Infection Prevention Research Articles

Occupational Risks Prevention Practices Among Medical Waste Handlers in Ogun State, Nigeria

Background: Medical waste handlers are at immediate risk of needle stick injuries and exposure to infectious materials from medical waste. Adequate knowledge and safe practices on the part of the workers are essential for the prevention of nosocomial infections. Objective: To assess and compare the factors involved in occupational risk prevention practices among medical waste handlers in two tertiary hospitals in Ogun State, Nigeria. Methods: This descriptive, cross-sectional study compared medical waste handlers and the risk prevention measures available in a specialist hospital and a teaching hospital. The 100 participants were randomly selected and surveyed using an interviewer-administered questionnaire. Results: The prevalence of needle stick injury at the teaching hospital and specialist hospital were 38% and 28%, respectively. Hepatitis B vaccine uptake was 6% in the teaching hospital compared to 70% at the specialist hospital. There was a significant difference concerning the provision of safety equipment (p<0.001), personal protective equipment (PPE) (p<0.001), Hepatitis vaccine (p<0.001), training (p<0.001) and availability of waste management policy (p = 0.015) but no significant difference concerning the regular supply of water and soap (p = 0.494) between both institutions. Conclusion: The waste handlers at the specialist hospital were better equipped for safety than those at the teaching hospital. A safer environment, equipment, and training for medical waste handlers are needed to enable them to practise occupational risk prevention more effectively.

Efficacy and safety of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause: A randomized double-blind placebo-controlled trial

ObjectivesThis study evaluated the efficacy of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause. Study designRandomized, double-blind, placebo-controlled, multicenter clinical trial conducted across 28 Spanish sites involving specialists in gynecology, urology, and primary care. A total of 108 postmenopausal women were randomly assigned in a 1:1 ratio to receive 1 g of vaginal gel with 50 micrograms of estriol or an identical moisturizing vaginal gel without estriol. Main outcome measuresThe primary outcome was the number of episodes of urinary tract infection by the end of the 24-week treatment. Secondary measures encompassed percentage of patients without recurrence, time to first recurrence, use of antibiotic treatment, vaginal pH, safety, and tolerability, among others. ResultsThe incidence rate of urinary tract infections (new cases per 100 women-year) was 26 % lower in the group that received estriol vs. the group that received placebo (32.34 vs. 43.76 (RR = 0.74) p < 0.001). The frequency of urinary tract infections fell during treatment in all patients in the estriol group. Favorable pH changes from baseline were observed in the estriol arm at all follow-up visits. ConclusionsUltra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH.Study registration N°: 2018-001481-42. Date of registration: 09-04-2018.

Investigation of the optimal method of oxygen administration with simultaneous use of a surgical mask in postoperative patients: a randomized cross-over study

BackgroundFrom the standpoint of infection prevention, anesthesiologists need to simultaneously use a surgical mask and an oxygen mask when administering oxygen to patients. However, there is a lack of scientific evidence to justify this method. We aimed to investigate a suitable method of oxygen administration when using a surgical mask in postoperative patients.MethodsThis was a randomized, single-blind, cross-over study involving 42 patients admitted to the ICU. We compared three methods of oxygen administration: nasal cannula under the surgical mask, oxygen mask under the surgical mask, and oxygen mask above the surgical mask, using a cross-over design. The primary endpoint was partial pressure of arterial oxygen (PaO2). The secondary endpoint was partial pressure of arterial carbon dioxide (PaCO2).ResultsPaO2 was higher when the oxygen mask was placed under the surgical mask (median values 197.7 mmHg), the nasal cannula was under the surgical mask (180.6 mmHg), and the oxygen mask was above the surgical mask (143.0 mmHg), in descending order, with significant differences between all groups (P < 0.001). PaCO2 did not differ between groups.ConclusionsThe current standard method of administering oxygen to postoperative patients using an oxygen mask over a surgical mask results in poor oxygenation. Adopting the method of oxygen administration under the surgical mask via an oxygen mask or nasal cannula should be considered instead.

Baseline evaluation of the World Health Organization (WHO) infection prevention and control (IPC) core components in Pacific Island Countries and Territories (PICTs)

BackgroundComprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable.MethodsFrom January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a ‘traffic light’ (present, in progress, not present) matrix. Each PICT’s overall status in achieving IPC core components was summarised using descriptive statistics.ResultsFifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records.ConclusionsIdentifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR.

Inflammatory Marker Changes Following Total Knee Arthroplasty for Rheumatoid Arthritis with Vancomycin-loaded Calcium Sulfate Bone Filling.

Rheumatoid arthritis (RA) patients undergoing total knee arthroplasty (TKA) face infection risk. The study evaluates vancomycin-loaded calcium sulfate bone as infection prevention. Patients with RA treated with TKA who had their femoral canal filled using either vancomycin-loaded calcium sulfate bone (experimental group [n = 35]) or the patient's own excised autologous bone (control group [n = 30]) at the Qingdao University Affiliated Hospital, Qingdao, China from January 1, 2017, to March 1, 2023, were retrospectively enrolled in this study. An experienced surgeon used midvastus approach. Surgeries included disinfection, antibiotics, and femoral filling. The age, gender, body mass index (BMI), comorbidities, and intraoperative details were extracted from the patient's medical records. Preoperation and postoperation markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), pain scale (Visual Analog Scale [VAS]), infection rate, and Knee Society Score (KSS) were collected. Groups matched in age, gender, and BMI. No preoperative inflammatory marker differences were observed. However, compared to the control group, the postoperative inflammatory markers were significantly lower in the experimental group at 1-week postsurgery (CRP: 40.80 ± 23.17 vs. 60.80 ± 43.12 mg/L, p = 0.021; ESR: 72.06 ± 17.52 vs. 83.87 ± 21.52 mm/h, p = 0.012) and at 1-month postsurgery (CRP: 15.63 ± 6.56 vs. 21.17 ± 13.16 mg/L, p = 0.032; ESR: 25.25 ± 20.44 vs. 38.40 ± 25.26 mm/h, p = 0.024). There were no significant differences in the VAS (2.79 ± 0.90 vs. 2.70 ± 0.84 score, p = 0.689) and KSS (64.31 ± 17.88 vs. 66.57 ± 12.36) at 1-month postsurgery. Experimental group: zero infections; control group: only one infection. Administering vancomycin and calcium sulfate during TKA in RA patients reduces postoperative inflammation, but does not significantly affect infection risk; further research may be necessary for validation.

Healthcare workers’ compliance with COVID-19 prevention and control measures at De Martino Hospital, Mogadishu, Somalia: a cross-sectional study

BackgroundHealthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia.MethodsA cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers’ socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version.ResultsIn total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23–65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23–108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all).ConclusionsLow levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals.

Standardized treatment of infection after anterior cruciate ligament reconstruction

Infection after anterior cruciate ligament reconstruction (ACLR) is a rare and catastrophic postoperative complication. The aims of this study were to investigate the diagnostic, treatment and rehabilitation measures for postoperative infection following after ACLR. A retrospective study was conducted on 1500 patients who underwent ACLR between January 2011 and January 2022. Twenty patients who met the criteria for summarizing the incidence patterns and treatment experiences were selected for a complete investigation of their diagnostic, therapeutic, and rehabilitation processes, as well as outpatient follow-up results. Among the 20 patients who developed postoperative infections, Staphylococcus aureus was the main pathogen (80%). The clinical manifestations mainly included fever (80%) and knee joint pain (100%). Laboratory tests demonstrated that C-reactive protein (CRP) levels were greater than 50 mmol/L in fifteen patients (75%). All of the patients received intravenous antibiotic therapy. Five patients (25%) of tendon socket infection were treated with continuous negative pressure suction irrigation, whereas the other fifteen patients with intra-articular infection were treated with arthroscopic debridement and continuous flushing. The Lysholm score of the affected knee was compared before treatment and 6 months after treatment, and the difference was statistically significant (t = 20.78, P < 0.001). The success rate of treatment was 100%, and there were no significant differences between patients who received secondary treatment and functional exercise and those who underwent ACLR in terms of knee joint function or range of motion during the same time period. Infection was rare after ACLR, however it was fatal, and the main pathogen was Staphylococcus aureus. Early diagnosis and a comprehensive treatment approach are pivotal for the successful management of postoperative infections following ACLR. The results of this study contribute valuable clinical insights for further refining surgical procedures, enhancing infection prevention measures, and optimizing rehabilitation protocols.

Pseudo-outbreak of Bacillaceae species associated with poor compliance with blood culture collection recommendations.

This study describes a pseudo-outbreak of Bacillaceae spp. bloodstream infections that spanned five months starting in May 2023 and the infection prevention measures implemented to control it. This retrospective study was conducted at a tertiary infectious disease hospital in Bucharest, Romania. An observational audit of the blood culture collection practice in our hospital was performed, and the materials used during blood culture collection were sampled. Bacterial colonies were identified using MALDI Biotyper. The Bacillaceae blood culture positivity rates in the previous four years were compared using the Kruskal‒Wallis rank test. Bacillaceae spp.-positive blood cultures were recovered from 60 patients over a five-month period. In the case of 58 patients, Bacillaceae spp.-positive blood cultures were considered contaminated. Two patients were treated for Bacillus spp. bacteraemia. The audit revealed significant variation during the preparation of the venipuncture site step and the use of nonsterile medical cotton wool. Medical cotton wool contaminated with species of Bacillaceae was found in 10 out of 12 wards. The control measures included repeated training on the blood culture collection procedure and the removal of Bacillaceae spp.-contaminated cotton wool. The pseudo-outbreak was caused by the unjustified use of medical cotton wool for disinfection of the skin and blood culture bottle septums. The investigation of this pseudo-outbreak highlighted a gap in blood culture collection practices at our facility and thus allowed for its improvement.

Use of local treatment in managing infections: Focus on antimicrobial locks, beads, and cement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The purpose of this review is to describe important considerations with local antimicrobial therapies such as locks, beads, and cement for adjunctive infection management or prevention. Local delivery of antimicrobials with locks, beads, and cement has been used for infection management with retained devices in an effort to improve clinical success. However, their use has been controversial due to conflicting clinical data and logistical issues. Antimicrobial lock therapy (ALT) has been used for both adjunctive treatment and prevention of catheter-related bloodstream infections for certain pathogens and based on patient-specific scenarios. ALT has been a controversial method for sterilizing the catheter lumen by delivering high concentrations of antibiotics with or without heparin into the catheter for prolonged durations. Studies differ regarding the selection and concentrations of antibiotics, dwell duration, presence of heparin in the ALT, clinical outcomes/definitions, and use for prevention or treatment of catheter-related bloodstream infections. Antibiotic beads and cement have been used for various surgical procedures but are predominately considered in orthopedic surgeries. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, studies differ regarding the selection and concentrations of antibiotics, clinical outcomes/definitions, and use for prevention or treatment of infections. Although antimicrobial locks, beads, and cement are commonly used for adjunctive treatment or prevention of infections, more data are needed to support their use to provide clinical efficacy and safety with consistent antimicrobial selection and logistics.

Patient satisfaction with infection prevention control practices in the acute hospital setting: a systematic review and meta-analysis protocol

Patient satisfaction with infection prevention control practices in the acute hospital setting: a systematic review and meta-analysis protocol

Lenacapavir: Playing the Long Game in the New Era of Antiretrovirals.

The mainstay of antiretroviral therapy (ART) has been combination oral therapy. While oral ART is highly effective, nonadherence remains a chief concern. Addressing this concern in recent years is the emergence of long-acting antiretrovirals for the treatment and prevention of HIV-1 infection. The most recently approved long-acting antiretroviral is the first-in-class capsid inhibitor lenacapavir (LEN) for heavily treatment-experienced adults with multidrug-resistant HIV-1 infection. Due to its biannual subcutaneous dosing scheme to inhibit the HIV-1 capsid, LEN exhibits unique pharmacokinetics and reinforces an evolving era of ART. In this review, we evaluate published and accepted research articles, conference proceedings, and clinical trial records to provide a comprehensive overview of LEN for treatment and preliminary data for the prevention of HIV-1 infection. These data include clinical trials outcomes, in vitro and in vivo resistance profiles, and preclinical data supporting downstream indications. We also discuss the unique clinical pharmacology of LEN with the goal of serving as a resource toward subsequent physiologically based, population-based, and other miscellaneous pharmacometric-focused analyses. Given the dynamic nature of the HIV treatment and prevention research fields, we also discuss ongoing studies related to LEN for treatment-naïve adults and for prevention. Lastly, we discuss important pharmacologic gaps in special populations, drug-drug interactions, and at the sites of action germane to HIV treatment and prevention. The information discussed in this review will provide knowledge and understanding of the unique pharmacologic properties of LEN to assist clinicians and researchers as they navigate the dynamic HIV research landscape.

A peer-to-peer infection prevention and control programme in neglected settings: The case of home care and nursing homes in North Italy

A peer-to-peer infection prevention and control programme in neglected settings: The case of home care and nursing homes in North Italy

Zoonoses Tuberculosis Risk from Non-Human-Primate Trade and Movement: Preventive Measure Perspective

The trade in non-human primates (NHPs) is economically profitable in both local and global markets. However, it also poses a significant threat of disease transmission between NHPs and humans, particularly zoonotic tuberculosis, which is frequently reported in NHPs. Due to the high similarity between NHPs and humans, they share many pathogens. As a potential hub for NHP trade, Indonesia needs to enhance its knowledge and preventive measures to manage tuberculosis transmission related to NHPs trade and movement. Legislation at both international and national levels has been established to address the prevention of tuberculosis infection from NHPs. In addition to legislative measures, effective prevention also relies on implementing screening and detection protocols, as well as maintaining good biosecurity practices during handling NHPs.

Comparison of the effect of anticoccidial drug, probiotic, synbiotic, phytochemicals and vaccine in prevention and control of coccidiosis in broiler chickens challenged with Eimeria spp

The objective of this study was to investigate the effects of an anti-coccidiosis drug, vaccine, probiotic, symbiotic, and phytochemicals in the prevention and control of coccidia infection in broilers. A total of 525 one-day-old Ross 308 chicks were randomly allocated to 7 experimental diets with 5 replicates of 15 birds each in a completely randomized design. Experimental diets consisted of negative control (NC) without any additives and not challenged. The other 6 groups were challenged with mixed Eimeria and fed the basal diet with no additives (Positive Control, PC) or supplemented with Coxidine 100 (1 g / 1 kg), probiotic, synbiotic, Livacox T vaccine and phytobiotic additives based on the manufacturer's recommended dose. Body weight gain (WG), feed intake (FI) and feed conversion ratio (FCR) were recorded weekly. Oocysts per gram of excreta (OPG) were determined on d 25 to 33 and 42. One bird per cage was euthanized to analyze lesion score and jejunum and ileum inflammatory genes expression. Coccidial challenge reduced WG (P < 0.05) during 15 to 28 d and vaccine treatment was more effective in improving WG and FCR on d 29 to 42 and 1 to 42 (P < 0.05) than other treatments. Birds in the PC group had higher (P < 0.05) OPG than NC group for all days and the vaccine treatment resulted in the lowest rate of OPG compared to other treatments (P < 0.05) at 27, 28, 29, 30, 32, and 33 d of age and overall average. Relative mRNA levels of IFN-γ, IL-1β and IL-10 were significantly upregulated among treatments under coccidiosis challenge in jejunum and ileum except for IL-1β expression in the ileum. In conclusion, based on the results of this study the individual characteristics of feed additives for the prevention of coccidiosis can be different depending on the type and source of feed additives, duration, and amount used, levels of oocyst inoculation and Eimeria types.

Microneedle Transdermal Patches- A Novel Painless Approach with Improved Bioavailability for the Treatment of Diseases with Special Prevalence to Neonatal Infection.

Microneedle transdermal drug delivery systems (TDDS) present a compelling substitute for parenteral and oral administration methods in the treatment of several illnesses. The past several decades have seen a revolution in technology that has changed the production of micro-structured devices, including the development of microneedles for transdermal patches. These devices are used to deliver drugs, proteins, insulin, antibiotics, vaccinations, and other therapies through the skin. They are proven to be beneficial for the prevention of newborn infections. Successful treatments for conditions like cancer, diabetes, rheumatoid arthritis, Alzheimer’s disease, and migraines can be achieved with the use of transdermal microneedle patches. Microneedles have the potential to offer prolonged immunity, dosage sparing, and improved protection against viral challenges. The epidermis and dermis are immunologically rich layers, and because of the needles’ micron-size structure, these devices have shown to be significantly more effective at targeting these layers, indicating their potential utility in the creation of next-generation vaccines. Within the framework of developing vaccines. Microneedle transdermal patches’ main benefits are that they are easy to use, painless, and non-invasive. Here, we discuss the types of microneedle transdermal patches and how microneedle transdermal patches are now being used to treat infections in newborns and vaccination and as a more cost-effective self-administration approach. This also enhances the bioavailability when used in vaccination therapy. Next, we’ll go over how microneedle transdermal patches are currently used to treat a variety of illnesses effectively, including those that affect newborns.

Formulation Attributes Impact Immune Profile of an Oral and Thermostable COVID-19 Subunit Vaccine.

While approved vaccines for COVID-19 provide protection against severe disease and death, they have limited efficacy in the prevention of infection and virus transmission. Mucosal immunity is preferred over systemic immunity to provide protection at the point of entry against pathogens such as SARS-CoV-2. VaxForm has developed an oral vaccine delivery platform that elicits mucosal and systemic immune responses by targeting immune cells in the gut through C-type lectin receptors. The technology consists of microencapsulating the vaccine with an enteric polymer, which also results in enhanced thermostability. This article describes the formulation development and in vivo testing of a novel protein-based oral COVID-19 vaccine using this technology. Results demonstrate successful induction of immune response in mice and showed that the particle size of the vaccines following administration can impact the ratio of mucosal to systemic response. Immunogenicity and thermostability of liquid suspension and dry powder versions of the vaccine were compared in mice. The liquid suspension vaccine showed excellent heat resistance by maintaining immunogenicity after 14 days of storage at 60 °C. While further investigation is needed to determine correlates of protection and duration of response for mucosal immunity, this study demonstrates the vaccine's potential as a COVID-19 booster to enhance mucosal protection in humans and improve global access by lowering the cost of production, removing cold-chain requirements, and allowing self-administration.

Adherence to Non-Antibiotic Prophylactic Regimens in Women with Recurrent Urinary Tract Infections.

Non-antibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often prescribed as prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed non-antibiotic prophylaxis for rUTI and to explore factors associated with adherence. This was an ambispective cohort study describing and comparing adherence to non-antibiotic prophylactic regimens for rUTIs. Adult women who sought care from a Urogynecology clinic at a tertiary care center for rUTIs or frequent UTIs between January 2020 and December 2021 were included if they were prescribed a non-antibiotic prophylactic regimen. The Medication Adherence Questionnaire (MAQ) was administered to all eligible patients prospectively and then their charts were reviewed retrospectively for demographic and clinical factors. A score of 0 on the MAQ defined medication adherence. Any score ≥ 1 defined medication non-adherence. A total of 90 patients met the inclusion criteria and completed the MAQ, with 33 (37%) in the adherent group and 57 (63%) in the non-adherent group. Mean age was 64.7 (± 14.7) years. Vaginal estrogen (81.1%) was the most commonly prescribed prophylactic regimen, followed by methenamine hippurate (26.7%). 73.3% of patients met criteria for rUTI at the index visit as per the American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to non-antibiotic prophylactic regimens. Non-antibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 37%. There were no predictors associated with patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.

THE EFFECTIVENESS OF THE IMMUNE-BOOSTING PREPARATIONS IN PREVENTION AND TREATMENT OF RESPIRATORY INFECTIONS

Respiratory infections are undoubtedly one of the most common diseases that both primary care physicians and specialists working in hospitals have to deal with. The percentage of these diseases is particularly high in children and, depending on the child's age, may range from 6% to even 25%. A major clinical problem is the recurrent nature of these infections and their complications. This results in receiving an increased number of medications that can cause numerous side effects. Overprescription of antibiotics and consequently, increase of antibiotic resistance are also observed. Looking forward, the prevention of the recurrent infections is the key problem. The aim of our work was to evaluate the efficacy of the most popular preparations available on the pharmaceutical market that can improve immunity and complement conventional methods of treating infections or completely replace them. These include: elderberry, β-Glucans, lactoferrin, colostrum, black cumin preparations, echinacea, propolis, Streptococcus salivarius K12, inosine pranobex, ginseng, OM-85 bacterial lysate. We reviewed the literature from 2012 to 2024 using Pubmed and Google Scholar. The assesment of the effectiveness of preparations for immunity was based primarily on the systematic reviews, meta-analyses and randomised controlled trials. The above-mentioned preparations are largely characterized by a positive impact on improving the immunity of people supplementing them by activating non-specific immunity mechanisms. Thanks to this, some of the respondents can observe the regulation of the body's inflammatory response and, consequently, a decrease in the number of infections and their course. Due to the still insufficient number of studies on these preparations and the discrepancies in the results obtained among authors, further researches are needed to take a clear stance on their effectiveness.

Pneumococcal infection in children with recurrent respiratory diseases

In frequently ill children with recurrent respiratory diseases (RRD), violations of local immunity and microbiocenosis of the mucous membranes can contribute to the development of acute and chronic bronchopulmonary diseases. Vaccination against major pathogens, including S. pneumoniae, can help prevent respiratory infections in children.Objective: to study the microbiocenosis and local immunological factors of the nasopharyngeal mucosa in children with RRD, the serotype composition of S. pneumoniae in children with community-acquired pneumococcal pneumonia (CAP) and pneumococcal carriers, as well as the correspondence of the serotype landscape to the composition of modern pneumococcal vaccines.Materials and methods: The study included 150 patients (104 children with RRD and 46 patients with CAP). To assess the condition of the nasopharyngeal mucosa cultural methods, morphofunctional, immunological and capsule PCR typing of S. pneumoniae isolates were performed. Statistical analysis was performed using the Statistica 10.0 package.Results: The age structure was dominated by children aged 3 to 6 years (36%). The majority of patients with RRD had pronounced nasopharyngeal mucosal dysbiosis (n=60), as well as destruction of epithelial cells (n=97). These factors may predispose to the development of bronchopulmonary diseases, including community-acquired pneumonia (CAP). Capsule PCR typing of S. pneumoniae isolates from the nasopharynx was performed in 46 patients. It has been established that in the structure of nasopharyngeal carrier S. pneumoniae in children with CAP, serotypes “3” and 19F prevailed, which were also the main pathogens in pneumococcal CAP. In nasopharyngeal pneumococcal carrier, the thirteen–valent pneumococcal conjugate vaccine (PCV13) overlapped 39.6% (95%CI 27.6–53.1%) of serotypes, in pneumococcal VP – 57.2% (95% CI 36.5-75.5%), while PCV20 overlapped 22.6% more S. pneumoniae serotypes in children with CAP.Conclusion: The strategy for the prevention of acute respiratory infections in children is immunization against pneumococcal infection, which should be carried out taking into account the regional prevalence of S. pneumoniae serotypes.

Risk-Adapted Use of Vancomycin in Secondary Scoliosis Surgery May Normalize SSI Risk in Surgical Correction of High-Risk Patients.

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.