Risk Of Gram-positive Infections Research Articles

(020) Does Climate Impact IPP Infection Risk? Assessment of Temperature and Dew Point on IPP Infections

Abstract Introduction Variations in climate have been associated with greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome. Although the pathogenic organisms for inflatable penile prosthesis (IPP) infections are commonly skin flora, limited data exists on the impact of climate on IPP infections. We sought to evaluate the impact of climate on the pathogenic organisms of IPP infections in a large international, multicenter cohort. Objectives To assess whether the time of the year, during which surgery was performed, affected device infections. Methods We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Additionally, we assessed the effect of temperature, dew point, and humidity on the microorganisms involved in implant infections. Infections were classified as Gram positive, Gram negative, or mixed (including a combination of Gram positive, Gram negative, and/or fungi). A univariate logistic regression analysis was undertaken. Results A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. A total of 103 (1.9%) infections were recorded. Overall, 38 (36.9%) infections were caused by Gram positive bacteria. An increase in temperature was associated with a higher risk of infection with Gram positive bacteria (OR: 1.03, 95% CI: 1 to 1.07, p = 0.035). No statistically significant differences were recorded in terms of season (p = 0.19) and month (p = 0.29). Conclusion Higher temperature is associated with greater risk of Gram positive infections whereas lower temperature and dew point were associated with a higher risk of mixed infections. These findings may help surgeons tailor antibiotic prophylaxis based on local climate. Disclosure No.

(179) Does Climate Impact IPP Infection Risk? Assessment of Temperature and Dew Point on IPP Infections

Abstract Introduction Variations in climate have been associated with greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome. Although the pathogenic organisms for inflatable penile prosthesis (IPP) infections are commonly skin flora, limited data exists on the impact of climate on IPP infections. Objective We sought to evaluate the impact of climate on the pathogenic organisms of IPP infections in a large international, multicenter cohort. Methods We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Additionally, we assessed the effect of temperature, dew point, and humidity on the microorganisms involved in implant infections. Infections were classified as Gram positive, Gram negative, or mixed (including a combination of Gram positive, Gram negative, and/or fungi). A univariate logistic regression analysis was undertaken. Results A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. A total of 103 (1.9%) infections were recorded. Overall, 38 (36.9%) infections were caused by Gram positive bacteria. An increase in temperature was associated with a higher risk of infection with Gram positive bacteria (OR: 1.03, 95% CI: 1 to 1.07, p=0.035). Infections were more frequent as temperature increased with 74.7% of infections occurring when mean ambient temperature was greater than 55□F. No statistically significant differences were recorded in terms of season (p=0.19) and month (p=0.29). Conclusions Higher temperature is associated with greater risk of Gram positive infections These findings may help surgeons tailor antibiotic prophylaxis based on local climate especially when temperatures are over 55□F. Our findings should prompt further studies regarding the impact of climate on infection prevention to further improve IPP outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: consultant Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, Acerus Pharma, Boston Scientific.

Pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury

Objective To investigate the pathogen distribution and risk factors of pulmonary infection after acute cervical spinal cord injury(ACSCI)in an attempt to offer reference for early anti-infection therapy. Methods The study comprised 223 cases who were admitted from October 2011 to October 2014. There were 149 males and 74 females, at(43.3±13.5)years of age. Species of pathogens identified were gram-positive, gram-negative and mixed. Effects of age, gender, injury types and tracheotomy on pathogen distribution were analyzed. Results Gram-negative infection was found in 114 cases(51.1%), with tracheotomy accounting for 7.0% of the cases and death accounting for 1.8% of the cases, and the main causative pathogens were Klebsiella pneumonia, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii. Gram-positive infection was found in 41 cases(18.4%), with tracheotomy accounting for 12.2% of the cases and death accounting for 7.3% of the cases, and the main causative pathogens were Staphylococcus aureus and Streptococcus pneumonia. Mixed infection was found in 68 cases(30.5%), with tracheotomy accounting for 22.1% of the cases and death accounting for 13.2% of the cases. Gender had no significant correlation with pathogen distribution. For the cases of complete spinal cord injury and tracheotomy, the ratio of mixed infection increased significantly(P<0.05). For the cases younger than 30 years, the pathogens were mainly gram-positive bacteria(P<0.05). Conclusions Main pathogens of pulmonary infection after ACSCI are gram-negative bacteria. The cases younger than 30 years are associated with higher risk of gram-positive infection, while the cases with complete injury or tracheotomy are associated with higher risk of mixed infection. Key words: Spinal cord injuries; Lung diseases; Pathogen

Antimicrobial Properties of a Chitosan Dextran-Based Hydrogel for Surgical Use

A chitosan dextran-based (CD) hydrogel, developed for use in endoscopic sinus surgery, was tested for antimicrobial activity in vitro against a range of pathogenic microorganisms. The microdilution technique was used to determine minimum inhibitory, minimum bactericidal, and minimum fungicidal concentrations. In addition, the time-kill efficacy of CD hydrogel was determined for two bacterial species. Scanning and transmission electron microscopy were carried out to elucidate the antimicrobial mechanism of this compound. CD hydrogel was found to be effective against Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, and Clostridium perfringens at its surgical concentration of 50,000 mg/liter. Minimum bactericidal concentrations ranged from 2,000 to 50,000 mg/liter. Dextran aldehyde (DA) was found to be the antimicrobial component of the CD hydrogel with MBC ranging from 2,000 to 32,000 mg/liter. S. aureus appeared to be killed at a slightly faster rate than E. coli. Candida albicans and Pseudomonas aeruginosa were more resistant to CD hydrogel and DA. Scanning and transmission electron microscopy of E. coli and S. aureus incubated with CD hydrogel and DA alone revealed morphological damage, disrupted cell walls, and loss of cytosolic contents, compatible with the proposed mode of action involving binding to cell wall proteins and disruption of peptide bonds. Motility and chemotaxis tests showed E. coli to be inhibited when incubated with DA. The antibacterial activity of CD hydrogel may make it a useful postsurgical aid at other body sites, especially where there is a risk of Gram-positive infections.

265: Daptomycin Plus Cefepime for Moderate and High-Risk Febrile Neutropenic Patients with Increased Risk of Gram-Positive Infection

265: Daptomycin Plus Cefepime for Moderate and High-Risk Febrile Neutropenic Patients with Increased Risk of Gram-Positive Infection

Use of fluoroquinolones as prophylactic agents in patients with neutropenia.

The use of fluorinated quinolone antibiotics to selectively decontaminate the gastrointestinal tract is a reasonable alternative to prevent infection in neutropenic patients. The fluoroquinolones represent ideal antibiotics with which to achieve the principles of selective decontamination by allowing colonization of anaerobes to inhibit the adherence, colonization and proliferation of potentially pathogenic aerobic flora. This report describes the prophylactic use of fluoroquinolones in neutropenic patients. The majority of studies of fluoroquinolone prophylaxis in neutropenic patients have shown a reduction in documented Gram-negative bacterial infections. However, Gram-positive infections, particularly those with viridans streptococci, present a major impediment to the use of single agent prophylaxis with a quinolone. Prophylaxis with fluoroquinolones in neutropenic patients was found to be advantageous, but it must be balanced against the risk of Gram-positive infections and the potential for antibiotic resistance.