). He was treated with ev antibiotic for six weeks after cardiac surgery. Additionally, chronic treatment with amoxicillin 500 mg/day was also prescribed at discharge. After six months follow–up, patients had no signs of endocarditis. Conclusion The management and treatment of chronic infection is of paramount importance to reduce the risk of prothesis infection procedure in patients needing a prothesis implantation. The last European Society of Cardiology guidelines on endocarditis do not provide any recommendation regarding a long–term treatment of patients with high risk of infection (i.e. due to chronic infection) and with an implanted cardiac device/prothesis. We believe this represents an important unmeet need.

CASE PRESENTATION: A COMPLEX CLINICAL SCENARIO IN A 43–YEAR–OLD MALE WITH DEVICE–RELATED COMPLICATIONS

Abstract A 43 yo male presented with an exposed pocket of his ICD in the right prepectoral and axillary region, along with total exposure of the lead electrodes up to the fixation sleeves.The patient, a known carrier of double–outlet right ventricle, underwent surgical correction. At the age of one, he received a dual–chamber pacemaker in the left prepectoral region due to AVB. Due to recurrent sustained ventricular tachycardias an ICD was implanted in the right prepectoral region, with removal of the left–sided pacemaker and concurrent abandonment of the ventricular pacing lead. In October 2019, he was admitted for a recurrence of pocket erosion.Device extraction was proposed but declined by the patient. Subsequently, he was referred to our institution for device removal. After heart team discussion, the patient was offered a transvenous lead extraction, with potential cardiothoracic surgical intervention if transvenous extraction proved to be challenging.An attempt was made to extract the leads using a transvenous approach. The procedure proceeded without complications, and the leads were released from adhesions up to the superior vena cava. However, there was an adhesion point at this location that was not overcome by mechanical dilation.Due to this limitation, a few days later, a cardiothoracic surgical intervention was performed to complete the lead wires‘ extraction using an invasive approach. In this context, a cardiac resynchronization device CRT–P was reimplanted in the left prepectoral region with epicardial electrodes. The patient underwent submuscular subclavian implantation of a SCID.The patient presented with a new pocket erosion of the CRT–P.Considering the high infection risk, It was therefore decided to implant a leadless device following electroanatomic mapping of the right ventricle, as there were surgical patches in the septal region. This approach aimed to identify the optimal anchoring site for the device. Subsequently, he will go extraction of the generator of the CRT–P.The decision to forgo biventricular stimulation was made, because of the elevated infectious risk.Complications associated with implantable devices pose an increasingly significant challenge in managing young patients with cardiac arrhythmias. Only through an integrated approach and proactive sharing of knowledge and expertise can we significantly improve clinical outcomes and the quality of life for this increasingly relevant population.

Evolutionary Digital Twin-Oriented Complex Networked Systems driven by node features and the mutation of feature preferences.

Accurate modelling of complex social systems, where people interact with each other and those interactions change over time, has been a research challenge for many years. This study proposes an evolutionary Digital Twin-Oriented Complex Networked System (DT-CNS) framework that considers heterogeneous node features and changeable connection preferences. We create heterogeneous preference mutation mechanisms to characterise nodes' adaptive decisions on preference mutation in response to interaction patterns and epidemic risks. In this space, we use nodes' interaction utilities to characterise the positive feedback from interactions and negative impact of epidemic risks. We also introduce social capital constraint to harness the density of social connections better. The nodes' heterogeneous preference mutation styles include the (i)inactive style that keeps initial social preferences, (ii) ignorant style that randomly mutates preferences, (iii) egocentric style that optimises individual interaction utility, (iv) cooperative style that optimises the total interaction utilities by group decisions and (v) collaborative style that further allows the cooperative nodes to transfer social capital. Our simulation experiments on evolutionary DT-CNSs reveal that heterogeneous preference mutation styles lead to various interaction and infection patterns. The results also show that (i) increasing social capital enables higher interactions but higher infection risks and uncertainty in decision-making; (ii) group decisions outperform individual decisions by eliminating the unawareness of the decisions of other nodes; (iii) the collaborative nodes under a strict social capital limit can promote interactions, reduce infection risks and achieve higher overall interaction utilities.

Visible-Light Cross-Linkable Multifunctional Hydrogels Loaded with Exosomes Facilitate Full-Thickness Skin Defect Wound Healing through Participating in the Entire Healing Process.

The management of severe full-thickness skin defect wounds remains a challenge due to their irregular shape, uncontrollable bleeding, high risk of infection, and prolonged healing period. Herein, an all-in-one OD/GM/QCS@Exo hydrogel was prepared with catechol-modified oxidized hyaluronic acid (OD), methylacrylylated gelatin (GM), and quaternized chitosan (QCS) and loaded with adipose mesenchymal stem cell-derived exosomes (Exos). Cross-linking of the hydrogel was achieved using visible light instead of ultraviolet light irradiation, providing injectability and good biocompatibility. Notably, the incorporation of catechol groups and multicross-linked networks in the hydrogels conferred strong adhesion properties and mechanical strength against external forces such as tensile and compressive stress. Furthermore, our hydrogel exhibited antibacterial, anti-inflammatory, and antioxidant properties along with wound-healing promotion effects. Our results demonstrated that the hydrogel-mediated release of Exos significantly promotes cellular proliferation, migration, and angiogenesis, thereby accelerating skin structure reconstruction and functional recovery during the wound-healing process. Overall, the all-in-one OD/GM/QCS@Exo hydrogel provided a promising therapeutic strategy for the treatment of full-thickness skin defect wounds through actively participating in the entire process of wound healing.

Dog ecology and rabies control including canine vaccination coverage: Impacts from a survey in Madagascar.

Rabies virus (RABV; species Lyssavirus rabies) is causing one of the oldest zoonotic diseases known to mankind, leading to fatal encephalomyelitis in animals and humans. Despite the existence of safe and effective vaccines to prevent the disease, an estimated 99% of human rabies deaths worldwide are caused by dog-mediated rabies with children at the highest risk of infection. Rabies has been endemic in Madagascar for over a century, yet there has been little research evaluating local knowledge and practices impacting on the rabies control and prevention. Thus, this study was undertaken to better understand the dog ecology including canine vaccine coverage and to assess knowledge and practices of dog owners and veterinarians. A cross-sectional study was conducted among 123 dog-owning households in thirteen fokontanys in Mahajanga from July 4 to September 13, 2016. Single and multi-member dog-owning households in the study area on the day of the interview were eligible for inclusion and purposively selected with the support of a local guide. The survey included a household questionnaire capturing information on the dog's demographics, husbandry practices, knowledge and practices towards rabies and its control measures; the dog ecology questionnaire collected dog characteristics, vaccination status and husbandry practices. All households that reported a dog bite incident, were invited to participate in a dog bite questionnaire. In addition, direct observations of roaming dogs were conducted to assess dog population demographics and to document behavioural characteristics. Two veterinarians were purposively selected and took part in an interview during the survey period, providing information on rabies control activities, including dog-care practices in the area. Descriptive and inferential data analyses were performed using Epi Info version 7.1.5.0 (CDC Atlanta, USA). We recorded a total of 400 dogs, of which 338 (84.5%) were owned amongst 123 households. More than half (67.8%) of owned dogs were between 1 to 5 years old and 95.6% were kept for guarding purposes. 45% of the surveyed dogs had free access to roam outside the premises. The majority (85.4%) of dog owners were knowledgeable that a dog bite could potentially transmit RABV to humans. 19 dog bites were reported and of these 73.6% were caused by the owner's or a neighbour's dog. In 6 of the 19 cases, children between 7 and 15 years of age were the victims. Dog vaccination coverage against rabies was 34% among owned dogs. Of the participants aware of a veterinarian, the majority (55/82) indicated that they accessed veterinarian services at irregular intervals. The main obstacles to vaccinations cited by dog owners were limited financial resources and difficulty accessing veterinary care. This study contributes to enhanced understanding of the dog ecology including canine vaccine coverage as well as knowledge and practices of dog owners in Madagascar. Most dogs in the study area were accessible for preventive vaccination through their owners, however only one third of the investigated canine population was vaccinated against rabies. Concerted national efforts towards rabies prevention and control should aim to address financial challenges and access to veterinary services.

Interleukin-1β Polymorphisms Are Genetic Markers of Susceptibility to Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty.

Periprosthetic joint infections (PJIs) are serious complications of prosthetic surgery. The criteria for the diagnosis of PJI integrate clinical and laboratory findings in a complex and sometimes inconclusive workflow. Host immune factors hold potential as diagnostic biomarkers in bone and joint infections. We reported that the humoral pattern-recognition molecule long pentraxin 3 (PTX3) predicts PJI in total hip and knee arthroplasty (THA and TKA, respectively). If and how genetic variation in PTX3 and inflammatory genes that affect its expression (IL-1β, IL-6, IL-10, and IL-17A) contributes to the risk of PJI is unknown. We conducted a case-control study on a Caucasian historic cohort of THA and TKA patients who had prosthesis explant due to PJI (cases) or aseptic complications (controls). Saliva was collected from 93 subjects and used to extract DNA and genotype PTX3, IL-1β, IL-6, IL-10, and IL-17A single-nucleotide polymorphisms (SNPs). Moreover, the concentration of IL-1β, IL-10, and IL-6 was measured in synovial fluid and plasma. No association was found between PTX3 polymorphisms and PJI; however, the AGG haplotype, encompassing rs2853550, rs1143634, and rs1143627 in IL-1β, was linked to the infection (p = 0.017). Also, synovial levels of all inflammatory markers were higher in cases than in controls, and a correlation emerged between synovial concentration of PTX3 and that of IL-1β in cases only (Spearman r = 0.67, p = 0.004). We identified a relationship between rs2853550 and the synovial concentration of IL-1β and PTX3. Our findings suggest that IL-1β SNPs could be used for the early identification of THA and TKA patients with a high risk of infection.

Intraoperative Hypertonic Saline Irrigation Preventing Seroma Formation in the Treatment of Axillary Bromhidrosis.

Subcutaneous seroma formation (SF) is commonly seen after axillary bromhidrosis surgeries and its treatment can be challenging and long. Current prevention methods are not consistent, and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of intraoperative hypertonic saline irrigation (IHSI) to axillary bromhidrosis subcutaneous dead space, which prevents postoperative SF and enables early drain removal due to reduced secretions. From 2015 to 2022, we performed the intraoperative irrigation of the cavity through normal saline in 100 patients with primary axillary bromhidrosis. Through an incision approximately 3 cm long at the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with straight scissors within the axillary area, and then, the undermined apocrine glands were removed with curved scissors. The skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Negative pressure drains were placed, and intraoperative irrigation of the cavity through the drains with 20 ml of NaCl 0.9% or NaCl 10% left at site for 10 min applies different saline solutions in the same patients. The volumeofdrainage on the 1st postoperative day was 6.54±0.36 mL for the group B, which was significantly less than 15.23±0.42 mL for the group A (p < 0.05). The time of drain removal for the group B was 24 h, which was shorter than 48 h for the group A. In group B, 4 percent of axillae showed significant SF postoperatively, which was lower than the 20 percent of axillae associated with the group A (p < 0.05). The rate of incision infection for the group B was 2 percent, which was significantly lower than the 6 percent of axillae in the group A (p < 0.05). Two percent of axillae showed skin edge necrosis postoperatively in the group B, which was lower than the 10 percent of axillae associated with the group A (p < 0.05). IHSI enhances adhesion formation and reduces secretion rate in subcutaneous dissection space after axillary bromhidrosis surgeries, therefore enables early drain removal and prevents SF, incision infection and skin edge necrosis. As a result, reducing the pain of patients, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Glycyrrhizic Acid Nanoparticles Subside the Activity of Methicillin-Resistant Staphylococcus aureus by Suppressing PBP2a.

Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) are classified as high-risk infections that can lead to death, particularly among older individuals. Nowadays, plant nanoparticles such as glycyrrhizic acid are recognized as efficient bactericides against a wide range of bacterial strains. Recently, scientists have shown interest in plant extract nanoparticles, derived from natural sources, which can be synthesized into nanomaterials. Interestingly, glycyrrhizic acid is rich in antioxidants as well as antibacterial agents, and it exhibits no adverse effects on normal cells. In this study, glycyrrhizic acid nanoparticles (GA-NPs) were synthesized using the hydrothermal method and characterized through physicochemical techniques such as UV-visible spectrometry, DLS, zeta potential, and TEM. The antimicrobial activity of GA-NPs was investigated through various methods, including MIC assays, anti-biofilm activity assays, ATPase activity assays, and kill-time assays. The expression levels of mecA, mecR1, blaR1, and blaZ genes were measured by quantitative RT-qPCR. Additionally, the presence of the penicillin-binding protein 2a (PBP2a) protein of S. aureus and MRSA was evaluated by a Western blot assay. The results emphasized the fabrication of GA nanoparticles in spherical shapes with a diameter in the range of 40-50 nm. The data show that GA nanoparticles exhibit great bactericidal effectiveness against S. aureus and MRSA. The treatment with GA-NPs remarkably reduces the expression levels of the mecA, mecR1, blaR1, and blaZ genes. PBP2a expression in MRSA was significantly reduced after treatment with GA-NPs. Overall, this study demonstrates that glycyrrhizic acid nanoparticles have potent antibacterial activity, particularly against MRSA. This research elucidates the inhibition mechanism of glycyrrhizic acid, which involves the suppressing of PBP2a expression. This work emphasizes the importance of utilizing plant nanoparticles as effective antimicrobial agents against a broad spectrum of bacteria.

Factors associated with cardiac implantable electronic device-related infections, New South Wales, 2016-21: a retrospective cohort study.

To quantify the rate of cardiac implantable electronic device (CIED)-related infections and to identify risk factors for such infections. Retrospective cohort study; analysis of linked hospital admissions and mortality data. All adults who underwent CIED procedures in New South Wales between 1 January 2016 and 30 June 2021 (public hospitals) or 30 June 2020 (private hospitals). Proportions of patients hospitalised with CIED-related infections (identified by hospital record diagnosis codes); risk of CIED-related infection by patient, device, and procedural factors. Of 37 675 CIED procedures (23 194 men, 63.5%), 500 were followed by CIED-related infections (median follow-up, 24.9 months; interquartile range, 11.2-40.8 months), including 397 people (1.1%) within twelve months of their procedures, and 186 of 10 540 people (2.5%) at high risk of such infections (replacement or upgrade procedures; new cardiac resynchronisation therapy with defibrillator, CRT-D). The overall infection rate was 0.50 (95% confidence interval [CI], 0.45-0.54) per 1000 person-months; it was highest during the first month after the procedure (5.60 [95% CI, 4.89-6.42] per 1000 person-months). The risk of CIED-related infection was greater for people under 65 years of age than for those aged 65-74 years (adjusted hazard ratio [aHR], 1.71; 95% CI, 1.32-2.23), for people with CRT-D devices than for those with permanent pacemakers (aHR, 1.46; 95% CI, 1.02-2.08), for people who had previously undergone CIED procedures (two or more v none: aHR, 1.51; 95% CI, 1.02-2.25) or had CIED-related infections (aHR, 11.4; 95% CI, 8.34-15.7), or had undergone concomitant cardiac surgery (aHR, 1.62; 95% CI, 1.10-2.39), and for people with atrial fibrillation (aHR, 1.33; 95% CI, 1.11-1.60), chronic kidney disease (aHR, 1.54; 95% CI, 1.27-1.87), chronic obstructive pulmonary disease (aHR, 1.37; 95% CI, 1.10-1.69), or cardiomyopathy (aHR 1.60; 95% CI, 1.25-2.05). Knowledge of risk factors for CIED-related infections can help clinicians discuss them with their patients, identify people at particular risk, and inform decisions about device type, upgrades and replacements, and prophylactic interventions.

Proton pump inhibitors associated with severe COVID-19 among two-dose but not three-dose vaccine recipients.

Proton pump inhibitors (PPIs) may increase the risk of COVID-19 among non-vaccinated subjects via various mechanisms, including gut dysbiosis. We aimed to investigate whether PPIs also affect the clinical outcomes of COVID-19 among vaccine recipients. This was a territory-wide cohort study of 3272286 vaccine recipients (aged ≥18years) of ≥2 doses of either BNT162b2 or CoronaVac. Exclusion criteria included prior gastrointestinal surgery, immunocompromised status, and prior COVID-19. The primary outcome was COVID-19, and secondary outcomes included COVID-19-related hospitalization and severe infection (composite of intensive care unit admission, ventilatory support, and/or death). Covariates include age, sex, the Charlson Comorbidity Index, comorbidities, and concomitant medication use. Subjects were followed from index date (first dose of vaccination) until outcome occurrence, death, additional dose of vaccination, or March 31, 2022. Exposure was pre-vaccination PPI use (any prescription within 90days before the index date). Propensity score (PS) matching and a Poisson regression model were used to estimate the adjusted incidence rate ratio (aIRR) of outcomes with PPI use. Among 439154 PS-matched two-dose vaccine recipients (mean age: 65.3years; male: 45.7%) with a median follow-up of 6.8months (interquartile range: 2.6-7.9), PPI exposure was associated with a higher risk of COVID-19 (aIRR: 1.08; 95% confidence interval [95% CI]: 1.05-1.10), hospitalization (aIRR: 1.20; 95% CI: 1.08-1.33), and severe infection (aIRR: 1.57; 95% CI: 1.24-1.98). Among 188360 PS-matched three-dose vaccine recipients (mean age: 62.5years; male: 49.0%; median follow-up: 9.1months [interquartile range: 8.0-10.9]), PPIs were associated with higher infection risk (aIRR: 1.11; 95% CI: 1.08-1.15) but not other outcomes. Although PPI use was associated with a higher COVID-19 risk, severe infection was limited to two-dose but not three-dose vaccine recipients.

Main Partner Relationships and the HIV Care Cascade: Examining the Predictive Utility of Sexual Agreements, Partner Concordance, and Drug Use Among Sexual Minority Men Living With HIV in the USA.

The past 15 years have seen increasing attention to relationship factors among sexual minority male (SMM) couples at high risk for HIV infection. Research has largely focused on HIV prevention outcomes. Outcomes relevant to SMM living with HIV have received relatively less attention. This study evaluated associations between relational covariates (relationship status, sexual agreements, and seroconcordance) and HIV care cascade outcomes (having a current antiretroviral therapy [ART] prescription, ART adherence, viral load (VL) testing, and VL detectability) above and beyond cannabis and stimulant drug use. Adult SMM (n = 36,874) living with HIV in the USA were recruited between November 1, 2017 and March 15, 2020 through social networking applications. They completed a cross-sectional survey online. Nonmonogamous SMM with serodiscordant partners were most likely to have an ART prescription. Those with seroconcordant partners (regardless of sexual agreements) were least likely to be adherent. While relational covariates were not associated with VL testing, SMM in nonmonogamous relationships with serodiscordant partners were significantly more likely to have an undetectable VL. Those in monogamous relationships with seroconcordant partners were significantly less likely to have an undetectable VL. SMM with seroconcordant partners and monogamous sexual agreements may experience diminished interpersonal motivation for HIV care engagement. HIV care cascade retention messages that emphasize the prevention of onward transmission may have limited relevance for these SMM. Novel intervention strategies are needed to enhance HIV care outcomes in this population, ideally ones that incorporate attention to drug use.

Impact and economic analysis of human T-cell lymphotropic virus type 1 (HTLV-1)-targeted antenatal screening, England and Wales, 2021.

BackgroundHuman T-cell lymphotropic virus type 1 (HTLV-1) is a neglected virus that can cause severe disease and be transmitted from mother to child through breastfeeding. Avoidance of breastfeeding prevents 80% of vertical transmission. The United Kingdom (UK) is currently assessing whether HTLV-1-targeted antenatal screening should be implemented.AimWe aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical transmission in England and Wales.MethodsWe estimated the number of pregnant women who have high risk of HTLV-1 infection based on their or their partner's country of birth. With data from 2021, we used a mathematical model to assess cost-effectiveness of HTLV-1 antenatal screening. We also estimated the annual number of infant infections and the number that could be prevented with screening and intervention.ResultsWe estimate that ca 99,000 pregnant women in England and Wales have high risk of HTLV-1 infection. In the absence of screening, 74 (range: 25-211) HTLV-1 infections in infants would be expected to occur every year in England and Wales. Implementation of targeted screening would prevent 58 (range: 19-164) infant infections annually. The intervention is effective (incremental 0.00333 quality-adjusted life years (QALY)) and cost-saving (GBP -57.56 (EUR -66.85)).ConclusionOur findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.

Knowledge and Practices of Airborne Infection Control at the Household Level among Pulmonary Tuberculosis Patients Attending a Tertiary Care Teaching Hospital in Central Karnataka, India

Abstract Background: Airborne transmission of tuberculosis (TB) is a major route of spread. Household contacts of TB patients are at high risk of infection. However, there is limited evidence on airborne infection control knowledge and practices among TB patients in India. This study was done to assess the knowledge and practices related to airborne infection control among pulmonary TB (PTB) patients at the household level and determine associated factors. Subjects and Methods: A cross-sectional study was conducted among 157 smear-positive PTB patients at a tertiary care hospital in Karnataka, India, using a pretested questionnaire. Knowledge and self-reported practices regarding airborne precautions were assessed. Bivariate analysis was done to determine associated factors. P &lt;0.005 was considered significant. Results: Major gaps were found in knowledge about ventilation (50.3%), avoiding visitors (39.5%), and sputum disposal (33.8%). Suboptimal practices were reported for using tissues (19%), handwashing (25%), ventilation (66%), sputum handling (54%), and waste disposal (30%). Good knowledge was associated with younger age, higher education, Hindu religion, family history of TB, intensive phase treatment, and presence of symptoms (P &lt; 0.05). Participants with good knowledge had significantly better preventive practices (P &lt; 0.00001). Conclusion: Tailored education on airborne precautions focusing on identified knowledge gaps and risky practices can help improve the adoption of infection control measures among TB patients at the household level. A multifaceted approach is required to translate improved awareness into optimal preventive behaviors.