Nosocomial Research Articles

Syzygium aromaticum extract mediated, sustainable silver nanoparticle synergetic with heterocyclic antibiotic clarithromycin and their antimicrobial activities

Microorganisms are becoming resistant to drugs and antimicrobials, making it a significantly critical global issue. Nosocomial infections are resulting in alarmingly increasing rates of morbidity and mortality. Plant derived compounds hold numerous antimicrobial properties, making them a very capable source to counteract resistant microbial strains. Syzygium aromaticum (Clove) extract has been proven by studies to contain active ingredients that demonstrate antibacterial, antifungal, antioxidant, and insecticidal properties. It has also been used historically for its pain relief especially for tooth ache. Clove extract derived nanoparticle synthesis is a promising method of combining therapeutics with metals at nanoscale. Such nanostructured systems in combination with the heterocyclic antibiotic clarithromycin could potentiate the action of plant extracts, decrease drug side effects and improve antimicrobial activity. In this study, clove extract (C) was successfully used to synthesize silver nanoparticles (AgNP) to create AgNPC and AgNPCA (A = clarithromycin). The two compounds underwent different analytical methods consisting of SEM, EDS, DLS, UV-vis, FTIR and XRD. These nanoparticles were used against a variety of 10 pathogens and exhibited very good to intermediate antibacterial properties. AgNPC resulted in better antibacterial properties and smaller nanoparticle size. This study demonstrates the potential of clove extract mediated AgNP synthesis in combination with and without the antibiotic clarithromycin.

Inovirus-Encoded Peptides Induce Specific Toxicity in Pseudomonas aeruginosa

Pseudomonas aeruginosa is a common opportunistic pathogen associated with nosocomial infections. The primary treatment for infections typically involves antibiotics, which can lead to the emergence of multidrug-resistant strains. Therefore, there is a pressing need for safe and effective alternative methods. Phage therapy stands out as a promising approach. However, filamentous prophages (Pfs) commonly found in P. aeruginosa encode genes with phage defense activity, thereby reducing the efficacy of phage therapy. Through a genomic analysis of the Pf4 prophage, we identified a 102 bp gene co-transcribed with the upstream gene responsible for phage release (zot gene), giving rise to a 33-amino-acid polypeptide that we have named Pf4-encoded toxic polypeptide (PftP4). The overexpression of PftP4 demonstrated cellular toxicity in P. aeruginosa, with subcellular localization indicating its presence in the cell membrane and a subsequent increase in membrane permeability. Notably, PftP4 homologues are found in multiple Pf phages and exhibit specificity in their toxicity towards P. aeruginosa among the tested bacterial strains. Our study reveals that the novel Pf-encoded polypeptide PftP4 has the potential to selectively target and eradicate P. aeruginosa, offering valuable insights for combating P. aeruginosa infections.

Efficacy of Ethanol Extract of Sambiloto (Andrographis paniculata) Against Pneumonia-Causing Klebsiella pneumoniae

Klebsiella pneumoniae is one of the most common pathogens in nosocomial respiratory infections. Antibiotics are often used for the treatment of K. pneumoniae infections. Increased bacterial resistance to antibiotics is closely related to the success rate of infectious disease therapy. The use of plants as phytopharmacology is currently an alternative treatment. Some medicinal plants that have antibacterial and immunomodulatory activity are Sambiloto (Andrographis paniculata) with an active compound called andrographol. The purpose of this study was to provide a solution to the problem above by developing a phytopharmaceutical using bitter extract to inhibit the growth of K. pneumoniae bacteria. Two sputum samples from the laboratory confirmed Covid-19 patients with pneumonia infection at the Hospital. The sambiloto was extracted by using 96% ethanol. The extract was further analyzed for its antimicrobial activity and phytochemical compounds. There were two K. pneumoniae isolates, namely KpRNG and KpTRI. The active compounds were saponin and steroids. The antimicrobial activity of the ginger extract was measured with different concentrations of 25%, 50%, 75%, and 100%. Its inhibitory zone against K. pneumoniae was ranging from 5.8 to 7 mm or had a moderate inhibition category.

Advanced techniques and nanotechnologies for point-of-care testing

Hospitals and other healthcare facilities harbor a complex interplay of microbial pathogens. The correct understanding of pathogens distribution and evolution is therefore crucial for infections control and for the design of effective prevention strategies. In parallel, the integration of cutting-edge nanotechnologies for the early detection and monitoring of these specific target pathogens is considered the most effective approach to face nosocomial infections. In this context, point-of-care (POC) testing, also known as near-patient testing, is becoming increasingly important. In this review we provide a systematic insight into the recent scientific and technological advances in pathogen detection that explore advanced nanotechnologies to realize devices and nanobiosensors, with improved selectivity and sensitivity. In particular, we report on the most diffused and affordable nanotechnologies developed and still developing for POC testing, with the aim to increase the sensitivity, speed and accuracy of pathogens detection in different environments, from intensive care units to outside the laboratory and hospital settings. The text is sub-divided in several sections, each one focused on different type of nanomaterials and techniques actually employed.

Correlation Analysis Between Multi-Drug Resistance Phenotype and Virulence Factor Expression of Clinical Pseudomonas aeruginosa

Pseudomonas aeruginosa (PA), as a common pathogen of nosocomial infections, has been experiencing an increasing rate of drug resistance with the widespread use and abuse of antimicrobial drugs. High-drug-resistance and high-virulence phenotypes are two distinctive features of the strong pathogenicity of multi-drug-resistant PA. Exploring the characterization of virulence factor expression and its relationship with the multi-drug resistance phenotype is essential to reduce the further development of resistance as well as a high standard of infection prevention and control. A total of 50 PA isolated from clinical practice were collected. The Kirby-Bauer test was used for drug-sensitive screening, and the results showed that 16 strains were resistant and 16 strains were sensitive. The drug resistance rate of multi-drug-resistant PA against cefepime, cefazolin, ampicillin, and imipenem was up to 100%. The multi-drug-resistant groups were superior in producing pyocyanin and forming biofilm to the sensitive groups. The distribution of isolates with different swarming motility capacities and elastase levels did not show pronounced differences among the multi-drug-resistant and sensitive groups. In addition, biofilm formation was moderately associated with imipenem resistance. Among the strains with strong virulence factor expression, the gene bands showed little difference, suggesting that the gene is highly homologous. The virulence factor matrix analysis showed that there were different degrees of correlation among the 4 virulence factors. The correlation between multidrug-resistant PA and virulence factor expression is complex. PA, which were good at producing pyocyain and forming biofilm, were highly resistant to cephalosporins, beta-lactams and carbepenems; hence, such drugs are not proper for anti-infective treatment in clinics.

Evolution of a patient safety program in an academic medical center

Background The Academic Medical Center earned a 1-Star CMS designation and received an F on the Leapfrog Safety Grade in 2015, which led to leadership setting Clinical Quality Improvement as the #1 Strategic Priority. This paper presents the evolution of a structured patient safety program as a component of this plan to direct and motivate employees to succeed in reducing patient harm. Methods Data-driven quality improvement using simple, timely, actionable data drillable scorecards available to all employees was the cornerstone of the above strategic priority. A comprehensive patient safety program was developed utilizing three phases: Error Prevention Training, Improved Event Reporting, and the Chasing Zero Harm initiative. Results Improvement was achieved in Culture of Safety Survey domains of overall safety, event reporting, nonpunitive response to errors, and hand-off communication. Patient safety indicators and hospital-acquired infections improved on the Medical Center's internal scorecard and public reported data by >60%. These resulted in improvement in Leapfrog Safety Score from an F in 2015 to a B in 2023, and increase from CMS 1-Star to 2-Star rank in 2023. Adverse event reports and review with follow up increased by 45% between 2018 and 2023. A Chasing Zero harm program was initiated following establishment of these steps. Discussion A successful patient safety program, predicated on high reliability, can successfully be built with leadership commitment, development of safety culture, and performance improvement.

Analysis of the Effect of the Head of Room's Leadership Style and Nurse's Hand Hygiene Compliance on the Prevention of Nosocomial Infections in Hospital

This study aims to analyze the influence of the leadership style of the head of the room and nurses' handwashing compliance on the prevention of nosocomial infections in hospitals—quantitative research with a survey approach involving 123 respondents with a proportional random sampling method. Data acquisition was done using a questionnaire instrument to measure the perception of leadership style, compliance, and prevention of nosocomial infections, and it was analyzed using a correlation test. The results of the T-test showed a Sig. Value of 0.001 <0.05, and the F test showed a Sig. Value of 0.002 <0.05 with a calculated F value of 41.437 indicating a significant influence between the leadership style of the head of the room and handwashing compliance on the prevention of nosocomial infections. This study concludes that the leadership style of the head of the room and nurses' hand hygiene compliance plays an important role in efforts to prevent nosocomial infections.

The basis of bacteriological safety in the neonatal intensive care unit (literature review)

Background. According to world statistics, 7% of patients out of 100 in high-income countries and 15% of patients out of 100 in low- and middle-income countries develop infections related to medical care. As follows from the report of the World Health Organization, one in four cases of hospital sepsis that occurred in the intensive care unit is caused by hospital strains. On average, one in ten of these patients has a hospital-acquired infection that is fatal. The high-risk group includes patients in intensive care units, including newborns. In 2023, 28973 cases of neonatal infections (including intrauterine infection) were registered in medical organizations of the Russian Federation. The highest rates of neonatal morbidity were recorded in the Sverdlovsk Region (42.2%), the Trans-Baikal Territory (33.0%), the Novosibirsk Region (26.0%), the Chelyabinsk Region (22.4%), the Krasnoyarsk Territory (21.8%) and the Irkutsk Region (21.3%). Thus, infection prevention and control strategies aimed at both patients and their environment are of paramount importance in neonatal intensive care units.Objective. To summarize current relevant data on the prevention of hospital infections in neonatal intensive care units.Materials and methods. A literature review was conducted using the MEDLINE database (PubMed) as of December 2024 using keywords and a filter: randomized controlled trial, meta-analysis, systematic review.Results. This review summarizes the main data on the prevention of hospital infections in neonatal intensive care units. According to the literature, ensuring bacteriological safety in relation to the development of hospital infections depends on many factors: hand hygiene of medical personnel, organization of venous access control, disinfection of medical equipment and premises, compliance with the rules of asepsis and antiseptics when performing invasive manipulations, the introduction of modern approaches in the care of premature infants.Conclusion. There are many tasks in the intensive care unit that require innovative strategies to ensure the safe care of premature newborns. Joint efforts to standardize the processing of specialized equipment, maintain the cleanliness of the environment, comply with vascular access care protocols, adequate hand hygiene, and the active introduction of parents into newborn care are an integral part of the program aimed at preventing nosocomial infections. Active cooperation between the neonatal intensive care unit and the epidemiological service of the institution will allow us to develop a rational policy for risk management and monitoring of hospital infections.

Redox-Modulating Capacity and Effect of Ethyl Acetate Roots and Aerial Parts Extracts from Geum urbanum L. on the Phenotype Inhibition of the Pseudomonas aeruginosa Las/RhI Quorum Sensing System

Pseudomonas aeruginosa is an opportunistic pathogen that causes nosocomial infections of the urinary tract, upper respiratory tract, gastrointestinal tract, central nervous system, etc. It is possible to develop bacteremia and sepsis in immunocompromised patients. A major problem in treatment is the development of antibiotic resistance. Therefore, new preparations of natural origin are sought, such as plant extracts, which are phytocomplexes and to which it is practically impossible to develop resistance. Geum urbanum L. (Rosacea) is a perennial herb known for many biological properties. This study aimed to investigate the redox-modulating capacity and effect of ethyl acetate (EtOAc) extracts from roots (EtOAcR) and aerial parts (EtOAcAP) of the Bulgarian plant on the phenotype inhibition of the P. aeruginosa Las/RhI quorum sensing (QS) system, which primarily determines drug resistance in pathogenic bacteria, including biofilm formation, motility, and pigment production. We performed QS assays to account for the effects of the two EtOAc extracts. At sub-minimal inhibitory concentrations (sub-MICs) ranging from 1.56 to 6.25 mg/mL, the biofilm formation was inhibited 85% and 84% by EtOAcR and 62% and 39% by EtOAcAP extracts, respectively. At the same sub-MICs, the pyocyanin synthesis was inhibited by 17–27% after treatment with EtOAcAP and 26–30% with EtOAcR extracts. The motility was fully inhibited at 3.12 mg/mL and 6.25 mg/mL (sub-MICs). We investigated the inhibitory potential of lasI, lasR, rhiI, and rhiR gene expression in biofilm and pyocyanin probes with the PCR method. Interestingly, the genes were inhibited by two extracts at 3.12 mg/mL and 6.25 mg/mL. Antiradical studies, assessed by DPPH, CUPRAC, and ABTS radical scavenging methods and superoxide anion inhibition showed that EtOAcAP extract has effective antioxidant capacity. These results could help in the development of new phytocomplexes that could be applied as biocontrol agents to inhibit the phenotype of the P. aeruginosa QS system and other antibiotic-resistant pathogens.

Multiplex lateral flow test sensitivity and specificity in detecting influenza A, B and SARS-CoV-2 in adult patients in a UK emergency department

BackgroundRapid identification of individuals with acute respiratory infections is crucial for preventing nosocomial infections. For rapid diagnosis, especially in EDs, lateral flow devices (LFDs) are a convenient, inexpensive option with...

Prevalence, Characterization, and Proteomic Relatedness Among β-Lactam-Resistant Bacteria Throughout the Poultry Production Chain in Greece

Extended-spectrum-β-lactamase (ESBL) and carbapenemase-producing Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp. are associated with hospital-acquired infections and are commonly isolated across the poultry food production chain. Comprehensive data regarding the prevalence, spatiotemporal variations, and characterization of β-lactam-resistant bacteria in poultry farms and slaughterhouses is scarce. This study examines the prevalence and characteristics of β-lactam-resistant E. coli, K. pneumoniae, and Acinetobacter spp. isolated from poultry farms, slaughterhouses, and associated personnel in Greece. Strains were selectively isolated and identified via MALDI-TOF MS, which was also employed to identify possible relatedness. E. coli isolates were further classified into phylogenetic groups. The prevalence of β-lactam-resistant strains in farm and slaughterhouse environments was 15.0% (n = 15 strains)/57.3% (n = 71 strains) for E. coli, 11.0% (n = 11 strains)/1.6% (n = 2 strains) for K. pneumoniae, and 1.0% (n = 1 strain)/25.8% (n = 38 strains) for Acinetobacter spp., respectively. The prevalence of Acinetobacter spp. and E. coli on farmers’ skin was 16.7% (n = 2 strains) and 8.3% (n = 1 strain), correspondingly. Significantly higher E. coli isolation rates were observed in warmer seasons. All strains were multidrug-resistant and most carried ESBL/AmpC genes. Most E. coli isolates belonged to phylogroups A (41.4%, n = 36) and B1 (24.1%, n = 21). Proteomic analysis indicated relatedness among strains from different regions and seasons. Thus, poultry farms and slaughterhouses may serve as significant reservoirs of β-lactam-resistant strains of E. coli, K. pneumoniae, and Acinetobacter spp.

Extended spectrum betalactamase and Carbapenemase producing gram negative bacteria from healthcare workers gowns at Debre Berhan Comprehensive Specialized Hospital, Ethiopia

Extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing (CP) gram-negative bacteria are the major public health concerns. Gowns used by healthcare workers (HCWs) in daily practice are a source of hospital-acquired infections in hospital settings. The study aimed to determine the prevalence of extended-spectrum beta-lactamase and carbapenemase-producing gram-negative bacteria from gowns of healthcare workers at Debre Berhan Comprehensive Specialized Hospital, Amhara Regional State, Ethiopia. A hospital-based cross-sectional study was conducted from August to October 2022. A total of 226 swab samples were collected from gowns of HCWs and cultured on MacConkey agar. Bacterial identifications were done by standard biochemical tests. Screening for ESBL and carbapenemase production was done using CHROME agar. Confirmation of ESBL and carbapenemase production was done by the combination disk method and modified carbapenem inactivation method, respectively. Data were analyzed by using SPSS version 25. The overall contamination rate of gowns was 46.9% (106/226). Among 226 swab samples, a total of 117 (51.7%) gram-negative bacteria were isolated. Among these, the most frequent isolates were E. coli, accounted 36 (30.8%) followed by K. pneumoniae, 26(22.2%). The overall multi-drug resistance (MDR) rate was 65 (55.6%). Of the 117 isolates, 17(14.5%) and 12(10.3%) were ESBL and carbapenemase producers respectively. Gown type (p = 0.041), laundering practice (p = 0.045), number of gowns (p = 0.002), and gown washing frequency per week (p = 0.017).were significantly associated with bacterial contamination of gowns. In this study, the prevalence of ESBL and CP Gram-negative bacteria from gowns of healthcare workers was found to be alarming. Therefore, strict infection prevention and control practices, as well as good hygienic practices, should be implemented to reduce and prevent cross-contamination and the spread of antimicrobial-resistant strains in hospital settings.

Serratia Infections in Burn Care.

Serratia marcescens is an opportunistic nosocomial pathogen with significant implications for burn care due to its multidrug resistance, virulence, and ability to colonize hospital environments. This retrospective study, conducted at an American Burn Association Verified Burn Centre, reviewed 22 cases of S. marcescens infections from 2015 to 2020. Patients exhibited a mean total body surface area (TBSA) burned of 28% (range: 2-71%), with 68% sustaining burns >20% TBSA and 40.9% presenting with inhalation injuries. The pathogen was most commonly isolated from sputum (36%) and burn wound tissue (50%), with a mean time to positive culture of 8.7 days. Early-onset infections were associated with increased mortality, particularly in patients with major burns, as five out of seven such individuals succumbed to infection. The overall mortality rate was 23%, despite timely antibiotic administration. Targeted topical antimicrobials, such as Dakin's solution, nanocrystalline silver, and polyhexamethylene biguanide (PHMB), offer potential benefits but lack robust evidence for optimal use. Stronger clinical data are needed to guide their application and improve outcomes. These findings underscore the need for enhanced surveillance, refined treatment strategies, and research into S. marcescens management in burn care.

Effectiveness of negative pressure wound therapy in treating deep surgical site infections after spine surgery: a meta-analysis of single-arm studies

BackgroundOne of the common complications in spinal surgery patients is deep surgical site infections (SSIs). Deep SSIs refer to infections that involve the deeper soft tissues of the incision, such as the fascia and muscle layers. This complication can lead to prolonged hospitalization, repeated surgeries, and even life-threatening conditions. In recent years, Negative Pressure Wound Therapy (NPWT) has been widely used as an effective wound healing method in the management of post-surgical infections. However, there is a lack of systematic research and comprehensive reviews regarding the exact effectiveness of NPWT in the treatment of deep SSIs following spinal surgery. Therefore, we conducted this meta-analysis to explore the efficacy of NPWT in treating deep SSIs after spinal surgery, aiming to provide clearer evidence to support clinical practice.MethodsA comprehensive search of databases, including CNKI, Wanfang data, VIP data, CBM, PubMed, Embase, Cochrane Library, and Web of Science, was conducted for studies up to August 20, 2024, examining the use of NPWT in treating SSIs after spinal surgery. Using Stata 15.0 software, we employed either fixed or random models to calculate combined effect sizes, depending on the level of heterogeneity observed.ResultsOf the 571 publications initially screened, 19 studies meeting the inclusion criteria were selected for analysis. The meta-analysis revealed that the mean duration of vacuum sealing drainage (VSD) treatment was 17.45 days [95% confidence interval (CI) (11.63 days, 23.28 days)], and the mean number of VSD uses was 2.57 times[95% CI (1.53times, 3.60times)]. Additionally, the recurrence rate of infection post-discharge was 2% (95% CI = 0-4%). The reoperation rate for internal fixation in NPWT-treated patients was 4% (95% CI = 0-14%).ConclusionAvailable evidence supports the effectiveness of NPWT in treating deep SSIs following spinal surgery, suggesting its clinical utility. However, further studies are needed to compare NPWT with other treatment options for SSIs management.RegistrationsPROSPERO CRD42024612412.

Risk Factors for Mortality Among Older Adults with Hospital-Acquired Bloodstream Infections in the Intensive Care Unit: A Multicenter Cohort Study.

We aimed to investigate risk factors for mortality among older adults (≥ 75years) with hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU). We included patients aged ≥ 75years with HA-BSI in ICU from the EUROBACT-2 cohort (2019-2021). Univariable and multivariable analyses were conducted to identify predictors of 28-day mortality. The cohort included 563 patients (median age 80, 39% women). Mortality at 28day was 50%. Factors associated with mortality in multivariate analysis were admission due to COVID-19, failure to achieve source control, and higher SOFA. Among older adults with Gram-negative BSI, corticosteroid administration for septic shock was an additional factor. Among functionally independent patients, age itself was not associated with mortality. HA-BSI in older adults in ICU are associated with high mortality. Inadequate source control is a significant modifiable risk factor. The use of corticosteroids in ICU management of older adults should be further investigated.

Cinnamic Acid Compounds (p-Coumaric, Ferulic, and p-Methoxycinnamic Acid) as Effective Antibacterial Agents Against Colistin-Resistant Acinetobacter baumannii

Colistin-resistant Acinetobacter baumannii (COLR-Ab) is an opportunistic pathogen commonly associated with nosocomial infections, and it is difficult to treat with current antibiotics. Therefore, new antimicrobial agents need to be developed for treatment. Based on this information, we investigated the antimicrobial, antibiofilm, and combination activities of p-coumaric acid (p-CA), ferulic acid (FA), and p-methoxycinnamic acid (p-MCA) against five COLR-Ab isolates. p-CA, FA, and p-MCA exhibited antimicrobial activity against COLR-Ab isolates, with minimum inhibitory concentration (MIC) values in the range of 256–128 µg/mL, 1024–512 µg/mL, and 512–128 µg/mL, respectively. The combination effects of the compounds with colistin (COL) were evaluated using a checkerboard synergy test. The combinations exhibited a synergistic effect and caused a 128- to 16-fold decrease in COL MIC values. In addition, the biofilm production capacities of the COLR-Ab isolates and the antibiofilm activities of the compounds were determined using the microtitre plate-based crystal violet (CV) technique. The compounds showed effective antibiofilm activity against strong and moderate biofilm-producing isolates, inhibiting biofilm formation by 77.5% and 19.7%. Spectrometric measurements were used to examine the effect of compounds on membrane permeability; 1.9-, 1.66-, and 1.34-fold increases in absorbance values were observed at MIC concentrations of p-CA, FA, and p-MCA, respectively. Furthermore, morphological changes caused by the compounds in the isolate were observed using scanning electron microscopy (SEM) micrographs. According to the WST assay, the compounds did not show any statistically significant cytotoxic effect on the cells (p > 0.05). These findings indicate that p-CA, FA, and p-MCA may be potential new alternative candidates against resistant A. baumannii.

Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.

Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population. The emergence of growth-friendly techniques has greatly benefited patients with early-onset deformity, allowing for correction and control of deviation without interrupting trunk growth, which is often already compromised in these patients. We describe the surgical technique and present preliminary clinical outcomes for a novel approach which combines self-sliding screws that allow for trunk growth with impaction of translumbosacral rods for distal fixation. Candidates for the technique were patients with myelomeningocele and congenital lumbar kyphosis, inability to assume supine position, and a history of skin ulcers, recurrent osteomyelitis and poor weight gain. They all lacked sensory or motor function below the level of the myelomeningocele. They underwent the same reconstruction technique after kyphectomy which combines self-sliding screws that allow for trunk growth with impaction of the translumbosacral rods for distal fixation. Case 1: Female; 4.5years old at surgery; 5year follow-up. 1 complication: loosening of one blocker. The child is doing well and did not require surgical revision. Mean growth per year: 9.5mm. Case 2: Male; 7.4Years old at surgery; 4year follow-up. 1 complication: post-surgical infection which required 2 debridements in the operating room and prolonged antibiotic therapy. Mean growth per year: 6mm. Case 3: Female; 5.5Years old at surgery; 27month follow-up. No complications reported so far. Mean growth per year: 9.42mm. None of the cases showed signs of sacral osteolysis or rod migration. To our knowledge, this is the first study that combines sliding screws with translumbosacral rod impaction. Although this technique has proven to be safe and effective, we are aware that the number of cases is limited and the follow-up is short. Further studies are necessary to confirm the method.

A Four-Year Study of Antibiotic Resistance, Prevalence and Biofilm-Forming Ability of Uropathogens Isolated from Community- and Hospital-Acquired Urinary Tract Infections in Southern Italy

The aim of this study was to investigate the differences between nosocomial and community microorganisms isolated from patients with UTI by determining their bacterial profile, antibiotic resistance and ability to produce biofilms. A retrospective study, based on bacterial isolates from consecutive urine samples collected between January 2019 and December 2023, was conducted at a university hospital. The main pathogens isolated from both community and hospital samples were the same, but their frequency of isolation differed. Compared with community-associated cases, hospital-associated infections have more isolates of Acinetobacter baumanii complex. In contrast, Proteus mirabilis isolates were more prevalent in community than in hospital infections. In both hospital and community isolates, gram-positive bacteria showed a lower overall antimicrobial resistance (22%) compared to gram-negative bacteria (30%). The data demonstrated that individual strains exhibited disparate degrees of capacity for biofilm formation. Additionally, the data indicate an inverse correlation between biofilm production and antibiotic resistance. Isolates from community patients exhibited lower capacities for biofilm production in comparison to the capacities demonstrated by microorganisms isolated from nosocomial patients (29% and 35%, respectively). Area-specific surveillance studies can provide valuable information on UTI pathogens and antimicrobial resistance patterns, which can be useful in guiding empirical treatment.

Long, Synthetic Staphylococcus aureus Type 8 Capsular Oligosaccharides Reveal Structural Epitopes for Effective Immune Recognition.

Staphylococcus aureus is a Gram-positive bacterium that is responsible for severe nosocomial infections. The rise of multidrug-resistant strains, which can pose significant health threats, prompts the development of new treatment interventions, and much attention has been directed at the development of prophylactic and therapeutic vaccination strategies. Capsular polysaccharides (CPs) are key protective elements of the S. aureus cell wall and have been proposed as promising candidate antigens. Thirteen different CP serotypes have been identified to date, of which types 5 and 8 are the most prominent. CP8 is composed of trisaccharide repeating units that are built up from an N-acetyl-4-O-acetyl-β-d-mannosaminuronic acid, that carries a C-4-O-acetyl, an N-acetyl-α-d-fucosamine, and an N-acetyl-α-l-fucosamine. Synthetic oligosaccharides are valuable tools to unravel the immunogenicity of bacterial oligosaccharides at the molecular level. However, the rare monosaccharides, cis-glycosidic linkages, and O-acetylation represent significant challenges for the synthesis of CP8 fragments. Here the stereoselective assembly of well-defined CP8 fragments, comprising a trimer, hexamer, nonamer, and dodecamer, is presented. This is the first time that fragments larger than a single repeating trisaccharide, which has been proven to be insufficient for antigenic activity, have been assembled. Structural studies have revealed a linear conformation for the oligosaccharides, with each trisaccharide repeat tilted ∼90° with respect to the flanking repeats, which is stabilized by the acetyl groups that prevent rotation around the glycosidic linkages. The N-acetyl groups in each repeating unit point in the same direction, generating a hydrophobic flank in the trisaccharide repeats. We applied the oligomers to generate model glycoconjugate vaccine modalities, which we then used to raise anti-CP8 antibodies. The antibody interaction and immunization studies have revealed a clear length dependent structure-activity relationship for the oligosaccharides, with an oligosaccharide of at least three repeating units required for an adequate immune response.

Comparative antibacterial activity of clove extract against Pseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen belonging to the γ-proteobacteria family, known to cause pneumonia linked with ventilator use and nosocomial infections. With the increasing prevalence of antibiotic-resistant bacteria, there is a pressing need to identify alternatives to conventional antibiotics. Plant-derived substances (PDSs) offer potential not only as antibacterial agents but also as modulators of antibiotic resistance. In this study, diffusion assay using disc agar, and the minimum inhibitory concentration (MIC) assay of each imipenem, amoxicillin-clavulanic acid, and clove extract was determined. The clove extract was analyzed via the UHPLC/MS, and the checkerboard assay was employed to evaluate the potential synergistic effects of combining clove extract with both antibiotics. The combination of clove extract to each antibiotic led to a significant reduction in their respective MICs. Moreover, each antibiotic exhibited synergistic effects on the fractional inhibitory concentration value (FIC) of clove extract. The analysis identified seventeen components in the clove extract, predominantly flavonoids and phenolic compounds. The antibacterial efficacy of the Syzygium aromaticum Myrtaceae extract against P. aeruginosa indicated its potential as a promising antibacterial agent capable of enhancing the effectiveness of existing medications.