Risk Of Bacterial Infections Research Articles

289. Prolonged Corticosteroid Usage, Associated Infectious Complications, and High Mortality in Adult Patients with COVID-19

Abstract Background Based on the RECOVERY trial, the NIH strongly recommends systemic corticosteroids for COVID-19 pneumonia with hypoxia. The study demonstrated reduced 28-day mortality after dexamethasone 6mg daily for up to 10 days compared to SOC alone. In practice, physicians may continue therapy for longer periods if potential benefit outweighs potential risk. Little is known about adverse events associated with prolonged corticosteroid use in patients with COVID-19; however, in general, this can increase risk for bacterial or fungal infections. This study aimed to explore the incidence of secondary infections during extended corticosteroid use for COVID-19. Methods A retrospective study was performed in adults at two community hospitals between September 2020 and May 2021 with a diagnosis of respiratory failure secondary to COVID-19 infection. Those with at least one new, laboratory-confirmed secondary infection during hospitalization after at least 10 cumulative days of corticosteroids were included. Demographic characteristics, clinical data and outcomes were extracted from the medical records. Quantitative analyses was performed using SPSS v27.0 and R. Results Of over 1,500 COVID-19 admissions within the timeframe, 73 patients met inclusion criteria (Table 1). No patient received immunomodulators for COVID-19 treatment. Patients had a median of 18 days on corticosteroids (range 10-65 days) prior to first positive culture. There were 130 positive cultures identified in blood, urine, and sputum samples (Figure 1), including polymicrobical cultures, yielding 34 clinically relevant organisms (Table 2). Hospital course was complicated by septic shock (68.5%), worsening of lung function (76.7%), and acute organ damage (57.5%); 55 (75%) patients expired during index admission. Conclusion Patients with COVID-19 on extended courses of corticosteroids have relatively higher rates of clinically significant invasive secondary infections and associated poor outcomes. Given there is limited information suggesting improved outcomes with these prolonged courses, risk to benefit analysis must be considered when deciding whether to extend corticosteroid treatment for more than 10 days for COVID-19. Disclosures All Authors: No reported disclosures.

473. Diabetes Mellitus as a Risk Factor for Cryptococcosis — a Multicenter Research Network Study

Abstract Background Diabetes mellitus type 2 (DM2) is a common medical condition that increases the risk of bacterial infections, and is often present in patients with cryptococcosis. The role of DM2 as an independent risk factor for cryptococcosis is debatable. We aim to better characterize the natural history of cryptococcosis in patients with DM2 as their only comorbidity. Methods We utilized TrinetX, a federal national network, to identify HIV-negative patients who had cryptococcosis without known risk factors. Demographic characteristics and outcomes were compared between patients with DM2 and those without DM2, who tested positive or had ICD based diagnoses of Cryptococcus infection within five years of diagnosis of DM2. Results Sixty patients with DM2 (as the sole risk factor) and 707 patients without DM2 had cryptococcosis. Patients with DM2 and cryptococcosis were older (61 ± 13.6 years vs. 55.8 ± 16.2 years, p=0.0219), and more likely to be Hispanic or Latino (18% vs. 9%, p=0.023). They had higher rates of hypertension (77% vs 44%, p< 0.0001), cystic fibrosis (18% vs 1%, p< 0.0001), tuberculosis (18% vs 1%, p< 0.0001), and chronic kidney disease (33% vs 18%, p=0.0026). The mean HbA1c among patients with DM2 who developed cryptococcosis was 8.16 (SD 2.62). The most common sites of cryptococcus infection were pulmonary (56% vs 55%, p=0.8930) and cerebral (36% vs 40%, p=0.5589), in both groups. The two groups had similar mortality (20% vs 25.47%, p=0.3676) (Figure 1), and hospitalization rates (20% vs 31.3%, p=0.08). The overall annual cryptococcosis risk among HIV-negative patients with DM2 without any additional risk factors was 0.001%. Conclusion Cryptococcosis occurs rarely in HIV-negative patients with DM2 and without additional risk factors. Hispanic or Latino ethnicity, uncontrolled hyperglycemia, and chronic kidney disease may increase the risk of cryptococcosis among patients with DM2. Cryptococcosis in patients whose only comorbidity is DM2 have as high of mortality as that seen with more established comorbitidies. Disclosures All Authors: No reported disclosures.

Catheter-associated urinary tract infection by Pseudomonas aeruginosa progresses through acute and chronic phases of infection

Healthcare-associated infections are major causes of complications that lead to extended hospital stays and significant medical costs. The use of medical devices, including catheters, increases the risk of bacterial colonization and infection through the presence of a foreign surface. Two outcomes are observed for catheterized patients: catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI). However, the relationship between these two events remains unclear. To understand this relationship, we studied a murine model of Pseudomonas aeruginosa CAUTI. In this model, we also observe two outcomes in infected animals: acute symptoms that is associated with CAUTI and chronic colonization that is associated with asymptomatic bacteriuria. The timing of the acute outcome takes place in the first week of infection, whereas chronic colonization occurs in the second week of infection. We further showed that mutants lacking genes encoding type III secretion system (T3SS), T3SS effector proteins, T3SS injection pore, or T3SS transcriptional activation all fail to cause acute symptoms of CAUTI. Nonetheless, all mutants defective for T3SS colonized the catheter and bladders at levels similar to the parental strain. In contrast, through induction of the T3SS master regulator ExsA, all infected animals showed acute phenotypes with bacteremia. Our results demonstrated that the acute symptoms, which are analogous to CAUTI, and chronic colonization, which is analogous to asymptomatic bacteriuria, are independent events that require distinct bacterial virulence factors. Experimental delineation of asymptomatic bacteriuria and CAUTI informs different strategies for the treatment and intervention of device-associated infections.

Impact of Fluoroquinolone Prophylaxis on Neutropenic Fever, Infections, and Antimicrobial Resistance in Newly Diagnosed AML Patients.

Fluoroquinolone prophylaxis is recommended during induction chemotherapy for patients with acute myeloid leukemia (AML) to reduce risk of neutropenic fever and systemic bacterial infections. We evaluated the effectiveness of primary fluoroquinolone prophylaxis in an area with high fluoroquinolone resistance. We performed a retrospective chart review of newly diagnosed adult AML patients who received frontline therapy at Mount Sinai Hospital in New York, NY, between 2012 and 2019. Primary outcome was development of neutropenic fever. Secondary outcomes were development of systemic bacterial infections and infections with multidrug-resistant organisms and Clostridioides difficile. Infectious outcomes were collected through 6 months after therapy initiation. We estimated the effect of fluoroquinolone prophylaxis with a time-dependent Cox proportional hazards model. Of 121 included patients, 87 received antibiotic prophylaxis and 34 did not. There was no difference in baseline characteristics, although the prophylaxis group had longer neutropenia duration (median 30 vs. 23 days, P=.013). The prophylaxis group had a reduced risk of neutropenic fever (hazard ratio 0.59, P=.039). The prophylaxis group had fewer gram-positive (P=.043) and gram-negative (P=.049) bloodstream infections and fewer clinically documented infections during frontline therapy (P=.005) and follow-up (P=.026). There was no difference in incidence of C. difficile or infection with fluoroquinolone-resistant or multidrug-resistant organisms. There was no mortality difference between groups. In an area with high fluoroquinolone resistance, primary fluoroquinolone prophylaxis in newly diagnosed AML patients reduced the risk of neutropenic fever and systemic bacterial infections without increased antimicrobial resistance. Prospective, randomized studies are needed to confirm these observations.

HTA160 A Systematic Review and Meta-Analysis of the Janus Kinase Inhibitors Safety Profile in Relation to the Risks of Secondary Bacterial Infections

Evaluation of the safety of drugs for preventive pathogenetic therapy of a newcoronavirus infection COVID-19 with the of Janus kinase inhibitors. A systematic review with a meta-analysis was conducted based on search queries in international databases. Search strategy included queries for controlled studies on the use of baricitinib and tofacitinib recommended for use as a preventive therapy for mild and moderate cases of a new coronavirus infection. Data were obtained from three randomized clinical trials. A meta-analysis of the results regarding the total number of serious adverse events (AEs) and adverse events belonging to the class "Infections and infestations" showed statistically significant evidence on the greater safety of baricitinib and tofacitinib in relation to the risks of these events compared with standard therapy: the risk ratio (RR) of serious adverse events in the comparison groups was 0.82 [95%, CI 0.69; 0.96] (p=0.02), the risk ratio of "Infections and invasions" was 0.78 [95% CI 0.63; 0.97] (p=0.03). In both cases RR was in favor of the use of Janus kinase inhibitors. The results of the meta-analysis demonstrated a favorable safety profile of baricitinib and tofacitinib when used in patients with COVID-19 in relation to the risks of developing serious AEs, as well as infections. Conducting studies of various designs in a wider patient population will allow more accurate assessment of the risks of developing secondary bacterial infections against the background of short-term use of Janus kinase inhibitors as part of their use as a preventive pathogenetic therapy during the COVID-19 pandemic.

Meeting the Challenges of Sepsis in Severe Coronavirus Disease 2019: A Call to Arms.

Sepsis is a life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Sepsis may be caused by bacterial, fungal, or viral pathogens. The clinical manifestations exhibited by patients with severe coronavirus disease 2019 (COVID-19)-related sepsis overlap with those exhibited by patients with sepsis from secondary bacterial or fungal infections and can include an altered mental status, dyspnea, reduced urine output, tachycardia, and hypotension. Critically ill patients hospitalized with severe acute respiratory syndrome coronavirus 2 infections have increased risk for secondary bacterial and fungal infections. The same risk factors that may predispose to sepsis and poor outcome from bloodstream infections (BSIs) converge in patients with severe COVID-19. Current diagnostic standards for distinguishing between (1) patients who are critically ill, septic, and have COVID-19 and (2) patients with sepsis from other causes leave healthcare providers with 2 suboptimal choices. The first choice is to empirically administer broad-spectrum, antimicrobial therapy for what may or may not be sepsis. Such treatment may not only be ineffective and inappropriate, but it also has the potential to cause harm. The development of better methods to identify and characterize antimicrobial susceptibility will guide more accurate therapeutic interventions and reduce the evolution of new antibiotic-resistant strains. The ideal diagnostic test should (1) be rapid and reliable, (2) have a lower limit of detection than blood culture, and (3) be able to detect a specific organism and drug sensitivity directly from a clinical specimen. Rapid direct detection of antimicrobial-resistant pathogens would allow targeted therapy and result in improved outcomes in patients with severe COVID-19 and sepsis.

Subtherapeutic levels of cefuroxime inside a cannulated pedicle screw used in spine surgery: results from a porcine microdialysis study.

Minimally invasive spine surgery has continuously evolved for specific surgical procedures and patient populations to lower morbidity and the risk of postoperative bacterial infection. Perioperative antibiotic prophylaxis is an important preventive measure and local tissue concentrations can be quantified with microdialysis. Insertion of spinal implants induces tissue trauma and inflammation, which may affect antibiotic proximate implant concentrations. We compared perioperative cefuroxime concentrations inside a cannulated pedicle screw used in minimally invasive spine surgery with the opposite non-instrumented vertebral pedicle. Microdialysis catheters were placed inside a cannulated pedicle screw and in the opposite non-instrumented vertebral pedicle of the same vertebra (L1) in 8 female pigs through a posterior lumbar surgical approach. Following a single-dose intravenous cefuroxime administration (1.5 g), dialysates and plasma were dynamically sampled over 8 hours. The primary endpoint was time above the cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 μg/mL (T>MIC4). Median T>MIC4 was 0 h (range 0-0) inside the cannulated pedicle screw, 1.6 h (range 1.1-2.4) in non-instrumented vertebral pedicle, and 1.9 h (range 1.9-2.9) in plasma. A single-dose intravenous cefuroxime administration provided low and subtherapeutic concentrations for prevention of infection inside a cannulated pedicle screw in the lumbar spine. Therapeutic concentrations were achieved in the opposite non-instrumented vertebral pedicle up to 1.5-2 h. Therefore, additional prophylactic strategies may be considered in cannulated instrumented spine surgery, especially in high-risk patients. Alternative dosing regimens seem relevant in lumbar spine surgery lasting longer than 1.5 h.

Persisting dental foci increase the risk for bacterial infections before and after liver transplant.

Patients awaiting liver transplant are usually assessed for presence of dental foci to prevent bacterial infection post-transplant, but evidence to support dental examination and treatment is limited. We investigated if treatment of dental foci decreased bacterial infections before and after transplant. Patients transplanted at the university hospital of Bonn were retrospectively assessed for occurrence of bacterial infections before and after transplant according to presence and treatment of dental foci. 35/110 patients showed good oral health, 39/110 patients received dental care and 36/110 patients did not receive dental care despite poor oral health. Patients with alcohol-associated liver disease presented with the highest rate of dental foci. Bleeding complications due to oral care occurred in five patients with poor coagulation. After transplant, the number of infections per patient was higher in patients with poor oral health (2.9) compared to patients after dental care (1.9) or with good oral health (1.8) (p=.02), with streptococcal infections being more frequent in patients with poor oral health. Before transplant, bacterial infections, in particular bacteraemia and spontaneous bacterial peritonitis, were also more common in patients with untreated dental foci. Streptococci and Staphylococci were more often detected in patients with dental foci. Dental treatment was associated with a reduction in bacterial infections. Presence of dental foci is associated with an increased risk for bacterial infections not only after but also before liver transplant. Dental treatment might be a safe and effective procedure to mitigate this risk.

Prevention of infections including vaccination strategies in multiple myeloma.

Infections are a major cause of morbidity and mortality in multiple myeloma. The increased risk for bacterial and viral infections results mainly from the disease-inherent and treatment-induced immunosuppression. Additional risk factors are older age with immune senescence, T cell depletion, polymorbidity, and male gender. Hence, every effort should be taken to reduce the risk for infections by identifying patients at higher risk for these complications and by implementing prophylactic measures, including chemoprophylaxis and immunization against various relevant pathogens. Here, we review the available evidence and provide recommendations for medical prophylaxis and vaccination in clinical practice.

Fifteen-minute consultation: The approach to the febrile child

Febrile children presenting to the emergency department pose unique challenges. This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red...

Temperature threshold in the screening of bacterial infections in young infants with hypothermia

BackgroundYoung infants with hypothermia presenting to the emergency department (ED) are at risk for serious bacterial infections (SBI), however there is no consensus temperature to prompt evaluation for SBI among...

Decorated Polyetheretherketone Implants with Antibacterial and Antioxidative Effects through Layer-by-Layer Nanoarchitectonics Facilitate Diabetic Bone Integration with Infection.

Patients suffering diabetic bone defects still need some new and effective strategies to achieve enhanced prognostic effects. Although medical implants are the common treatment of bone defects, the excessive oxidative stress and high risk of bacterial infection in diabetes mellitus lead to a higher risk of implant failure. To improve the healing ability of diabetic bone defects, herein, polyetheretherketone (PEEK) was modified through a developed layer-by-layer (LBL) construction strategy to obtain multifunctional PEEK (SP@(TA-GS/PF)*3) by the assembly of tannic acid (TA), gentamicin sulfate (GS) and Pluronic F127 (PF127) on the basis of prepared porous PEEK through sulfonation (SPEEK). The prepared SP@(TA-GS/PF)*3 exhibited sustained antimicrobial activity and enhanced the differentiation of osteoblast (MC3T3-E1) for needed osteogenesis. Moreover, SP@(TA-GS/PF)*3 scavenged excessive oxidative stress to promote the growth of H2O2 damaged HUVEC with enhanced secretion of VEGF for neovascularization. In addition, the remarkable in vivo outcomes of angiogenesis and osseointegration were revealed by the subcutaneous implant model and bone tissue implant model in diabetic rats, respectively. The in vitro and in vivo results demonstrated that modified PEEK with multifunction can be an attractive tool for enhancing bone integration under diabetic conditions, underpinning the clinical application potential of modified implants for diabetic osseointegration.

Granulocyte Transfusions in Children Undergoing Hematopoietic Stem Cell Transplantation

Introduction Neutropenia, often encountered in patients undergoing hematopoietic stem cell transplantation (HSCT) increases the risk of bacterial and/or fungal infections. Granulocyte transfusions (GT) have been indicated for neutropenic patients with severe infections that are often refractory to antimicrobial therapy. There is paucity of pediatric studies on the use of GT in children, leading to reluctance in using GT even when severe documented infections are present. This retrospective study was done on all patients who received at least a single GT at our institution until 2021 to study the indications, dosage, safety, and tolerability of GT. As mandated by the nursing policy all but one patient received their infusion(s) in the pediatric intensive care unit (PICU) for concern of possible reaction or decompensation following GT. Results Thirteen patients who underwent 16 transplants (hematological malignancies = 11, immune dysregulation = 1, severe aplastic anemia = 1) and received GT during their stay for transplant. All patients had prolonged neutropenia and were given 1- to 69 GT (median = 5) for fungal or bacterial infections (n = 5 each), fungal and bacterial infection (n=1) and perianal cellulitis (n =2). The dose of GT for each patient ranged from 145-470 mL per infusion. GT were given no more than once a day, and varied with 3, 5, 1, 1, 2 and 1 patients getting 1, 5, 8, 11, 13 and 69 days of granulocytes. The patient who got 69 GT, got them over 4 separate time periods during his prolonged stay in hospital for graft failure after first and second transplants. Nine patients received premedication with acetaminophen, diphenhydramine, and/or hydrocortisone. None of the patients had any major transfusion reaction or hemodynamic instability during or after the GT. The primary indication for which GT were given, improved in 8/13 (61.5%) of the patients, with partial response in an additional patient, and no response in the remaining 4 patients. At the time of this study, 3/13 patients were alive and the cause of death of the remaining 10 patients was relapse (n=2), primary or secondary graft failure (n=3), VOD (n=2), steroid refractory acute GvHD (n=1), and disseminated fungal disease (n=2). Of the 3 patients still living, all are in remission with 2 having chronic GVHD. Conclusion In our study, GT were well tolerated without any reported significant side effects and after our study, all GT were allowed to be given on the regular floor avoiding the need for transfer to PICU. While GT appear to be safe, those who received infusions for localized infections in the setting of neutropenia had better outcomes compared to those who received infusions for disseminated or systemic disease. A small sample size and retrospective study are the major limitations of our study. We propose that in children undergoing HSCT, in the setting of prolonged neutropenia of any cause, GT can be helpful in ameliorating infectious complications like perianal cellulitis/fistulas, and bacterial or fungal blood stream infections. A larger prospective study is needed to address the effects of GT on overall survival.

Evaluation of the antibacterial activities of face masks coated with titanium dioxide nanoparticles

To control infectious diseases, various applications of nanotechnology have been used to enhance the self-cleaning and antibacterial properties of materials. This study aimed to evaluate the antibacterial properties of face masks coated with TiO2 nanoparticles. The antibacterial efficacies of cloth face masks coated with TiO2 were measured by inoculating them in bacterial suspensions (105 CFUs from both E. coli and S. aureus). The results showed that TiO2 nanoparticle solutions (at 2%) reduced the starting inoculum of 105 CFUs (5 log cfu/cm2) of E. coli and S. aureus to 1.3 and 1.68 log, respectively, with antibacterial activities of 3.7 and 3.34 log, respectively. Furthermore, at a 1% concentration, the antibacterial activities against E. coli and S. aureus were 2.1 and 2.01 log, respectively, while at a low concentration (0.5%), the antibacterial activities against E. coli and S. aureus were 1.8 and 1.72 log, respectively. The CFUs in all the experimental groups were significantly lower than those in the control group (saline). In conclusion, TiO2 nanoparticle solutions with a high concentration (2%) demonstrated a strong antibacterial effect on E. coli and S. aureus, and the difference was statistically significant, while a significant antibacterial activity was demonstrated with lower concentration (0.5% and 1%) nanoparticle solutions of TiO2 after 18 h. There was a statistically significant difference regarding colony reduction between E. coli and S. aureus even at 3 h. The antibacterial activities of TiO2 in face masks could be promising for reducing the risk of bacterial infections.

Adverse effect of donor-specific anti-human leukocyte antigen (HLA) antibodies directed at HLA-DP/-DQ on engraftment in cord blood transplantation

Background aimsWhile donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) in the recipient before transplantation are associated with graft failure in cord-blood transplantation (CBT), effects of DSAs other than against HLA-A, -B or -DRB1 on transplantation outcomes remained poorly understood. MethodsWe retrospectively analyzed 567 single-unit CBT recipients to evaluate impact of DSAs against HLA-DP and -DQ on CBT outcomes. ResultsAmong 143 recipients (25.2%) who had anti-HLA antibodies, nine harbored DSAs against HLA-DP or -DQ. DSAs against HLA-DP or -DQ were associated with a significantly lower neutrophil engraftment rate (55.6% versus 91.8%, P = 0.032) and with a marginally lower platelet engraftment rate (46.7% versus 75.3%, P = 0.128) at day 100 after transplantation, compared with patients without anti-HLA antibodies. Time to neutrophil and platelet engraftment in patients with DSAs for HLA-DP or -DQ was significantly longer than that in patients without anti-HLA antibodies (median, 25 versus 21 days, P = 0.002 in neutrophil; median 61 versus 46 days, P = 0.014 in platelet). Cumulative incidence of bacterial infection at day 100 was significantly greater (88.9% versus 57.1%, P = 0.024), and re-transplant-free survival was marginally lower (55.6% versus 76.8%, P = 0.132) in patients with DSAs against HLA-DP or -DQ, compared with those without anti-HLA antibodies. These findings suggest that DSAs against HLA-DP or -DQ lead to unfavorable engraftment, which may increase risk of bacterial infection, and reduce survival soon after CBT. ConclusionsOur results suggest the importance of evaluating DSAs against HLA-DP and -DQ in recipients before selecting CB units.

Real-World Use of Loteprednol Etabonate 0.5%/Tobramycin 0.3% Ophthalmic Suspension for the Treatment of Ocular Surface Inflammatory Conditions.

Use of a combination corticosteroid/antibiotic product is common in ocular surface inflammatory conditions for which corticosteroid therapy is indicated and there exists a risk of superficial bacterial infection. Combination loteprednol etabonate 0.5% and tobramycin 0.3% (LE/T) has been evaluated for blepharokeratoconjunctivitis in two trials, but there has been limited reporting on its real-world use. This was a retrospective chart review conducted at three optometry practices in the USA. Data were collected from cases in which LE/T was used and data were recorded for the period commencing with therapy with a minimum of one follow-up visit (within 2 months). Data abstracted included patient demographics, diagnosis, LE/T dosing regimen, pre- and post-treatment ocular signs and symptoms, intraocular pressure (IOP) measurements, adverse event (AE) reports, visual acuity (VA), and any notations as to resolution of baseline condition. Primary outcomes of interest included IOP changes and AEs. Ninety-six patient charts were extracted, and data from 87 charts (115 LE/T-treated eyes) were included. Mean (SD) years of age was 45.6 (19.7), most patients were white (83.9%), and just over half were female (58.6%). Common baseline conditions were conjunctival injury/corneal abrasion (25.3%), keratitis (18.4%), viral conjunctivitis (16.1%), and blepharitis/eyelid inflammation/MGD (11.5%). The most common LE/T dosing regimen was one drop QID. Mean (SD) IOP was 15.2 (4.4) mm Hg at baseline and 15.7 (4.4) mm Hg at the first follow-up visit (p = 0.2467). No AEs were recorded, and there were no significant changes in mean VA. Where recorded, most patients (83%) were noted as having their condition resolved/resolving at the first or second follow-up visit. LE/T appears to have a high level of safety when used for the management of various ocular surface inflammatory conditions encountered in optometric practice.

Codex Alimentarius Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance Are Incompatible with Available Surveillance Data

Foodborne antimicrobial-resistant (AMR) microorganisms are a global food safety concern. Antimicrobial drug use (AMU) in livestock may increase the risk of resistant foodborne bacterial infections in humans via contaminated animal products. Consequently, countries have implemented different livestock AMU restriction policies, opening the potential for trade disputes. AMR risk equivalence between countries with different AMU policies must be established by using scientifically justified risk assessments. The Codex Alimentarius Commission's Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance (AMR Codex) recommends an approach that requires quantification of detailed information, for which, in many instances, little to no data exist. Using AMR Salmonella exposure from beef consumption as an example, we demonstrate the difficulty of implementing the AMR Codex by comparing key regionally specific parameters within the United States and European Union, two regions with substantial beef production and consumption, robust foodborne pathogen sampling and surveillance systems, and different AMU policies. Currently, neither region fully captures data for key regional variables to populate a detailed risk assessment as outlined in the AMR Codex, nor are they able to adequately link AMU in livestock to AMR infections in humans. Therefore, the AMR Codex guidelines are currently aspirational and not a viable option to assess the impact of livestock AMU reductions on the human health risk of AMR salmonellosis from beef or produce regionally comparable estimates of risk. More flexible risk assessment guidelines that more directly link livestock AMU to human health risk and are amenable to currently available data are needed to allow for country variations and to calculate comparable regional risk estimates, which can be used to guide international trade policy.

Vaccination as an immune system status optimization tool for the high-performance sports: review

Objective: consideration of the importance of vaccination as a preventive measure of support the athlets immunne system in conditions of extreme physical exertion and increased epidemic risks.Materials and methods: analysis of local and foreign dates of immunocorrection and vaccination problems.Results: the presented review provides an integral assessment of the transitory immunosuppression, developing by the intensive training and competitive activities — exercise-induced immunosuppression. These dates described as an “open window” syndrome and characterized by an increased risk of viral and/or bacterial infection with predominant damage of the upper respiratory tract and gastrointestinal tract. Widespread immunoprophylaxis provides an effective and relatively safe method of infectious control at risk groups including athletes.Conclusion: Vaccines of National Immunization Schedule and Epidemiological Immunization Schedule provide complex impact to the athletes immune status in wide variety of physical and psychological stresses. Vaccination increases the ability of specific and nonspecific resistance to infections that provide significant prevention of the “open window” syndrome.

Incidence and risk factors for bacterial infection using bortezomib, lenalidomide, and dexamethasone (RVd) in newly diagnosed multiple myeloma

Infections are an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the real-world risk using modern induction regimens such as bortezomib, lenalidomide, and dexamethasone (RVd) is not well described. We performed a retrospective single-center cohort study to identify infections and risk factors in patients treated with first-line RVd from January 2014 to January 2020 and collected demographic and clinical data. Of 144 patients treated with RVd for NDMM, 21 patients (14.5%) experienced a bacterial infection during induction, of which 8 (5.5%) were grade 3 infections despite a low rate of antibiotic prophylaxis use (12%). Grade 3 neutropenia occurred in 11% of patients, 2% had febrile neutropenia and there were no deaths from infection. On multivariable analysis, age, smoking history, diabetes, antibiotic use in the 60 days preceding the start of RVd, and high-risk cytogenetics were associated with higher risk of bacterial infection.

The role of TAS2R38 genotype in surgical outcomes and culturable bacteria in chronic rhinosinusitis with or without nasal polyps.

Recent studies reported the relationship between genetic variations and TAS2R38, which is a bitter taste receptor expressed in the cilia of human sinonasal epithelial cells, among the predisposing factors playing role in immune response to upper respiratory tract bacterial infection. The present study aims to examine the relationship of TAS2R38 genotype with the active microorganism and the effect of genotype on the surgical outcomes among chronic rhinosinusitis patients. 34 patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with or without polyps (23 CRSwNP, 11 CRSsNP) and 30 patients undergoing septoplasty surgery for isolated nasal septum deviation were included. All the patients were genotyped for TAS2R38. Scoring was made using endoscopic Modified Lund-Kennedy and radiological Lund-Mackay systems preoperatively. Sino-Nasal Outcome Test with 22 items (SNOT-22) was implemented preoperatively and postoperatively. Nasal swab culture samples were taken intraoperatively from CRS patients and the active microorganism were isolated. In the TAS2R38 genotyping of the study group, PAV/PAV was found in 32.4% of patients, PAV/AVI in 47.1%, and AVI/AVI in 20.6%. In the control group, PAV/PAV was found in 26.7%, PAV/AVI in 36.7%, and AVI/AVI in 36.7%. In the study group, there was no statistically significant difference between the CRS and CRS subgroups in terms of TAS2R38 genotype distributions. The changes in patients' preoperative and postoperative SNOT-22 scores were similar between the genotypes. Proliferation was detected in culture in the whole AVI-AVI group, 81.8% of PAV-PAV group, and 56.3% of PAV-AVI group but the difference was not found to be statistically significant. The proliferation level of Staphylococcus epidermidis by TAS2R38 genotype was found to be statistically significantly higher among patients, who had AVI-AVI genotype, in CRSwNP. We did not find a statistically significant relationship between the TAS2R38 genotype and CRS subtype, sinonasal bacterial infection risk increase and surgical success rate in CRS patients. Long-term and large-scale studies are needed, which are to be carried out by individual genotyping and sequencing to provide more information on the effects of these genetic variants.