Post Infections Research Articles

Antibiotic Management After Neonatal Enteric Operations in US Children's Hospitals

BackgroundThere are few evidence-based guidelines for perioperative antibiotic management in neonates who undergo enteric operations. We sought to assess antibiotic administration practices in a large population of patients who underwent operations involving enteric anastomoses and evaluate the incidence of postoperative infection and other outcomes based on antibiotic approach. MethodsThe Pediatric Health Information Systems database was queried for patients who underwent repair of esophageal, duodenal or jejuno-ileal atresia in 2021. The type and number of consecutive days of perioperative antibiotics was determined and ICD-10 codes corresponding to infection were noted. The incidences of post operative infections (bacterial and fungal), antibiotic-resistant infections and anti-fungal medication administration were determined. Results516 infants were identified. A wide variety of antibiotics were administered and 39 % of patients received more than one day of treatment. There were no differences in the incidence of postoperative infection between those who received more or less than one day of perioperative antibiotics for any of the operations assessed. The incidence of bacterial infection in patients treated with cefazolin or cefoxitin monotherapy was no different than that for all other regimens. There were no significant differences in the incidence of post-operative fungal infection based on antibiotic type or duration. ConclusionThere was substantial variation in the duration and type of antibiotics administered after neonatal enteric operations. We identified a low incidence of infection with only one day of perioperative antibiotics and there was no evidence that longer treatment reduced infection risk. Cefazolin monotherapy was likewise associated with a low risk for perioperative infections. Study typeNon-interventional observational database study. Level of evidence3.

P.522: Study of clinical profile of post renal transplant Infections during first year after transplant- A single center study.

P.522: Study of clinical profile of post renal transplant Infections during first year after transplant- A single center study.

Prevalence of bacterial isolates of post caesarean wounds from hospitals in Otukpo, Benue state, NigeriaC

Sepsis after caesarean section (CS) is still a major problem in our hospitals. A large percentage of caesarean section wound infections arise from preventable causes which if addressed could significantly reduce rate of wound sepsis. The aim of this study was to identify the prevalence of bacterial pathogens associated with post caesarean wound infections and determine their relationship with some risk factors. A prospective descriptive study was conducted in randomly selected hospitals in Otukpo which included 278 women (mean age; 26.94) who underwent surgical procedure for delivery. Data were collected from patients following wound examination and compared in terms of surgical site infection and study variables (age, parity, type of CS, type of incision, duration of hospital stay and duration of Labour. Out of the 278 caesarean sections, 187(67.3%) were emergency procedures and 91 (32.7%) were elective procedures. Twenty three of the cases developed surgical site infections (SSI). Staphylococcus aureus (n=11; 47.83%) was the most commonly isolated organism followed by E. coli (n=5; 21.74). Caesarean section infection was found to be common in women who had emergency CS (p<0.0001), who had longer duration of Labour and hospital stay (p<0.0001) and had sub-umblical type of skin incision (p<0.0001). Development of infection following caesarean section is multifactorial and can be minimized or prevented if health care professionals develop and implement strict protocol for performing caesarean sections.

Presenting clinical symptoms of post-COVID-19 breakthrough infection: Predictors of mortality in a Middle Eastern population

ObjectiveBreakthrough COVID-19 infections are common following immunisation with various types of vaccines. The patterns of infections have not been well established. We aimed to analyse the signs and symptoms of post vaccination infections in addition to the need for hospital admission, ER visit and supplemental oxygen in relation to age and gender. MethodsA cross-sectional cohort study was conducted in JUH from March 2021 to August 2022, we interviewed 1479 individuals who are >15 years of age and got a breakthrough infection. The statistical analysis was performed using STATA statistical software. ResultsOut of the 1479 cases, 50.2 % and 69.4 % were females and less than 45 years of age respectively. Symptoms of cough, fever and headache were reported by nearly 50 % of the patients, while one-third complained of dyspnoea. We found that participants older than 45 years had worse clinical outcomes (P-value < 0.001). 13 deaths were identified in this study due to breakthrough infection, 92.3 % of them were older than 45 years (P-value < 0.001). Participants ≥45 years who experienced a breakthrough infection of COVID-19 were 0.7 times less likely to be females using adjusted logistic regression. ConclusionThis study indicates that despite more severe symptoms reported in younger patients, the major clinical outcomes were worse among older patients, which makes age a major risk for poor outcomes regardless of symptoms. Thus, older people should be evaluated carefully when presenting with mild symptoms of COVID-19 breakthrough infection. The study also confirms that there is no difference in the incidence of COVID-19 breakthrough infections between males and females. Prospective studies are needed to risk stratify COVID-19 breakthrough infections, which should take into account variants of the virus and comorbidities.

Doxycycline cotherapy with albendazole relieves neural function damage in C57BL/6 and BALB/c mice infected with Angiostrongylus cantonensis

BackgroundWe investigated the effects of combination therapy albendazole and doxycycline in Angiostrongylus cantonensis-infected mice during early and late treatment. Materials and methodsC57BL/6 and BALB/c mice were divided into five groups: (i) uninfected, (ii) infected with A. cantonensis, (iii) infected + 10 mg/kg albendazole, (iv) infected + 25mg/kg doxycycline, and (v) infected + 10 mg/kg albendazole + 25 mg/kg doxycycline. We administered drugs in both early treatments started at 7-day post infections (dpi) and late treatments (14 dpi) to A. cantonensis-infected C57BL/6 and BALB/c mice. To assess the impact of these treatments, we employed the Morris water maze test to evaluate spatial learning and memory abilities, and the rotarod test to measure motor coordination and balance in C57BL/6 mice. Additionally, we monitored the expression of the cytokine IL-33 and GFAP in the brain of these mice using western blot analysis. ResultsIn this study, A. cantonensis infection was observed to cause extensive cerebral angiostrongyliasis in C57BL/6 mice. This condition significantly affected their spatial learning and memory abilities, as assessed by the Morris water maze test, as well as their motor coordination, which was evaluated using the rotarod test. Early treatment with albendazole led to favorable recovery outcomes. Both C57BL/6 and BALB/c mice express IL-33 and GFAP after co-therapy. The differences of levels and patterns of IL-33 and GFAP expression in mice may be influenced by the balance between pro-inflammatory and anti-inflammatory signals within the immune system. ConclusionsCombination therapy with anthelmintics and antibiotics in the early stage of A. cantonensis infection, in C57BL/6 and BALB/c mice resulted in the death of parasites in the brain and reduced the subsequent neural function damage and slowed brain damage and neurobehavior impairment. This study suggests a more effective and novel treatment, and drug delivery method for brain lesions that can decrease the neurological damage of angiostrongyliasis patients.

Decreasing post hysterectomy surgical site infections with the implementation of a hysterectomy-specific bundle

Surgical site infections (SSI) are a common complication of hysterectomy. Surgical bundles have been shown to reduce SSIs. Here we describe a bundle that was used to combat an abnormal rise in SSI events that resulted in a greater than 75% reduction at our institution. A hysterectomy-specific bundle was developed based on the prior success of SSI prevention bundles. Development involved longitudinal education and training to ensure accuracy and compliance. All inpatient abdominal, laparoscopic, and vaginal hysterectomies performed at a tertiary referral center were included. The preintervention, intervention, and postintervention periods were each one year in length. SSI rates were peer-reviewed monthly and overall trends were tracked, including compliance with bundle guidelines. Preintervention, an abnormal rise in SSI was identified at 3.76%. During the intervention, 309 inpatient hysterectomies were completed. In this period, 6 posthysterectomy SSI events occurred (3.76% vs 1.94%, P=.21). Four SSIs followed laparotomy and 2 followed laparoscopy. Compliance during the intervention period ranged from 79% to 89% with a mean of 85%. In the postintervention period, there were 6 SSI following 689 hysterectomies (3.76% vs 0.87%, P=.004). The majority of SSI occurred after abdominal hysterectomy. Implementation of a hysterectomy-specific surgical bundle allowed for a significant reduction in post hysterectomy SSI during a yearlong intervention period and a sustained, further reduction in the postintervention period.

UNMET CLINICAL NEEDS AND CHALLENGES IN ORTHOPAEDIC IMPLANTS

Infections are among the most diffused complications of the implantation of medical devices. In orthopedics, they pose severe societal and economic burden and interfere with the capability of the implants to integrate in the host bone, significantly increasing failure risk. Infection is particularly severe in the case of comorbidities and especially bone tumors, since oncologic patients are fragile, have higher infection rate and impaired osteoregenerative capabilities. For this reason, prevention of infection is to be preferred over treatment.This is even more important in the case of spine surgery, since spine is among the main site for tumor metastases and because incidence of post operative surgical-site infections is significant (up to 15-20%) and surgical options are limited by the need of avoiding damaging the spinal cord.Functionalization of the implant surfaces, so as to address infection and, possibly, co- adjuvate anti-tumor treatments, appears as a breakthrough innovation. Unmet clinical needs in infection and tumors is presented, with a specific focus on the spine, then, new perspectives are highlighted for their treatment.

Histopathological spectrum of fungal infections in COVID 19 cases – A retrospective observational study

A wide range of fungal and bacterial infections are associated with Corona virus disease (COVID19). There was a surge of mucormycosis during COVID19 pandemic in 2021. This study elaborates the histopathological findings observed in fungal infections of head and neck in COVID 19 patients. A retrospective observational study of histopathological findings of invasive fungal infection in COVID 19 case was conducted in our laboratory. All the tissue samples diagnosed as post COVID fungal infections during January 2021 to June 2021 were analyzed. Representative sections were taken and slides were stained with Hematoxylin &amp; Eosin, Periodic Acidic Schiff (PAS) and Gomori Methenamine silver (GMS) stains. Histopathological features were studied. There were total 32 cases which had invasive fungal infections associated with COVID 19. The most affected age group was 31 to 50 years of age (50%), with male preponderance (87.5%). Diabetes was present in 62.5% cases, and steroid use during the treatment was present in 31.3% of the cases. The most common site was maxillary sinus (53.1%) followed by nasal cavity (34.4%). Isolated infection by mucor was seen in 68.8% cases, there were cases of secondary bacterial infection and candida with aspergillus infection. Angioinvasion was present in 56.3% cases and bone destruction in 15.6% cases.COVID 19 infection results in immune dysregulation and background of diabetes and over use of steroids increases risk of mucormycosis. An early histopathological diagnosis provides early diagnosis.

Investigation the Role of Various Antiseptics on the Prevalence of Skin Microbiota and Post Cesarean Surgery Infections

During this study, 690 swabs were taken from different sites divided as the following: First, 350 swabs from surgical instruments, doctor gloves, and antiseptics before beginning cesarean surgery to ensure their sterilization. Second, 310 swabs from 70 skins (out of 100) of female patients attending Al-Elwiya Educational Maternity Hospital were taken at the site of cesarean surgery incision before and after sterilization with 10% povidone-iodine and 10% povidone-iodine mixed with 70% ethanol to detect the efficiency of antiseptics and any bacterial invasion might cause post operative infections. Furthermore, 30 swabs from infected surgical sites were taken from 30 female patients with post operative cesarean infections to detect the causative bacterial pathogen. The result of 350 swabs that were all taken from different surgical instruments, doctor gloves, and antiseptics before surgery in all groups showed negative growth culture. The bacterial isolates were primary identified by phenotypic examinations and biochemical tests and final identification by VITEK -2 system. Staphylococcus epidermidis was revealed to be the prevalent bacterial species from all skin sample sources, while Staphylococcus aureus was dominant in surgical site infections. Sterilization with 10% povidone iodine mixed with 70% ethanol showed less bacterial load on skin with a significant decrease in the numbers of isolated bacteria in comparison to use 10% povidone iodine solution alone.

Prevalence of Post Caesarean Wound Infections and Associated Factors among Mothers Delivering from Kampala International University Teaching Hospital

Caesarean section simply is an operative technique by which a fetus is delivered through an abdominal and uterine incisions after a minimum period of 28 weeks of amenorrhea, whilst a post caesarean section wound infection (PCWI) is an infection that occurs after a C- section, usually due to a bacterial infection in the surgical incision site. The purpose of this study was to determine the prevalence of post caesarean wound infections among mothers who delivered from KIU-TH, and to identify common factors associated with post caesarean wound infections among these mothers. Descriptive statistics were used to characterize and highlight the difference among the post-caesarean patients. Data was entered and analyzed using SPSS version 16. The analyzed data was then presented using tables and charts. The results indicate that the prevalence of post-caesarean wound infection at Kampala International University-Teaching Hospital is still low (3.2%) but may increase if the steps are not taken to initiate its prevention and eradication. The results indicate that post-caesarean wound infection is positively and significantly associated with age (X2 = 10.747, P&lt;0.05), the cause/reason of caesarean section (X2 = 62.000, P&lt;0.05), color of liquor (X2 =45.983, P&lt;0.05), duration of labor (X2 =10.067, P&lt; 0.05) and amount of blood lost (X2 = 3.844, P&lt;0.05). The prevalence of PCWIs at KIU-TH was 3.2% and the factors associated were the reason for caesarean section, color of liquor, duration of labor, amount of blood lost. Based on the results and the findings, the study recommends that recognition of the consequences and the building of the strategies to prevent and treat Post-caesarean wound infections at Kampala international university-teaching hospital is essential for reducing post- caesarean maternal morbidity and mortality. In addition, the study also recommends the recognition of the associated risk factors particularly the modifiable and their modification to reduce the occurrence of Post-caesarean wound infection. Keywords: Prevalence, Post Caesarean, Wound Infections and Mothers Delivering

Variety of Antibody Responses to BNT162b2 and BBIBP-CorV Vaccinations Against COVID-19 Infections in Baghdad and Fallujah, Iraq

The huge impact of COVID-19 worldwide led to the rapid development of vaccines with inadequate data about its longevity, effectivity, and safety. This study aims to evaluate the effectiveness and safety of COVID-19 vaccines available in Iraq and to measure longevity of created antibody response among different time points of both Pfizer-BioNTech and Sinopharm vaccines in Baghdad and Fallujah, Iraq. A two-axis method was used: the first was cross sectional study on the vaccination state for COVID-19 in Baghdad and Fallujah, using an online survey contained questions about city, vaccine type, side effect, pre and post infections, and chronic diseases. The second part involved a prospective observational study of the vaccine’s immunological effectiveness and stability in 60 serum samples from completely vaccinated individuals (second dose) of Pfizer or Sinopharm along different time points (1 - 6 months) by measuring the SARS-CoV-2 Anti-RBD-IgG concentration and evaluating its correlation with pre-infection with COVID-19. Among different types of vaccines available in Iraq, people in Baghdad and Fallujah preferred Pfizer vaccine over other available types, particularly those with chronic diseases. No statistically significant difference was noticed between IgG concentrations at different points of time, IgG concentrations in Pfizer vaccinated individuals were more elevated than Sinopharm, and all of Pfizer vaccinated people showed positive results. Our study established a synergistic impact between recent COVID-19 infection and vaccination, leading to increased levels of IgG antibodies, notably in individuals who received the Pfizer vaccine. Additionally, our findings demonstrate that IgG concentrations remained stable in vaccinated individuals even six months after completing the vaccination with second dose.

Neutrophil-derived reactive agents induce a transient SpeB negative phenotype in Streptococcus pyogenes

BackgroundStreptococcus pyogenes (group A streptococci; GAS) is the main causative pathogen of monomicrobial necrotizing soft tissue infections (NSTIs). To resist immuno-clearance, GAS adapt their genetic information and/or phenotype to the surrounding environment. Hyper-virulent streptococcal pyrogenic exotoxin B (SpeB) negative variants caused by covRS mutations are enriched during infection. A key driving force for this process is the bacterial Sda1 DNase.MethodsBacterial infiltration, immune cell influx, tissue necrosis and inflammation in patient´s biopsies were determined using immunohistochemistry. SpeB secretion and activity by GAS post infections or challenges with reactive agents were determined via Western blot or casein agar and proteolytic activity assays, respectively. Proteome of GAS single colonies and neutrophil secretome were profiled, using mass spectrometry.ResultsHere, we identify another strategy resulting in SpeB-negative variants, namely reversible abrogation of SpeB secretion triggered by neutrophil effector molecules. Analysis of NSTI patient tissue biopsies revealed that tissue inflammation, neutrophil influx, and degranulation positively correlate with increasing frequency of SpeB-negative GAS clones. Using single colony proteomics, we show that GAS isolated directly from tissue express but do not secrete SpeB. Once the tissue pressure is lifted, GAS regain SpeB secreting function. Neutrophils were identified as the main immune cells responsible for the observed phenotype. Subsequent analyses identified hydrogen peroxide and hypochlorous acid as reactive agents driving this phenotypic GAS adaptation to the tissue environment. SpeB-negative GAS show improved survival within neutrophils and induce increased degranulation.ConclusionsOur findings provide new information about GAS fitness and heterogeneity in the soft tissue milieu and provide new potential targets for therapeutic intervention in NSTIs.

Risk Factors in Post Operative Wound Infections Following Elective Abdominal Operations

Introduction: Surgical site infections are common post operative complication and cause significant post operative morbidity and mortality, and have serious consequences for outcomes and costs. Different risk factors are involved, including age, sex, smoking, nutrition, diabetes, pre existing illness, pre operative hospital stay time, pre operative shaving, level of surgeon, length of incision, duration of operation, per operative blood transfusion, wound drainage and nature of wound. The objective of this study was to determine the risk factors affecting abdominal surgical site infections and their rate at Dhaka Medical College &amp; Hospital, a major referral teaching hospital in Bangladesh. Objectives: were to identify risk factors in post operative wound infections following elective abdominal surgery. Materials and Methods: A Cross sectional type of observation study was carried out among 153 patients in Department of Surgery, Dhaka Medical College Hospital, Dhaka from January 2008 to December 2009. Results: Patients (n = 153) who had undergone elective surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. To test the independence of the risk factors, the significant variables (p _.05) in the univariate analyses were entered into a stepwise logistic regression equation. Data were collected through pre and postoperative examinations. The subjects were followed till discharge. Of the 153 patients, 13 suffered from SSI (8.5%). Among the infections superficial SSI was in 8 cases (61.54%), deep SSI in 3 cases (23.08%), and organ/space SSI in 2 (15.38%) cases. There were 14 different variables in study to determine the risk factors. In univariate analysis ten risk factors were identified: age, underweight, diabetes, ASA score, pre operative hospital stay, per operative blood transfusion, length of incision, duration of operation, wound drain and contaminated wound. And in multivariate analysis duration of operation, diabetes mellitus and ASA score appeared to be independent risk factors for wound infection. Conclusion: The total elimination of wound infection is not possible, a reduction in the infection rate to a minimal level could have significant benefits in terms of both patient comfort and medical resources used. The SSI may be reduced to a more acceptable level by reducing the average operation time to less than 2 hours, pre operative hospital stay, and by reducing contamination during operation and wound drainage. Furthermore post operative study in large scale is recommended. Medicine Today 2023 Vol.35(1): 56-62

Isolation and identification of gram negative bacteria fromYouncl infection in general lrospital at Diyala city

Fifty patients with post operative wound infections at a district general hospital in Baaquba were tested for bacterial growth. These patients were exposed to different operations such as (labroectomy,surgical ppendectomy, bullets accidents ,bombing acc.dents anddifferent surgical operations).All patients wounds were swabbed in period from May to August 2006and cultured , the isolated microorganisms were identified on the bases of their morphological ,cultural and biochemical characteristics.twenty six (52%) were positive for bacterial growth .Twenty (77%) yielded a pure culture and six(23%)of mixed culture isolate. These isolates,1(5%)were Pseudomonas aeruginosa 4(20%) were E coli , 3(15%)were Klebsiella pneumoniae and12(60%)were Gram positive. The incidence of bacterial growth was high among adult more than 15 years than children less than 13 years Single and mixed culture were sixty six percent and sixty percent were in adults more than 15 years respectively whereas thirty four and forty percent of single and mixed culture were investigated in children less than 13 years respectively. The study also investigated the bacterial contamination in theater and coach of the same hospital, (1)were Pseudomonas aeruginosa , (3)were E .coli, (0) were Klebsiella and (7) were Gram positive for theater while(0) were Pseudomonas aeruginosa , (2) were E. coli, (1) were Klebsiella and (3) were Gram positive for coaches.

Role of radiology in post COVID-19 rhinocerebral fungal infections

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Gaucher Disease in Internal Medicine and Dentistry

Gaucher disease (GD) is a lysosomal storage pathological condition, characterized by a genetic autosomal recessive transmission. The GD cause is the mutation of GBA1 gene, located on the chromosome 1 (1q21), that induces the deficiency of the lysosomal enzyme glucocerebrosidase with consequent abnormal storage of its substrate (glucosylceramide), in macrophages. The GD incidence in the general population varies from 1:40,000 to 1:60,000 live births, but it is higher in the Ashkenazi Jewish ethnicity (1:800 live births). In the literature, five different types of GD are described: type 1, the most common clinical variant in Europe and USA (90%), affects the viscera; type 2, characterized by visceral damage and severe neurological disorders; type 3, in which the neurological manifestations are variable; cardiovascular type; and, finally, perinatal lethal type. The most affected tissues and organs are the hematopoietic system, liver, bone tissue, nervous system, lungs, cardiovascular system and kidneys. Another aspect of GD is represented by oral and dental manifestations. These can be asymptomatic or cause the spontaneous bleeding, the post oral surgery infections and the bone involvement of both arches through the Gaucher cells infiltration into the maxilla and mandibular regions. The pharmacological treatment of choice is the enzyme replacement therapy, but the new pharmacological frontiers are represented by oral substrate reduction therapy, chaperone therapy, allogeneic hematopoietic stem cell transplantation and gene therapy.

The Psychological Impact of the Second Wave of COVID-19 on People Living with Type-2 Diabetes Mellitus

BACKGROUND: COVID-19 pandemic has led to an increase in various psychological problems for people in India. AIM: The aim of this research was to assess the psychological impact of COVID-19 on people living with Type 2 Diabetes Mellitus evaluating their stress, anxiety, and depression levels during pandemic. MATERIALS AND METHOD: The study used validated Hindi version of GASS-21 questionnaire, It was handed out to 1143 eligible and consenting patients across eight secondary care centres in Lucknow. RESULTS: The study enrolled 1143 participants and out of that, 8% were depressed, 19% were anxious, and 6% were stressed. The significant psychological drivers were family members who tested positive for COVID 19, death of a first degree family member, post covid infections and vaccination status. Patients who were not vaccinated for COVID were significantly more affected psychologically. CONCLUSION: COVID-19 and associated morbidity and mortality, post covid complications and vaccinations on apprehensions were significantly associated COVID-19 related psychological impacts that were studied.

Emerging Antibiotic Resistance in Post-COVID-19 Co-infections

There is emerging evidence of antibiotic resistance, particularly for antibiotics commonly used to treat secondary bacterial infections in COVID-19 patients. The overuse of antibiotics in COVID-19 patients has contributed to the development of antibiotic-resistant bacterial strains against amoxicillin, azithromycin, cephalosporins, ciprofloxacin, and carbapenem. The most resistant bacteria isolated from COVID-19 patients include Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa, which showed multiple antibiotic resistance. The increasing rates of antibiotic resistance are labeled as a “silent pandemic” as post covid-19 bacterial infections caused by deadly pathogens are the most significant threats to global health.

Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

IntroductionDespite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. MethodsRetrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23–30) vs 33 g/L (IQR: 26–36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. ConclusionsPatients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Profile and Predictors of Infection Following Anti-thymocyte Globulin or Anti-lymphocyte Globulin with Cyclosporine in Aplastic Anemia.

Immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and Cyclosporine (CSA) in aplastic anaemia (AA) results in improvement of blood counts between 3 and 6months for the majority of patients. Infection is the most lethal complication in aplastic anemia and may arise due to several factors. We performed this study to determine the prevalence and predictors of specific infection types before and after IST. Six hundred and seventy-seven (546 adults; 434 males) transplant ineligible patients received ATG and CSA between 1995 and 2017. All patients who were transplant ineligible and received IST in this period were included. Infections before IST was seen in 209 (30.9%) and in 430 (63.5%) patients post IST. There were 700 infective episodes in the six months post-IST, including 216 bacterial, 78 fungal, 33 viral, and 373 culture-negative febrile episodes. Infections were highest (98, 77.8%) in very severe aplastic anaemia as compared to Severe AA (SAA) and Non-Severe AA (NSAA) (p < 0.001). Infections were also significantly higher in those who did not respond to ATG (71.1% vs. 56.8%, p = 0.003). At six months post-IST were 545 (80.5%) alive, and there were 54 (7.9%) deaths due to infection. Significant predictors of mortality were paediatric AA, very severe aplastic anaemia, pre or post ATG infections, and lack of response to ATG. Mortality was highest in those with combined bacterial and fungal infections post IST (p < 0.001). We conclude that infections are a common complication (63.5%) of IST. Mortality was highest when both bacterial and fungal infections were present. Routine use of growth factors and prophylactic antifungal and antibacterial agents was not part of our protocol, despite which 80.5% of the cohort was alive at the end of six months.