Incidence Of Bacterial Infections Research Articles

Significance of absolute neutrophil count before allogeneic hematopoietic stem cell transplantation in adult patients with aplastic anemia.

The impact of absolute neutrophil count (ANC) before allogenic hematopoietic stem cell transplantation (HSCT) on the outcomes for patients with aplastic anemia (AA) remains unclear. We retrospectively evaluated the relationship between ANC before transplantation and patient outcomes, involving 883 adult Japanese patients with AA who underwent allogeneic HSCT as their first transplantation between 2008 and 2020. Patients were divided into three groups based on ANC: 0/µL (n = 116); 1-199 (n = 210); and ≥ 200 (n = 557). In the low ANC groups (ANC < 200), patient age was higher, previous anti-thymocyte globulin (ATG) treatments were infrequent, duration from diagnosis to transplantation was shorter, hematopoietic cell transplantation-comorbidity index (HCT-CI) was higher, ATG-based conditioning was used infrequently, and peripheral blood stem cell from related donor and cord blood were used frequently. In multivariate analysis, patient age, previous ATG treatment, HCT-CI, stem cell source, and ANC before transplantation were significantly associated with 5-year overall survival (OS) ("ANC ≥ 200": 80.3% vs. "ANC 1-199": 71.7% vs. "ANC 0": 64.4%). The cumulative incidence of bacterial infection, invasive fungal disease, and early death before engraftment were significantly higher in the low ANC groups. Among patients with ANC of zero before transplantation, younger patient age, shorter duration from diagnosis to transplantation, HCT-CI of 0, and bone marrow from related donor as stem cell source were significantly associated with better OS. Consequently, ANC before allogeneic HSCT was found to be a significant prognostic factor in adult patients with AA. Physicians should pay attention to ANC before transplantation.

Retrospective clinical study on cryopreservation-free integrated autologous hematopoietic stem cell transplantation model for newly diagnosed multiple myeloma

Objective: To explore the efficacy and safety of cryopreservation-free integrated autologous hematopoietic stem cell transplantation (HSCT) model for patients with multiple myeloma. Methods: A total of 96 patients with newly diagnosed multiple myeloma (NDMM) between July 31, 2020, and December 31, 2022, were retrospectively analyzed, of which 41 patients in the observation group received integrated non-cryopreserved transplantation mode. After hematopoietic stem cells were mobilized and collected, melphalan was started immediately for pre-transplant conditioning, and non-cryopreserved grafts from the medical blood transfusion refrigerator were directly injected intravenously into the patient within 24-48 h after the melphalan conditioning. The control group consisted of 55 patients who received traditional transplantation mode. After hematopoietic stem cells were collected, stem cell cryopreservation was performed in liquid nitrogen, and then the transplant plans were started at the right time. All patients received mobilization of autologous hematopoietic stem cells using the G-CSF combined with the plerixafor. Results: ① A total of 34 patients (82.9% ) with VGPR plus CR in the observation group were significantly higher than 33 patients (60.0% ) in the control group (P=0.016). ②Compared with the control group, the incidence of grade 1 oral mucosal inflammation was higher in the observation group (P<0.001) ; however, the incidence of grades 2 and 3 oral mucosal inflammation was lower (P=0.004, P=0.048), and neither group experienced grade 4 or above oral mucosal inflammation. The incidence of grade 1 diarrhea was higher in the observation group (P=0.002), whereas the incidence of grade 3 diarrhea was lower (P=0.007). No statistically significant difference was observed in the incidence of grade 4 diarrhea (P=0.506), and neither group experienced grade 5 diarrhea. ③ The incidence of bacterial infection in the observation group was lower than that in the control group (34.1% vs 65.5%, P=0.002), whereas no statistically significant difference was observed in the incidence of fungal infection (29.3% vs 31.4%, P=0.863) and viral infection (4.88% vs 3.64%, P=0.831). ④No statistically significant difference was observed in the implantation time of granulocytes and platelets between the observation and control groups [10 (8-20) days vs 11 (8-17) days, P=0.501; 13 (10-21) days vs 15 (10-20) days, P=0.245]. ⑤ All patients did not receive lenalidomide treatment 100 days post-transplantation. At 30 days post-transplantation, the CTL, NK, and Th cell counts in the observation group were lower than those in the control group (P<0.001, P=0.002, P=0.049), and the NKT cell counts were higher than those in the control group (P=0.024). At 100 days post-transplantation, the CTL, NKT, and Th cell counts in the observation group were higher than those in the control group (P=0.025, P=0.011, P=0.007), and no statistically significant difference in NK cell counts was observed between the two groups (P=0.396). ⑥ The median follow-up was 18 (4-33) months. The overall 2-year survival rates of the observation and control groups post-transplantation were 91.5% and 78.2%, respectively (P=0.337). The recurrence-free survival rates were 85.3% and 77.6%, respectively (P=0.386), and the cumulative recurrence rates were 9.8% and 16.9%, respectively (P=0.373) . Conclusion: In NDMM, the cryopreservation-free integrated autologous HSCT model can achieve similar therapeutic effects as traditional transplantation models, with lower rates of severe mucosal inflammation and infection compared with traditional transplantation models.

Correlation of CD4+ count and viral load with urinary tract infection and antimicrobial resistance pattern of bacterial uropathogens among HIV patients in Wolaita Sodo, South Ethiopia.

The permanence of HIV patients in healthcare provision centers exposes their weak immunity to various nosocomial microorganisms that migrate into and out of the hospital environment. The incidence of bacterial infections, including urinary tract infection, was inversely correlated with CD4+ T cells. Urinary tract infection (UTI) is one of the clinical problems among HIV patients. There was scarcity of published data on the relationship between viral load, CD4+ level, and UTI. This study aimed to assess the relationship between viral load and CD4 with bacterial UTI among HIV patients. The cross-sectional study was conducted in the Wolaita Sodo Town Health Center ART clinic. The socio-demographic data were collected using a pre-designed questionnaire. Patients' charts were reviewed to collect the current CD4 and viral load. Urine specimens were inoculated on blood agar, cysteine lactose electrolyte deficient (CLED) agar, and MacConkey agar, and bacterial species were finally identified using various biochemical methods. Antimicrobial sensitivity testing was conducted using standard microbiological tests. Bivariate and multivariate analyses were employed to describe the association between pairs of variables and to examine the relationship between independent variables and dependent variables. In this study, the overall prevalence of urinary tract infection (UTI) was 13.7%. Escherichia coli, Staphylococcus aureus, Pseudomonas aeroginosa, Staphylococcus saprophyticus, Proteus mirabilis, and Klebsiella pneumoniae were bacterial uropathogens detected in this study. E.coli (45.7%) was the predominant isolate followed by S. aureus (14.3%). Positive correlation between CD4+ count and urinary tract infection was detected and found statistically significant (r = 0.288 p > 0.01), whereas the viral load and urinary tract infection negatively correlated and showed statistically significant association (p < 0.01). The resistance rate of E.coli was 94%, 75%, and 69% to ciprofloxacin, norfloxacin, and cefepime, respectively. This study revealed that E.coli exhibited 94% and 75% resistance to amoxicillin-clavulanic acid and tetracycline, respectively. K. pneumoniae demonstrated complete resistance (100%) to amoxicillin-clavulanic acid, tetracycline, and trimethoprim-sulfamethoxazole, while showing 100% susceptibility to ciprofloxacin and nitrofurantoin. In the present study, the magnitude of the multi-drug resistance (MDR) was found to be 80%. CD4+ count, combination of antiretroviral therapy (ART) drugs, and a history of hospitalization were risk factors for urinary tract infection. In the current study, urinary tract infection emerged as a significant health concern among people living with HIV following their ART. The occurrence of urinary tract infection among HIV patients could be influenced by multifactorial factors that require further study. The CD4+ count was positively correlated with the prevalence of UTI, whereas the viral load was negatively correlated. The CD4+ count, combination of ART, and history of hospitalization were independent risk factors for UTI. The prevalence of MDR bacterial pathogens were notably high. Therefore, the treatment of UTI in HIV patients should be prescribed based on antibacterial susceptibility testing results.

Study of synergetic effect between BODIPY and ZnO on visible light-enhanced antibacterial activity

High incidence of bacterial infections and the growing of drug-resistant bacteria to conventional antibiotics have become great concerns. Developing new antibacterial agents and methods to inhibit bacterial-resistance have attracted great research interest. Due to their multiple antibacterial mechanisms, light-induced antibacterial materials are promising to combat antibiotic-resistant bacteria. In the present work, visible light response ZnO-based nanocomposite (BIN-ZnO) was prepared by nano-ZnO modified with a novel boron dipyrromethene photosensitizer (BIN) via simple coordination-driven self-assembly reaction. Compared with the individual BIN and ZnO, BIN-ZnO shows higher visible light-enhanced antibacterial activity against E. coli and S. aureus. This is attributed to the synergism between BIN and ZnO, which overcome high aggregation of BIN and insensitivity to visible light of ZnO. And The antibacterial mechanism study indicates that synergism between BIN and ZnO increases ROS yields and accelerates release of Zn ions, which is beneficial for higher antibacterial activity.

Lung volume measurement using chest CT in COVID-19 patients: a cohort study in Japan

ObjectiveThis study aimed to investigate the utility of CT quantification of lung volume for predicting critical outcomes in COVID-19 patients.MethodsThis retrospective cohort study included 1200 hospitalised patients with COVID-19 from...

Influence of surgical scrubs outside the operation theatre on post-operative infections - A systematic review.

Healthcare workers (HCWs), which include surgeons, anaesthesiologists, nurses, technicians, and other non-medical staff working in the operation theatre (OT), change to surgical scrubs for providing designated services. This study was intended to investigate the association of moving in and out of OT to other hospital areas without changing scrubs and its impact on bacterial infection. After PROSPERO registration, we performed a systematic review to compare the occurrence of surgical site infections (SSIs) with or without the movement of HCWs outside OT. We searched PubMed, Scopus, and Cochrane Library using relevant keywords. RoB-2 and ROBINS-E tools were used to assess the risk of bias in randomised controlled trials (RCTs) and observational studies, respectively. We identified six articles that fulfilled the inclusion criteria: three RCTs and three observational studies. A risk of bias assessment revealed an overall low bias in the RCTs and an overall high bias in the observational studies. The analysis revealed a comparable incidence of bacterial infection in terms of colony-forming units when scrubs when HCWs moved in and out of OT with the same scrubs. A meta-analysis was not performed due to heterogeneity in participants and the OT set-up, as well as fewer studies and sample size. The evidence is insufficient to suggest that wearing scrubs outside the OT could increase the incidence of SSI in surgical patients or transmit the organisms to patients, causing infection. The present review neither supports nor is against wearing surgical scrubs outside OT premises.

Microbiological Findings, Infection Risk Factors and Complications Among Children after Tracheostomy

Introduction. Bacterial infection of the respiratory tract is highly common among pediatric patients with tracheostomy, yet there is no wide knowledge about the prevalence of different airway microbes, the incidence of bacterial infection, infection risk factors, and complications. The aim of the study was to analyze the prevalence of airway microbes, the incidence of bacterial infection, infection risk factors, and complications. Methods. Retrospective data of officially reported cases were collected from 2018 to 2022 at Riga Children's Clinical University Hospital (RCCUH). Demographic factors, airway microbiological findings, tracheostomy-related complications, underlying conditions, and outcomes for 37 patients were gathered from the hospital's database Andromeda. The data were analyzed using MS Excel. This study received ethical approval from RSU Ethics Committee. Results. Microbiological analyses were done in 78.3% (n=29) of the cases. Most cultures were obtained from airway aspirate. Altogether 46 different species of microbes were identified. The most frequently identified bacteria were Pseudomonas aeruginosa (in 72.4% of the cases; n=21) and Staphylococcus aureus (65.5%; n=19). Forty-eight percent (n=18) of the patients had respiratory tract infections that required hospitalization. Overall, there were 60 hospitalization episodes of which 51.6% (n=31) were caused by pulmonary bacterial infection, 25.0% (n=15) by non-bacterial infection, and 0.05% (n=3) because of local wound infection. The rest 18.3% (n=11) of hospitalization episodes were due to granulation tissue. The risk factor that showed the greatest significance in the development of bacterial infection was ventilator dependency. Formation of granulation tissue in the airways was found to be the most common complication among pediatric patients with tracheostomy. Conclusion. This study summarizes the most common pathogens, risk factors, and complications, which should be considered while treating pediatric patients after tracheostomy. The results of this study demonstrate that P. aeruginosa and S. aureus have the highest prevalence among these patients. This research is currently used to develop guidelines for pediatric patients with tracheostomy care in RCCUH. Keywords: pediatric tracheostomy; respiratory infections; tracheostomy complications.

Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults

BackgroundThe incidence of sepsis increases significantly with age, including a high incidence of bacterial infection in the old adults. Eosinopenia and the CIBLE score have been proposed in critically ill adults and in internal medicine wards. This study aimed to assess whether a low eosinophil count was associated with acute bacterial infection among hospitalized older adults, and to find the most efficient eosinophil count cut-off to differentiate acute bacterial infection from other inflammatory states.MethodsThis was a prospective study from July 2020 to July 2022 in geriatric wards of the University Paul Brousse Hospital (Villejuif, France) including patients aged of 75 y/o or over suffering from fever or biological inflammation. Acute bacterial infection was assessed using biological identification and/or clinical and radiological data.ResultsA total of 156 patients were included. Eighty-two (53%) patients suffered from acute bacterial infection (mean age (SD) 88.7 (5.9)). Low eosinophil count was independently associated with acute bacterial infection: OR [CI95%] 3.03 [1.04–9.37] and 6.08 [2.42–16.5] for eosinophil count 0–0.07 G/L and 0.07–0.172 G/L respectively (vs. eosinophil count > 0.172 G/L). Specificity and sensitivity for eosinophil count < 0.01 G/L and CIBLE score were 84%-49% and 72%-62%, respectively with equivalent AUCs (0.66 and 0.67).ConclusionEosinophil count < 0.01 G/L is a simple, routinely used and inexpensive tool which can easily participate in antibiotic decisions for older adults. Further studies are needed to assess clinical benefits.Trial registrationThe study was registered at Clinical trial.gov (NCT04363138–23/04/2020).

Impact of Antibacterial Prophylaxis on Morbidity-Mortality of Patients with Myeloid Neoplasms Treated with Non-Intensive Venetoclax Combinations

Background and aims: The addition of Venetoclax (VEN) to the treatment of myeloid neoplasms, particularly newly diagnosed and relapse/refractory (R/R) Acute Myeloid Leukemia (AML), has shown improved responses compared to hypomethylating agents (HMA) in unfit patients. Nevertheless, side effects derived from deep cytopenias (infections) could potentially be a caved of such strategy. The use of antibacterial prophylaxis in this setting is controversial and its employment heterogeneous across centers, making difficult to draw conclusions from real-world studies. In this study we aimed to ascertain whether the use of antibacterial prophylaxis has an impact on the incidence of bacterial infections, hospitalization rates, infection severity, and mortality due to the infection. Finally, we also aimed to identify potential risk factors for bacterial infections. Methods: Retrospective data collection of patients with de novo, R/R or secondary AML, High Risk Myelodisplastic Syndrome and accelerated phases of Myeloproliferative Neoplasms treated with HMA or low dose cytarabine + VEN between January 2018 and May 2023 in 10 Spanish centers. Baseline characteristics and infectious episodes [presented as Microbiologically Documented Bacterial Infections (MDBI) or Clinically Documented infections without Isolation (CDI)], or febrile neutropenia without isolation or focus (FN) were recorded. Confirmed or suspected infections of parasites/fungi/viruses were excluded in this study. For each event, antibacterial prophylaxis, days of hospitalization, severity, disease status and dead due to infectious events/FN were collected. Results: In total, 165 patients have been included (clinical characteristics summarized in Table 1). VEN was initially used as 28 days/cycle and it had to be adjusted in 78 (48.75%) patients, mainly due to cytopenias and infections. The univariate analysis showed that infectious events and FN occurred more frequently in patients with high ELN risk than in those with Intermediate/favorable (OR; 2.71, 95% CI; 1.03-7.11, p = 0.041). In our cohort, 175 infections (MDBI/CDI) or FN occurred in 113 patients (68.5%) with an incidence of 26.1/100 cycles. These episodes correspond to 70 (40%) cases of MBI, 59 cases of CDI (33.7%) and 46 (26.3%) cases FN, with a median of 1 episode per patient (range 1-5). Most events occurred in the first (85; 48.9%) and second cycle (43; 24.7%) with a median of cycles at the moment of the event of 2 (p25-p75: 1-3) and a median time from VEN start to episode of 44 days (p25-p75: 18-105) because infections/FN usually led to delays on subsequent cycles. Considering the total number of events in patients with at least first disease evaluation available at the time of infection, only 48 (31%) had cytologic response (&amp;lt;5% blasts). Table 1 shows type of episode/isolation/focus. Antibacterial prophylaxis was used in 48 patients (29.5%), primarily with quinolones (levofloxacin 74%, ciprofloxacin 23%) according to physician decision. Incidence of infections (MDBI/CDI) or FN was lower in patients with antibacterial prophylaxis (OR; 0.37, 95% CI; 0.18-0.74, p = 0.05). Additionally, the median number of infections was lower in prophylaxis group (0.77 vs 1.18; p= 0.004). However, no differences were observed between both groups regarding hospitalization incidence or infection severity (defined as need of vasoactive drugs, high-flow oxygen therapy or deaths caused by the infectious episode). Microbiological isolations were significantly higher in non-prophylaxis group with infections (45.6% vs 23.7%, p 0.015). Incidence of multidrug-resistant organisms was 10.2% among all patients, with no differences between groups neither in Clostridioides difficile incidence (3.6%). In the competitive risk survival analysis, cumulative incidence of death from MBI/CDI or FN cause showed no differences between patients receiving or not antibacterial prophylaxis ( p= 0.98) (Figure 1). Conclusions: Our data suggest that avoiding antibacterial prophylaxis in non-intensive VEN-based treatments may result in a higher incidence of FN and infectious events, but it does not lead to impaired outcomes in terms of severity and/or mortality related to infections. Having a greater availability of microbiological isolations could enable more targeted antibiotic therapy, avoiding drug resistance. Additional data from the prophylaxis cohort will be included in the presentation.

Post-transplantation cyclophosphamide is associated with increased bacterial infections.

Post-transplant cyclophosphamide (PTCy) is increasingly used to reduce graft-versus-host disease after hematopoietic cell transplantation (HCT); however, it might be associated with more infections. All patients who were ≥2 years old, receiving haploidentical or matched sibling donor (Sib) HCT for acute leukemias or myelodysplastic syndrome, and either calcineurin inhibitor (CNI)- or PTCy-based GVHD prophylaxis [Haploidentical HCT with PTCy (HaploCy), 757; Sibling with PTCy (SibCy), 403; Sibling with CNI-based (SibCNI), 1605] were included. Most bacterial infections occurred within the first 100 days; 953 patients (34.5%) had at least 1 infection and 352 patients (13%) had ≥2 infections. Patients receiving PTCy had a greater incidence of bacterial infections by day 180 [HaploCy 46%; SibCy 48%; SibCNI 35%; p < 0.001]. Compared with the SibCNI without infection cohort, 1.99-fold, 3.33-fold, 2.78-fold, and 2.53-fold increased TRM was seen for the HaploCy cohort without infection and HaploCy, SibCy, and SibCNI cohorts with infection, respectively. Bacterial infections increased mortality [HaploCy (HR1.84, 99% CI: 1.45-2.33, p < 0.0001), SibCy cohort (HR,1.68, 99% CI: 1.30-2.19, p < 0.0001), and SibCNI cohort (HR,1.76, 99% CI: 1.43-2.16, p < 0.0001). PTCy was associated with increased bacterial infections regardless of donor, and bacterial infections were associated with increased mortality irrespective of GVHD prophylaxis. Patients receiving PTCy should be monitored carefully for bacterial infections following PTCy.

Planning and development of an antimicrobial stewardship program in penitentiary facilities: strategies to optimize therapeutic prescribing and reduce the incidence of antibiotic resistance.

In correctional facilities, due to the high incidence of bacterial infections, antibiotics are widely prescribed. As a result, it may occur a massive and improper use of antibiotics, which promotes the development of antibiotic-resistant bacteria. However, in literature, specific experiences, interventions or guidelines aimed to optimize their prescription within prisons are sporadic. In an Italian hospital where belong patients from four penitentiary institutions, a multidisciplinary team has implemented an antimicrobial stewardship project. The aim of the project was to reduce the incidence of antibiotic resistance in penitentiary institutions by optimizing and rationalizing antibiotic prescribing. Following the analysis of microbiological prevalence and antibiotic consumption data within correctional facilities, the Antimicrobial Stewardship Team developed operational tools to support prison healthcare staff to manage properly antibiotic therapies. The analysis showed a gradual increase in antibiotic resistance: in 2021 the prevalence of resistant microorganisms was 1.75%, four times higher than in 2019. In contrast, between 2019 and 2021, antibiotic consumption decreased by 24%. Based on consumption data, pharmacy has drafted an antibiotic formulary for correctional facilities, supplemented with guidelines and data sheets, and also developed a prescription form for critical antibiotics. Results showed an increasing incidence of antibiotic resistance within prisons, highlighting the need to establish a dedicated antimicrobial stewardship program. This project may impact positively not only on prisoners, but also for the entire community, as prisons can be considered as places of health education and promotion.

Metagenomic next-generation sequencing in detecting pathogens in pediatric oncology patients with suspected bloodstream infections.

Studies on mNGS application in pediatric oncology patients, who are at high risk of infection, are quite limited. From March 2020 to June 2022, a total of 224 blood samples from 195 pediatric oncology patients who were suspected as bloodstream infections were enrolled in this study. Their clinical and laboratory data were retrospectively reviewed, and the diagnostic performance of mNGS was assessed. Compared to the reference tests, mNGS showed significantly higher sensitivity (89.8% vs 32.5%, P < 0.001) and clinical agreement (76.3% vs 51.3%, P < 0.001) in detecting potential pathogens and distinguishing BSI from non-BSI. Especially, mNGS had an outstandingperformance for virus detection, contributing to 100% clinical diagnosed virus. Samples from patients with neutropenia showed higher incidence of bacterial infections (P = 0.035). The most identified bacteria were Escherichia coli, and the overall infections by gram-negative bacteria were significantly more prevalent than those by gram-positive ones (90% vs 10%, P < 0.001). Overall, mNGS had an impact on the antimicrobial regimens' usage in 54.3% of the samples in this study. mNGS has the advantage of rapid and effective pathogen diagnosis in pediatric oncology patients with suspected BSI, especially for virus. Compared with reference tests, mNGS showed significantly higher sensitivity and clinical agreement in detecting potential pathogens and distinguishing bloodstream infections (BSI) from non-BSI. mNGS is particularly prominent in clinical diagnosed virus detection. The incidence of bacterial infection was higher in patients with neutropenia, and the overall infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria. mNGS affects the antimicrobial regimens' usage in more than half of patients.

ANTIBACTERIAL POTENTIAL OF EGGPLANT FRUIT (Solanum melongena L) ETHANOL EXTRACT AGAINST Propionibacterium acnes BACTERIAL GROWTH

Acne is one of the skin problems that, without our realizing it, can reduce self-confidence, despair, and even depression among teenagers and young adults. The incidence of bacterial infections is increasing with the increasing cases of resistance of bacteria, such as Propionibacterium acnes, to the side effects of anti-acne drugs. Indonesia has many plants that are beneficial to humans and have properties for treating and improving health, one of which is the eggplant. The purpose of this study is to test whether eggplant has antibacterial activity against P. acnes. The eggplant was extracted using a maceration extraction method. For antibacterial activity, well diffusion agar was used with extract concentrations of 60%, 70%, 80%, and 90%. The inhibition zones of the ethanol extract of S. melongena at 60%, 70%, and 80% concentrations were 13,76 mm, 18,63 mm, and 20,79 mm, respectively, with the highest inhibition zone at 90% concentration at 20,64 mm. The ethanolic extract of S. melongena has a strong inhibitory effect on P. acnes. Keywords: antibacterial activity, Solanum melongena L, maceration, Propionibacterium acnes.

Improving Outcomes with Haploidentical Stem Cell Transplantation [HaploSCT] in Children Using Post-transplant Cyclophosphamide: a Single Center Experience.

Haplo-identical stem cell transplant using post-transplant cyclophosphamide is increasingly being used in children without a matched sibling donor. Between 2010 and June 2021, 127 children underwent 138 transplants with a median age of 7.1years for malignant and non-malignant disorders. Conditioning regimens included both myeloablative and reduced intensity regimens with peripheral blood stem cells as the main graft source. Engraftment occurred in 113 [81.9%] at a median of 16days [range: 10-32] with primary graft failure in 10.2%. Cumulative incidence of grade II-IV acute graft versus host disease (GVHD) was 49.5% and chronic GVHD in 40.7%. Majority [92.7%] had at least one infection with 31% incidence of bacterial infection, 76% incidence of viral and 16% incidence of fungal infection. The 2-year overall survival (OS) is 54.9 ± 4.6% with a lower survival among young children aged 0-5years [28.2 ± 6.4%] compared to 5-10years [71.3 ± 6.8%] and 11-15years [55.7 ± 8.8%] [p = 0.032]. 2-year OS has gradually improved from 25.0 ± 2.1% for 2010-2013 to 47.5 ± 6.2% for 2014-2017 and 67.1 ± 6.6% for 2018-2021 [p = 0.049]. On multivariate analysis, bacterial infection [p = 0.017], invasive fungal disease [p = 0.002] and graft failure [p = 0.029] negatively impacted overall survival. Haplo-identical SCT with post-transplant cyclophosphamide is a reasonable option for children who do not have a matched sibling donor. Strategies to reduce graft failure, infection related mortality and GVHD needs to be explored.

Abstract PO-081: Patterns of immune susceptibility in young, non-smoking, oral cancer patients

Abstract Introduction: Oral squamous cell carcinoma (OSCC) is peculiarly increasing in non-smokers, many of whom are younger than traditional, smoking related OSCC. The cause of this trend is unknown, and it is unclear whether these cancers represent a distinct disease, as compared to smoking-related OSCC. We hypothesize that young non-smokers with OSCC have immunological differences that increase susceptibility to infectious and immunological disease (including cancer) as compared to smokers with OSCC. Therefore, we investigated the incidence of bacterial, viral, and autoimmune illness in young OSCC patients. Methods: We performed a retrospective cohort study at a single tertiary care institution of patients under age 55 diagnosed with OSCC from 2003-2021. Multiple encounters for the same ICD-10 code in the same year were counted as one. Bacterial infections included bacterial pneumonia (ICD-10 J13-J15), cellulitis and lymphangitis (L03), urinary tract infection (N39.0), and post-surgical infection (T81.4). Viral infections included viral pneumonia (J10-J12), skin herpesvirus (A60, A63, B00, B07), infectious mononucleosis (B27), herpes zoster-related infections (B02), HIV (B20), viral hepatitis (B15-19), CMV disease (B25), viral conjunctivitis (B30), and other unclassified viral diseases (B33-34). Autoimmune disease included rheumatoid arthritis (M05), systemic Lupus (M32, L93), psoriasis (L40), inflammatory bowel disease (K50-52), Sjogren disease (M35.0), type 1 diabetes (E10), multiple sclerosis (G35), myasthenia gravis (G70), and autoimmune thyroiditis (E06.3). When patients were known to be deceased, but date of death was unavailable, they were presumed deceased at date of last encounter. Kaplan Meier analysis was used to analyze survival. Poisson regression was used to model the incidence of illness. Results: In total, 749 patients were analyzed; 467 were never smokers (NS) and 282 were current or former smokers (S). In NS, median age (interquartile range) was 47.9 (40.4-51.9) and 267 (57.2%) were male. In S, median age was 49.3 (44.6-52.7) and 208 (73.8%) were male. Five-year OS was 89% (95% confidence interval 86-93%) in NS vs. 89% (85%-93%) in S (p=0.66). The incidence of bacterial infection was 25.9 per 1000 person-years (py) in NS vs. 37.0/1000py in S (p&amp;lt;0.01). The incidence of viral infection was 37.8/1000py in NS vs. 31.4/1000py in S (p=0.14). The incidence of autoimmune disease was 26.7/1000py in NS and 36.0/1000py in S (p=0.02). Conclusions: NS were more likely to be female vs. S. OS was similar between NS and S. The incidence of bacterial infections and autoimmune diseases were significantly higher in S vs. NS, in line with pre-existing evidence that smoking is associated with increased susceptibility to bacterial infection and increased incidence and severity of autoimmune disease. Interestingly, there was a trend towards increased viral infections in NS vs. S, although not statistically significant. In the context of pre-existing evidence showing that smoking increases risk of viral infection, this finding warrants further study. Citation Format: Maxwell Y. Lee, Fred M. Baik, John B. Sunwoo. Patterns of immune susceptibility in young, non-smoking, oral cancer patients [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-081.

Resensitizing multidrug-resistant Gram-negative bacteria to carbapenems and colistin using disulfiram

The increasing incidence of bacterial infections caused by multidrug-resistant (MDR) Gram-negative bacteria has deepened the need for new effective treatments. Antibiotic adjuvant strategy is a more effective and economical approach to expand the lifespan of currently used antibiotics. Herein, we uncover that alcohol-abuse drug disulfiram (DSF) and derivatives thereof are potent antibiotic adjuvants, which dramatically potentiate the antibacterial activity of carbapenems and colistin against New Delhi metallo-β-lactamase (NDM)- and mobilized colistin resistance (MCR)-expressing Gram-negative pathogens, respectively. Mechanistic studies indicate that DSF improves meropenem efficacy by specifically inhibiting NDM activity. Moreover, the robust potentiation of DSF to colistin is due to its ability to exacerbate the membrane-damaging effects of colistin and disrupt bacterial metabolism. Notably, the passage and conjugation assays reveal that DSF minimizes the evolution and spread of meropenem and colistin resistance in clinical pathogens. Finally, their synergistic efficacy in animal models was evaluated and DSF-colistin/meropenem combination could effectively treat MDR bacterial infections in vivo. Taken together, our works demonstrate that DSF and its derivatives are versatile and potent colistin and carbapenems adjuvants, opening a new horizon for the treatment of difficult-to-treat infections.

Risk factors of early bacterial infection and analysis of bacterial composition, distribution and drug susceptibility after cadaveric liver transplantation

BackgroundThis study provided a theoretical basis for the clinical diagnosis and treatment of bacterial infection after liver transplantation through analyzing the pathogenic distribution, drug sensitivity and risk factors of bacterial infection after liver transplantation.MethodsWe collected clinical data from 207 recipients undergoing liver transplantation of graft from donation after citizens’ death donors in the Third Xiangya Hospital of Central South University from January 2019 to December 2021 and analyzed the composition and distribution of bacterial pathogens, drug resistance and risk factors of infection.ResultsA total of 90 bacterial infections occurred in 55 recipients within two months after liver transplantation, and the incidence of bacterial infection was 26.6% (55/207). The gram-negative bacteria (46/90, 51.1%) were more prevalent than gram-positive bacteria (44/90, 48.9%). Common sites of infection were the abdominal/biliary tract (26/90, 28.9%), lung (22/90, 22.4%) and urinary tract (22/90, 22.4%). Fourteen cases (6.8%) died after liver transplantation. Klebsiella pneumoniae (17/90, 18.9%) was the most frequent gram-negative bacteria causing infection in liver transplant recipients and 58.7%, 50%, 80.4% and 89.1% of gram-negative bacteria were sensitive to amikacin, minocycline, tigecycline and polymyxin B, respectively. The most common gram-positive bacteria was Enterococcus faecium (30/90, 33.3%) and 97.7%, 100%, 86.4%, 100% and 100% of gram-positive bacteria were sensitive to vancomycin, teicoplanin, daptomycin, tigecycline and linezolid, respectively. Univariate analysis revealed that bacterial infection was associated with female, age (≥ 50 years old), preoperative albumin (≤ 30 g/L), operation duration (≥ 400 min), intraoperative blood loss (≥ 3000 ml) and postoperative ventilator support. Binary Logistic regression analysis showed that female (OR = 3.149, 95% CI: 1.418–6.993, P = 0.005), operation duration (≥ 400 min) (OR = 2.393, 95% CI: 1.202–4.765, P = 0.013) and intraoperative blood loss (≥ 3000 ml) (OR = 2.052, 95% CI: 1.007–4.183, P = 0.048) were independent risk factors for bacterial infection after liver transplantation.ConclusionThe incidence of early bacterial infection after liver transplantation was high, and the infection sites were mainly abdominal/biliary tract, respiratory tract and urinary tract. The most common pathogenic bacterium was gram-negative bacterium. Our study also identified several independent risk factors for bacterial infection after liver transplantation, including female gender, operation duration of 400 min or more, and intraoperative blood loss of 3000 ml or more. By addressing these risk factors, such as implementing strategies to optimize surgical procedures and minimize blood loss, healthcare professionals can work towards reducing the incidence of bacterial infections following liver transplantation.

Hematopoietic stem-cell transplantation in a zoo of multidrug-resistant organisms: Data from a cancer center in eastern India.

Infections by multidrug-resistant organisms (MDRO) are a major hurdle in hematopoietic stem-cell transplants (HSCTs). Conditioning regimens lead to mucosal barrier injury, which in-turn leads to transmigration of gut bacteria and sepsis. Pre-transplant stool and throat surveillance cultures can guide empirical antibiotic policy during the neutropenic period. In this paper, we document colonization with MDRO in pre-transplant surveillance cultures and the correlation with bloodstream infections in HSCT patients and analyze transplant outcomes with respect to these infections. A single-center, retrospective study on HSCT was performed between January 2021 and December 2021. The incidence of bacterial infections, percentage of MDROs, correlation with pre-transplant stool/throat surveillance cultures, and their impact on overall 100-day and post-100-day to 6-month post-transplant survival were analyzed. Sixty-four patients were included in the study. Pre-transplant stool surveillance cultures were positive for MDRO in 85.9% of patients. Almost half (48.5%) of the isolates were positive for carbapenemase-producing genes (mainly New Delhi metallo-beta-lactamase-1 [NDM-1] and oxacillinase-48 [OXA-48]). Eighteen patients (18/64, 28%) had a positive blood culture for MDRO in the peri-engraftment neutropenic period. Correlation between surveillance and blood cultures was seen in 61% (11/18) of patients. All-cause mortality was 14.1% (9/64) and 25% (16/64) in patients at 100 days and 6 months post-HSCT, respectively. The 100-day and post-100-day all-cause mortality rates were higher in patients with Gram-negative MDRO bloodstream infections (p<.012 and <.008, respectively). MDRO infections can adversely affect HSCT outcomes. Pre-transplant stool and throat surveillance cultures may guide empirical antibiotic policy and lead to favorable transplant outcomes.

Comparison of Bacterial Pathogens Causing Urinary Tract Infection among Catheterized and Non-catheterized Patients at a Tertiary Care Hospital, Jamnagar

Urinary tract infections (UTIs) are among the most common bacterial infections of the urinary tract, accounting for a high percentage of all infections. The insertion of a catheter into the bladder increases the susceptibility of the patient to tract infection and serves as the initial site of infection by introducing pathogenic organisms into the tract. Indwelling catheters in the bladder facilitate the colonization of uropathogens through various mechanisms. The objective of this study was to compare the different pathogenic bacteria causing UTIs and their antibiotic sensitivity patterns in catheterized and non-catheterized patients. The study included catheterized and non-catheterized patients, regardless of gender, exhibiting clinical signs or symptoms of urinary tract infection. Urine samples were examined and cultured for bacterial growth using standard microbiological procedures. After confirming the pathogens, antibiotic susceptibility testing was conducted on Mueller-Hinton agar using the Kirby-Bauer disc diffusion method. Out of the 200 samples, 88 were catheterized and 112 were non-catheterized. Catheterized patients exhibited a higher infection rate (39, 44.32%) compared to non-catheterized patients (31, 27.68%), and women had a higher infection rate than men. Various organisms were isolated, with Escherichia coli being the most common organism in both catheterized and non-catheterized patients. Among the tested drugs against gram-negative organisms, nitrofurantoin displayed higher sensitivity. The present study demonstrated a higher incidence of bacterial infection in catheterized patients compared to non-catheterized patients, highlighting the importance of avoiding unnecessary catheter insertion. To prevent antimicrobial resistance, it is crucial to implement various infection control policies, care bundle approaches, and regular surveillance.

Mass drug administration in neglected tropical diseases: beyond elimination

Mass drug administration in neglected tropical diseases: beyond elimination