Received Antibiotic Therapy Research Articles

Treatment strategies in different phenotypic forms of bacterial vaginosis

BACKGROUND: Bacterial vaginosis represents the most prevalent non-inflammatory syndrome affecting the lower genital tract in women. It is associated with significant complications in obstetric and gynecological practice. At present, the only recommended treatment regimens for bacterial vaginosis include antibiotics (metronidazole and clindamycin), which have been observed to have only short-term effects. Recurrence of bacterial vaginosis occurs in 50–80% of cases within a year of completing treatment. This may be attributed to the distinctive characteristics of the vaginal microbiome and the fact that following antibiotic treatment, beneficial strains of Lactobacillus spp., such as L. crispatus, are unable to recolonize the vagina. In the absence of an efficacious and long-term treatment, clinicians and scientists are investigating alternative approaches to the management and prevention of this syndrome. This has led to a rapid evolution in the understanding of the etiology of bacterial vaginosis and of the best patient care. Current research in this field is focused on the use of antiseptics, probiotics, prebiotics, transplantation of the vaginal microbiome, pH modulation and biofilm disruption as potential treatments for bacterial vaginosis. AIM: The objective is to identify the species of vaginal Lactobacillus and the genotypes of Gardnerella vaginalis in women before treatment of bacterial vaginosis and after administration of a one-step antibacterial regimen in comparison to a two-step therapy with suppositories containing at least 10⁷ live Lactobacillus acidophilus or a lactic acid-glycogen complex. MATERIAL AND METHODS: A prospective, comparative, randomized study was conducted in 90 women aged 18 to 45 years old diagnosed with bacterial vaginosis based on the molecular genetic characteristics of the vaginal microbiota. The patients were randomized to one of three groups, with 30 subjects in each. Group 1 received only antibiotic therapy, Group 2 received antibiotic therapy concomitantly with a suppository containing ≥107 live Lactobacillus acidophilus, and Group 3 received antibiotic therapy concomitantly with lactic acid and glycogen. Clinical and laboratory efficacy of the treatment was assessed at the end of Week 4. RESULTS: The results showed that four weeks after treatment, all study groups experienced favorable changes in the symptoms and signs, normalization of vaginal pH, and improvements in molecular genetic testing. These effects were more pronounced in Group 2 patients. CONCLUSION: The combination of antibiotic therapy with lactic acid and glycogen demonstrated high clinical efficacy and good tolerability. However, further studies are needed to assess the long-term results of this treatment approach.

Resolution of Chronic Bacterial Prostatitis with Bacteriophage-antibiotic Therapy

Chronic bacterial prostatitis is a commonly diagnosed genitourinary infection that presents significant challenges both in diagnosis and treatment. In an upcoming era of antibiotic resistance, and limited therapeutic options it becomes imperative to revise current guidelines and to provide more effective treatment strategies. At the Eliava Phage Therapy Center (Tbilisi, Georgia) we utilize bacteriophage therapy as an alternative approach against chronic bacterial infections. Bacteriophages, viruses that target and lyse specific bacterial cells, can be used as a stand-alone treatment or in conjunction with antibiotics. We present a case report of a patient with prostatitis caused by Escherichia coli infection, who prior to addressing our clinic, has been receiving antibiotic therapy without any positive effect. Our approach of combined use of antibiotics and phages was successful not only in complete clinical improvement but also in total bacterial eradication. This outcome shows the potential of bacteriophage therapy as a valuable adjunct to conventional antibacterials in the management of prostatitis.

Evaluation of Sequential Oral Versus Intravenous Antibiotic Treatment of Enterococcus faecalis Bloodstream Infections.

Intravenous (IV) antibiotics have historically been considered standard of care for treatment of bloodstream infections (BSIs). Recent literature has shown sequential oral (PO) therapy to be noninferior to IV antibiotics for certain pathogens and disease states. However, a gap exists in the literature for BSI caused by Enterococcus faecalis. To compare outcomes of definitive sequential PO therapy to definitive IV therapy in patients with E faecalis BSI. Multicenter, retrospective, matched cohort study of adult patients with at least one blood culture positive for E faecalis from January 2017 to November 2022. Patients with polymicrobial BSI, concomitant infections requiring prolonged IV antibiotic therapy, those who did not receive antibiotic therapy, and those who died within 72 hours of index culture were excluded. Subjects were matched based on source of infection in a 2:1 (IV:PO) ratio. The primary outcome was a composite of all-cause mortality and treatment failure. Secondary outcomes included hospital length of stay (LOS), antibiotic duration, and 30-day readmission rate. Of the 186 patients who met criteria for inclusion, there was no statistically significant difference in the primary composite outcome for PO compared to IV therapy (14.5% vs 21.8%; OR 0.53 [0.23-1.25]) or 30-day readmission (17.5% vs 29%; OR 0.53 [0.25-1.13]). Hospital LOS was significantly longer in patients receiving IV-only therapy (6 days vs 14 days; P < 0.001). Sequential oral therapy for E faecalis BSI had similar outcomes compared to IV-only treatment and may be considered in eligible patients.

&lt;b&gt;Phylogenetic analysis &lt;i&gt;bla&lt;/i&gt;TEM gene of &lt;i&gt;Escherichia coli&lt;/i&gt; isolated from cave bats in West Nusa Tenggara Province, Indonesia&lt;/b&gt;

Background: The blaTEM, blaCTX-M and blaSHV are the result of mutations in the ESBL enzyme which can be seen genotypically. Wild bats have never received antibiotic therapy, the presence of AMR in bats indicates the level of AMR in the environment, the circulation of ESBL Escherichia coli between humans or animals in Indonesia and wild animals is still not widely known. Whole genome sequencing is used to determine the circulation of ESBL Escherichia coli in detail. Aim: Our research aims to determine the genetic level of relatedness of blaTEM samples of cave bat isolates in West Nusa Tenggara, Indonesia. Methods: This research is a laboratory exploration to detect ESBL genes in guano isolate samples from cave bats in West Nusa Tenggara Province, Indonesia. Samples were obtained by swabbing the rectum of live bats caught from caves on the island of West Nusa Tenggara Province, namely Lawah Cave and Saung Pengembur Cave. A total of 50 samples from Lawah cave and 85 samples from Saung Pengembur cave were identified to find an Escherichia coli bacteria using Gram-stain test and IMViC for biochemical test from isolates which showed a metallic green color on Eosin Methylene Blue Agar media. Escherichia coli isolates were tested for sensitivity using antibiotics, followed by a polymerase chain reaction test showed positive results for the blaTEM gene and phylogenetic analysis to determine relationships. Results: Phylogenetic analysis shows a genetic closeness between the isolates from Lawah cave and Saung Pengembur cave is 95%. Between samples from Lawah and Saung Pengembur cave, we found there was a closeness of 86% to the E. coli strain A2-2 sample from Thailand with the code OR680712.1. at GenBank. Conclusion: The blaTEM gene characteristics of bat isolates from West Nusa Tenggara are close to pig isolates from Thailand. The genetic proximity between blaTEM gene samples from Lawah Cave and Saung Pengembar Cave analyzed using the phylogenetic tree shows a closeness to samples from Thailand, even though they come from samples with distant locations, which can have a negative impact on human health.

Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Drug Utilization and Evaluation of Antibiotics and Classifying them based on WHO AWaRe Classification

Antibiotics are the most prescribed medicaments in medical practices worldwide. Indiscriminate use of antibiotics adds to the emergence of Antibiotic resistance (ABR) leading to inefficiency of antibiotics. WHO fostered three unique classification systems - Access, Watch, and Reserve (AWaRe classification)- a tool to identify the safe use of antibiotics. The study aimed to evaluate antibiotic use in the Department of Surgery using the WHO ATC/DDD method and further classified the antibiotics based on WHO AWaRe Classification. An observational study was carried out among 305 samples in the In-Patient Department of Surgery at a teaching hospital, in Bangalore. Data was collected from the patient’s case files using a self-designed data collection form. The collected data were entered in Microsoft Excel and appropriate statistical analysis were performed. It was found that most (28.53%) of the patients belonged to the age group of 38-47 years and most of them received antibiotic therapy as prophylaxis (69%). It was found that Ceftriaxone (28.51%), Metronidazole (21.15%), and Cefixime (18.52%) were the most frequently prescribed antibiotics. The most frequently prescribed antibiotic class was Beta-lactams (65.3%), and most prescribed antibiotics belonged to the Watch Group (53%). The most utilized antibiotics were Ceftriaxone (3.32 DDD/100 bed days) followed by Cefixime (2.15 DDD/100 bed days) and Metronidazole (1.59 DDD/100 bed days). This study shows a need to prepare and implement proper policies or guidelines for prescribing antibiotics in the hospital.

Микробный пейзаж пролежней у больных с тяжелыми травмами центральной нервной системы

Research goal. To investigate the incidence of pressure ulcers and the structure of bacterial pathogens in young patients who have suffered severe trauma to the brain or spinal cord. Materials and methods. The prospective observational study included 69 patients who had suffered a severe brain or spinal cord injury within 3 to 9 months prior to admission to the hospital. During the stay in the hospital, a microbiological study of biopsy specimens obtained during the surgical treatment of pressure ulcers was regularly carried out. Results. All study participants were male. The age of the patients included in the study ranged from 19 to 52 years, mean – 31.4±7.8 years. Pressure ulcers were observed in 37 of 69 patients (53.6%). Initially, microbiological examination most often revealed Pseudomonas aeruginosa – 13 patients (35.1%), Staphylococcus aureus – 11 (29.7%), Enterococcus faecalis – 7 (18.9%), Proteus mirabilis – 5 (13.5%), Klebsiella pneumoniae – in 4 (10.8%), Acinetobacter baumannii – in 1 (2.7%). In total, 62.2% of patients were prescribed antibiotic therapy for the treatment of infected pressure ulcers, 37.8% did not receive antibiotic therapy or antibiotics were prescribed only for the purpose of perioperative antibiotic therapy (during plastic closure). Along with traditional therapy, 20 patients (54%), after necrectomy, were given a vacuum-asssisted dressing, from 1 to 7 sessions, lasting from 3 to 7 days. Against the background of the therapy, in 21 cases it was possible to achieve complete elimination of microorganisms, especially when infected with P. aeruginosa. During inpatient treatment, only two patients had the same microflora in pressure ulcers (S. aureus), other patients registered superinfection. In 15 patients accession of Enterococcus spp. was observed (1 has extremely resistant strains, 1 has polyresistant strains). In 10 patients, infection with K. pneumoniae was registered (in 3, extremely resistant strains, in 4, polyresistant, in 1, pan-resistant), in 9 – Proteus spp. (in 6 – extremely resistant strains, in 1 – pan-resistant, in 1 – multi-resistant), in 6 – S. aureus (in 4 – multi-resistant strains), in 3 – Escherichia coli (susceptible strains), in 3 – A. baumannii (in 2 – pan-resistant strains, in 1 – multi-resistant strains). During inpatient treatment, autodermoplasty was performed in 14 patients (37.8%), in 13 of these cases it was successful. Conclusion. The results of a pilot study indicate the effectiveness of combination therapy with antibacterial drugs and VAC-therapy in young patients with infected pressure ulcers caused by severe injuries of the central nervous system.

The role of culture-negative infection among infectious complications after total knee arthroplasty

Introduction Diagnosis of chronic periprosthetic joint infection (PJI) is difficult with the clinical signs of periprosthetic inflammation showing no growth of microorganism in the biomaterial. The frequency of culture-negative infection can reach 42.1 %. The objective of the study was to analyze outcomes of two-stage treatment of chronic PJI of the knee joint depending on the etiology of the infectious process.Material and methods A retrospective analysis of outcomes was produced for 103 patients: group I (n=30) showing no growth of microorganisms and group II (n = 73) demonstrating positive growth of pathogens. Knee PJI was diagnosed according to the 2018 ICM criteria. A favorable outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, “life with a spacer” without signs of infection.Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. Recurrence of infection was 3.4 % in group I and 16.9 % in group II (p = 0.0928), the two-stage treatment was successful in 96.7 % and 74 %, respectively (p = 0.0064).Discussion Causes for the lack of growth of microorganisms in biological materials included previous antibiotic therapy, wound drainage, violations of the rules for sampling of biological material, absence of media for the growth of atypical microorganisms and the ability of microorganisms to form biofilms on implant surfaces. An emergency histological examination of the affected tissues was practical during surgery in doubtful situations for adequate surgical approach. The results of a meta-analysis (2023) showed that the replacement of an infected endoprosthesis was more effective for the treatment of a culture-negative infection compared to debridement and preservation of implant.Conclusion The culture-negative infection group in our series showed better success rate of a two-stage treatment of PJI using implant replacement and broad-spectrum empiric antibiotic therapy at a two-year follow-up period. The negative microbiological result in the group could be caused by antibacterial drugs administered prior to diagnosis of PJI.

Presepsin Levels and Neutrophil-to-Lymphocyte Ratio are Positively Correlated with Procalcitonin Levels in Early Onset Neonatal Sepsis

BACKGROUND: Early-onset neonatal sepsis (EONS) is an acute infection and sepsis occurring within the first 24 hours of new-born life. An increase in procalcitonin levels, presepsin levels, and neutrophil-to-lymphocyte ratio (NLR) in EONS subjects have been reported. However, whether presepsin levels and NLR affect the procalcitonin levels in EONS patients who have received antibiotic therapy has not been certainly known. This study was conducted to determine the correlation between presepsin levels and NLR with procalcitonin levels in EONS subjects.METHODS: A cross-sectional study involving 52 EONS subjects were conducted, and blood samples from subjects were collected. Presepsin levels were examined by enzyme-linked immunosorbent assay (ELISA) method, NLR was calculated from the absolute number of neutrophils divided by the absolute number of lymphocytes, and procalcitonin levels were examined by chemiluminescent microparticle immunoassay (CMIA) method. RESULTS: Median of procalcitonin levels and presepsin levels were 0.435 (0.12-9.11) ng/mL and 108.33 (71.43-1287.76) ng/L, respectively. While NLR value was 1.68 (0.2-7.52). There was significant difference between procalcitonin and presepsin levels (p=0.000), and so does between procalcitonin levels and NLR (p=0.001). Based on the multivariate analysis, presepsin levels also affected the procalcitonin levels (p=0.000; 95% CI: 0.001-0.004).CONCLUSION: The results of the study showed that there was significant correlation between presepsin levels and NLR with procalcitonin levels in EONS patients, suggesting that presepsin levels, NLR, and procalcitonin levels are potential candidates for EONS biomarkers.KEYWORDS: EONS, NLR, presepsin, procalcitonin

Результаты проспективного сравнительного рандомизированного исследования по изучению эффективности и безопасности биологически активного комплекса «Нефробак»® в комплексном лечении пациентов с хроническим пиелонефритом.

Introduction. Chronic pyelonephritis is the most common kidney disease. In accordance with the chronic nature of the infection, an important aspect of the treatment of recurrent uncomplicated urinary tract infections is antibiotic resistance. The aim of this work is to evaluate dynamics of the number of relapses and severity of symptoms of chronic pyelonephritis against the background of the complex drug «Nephrobac»®. Materials and methods. The study included 60 patients aged 24 to 56 years with complaints of pain in the lumbar area, fever, and dysuria. Based on the examination, the patients were diagnosed with chronic pyelonephritis. The patients were randomized into two groups: the first group received only antibacterial therapy, the second group received antibacterial therapy in combination with the biologically active complex «Nephrobac»® 1 capsule 2 times a day for 1 month. Patients of both groups were observed for 6 months from the start of therapy. Results. Fewer cases of leukocyturia were observed in the group receiving the antibiotic in combination with «Nephrobac»®, 45% and 75% after 3 and 6 months, respectively. In addition, in the same group, there were significantly fewer patients with bacteriuria after 3 visits in the main group compared with the control group receiving antibiotic therapy. There were no relapses registered 6 months after the start of the study in the group receiving combination therapy, including «Nephrobac»®, there were three patients with 1 relapse each in the control group. Conclusions. «Nephrobac»® can be recommended as a part of the complex therapy of chronic pyelonephritis, which has an anti-relapse and anti-inflammatory effect, enhancing antibiotics.

Meropenem antibiotic therapy in acute secondary peritonitis, therapeutic effects superior to other therapies - experimental clinical and histopathological study in the laboratory animal.

A perforated peptic ulcer is the most common cause of peritonitis through the perforation of the digestive tube, which occurs in a percentage between 2% and 14% of patients diagnosed with peptic ulcer and being associated with a 10% to 30% mortality rate. Considering the above, we imagined a study, using laboratory animals, in which we produced gastric perforations, then followed their evolution without antibiotic treatment and under antibiotic therapy with Cefuroxime 25 mg∕kg∕24 hours intravenously or Meropenem 40 mg∕kg∕24 hours intravenously, following the tissue changes both macroscopically and microscopically. The study revealed a mortality of 36.6%, most deaths (81.82%) occurred in the first 24 hours after the perforation, all subjects belonging to the group that did not receive antibiotic treatment and the group treated with Cefuroxime. From a clinical point of view (evaluation of the general condition), macroscopically and microscopically, a better evolution of the subjects who received antibiotic therapy can be observed, compared to those who did not receive antibiotic therapy, thus in the case of subjects who received antibiotic therapy, the absence or the presence of a small amount of intraperitoneal fluid, which has a serocitrine appearance, as well as the absence of macroscopic changes at the level of unaffected intraperitoneal organs, can be observed. Microscopically, it can be seen that in the subjects treated with Meropenem, changes in the parietal peritoneum were minimal. Antibiotic therapy with Meropenem in acute peritonitis has a survival rate comparable to peritoneal lavage and source control.

Short Course of Antibiotic Therapy for Gram-Negative Bacilli Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation: Less Is Possible.

Data about short courses of antibiotic therapy for Gram-negative bacilli (GNB) bacteremia in immunosuppressed patients are limited. This is a prospective observational study performed on adult patients with cancer and hematopoietic stem cell transplant (HSCT) who developed GNB bacteremia and received appropriate empirical antibiotic therapy (EAT), had a clinical response within 7 days and survived 48 h after the end of therapy. They received antibiotic therapy in the range of 7-15 days and were divided into short course, with a median of 7 days (SC), or long course, with a median of 14 days (LC). Seventy-four patients were included (SC: 36 and LC: 38). No differences were observed in baseline characteristics or in the presence of neutropenia: 58.3% vs. 60.5% (p = 0.84). Clinical presentation and microbiological characteristics were similar in SC and LC, respectively: clinical source of bacteremia 72.2% vs. 76.3% (p = 0.68); shock 2.8% vs. 10.5% (p = 0.35) and multidrug-resistant GNB 27.8% vs. 21.1% (p = 0.50). Overall, mortality was 2.8% vs. 7.9% (p = 0.61), and bacteremia relapse was 2.8% vs. 0 (p = 0.30). The length of hospitalization since bacteremia was 7 days (interquartile range (IQR), 6-15) for SC and 12 days (IQR, 7-19) (p = 0.021) for LC. In the case of patients with cancer or HSCT and GNB bacteremia who receive appropriate EAT with clinical response, 7 days of antibiotic therapy might be adequate.

Myélinolyse centropontine réversible sans hyponatrémie chez un enfant atteint de leucémie aigue lymphoblastique: à propos d’un cas

Central pontine myelinolysis is a demyelinating disorder mainly affecting the central pons. In some cases, it is associated with extrapontine myelinolysis. It is usually caused by rapid correction of hyponatremia and osmotic shock. We here report the case of a 3.5-year-old girl diagnosed with acute lymphoblastic leukemia admitted to our Oncology Unit with neutropenic fever and diarrhea. Laboratory tests showed mild neutropenia, normochromic normocytic anemia. Electrolyte tests were normal without hyponatremia. She received antibiotic therapy with Metronidazole. Five days later, she developed flaccid quadriparesis with mutism. Computerized tomography (CT) scan was normal, cerebrospinal fluid (CSF) examination was normal (there was no evidence of leukemic cells) and ophthalmological examination did not show any abnormalities. Brain MRI found hyperintense signal in the pons. The child improved without specific treatment, and clinical and complete neurological recovery was noted. This case highlights that myelinolysis can occur under some circumstances not related with hyponatremia such as malignancy, chemotherapy.

Phage therapy in overcoming antibiotic resistance in chronic rhinosinusitis

To evaluate the effectiveness of phage therapy in the complex treatment of exacerbations of chronic rhinosinusitis. The study included 55 patients with a verified diagnosis of chronic rhinosinusitis and a history of periodic exacerbations throughout the year, hospitalized at the St. Petersburg State Budgetary Institution «Elizabeth Hospital» from January 2022 to February 2023.Depending on the antimicrobial treatment received, patients were divided into groups that received an antibiotic or a bacteriophage.All patients underwent puncture of the maxillary sinuses. All patients in the first group taking an antibiotic, underwent sinus rinse with saline, and in the second group, a bacteriophage sinus rinse was used. Material from the first puncture of the maxillary sinuses was used to determine sensitivity to antibiotics and bacteriophages. The average duration of treatment to positive outcome in the group receiving antibiotic therapy was 8±1.59 days, whereas in the group receiving bacteriophage therapy 7.69±1.35 days (p=0.3008). There were no significant differences between groups in the average duration of treatment until a favorable outcome was achieved. The high efficiency of phage therapy, the absence of its effect on the growth of antibiotic resistance allows us to recommend the use of bacteriophages in the treatment of chronic rhinosinusitis.

2171. Clinical Characteristics and Outcomes of Immunocompromised Patients with Enterococcal Pneumonia

Abstract Background Although Enterococcus species can colonize and cause infection in multiple body sites, it is considered a rare cause of pneumonia (PNA). The study objective was to describe clinical outcomes in immunocompromised patients with PNA and Enterococcus in respiratory cultures to better elucidate the pathogenic role played by Enterococci. Methods A retrospective, descriptive observational study was conducted on immunocompromised patients with Enterococcus spp on lower respiratory culture from January 1, 2015 to September 22, 2021 with clinical PNA. Data was collected on patient demographics, microbiologic details including bacteremia, other potential infectious causes of PNA and clinical outcomes. Results 116 cases of immunocompromised patients with PNA and Enterococcus spp on respiratory culture were identified. Two patients also grew Enterococcus spp on pleural fluid and 1 on lung tissue. Vancomycin-resistant Enterococcus grew in 41/116 (35%) cases. Six (5%) patients had a bloodstream infection due to Enterococcus spp and a central line was present in all cases. In 52/116 (45%) cases there was growth of another organism, and 61/116 (53%) cases had an alternative infectious cause for PNA, whether it was a typical respiratory bacterial pathogen, viral illness, or invasive fungal infection. In 55 (47%) cases, there was no alternative infectious cause of PNA identified; 44 (80%) of these patients received an antibiotic active against Enterococcus spp and of these, 30 (68%) were clinically improved after 14 days. Overall mortality was high with 52/116 total cases (45%) in which the patient was alive after 90 days. In 25 cases patients did not receive antibiotic therapy active against Enterococcus and 28% were alive at 90 days. Conclusion Enterococcus spp should be considered a significant pulmonary pathogen in immunocompromised hosts in the appropriate clinical context. At our institution, the majority of immunocompromised patients with a monomicrobial pulmonary infection with Enterococcus were treated with targeted antibiotics. Further studies should evaluate outcomes of and indications for targeted treatment of pleuropulmonary Enterococcus. Disclosures All Authors: No reported disclosures.

Efficacy of Saccharomyces boulardii CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19

To evaluate the efficacy of Saccharomyces boulardii (S. boulardii) CNCM I-745 probiotic drug in preventing and treating diarrhea in hospitalized patients with COVID-19. A prospective comparative study was conducted in two parallel groups. The study included males and females aged 18 to 60 with the following diagnosis confirmed by polymerase chain reaction: U07.2 Coronavirus infection COVID-19, caused by SARS-CoV-2 virus (grade 1-3 pneumonia according to CT scan). All patients received antibiotic therapy. The patients were subdivided into two equal groups (n=60) depending on the administration of S. boulardii CNCM I-745 probiotic drug in addition to standard treatment. The probiotic was prescribed by the attending physician; the dose was 2 capsules per day (500 mg/day) 30 min before the meal for 10 days. All patients were monitored for main clinical, laboratory, and instrumental parameters during the study. In addition, the symptom of diarrhea (stool with a frequency of more than 3 times a day of type 6 and 7 according to the Bristol stool scale), including its frequency, duration, and the number of bowel movements of loose stool per day were precisely evaluated in both groups. In the overall patient pool, diarrhea was reported in 21.7% of in-patients during the observation period (95% confidence interval [CI] 14.2-29.1) with a mean duration of 4.6154 days (95% CI 3.7910-5.4398). The incidence of diarrhea in group 1 was 13.3% (95% CI 4.5-22.2), and in group 2, it was 30.0% (95% CI 18.1-41.9). Relative risk showed that the use of the S. boulardii CNCM I-745 probiotic drug leads to a significant reduction in the risk of diarrhea in hospitalized patients with COVID-19 infection receiving antibiotic therapy (odds ratio [OR] 0.3590, 95% CI 0.1421-0.9069; p=0.0303). In group 1, the duration of diarrhea was 3.1250 days (95% CI 2.5892-3.6608) versus 5.2778 days (95% CI 4.2290-6.3265) in group 2, p=0.0112. The mean daily frequency of loose stools in patients with diarrhea in group 1 was 3.2500 (95% CI 2.6588-3.8412) versus 4.3889 (95% CI 3.7252-5.0525) in group 2, p=0.0272. The secondary endpoint, duration of hospital stay, was also significantly shorter in group 1 patients - 11.6833 days (95% CI 11.2042-12.1625) versus 12.7333 days (95% CI 12.1357-13.3309) in group 2, p=0.0120. The present prospective comparative study demonstrated that adding S. boulardii CNCM I-745 probiotic drug into the standard treatment regimen of patients with new coronavirus infection COVID-19 receiving antibiotic therapy helps reduce the incidence of diarrhea and its severity during hospitalization, as well as the duration of hospital stay.

ROLE OF PROCALCITONIN IN PATIENTS WITH COVID-19 AND HOSPITAL-ACQUIRED PNEUMONIA

ROLE OF PROCALCITONIN IN PATIENTS WITH COVID-19 AND HOSPITAL-ACQUIRED PNEUMONIA

The Role of Antibiotics in Endoscopic Transmural Drainage of Post-Inflammatory Pancreatic and Peripancreatic Fluid Collections.

BackgroundAlthough endoscopic treatment of symptomatic post-inflammatory pancreatic and peripancreatic fluid collections (PPPFCs) is an established treatment method, some aspects of endotherapy and periprocedural management remain controversial. The role of antibiotics is one of the most controversial issues in interventional endoscopic management of local complications of pancreatitis.MethodsThis study was a randomized, non-inferiority, placebo-controlled, and double-blinded clinical trial to investigate the role of antibiotic prophylaxis in endoscopic transmural drainage in patients with symptomatic non-infected PPPFCs and assess the influence of antibiotic treatment on the results of endotherapy in patients with symptomatic infected PPPFCs.This trial included 62 patients treated endoscopically for PPPFCs in 2020 at our medical center. Patients were divided into two groups; group 1 comprised patients who had received empirical intravenous antibiotic therapy during endotherapy and group 2 comprised patients who did not receive antibiotic therapy during endoscopic drainage of PPPFCs. The end points were clinical success and long-term success of endoscopic treatment.ResultsThirty-one patients were included in group 1 (walled-off pancreatic necrosis [WOPN, 51.6%; pseudocyst, 48.4%) and 31 patients in group 2 (WOPN, 58.1%; pseudocyst, 41.9%) (p=0.6098/nonsignificant statistical [NS]). Infection with PPPFCs was observed in 15/31 (48.39%) patients in group 1 and in 15/31 (48.39%) patients in group 2 (p=1.0/NS). The average time of active (with flushing through nasocystic drainage) drainage in group 1 was 13.0 (6 – 21) days and was 14.0 (7 – 25) days in group 2 (p=0.405/NS). The average total number endoscopic procedures on one patient was 3.3 (2 – 5) in group 1 and 3.4 (2 – 7) in group 2 (p=0.899/NS). Clinical success of PPPFCs was observed in 29/31 (93.5%) patients from group 1 and in 30/31 (96.8%) patients from group 2 (p=0.5540/NS). Complications of endotherapy were noted in 8/31 (25.8%) patients in group 1 and in 10/31 (32.3%) patients in group 2 (p=0.576/NS). Long-term success in group 1 and 2 was reported in 26/31 (83.9%) and 24/31 (77.4%) patients, respectively (p=0.520/NS).ConclusionsThe effective endoscopic drainage of sterile PPPFCs requires no preventive or prophylactic use of antibiotics. In infected PPPFCs, antibiotic therapy is not required for effective endoscopic transmural drainage.

Procalcitonin as marker for bacterial coinfection among adult COVID-19 patients in a tertiary-care hospital in the Philippines

Background: Antimicrobials are often given to patients with COVID-19 despite the absence of a bacterial coinfection. Procalcitonin (PCT), when elevated, often indicates the presence of a bacterial infection and is used to guide empiric antibiotic therapy. We sought to determine the utility of PCT and the optimal cutoff value of PCT among patients with COVID-19. Methods: We retrospectively reviewed all COVID-19 confirmed ca-ses hospitalized in our institution from March to December 2020. Of 729 cases, we included 403 (55.3%) who had baseline PCT and blood or respiratory tract specimens (eg, sputum, endotracheal aspirate) within 48 hours of admission. Participants were classified according to PCT levels and COVID-19 severity. A receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) obtained was used to compute the possible optimal cutoff value using the Youden index. A χ2 test was used to define association between groups according to the characteristics of variables. Results: Of a total cohort of 403, 245 (57%) were male, with an overall median age of 60 years (range, 22–94). Overall, 28 presented with mild COVID-19, 194 presented with moderate COVID-19, and 181 presented with severe or critical COVID-19. Moreover, 363 (90%) were given antibiotics. Of 28 with mild COVID-19, 22 (79%) received empiric antibiotics. The rate of bacterial coinfection was high at 28% (113 of 403). Klebsiella pneumoniae was the most commonly identified microorganism: 52 (19.5%) of 266 patients. Based on the ROC curve, the optimal cutoff for PCT was 4.72 ng/mL, with 97% specificity and only 6% sensitivity. Only 17 participants had PCT &gt; 4.72 ng/mL. Of these, 1 was mild, 5 were moderate COVID-19, 8 had severe COVID-19, and 3 had critical COVID-19; all received antibiotic therapy. Conclusions: In our cohort, the rate of bacterial coinfection was high. A PCT of &gt;4.72 ng/mL increased the likelihood of a coinfection. However, PCT had poor sensitivity and may not detect the presence of bacterial coinfection, especially when used alone. Serial PCT monitoring, its use in conjunction with other markers, or as a prognostic tool, need to be explored further.Funding: NoneDisclosures: None

Influence of lavender essential oil (Lavandula angustifolia) and oxytetracycline in nutrition of honey bees, prevention of American foulbrood and overall welfare

Recently, there has been an increasing demand for natural, healthy, and safe products without residual antibiotics for human consumption, particularly bee products. Beekeepers have been struggling with this problem many years, having in mind often occurrence of American foulbrood, which is one of the most severe honey bee brood diseases, and till now have been successfully eradicated with heavy usage of antibiotics. Such controlled, or mostly uncontrolled usage of antibiotics in fighting against American foulbrood lead to a residual quantity of antibiotic in honey. To overcome this problem, this research aimed to investigate the influence of single essential oil (Lavandula angustifolia) compared to antibiotics in honey bee production on the prevention of American foulbrood. Totally three treatments were formed artificially infected with P. larvae spore suspension, at concentration 2×109 spore/ml. The course of the disease was regularly monitored. Treatment one (T1) did not receive antibiotic therapy. Treatment two (T2) was given lavender essential oil at a concentration of 0.1% of sugar syrup. The treatment was applied for 30 days, at 48h intervals. Treatment three (T3) received antibiotics in the sugar syrup at a concentration of 0.1%, respectively. Clinical and laboratory examinations were performed on days 10, 20, 40 and 60, respectively. Besides, L. angustifolia essential oil rich in Ethanol, 2-(2-ethoxyethoxy)- (13.05%), linalool (10.71%), α-Terpinyl acetate (10.93%) and linalool acetate (9.60%), showed its positive effects against antibiotics in combat of American foulbrood, further research with a specifically designed qualitative and quantitative mixture of essential oils are more than necessary because single essential oil is not enough and didn’t show expected results.