Opportunistic Infections Research Articles

Clinical Outcomes and Molecular Characteristics of Bacteroides fragilis Infections.

Bacteroides fragilis is the most common opportunistic anaerobic pathogen. In the absence of appropriate antimicrobial therapy, mortality rates associated with B. fragilis group infections can reach as high as 50%. Therefore, we aimed to elucidate the clinical characteristics and outcomes of B. fragilis infections and the molecular genetic characteristics of B. fragilis isolates. Forty B. fragilis clinical isolates were collected at Hanyang University Hospital between January 2022 and December 2023. Antimicrobial susceptibility was tested using the agar dilution method. Whole-genome sequencing was conducted using the Illumina platform (Illumina, San Diego, CA, USA). Various multilocus sequence types of B. fragilis were identified, including ST149 (N=4), ST11 (N=4), ST1 (N=3), ST21 (N=2), and ST157 (N=1). The insertion sequence (IS) IS1187, located upstream of cfiA, was associated with high-level carbapenem resistance in the ST157 isolate. B. fragilis toxin genes (bft ) were identified in 30% of isolates. The most common comorbidities were diabetes mellitus (26.5%) and non-metastatic cancer (23.5%). Five patients (14.7%) died within 30 days, and two (5.9%) deaths were directly attributable to B. fragilis infection. The emergence of high-level MIC carbapenem-resistant B. fragilis ST157 has led to caution in the presence of B. fragilis infections.

Mucormycosis and COVID-19: Unraveling the Interplay of Fungal Infection in a Global Health Crisis: An Overview.

The healthcare system has been greatly affected by the COVID-19 pandemic, result-ing in an increase in secondary and co-infections among patients. Factors like pulmonary dam-age and weakened immune systems make patients more susceptible to fungal infections. Mu-cormycosis, an opportunistic fungal infection, prospers in environments with limited oxygen, and elevated glucose levels due to conditions such as diabetes and steroid use, as well as in acidic environments from metabolic acidosis and diabetic ketoacidosis, where it demonstrates heightened germination ability. Recognizing these complications is critical to minimize harm to patients. The insights gained from this review can improve our understanding of how fungal infections develop in connection to COVID-19, leading to better predictive algorithms, tailored care plans, enhanced antifungal treatments, quicker diagnostics, and improved management strategies.

Identification of an ArgR-controlled promoter within the outermost region of the IS10R mobile element.

Mobile genetic elements are small DNA fragments that can relocate within the genome, causing either gene inactivation or enhanced gene expression. Our research identified a new functional promoter and mRNA translation region within the IS10R element, which is part of the widely distributed Tn10 transposon. We found that the global regulators ArgR and IHF control the activity of this promoter. Additionally, insertion of this mini-Tn10 derivative into the barA gene resulted in the expression of a truncated but constitutive active form of the BarA sensor kinase. Overall, our work sheds light on how mobile genetic elements could impact the physiology and virulence of opportunistic pathogenic bacteria.

Influence of gender, age, and body mass index on the gut microbiota of individuals from South China.

The symbiotic gut microbiota is pivotal for human health, with its composition linked to various diseases and metabolic disorders. Despite its significance, there remains a gap in systematically evaluating how host phenotypes, such as gender, age, and body mass index (BMI), influence gut microbiota. We conducted an analysis of the gut microbiota of 185 Chinese adults based on whole-metagenome shotgun sequencing of fecal samples. Our investigation focused on assessing the effects of gender, age, and BMI on gut microbiota across three levels: diversity, gene/phylogenetic composition, and functional composition. Our findings suggest that these phenotypes have a minor impact on shaping the gut microbiome compared to enterotypes, they do not correlate significantly within- or between-sample diversity. We identified a substantial number of phenotype-associated genes and metagenomic linkage groups (MLGs), indicating variations in gut microflora composition. Specifically, we observed a decline in beneficial Firmicutes microbes, such as Eubacterium, Roseburia, Faecalibacterium and Ruminococcus spp., in both older individuals and those with higher BMI, while potentially harmful microbes like Erysipelotrichaceae, Subdoligranulum and Streptococcus spp. increased with age. Additionally, Blautia and Dorea spp. were found to increase with BMI, aligning with prior research. Surprisingly, individuals who were older or overweight exhibited a lack of Bacteroidetes, a dominant phylum in the human gut microbiota that includes opportunistic pathogens, while certain species of the well-known probiotics Bifidobacterium were enriched in these groups, suggesting a complex interplay of these bacteria warranting further investigation. Regarding gender, several gender-associated MLGs from Bacteroides, Parabacteroides, Clostridium and Akkermansia were enriched in females. Functional analysis revealed a multitude of phenotype-associated KEGG orthologs (KOs). Our study underscores the influence of gender, age, and BMI on gut metagenomes, affecting both phylogenetic and functional composition. However, further investigation is needed to elucidate the precise roles of these bacteria, including both pathogens and probiotics.

023. Isolated Calvarial Tuberculosis in An Immunocompromised Patient: A Case Report

Background: Isolated Calvarial tuberculosis is a rare occurrence, first reported by Reid in 1842, with majority of cases (75-90%) appearing under the age group of 20-30 years and involving frontal and parietal bones because of the greater amount of cancellous bone with diploic channels. The Human Immunodeficiency Virus (HIV) Infection is currently a huge threat to Indonesia, with Tuberculosis (TB) infection is one example of opportunistic infection that can lead to death in People living with HIV. The objective of this article is to report a rare case of Isolated Calvarial Tuberculosis in an Immunocompromised Patient Case: A 26-year-old male, known to be immunocompromised with HIV infection, presented to hospital with chief complaint of a painless lump on the left temple since 1 month prior. Head CT-Scan examination revealed osteolytic appearance in the left frontal area and swelling of the surrounding soft tissue. The patient then underwent surgery with intraoperative findings of a cystic mass filled with yellowish fluid. A craniotomy of the surrounding healthy bone including the dura mater and excision of the overlying soft tissue were performed, and histopathological result revealed a chronic tuberculosis inflammation. Conclusion: Calvarial Tuberculosis is a rare form of skeletal tuberculosis occurring in younger population, but can also present in older patient with immunocompromised state, that present with main complaint of painless swelling or lump in the frontal or parietal area because of its favourable bone structure. Diagnostic including X-ray and CT-Scan with microbiologic findings of multiple epithelioid granulomas with Langerhans type giant cells. Preferred treatment including both surgical and antituberculosis therapy to achieve favourable outcome.

Performance of a Global Functional Assay Based on Interferon-γ Release to Predict Infectious Complications and Cancer After Kidney Transplantation.

The QuantiFERON-Monitor assay (QTF-Monitor) is intended to assess innate and adaptive immune responses by quantifying interferon (IFN)-γ release upon whole blood stimulation with a TLR7/8 agonist and an anti-CD3 antibody. We performed the QTF-Monitor in 126 kidney transplant recipients (KTRs) at different points during the first 6 post-transplant months. The primary outcome was overall infection, whereas secondary outcomes included bacterial infection, opportunistic infection and de novo cancer. The association between IFN-γ production and outcomes was analyzed as "low" immune responses (<15IU/mL) and as a continuous variable to explore alternative thresholds. There were no significant differences in the occurrence of overall infection according to the QTF-Monitor at any monitoring point. Regarding secondary outcomes, KTRs with a low response at week 2 experienced a higher incidence of bacterial infection (50.8% versus 24.4%; P-value = 0.006). Low response at month 1 was also associated with opportunistic infection (31.6% versus 14.3%; P-value = 0.033). The discriminative capacity of IFN-γ levels was poor (areas under the ROC curve: 0.677 and 0.659, respectively). No differences were observed for the remaining points or post-transplant cancer. In conclusion, the QTF-Monitor may have a role to predict bacterial and opportunistic infection in KTRs when performed early after transplantation.

Agricultural Soil as a Reservoir of Pseudomonas aeruginosa with Potential Risk to Public Health

Pseudomonas aeruginosa is an opportunistic pathogen with a high capacity to adapt to different factors. The aim of this study is to analyze the pathogenicity in P. aeruginosa strains and their resistance to heavy metals and antibiotics, in agricultural soil of the state of Tamaulipas, Mexico. Susceptibility to 16 antibiotics was tested using the Kirby-Bauer method (CLSI). Eight virulence factors (FV) and six genes associated with heavy metal resistance were detected by PCR. As a result, P. aeruginosa was detected in 55% of the samples. The eight virulence factors were identified in ≥80% of the strains. The strains showed some level of resistance to only three antibiotics: 32.8% to ticarcillin, 40.8% to ticarcillin/clavulanic acid and 2.4% to aztreonam. The most frequent heavy metal resistance genes were arsC (92.8%) and copA (90.4%). However, copB and arsB genes were also identified in a percentage greater than 80%, and the least frequent genes were merA in 14.4% and czcA in 7.2%. Although P. aeruginosa strains showed a high percentage of factor virulence (potential ability to cause infections), their high levels of susceptibility to antibiotics lead to the assumption that infections are easily curable.

Rosmarinic Acid Exhibits Antifungal and Antibiofilm Activities Against Candida albicans: Insights into Gene Expression and Morphological Changes

Candida species, opportunistic pathogens that cause various infections, pose a significant threat due to their ability to form biofilms that resist antifungal treatments and immune responses. The increasing resistance of Candida spp. and the limited availability of effective treatments have prompted the research of natural compounds as alternative therapies. This study assessed the antifungal properties of RA against Candida species, focusing on its impact on C. albicans biofilms and the underlying mechanisms. The antifungal efficacy of RA was evaluated using the CLSI M27-A3 microdilution method on both fluconazole-susceptible and -resistant strains. Biofilm formation by C. albicans was assessed through a crystal violet assay, while its antibiofilm activity was analyzed using an MTT assay and field emission scanning electron microscopy (FESEM). Gene expression related to biofilm formation was studied using quantitative real-time PCR (qRT-PCR), and statistical analysis was performed with an ANOVA. Among the 28 Candida strains tested, RA exhibited minimum inhibitory concentration (MIC) values ranging from 160 to 1280 μg/mL. At a 640 μg/mL concentration, it significantly reduced the expression of genes associated with adhesion (ALS3, HWP1, and ECE1), hyphal development (UME6 and HGC1), and hyphal cAMP-dependent protein kinase regulators (CYR1, RAS1, and EFG1) in RAS1-cAMP-EFG1 pathway (p &lt; 0.05). FESEM analysis revealed a reduction in hyphal networks and disruptions on the cell surface. Our study is the first to demonstrate the effects of RA on C. albicans adhesion, hyphae development, and biofilm formation through gene expression analysis with findings supported by FESEM. This approach distinguishes our study from previous studies on the effect of RA on Candida. However, the high MIC values of RA limit its antifungal potential. Therefore, more extensive research using innovative methods is required to increase the antifungal effect of RA.

Intestinal microflora and metabolites affect the progression of acute pancreatitis (AP)

Specific intestinal metabolites are closely associated with the classification, severity, and necrosis of acute pancreatitis (AP) and provide novel insights for in-depth clinical investigations. In this study, the gut microbiota and metabolites of 49 AP patients at different treatment stages and severities were analysed via 16S rDNA sequencing and untargeted metabolomics to investigate the trends in gut microbiota composition and metabolome profiles observed in patients with severe AP. These findings revealed an imbalance in intestinal flora homeostasis among AP patients characterized by a decrease in probiotics and an increase in opportunistic pathogens, which leads to damage to the intestinal mucosal barrier through reduced short-chain fatty acid (SCFA) secretion and disruption of the intestinal epithelium. This dysbiosis influences energy metabolism, anti-inflammatory responses, and immune regulation, and these results highlight significant differences in energy metabolism pathways. These findings suggest that the differential composition of intestinal flora, along with alterations in intestinal metabolites and metabolic pathways, contribute to the compromised integrity of the intestinal mucosal barrier and disturbances in energy metabolism in patients with severe AP.

Suspected nocardiosis in an immunosuppressed patient: a case report highlighting diagnostic challenges and management strategies

Nocardiosis is a rare but potentially fatal opportunistic infection caused by Nocardia species, predominantly affecting immunocompromised individuals. This case report details the clinical course, diagnostic workup, and management of a 63-year-old female with a history of renal transplantation. Initial investigations, including imaging studies, revealed multiple cavitary pulmonary nodules and a solitary brain lesion, raising concerns for disseminated infection. The diagnostic challenge was compounded by the broad differential diagnosis in this patient population, including fungal, mycobacterial, and other opportunistic infections. Empirical antimicrobial therapy was initiated, and subsequent microbiological confirmation of Nocardia asteroides from bronchoalveolar lavage specimens established the diagnosis. Despite initial therapeutic response, the patient developed worsening neurological symptoms indicative of CNS involvement, necessitating prolonged treatment with a combination of trimethoprim-sulfamethoxazole and imipenem. This report underscores the importance of early recognition, comprehensive diagnostic evaluation, and individualized therapeutic approaches in managing suspected nocardiosis in immunocompromised patients. Furthermore, it discusses the diagnostic pitfalls, highlights the need for a high index of suspicion, and reviews current therapeutic recommendations for both pulmonary and disseminated nocardiosis, providing a valuable reference for clinicians managing similar cases.

Molecular Characteristics Demonstrate the Occurrence of Phylogenetic Similar Isolates of &lt;i&gt;Vibrio alginolyticus&lt;/i&gt; and &lt;i&gt;Vibrio parahaemolyticus&lt;/i&gt; in Aquatic Environments

Vibrio alginolyticus is an opportunistic fish pathogen with a potential to cause septicemia and often associated with other Vibrio infections, particularly Vibrio parahaemolyticus, and can pose a significant threat to aquatic health. This study investigated the biochemical and phylogenetic characteristics of V. alginolyticus isolated from various aquaculture farms, focusing on its prevalence, hemolysin genes, genetic relatedness, and antibiotic susceptibility. Out of 92 brackish water aquaculture farm samples, 16 isolates were biochemically confirmed as V. alginolyticus, with 12 subsequently confirmed by polymerase chain reaction targeting collagenase gene. Molecular analysis of the thermolabile hemolysin gene (tlh) via specific PCR amplified a 450 bp fragment in 8 isolates, confirming the presence of the tlh gene. Pulsed Field Gel Electrophoresis (PFGE) typing differentiated tlh-positive and tlh-negative V. alginolyticus isolates with 92% genetic similarity. The isolates exhibited proteolytic, lipolytic, and lecithinase activities. Notably, the isolates showed intermediate resistance to most of the tested antibiotics, indicating exposure to antimicrobial agents. This study provides evidence of the presence of similar phylogenetical isolates of V. alginolyticus and V. parahaemolyticus in aquatic environments. Furthermore, this study emphasizes the importance of expanding surveillance programs by incorporating strain-specific characterization to better understand and control vibriosis in aquaculture.

Influence of starter cultures of lactic acid bacteria on microbiological parameters and shelf life of sausages

The main spoilage microorganisms of the vacuum-packaged sausages on the first day of chilled storage are the bacteria of the following families: Enterobacteriaceae (Raoultella planticola, Raoultella ornithinolytica, and Citrobacter freundii), Morganellaceae (Morganella morganii) and Staphylococcaceae (Macrococcus caseolyticus), and at the end of the shelf life (on the twenty-first day) - Enterobacteriaceae (Proteus mirabilis, Moellerella wisconsensis and Serratia liquefaciens). An appearance of cloudy juice, surface slime and delamination of the vacuum packaging characterises the sausage spoilage. QMAFAnM in the sausages was increased by 1.09 lg CFU/g and 1.53 lg CFU/g on the first day of storage, by 1.18 lg CFU/g and 1.54 lg CFU/g on the twelfth day, by 0.92 lg CFU/g and 1.96 lg CFU/g on the eighteenth day, respectively, compared to the control sample, because “Vienna sausages with chicken fillet” were treated with starter culture SafePro BLC-48 (Lactobacillus curvatus) or the mixture of starter cultures SafePro BLC-48 (Lactobacillus curvatus) + Bactoferm Rubis (Lactococcus lactis subsp. Lactis) before vacuum packaging. Because the sausages were treated with the mixture of starter cultures SafePro BLC-48 + Bactoferm Rubis, the lactic-acid microorganisms were increased by 0.63 lg CFU/g and 0.53 lg CFU/g on the twenty-fifth and thirtieth days, respectively, compared to the sausages that were treated with SafePro BLC-48. During the entire shelf life, no pathogenic and opportunistic pathogenic bacteria, in particular S. aureus, L. monocytogenes, Salmonella spp., E. coli, coliform bacteria, as well as yeast and mold, were detected in the sausages under all treatment options. The use of starter culture SafePro BLC-48 (Lactobacillus curvatus) or the mixture of starter cultures SafePro BLC-48 (Lactobacillus curvatus) + Bactoferm Rubis (Lactococcus lactis subsp. Lactis) increases the shelf life of the vacuum-packaged sausages if they are kept in a refrigerator for up to 30 days, which is 12 days longer than their shelf life without treatment. The sausage treatment with the mixed starter cultures of the lactic-acid microorganisms may be promising if the development of the aerobic spoilage bacteria is confirmed.

A Novel Methylene Blue Indicator-Based Aptasensor for Rapid Detection of Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a significant opportunistic pathogen highly prevalent in the environment, requiring early detection methods to prevent infections in vulnerable individuals. The most specific aptamer for P. aeruginosa, F23, has been used for the development of various assays and sensors for early diagnosis and monitoring. In this study, a novel F23-based electrochemical aptasensor was designed using disposal gold screen-printed electrodes (Au-SPEs) with high reproducibility. Methylene blue (MB) was used as an exogenous indicator, which significantly amplified the electrochemical signal and improved the sensitivity of detection. The aptasensor explored a limit of detection (LOD) of 8 CFU·mL-1 and high selectivity for P. aeruginosa over other interfering bacteria. Furthermore, it showed potential to detect P. aeruginosa in tap water samples, offering a point-of-care tool for rapidly controlling the growth of this bacterium in various applications.

Observation of two novel mcr-10.1–carrying plasmids in clinical Escherichia coli strains

Abstract Polymyxins are a class of last-resort antibiotics used to treat infections caused by multidrug-resistant bacteria. Mobile resistance determinants for polymyxins, including mcr-1 to mcr-10 genes, have previously been reported. Among them, mcr-10 has commonly been observed in Enterobacter and Klebsiella species. However, the presence of mcr-10 in Escherichia coli, an important opportunistic pathogen, has rarely been reported. This work describes the observation of mcr-10.1 in two clinical E. coli strains, with mcr-10.1 hosted on two novel plasmids, one of which carrying transconjugation genes. These strains were isolated from anal fistula–suffering patients, suggesting their close relation to human bacterial infection. The genetic context of mcr-10.1 was also found to differ from those previously identified in E. coli strains. This work is the first observation of mcr-10.1–carrying E. coli in clinical settings, expanding our knowledge of this important antibiotic resistance gene.

Substrate identification of putative NCS1 and NCS2 nucleobase transporters in Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a frequently multidrug-resistant opportunistic pathogen and one of the most common causes of healthcare-acquired infections. While nucleobases are known to support growth in nutrient-limited conditions, recent work showed that adenine and hypoxanthine can also decrease P. aeruginosa biofilm formation by disrupting c-di-GMP metabolism. Thus, nucleobase transport may be relevant to multiple aspects of P. aeruginosa biology and pathogenesis. However, there is currently little known about the transport of nucleobases in P. aeruginosa. Our work reports initial substrate identifications for 10 putative nucleobase transporters in P. aeruginosa, providing new tools to address previously difficult-to-test hypotheses relating to nucleobase transport in this organism.

Streptococcus anginosus orchestrates antibacterial potential of NETs facilitating survival of accompanying pathogens

Streptococcus anginosus is considered an emerging opportunistic pathogen causing life-threatening infections, including abscesses and empyema. Noticeably, clinical data revealed that S. anginosus also constitutes an important component of polymicrobial infections. Here, we showed for the first time that S. anginosus inactivates the antibacterial potential of neutrophil extracellular traps (NETs). The process is determined by a cell wall-anchored nuclease referred to as SanA, which high expression dominates in clinical strains isolated from severe infections. Nuclease activity protects S. anginosus against the antibacterial activity of NETs, supporting at the same time the survival of coexisting highly pathogenic species of Enterobacteriales. Obtained data suggest that SanA nuclease should be recognized as a critical S. anginosus virulence factor determining severe monospecies purulent infections but also shielding other pathogens promoting the development of polymicrobial infections.

Molecular Characterization and Antibiogram of &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; Isolated from Fish Sold in Markets of Tirupati, India

Pseudomonas aeruginosa is an emerging opportunistic pathogen and is one of the pathogens in the acronym ESKAPE representing a global threat to human health associated with antimicrobial resistance. The present study aimed for molecular characterization, virulence gene profiling and antimicrobial resistance studies of P. aeruginosa isolated from 200 fish samples collected from different fish markets in Tirupati, Andhra Pradesh, India. Of the 200 fish samples screened, 30.5% were confirmed as P. aeruginosa by PCR, targeting the 16S rRNA gene. Among the positive isolates, it was found that 70.4% and 75.4% of the isolates harbored toxA and exoS virulence markers, respectively. All 61 P. aeruginosa isolates recovered were phenotypically characterized for antimicrobial resistance patterns by the disc diffusion method. The study has found 100% resistance against erythromycin followed by 98.4% resistance to amoxicillin, 91.8% resistance against tetracycline, 88.5% resistance to vancomycin and cotrimoxazole, 45.9% resistance to ciprofloxacin, 44.2% resistance against cefepime and 9.9% resistance to gentamicin. The MAR indices were in the range from 0.5 to 1.0. The prevalence of multiple antibiotic resistance of P. aeruginosa harboringvirulence genes in fish can pose a serious threat and hazard to public health through the consumption of raw or undercooked fish.

Post COVID rhino-cerebral mucormycosis at a tertiary hospital in Central India: a retrospective cohort study

BackgroundUsually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis.ResultsThis is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death.ConclusionEffective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease.

Isoniazid Prophylaxis Based on Tuberculosis Risk Factors in Living Kidney Transplantation Recipients: A Retrospective Cohort Study

BackgroundTuberculosis (TB) is a major and severe opportunistic infection among solid organ transplant recipients. Chemoprophylaxis is advised for those with latent tuberculosis infection (LTBI). However, the effectiveness of an isoniazid (INH) prophylactic approach based on TB risk factors remains uncertain. MethodsThis study included all living-donor kidney transplant recipients (KTRs) between January 2016 and December 2022. The recipients were categorized into three groups: the risk group with isoniazid (R-INH), the risk group without isoniazid (R-NINH), and the non-risk group (NR), based on the presence of TB risk factors and INH usage. The R-INH group received a 6-month INH prophylactic regimen to prevent post-transplant TB infection. The incidence of active TB among the groups was assessed. ResultsA total of 1348 patients were divided into R-INH (n=108), R-NINH (n=371), and NR (n=869). Forty-seven patients (3.49%) developed TB with an incidence rate of 16.0 per 1000 person-years. Compared to NR, the TB incidence in R-INH was not statistically different (HR, 0.55, 95% CI, 0.07-4.21, P = 0.564), whereas it was significantly higher in R-NINH (HR, 5.04, 95% CI, 2.64-9.62, P < 0.001). The median time from transplantation to TB was 19 months (IQR: 6-39), and 18 patients (38.3%) were diagnosed within one year of transplantation. Ninety-four patients (87.0%) completed INH prophylaxis, with adverse events including two cases of hepatotoxicity (1.85%) and one case of peripheral neuritis (0.93%). ConclusionsA 6-month INH regimen based on TB risk factors is effective and well tolerated for preventing post-transplant TB in KTRs

Klebsiella in Wildlife: Clonal Dynamics and Antibiotic Resistance Profiles, a Systematic Review

Klebsiella spp. are a genus of Gram-negative, opportunistic bacteria frequently found in the flora of the mucosal membranes of healthy animals and humans, and in the environment. Species of this group can cause serious infections (meningitis, sepsis, bacteraemia, urinary tract infections, liver damage) and possible death in immunocompromised organisms (and even in immunocompetent ones in the case of hypervirulent K. pneumoniae) that are exposed to them. K. pneumoniae is part of the ESKAPE organisms, and so it is important to understand this genus in terms of multidrug-resistant bacteria and as a carrier of antibiotic resistance mechanisms. As it is a durable bacterium, it survives well even in hostile environments, making it possible to colonize all kinds of habitats, even the mucosal flora of wildlife. This systematic review explores the prevalence of Klebsiella spp. bacteria in wild animals, and the possibility of transmission to humans according to the One Health perspective. The isolates found in this review proved to be resistant to betalactams (blaTEM, blaOXA-48…), aminoglycosides (strAB, aadA2…), fosfomycin, tetracyclines, sulphonamides, trimethoprim, phenicols (catB4), and polymyxins (mcr4).