Microbiological Isolation Research Articles

DISSEMINATED TB IN AN IMMUNOCOMPETENT PATIENT

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Disseminated tuberculosis (TB) is a rare presentation, more common in patients with HIV, chronic liver disease or alcohol abuse and associated with high rates of treatment failure. CASE PRESENTATION: A 28 years-old male, with history of asthma, started complains of cough, sputum production and asthenia . Despite inhaled steroids, he continued to deteriorate. Skin ulcerations on the right wrist, elbow and leg appeared 4 months later. Fourteen months after the first symptoms, there was purulent drainage in the ulcers and a right knee edema which prevented the patient from walking. The patient presented to the hospital with extreme weight loss (20Kg). HIV screening was negative. CT scan with peri broncho-vascular opacities, tree-in-bud, cavitary lesions and pneumomediastinum. PCR for Mycobacterium tuberculosis was positive on sputum and knee pus. The patient started antibiotics (Clindamycin) and anti-TB drugs. A drain was placed on the right knee. Bone MRI revealed osteomyelitis in the knee, femur and cervical-dorsal spine, with need for surgical cleaning. DISCUSSION: A long evolution of symptoms was probably responsible for the exuberant presentation in this case of disseminated TB. The antibiotics and surgical strategies to treat the skin lesions were very challenging due to different microbiologic isolates and recurrence after drainage. The extension of lesions to the bone led to leg and arm movement impairment. Due to this, a multidisciplinary evaluation and decision to perform surgery were essential to prevent permanent disability. CONCLUSIONS: This case highlights the challenges in the management of thoracic complications of cavitary lesions, cutaneous ulceration and osteomyelitis due to TB. DISCLOSURE: Nothing to declare. KEYWORD: disseminated tuberculosis

MICROBIOLOGICAL ISOLATES AND IT’S RESISTOTYPE FROM CLINIC OF VASCULAR SURGERY FOR THE FIRST QUATER OF 2022

One of the most common complications of surgical exposures is the surgical site infection (SSI). Although it varies between different surgical profiles, it can reach up to one third of all complications. In vascular surgery patients ischemic ulcers are very common, as well as factors, compromising the immune system such as diabetes, chronic kidney disease etc. One of the main surgical exposures in vascular surgery is inguinal, providing access to the femoral artery and its bifurcation. Although it allows a wide range of reconstructions, implanting different types of prosthetic materials, stents and providing anastomosis site, it contains lymph nodes, which can contaminate the reconstruction and cause SSI with severe consequences. Patients, prone to SSI due to concomitant diseases, are threatened by sepsis, limb loss and even death, which makes prevention of those type of complications essential. Aim: To investigate etiological spectrum of microbiological isolates and their resistance against most common antimicrobials among vascular surgery patients. Materials and methods: The study is retrospective, conducted in the period 01 January 2022 – 31 March 2022. All of the samples were obtained from patients of Clinic of Vascular Surgery. After isolation of pure culture from the samples, the strains were identified by MALDI TOF MS and Vitec – 2 Compact. Antibiotic resistance was determined with Bauer-Kirby disk diffusion method. Results: From all 419 of the patients, hospitalized in the Clinic of Vascular surgery for this period, 28 isolates from 26 (6,21%) patients were obtained, of which Gram-negative were 19 (67,86%) and Gram-positive - 9 (32,14%). From Gram-negative - enterobacteria – 14 (73,68%), and non-fermenting gram-negative bacteria (NFGNB) were 5 (26,32%). Only 3 (21,43%) from all enterobacteria were extended spectrum beta-lactamases producing strains (ESBLs). No strains, resistant to carbapenems (RCP) were isolated. Five (55,55%) of the Gram-positive isolates were Staphylococcus aureus, 4 (80%) of which were methicillin resistant Staphylococcus aureus (MRSA). Two of the Gram-positive species isolated were Enterococcus faecalis, of which 1 with a high-level aminoglycoside resistance (HLAR). No Vancomycin resistant enterococci (VRE) were discovered. There were no colistin-resistant Acinetobacter baumannii and Pseudomonas aeruginosa strains. Conclusion: From all 28 isolates 8 (28,57%) were with acquired types of antimicrobial resistance. With almost one third of the isolates that are problematic in terms of antibiotic susceptibility, treatment of those patients can be challenging. Prevention of in hospital contamination with polyresistant strains, associated with medical care it is crucial for reducing the number of severe complications, decreasing of hospital stay and cost for treatment.

Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance.

Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007–December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.

Outcomes of a Neoaortoiliac System for Primary and Secondary Aortic Infections: A Single Institution’s Experience

A neoaortoiliac system (NAIS) procedure using autologous femoral vein grafts remains the surgical standard of care for aortic reconstruction for primary aortic and aortic graft infections. Evidence regarding the short- and long-term outcomes following NAIS is limited. We report a single institution’s experience with NAIS and correlate the presence of specific microbiologic isolates to procedural outcomes and patient characteristics.

Oral sequential therapy in the treatment of post-surgical epidural abscess and subdural empyema.

The management of post-surgical subdural empyema and subdural abscess is not standardised. The objective was to analyse the efficacy and safety of oral sequential therapy (OST). Retrospective observational study in a tertiary hospital in Vigo (Spain). We included adult patients with subdural abscess or epidural empyema with microbiological isolation. Clinical and demographic variables, isolated microorganisms and treatment regimens were included, as well as mortality and adverse effects during the follow-up period. Thirty patients were reviewed, two died due to causes other than infection. Six-month recurrence rate was 2/28 and all other patients (26/28) had clinical cure at the end of the treatment. The commonest isolated microorganisms were Gram-positive, especially Staphylococcus aureus. The most widely used oral antibiotic was trimethoprim-sulfamethoxazole (80%). No side effects related to oral treatment were observed. After adequate source control, OST can be a safe practice in the management of post-surgical epidural abscess and subdural empyema.

COMMUNITY-ACQUIRED THORACIC EMPYEMA - DOES MICROBIOLOGICAL IDENTIFICATION MATTER?

To describe the clinical characteristics, comorbidities and clinical outcome of hospitalized patients with the diagnosis of community acquired thoracic empyema in our hospital, with particular emphasis on the impact of identification of the causative agent. We performed a retrospective review of the clinical files of hospitalized adult patients diagnosed with community acquired thoracic empyema between 2012 and 2016. A total of 81 patients (64 men and 17 women), with a mean age of 54.6+-17.3 years, were included in this study. It was possible to identify the microbiological agent in 59.3% (n=48) of the patients. The median length of hospital stay was 29 days (P25=20 and P75=44.5) and a tendency to longer duration was seen in patients with a microbiological isolation (32 days vs 23 days; p=0.056). No significant difference was observed between patients with and without microbiological isolation, regarding the mortality. In this group of patients a positive pleural fluid culture tends to be associated with longer lengths of hospital stay, which may lead to speculation that they were more advanced infectious processes at the time of diagnosis.

Microorganisms and Antibiotic Resistance of Bacterial Keratitis at a Rural County Hospital in Seville.

To review the incidence, resistance patterns, and management of bacterial keratitis during the past 4 years. We retrospectively reviewed the clinical records of microbiological isolates from patients with a clinical diagnosis of bacterial keratitis. A total of 159 patients were analyzed, and 102 microorganisms were isolated from 129 cultures. In these cultures, 23.7% of the microorganisms were gram positive, 60.8% were gram negative, and 15.5% were fungi. Pseudomonas aeruginosa was the most common bacteria (9.2%), followed by Serratia marcescens (4.4%) and Staphylococcus aureus (4%). Resistance to fluoroquinolones and aminoglycosides was found to be 23.1% and 53.1% in gram-positive and 2.8% and 13.9% in gram-negative bacteria, respectively. Resistance to ceftazidime against gram-negative bacteria was 13.9%. No resistance to vancomycin was observed. A high resistance rate to aminoglycosides and fluoroquinolones was observed in gram-positive bacteria. We concluded that fluoroquinolones or aminoglycosides may not be suitable for initial monotherapy in patients with severe bacterial keratitis.

Pyopneumothorax of unusual aetiology.

A 50-year old diabetic male presented with cough, breathlessness, fever, and chest pain. Clinical and radiological evaluation revealed a right-sided pyopneumothorax. Surgical drainage with tube thoracostomy was performed. Pleural fluid cultures grew Enterococcus fecium as a sole organism. Our patient was treated with vancomycin and amikacin with an excellent clinical response. Enterococci are rarely implicated in the lower respiratory tract and pleural infections and are not usually considered if initiating empirical treatment. Their intrinsic resistance to empirically used antibiotics may complicate the course of the disease. Hence initial Gram staining and expeditious microbiological isolation with susceptibility testing is warranted in all cases. Gram-positive aerobes, notably staphylococcus followed by streptococcus and pneumococcus, are the commonly encountered organisms in pleural infections.

Risk of Bacterial, Viral, and Fungal Infections in Patients With Solid Malignant Tumors Treated With Curative Intent Radiation Therapy

PurposeThe incidence, etiology, and association of infections with radiation therapy (RT)–induced lymphopenia in patients with solid tumors is not well elucidated. Methods and MaterialsWe identified possible, probable, and definite infections caused by bacteria, fungi, and viruses, combining data on medication, microbiology, and diagnoses. Definite infections had either a diagnosis or a positive microbiological isolation. We analyzed the incidence and adjusted incidence-rate ratio of infections in the year after the start of RT among patients who received RT plus chemotherapy and RT monotherapy, by type of infection and according to the degree of RT-induced lymphopenia. ResultsA total of 4450 of 6334 (70.3%) patients experienced 11264 infections overall; 1424 (22.5%) patients developed 2104 definite infections in the first year after RT. Infections were more frequent among patients who received RT plus chemotherapy (2590 of 3469; incidence: 16.5 [95% confidence interval {CI}, 16.1-17.0], per 100 patient-years) compared with patients who received RT monotherapy (1860 of 2865; incidence: 12.7 [95% CI, 12.3-13.2]). The incidence of infection was highest in the first 3 months overall (28.2 vs 18.0 in patients who received RT plus chemotherapy compared with those who received RT monotherapy) and for definite infections (4.7 vs 3.8). The proportion of specific bacterial infections were similar among patients who received RT plus chemotherapy versus those who received RT monotherapy. Urinary tract infections were the most frequent (51.2% vs 56.2%), followed by pneumonias (24.1% vs 22.4%). Viral and fungal infections were more frequent among patients who received RT plus chemotherapy, but they were uncommon. In multivariable analyses, patients who received RT plus chemotherapy with a lymphopenia grade of 1-2 or ≥3 versus no lymphopenia at end of RT had an increased risk of bacterial infections 0 to 3 months after RT (incidence rate ratio, 1.45 [95% CI, 1.06-1.97] and 1.71 [95% CI, 1.26-2.34], respectively). Limiting to definite bacterial infections, the incidence rate ratio for lymphopenia grade ≥3 versus no lymphopenia was 2.66 (95% CI, 1.40-5.03). ConclusionsThe incidence of bacterial infections 0 to 3 months after RT plus chemotherapy for solid tumors was high, especially among patients with RT-induced lymphopenia grade 1-2 and ≥3.

The changing pattern of bacterial and fungal respiratory isolates in patients with and without COVID-19 admitted to intensive care unit

ObjectivesSevere acute respiratory syndrome 2 (SARS-CoV-2) pandemic has had a heavy impact on national health system, especially in the first wave. That impact hit principally the intensive care units (ICUs). The large number of patients requiring hospitalization in ICUs lead to a complete upheaval of intensive wards. The increase in bed, the fewer number of nurses per patient, the constant use of personal protective equipment, the new antimicrobial surveillance protocols could have had deeply effects on microbiological flora of these wards. Moreover, the overconsumption of antimicrobial therapy in COVID-19 patients, like several studies report, could have impact of this aspect. Aim of this study is to evaluate the changing pattern of microbiological respiratory isolates during and before COVID-19 pandemic in a tertiary hospital ICUs.MethodsA retrospective, observational study was conducted in ICUs of “ASST Papa Giovanni XXIII”, a large tertiary referral hospital in Northern Italy. We have retrospectively collected the microbiological data from bronchoalveolar lavage (BAL) and tracheal aspirate (TA) of patients with COVID-19, hospitalized in ICUs from 22nd February 2020 to 31st May 2020 (Period 1), and without COVID-19, from 22nd February 2019 to 31st May 2019 (Period 2). We compared the prevalence and the antibiotic profile of bacterial and fungal species in the two time periods.ResultsThe prevalence of Pseudomonas spp. shows a statistically significant increase from patients without COVID-19 compared to COVID-19 positive as well as the prevalence of Enterococcus spp. On the contrary, the prevalence of Gram negative non fermenting bacteria (GN-NFB), Haemophilus influenzae and Streptococcus pneumoniae showed a significant reduction between two periods. There was a statistically significant increase in resistance of Pseudomonas spp. to carbapenems and piperacillin/tazobactam and Enterobacterales spp. for piperacillin/tazobactam, in COVID-19 positive patients compared to patients without COVID-19. We did not observe significant changing in fungal respiratory isolates.ConclusionsA changing pattern in prevalence and resistance profiles of bacterial and fungal species was observed during COVID-19 pandemic.

Impact of the use of molecular techniques (PCR) on detection and eradication success against Helicobacter pylori

IntroductionHelicobacter pylori infection affects more than 50% of the world population. Increased antibiotic resistance is the main cause of treatment failure. The main objective was to analyze the eradication success after the application of the new ESPGHAN treatment recommendations and the introduction of PCR as a direct diagnosis technique, describe the evolution of the local pattern of antibiotic resistance, and assess the cost-effectiveness of PCR application, isolated or in conjunction with culture as a diagnostic strategy. Patients and methodsRetrospective descriptive study of all microbiological isolates of Helicobacter pylori in 2013–2019 in our center, by comparing the percentage of resistance and eradication success between the periods 2013−2016 and 2017−2019. Cost-effectiveness study of direct diagnostic tests, comparing 3 different options: culture and PCR; only culture; PCR only. Results192 patients were included, 98 were detected by culture (2013−2016) and 94 by culture and/or PCR (2017−2019). Antibiotic treatment was established in 153 patients, 90 in the first period (2011 ESPGHAN guidelines: eradication percentage 62.2%), 63 in the second (2017 ESPGHAN guidelines: eradication percentage: 73%). An increase in resistance to clarithromycin was observed, going from 16.3% (n=16) in the first period, to 53.2% (n=48) in 2017−2019 (98% detected by PCR, 60% by culture). There were no differences in the rest of antibiotic resistances. The isolated PCR application presented a cost-effectiveness analysis ratio (CEAR) of 71.91, compared to 92.16 for the culture and 96.35 for the culture and PCR combined. ConclusionsThe application of the ESPGHAN 2017 guidelines achieved greater eradication success, although less than that observed in previous publications, without reaching the target of at least 90%. An increase in resistance to macrolides was observed, without being able to discriminate whether it is a real increase or a greater diagnostic sensitivity of molecular techniques, with the isolated request for PCR being the most cost-effective strategy.

Animal bite wounds and their management in tropical Australia

ObjectiveTo define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. MethodsThis retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. ResultsA wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). ConclusionsA wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds.

Defining Clinical and Microbiological Nonresponse in Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is a severe complication of mechanical ventilation, with mortality reduced most effectively by adequate early antibiotic treatment. The clinical and microbiologic response can be assessed easily from 72 hours after starting antibiotic treatment. Evidence of nonresponse is based on several factors: (1) lack of clinical improvement, (2) radiographic progression, (3) an impaired Sequential Organ Failure Assessment (SOFA) score, (4) no improvement by days 3 to 5 on the Clinical Pulmonary Infection Score (CPIS), (5) no decreased in biomarkers on day 3, and (6) isolation of a new pathogen on day 3. Among the clinical markers of treatment failure, physicians should consider no improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), persistence of fever or hypothermia, persistence of purulent respiratory secretions, and new-onset septic shock or multiple-organ dysfunction syndrome. Microbiological isolation of a new pathogen on day 3 is also associated with higher mortality, but persistence of the original pathogen does not seem to be associated with a worse prognosis. The real impact of changes to treatment after diagnosing nonresponsive VAP is unknown. Physicians must evaluate whether treatments are adequate in terms of sensitivity, dose, and route. Pharmacokinetically and pharmacodynamically optimized doses are recommended in these patients. Clinical stabilization of comorbidities or underlying conditions may be of benefit.

First report of fungal Sporothrix schenckii complex isolation from feline with possible zoonotic transmission in the city of Belém, Pará, Brazil: Case report

Feline sporotrichosis is a subcutaneous, infectious, and contagious mycosis, with zoonotic characteristics. Until now there are no reports on the isolation of Sporothrix sp. in cats in the state of Pará. The present work aimed to isolate Sporothrix spp. from a cat with possible zoonotic involvement in the city of Belém, Pará. Through the active search for suspected cases of sporotrichosis, carried out by members of the Center for the Control of Zoonoses of Belém (CCZ, Belém) the suspicion of the disease in a feline was reported, with probable transmission to its owner. Clinical evaluation was performed, and biological material was collected from the animal for identifying the agent. Microscopic evaluation of the collected sample and microbial culture confirmed the presence of Sporothrix sp. in the sample. This study is the first to report the microbiological isolation of Sporothrix sp. in a cat in the metropolitan region of Belém, Pará, with possible zoonotic transmission. This indicates a probable underreporting of cases, an unknowing regarding the reality of health conditions and the need for more accurate and comprehensive evaluation of sporotrichosis in this region.

A novel growth and isolation medium for exoelectrogenic bacteria

A microbiological isolation and growth medium that can effectively discriminate electrochemically active exoelectrogenic bacteria from other non-exoelectrogenic bacteria, is currently unavailable. In this study, we developed a novel chromogenic growth and isolation solid medium based on MnO2 that can selectively allow the growth of exoelectrogenic bacteria and change the medium colour in the process. Known exoelectrogenic bacteria such as Shewanella oneidensis MR1 and other such bacteria from functional microbial fuel cell (MFC) anodes were capable of growing and changing colour in the novel growth medium. On the contrary, non-exoelectrogenic bacteria such as Escherichia coli ATCC 25922 were incapable of growing and inducing a colour change in the novel medium. Further biochemical characterisation of these isolated exoelectrogenic bacteria by Raman micro-spectroscopy demonstrated that these bacteria over express cytochrome proteins that are vital in extracellular electron transfer events. This medium is a convenient method to isolate exoelectrogenic bacteria from complex environmental samples.

Бактеріальні хвороби соргових культур

Goal. To analyze the data on the range of pathogens of sorghum bacterial diseases common in the world and assess the possibility of their introduction in Ukraine, and the lesion of sorghum crops by bacterial pathogens. Methods. General scientific (generalization, comparison, system analysis), field (visual inspection of sorghum crops), microbiological (isolation of bacteria from affected plants, study of physiological and biochemical properties of isolates). Results. The most common bacterial diseases of sorghum are the bacterial spot of sorghum (Pseudomonas syringae pv. syringae), the striped spot of sorghum (Xanthomonas vasicola pv. holcicola), the striatal spot of sorghum (Robbsia andropogonis). The main symptom of sorghum crops affected by bacteriosis pathogens are spots on leaves and stems. Symptoms typical of bacterial lesions on soriz leaves were found during the inspection of crops in farms of the Cherkasy region in 2019–2021. Conclusions. Phytopathogenic bacteria cause damage to sugar and grain sorghum in all countries where these crops are grown. A Survey of sorghum and soriz plantations for the presence of bacterial diseases should be carried out in July–September. New sorghum crop — soriz in the field is affected by the causative agent of bacterial spot sorghum Pseudomonas syringae pv. syringae.

ELISA indreto como método complementar de diagnóstico da tuberculose bovina

ABSTRACT: Bovine tuberculosis is an economic and health problem, requiring precise diagnostic methods for its control and eradication. The aim of this study was to evaluate the performance of a commercial enzyme-linked immunosorbent assay (ELISA) test for the diagnosis of bovine tuberculosis. A total of 1,644 cattle from eight dairy herds were evaluated using the comparative cervical tuberculin test (CCTT). Three of the herds had no recent tuberculosis infection, and the other five had shown positive results in a previous tuberculin test. For the serological diagnosis of tuberculosis, a commercial ELISA antibody test kit for Mycobacterium bovis was used. Serum samples from 846 cattle from the eight herds were evaluated using ELISA for M. bovis. Animals that were positive based on either CCTT or ELISA for M. bovis or both were sent to slaughter. Samples of their lungs, livers, and lymph nodes were collected and stored under refrigeration for microbiological culture and subsequent confirmation by polymerase chain reaction. Samples from the same tissues were also fixed with 10% formaldehyde in bottles for histopathological examination and stained with hematoxylin and eosin (HE). Of the 1,644 cattle, 61 were considered positive and 65 inconclusive based on CCTT. Retesting of the inconclusive samples identified an additional 19 positive cases, totaling 80 (4.8%) CCTT-positive animals from five herds. ELISA for M. bovis identified 4.2% (36/846) positive cattle, of which 35 were considered negative and one inconclusive based on CCTT. Of the 36 positive cases identified by ELISA for M. bovis, 27 were euthanized, 11% (3/27) showed suggestive lesions of tuberculosis on macroscopic examination, and two were confirmed by histological, microbiological, and PCR methods. The weak association of ELISA for M. bovis with the results obtained by macroscopic, histological, and microbiological isolation indicates the fragility of ELISA performance in field conditions. Therefore, it is suggested that its use as a complementary method for herd sanitation be based on the local epidemiological situation.

Influence of donor profile on pre and post-pasteurization bacteriology of donated human milk

Introduction: breastfeeding is the gold standard for infant's nutrition. Human milk bank is an essential tool to guarantee availability and safety in those situations when breastfeeding is not an option. The manipulation during the extraction of the human milk by the donors is a critical point to ensure an adequate microbiological safety. Therefore, knowing the bacterial flora that prevails in donated milk is essential to draw conclusions that can lead to taking measures in the management of the bank. Objectives: to analyze the prevalence of microorganisms in milk samples donated to the milk bank and how the bacterial flora behaves according to the profile of the donors and the donor milk circuits. Methods: the present work is a retrospective descriptive observational study that analyzes characteristics and the positive microbiological results within our milk bank samples from June 1, 2016 to December 31, 2020. All milk bank donors voluntarily signed an informed consent that authorizes the use of data to investigation. Results: during the study period, a total of 1,587 liters of raw milk were donated by 266 women, highlighting that, despite the SARS-CoV-2 virus pandemic, 2020 has been the year in which more volume of milk has been dispensed. The results show that 221 batches had at least one positive microbiological isolation (149 of them were before and 46 after pasteurization). Pre and post-pasteurization rate varies over the years with a decrease in the pre-pasteurization discard rate (3,9%) and increase in the post-pasteurization rate (5,3%). The most frequently isolated germs found in pre-pasteurization cultures were gram positive cocci and Enterobacter and a decrease in the positivity to S. aureus after establishing an eradication protocol. In post-pasteurization cultures, the most commonly found germs are Bacillus. Regarding the donor's profile, it was found a non statistically significant way that those women with the highest donation volume and/or admission of their offspring in Neonatology were associated with higher frequency of positive cultures. Conclusions: bacteriological analysis of milk samples is an essential part of quality control for a milk bank. Our results reflect a good extraction system and transportation, as well as good training from the bank's professionals. Nevertheless, improvement of processes is necessary to reduce the rate of contamination and the amount of discarded milk.

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital.

Background: Microbial drug resistance is one of the biggest public health problems. Antibiotic consumption is an essential factor for the emergence and spread of multiresistant bacteria. Therefore, we aimed to analyze the antibiotics consumption in the Intensive Care Unit (ICU), identifying trends in the antibiotics use profile and microbiological isolates throughout the COVID-19 pandemic. Methods: We performed this retrospective observational study in intensive care units of a Brazilian tertiary hospital from January 2019 to December 2020. The primary outcome was antimicrobial consumption in the ICU, measured by defined daily doses (DDDs) per 100 bed-days. As a secondary outcome, bacterial infections (microbiological isolates) were calculated in the same fashion. Outcomes trends were analyzed using Joinpoint regression models, considering constant variance (homoscedasticity) and first-order autocorrelation assumptions. A monthly percent change (MPC) was estimated for each analyzed segment. Results: Seven thousand and nine hundred fifty-three patients had data available on prescribed and received medications and were included in the analyses. Overall, the use of antibiotics increased over time in the ICU. The reserve group (World Health Organization Classification) had an increasing trend (MPC = 7.24) from February to April 2020. The azithromycin consumption (J01FA) increased rapidly, with a MPC of 5.21 from January to April 2020. Polymyxin B showed a relevant increase from March to June 2020 (MPC = 6.93). The peak of the antibiotic consumption of Reserve group did not overlap with the peak of the pathogenic agents they are intended to treat. Conclusion: Overall antimicrobial consumption in ICU has increased in the context of the COVID-19 pandemic. The peaks in the antimicrobial’s use were not associated with the rise of the pathogenic agents they intended to treat, indicating an empirical use, which is especially concerning in the context of treating multidrug-resistant (MDR) infections. This fact may contribute to the depletion of the therapeutic arsenal for MDR treatment.

Surveillance of hospital-acquired infections and monitoring of empiric antibiotic therapy in an internal medicine department

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.