Risk Of Bacteremia Research Articles

Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials.

The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is still controversial. To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP. This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed. Only randomized controlled trials were included. The outcomes analyzed included bacteremia, cholangitis, sepsis, pancreatitis, and mortality. The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials. The quality of evidence was assessed by the Grading of Recommendation Assessment, Development, and Evaluation. Meta-analysis was performed using the Review Manager 5.4 software. Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included. There was no significant difference between groups regarding incidence of cholangitis after ERCP [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05, 0.02, P = 0.32], cholangitis in patients with suspected biliary obstruction (RD = 0.02, 95%CI: -0.08 to 0.13, P = 0.66), cholangitis on intravenous antibiotic prophylaxis (RD = -0.02, 95%CI: -0.05 to 0.01, P = 0.25), septicemia (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.25), pancreatitis (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.19), and all-cause mortality (RD = 0.00, 95%CI: -0.01 to 0.01, P = 0.71]. However, the antibiotic prophylaxis group presented a 7% risk reduction in the incidence of bacteremia (RD= -0.07, 95%CI: -0.14 to -0.01, P = 0.03). The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis, septicemia, pancreatitis, and mortality.

Dynamics and Predictive Value of T-Cell Chimerism after Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide

Background: T-cell chimerism after allogeneic hematopoietic cell transplantation (alloHCT) is an important tool to investigate T-cell reconstitution. Haploidentical HCT (haplo-HCT) using post-transplantation cyclophosphamide (PTCy) has been increasingly applied due to readily available donors and favorable outcomes. PTCy induces immune tolerance by depleting expansion of alloreactive T-cells. However, limited clinical data exist regarding the impact of PTCy on the dynamics of T-cell chimerism. Methods: Adult patients receiving haplo-HCT with PTCy and reduced-intensity conditioning regimens were retrospectively reviewed. Patients with primary graft failure or receiving donor-lymphocyte infusion prior to +90 days were excluded. T-cell chimerism was measured from sorted CD3+ cells collected from peripheral blood or bone marrow at 1, 2, 3, 6, and 12 months. Complete chimerism was defined as < 5% donor T-cells. Patients were divided into full and partial T-cell chimerism groups based on their T-cell chimerism status at Month 1 and 3. Results: From 1/2017 to 6/2021, 34 patients underwent haplo-HCT and met inclusion criteria (Table 1). One month post HCT, 29 (85.3%) patients achieved complete T-cell chimerism; 3 months post HCT, 31 (93.9%) patients achieved complete T-cell chimerism (Figure A). In univariate logistic regression analysis, peripheral blood rather than bone marrow as the donor source, and the occurrence of cytokine-release syndrome (CRS), were significantly associated with higher incidences of full T-cell chimerism at Month 1 (Table 2). In multivariable analysis, only the occurrence of CRS was significantly associated with full T-cell chimerism at Month 1 (odds ratio 18.7, 95% confidence interval [CI] 1.30 to 641, p=0.04, Table 2). Next, we investigated whether early achievement of full T-cell chimerism would affect clinical outcomes. After a median follow up of 363 and 530 days for patients with full and partial T-cell chimerism at Month 1, respectively, there was no significant difference of progression-free survival (PFS) (median PFS not reached v.s. 367 days, hazard ratio [HR] 0.54, 95%CI 0.14 to 2.07, Figure B) or overall survival (OS) (median OS not reached vs 530 days, HR 0.41, 95%CI 0.10 to 1.69, Figure C). In contrast, patients who achieved full T-cell chimerism at Month 3 had significantly longer OS than those with partial T-cell chimerism (median OS not reached v.s. 492 days, HR 0.18, 95%CI 0.03 to 0.90; p=0.04, log-rank test; Figure E). Of note, for the two deaths in the partial T-chimerism group, 1 died from relapse and the other from sepsis in the setting of Grade 4 acute graft-versus-host disease. Moreover, patients who achieved full T-chimerism at Month 3 had a trend of improved PFS over those with partial T-chimerism, although the difference was not statistically significant (HR 0.23, 95%CI 0.05 to 1.11; p=0.07; Figure D). Lastly, achieving partial T-cell chimerism at Month 1 or Month 3 was not associated with an increased risk of bacteremia (p=0.83 for Month 1; p=0.99 for Month 3; Chi-square test) or pneumonia (p=0.31 for Month 1; p=0.38 for Month 3), compared with those with full T-cell chimerism. Conclusion: For patients receiving haplo-HCT with PTCy, the majority achieved full T-cell chimerism within the first month. The occurrence of CRS was associated with a significantly higher chance of achieving full T-cell chimerism at Month 1. Achieving a full T-cell chimerism at Month 3 was associated with significantly improved OS compared with those with partial T-cell chimerism. These data should be confirmed in a larger patient cohort. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predictive value of perioperative peripheral blood cells counts for bacteremia and 90-day mortality in severe burn patients

ObjectiveBurn bacteremia is related to immune barrier damage, but whether the level of circulating immune cells predicts outcomes in severe burns is still not clear. This study aimed to explore the predictive value of perioperative blood cells of the first surgery after burn for bacteremia and 90-day death. MethodsData from severe burn patients treated at the First Affiliated Hospital of Sun Yat-sen University from 2011 to 2020 were retrospectively analyzed. Data on monocytes (M), lymphocytes (L), white blood cell-to-platelet ratio (WPR), neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and changes in temperature (T-37) were collected at one day before(X0), the first day after (X1) and the third day after (X3) the primary surgery.Univariate and multivariate logistic regression were used to identify the independent risk factors of bacteremia and death within 90 days, which were used to establish the risk prediction models (xbac and x90d-m) in severely burned patients. Severe burn cases from two other burn centers were selected to verify the prediction models. ResultsWe analyzed 169 severe burn cases in the training dataset, with a 90-day mortality of 21.3% (36/169); 56 (33.1%) patients experienced burn bacteremia. Higher M0, WPR0, NLR0, NLR3, T3–37, ∆M (M0-M3) and lower M3, L3 were associated with higher risk of bacteremia (P < 0.05). Multivariate regression analysis showed that SOFA0, WPR0, M3, and T3–37 were independently associated with bacteremia. The prediction model for bacteremia Xbac = 0.1809 × SOFA0 + 6.532 × WPR0–1.171 × M3 + 0.6987 × T3–37- 2.297. TBSAB, SOFA0, and ∆M (M0-M3) were independently correlated with 90-day mortality. The risk prediction model X90d-m= 0.055 × TBSAB + 0.301 ×SOFA0 + 1.508 × ∆M - 7.196. External validation suggested that the specificity, sensitivity and AUC of the prediction model Xbac was 90.7%, 62.5% and 0.797, respectively; of the prediction model X90d-m was 69.2%, 90.0% and 0.873, respectively. ConclusionPeripheral M3, WPR0 and ∆M (M0-M3) during the primary surgery has reasonable predictive ability for bacteremia and 90-day mortality in severe burn patients, which could inform clinical antimicrobial judgment and prognostication.

QSOFA does not predict bacteremia in patients with severe manifestations of sepsis.

Bloodstream infections in septic patients may be missed due to preceding antibiotic therapy prior to obtaining blood cultures. We leveraged the FABLED cohort study to determine if the quick Sequential Organ Failure Assessment (qSOFA) score could reliably identify patients at higher risk of bacteremia in patients who may have false negative blood cultures due to previously administered antibiotic therapy. We conducted a multi-centre diagnostic study among adult patients with severe manifestations of sepsis. Patients were enrolled in one of seven participating centres between November 2013 and September 2018. All patients from the FABLED cohort had two sets of blood cultures drawn prior to the administration of antimicrobial therapy, as well as additional blood cultures within 4 hours of treatment initiation. Participants were categorized according to qSOFA score, with a score ≥2 being considered positive. Among 325 patients with severe manifestations of sepsis, a positive qSOFA score (defined as a score ≥2) on admission was 58% sensitive (95% CI 48% to 67%) and 41% specific (95% CI 34% to 48%) for predicting bacteremia. Among patients with negative post-antimicrobial blood cultures, a positive qSOFA score was 57% sensitive (95% CI 42% to 70%) and 42% specific (95% CI 35% to 49%) to detect patients who were originally bacteremic prior to the initiation of therapy. Our results suggest that the qSOFA score cannot be used to identify patients at risk for occult bacteremia due to the administration of antibiotics pre-blood culture.

Dose Vesicoureteral Reflux Increase Risk for Bacteremia in Urinary Tract Infection?

Dose Vesicoureteral Reflux Increase Risk for Bacteremia in Urinary Tract Infection?

Pediatric Candida Bloodstream Infections Complicated with Mixed and Subsequent Bacteremia: The Clinical Characteristics and Impacts on Outcomes.

Background: Pediatricians face a therapeutic challenge when patients with Candida bloodstream infections (BSIs) simultaneously have positive bacterial culture. We aim to characterize the clinical characteristics of pediatric Candida BSIs complicated with mixed bacteremia and subsequent bacterial infections, risk factors and impacts on outcomes. Methods: All episodes of pediatric Candida BSIs between 2005 and 2020 from a medical center in Taiwan were reviewed. Mixed Candida/bacterial BSIs were defined as isolation of a bacterial pathogen from blood cultures obtained within 48 h before or after the onset of Candida BSI. The clinical features and impacts of mixed Candida/bacterial BSIs were investigated. Results: During the study period, 320 patients with a total of 365 episodes of Candida BSIs were identified and analyzed. Mixed Candida/bacterial BSIs were 35 episodes (9.6%). No significant difference was found between mixed Candida/bacterial BSIs and monomicrobial Candida BSIs in terms of patient demographics, Candida species distributions, most chronic comorbidities or risk factors. Patients with mixed Candida/bacterial BSIs were associated with a significantly higher risk of subsequent bacteremia (51.4% vs. 21.2%, p &lt; 0.001) and a relatively higher candidemia-attributable mortality rate (37.2% vs. 22.4%, p = 0.061) than those with monomicrobial Candida BSIs. Mixed Candida/bacterial BSIs were not an independent risk factor of treatment failure or final mortality according to multivariate logistic regression analyses. Conclusions: The clinical significance of mixed Candida/bacterial BSIs in children included a longer duration of septic symptoms, significantly higher likelihood to have subsequent bacteremia, and relatively higher risk of candidemia attributable mortality.

Diagnostic Performance of Physician Gestalt for Bacteremia in Patients in the Process of Being Admitted With Suspected Infection.

Due to potentially fatal consequences of missed bacteremia, blood cultures are often overused. While there are several prediction models that can be used to identify patients who truly need blood cultures, physicians often rely on their gestalt. We evaluated the diagnostic performance of physician gestalt for bacteremia in comparison with 2 existing prediction models: Takeshima and Shapiro. The study enrolled consecutive adult patients with suspected infection who were in the process of being admitted to the general medicine department at 2 hospitals between April 2017 and January 2019. Attending physicians provided gestalt regarding risk of bacteremia (0%-100%). Patients with a <10% risk estimated via each strategy (ie, physician gestalt or 2 existing models) were categorized as bacteremia excluded (ie, blood cultures were considered unnecessary). Strategies were compared in terms of safety (proportion of patients with bacteremia among those classified as bacteremia excluded) and efficiency (proportion of patients classified as bacteremia excluded among the total cohort). Among 2014 patients, 292 (14.5%) were diagnosed with bacteremia. The safety of physician gestalt and the Takeshima and Shapiro models was 3.7% (95% confidence interval [CI], 2.2% to 5.7%), 6.5% (95% CI, 5.0% to 7.9%), and 10.8% (95% CI, 9.4% to 12.3%), whereas the efficiency of each strategy was 22.4% (95% CI, 22.5% to 26.3%), 52.7% (95% CI, 50.5% to 54.9%), and 87.8% (95% CI, 86.3% to 89.2%), respectively. Physician gestalt was safer but less efficient than existing models. Clinical prediction models could help reduce the overuse of blood cultures.

Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation

The effectiveness of selective decontamination of the digestive tract (SDD) in critically ill adults receiving mechanical ventilation is uncertain. To determine whether SDD is associated with reduced risk of death in adults receiving mechanical ventilation in intensive care units (ICUs) compared with standard care. The primary search was conducted using MEDLINE, EMBASE, and CENTRAL databases until September 2022. Randomized clinical trials including adults receiving mechanical ventilation in the ICU comparing SDD vs standard care or placebo. Data extraction and risk of bias assessments were performed in duplicate. The primary analysis was conducted using a bayesian framework. The primary outcome was hospital mortality. Subgroups included SDD with an intravenous agent compared with SDD without an intravenous agent. There were 8 secondary outcomes including the incidence of ventilator-associated pneumonia, ICU-acquired bacteremia, and the incidence of positive cultures of antimicrobial-resistant organisms. There were 32 randomized clinical trials including 24 389 participants in the analysis. The median age of participants in the included studies was 54 years (IQR, 44-60), and the median proportion of female trial participants was 33% (IQR, 25%-38%). Data from 30 trials including 24 034 participants contributed to the primary outcome. The pooled estimated risk ratio (RR) for mortality for SDD compared with standard care was 0.91 (95% credible interval [CrI], 0.82-0.99; I2 = 33.9%; moderate certainty) with a 99.3% posterior probability that SDD reduced hospital mortality. The beneficial association of SDD was evident in trials with an intravenous agent (RR, 0.84 [95% CrI, 0.74-0.94]), but not in trials without an intravenous agent (RR, 1.01 [95% CrI, 0.91-1.11]) (P value for the interaction between subgroups = .02). SDD was associated with reduced risk of ventilator-associated pneumonia (RR, 0.44 [95% CrI, 0.36-0.54]) and ICU-acquired bacteremia (RR, 0.68 [95% CrI, 0.57-0.81]). Available data regarding the incidence of positive cultures of antimicrobial-resistant organisms were not amenable to pooling and were of very low certainty. Among adults in the ICU treated with mechanical ventilation, the use of SDD compared with standard care or placebo was associated with lower hospital mortality. Evidence regarding the effect of SDD on antimicrobial resistance was of very low certainty.

Models for bacteraemia risk prediction. Clinical implications.

Bacteraemia has important consequences for the patient, as it is associated with worse clinical outcomes. On the other hand, unnecessarily obtaining samples for blood cultures increases costs and the workload in the microbiology laboratory. Its diagnosis implies a time delay, but decisions about start antibiotic treatment, discharge, or admits the patient must be taken during the first attention and, therefore, before known the blood cultures results. This manuscript reviews the different strategies based on clinical scores and biomarkers that are useful for predicting bacteraemia and improving initial decision-making.

Probiotics Safety Aspect of Functional Foods

ABSTRACT In recent years, interest in probiotics has increased as functional foods improve quality of life and consumers become more health-conscious. The European Food Safety Authority (EFSA) has determined that all common probiotics are safe for the general population. However, this definition does not guide the outcomes of using probiotics in people with diseases that favor them, as there are no strict regulations governing applicable trademark law and the manufacture of probiotics. For this reason, Probiotics are recognized to be beneficial for the majority of patients during treatment; however, patients with weakened immune systems may be at risk for bacteremia, endocarditis, and peritonitis. There are no necessary standards regarding safety and use protocols for probiotics. More information is needed on their use before recommending probiotics to treat or prevent disease in privileged groups. These products may be considered a public health concern by reviewing information on the use of probiotics to predict the likelihood of side effects in vulnerable groups (young children, the elderly, and pregnant women).

Predicting Bacteremia among Septic Patients Based on ED Information by Machine Learning Methods: A Comparative Study.

Introduction: Bacteremia is a common but life-threatening infectious disease. However, a well-defined rule to assess patient risk of bacteremia and the urgency of blood culture is lacking. The aim of this study is to establish a predictive model for bacteremia in septic patients using available big data in the emergency department (ED) through logistic regression and other machine learning (ML) methods. Material and Methods: We conducted a retrospective cohort study at the ED of National Cheng Kung University Hospital in Taiwan from January 2015 to December 2019. ED adults (≥18 years old) with systemic inflammatory response syndrome and receiving blood cultures during the ED stay were included. Models I and II were established based on logistic regression, both of which were derived from support vector machine (SVM) and random forest (RF). Net reclassification index was used to determine which model was superior. Results: During the study period, 437,969 patients visited the study ED, and 40,395 patients were enrolled. Patients diagnosed with bacteremia accounted for 7.7% of the cohort. The area under the receiver operating curve (AUROC) in models I and II was 0.729 (95% CI, 0.718–0.740) and 0.731 (95% CI, 0.721–0.742), with Akaike information criterion (AIC) of 16,840 and 16,803, respectively. The performance of model II was superior to that of model I. The AUROC values of models III and IV in the validation dataset were 0.730 (95% CI, 0.713–0.747) and 0.705 (0.688–0.722), respectively. There is no statistical evidence to support that the performance of the model created with logistic regression is superior to those created by SVM and RF. Discussion: The advantage of the SVM or RF model is that the prediction model is more elastic and not limited to a linear relationship. The advantage of the LR model is that it is easy to explain the influence of the independent variable on the response variable. These models could help medical staff identify high-risk patients and prevent unnecessary antibiotic use. The performance of SVM and RF was not inferior to that of logistic regression. Conclusions: We established models that provide discrimination in predicting bacteremia among patients with sepsis. The reported results could inspire researchers to adopt ML in their development of prediction algorithms.

Estimating the risk of bacteraemia in hospitalised patients with pneumococcal pneumonia

To construct a prediction model for bacteraemia in patients with pneumococcal community-acquired pneumonia (P-CAP) based on variables easily obtained at hospital admission. This prospective observational multicentre derivation-validation study was conducted in patients hospitalised with P-CAP between 2000 and 2020. All cases were diagnosed based on positive urinary antigen tests in the emergency department and had blood cultures taken on admission. A risk score to predict bacteraemia was developed. We included 1783 patients with P-CAP (1195 in the derivation and 588 in the validation cohort). A third (33.3%) of the patients had bacteraemia. In the multivariate analysis, the following were identified as independent factors associated with bacteraemia: no influenza vaccination the last year, no pneumococcal vaccination in the last 5 years, blood urea nitrogen (BUN) ≥30mg/dL, sodium <130mmol/L, lymphocyte count <800/µl, C-reactive protein ≥200mg/L, respiratory failure, pleural effusion and no antibiotic treatment before admission. The score yielded good discrimination (AUC 0.732; 95% CI: 0.695-0.769) and calibration (Hosmer-Lemeshow p-value 0.801), with similar performance in the validation cohort (AUC 0.764; 95% CI:0.719-0.809). We found nine predictive factors easily obtained on hospital admission that could help achieve early identification of bacteraemia. The prediction model provides a useful tool to guide diagnostic decisions.

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results.

To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

The Prevalence of Malaria and Bacteremia Co-Infections among Febrile Patients: A Systematic Review and Meta-Analysis.

Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the co-existence of malaria and bacteremia in the literature to provide evidence-based information for future studies investigating the clinical significance of this co-infection. The study protocol was registered at PROSPERO (ID: CRD42021287971). Relevant studies were identified from PubMed, Web of Science, and Scopus. The pooled prevalence of (1) co-existent malaria and bacteremia among febrile patients, (2) the pooled prevalence of bacteremia among patients with malaria, (3) the probability of co-infection, and (4) the pooled prevalence of deaths were estimated by the random-effects model. Fifty-one studies involving 1583 cases of co-infection were included in the analyses. Typhoidal Salmonella spp. and Staphylococcus aureus were the most common Gram-negative and Gram-positive bacteria, respectively. The prevalence of co-existent malaria and bacteremia among febrile patients was 1.9% (95% confidence interval (CI) = 1.5–2.2%, I2 = 96.64%, 31 studies). The prevalence of bacteremia among patients with malaria was 7.6% (95% CI = 6.7–8.7%, and I2 = 96.68%, 43 studies). Co-infection by malaria and bacteremia did not occur by chance (p = 0.024, odds ratio = 0.64, 95% CI = 0.43–0.94, and I2 = 95.7%, 29 studies). The pooled prevalence of deaths among patients with co-infection was 15.0% (95% CI = 8.0–23.0%, I2 = 75.23%, 8 studies). On the basis of this study, we conclude that although the prevalence of co-infection was low, patients with malaria appear at greater risk of bacteremia and death.

246.3: MicroRNA Tests for Complex Diagnostic of Acute Rejection And Bacterial Infection After Heart Transplantation

Introduction: The acute rejection and bacterial infections are the main risk factors of primary graft dysfunction and high mortality after heart transplantation (HTx). The search for new minimally invasive diagnostic methods and biomarkers of graft damage is extremely relevant. MicroRNAs are widely known as small molecules, regulating gene expression. Some of them (miR-27, -101, and -424) are involved in the mechanisms of cardiovascular diseases. The aim of the study is to determine the diagnostic value of miR-27, miR-101 and miR-424 levels for early post-transplant complications – heart graft acute rejection and gram-negative bacterial infections. Methods: The study enrolled 83 heart transplant recipients, aged 16 to 70 (48.6±10.9) years. The expression levels of miR-27, -101, and -424 were measured by PCR (Qiagen, USA) in plasma after HTx. Graft rejection was verified through morphological analysis of endomyocardial biopsy specimens; infection – through microbiological identification in blood culture. Results: The miR-424 level didn’t differ (p=0.47) in recipients with (n=39) and without acute graft rejection (n=44), however miR-27 and miR-101 levels are significantly lower in recipients with acute graft rejection than in recipients without (p=0.01 and p=0.02 resp.). By the way the diagnostic value of miR-27 and -101 and its’ threshold value for heart transplant acute rejection was found: when miR-27 expression level is below threshold value the relative risk of acute rejection is RR=1.8 [95% CI 1.13–3.01]; miR-101 – below threshold value RR=1.9 [95% CI 1.13–3.37]. For miR-27 the sensitivity (Se) and specificity (Sp) were 53.6% and 79.2%; for miR-101 – 64.3% and Sp=70.8% resp. (Fig. 1). MiR-27, -101 and -424 levels were determined in heart transplant recipients with bacterial infections after HTx (n=20). More than 50% of bacteria spectrum were gram-negative pathogenes: Аcinetobacter baumannii (55%), and Klebsiella pneumoniae (40%). MiR-27 and -101 didn’t differ in recipients with and without infection (p>0.05), but miR-424 level was significantly higher in heart transplant recipients with gram-negative bacteremia (p=0.02). When miR-424 level is above -5.72 fold change, the relative risk of bacteremia is RR=3.9 [95% CI 1.94–7.61]; Se=60.0%; Sp=89.2% (Fig. 2). Conclusion: The measurement of miR-27, -101, and -424 expression levels can be used as complex tests for monitoring the risk of acute rejection and bacterial infections after HTx.

Upregulated circulating mir-424 and its' diagnostic value for gram-negative bacteremia after thoracic transplantation.

AimsEarly post-transplant complications such as acute graft rejection and infections are associated with high morbidity and mortality of heart and lung transplant recipients who are in vital need of immunosuppressive therapy. MiR-424 is a member of the miR-16 family, which plays an important physiological role in the development of cardiovascular and respiratory pathology, is involved in the regulation of monocyte and macrophage differentiation, and has an immunosuppressive potential. The aim of the study was to determine the diagnostic value of circulating miR-424 as a potential biomarker of post-transplant complications in heart and lung transplant recipients.MethodsThe study enrolled 83 heart transplant recipients, aged 18 to 70 (48 ± 13) years; 26 lung transplant recipients, aged 10 to 74 (36 ± 16) years. The miR-424 plasma expression was detected by real-time PCR (Qiagen, USA). Significance of miR-424 level was assessed through the ΔCt method. Acute graft rejection was verified by the results of endomyocardial or transbronchial biopsy. Post-transplant infectious complications were verified through microbiological identification of bacteremia from blood cultures.ResultsOur study shows miR-424 upregulation in plasma of patients with chronic heart or respiratory failure in comparison with healthy individuals (p = 0.003 and p = 0.04 resp.). There was a direct correlation of miR-424 expression with red blood cells and hemoglobin levels in patients before heart transplantation (p = 0.01 and p = 0.03 resp.). After transplantation the expression of plasma miR-424 correlated with the level of C-reactive protein (CRP) both in heart (r = 0.75; p = 0.02) and lung (r = 0.50; p = 0.04) transplant recipients. The expression of plasma miR-424 correlated with tacrolimus blood concentration after heart transplantation (r = 0.38; p = 0.04). The miR-424 level didn't differ in heart or lung transplant recipients with and without acute graft rejection (p = 0.47 and p = 0.78 resp.), but was significantly higher in heart and lung transplant recipients with gram-negative bacteremia (p = 0.002). When the miR-424 level is above a threshold value (−5.72 fold change), the relative risk of bacteremia is RR = 3.84 [95% CI 1.94–7.61]; Se = 60.0%; Sp = 89.2%. CRP concentration above 7 mg/L in duplex test with miR-424 improves the diagnostic characteristics of miR-424 for post-transplant gram-negative bacteremia in heart and lung transplant recipients up to RR = 9.17 [95% CI 1.37–61.46]; Se = 83.3% and Sp = 90.1%.ConclusionMiR-424 plasma expression was upregulated in patients with chronic heart and respiratory failure and in heart and lung transplant recipients in the early post-transplant period. The duplex test, including miR-424 and CRP, has a diagnostic value for detecting the high risk of post-transplant gram-negative bacteremia in heart and lung transplant recipients.

Abscess Formation After Tooth Extraction: A Long-Term Complication of Polyacrylamide Hydrogel Filler

A 35-year-old woman with a history of polyacrylamide hydrogel filler injection was referred with a fluctuating facial abscess after decayed tooth extraction. MRI imaging confirmed the diagnosis of an abscess. After appropriate treatment, the patient healed with a little hyperpigmentation and deformity in the zygomaticotemporal area. Although polyacrylamide hydrogel filler injection is considered non-toxic, non-immunogenic, and biocompatible; as a permanent material, physicians should be aware of the risk of its late complications such as late infections. In addition to antiseptic measures, antibiotic prophylaxis may be necessary before the procedures which have a risk of bacteremia and close to the permanent filler location.

Antimicrobial prophylaxis and the rate of blood stream infections and Clostridioides difficile in pediatric stem cell transplantation: A single-center retrospective study.

The use of prophylactic antibiotics in the pre-engraftment period to minimize the risk of bacteremia is debatable given concerns of Clostridioides difficile (C.diff), antibiotics resistance, and disruption of gut microbiota. We retrospectively reviewed the rate and characteristics of bacteremia and C.diff infections within the first 100 days post-HSCT in all pediatric patients who received routine antibacterial prophylaxis during HSCT from 2015 to 2018. C.diff infection was defined by the presence of three or more unformed stools in 24h and positive stool test for C.diff or its toxins. One hundred and thirty-five (100 allogeneic and 35 autologous) transplants in 123 patients were eligible for analysis. Median age at transplant was 7.1 (range 0.2-13.7), 67 (55%) were women, and diagnosis was malignant condition in 68 patients. Median time to neutrophil engraftment was 18 days (13-23). Cefepime or piperacillin-tazobactam prophylaxis was used in 105 (78%) and 28 (21%) of patients, respectively. Only five (3%) patients had bacteremia during the pre-engraftment period, and 13 (11%) patients developed bacteremia postengraftment. Septic shock was present in only one patient pre-engraftment and was due to gram-negative bacteria. All patients who developed bacteremia received MAC. Thirteen patients (10%) of patients fulfilled C.diff infection definition. There was no mortality related to bacterial infections among our patients. The use of antibiotic prophylaxis was associated with low rate of bacteremia in the pre-engraftment period and a 10% risk of C.diff infections. More studies are needed to better evaluate the efficacy of antibiotic prophylaxis in HSCT patients.

Comparison of pneumonia and nonpneumonia-related Acinetobacter baumannii complex bacteremia: A single-center retrospective study

Acinetobacter baumannii complex (ABC) is a group of increasingly prevalent opportunistic pathogens that cause a variety of life-threatening nosocomial infections, especially in the intensive care unit (ICU). This study assessed the differences between pneumonia- and non-pneumonia-related ABC bacteremia and possible independent risk factors for 30-day mortality. The clinical data of ICU patients diagnosed with ABC bacteremia at a tertiary care hospital from January 2009 to December 2020 were collected, and sorted into groups of ABC bacteremia with and without pneumonia. Significant changes in the incidence of ABC bacteremia and antibiotic resistance were observed over the 12-year study. Compared with nonpneumonia-related ABC bacteremia, pneumonia-related ABC bacteremia was associated with a higher rate of hypertension, less prior tigecycline use, more carbapenem-resistant (CR) strains, and a higher 30-day mortality rate. In multivariate analysis, immunosuppression, higher APACHE II score, and SOFA score were independent risk factors for 30-day mortality. Moreover, the risk of death was 1.919 times higher in the pneumonia-related group. Although pneumonia-related ABC bacteremia had worse outcomes, it was not an independent risk factor for death statistically. Immunosuppression and disease severity levels increased the risks of death in ICU patients with ABC bacteremia.

Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.

Surviving Sepsis guidelines recommend blood cultures before administration of intravenous (IV) antibiotics for patients with sepsis or moderate to high risk of bacteremia. Clinical decision support (CDS) that reminds emergency department (ED) providers to obtain blood cultures when ordering IV antibiotics may lead to improvements in this process measure. This was a multicenter causal impact analysis comparing timely blood culture collections prior to IV antibiotics for adult ED patients 1year before and after a CDS intervention implementation in the electronic health record. A Bayesian structured time-series model compared daily timely blood cultures collected compared to a forecasted synthetic control. Mixed effects models evaluated the impact of the intervention controlling for confounders. The analysis included 54 538 patients over 2years. In the baseline phase, 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. Causal impact analysis determined an absolute increase of 13.1% (95% CI 10.4-15.7%) of timely blood culture collections overall, although the difference in patients with a sepsis diagnosis or who met CDC Adult Sepsis Event criteria was not significant, absolute difference 8.0% (95% CI -0.2 to 15.8). Blood culture positivity increased in the intervention phase, and contamination rates were similar in both study phases. CDS improved blood culture collection before IV antibiotics in the ED, without increasing overutilization. A simple CDS alert increased timely blood culture collections in ED patients for whom concern for infection was high enough to warrant IV antibiotics.