Risk Of Subsequent Infection Research Articles

The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis.

ObjectivesAs well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures.MethodsA comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis.ResultsIn total, eight studies which included 2738 patients were eligible for quantitative synthesis. The effect of antibiotic-loaded poly(methyl methacrylate) beads was investigated by six of these studies, and two studies evaluated the effect of local antibiotics applied without a carrier. Meta-analysis showed a significantly lower infection rate when local antibiotics were applied (4.6%; 91/1986) than in the control group receiving standard systemic prophylaxis alone (16.5%; 124/752) (p < 0.001) (odds ratio 0.30; 95% confidence interval 0.22 to 0.40).ConclusionThis meta-analysis suggests a risk reduction in FRI of 11.9% if additional local antibiotics are given prophylactically for open limb fractures. However, due to limited quality, heterogeneity, and considerable risk of bias, the pooling of data from primary studies has to be interpreted with caution.Cite this article: M. Morgenstern, A. Vallejo, M. A. McNally, T. F. Moriarty, J. Y. Ferguson, S. Nijs, WJ. Metsemakers. Bone Joint Res 2018;7:447–456. The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1

Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent death or infection.

Loss of colonization resistance within the gastrointestinal microbiome facilitates the expansion of pathogens and has been associated with death and infection in select populations. We tested whether gut microbiome features at the time of intensive care unit (ICU) admission predict death or infection. This was a prospective cohort study of medical ICU adults. Rectal surveillance swabs were performed at admission, selectively cultured for vancomycin-resistant Enterococcus (VRE), and assessed using 16S rRNA gene sequencing. Patients were followed for 30days for death or culture-proven bacterial infection. Of 301 patients, 123 (41%) developed culture-proven infections and 76 (25%) died. Fecal biodiversity (Shannon index) did not differ based on death or infection (p = 0.49). The presence of specific pathogens at ICU admission was associated with subsequent infection with the same organism for Escherichia coli, Pseudomonas spp., Klebsiella spp., and Clostridium difficile, and VRE at admission was associated with subsequent Enterococcus infection. In a multivariable model adjusting for severity of illness, VRE colonization and Enterococcus domination (≥ 30% 16S reads) were both associated with death or all-cause infection (aHR 1.46, 95% CI 1.06-2.00 and aHR 1.47, 95% CI 1.00-2.19, respectively); among patients without VRE colonization, Enterococcus domination was associated with excess risk of death or infection (aHR 2.13, 95% CI 1.06-4.29). Enterococcus status at ICU admission was associated with risk for death or all-cause infection, and rectal carriage of common ICU pathogens predicted specific infections. The gastrointestinal microbiome may have a role in risk stratification and early diagnosis of ICU infections.

791 - Gastrointestinal Bacterial Pathogen Colonization and Risk for Subsequent Infection in the Intensive Care Unit

791 - Gastrointestinal Bacterial Pathogen Colonization and Risk for Subsequent Infection in the Intensive Care Unit

Decolonization of Intestinal Carriage of MDR/XDR Gram-Negative Bacteria with Oral Colistin in Patients with Hematological Malignancies: Results of a Randomized Controlled Trial.

BackgroundIntestinal colonization by MDR/XDR gram-negative bacteria leads to an increased risk of subsequent bloodstream infections (BSI) in patients receiving chemotherapy as a treatment for hematologic malignancies.ObjectivesThe objective of this study was to evaluate the efficacy of oral colistin in eradicating the intestinal carriage of MDR/XDR Gram-negative bacteria in patients with hematological malignancies.MethodsIn a tertiary hematology center, adult patients with intestinal colonization by MDR/XDR Gram-negative bacteria were included in a randomized controlled trial (RCT) during a period from November 2016 to October 2017. Patients were treated with oral colistin for 14 days or observed with the primary outcome set as decolonization on day 21 post-treatment. Secondary outcomes included treatment safety and changes in MICs of isolated microorganisms. ClinicalTrials.gov Identifier: NCT02966457.ResultsShort-time positive effect (61.3% vs 32.3%; OR 3.32; 95% CI 1.17–9.44; p=0.0241) was demonstrated on the day 14 of colistin treatment, without any statistical difference on day 21 post-treatment. The incidence of BSI in decolonization group was lower in the first 30 days after the intervention (3.2% vs. 12.9%), but overall in the 90-day observation period, it did not show any advantages comparing to control group (log-rank test; p=0.4721). No serious adverse effects or increase in resistance to colistin was observed.ConclusionsThis study suggests that in hematological patients the strategy of selective intestinal decolonization by colistin may be beneficial to decrease the rate of MDR/XDR Gram-negative intestinal colonization and the risk of BSI in the short-term period, having no long-term sustainable effects.

Cell-surface signatures of immune dysfunction risk-stratify critically ill patients: INFECT study

PurposeCellular immune dysfunctions, which are common in intensive care patients, predict a number of significant complications. In order to effectively target treatments, clinically applicable measures need to be developed to detect dysfunction. The objective was to confirm the ability of cellular markers associated with immune dysfunction to stratify risk of secondary infection in critically ill patients.MethodsMulti-centre, prospective observational cohort study of critically ill patients in four UK intensive care units. Serial blood samples were taken, and three cell surface markers associated with immune cell dysfunction [neutrophil CD88, monocyte human leucocyte antigen-DR (HLA-DR) and percentage of regulatory T cells (Tregs)] were assayed on-site using standardized flow cytometric measures. Patients were followed up for the development of secondary infections.ResultsA total of 148 patients were recruited, with data available from 138. Reduced neutrophil CD88, reduced monocyte HLA-DR and elevated proportions of Tregs were all associated with subsequent development of infection with odds ratios (95% CI) of 2.18 (1.00–4.74), 3.44 (1.58–7.47) and 2.41 (1.14–5.11), respectively. Burden of immune dysfunction predicted a progressive increase in risk of infection, from 14% for patients with no dysfunction to 59% for patients with dysfunction of all three markers. The tests failed to risk stratify patients shortly after ICU admission but were effective between days 3 and 9.ConclusionsThis study confirms our previous findings that three cell surface markers can predict risk of subsequent secondary infection, demonstrates the feasibility of standardized multisite flow cytometry and presents a tool which can be used to target future immunomodulatory therapies.Trial registrationThe study was registered with clinicaltrials.gov (NCT02186522).

Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were reviewed retrospectively over a five-year period. Pre-operative urine samples within one year of surgery were analysed, and those with ASB were identified. The primary outcome was PJI within the first postoperative year. In total, 5542 patients were included. Of these, 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with PJI, 33 had a pre-operative urine sample recorded. The infection rates were 5% (seven of 140) in the ASB group, 0.61% (26 of 4228) in the no-ASB group and 1.96% (23 of 1174) in the group without a urine sample (P<0.001). The ASB isolate was the same micro-organism as the PJI isolate in one of the seven cases. The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggesting that the relationship is unlikely to be causal.

Determination of Proper Timing for the Placement of Intra-Abdominal Mesh after Incidental Enterotomy in a Rodent Model (Rattus norvegicus)

Controversy exists regarding the appropriate timing for placement of permanent intra-abdominal mesh after inadvertent enterotomy during elective hernia repair. The aim of this study was to examine mesh placement at variable postoperative periods and the subsequent risk of infection. Fifty rodents were divided into five groups. Groups one to four underwent laparotomy, enterotomy, and repair. Physiomesh® was placed at the index operation one, three, or seven days postoperatively in Groups 1, 2, 3, and 4. Group 5 underwent mesh placement only. Necropsy with mesh harvest was performed seven days after placement. Cultures of mesh were obtained and Fisher's exact test was used to compare groups. Bacterial growth postsonication was identified in 30, 30, 50, and 90 per cent versus 20 per cent in controls. Compared with controls, there was significantly increased risk of mesh infection when it was placed seven days after enterotomy (P = 0.006). There was no significant difference in bacterial growth when mesh was placed at the time of enterotomy, one or three days later. The risk of bacterial contamination of permanent mesh placed immediately after inadvertent enterotomy during elective hernia repair is as safe as placing mesh at one or three days. Placing mesh at seven days significantly increased the risk of mesh contamination.

MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION Nahid Punjani, Brent Lanting, Andrew McClure, Jennifer Winick-Ng, and Blayne Welk Nahid PunjaniNahid Punjani More articles by this author , Brent LantingBrent Lanting More articles by this author , Andrew McClureAndrew McClure More articles by this author , Jennifer Winick-NgJennifer Winick-Ng More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prosthetic infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) are significant complications, and there are conflicting reports of their association with urologic complications. The purpose of this study is to determine if urinary tract infection (UTI) and acute urinary retention (AUR) are significant risk factors for joint infections after THA or TKA. METHODS This study is a population-based retrospective cohort study of all patients greater than 66 years of age undergoing a THA or TKA in Ontario, Canada between April 1, 2003 and March 31, 2013 (n = 113,061). Cases were reviewed for post-operative UTI requiring presentation to the emergency department or hospital admission within 2 years of joint replacement, as well as acute urinary retention within 30 days of THA/TKA. The primary outcome is joint infection requiring hospital admission following THA and TKA. We hypothesized that both UTI and AUR would increase the risk of subsequent joint infection after arthroplasty. RESULTS A total of 113,061 patients met inclusion criteria and had arthroplasties during the study period (44,495 with THA and 68,566 with TKA). Median age was 74 (IQR 70-79). A total of 28,256 (25.0%) had at least one UTI, and were more likely to be older, female, have previous antibiotic exposure, cystoscopy or retention, and have atrial fibrillation. A total of 2,516 (2.2%) patients had AUR within 30 days of procedure, and were more likely to be older, male, have medical comorbidities, previous transurethral procedures or cystoscopy, previous Urology visits and a general anesthetic during their procedure. A total of 1,262 (1.1%) patients had joint infection requiring hospital admission at a median of 86 days (IQR 21-377). In multivariate Cox regression analysis, UTI was associated with an increased risk of joint infection (HR 1.21, 95% CI 1.14-1.28, p<0.01). However multivariate analysis did not demonstrate an association with AUR and joint infection (HR 0.99, 95% CI 0.60-1.64, p=0.98). CONCLUSIONS UTI is associated with increased risk of peri-prosthetic joint infection of THA or TKA, whereas acute urinary retention is not a significant risk factor. Timely and appropriate treatment of symptomatic UTIs in this patient population may be important in prevention of prosthetic joint infection. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e122-e123 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nahid Punjani More articles by this author Brent Lanting More articles by this author Andrew McClure More articles by this author Jennifer Winick-Ng More articles by this author Blayne Welk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fecal Microbiome Among Nursing Home Residents with Advanced Dementia and Clostridium difficile.

Patients colonized with toxinogenic strains of Clostridium difficile have an increased risk of subsequent infection. Given the potential role of the gut microbiome in increasing the risk of C. difficile colonization, we assessed the diversity and composition of the gut microbiota among long-term care facility (LTCF) residents with advanced dementia colonized with C. difficile. Retrospective analysis of rectal samples collected during a prospective observational study. Thirty-five nursing homes in Boston, Massachusetts. Eighty-seven LTCF residents with advanced dementia. Operational taxonomic units were identified using 16S rRNA sequencing. Samples positive for C. difficile were matched to negative controls in a 1:3 ratio and assessed for differences in alpha diversity, beta diversity, and differentially abundant features. Clostridium difficile sequence variants were identified among 7/87 (8.04%) residents. No patient had evidence of C. difficile infection. Demographic characteristics and antimicrobial exposure were similar between the seven cases and 21 controls. The overall biodiversity among cases and controls was reduced with a median Shannon index of 3.2 (interquartile range 2.7-3.9), with no statistically significant differences between groups. The bacterial community structure was significantly different among residents with C. difficile colonization versus those without and included a predominance of Akkermansia spp., Dermabacter spp., Romboutsia spp., Meiothermus spp., Peptoclostridium spp., and Ruminococcaceae UGC 009. LTCF residents with advanced dementia have substantial dysbiosis of their gut microbiome. Specific taxa characterized C. difficile colonization status.

Intrawound Antibiotic Powder Decreases Frequency of Deep Infection and Severity of Heterotopic Ossification in Combat Lower Extremity Amputations.

Amputations sustained owing to combat-related blast injuries are at high risk for deep infection and development of heterotopic ossification, which can necessitate reoperation and place immense strain on the patient. Surgeons at our institution began use of intrawound antibiotic powder at the time of closure in an effort to decrease the rate of these surgical complications after initial and revision amputations, supported by compelling clinical evidence and animal models of blast injuries. Antibiotic powder may be useful in reducing the risk of these infections, but human studies on this topic thus far have been inconclusive. We sought to determine whether administration of intrawound antibiotic powder at the time of closure would (1) decrease the risk of subsequent deep infections of major lower-extremity combat-related amputations, and (2) limit formation and decrease severity of heterotopic ossification common in the combat-related traumatic residual limb. Between 2009 and 2015, 252 major lower extremity initial and revision amputations were performed by a single surgeon. Revision cases were excluded if performed specifically to address deep infection, leaving 223 amputations (88.5%) for this retrospective analysis. We reviewed medical records to collect patient information, returns to the operating room for subsequent infection, and microbiologic culture results. We also reviewed radiographs taken at least 3 months after surgery to determine the presence and severity of heterotopic ossification using the Walter Reed classification system. We grouped cases according to whether limbs underwent initial or revision amputations, and whether the limbs had a history of a prior infection. Apart from the use of antibiotic powder and duration of followup, the groups did not differ in terms of age, mechanism of injury, or sex. We then calculated the absolute risk reduction for infection and heterotopic ossification and the number needed to treat to prevent an infection. Overall, administration of antibiotic powder resulted in a 13% absolute risk reduction of deep infection (14 of 82 [17%] versus 42 of 141 [30%]; p = 0.03; 95% CI, 0.20%-24.72%). In revision amputation surgery, the absolute risk reduction of infection with antibiotic powder use was 16% overall (eight of 58 versus 17 of 57; 95% CI, 1.21%-30.86%), and 25% for previously infected limbs (eight of 46 versus 14 of 33; 95% CI, 4.93%-45.14%). The number needed to treat to prevent one additional deep infection in amputation surgery is eight in initial amputations, seven in revision amputations, and four for revision amputation surgery on previously infected limbs. With the numbers available, we observed no reduction in the risk of heterotopic ossification with antibiotic powder use, but severity was decreased in the treatment group in terms of the number of residual limbs with moderate or severe heterotopic ossification (three of 12 versus 19 of 34; p = 0.03). Our findings show that administration of intrawound antibiotic powder reduces deep infection in residual limbs of combat amputees, particularly in the setting of revision amputation surgery in apparently aseptic residual limbs at the time of the surgery. Furthermore, administration of antibiotic powder for amputations at time of initial closure decreases the severity of heterotopic ossification formation, providing a low-cost adjunct to decrease the risk of two complications common to amputation surgery.Level of Evidence Level III, therapeutic study.

Early use of peripherally inserted central catheters is safe in Staphylococcus aureus bacteraemia.

Management of Staphylococcus aureus bacteraemia (SAB) includes prolonged intravenous antibiotics often administered through a peripherally inserted central catheter (PICC). Optimal timing of PICC insertion for SAB treatment is unknown. There are concerns that early insertion may increase the risk of subsequent line infection. This retrospective audit aims to determine if early PICC insertion is safe. The outcomes considered included crude mortality, attributable mortality, PICC line infections, duration of bacteraemia and relapsed SAB. Patients with SAB at our institution between March 2013 and September 2016 were identified. Early PICC line insertion was defined as occurring within 48 h of index positive blood culture. This retrospective audit identified 357 patients with SAB who subsequently received a PICC. This study did not show any significant differences between the early and late PICC insertion groups for attributable mortality (6.3% and 4.8%, P = 0.27), duration of bacteraemia (median 2 days for both groups, P = 0.48) and relapsed SAB (4.7% and 4.1%, P = 0.74). Importantly, no confirmed PICC infections were identified in either group. Early PICC insertion in SAB appears safe in this retrospective audit. If validated in prospective studies, this should allow for the early establishment of safe, reliable intraveous access in SAB patients.

Effects of drying-off procedure of ewes’ udder, with intramammary antibiotic administration, in subsequent mammary infection and development of mastitis

Objective of the study was to evaluate effects of the procedure followed for drying-off of ewes’ udder in subsequent mammary infection and development of mastitis, in an experiment, where intramammary antibiotic administration (procaine penicillin and neomycin) was performed into the right mammary gland of animals at end of lactation period. In ewes of group A, drying-off took place progressively during a period of 22 days; in ewes of group B, drying-off took place abruptly. Samples of teat duct material and milk for bacteriological and cytological examination were collected before start of the drying-off procedure and on two occasions after the subsequent lambing. Median time to first teat duct infection postpartum was 2 and 4.5 days (left and right, respectively) for group A and 6.5 and 3.5 days for group B (P &gt; 0.38); median time to first mammary infection post-partum was 4.5 and 7 days (left and right, respectively) for group A and 6.5 and 3.5 days for groupB (P &gt; 0.22). Principal bacterial isolates were coagulase-negative staphylococci. No significant differences were observed between the two groups in post-partum frequency of: teat duct infection (P &gt; 0.17), mammary infection (P &gt; 0.36), subclinical mastitis (P &gt; 0.36), abnormal findings in a mammary gland (P &gt; 0.17). No significant differences were seen between the two groups in post-partum incidence risk of the following outcomes: teat duct infection (P &gt; 0.75), mammary infection (P &gt; 0.42), subclinical mastitis (P &gt; 0.39), abnormal findings in a mammary gland (P &gt; 0.85). No significant differences were evident between the two groups in cure rate of abnormal findings in a mammary gland (P &gt;0.89); a significant difference was evident between left and right mammary glands (P &lt; 0.045). The results support a hypothesis that the procedure for udder drying-off (i.e., progressive or abrupt cessation of lactation) does not appear to affect the risk of subsequent mammary infection and development of mastitis, in cases of intramammary administration of antibiotics at the end of a lactation period. Intramammary administration of antibiotics improved cure rates of mammary abnormalities, independently of the procedure followed for udder drying-off.

The importance of human population characteristics in modeling Aedes aegypti distributions and assessing risk of mosquito-borne infectious diseases

BackgroundThe mosquito Aedes aegypti has long been a vector for human illness in the Southeastern United States. In the past, it has been responsible for outbreaks of dengue, chikungunya, and yellow fever and, very recently, the Zika virus that has been introduced to the region. Multiple studies have modeled the geographic distribution of Ae. aegypti as a function of climate factors; however, this ignores the importance of humans to the anthropophilic biter. Furthermore, Ae. aegypti thrives in areas where humans have created standing water sites, such as water storage containers and trash. As models are developed to examine the potential impact of climate change, it becomes increasingly important to include the most comprehensive set of predictors possible.ResultsThis study uses Maxent, a species distribution model, to evaluate the effects of adding poverty and population density to climate-only models. Performance was evaluated through model fit statistics, such as AUC, omission, and commission, as well as individual variable contributions and response curves. Models which included both population density and poverty exhibited better predictive power and produced more precise distribution maps. Furthermore, the two human population characteristics accounted for much of the model contribution—more so than climate variables.ConclusionsModeling mosquito distributions without accounting for their dependence on local human populations may miss factors that are very important to niche realization and subsequent risk of infection for humans. Further research is needed to determine if additional human characteristics should be evaluated for model inclusion.

Association between prior antibiotic therapy and subsequent risk of community-acquired infections: a systematic review.

Antibiotic use can have negative unintended consequences including disruption of the human microbiota, which is thought to protect against pathogen overgrowth. We conducted a systematic review to assess whether there is an association between exposure to antibiotics and subsequent risk of community-acquired infections. We searched MEDLINE, EMBASE and Web of Science for studies published before 30 June 2017, examining the association between antibiotic use and subsequent community-acquired infection. Infections caused by Clostridium difficile and fungal organisms were excluded. Studies focusing exclusively on resistant organism infections were also excluded. Eighteen of 22588 retrieved studies met the inclusion criteria. From these, 16 studies reported a statistically significant association between antibiotic exposure and subsequent risk of community-acquired infection. Infections associated with prior antibiotic use included Campylobacter jejuni infection (one study), recurrent furunculosis (one study), invasive Haemophilus influenzae type b infection (one study), infectious mastitis (one study), meningitis (one study), invasive pneumococcal disease (one study), Staphylococcus aureus skin infection (one study), typhoid fever (two studies), recurrent boils and abscesses (one study), upper respiratory tract infection and urinary tract infection (one study) and Salmonella infection (five studies), although in three studies on Salmonella infection the effect was of marginal statistical significance. We found an association between prior antibiotic use and subsequent risk of a diverse range of community-acquired infections. Gastrointestinal and skin and soft tissue infections were most frequently found to be associated with prior antibiotic exposure. Our findings support the hypothesis that antibiotic use may predispose to future infection risk, including infections caused by both antibiotic-resistant and non-resistant organisms.

Fungal plant pathogens on inoculated maize leaves in a simulated soil warming experiment

Climate change will affect the survival of plant pathogens and the decomposition of crop residues on temperate arable soils. Information on the survival of fungal plant pathogens is important for assessing the subsequent infection risk of susceptible agricultural crops. Therefore, a soil warming experiment was performed to examine the effects of rising winter soil temperatures on the inoculum load of fungal plant pathogens (Fusarium culmorum, F. graminearum, Rhizoctonia solani) and the decomposition of infested maize leaves under field conditions. Using heating cables, an arable soil was subjected to temperature treatments simulating medium (+1.3°C up to the year 2050) and long-term (+2.7°C up to the year 2100) climate warming scenarios. Litterbags filled with pathogen-inoculated and non-inoculated maize leaves were placed on top of the soil. Soil microbial biomass below the litterbags, maize leaf decomposition as well as microbial colonisation of leaves were measured after 152days. Pathogen load was estimated by DNA, total saprotrophic biomass by fungal glucosamine and bacterial muramic acid. Rising soil temperatures increased decomposition of pathogen-infested, but not that of non-inoculated maize leaves, without correlation to fungal and bacterial biomass. F. culmorum DNA produced the largest increase in DNA on maize leaves, but did not significantly respond to soil temperatures. In contrast, the increase in F. graminearum DNA was considerably lower, but revealed a significant positive response to rising soil temperatures. DNA from mycelia and sclerotia of R. solani strongly decreased. Rising winter soil temperatures will most likely cause shifts within the plant residue colonizing fungal community, especially between different Fusarium species.

Predicting Risk of Infection in Patients with Newly Diagnosed Multiple Myeloma: Utility of Immune Profiling.

A translational study in patients with myeloma to determine the utility of immune profiling to predict infection risk in patients with hematological malignancy was conducted. Baseline, end of induction, and maintenance peripheral blood mononuclear cells from 40 patients were evaluated. Immune cell populations and cytokines released from 1 × 106 cells/ml cultured in the presence of a panel of stimuli (cytomegalovirus, influenza, S. pneumoniae, phorbol myristate acetate/ionomycin) and in media alone were quantified. Patient characteristics and infective episodes were captured from clinical records. Immunological variables associated with increased risk for infection in the 3-month period following sample collection were identified using univariate analysis (p < 0.05) and refined with multivariable analysis to define a predictive immune profile. 525 stimulant samples with 19,950 stimulant-cytokine combinations across three periods were studied, including 61 episodes of infection. Mitogen-stimulated release of IL3 and IL5 were significantly associated with increased risk for subsequent infection during maintenance therapy. A lower Th1/Th2 ratio and higher cytokine response ratios for IL5 and IL13 during maintenance therapy were also significantly associated with increased risk for infection. On multivariable analysis, only IL5 in response to mitogen stimulation was predictive of infection. The lack of cytokine response and numerical value of immune cells were not predictive of infection. Profiling cytokine release in response to mitogen stimulation can assist with predicting subsequent onset of infection in patients with hematological malignancy during maintenance therapy.

Feasibility of Gynecologic High Dose Rate Brachytherapy Despite Uterine Perforation or False Passage Creation: Not Throwing Out the Baby With the Bathwater

The reported incidence of uterine perforation in tandem & ovoid brachytherapy ranges from 2 to 10%. Perforation not only potentially increases short term infection risk but treating a tandem in extrauterine or in a false myometrial passage may increase the risk of late rectal or sigmoid complications. When identified at the time of simulation, the brachytherapy may be cancelled, the apparatus removed, and antibiotics started with a subsequent low risk of infection. However, with modern HDR plan optimization, another option may be to treat before device removal if satisfactory dosimetry is achievable since the patient has already accrued the risks of a perforation. Between 2009-2016, 407 tandem & ovoid and 3 tandem & interstitial procedures were performed in 103 patients with cervical cancer. Procedures where the tandem perforated the uterus or created a false passage were identified from the simulation CT scans. HR-CTVs were retrospectively contoured in order to compare V100, D100, D90, rectal Dmax, and sigmoid Dmax doses between insertions with or without perforations and for patients with tandem false passages. Uterine perforations were identified in 12 insertions (2.9%) of which 9 (in 6 pts) were treated before removal. Tandem myometrial false passages without perforation were identified in 20 insertions (5%) in 4 pts all of whom were treated. Median follow up for all patients was 18 months (5 – 69). No acute complications and only 2 late GI toxicities occurred (1, Gr 2 and 1, Gr 3, both from false passage cases). At last follow up, there was 1 pt (10%) with local failure, 1 pt (10%) dead of metastases, 1 (10%) alive with metastases, and 7 (70%) alive without disease. For the 6 patients who had insertions with (9) and without (13) perforations, dosimetry for perforation vs. non-perforation insertions was: V100 74.5% (54 – 97) vs. 86.7% (66 – 100), D100 2.9 Gy (1.8 – 3.4) vs. 3.9 Gy (2.7 – 6.1), D90 4.7 Gy (3.1 – 6.1) vs. 6.2 Gy (3.8 – 9.6), rectal Dmax 3.7 Gy (1.6 – 6.6) vs. 3.8 Gy (2.4 – 5.1), and sigmoid Dmax 9.5 Gy (5 – 14) vs. 9.3 Gy (5.1 – 22). There were no statistically significant differences between the V100, D100, D90, rectal, and sigmoid doses between the insertions with and without perforations. For the false passage insertions (20 in 4 patients): V100 84.4% (66 – 99), D100 3.4 Gy (2.2 – 5.4), D90 5.6 Gy (3.8 – 8.8), rectum Dmax 3.7 Gy (2.1 – 4), and sigmoid Dmax 7.2 Gy (5.4 – 10). Routine abandonment of malpositioned tandem and ovoid brachytherapy insertions may not be necessary. Acute toxicity following uterine perforation is low. Moreover, in selected cases, optimized dosimetry may make possible comparable target volume coverage and normal tissue sparing despite perforating or malpositioned tandems.

Low incidence of subsequent bacteraemia or fungaemia after removal of a colonized intravascular catheter tip

ObjectivesWe determined the frequency of subsequent bloodstream infection more than 2 days after removal of a catheter with positive tip cultures. MethodsWe conducted a nationwide, observational study on intravascular catheter (IVC) tip cultures in Switzerland from 2008 to 2015 using data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). An IVC tip culture was included in the analysis if at least one microorganism could be cultivated from it. We excluded all data from patients with concurrent bacteraemia with the same microorganism identified 7 days before to 2 days after IVC removal. Subsequent bloodstream infection was defined as isolating (from blood cultures performed more than 2 days up to 7 days after catheter removal) the same microorganism as the one recovered from the IVC. Data on antibiotic therapy were not available in this surveillance study. ResultsOver the 8-year period, 15 033 positive IVC tip cultures were identified. Our study population comprised 12 513 episodes of positive IVC tip cultures without concurrent bacteraemia. The frequency of sBSI was 1.8% (n = 219). Subsequent bloodstream infections were more frequently detected after identification of C. albicans (10/113, 8.8%), S. marcescens (9/169, 5.3%), and S. aureus (30/623, 4.8%) on a catheter tip. ConclusionsA very low incidence of subsequent bloodstream infection was observed if a microorganism was identified on a removed IVC tip without concurrent bacteraemia. The risk of subsequent bloodstream infection increased if C. albicans, S. aureus, or S. marcescens were identified in this context.

Biomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study.

Mineral and bone disorders (MBDs) might be relevant in the etiology of infection. To determine whether MBD biomarkers were associated with the incidence of hospitalization with infection. We also assessed the cross-sectional association between MBD biomarker levels and kidney function. Community-based cohort study of 11,218 participants with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 in the Atherosclerosis Risk in Communities study. We assessed the cross-sectional associations of five MBD markers-fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), calcium corrected for hypoalbuminemia, and phosphorus-with eGFR from 1990 to 1992 and their longitudinal associations with incident hospitalization with infection in 1990 to 2013. Incident hospitalization with infection. In age-, sex-, and race-adjusted models, lower eGFRs were significantly associated with greater levels of FGF23, PTH, and corrected calcium but not 25(OH)D or phosphorus. During follow-up, 5078 hospitalizations with infection occurred. In fully adjusted Cox models, with the second quartile as the reference, the hazard ratio (HR) was significantly greater in the highest quartile of FGF23 [HR, 1.12; 95% confidence interval (CI), 1.03 to 1.21], PTH (HR, 1.09; 95% CI, 1.01 to 1.18), and corrected calcium (HR, 1.11; 95% CI, 1.03 to 1.20), and lowest quartile for 25(OH)D (HR, 1.11; 95% CI, 1.03 to 1.21). The association with phosphorus was significant only when the outcome was restricted to primary diagnosis of infection. These findings were consistent across subgroups of age, sex, race, and eGFR (<60 vs ≥60 mL/min/1.73 m2). MBD biomarkers were associated with eGFR and the subsequent risk of infection, supporting MBD involvement in the etiology of infection.

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

ObjectiveTo summarize published studies on the prevalence of and risk factors for maternal bacterial colonization and/or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa. MethodsA systematic review was conducted using the PubMed, Scopus, and Google Scholar databases. Bibliographies of included eligible studies were manually searched to identify additional relevant articles. No language restriction was applied. The timeframe of the search included all records from electronic database inception to July 15, 2017. A random-effects meta-analysis was performed to summarize the prevalence and the 95% confidence intervals (CI) of ESBL-E colonization or infection in pregnant or post-partum women in Africa. The meta-analysis was conducted using STATA IC 13.1 software and the metaprop function/plugin. ResultsTen studies (seven on pregnant women and three on post-partum women) were included, documenting a 17% prevalence of maternal colonization with ESBL-E in Africa (95% CI 10–23%). The prevalence of ESBL-E in community isolates exceeded that in isolates from the hospital setting (22% vs. 14%). The most frequently reported ESBL-encoding gene was CTX-M (cefotaxime hydrolyzing capabilities). Data on risk factors for maternal ESBL-E colonization and infection are very limited. ConclusionsThe prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.