Presumptive Identification Research Articles

Effectiveness of Antileishmanial Treatments in Three Endemic Areas of Colombia: A Community-Based Cohort Study.

The effectiveness of treatment of cutaneous leishmaniasis (CL) in rural settings remains underexplored. This study assessed the effectiveness of standard antileishmanial treatments using a community-based approach supported by mobile health (mHealth) in three rural areas of Colombia. From January 2018 to September 2021, we assessed treatment outcomes, adherence, and adverse drug reactions in CL patients, with the support of the Guaral+ST app. Treatment decisions were made by providers at health facilities at each site in accordance with national guidelines, whereas treatment follow-up and presumptive case identification were made by trained community leaders and health agents at the community level. In total, 231 participants received antileishmanial treatment (63 received miltefosine, 110 meglumine antimoniate, and 58 pentamidine). Disease presentation was mild (median number of lesions = 1, interquartile range [IQR]: 1-2) and of short duration (1.5 months, IQR: 1-3). The strategy yielded information on the therapeutic outcomes in 81% of study participants. Effectiveness, measured as the proportion of cure at 90 to 180 days, was 86.3% (95% CI: 73.3-93.48) for miltefosine; 77.6% (67.5-85.3) for meglumine antimoniate, and 73.1% (59.0-83.6) for pentamidine. The effectiveness of pentamidine in children ≤10 years old was 79.4% (61.6-90.3). This is one of the few reports of effectiveness of pentamidine in children with prospective data collection in the Americas. Adverse drug reactions occurred in 32% of patients, most frequently with meglumine antimoniate. Our findings demonstrate that standard antileishmanial treatments are effective in rural areas where the disease is endemic and that mHealth has a pivotal role in improving patient follow-up and data collection on therapeutic outcomes.

Presumptive Identification of Clinically Significant Hemoglobin Variants Hb E, Hb S, Hb D in Hb A1c Capillary Electrophoresis.

The quantitation of glycated hemoglobin (Hb A1c) represents an average blood glucose level for a period of 2 to 3 months for diagnosing, monitoring, and managing diabetes mellitus. Unreliable results are reported when hemoglobin (Hb) variants are present in the sample. Patients are advised to use an alternate method due to the presence of the variant Hb and a reflex test to Hb electrophoresis to obtain precise information about the Hb variant. The present study utilizes x axis values from Hb A1c capillary electrophoresis (CE) to identify clinically significant Hb variants Hb E, S, and D. Patient samples (n = 60) that showed a variant peak in the Hb A1c test with an x axis value of 190 to 240 were selected for the study. The migration position of the Hb variant (x axis value) and variant percent of the Hb A1c test were compared with the x axis value and variant percent in the Hb electrophoresis test to presumptively identify the variants. The identity of the variants was confirmed using mass spectrometry (MS). Out of 60 samples, 20 samples were identified as Hb E (x axis 225-227), 20 samples were identified as Hb S (x axis 210-214), and 18 samples were identified as Hb D-Punjab (x axis 200-201). Two variants with an x axis value of 194 were identified as an α variant Hb Q India using MS. There is an overall negative shift of the x axis (-1 to -13 units) and a lower variant percent (-0.2% to -8.7%) in Hb A1c CE when compared with Hb electrophoresis. The present study highlights the significance of the x axis value and variant percent to identify clinically significant Hb variants in the Hb A1c CE test.

Bridging Diagnostic Gaps: Utilising HiCrome Agar and Tetrazolium Reduction Medium for the Rapid and Presumptive Identification and Speciation of Candida Species in Vulvovaginal Candidiasis in Low-Resource Environments.

Background Vulvovaginal candidiasis (VVC) is a common fungal infection caused by an overgrowth of Candida species, primarily Candida albicans (C. albicans). Using HiCrome agar and tetrazolium reduction medium offers cost-effectiveness in Candida detection by eliminating the need for additional tests, reducing equipment costs compared to automated systems, and simplifying workflow with direct species identification while maintaining high specificity. They expedite detection by directly identifying Candida species based on colony colour, bypassing the multiple steps of phenotypic methods. This efficiency saves time in the laboratory, providing rapid results without the extended processing times associated with automated systems and facilitating prompt diagnosis and treatment decisions. These diagnostic tools are especially valuable in low-resource environments where a quick and accurate diagnosis of VVC is crucial for effective treatment and management of antifungal resistance. Aims and objectives This study aims to evaluate the efficacy of HiCrome agar and tetrazolium reduction medium's efficacy in speciating Candida species in VVC cases. Materials and methods A cross-sectional observational study was conducted at Saveetha Medical College and Hospitals, Chennai, India, over six months. High vaginal swabs from 126 patients suspected of VVC were collected and plated on Sabouraud dextrose agar (SDA), HiCrome Candida differential agar (Himedia, Mumbai, India), and tetrazolium reduction medium. The results were compared with those obtained from the VITEK2 compact system (bioMérieux, Marcy-l'Étoile, France). Results Of the 126 samples, 74.6% showed single yeast infections, 7.9% displayed mixed yeast infections, and 17.5% showed no growth. A total of 114 Candida isolates were identified. Both HiCrome agar and tetrazolium reduction medium accurately identified all isolates, with complete concordance with the VITEK2 compact system. The most commonly isolated species were C. albicans (55.2%), Candida tropicalis (32.4%), Candida glabrata (8.8%), and Candida parapsilosis (3.6%). Both media provided rapid and accurate presumptive identification in low-resource settings. Conclusions HiCrome agar and tetrazolium reduction medium demonstrated high sensitivity and specificity in identifying Candida species. These methods are reliable for rapid and accurate diagnosis, particularly in resource-limited settings. However, they may require supplementary tests for definitive species identification. The adoption of these diagnostic tools represents a significant advancement in clinical microbiology, improving VVC management and addressing antifungal resistance.

Chemical and Microbiological Quality of Municipal Supply Water in Dhaka South Area, Bangladesh

This project aimed to find out the microbiological quality of municipal supply water in Dhaka South area and if the current regime of microbiological quality testing can determine the risk to public health from supply water satisfactorily. Water samples were collected from six different points of the water distribution network of Dhaka’s south locality, starting from the source (Shitalakhyariver, Narayanganj) to Jagannath University, Dhaka. The dominant taxonomic units were isolated using standard culture techniques, followed by biochemical identification, VITEK2 identification, and biofilm-forming potential of each isolate individually and co-cultured with other isolates. Presumptive identification of isolates from the Shitalakhya River revealed the presence of Citrobacter sp., Alcaligenes sp., and Pseudomonas putida. The sample from Saydabad Water Treatment Plant yielded Vibrio mimicus, Pseudomonas fluorescence, and Alcalimonas. The major aerobic bacteria in the water specimen from the community overhead tank included S aureus, Bacillus cereus, Micrococcus sp., Enterococcus sp., Lactococcus sp. Tap water revealed the presence of Escherichia coli, Lactococcus, Enterobacter, Shigella, Klebsiella, Pseudomonas, and Staphylococcus aureus, as well as anaerobic bacteria. Biochemical tests and VITEK2 yielded different results. Potential biofilm formers such as Klebsiella, E. coli, Enterococcus, Aerococcus, Enterobacter, and Cronobacter indicated quality deterioration potential inside the piped water supply system. Alteration in the major taxonomic units throughout the municipal water distribution network and the presence of opportunistic pathogens and biofilm-formers indicate the necessity for an updated water treatment, quality control, and in-line maintenance system.

Hand Washing Practices and Antibiotic Susceptibility of Palmar Bacterial Flora in a Tertiary Education Institution in Nigeria

Introduction: Hand hygiene is one of the most effective and inexpensive means of preventing the spread of communicable diseases. Rates of handwashing worldwide are low, and poor handwashing practices in universities remain a public health challenge. Objective: The objective of this study was to examine the practice of handwashing, the microbial communities, and the susceptibility pattern of micro-organisms isolated from the palms of students of the Obafemi Awolowo University in Ile-Ife, Osun, Nigeria. Methods: A combination of qualitative and quantitative methods was used to retrieve data. A self-administered questionnaire was utilised to gather socio-demographic characteristics and the practice scale of handwashing from the respondents. Isolation and identification were carried out by culture-based surveys and biochemical tests. Disk diffusion was used to determine susceptibility. Results: The majority of respondents were between ages 21–25 years, with 54.3% of them being female. About half of individuals never used an alcohol-based hand sanitiser, while only 4.9% of respondents admitted to always using soap to wash their hands. Presumptive identification of the organisms showed 38.1% of organisms as Staphylococcus epidermidis and 17.58% as Micrococcus spp. None of the antibiotics showed total efficacy. The resistance to chloramphenicol was low, and <50% of the isolates showed resistance to tetracycline, novobiocin, and sulphonamide. Resistance to nalidixic acid was seen in 58.4% of organisms tested, and 77.75% were susceptible to tetracycline. Conclusion: Instances of improper hand hygiene were high, and this may increase the spread of micro-organisms through hand carriage. High resistance to the antibiotics tested was prevalent. Local trends of antimicrobial resistance must be robustly studied and proper interventions developed.

Multidrug-resistant Enterococcus and coagulase-negative Staphylococcus isolates from poultry farms and nearby wells in Ibadan, Nigeria and their resistant genes

Objective: To determine the antibiotic resistance patterns and resistance genes in enterococci and coagulase-negative staphylococci (CoNS) isolated from poultry farms and nearby wells in Ibadan, Nigeria. Methods: Poultry litter and well water samples were collected from three farms. Isolation of bacterial isolates were done using bile esculin azide agar and presumptive identification was done using conventional methods and confirmed by 16S rRNA using PCR. Antibiotic susceptibility testing was by disk diffusion method, while antibiotics resistance genes (ARGs) was detected by PCR. Results: Of the 86 Gram-positive cocci isolated, 71 (82.6%) were CoNS comprising Staphylococcus (S.) sciuri (69.0%) and S. xylosus (31.0%), while the remaining 15 (17.4%) were Enterococcus spp. comprising Enterococcus (E.) faecalis (60.0%) and E. faecium (40.0%). Antibiotics resistance of the isolates showed that 91.5% (CoNS) and 93.0% (enterococci) were resistant to penicillin, 90.1% and 86.7% to tetracycline and 94.4% and 66.7% to erythromycin, respectively. Also, all the 15 (100%) Enterococcus spp. and 68 (95.8%) CoNS were multidrug resistant. The ARGs detected in the CoNS include: tetM (45.4%), tetL (9.0%) and ermB (27.3%), while tetM (9.1%), tetL (4.5%) and ermB (4.5%) were found in Enterococcus spp. Conclusions: This study revealed that poultry litters in the study area are pools of antimicrobial resistant enterococci and CoNS, as well as, the corresponding ARGs. Therefore, necessary monitoring and ample treatment of poultry waste should be done before their release into the environment.

Study of 25R-NBOHs (R = Br, Cl, Et, I): Thermal stability investigation and presumptive identification by SCXRD and PXRD data

New psychoactive substances (NPS) are present in the drug market and can be used as legal substitutes, making enforcement difficult. One of the classes of NPSs is the phenylethylamines, among which 25R-NBOHs (with R being a halogen or an alkyl group) are included. These compounds degrade when subjected to gas chromatography-mass spectrometry (GC–MS), one of the techniques routinely used to identify illicit substances, thereby complicating their identification. This study conducted the identification of NBOH samples using FTIR, XRD, and GC–MS techniques, as well as thermal analysis to obtain information that may assist in the development of new methods for the analysis of these synthetic substances. ATR-FTIR spectra presented characteristic bands of 25R-NBOH compounds (R = Br, Cl, Et, I). The UV–Vis spectra of the 25R-NBOH (R = Br, Cl, I) and 25E-NBOH samples showed a different profile, which may serve as a means to differentiate these compounds. The crystalline structure of the compounds was confirmed by comparing the experimentally obtained diffractograms with the diffraction patterns calculated using data from the Cambridge Crystallographic Data Center (CCDC) database. Thermal analysis indicated that the samples were not pure, confirming the FTIR and XRD analyses, which revealed the presence of impurities and the onset of sample degradation.

Enhanced detection of lysergic acid diethylamide using Ehrlich reagent and screen-printed electrodes: A hybrid method for application in forensic analysis

In forensic investigations, the presumptive identification of illicit substances, such as Lysergic Acid Diethylamide (LSD), is crucial. While the Ehrlich's colorimetric reagent (EHR) is commonly employed for LSD detection, producing a characteristic colour change, its lack of selectivity often leads to false-positive or misinterpreted results. Addressing this, we propose a novel method combining electrochemical detection with EHR, enhancing selectivity for LSD’s preliminary identification in forensic samples. This method utilizes a screen-printed carbon electrode (carbon-SPE) in a pH 12 phosphate buffer. We observed two irreversible oxidation processes for LSD at Epa= + 0.35 V (Ox1) and + 0.65 V (Ox2), and for EHR at + 0.62 V and + 0.83 V (vs Ag/AgCl). The LSD + EHR combination displayed three distinct irreversible oxidation processes at + 0.35 V, + 0.66 V, and + 0.86 V. This approach provides three analytical responses for LSD identification: (1) colour change post-EHR test; (2) voltammetric detection of LSD’s two oxidation processes on carbon-SPE; (3) decreased peak current of LSD at Ox1 post-reaction after EHR. Additionally, our method facilitates LSD quantification, exhibiting a low limit of detection (LOD) of 0.69 μmol/L, and consistent electrochemical responses (RSD < 3.0 %) using the same or different carbon-SPEs. Interference studies with other illicit drugs underscored the method’s reliability and selectivity in LSD detection. Moreover, addition-recovery studies on real seized samples approached 100 %, and LSD identification was corroborated by QTOF-LC/MS analyses. Therefore, combining voltammetry with carbon-SPE and EHR offers significant potential for a rapid, simple, and selective LSD screening test in forensic analysis.

Screening for Forensically Relevant Drugs Using Data-Independent High-Resolution Mass Spectrometry.

Forensic and clinical laboratories are expected to provide a rapid screening of samples for a wide range of analytes; however, the ever-changing landscape of illicit substances makes analysis complicated. There is a great need for untargeted methods that can aid these laboratories in broad-scope drug screening. Liquid chromatography hyphenated with high-resolution mass spectrometry (LC-HRMS) has become a popular technique for untargeted screening and presumptive identification of drugs of abuse due to its superior sensitivity and detection capabilities in complex matrices. An untargeted extraction and data acquisition method was evaluated for the broad screening of high-priority drugs of abuse in whole blood. A total of 35 forensically relevant target analytes were identified and extracted at biologically relevant low and high (10× low) concentrations from whole blood using supported liquid extraction. Data-independent acquisition was accomplished using ultraperformance liquid chromatography and a quadrupole time-of-flight mass spectrometry. Results were acceptable for screening assays, with limits of detection at or below the recommended low-concentration cutoffs for most analytes. Analyte ionization varied from 30.1 to 267.6% (average: 110.5%) at low concentrations and from 8.6 to 383.5% (average: 93.6%) at high concentrations. Extraction recovery ranged from 8.5 to 330.5% (average: 105.3%) at low concentrations and from 9.4 to 127.5% (average: 82.7%) at high concentrations. This variability was also captured as precision, ranging from 4.7 to 135.2% (average: 36.5%) at low concentrations and from 0.9 to 59.0% (average: 21.7%) at high concentrations. The method described in this work is efficient and effective for qualitative forensic toxicology screening, as demonstrated by analysis of 166 authentic suspected impaired driver and postmortem specimens. That said, it is critical that laboratories establishing untargeted LC-HRMS screening assays be aware of the strengths and limitations across diverse drug categories and chemical structures.

Multidrug-Resistant Staphylococcus sp. and Enterococcus sp. in Municipal and Hospital Wastewater: A Longitudinal Study.

The objective of the study was to detect multidrug-resistant Staphylococcus sp. and Enterococcus sp. isolates in municipal and hospital wastewater and to determine their elimination or persistence after wastewater treatment. Between August 2021 and September 2022, raw and treated wastewater samples were collected at two hospital and two community wastewater treatment plants (WWTPs). In each season of the year, two treated and two raw wastewater samples were collected in duplicate at each of the WWTPs studied. Screening and presumptive identification of staphylococci and enterococci was performed using chromoagars, and identification was performed with the Matrix Assisted Laser Desorption Ionization Time of Flight mass spectrometry (MALDI-TOF MS®). Antimicrobial susceptibility was performed using VITEK 2® automated system. There were 56 wastewater samples obtained during the study period. A total of 182 Staphylococcus sp. and 248 Enterococcus sp. were identified. The highest frequency of Staphylococcus sp. isolation was in spring and summer (n = 129, 70.8%), and for Enterococcus sp. it was in autumn and winter (n = 143, 57.7%). Sixteen isolates of Staphylococcus sp. and sixty-three of Enterococcus sp. persisted during WWTP treatments. Thirteen species of staphylococci and seven species of enterococci were identified. Thirty-one isolates of Staphylococcus sp. and ninety-four of Enterococcus sp. were multidrug-resistant. Resistance to vancomycin (1.1%), linezolid (2.7%), and daptomycin (8.2%/10.9%%), and a lower susceptibility to tigecycline (2.7%), was observed. This study evidences the presence of Staphylococcus sp. and Enterococcus sp. resistant to antibiotics of last choice of clinical treatment, in community and hospital wastewater and their ability to survive WWTP treatment systems.

Engagement of private health care facilities in TB management in Lusaka district of Zambia: lessons learned and achievements

BackgroundGlobally, at least 3 million TB patients are missed every year. In Zambia, the TB treatment coverage increased from 66% in 2020 to 92% in 2022. Involvement of all levels of health care service delivery is critical to finding all the missing TB patients.MethodsA survey was undertaken in 15 private facilities in Lusaka district of Zambia using a structured tool administered by project team and a district health team member. Data collected during the survey was analysed and results were used to determine the type of TB services that were offered as well as barriers and enablers to TB service provision. This was followed by a set of interventions that included; training and mentorship on active case finding and systematic TB screening, increased diagnostic capacity, provision of national recording and reporting tools and provision of TB medication through linkage with the National TB program (NTP). We report findings from the baseline survey and changes in presumptive TB identification and notification following interventions.ResultsMajor barriers to TB service delivery were the high cost of TB diagnostic testing and treatment in facilities where services were not supported by the National TB program; the mean cost was 33 (SD 33) and 93 (SD 148) for GeneXpert testing and a full course of treatment respectively. Pre-intervention, presumptive TB identification appeared to increase monthly by 4 (P = 0.000, CI=[3.00–5.00]). The monthly trends of presumptive TB identification during the intervention period increased by 5.32 (P = 0.000, [CI 4.31–6.33. Pre-intervention, the notification of TB appeared to decrease every month by -4.0 (P = 0.114, CI=[-9.00-0.10]) followed by an immediate increase in notifications of 13.94 TB patients (P = 0.001, CI [6.51, 21.36] in the first month on intervention. The monthly trends of notification during the intervention period changed by 0.34 (P = 0.000 [CI 0.19–0.48]). Private facility contribution to TB notification increased from 3 to 7%.ConclusionEngagement and inclusion of private health facilities in TB service provision through a systems strengthening approach can increase contribution to TB notification by private health facilities.

Effectiveness of Medicinal Plant Extract against Pathogenic Bacteria in the Prevention and Treatment of Urinary Tract Infections

A urinary tract infection (UTI) is an infectious disease that infects humans in the presence of microorganisms, often not treated with broad-spectrum antibiotics because they contribute to developing resistant microorganisms. Therefore, this study aimed to investigate the antibacterial efficacy of medicinal plants used to treat infection in the urinary tract. One hundred samples were collected from patients with UTIs, ranging in age from 10–60 years. Outpatients and inpatients with UTIs live in Al-Najaf Center and attend treatment at Al-Hakeem Hospital and Al-Sader Teaching Hospital. Ten microliters of urine samples were inoculated on selective media to isolate and identify pathogenic bacteria, presumptive identification was performed using the Viteck-2 system. Eight antibiotics were used for showed antibiotic susceptibility: cefixime (5 μg), streptomycin (25 μg), amoxicillin (30 μg), erythromycin (10 μg), ciprofloxacin (10 μg), azithromycin (15 μg), gentamicin (10 μg), and nitrofurantoin (50 μg). Two species of plants were used to determine antibacterial activity: Castanea crenata and Saussurea costus. Of 100 urine samples, 80 tested positive for bacteriuria. Escherichia coli was the most prevalent bacterium in the urine 50 (62.5%), followed by Klebsiella pneumonia 10 (12.5%), Proteus vulgaris seven (8.75%), Pseudomonas aeruginosa six (7.5), Staphylococcus aureus four (5%), and Streptococcus pyogenes three (3.75%). Some bacteria with Gram staining comprising E. coli, Klebsiella spp., Pseudomonas spp., and Proteus spp. are resistant to many antibiotics. C. crenata and S. costus inhibited the growth of pathogenic bacteria isolated from the urine samples. Testing and determining the antimicrobial activities of medicinal plants will help pharmaceutical companies develop modifiers or precursors for synthesizing new therapeutic alternative drugs to treat infectious diseases caused by pathogens.

Identification of Burkholderia cepacia strains that express a Burkholderia pseudomallei-like capsular polysaccharide.

Burkholderia pseudomallei and Burkholderia cepacia are Gram-negative, soil-dwelling bacteria that are found in a wide variety of environmental niches. While B. pseudomallei is the causative agent of melioidosis in humans and animals, members of the B. cepacia complex typically only cause disease in immunocompromised hosts. In this study, we report the identification of B. cepacia strains isolated from either patients or soil in Laos and Thailand that express a B. pseudomallei-like 6-deoxyheptan capsular polysaccharide (CPS). These B. cepacia strains were initially identified based on their positive reactivity in a latex agglutination assay that uses the CPS-specific monoclonal antibody (mAb) 4B11. Mass spectrometry and recA sequencing confirmed the identity of these isolates as B. cepacia (formerly genomovar I). Total carbohydrates extracted from B. cepacia cell pellets reacted with B. pseudomallei CPS-specific mAbs MCA147, 3C5, and 4C4, but did not react with the B. pseudomallei lipopolysaccharide-specific mAb Pp-PS-W. Whole genome sequencing of the B. cepacia isolates revealed the presence of genes demonstrating significant homology to those comprising the B. pseudomallei CPS biosynthetic gene cluster. Collectively, our results provide compelling evidence that B. cepacia strains expressing the same CPS as B. pseudomallei co-exist in the environment alongside B. pseudomallei. Since CPS is a target that is often used for presumptive identification of B. pseudomallei, it is possible that the occurrence of these unique B. cepacia strains may complicate the diagnosis of melioidosis.IMPORTANCEBurkholderia pseudomallei, the etiologic agent of melioidosis, is an important cause of morbidity and mortality in tropical and subtropical regions worldwide. The 6-deoxyheptan capsular polysaccharide (CPS) expressed by this bacterial pathogen is a promising target antigen that is useful for rapidly diagnosing melioidosis. Using assays incorporating CPS-specific monoclonal antibodies, we identified both clinical and environmental isolates of Burkholderia cepacia that express the same CPS antigen as B. pseudomallei. Because of this, it is important that staff working in melioidosis-endemic areas are aware that these strains co-exist in the same niches as B. pseudomallei and do not solely rely on CPS-based assays such as latex-agglutination, AMD Plus Rapid Tests, or immunofluorescence tests for the definitive identification of B. pseudomallei isolates.

Performance of Chromogenic Candida Lab-Agar® Medium in Presumptive Identification of Candida Species from Clinical Samples at Sourô Sanou University Hospital of Bobo-Dioulasso, Burkina Faso

Introduction: The incidence of Candida infections is increasing worldwide. In clinical laboratories of resource-constrained countries, Candida speciation is commonly limited to germ tube tests and culture onto a chromogenic medium. In this study, we evaluated the diagnostic performance of Chromogenic Candida Lab-Agar® (CCL) in identifying Candida species from clinical samples. Methods: We evaluated the diagnostic performance of CCL with 83 yeast isolates collected from 73 clinical samples at the laboratory department of Sourô Sanou University Hospital of Bobo-Dioulasso, Burkina Faso. Clinical specimens included vaginal swabs, urine, and blood cultures. After preliminary isolation on Sabouraud chloramphenicol agar, yeast isolates were inoculated onto the CCL medium and incubated at 35 °C for 48 h. Matrix-assisted laser desorption/ionisation time of flight mass spectrometry (MALDI-TOF MS) and ribosomal DNA internal transcribed spacer (ITS) sequencing were used as reference methods. Results: Among yeast species, Candida albicans was the most prevalent (43.4%), followed by C. krusei (13.3%), C. glabrata (12.0%), C. kefyr (8.4%), and C. tropicalis (7.2%). The overall agreement rate of CCL was 56.6% and varied across Candida species; it was 94.4% for C. albicans, 50% for C. glabrata, 18.2% for C. krusei, and 33.3% for C. tropicalis. Conclusions: This study showed that CCL had moderate accuracy in identifying Candida at the species level from clinical specimens in a routine laboratory in Burkina Faso. The misidentification of non-albicans species may expose patients to inadequate antifungal treatment. Therefore, identifying yeast in a routine based on CCL is not enough and should be associated with more accurate methods.

Comparison of CHROMagar Orientation Medium with Traditional Methods in Urinary Tract Infection Cultures.

Urinary tract infections (UTIs) are the most common infections in adults, and urine culture is the parameter that uses the most time and cost in microbiology laboratories. For this reason, the selection of fast and cost-effective methods in the evaluation of urine samples is one of the priority issues of microbiology laboratories. The aim of this study was to investigate the compatibility and cost-effectiveness of routinely used Blood Agar (BA), Eosin Methylene Blue (EMB) medium, and CHROMagar Orientation Medium (CO Medium) in the identification of microorganisms in urine samples. Consecutive urine samples (n: 700) sent to our laboratory were simultaneously inoculated onto BA/EMB media and CO medium. Urine samples were evaluated after 18 - 24 hours of incubation at 37℃ and the compatibility of the two methods was compared. The use of 104 Gram stains, 198 biochemical tests, and 9 identification kits was required with BA/EMB agar. When 104 colonies with single growth were evaluated, presumptive identification with CO medium was found to be 100% compatible with the VITEK 2 system. The most isolated 62 Escherichia coli (E. coli) colonies gave dark pink-red color and were found to be fully compatible with the VITEK 2 system. Compatibility of BA and EMB medium evaluations with VITEK 2 system; E. coli (n: 62), KES group (n: 26), Pseudomonas spp. (n: 6) and Proteus spp. For (n: 2), it was determined as 69.3%, 57.69%, 100%, and 100%, respectively. According to the results of our study, when BA/EMB and CO Medium methods were compared, 182 Euro (€) savings were achieved in 700 urine cultures with CO Medium. It was estimated that the amount of savings could be 15,600 € per year. CHROMagar Orientation Medium method can be used routinely with its advantages such as being cost-effective, reducing the workload, and not requiring additional operations. CHROMagar Orientation Medium can also be considered as an easily accessible method and opportunity that does not require infrastructure and trained personnel, especially for laboratories with low test capacity and having problems with the supply of com-mercial kits and automated systems.

In vitro activity of ceftazidime/avibactam, cefiderocol, meropenem/vaborbactam and imipenem/relebactam against clinical strains of the Stenotrophomonas maltophilia complex.

Infections caused by Stenotrophomonas maltophilia and related species are increasing worldwide. Unfortunately, treatment options are limited, whereas the antimicrobial resistance is increasing. We included clinical isolates identified as S. maltophilia by VITEK 2 Compact. Ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, cefiderocol, quinolones, and tetracycline family members were evaluated by broth microdilution method and compared with first-line treatment drugs. Minimum inhibitory concentrations (MICs) were reported for all antibiotics. We sequenced the Whole Genome of cefiderocol resistant strains (CRSs) and annotated their genes associated with cefiderocol resistance (GACR). Presumptive phylogenetic identification employing the 16S marker was performed. One hundred and one clinical strains were evaluated, sulfamethoxazole and trimethoprim, levofloxacin and minocycline showed susceptibilities of 99.01%, 95.04% and 100% respectively. Ceftazidime was the antibiotic with the highest percentage of resistance in all samples (77.22%). Five strains were resistant to cefiderocol exhibiting MIC values ≥ 2 μg/mL (4.95%). The β-lactamase inhibitors meropenem/vaborbactam and imipenem/relebactam, failed to inhibit S. maltophilia, preserving both MIC50 and MIC90 ≥64 μg/mL. Ceftazidime/avibactam restored the activity of ceftazidime decreasing the MIC range. Tigecycline had the lowest MIC range, MIC50 and MIC90. Phylogeny based on 16S rRNA allowed to identify to cefiderocol resistant strains as putative species clustered into Stenotrophomonas maltophilia complex (Smc). In these strains, we detected GARCs such as Mutiple Drug Resistance (MDR) efflux pumps, L1-type β-lactamases, iron transporters and type-1 fimbriae. Antimicrobial resistance to first-line treatment is low. The in vitro activity of new β-lactamase inhibitors against S. maltophilia is poor, but avibactam may be a potential option. Cefiderocol could be considered as a potential new option for multidrug resistant infections. Tetracyclines had the best in vitro activity of all antibiotics evaluated.

Molecular Detection of Equine Herpesviruses from Field Outbreaks in Donkeys in Northwest Amhara Region, Ethiopia.

Equine herpesviruses pose a threat to equine health and potentially cause substantial economic losses to the global equine industry. EHV outbreaks have been reported in various parts of Ethiopia and the Amhara region specifically. This study aimed to detect EHVs from suspected outbreak cases in selected districts of the Northwest Amhara region. A cross-sectional study was performed from January 2022 to July 2022 to detect EHVs from suspected outbreak cases. Clinical observation was conducted for the presumptive identification of equine herpesvirus infection, and nasopharyngeal swab samples were collected for molecular detection of the viruses for confirmation. Out of 463 donkeys observed, 23 donkeys showed clinical signs suggestive of equine herpesvirus infection. Samples from 10 suspected donkeys were further subjected to polymerase chain reaction (PCR) test, amplifying ORF30 for EHV-1 and gB for EHV-2 and EHV-5. Among the 10 donkeys tested, seven (n = 7) were positive for EHV-5. All ten (n = 10) tested donkeys were negative for EHV-1 and EHV-2. EHV-5 was detected in animals with nervous signs, respiratory signs, a combination of nervous and respiratory signs, and a combination of abortion, respiratory, and nervous signs. Generally, only EHV-5 was identified from the outbreak, and more detailed epidemiological/molecular studies should be performed to better understand its dynamics and inform preventive measures.

Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases.

Current evidence on the surgical rate, indication, procedure, risk factors, mortality, and postoperative rebleeding for acute lower gastrointestinal bleeding (ALGIB) is limited. We constructed a retrospective cohort of 10,342 patients admitted for acute hematochezia at 49 hospitals (CODE BLUE J-Study) and evaluated clinical data on the surgeries performed. Surgery was performed in 1.3% (136/10342) of the cohort with high rates of colonoscopy (87.7%) and endoscopic hemostasis (26.7%). Indications for surgery included colonic diverticular bleeding (24%), colorectal cancer (22%), and small bowel bleeding (16%). Sixty-four percent of surgeries were for hemostasis for severe refractory bleeding. Postoperative rebleeding rates were 22% in patients with presumptive or obscure preoperative identification of the bleeding source and 12% in those with definitive identification. Thirty-day mortality rates were 1.5% and 0.8% in patients with and without surgery, respectively. Multivariate analysis showed that surgery-related risk factors were transfusion need ≥ 6 units (P < 0.001), in-hospital rebleeding (P < 0.001), small bowel bleeding (P < 0.001), colorectal cancer (P < 0.001), and hemorrhoids (P < 0.001). Endoscopic hemostasis was negatively associated with surgery (P = 0.003). For small bowel bleeding, the surgery rate was significantly lower in patients with endoscopic hemostasis as 2% compared to 12% without endoscopic hemostasis. Our cohort study elucidated the outcomes and risks of the surgery. Extensive exploration including the small bowel to identify the source of bleeding and endoscopic hemostasis may reduce unnecessary surgery and improve the management of ALGIB.

Studying the Composition of Cluster Ions by Matrix- and Surface-Activated Laser Desorption/Ionization in Samples Obtained from Solutions of Sodium Stannate and Tin(II) Chloride

The purpose of this work was to study the composition of cluster ions in samples containing sodium stannate and tin(II) chloride. It has been shown that the composition of mass spectra is influenced by such parameters as the laser radiation energy and the substance content in the sample being studied. Conditions for preparing samples and recording mass spectra using these parameters were optimized. Presumptive identification of peaks in the recorded mass spectra was carried out. It has been shown that many of the ion peaks observed in the mass spectra may correspond to clusters containing tin. In the mass spectra of sodium stannate, ions of the general composition SnxOyNazHm were detected, in which the number of tin atoms reaches eight, and the maximum ion mass-to-charge ratio (m/z) is 1100. In the mass spectra of tin(II) chloride, there are ions of the general composition SnxOyHmClp and SnxCly, where the number of tin atoms reaches 4, and the highest m/z value is 1000.

Hierarchical AI enables global interpretation of culture plates in the era of digital microbiology

Full Laboratory Automation is revolutionizing work habits in an increasing number of clinical microbiology facilities worldwide, generating huge streams of digital images for interpretation. Contextually, deep learning architectures are leading to paradigm shifts in the way computers can assist with difficult visual interpretation tasks in several domains. At the crossroads of these epochal trends, we present a system able to tackle a core task in clinical microbiology, namely the global interpretation of diagnostic bacterial culture plates, including presumptive pathogen identification. This is achieved by decomposing the problem into a hierarchy of complex subtasks and addressing them with a multi-network architecture we call DeepColony. Working on a large stream of clinical data and a complete set of 32 pathogens, the proposed system is capable of effectively assist plate interpretation with a surprising degree of accuracy in the widespread and demanding framework of Urinary Tract Infections. Moreover, thanks to the rich species-related generated information, DeepColony can be used for developing trustworthy clinical decision support services in laboratory automation ecosystems from local to global scale.