Cause Of Infections Research Articles

Detection of respiratory syncytial virus in cases of acute lower respiratory tract infection in pediatric age group by antigen detection and PCR analysis in a tertiary care hospital of eastern Odisha

: Respiratory Syncytial Virus (RSV) is one of the most common causes of acute lower respiratory infection (ALRI) in the paediatric age group. Various demographic and risk factors are associated with the severity of the disease.: This study was conducted to detect RSV from ALRI cases using two different methods and to correlate the findings with various risk factors.: The study was carried out over a period of 2 years on 242 ALRI cases in the Paediatrics Department of SCB Medical College and Hospital, Cuttack. Nasopharyngeal aspirates were collected using standard procedures and subjected to a rapid immunochromatographic test (ICT) for antigen detection, and molecular detection was performed using PCR.: Clinical and demographic data were collected and analyzed. Among the 242 clinically diagnosed ALRI cases, 14.05% were positive for RSV by one or both methods (ICT and RT-PCR). Considering real-time RT-PCR as the gold standard, the sensitivity, specificity, PPV, and NPV of the ICT were found to be 82.35%, 100%, 100%, and 97.19%, respectively. There was a significant association between risk factors such as prematurity, vitamin A supplement deficiency, and smokers in the household with RSV infections (p-values of 0.001, 0.003, and 0.002, respectively).: The study demonstrates two different methods for identifying RSV; thus, a simple, rapid method can be used as an alternative in resource-limited settings, enabling clinicians to avoid unnecessary antibiotic prescriptions in such cases. It also highlights risk factors that are adversely associated with disease morbidity, whose efficient control can significantly reduce the disease burden.

Targeted syndromic next-generation sequencing panel for simultaneous detection of pathogens associated with bovine reproductive failure.

Bovine reproductive failure, which includes infertility, abortion, and stillbirth in cattle, leads to significant economic losses for beef and milk producers. Diagnosing the infectious causes of bovine reproductive failure is challenging as there are multiple pathogens associated with it. The traditional stepwise approach to diagnostic testing is time-consuming and can cause significant delays. In this study, we have developed a syndromic next-generation sequencing panel (BovReproSeq) for the simultaneous detection of 17 pathogens (bacteria, virus, and protozoa) associated with bovine reproductive failure. This targeted approach involves amplifying multiple pathogen-specific targets using ultra-multiplex PCR, followed by sequencing with the Oxford Nanopore platform and subsequent analysis of the data using a custom bioinformatic pipeline to determine the presence or absence of pathogens. We tested 116 clinical samples and found that BovReproSeq results matched with current diagnostic methods for 93% of the samples, and most of the disagreements occurring in samples with very low pathogen loads (Ct >35). At the optimal read-count threshold of 10 reads (minimum number of reads to classify the sample as positive), the clinical sensitivity of the assay was approximately 82%, while clinical specificity was 100%. The overall accuracy of the assay was 98.8%. Matthews correlation coefficient (correlation coefficient of binary classification) was approximately 0.90 and F1 score (harmonic mean of precision and recall) was 0.90, indicating excellent overall performance. Our study presents a significant advancement in detecting the infectious agents associated with bovine reproductive failure and the BovReproSeq panel's ability to detect 17 pathogens makes it a promising tool for veterinary diagnostics.IMPORTANCEBovine reproductive failure causes substantial economic losses to beef and milk producers, and infectious disease contributes significantly to this syndrome. Etiologic diagnosis is complicated since multiple pathogens can be involved and infections with some pathogens are asymptomatic or cause similar clinical signs. A stepwise approach to diagnostic testing is time-consuming and increases the risk of missing the correct diagnosis. BovReproSeq is a next-generation sequencing-based diagnostic panel that allows detection of 17 reproductive failure pathogens simultaneously.

A multidisciplinary comprehensive nursing Management Approach for Catheter-related bloodstream infections.

Catheter-related bloodstream infection (CR-BSI) stands as one of the leading causes of hospital-acquired infections, often resulting in high healthcare expenditure and mortality rates. Despite efforts, reducing the incidence of CR-BSI remains a significant challenge. This study aimed to assess the impact of a multidisciplinary organizational intervention on reducing intravenous CR-BSI. A quality improvement team was established to implement various interventions, utilizing the FOCUS-PDCA continuous quality improvement model and fishbone diagram for analysis and improvement. After the interventions, operational indicators for catheter insertion, maintenance, and removal improved from 82.50% ± 1.15%, 83.60% ± 1.60%, and 81.60% ± 1.80-95.30% ± 1.00%, 96.20% ± 1.62%, and 97.25% ± 0.50%, respectively. Additionally, catheter dwell time decreased from 7.50 ± 0.85 days to 3.50 ± 0.75 days, and the quarterly infection rate was reduced from 2.328% ± 1.85-0.305% ± 0.95% following the implementation of the intervention. Despite the available evidence, there remains a noticeable gap between the ideal evidence-based practices and their practical implementation. We aim to eradicate CR-BSIs within the surgical intensive care units (ICUs) of hospitals. To achieve this goal, we have introduced a comprehensive quality improvement framework designed not only to benefit our own ICU but also to serve as a model for implementation in other similar healthcare settings.

Mechanistic Insights into Succinic Acid as an Adjuvant for Ciprofloxacin in Treating Pseudomonas aeruginosa Growing Within Cystic Fibrosis Airway Mucus

Pseudomonas aeruginosa is a major cause of chronic respiratory infections in patients with cystic fibrosis (CF), with biofilm formation contributing to its persistence and antibiotic resistance. This study aimed to gain insights into the mechanistic action of succinic acid as a ciprofloxacin adjuvant against clinically relevant CF isolates, including small colony variants and mucoid strains, and a ciprofloxacin-resistant strain grown within CF dense mucus. Time-kill assays in artificial CF mucus, along with planktonic and surface-attached biofilm experiments, were used to assess the activity of succinic acid alone and in combination with sublethal ciprofloxacin concentrations. Succinic acid demonstrated an adjuvant effect of ciprofloxacin against P. aeruginosa grown within CF mucus at pH levels below pKa1 during the early bacterial growth stages. In examining planktonic growth and biofilms under these conditions, we found that succinic acid demonstrated strong antibacterial and antibiofilm properties. Conversely, succinic acid activity decreased at later growth stages, though it enhanced the ciprofloxacin effect, especially against mucoid biofilms. Moreover, we noted that, in dense CF mucus, succinic acid activity was attenuated compared to a non-CF environment, indicating diffusion challenges. These findings underscore the potential of succinic acid as a therapeutic adjuvant for improving antibiotic treatment outcomes and overcoming biofilm-associated resistance in CF.

Molecular Detection of Haemoprotozoan Diseases in Anaemic Goats of Southern India: A Pilot Study

Background: Anaemia is a common and important clinical presentation in goats due to infectious, traumatic, nutritional, haemoprotozoal, endo and ecto parasitic causes. Haemoprotozoan are obligate intracellular pathogens transmitted by ticks with an impact on animal health. Anaplasma ovis, Babesia ovis, Babesia motasi and Theileria luwenshuni that infects goats can be diagnosed by different methods like giemsa staining, PCR or competitive ELISA. Methods: Goats presented to Large Animal Clinics of Madras Veterinary College Teaching Hospital, Chennai, India, were screened for the signs of anaemia. In this study, PCR method was used for the detection of Anaplasma, Babesia and Theileria infection. Result: Among 25 blood samples collected from anaemic goats, 48 per cent were found positive for haemoprotozoan disease. Out of which 32 per cent were Anaplasma ovis followed by 4 per cent of Babesia motasi and Babesia ovis each whereas remaining 8 per cent showed mixed infection. This indicated a high incidence of haemoprotozoan infection as a major cause of anaemia in goats reared under field conditions.

Longitudinal assessment of immunoglobulin response and disease progression in critically ill patients with community acquired pneumonia

BackgroundLow endogenous immunoglobulin(Ig)-levels are common in critically ill patients with sepsis, but it is unknown whether low Ig-levels are associated with poor outcome, and in which patients Ig-replacement therapy (IgRT) improves outcome. Given the crucial role of immunoglobulins in eliminating certain encapsulated pathogens, we examined the relationship between serial Ig-levels and disease course in critically ill patients with community acquired pneumonia (sCAP) caused by encapsulated or other pathogens.MethodsWe included a cohort of consecutive critically ill patients with CAP, and PaO2/FiO2-ratio < 200 with or without septic shock, from an existing biorepository where microbiological causes of infection had been adjudicated in a protocolized manner. We used generalized linear mixed models to assess the association between IgG and IgM (measured on admission days 1, 3 and 7) and disease course (Sequential Organ Failure Assessment (SOFA)-score on day 2, 4, and 8) for all-cause sCAP and for episodes caused by Streptococcus (S.) pneumoniae or Haemophilus (H.) influenzae.ResultsWe included 255 eligible patients admitted with CAP, of which 82 (32%) episodes were caused by S. pneumoniae or H. influenzae. 151 (59%) patients had low IgG (< 7.0 g/L), 77 (30%) had low IgM (< 0.4 g/L), and 56 (22%) had both. A lower IgG-level was related to a slightly higher SOFA-score at admission (β = − 0.07 per 1 g/L IgG, p = 0.029), but an IgG-level decline over time was not associated with a SOFA-score increase (β = − 0.04, p = 0.564). IgM-levels were not associated with changes in SOFA-score over time. Neither association was affected by the presence or absence of S. pneumoniae and H. influenzae.ConclusionIn critically ill patients with CAP, IgG and IgM dynamics in the first week of ICU stay are not associated with clinically relevant changes in disease course, regardless of the causative pathogen.

Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

IntroductionMalnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition’s role in...

Perinatal outcomes after surgical treatment of cervical LSIL and conservative treatment of endometrial cancer. A clinical case analysis

This article describes a clinical case of pregnancy management in a patient after surgical treatment of low-grade squamous intraepithelial lesions (LSIL) of the cervix and endometrial cancer. In the structure of female oncological morbidity, precancerous conditions and malignant diseases of the female genital organs occupy leading positions and require the most sparing treatment in women who have not realized reproductive function. The frequency of miscarriage in early pregnancy associated with a history of endometrial cancer, requiring repeated invasive manipulations to assess the effectiveness of treatment, reaches 36–40%, depending on the age of the woman. After surgical interventions on the cervix, regardless of the method of exposure, the frequency of miscarriage significantly increases due to the formation of an organic form of isthmic-cervical insufficiency, which dictates the need for preventive cervical circumcision in a regulated time. In addition, the results of numerous studies also indicate an infectious cause as the main etiological factor in the development and progression of isthmic-cervical insufficiency. Management tactics, obstetric risks, as well as the possibilities of choosing a treatment method are discussed on the basis of the presented clinical case.

Chronic Neutrophilic Meningitis in Tuberculous Infection: A Rare Case Presentation and review of the literature

Persistent neutrophilic pleocytosis syndrome is a rare form of tuberculous meningitis that is defined as the persistence of neutrophils in cerebrospinal fluid for more than 7 days, in association with the clinical features of meningitis (headache, fever, and positive meningeal signs).1 The exact pathogenesis of this syndrome is not well known yet, and it has many diverse etiologies, including infectious and noninfectious ones. among infectious ones: bacteria such as Nocardia and Actinomyces, and systemic mycoses such as Aspergillus and the zygomycetes, as well as mycobacterium.2 This entity is very rare in immunocompetent patients, and most of the cases are due to infectious causes in those who are immunocompromised. The usual scenario in such cases is initiating broad-spectrum antimicrobial agents without any improvement, therefore the diagnosis is difficult initially and often delayed. Therefore, the epidemiologic features and clinical profile may offer clues to the etiologic agent, especially in the immunocompromised host.3

Determinants of Anemia in Schoolchildren in the Highland Bolivia

Anemia is a health problem of concern among schoolchildren in underprivileged rural regions, where recurrent parasitic infections are common. A cross-sectional study was conducted in 229 schoolchildren in rural highland Bolivia in the department of La Paz, an area with a high prevalence of protozoan and helminth infections, to determine the types and mechanisms of anemia. A substantial proportion of children (40.2%) were found to be anemic based on hemoglobin measurements. No associations were found between low hemoglobin levels and helminth or protozoan infections when evaluating infectious causes of anemia, nor with Giardia lamblia or Blastocystis hominis, which are associated with iron deficiency and nutrient malabsorption and were highly prevalent in this study. The significant association between anemia and hypochromia suggests iron deficiency, aligned with low hemoglobin levels. A total of 39 out of 150 children (26%) had markers consistent with iron deficiency anemia (IDA), 26 out of 127 children (20%) met the criteria for anemia of inflammation (AI). Furthermore, 12 of the 127 tested children (9.4%) met the criteria for mixed AI with IDA according to the soluble transferrin receptor (sTfR)/log ferritin levels, which increased significantly due to overall infections by Hymenolepis nana and Ascaris lumbricoides helminths. The findings highlight the need for integrated public health interventions to address iron nutrition and parasitic infections to effectively prevent anemia in this vulnerable population.

A Review on Risk Factors, Traditional Diagnostic Techniques, and Biomarkers for Pneumonia Prognostication and Management in Diabetic Patients

People of all ages can contract pneumonia, and it can cause mild to severe disease and even death. In addition to being a major cause of death for elderly people and those with prior medical conditions such as diabetes, it isthe world’s biggest infectious cause of death for children. Diabetes mellitus is a metabolic condition with a high glucose level and is a leading cause of lower limb amputation, heart attacks, strokes, blindness, and renal failure. Hyperglycemia is known to impair neutrophil activity, damage antioxidant status, and weaken the humoral immune system. Therefore, diabetic patients are more susceptible to pneumonia than people without diabetes and linked fatalities. The absence of quick, precise, simple, and affordable ways to identify the etiologic agents of community-acquired pneumonia has made diagnostic studies’ usefulness contentious. Improvements in biological markers and molecular testing techniques have significantly increased the ability to diagnose pneumonia and other related respiratory infections. Identifying the risk factors for developing severe pneumonia and early testing in diabetic patients might lead to a significant decrease in the mortality of diabetic patients with pneumonia. In this regard, various risk factors, traditional testing techniques, and pathomechanisms are discussed in this review. Further, biomarkers and next-generation sequencing are briefly summarized. Finding biomarkers with the ability to distinguish between bacterial and viral pneumonia could be crucial because identifying the precise pathogen would stop the unnecessary use of antibiotics and effectively save the patient’s life.

Immunoinformatics design of a multi-epitope vaccine for Chlamydia trachomatis major outer membrane proteins

Chlamydia trachomatis (CT) remains a significant infectious cause of blindness and sexually transmitted infections worldwide. The objective and novelty of this study lie in using different serovars of CT to design a broad-spectrum multi-epitope vaccine that might confer immunity against different CT infections. As the major outer membrane protein in CT has good immunodominance properties and high conservation and also determines the several serotypes of CT, it is selected as an antibody target in this study. T-cell and B-cell epitopes from serovars A, B, D, E, L1, and L2 were predicted and combined into a single construct by incorporating adjuvants and linkers to enhance immunogenicity and stability. Physicochemical characterization confirmed the constructed vaccine’s anti-allergic, immunogenicity, and thermostable characteristics, followed by structural modeling to refine its 3D configuration. The 3D model structure of the vaccine was validated through the Ramachandran plot and ProSA z-score. Molecular docking studies of the vaccine demonstrated stable binding with toll-like receptor 3, along with molecular dynamics simulations and binding free energy calculations supporting the complex’s stability. In silico cloning has indicated a high potential for expression in Escherichia coli. Lastly, immune simulations revealed robust activation of B cells, cytotoxic T cells, and antigen-presenting cells, alongside significant production of IgM, IgG antibodies, and balanced Th1/Th2 cytokine response, which is crucial for effective immunity. These results suggest the multi-epitope vaccine could effectively induce comprehensive immune responses against CT, highlighting the need for further in vivo validation to advance this promising candidate toward clinical use.

Erosive bilateral glenohumeral osteoarthritis caused by urosepsis-induced septic arthritis.

Staphylococcus aureus is a common cause of bacterial infections of the skin, soft tissues, bones, bloodstream, and respiratory system. When the infection spreads to the joints, it is known as septic arthritis. The shoulder is the third most common location for septic arthritis in adults. Treatment is arthroscopic or open irrigation and debridement, but even after eradicating the bacteria, cartilage and bone destruction can occur. This article describes a patient who developed bilateral septic arthritis of the shoulders shortly after a urinary tract infection, and was treated with a relatively rare reverse shoulder hemiarthroplasty procedure.

Determination of Ideal Factors for Early Adoption and Standardization of Metagenomic Next-generation Sequencing for Respiratory System Infections.

Metagenomic next-generation sequencing (mNGS) demonstrates great promise as a diagnostic tool for determining the cause of pathogenic infections. The standard diagnostic procedures (SDP) include smears and cultures and are typically viewed as less sensitive and more time-consuming when compared to mNGS. There are concerns about the logistics and ease of transition from SDP to mNGS. mNGS lacks standardization of collection processes, databases, and sequencing. Additionally, there is the burden of training clinicians on interpreting mNGS results. Until now, few studies have explored factors that could be used as early adoption candidates to ease the transition between SDP and mNGS. This study evaluated 123 patients who had received both SDP and mNGS and compared several variables across a diagnostic test evaluation. The diagnostic test evaluation observed metrics such as sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR), positive and negative predictive values (PPV, NPV), and accuracy. Factors included various sample sources such as bronchoalveolar lavage fluid (BALF), lung tissue, and cerebral spinal fluid (CSF). An additional factor observed was the patient's immune status. Pathogen detection was found to be significantly greater for mNGS for total patients, BALF sample source, CSF sample source, and non-immunocompromised patients (p<0.05). Pathogen detection was found to be insignificant for lung tissue sample sources and immunocompromised patients. Sensitivity, PLR, NLR, PPV, NPV, and accuracy appeared to be higher with mNGS for the total patients, BALF sample source, and non-immunocompromised patients when compared with SDP (p<0.05). With higher metrics in sensitivity, specificity, PLR, NLR, PPV, NPV, and accuracy for overall patients, mNGS may prove a better diagnostic tool than SDP. When addressing sample sources, mNGS for BALF-collected samples appeared to have higher scores than SDP for the same metrics. When patients were in a non-immunocompromised state, mNGS also demonstrated greater diagnostic benefits to BALF and overall patients compared to SDP. This study demonstrates that using BALF as a sample source and selecting non-immunocompromised patients may prove beneficial as early adoption factors for mNGS standard protocol. Such a study may pave the road for mNGS as a routine clinical method for determining the exact pathogenic etiology of lung infections.

Serotype 3 Streptococcus pneumoniae Escapes the Immune Responses Induced by PCV13 in Mice With High Susceptibility to Infection.

Streptococcus pneumoniae (pneumococcus) is a common cause of respiratory and invasive infections in humans. PCV13, a pneumococcal conjugate vaccine used globally, is highly effective against diseases caused by pneumococcal serotypes included in its formulation. However, one of them, the serotype 3 (ST3) is still being relatively commonly isolated from patients, suggesting an escape from vaccine-induced immunity. The thick capsule produced by ST3 facilitates bacterial evasion from the immune system. Additionally, host immune responses may influence the outcome of ST3 infection. Here we evaluated the influence of inflammation in the adaptive immune responses and protection induced by PCV13 against ST3, using two outbred mice lines that were phenotypically selected for high (AIRmax) and low (AIRmin) inflammatory responses. AIRmin and AIRmax mice were immunized with PCV13. Inbred BALB/c mice were used as reference for vaccine efficacy. Induction of IgG against polysaccharides (PS) from pneumococcal serotype 1 (ST1) and ST3 were evaluated by ELISA. Protection was tested against invasive infections with ST1 and ST3 pneumococcal strains. Sera were compared by IgG binding to pneumococcal surface, induction of pneumococcal agglutination and opsonophagocytosis. The phagocytic capacity of mice-derived neutrophils was also evaluated. Immunization of AIRmin, AIRmax and BALB/c mice with PCV13 induced IgG against PS from ST1 and ST3 pneumococci. Despite vaccination, AIRmin mice were not protected against fatal infection with ST3. Sera from AIRmin mice immunized with PCV13 presented lower levels of anti-PS3 IgG, with reduced capacity to bind to pneumococcal surface. Reduced capacity to induce opsonophagocytosis of ST3 pneumococci in vitro was also observed. Conversely, PCV13 protected AIRmin mice against fatal infection with ST1 and this correlated with the capacity of the sera to induce ST1 opsonophagocytosis. Our results show that both host and bacterial features can influence the outcome of protection induced by PCV13 against ST3 pneumococcal infection.

CLINICAL PROFILE OF MICROSPORIDIAL KERATITIS AT A TERTIARY EYE CARE CENTER IN BUNDELKHAND REGION

Background: Although rare, microsporidia are sometimes misdiagnosed as the cause of corneal infections. The ubiquitous, obligatory, intracellular parasite is the causal agent. In Asia, the prevalence of microsporidiosis is rising in tandem with the monsoon season. Immunosuppression (HIV infection, topical corticosteroids), contact lens usage, and injuries from water or dirt exposure are risk factors. Purpose: To study clinical profile of patient with microsporidial keratitis in department of ophthalmology at M.L.B. Medical College Jhansi between April to October 2024. To summarizes the current literature on the etiology and clinical presentation of microsporidial infections of the cornea and highlights ongoing developments in available diagnostic modalities and treatment regimens. Materials and Methods: Prospective study of 20 patients of microsporidial keratitis present in Department of Ophthalmology at M.L B Medical College Jhansi. Results: A total of 20 patients were examined out of which 19 patients (95%) presented with pain and redness, 18 patients (90%) present with foreign body sensation and blurring of vision, 15 patients (75%) present with photophobia, 14 patients (70%) present with lid swelling. 18 patients (90%) have conjunctival hyperemia, 16 patients (50%) have diffuse punctate epitheliopathy and 1 have deep stromal infiltrateson examination. Conclusion: Most commonly patients presents with redness and eye pain, followed by foreign body sensation, blurring of vision, photophobia and least commonly with lid swelling.

Virulence determinants and pathogenicity in Enterococcus faecalis and E. faecium

Enterococci are Gram-positive bacteria that inhabit the gastrointestinal tract of many organisms, including humans. These bacteria can easily adapt to their surrounding environment, even under stress conditions that can be lethal to other microorganisms. Among the species described in this genus, faecalis and faecium stand out, considered one of the main causes of nosocomial infections due to their ability to adapt and resist in clinical environments. They are recognized as opportunistic pathogens that can cause a variety of serious infections, such as endocarditis, urinary tract infections, and bacteremia, especially in immunocompromised patients or those with invasive medical devices. Recently, it has been observed that Enterococcus presents an increase in resistance to antibiotics, heavy metals, as well as external environmental conditions such as heat and desiccation. This resistance has been directly related to the capacity to form biofilm, an organized microbial ecosystem that makes it almost impermeable and serves as a shield for the bacteria. In addition, biofilm has been linked to bacterial virulence due to the presence of virulence factors. Therefore, researchers are interested in conducting research on the correlation between biofilm formation, virulence factors and antimicrobial resistance, which is essential to understanding the pathogenesis of these infections and improving treatment strategies.

Sensitivity Pattern in Children Respiratory Bacterial Infections

Background: Bacterial respiratory infections are a major health concern, especially in underdeveloped and developing countries. This study aims to evaluate the prevalence of Gram-negative and Gram-positive bacteria in respiratory infections and assess the efficacy of antibiotics. Methods: A prospective, observational study was conducted from July 2010 to July 2011. Patients with respiratory infections were categorized by age, bacterial pathogen, disease type, and season of infection. Diagnostic methods, including throat swabs, blood cultures, and antibiograms, were used to identify pathogens and determine antibiotic resistance profiles. The infection rate was calculated using standard epidemiological formulas. Results: Gram-negative bacteria accounted for 84.7% of infections, with Acinetobacter baumannii (26.4%) being the most common pathogen. Gram-positive infections, primarily caused by Streptococcus pneumoniae (77%), were also prevalent. The highest infection rates were observed in the spring, particularly among children under one year and those aged 1-6 years. Pneumonia was the most common diagnosis (43.5%). Ampicillin resistance was widespread, but Acinetobacter baumannii, E. coli, and Klebsiella pneumoniae showed sensitivity to Sulbactam, Cefoperazone, and Piperacillin/Tazobactam. Conclusion: Acinetobacter baumannii was the predominant cause of respiratory infections, especially in young children and during spring. Ampicillin resistance was common, but Sulbactam, Cefoperazone, and Piperacillin/Tazobactam were more effective. These findings highlight the importance of targeted antibiotic therapy, particularly for Gram-negative bacterial infections.

Healthcare utilization and costs following molecular diagnostic testing among patients with vaginitis.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics® Plus database to identify adult patients with a diagnosis for vaginitis (first claim=index) from January 2021 to April 2023, with 6months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607[$15,122] vs $6680[$20,751], p=0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964[$9666] vs $3174[$7113], p=0.0110; other medical: $1961[$9244] vs $2099[$6475], p=0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067[$12,341], p<0.0001; other medical: $1961[$9244] vs $2973[$11,685]; p<0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p=0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p<0.0001) and No Test subcohorts (78.3% vs 83.0%, p=0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

The prevalence of optrA-carrying Enterococci in the vaginal micro-ecology of pregnant women in late pregnancy.

The colonization of Enterococcus in the female vagina leads to neonatal and pediatric enterococcal septicemia. Linezolid (LZD) is a kind of mainstream drug for treating multidrug-resistant Gram-positive infections. OptrA is the main LZD-resistance gene at Enterococci in human isolates. It is essential to explore the prevalence of optrA-carrying Enterococcus in vaginal secretions of late pregnant women and the drug resistance of optrA. From May to June 2023, this study recruited 340 volunteers in late pregnancy (35-40 weeks of pregnancy) to provide non-repetitive vaginal discharge samples. Luria-Bertani broth and florfenicol (10 µg/mL) were used to enrich bacteria. Enterococci was identified through time-of-flight mass spectrometry. Additionally, antimicrobial susceptibility, polymerase chain reaction, and next-generation sequencing assays were applied to this study. Fifty-four optrA-carrying Enterococcus strains were obtained, the proportion of the whole vagina of late pregnant women was 15.88% (54 out of 340), and Enterococcus faecalis account the highest proportion. All optrA-carrying Enterococcus were resistant to at least three drugs. Tetracycline, chloramphenicol, erythromycin, and LZD have higher bacterial resistance rates. Genetic environment analysis revealed that IS1216E, fexA, and erm(A) may synergistically exert multidrug resistance with optrA. It is necessary to strengthen the surveillance of optrA-carrying Enterococcus in pregnant women. This study provides scientific support for controlling hospital infections and managing antibiotic-resistant bacteria, and provides a scientific basis for rational clinical medication.IMPORTANCEThe disruption of cervicovaginal microbiota homeostasis is considered a key factor in causing imbalance in the microenvironment, leading to inflammation, transmission of infections, and illness. Enterococcus is considered a major cause of healthcare-related infections globally. It has resistance to multiple antimicrobial drugs, which pose significant challenges for clinical treatment. Therefore, it is crucial to assess the prevalence of optrA-carrying Enterococcus in vaginal secretions of late pregnant women and the drug resistance of optrA. This study detected 15.88% of optrA-carried Enterococci in 340 pregnant women. Furthermore, we found that optrA-carrying Enterococcus strains are highly resistant to tetracycline, chloramphenicol, erythromycin, and Linezolid. Additionally, genetic environment analysis revealed that IS1216E, fexA, and erm(A) may synergistically exert multidrug resistance with optrA. This study provides scientific support for controlling hospital infections and managing antibiotic-resistant bacteria and provides a scientific basis for rational clinical medication.