Risk Factor For Systemic Infection Research Articles

Multidrug-Resistant Bacteria in Immunocompromised Patients.

The increasing incidence of antibiotic resistance in bacteria is a major problem in terms of therapeutic options, especially in immunocompromised patients, such as patients from intensive care units (ICUs), HIV-positive patients, patients with malignancies or transplant patients. Commensal bacteria, especially anaerobes, serve to maintain microbial stability by preventing overpopulation with pathogenic bacteria. In immunocompromised patients, microbiota imbalance caused by antibiotic therapy and decreased host immunity favors intestinal overpopulation with pathogenic species, leading to increased bacterial translocation and susceptibility to systemic infections. Infections with multidrug-resistant (MDR) bacteria pose major challenges to the establishment of appropriate treatment and lead to increased mortality. Asymptomatic colonization with MDR bacteria usually precedes infection and tends to persist for long periods of time, and in immunocompromised patients, colonization with MDR bacteria is a risk factor for systemic infections. This review aims to assess the relation between colonization and infection with MDR bacteria in immunocompromised patients such as ICU patients, HIV-positive patients and cancer patients and to identify the prevalence and patterns of MDR bacterial colonization and infection in this category of patients.

Acute Appendicitis in the Elderly: A Nationwide Retrospective Analysis.

Background: Acute appendicitis (AA) in older individuals remains understudied. We aimed to assess AA characteristics in patients older than 60 years and evaluate the impact of comorbidities. Methods: This retrospective study analyzed data from the American National Inpatient Sample between 2016 and 2019 to compare AA characteristics in patients younger and older than 60 years. Results: Of the 538,400 patients included, 27.5% were older than 60 years. Younger patients had a higher appendectomy rate (p < 0.01), while the complicated appendicitis rate was higher in older patients. Superficial wound infection, systemic infection, and mortality rates were higher in older patients (p < 0.01). Risk factors for superficial wound infection in patients younger than 60 years included cerebrovascular disease, chronic kidney disease, hypertension, heart failure, and obesity, whereas only heart failure was a risk factor in older patients. Risk factors for systemic infection in young patients included hypertension, heart failure, obesity, and diabetes mellitus, while in older patients they included hypertension, heart failure, and obesity. Complicated appendicitis was not a risk factor for infections in either group. Conclusions: This study highlights a higher incidence of AA in older individuals than previously reported, with comorbidities posing differing risks for infections between age groups.

Candiduria in Renal Transplant Recipients

ABSTRACT Introduction: The incidence of candiduria has increased significantly in recent years. A prospective study was carried out from January 1, 2017 to June 31, 2017 in the nephrology department at the Batna University Hospital, the aim of which is to determine the incidence of candiduria. Method: A total of 35 patients were included in our study, eight of them (22.85%) developed candiduria during their hospitalization. The majority of patients were women. The age group between 40-60 years was the most representative. Several risk factors were sought, the most frequently found were: immunosuppressive treatment, corticosteroid therapy and broad-spectrum antibiotic therapy. Candida albicans was the most isolated species (62.5%). Results: This study demonstrated the role of candiduria as a potential risk factor for systemic infection (candidemia), three cases of candidemia were diagnosed in patients with high candiduria. The death rate in our study was (37, 5%), they all had candidemia. Conclusion: Candiduria can be associated with high morbidity and mortality. It is a major risk factor for systemic infections. Early post-transplantation screening is therefore essential.

Incidence and Risk Factors for Systemic Infection in Deceased Donors

BackgroundOrgan donation shortage is the primary barrier to all organ transplantations.Infectious disease transmission through transplantation is considered controversial for organ retrieval. Donors with bacteremia and sepsis are considered controversial for organ retrieval due to potential transmission of an infectious agent to the recipient. MethodsWe retrospectively reviewed the results of bacterial culture of the donor's blood from peripheral venous or central venous catheter, urine, and bronchial aspiration from the organ donation registries of 102 potential donors from the Ministry of Health and Tissue Transplant Coordination Center of Istanbul Region in 2015. ResultsOf the 102 deceased donors included in the analysis, 24 (23.5%) had infection. The most common sites of infection were the bloodstream (41.6%) and the respiratory system (37.5%). The most common isolated pathogens of the bacterial cultures were Gram-positive bacteria (21), Gram-negative microorganisms (14), and Candida (1). The significant risk factor for infection was duration of stay at the intensive care unit (median: 5 day; 25–75%: 3–5 day) (odds ratio, 2.94; 95% confidence interval, 1.06–8.12; P < .05). The presence of infection in the donor accounted for a significant part of the reasons why the organs were not accepted for transplantation (kidneys 9%, liver 4%, heart 6%). ConclusionsThe study showed that deceased donors with prolonged stays in the intensive care unit have an increased risk for developing nosocomial infections; so there is a need for establishing and enforcing the prevention and control of infection in possible donors.

Frequency of icaA and icaD determinants and biofilm formation among coagulase-negative staphylococci associated with nasal carriage in neonatal intensive care units.

Nasal colonization with coagulase-negative staphylococci (CoNS) may be a preliminary risk factor for systemic infection. The aim of this study was to assess the frequency of ica A and D genes and biofilm formation among hospital-acquired nasal colonizing CoNS strains isolated from neonates in the neonatal intensive care units (NICUs). Antibiotic sensitivity patterns and some relevant risk factors were estimated. This study assessed nasal colonization with CoNS among neonates at days one and three of admission to NICUs of Beni-Suef University Hospital and Beni-Suef General Hospital from November 2015 to May 2016. The isolates were screened and identified; susceptibility testing was performed. Biofilm formation was examined using the Congo red agar method. Isolates identified as CoNS were tested by polymerase chain reaction (PCR) for the presence of mecA and icaA and icaD genes. A total of 340 nasal swabs were collected from 170 neonates. The incidence of nasal colonization with CoNS was 50%. The species most frequently isolated were S. haemolyticus and S. epidermidis. Multidrug resistance (MDR) was detected in 86% of isolates. It was found that there was a strong association between the presence of mecA gene and phenotypic resistance to methicillin and also the presence of the icaA gene and biofilm formation. Neonates admitted to NICUs can become reservoirs for CoNS strains, leading to potential dissemination of MDR strains into the community.

Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment

Human adenovirus (HAdV) infections constitute a major cause of morbidity in paediatric haematopoietic stem cell transplant (HSCT) patients. New antiviral treatments offer promising perspectives. However, it remains challenging to identify patients at risk for disseminated infection, and who should receive early antiviral intervention. We conducted a longitudinal study of allogeneic HSCT recipients, including weekly HAdV monitoring, to determine the risks factors associated with HAdV infection and dissemination, and to assess whether HAdV loads in stools may be used as surrogate markers for HAdV dissemination. Between September 2010 and December 2011, out of 72 patients, the cumulative incidence rates at day 100 of HAdV digestive infection, systemic infection and related disease were 35.9%, 24.0%, and 18.3%, respectively. In multivariate analysis, the risk factors for HAdV digestive and systemic infection were cord blood and in vitro T-cell depletion. Graft-versus-host disease (GVHD) grade >2 was also associated with systemic infection. In patients with HAdV digestive shedding, GVHD grade >2 and HAdV load in stools were the only risk factors for systemic infection. The median peak levels of HAdV in stool were 7.9 and 4.0 log10 copies/mL, respectively, in patients with HAdV systemic infection and in those without. HAdV monitoring in stools of paediatric HSCT recipients receiving cord blood or in vitro T-cell depleted transplants helps to predict patients at risk for HAdV systemic infection. Our results provide a rationale for randomized controlled trials to evaluate the benefit of anti-HAdV pre-emptive treatments based on HAdV DNA levels in stools.

Çocuklarda İntravenöz Kolistin Kullanımı: Tek Merkez Deneyimi

Objective: Colistin, a bactericidal antibiotic, was used in the 1960s for the treatment of infections by gram-negative bacteria. Because of its side effects and the development of safer drugs, its use was abandoned in the 1980s. In infections within clinics where multi-drug-resistant gram-negative bacteria (MDRGNB) (especially Pseudomonas spp. and Acinetobacter spp.) are present, colistin usage is suggested if there is drug resistance to any other antibiotics. Nephrotoxicity is one of the commonly observed adverse effects following intravenous (IV) administration of colistin. Nephrotoxicity is dose-dependent and reversible. The aim of this study is to evaluate the efficacy and safety of colistin in MDRGNB infections occurring in pediatric and neonatal patients. Material and Methods: The files of all patients under the age of 18 who were given IV colistin treatment, apart from inhaler treatments, were retrospectively investigated. Demographic characteristics of patients, risk factors for systemic infection, causative microorganisms, and susceptibilities and side effects of colistin were evaluated. Results: Twenty-three patients meeting the criteria were included in the study. The median age was 2 years (4 days-17 years). Colistin was used for infections caused by MDR Acinetobacter baumannii 78.2% (18/23) and MDR Pseudomonas aeruginosa 21.8% (5/23). MDR A. baumannii was found growing in the blood cultures of 15 patients and in the urine, wound, and respiratory sample of 1 patient. MDR P. aeruginosa was found in respiratory samples of 4 patients and the blood culture of 1 patient. The duration of treatment with colistin was a median of 13 (4-30) days. All patients were given additional antibiotics with colistin. The most commonly used antibiotics were carbapenems (13 patients), with 5 patients given sulbactam-ampicillin, 4 given ciprofloxacin, and 3 given aminoglycoside. One patient died during treatment with colistin. No patient developed nephrotoxicity or neurotoxicity. Conclusion: It appears that IV colistin use is effective and safe for MDRGNB treatment in pediatric patients. (J Pediatr Inf 2014; 8: 153-8)

Choroidal tuberculoma in a patient with ocular Behçet disease

Behçet disease is a chronic relapsing inflammatory disease affecting many different organs. Ocular involvement is quite common in the course of Behçet disease and is frequently manifested by bilateral panuveitis and retinal vasculitis. Medications such as corticosteroids and immunosuppressive agents are used to reduce inflammation in patients with posterior or panuveitis. Chronic immunosuppression is a risk factor for systemic infections. We report a case of choroidal tuberculoma associated with tuberculosis in a patient with ocular Behçet disease. A 25-year-old female with known ocular Behçet disease contracted tuberculosis 3 months earlier. She had been receiving methotrexate and oral steroids. Funduscopy of the left eye revealed a choroidal tuberculoma located superonasally to the optic disc. Fluorescein angiography showed a central area of hypofluorescence surrounded by a hyperfluorescent zone. Since she was already receiving antituberculosis treatment combined with oral steroids, the same treatment was continued. Diagnosis of the other diseases that may cause uveitis in patients with Behçet disease should not be missed. This is especially important since immunosuppressive drugs, that cause an increased incidence of systemic infections, are the common treatment of choice for patients with Behçet disease.

Prophylactic oral nystatin for preterm babies under 33 weeks’ gestation decreases fungal colonisation and invasive fungaemia

Background:Invasive fungal infection is an important cause of mortality and morbidity in extremely preterm babies. Colonisation with Candida is a risk factor for systemic infection. A policy of oral nystatin...

Patterns of Fungal Colonization in Preterm Infants Weighing Less Than 1000 Grams at Birth

Colonization with Candida spp. is an important risk factor for systemic infection in very low birth weight (VLBW; <1500 g) and extremely low birth weight (ELBW, <1000 g) infants. ELBW infants are at a higher risk than VLBW infants for fungal sepsis and its associated mortality, but few studies have examined fungal colonization exclusively in ELBW infants. Fungal colonization data were analyzed retrospectively in 50 high risk ELBW infants. Weekly surveillance fungal cultures of the skin, gastrointestinal tract, respiratory tract and umbilicus had been performed from birth through the first 6 weeks of life. Colonization was analyzed for time of initial colonization, site, species and spread of Candida from one site to another. Candida was isolated from surveillance cultures in 31 of 50 (62%) infants. Colonization was inversely proportional to gestational age. Initial week of both the fungal colonization of the skin [1 (0-6) week, median (range)] and gastrointestinal tract [2 (0-6)] preceded colonization of the respiratory tract [3 (1-6)] (P = 0.0001). Among infants colonized by only 1 of the species, colonization at 2 or more sites occurred similarly with Candida albicans (77%) and Candida parapsilosis (85%), whereas colonization at 3 or more sites occurred more frequently with C. albicans (69%) compared with C. parapsilosis (23%) (P = 0.047). Fungal colonization occurs on the skin and gastrointestinal tract before the respiratory tract. In addition, C. albicans is more likely than C. parapsilosis to colonize multiple sites.

Spread of antibiotic-resistant bacteria from acne patients to personal contacts-a problem beyond the skin?

Spread of antibiotic-resistant bacteria from acne patients to personal contacts-a problem beyond the skin?