Risk Of Serious Infections Research Articles

Risk of Infection with Methotrexate Therapy in Inflammatory Diseases: A Systematic Review and Meta-Analysis.

The aim of this study was to determine the risk of infection in adults with inflammatory rheumatic diseases (IRDs) treated with methotrexate. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing methotrexate versus placebo in adults using MEDLINE, EMBASE, and CENTRAL databases from 1980 to August 2017. The primary outcome was the risk of infection associated with methotrexate therapy. We chose a random effect model to summarize adverse event outcomes as risk ratios (RRs) and related 95% confidence intervals (95% CI). Twelve RCTs (total patients 1146) met the inclusion criteria for our main analysis, and ten for risk of serious infection (total patients 906). Overall, methotrexate was associated with increased risk of infection in rheumatoid arthritis (RA) (RR: 1.25; 95% CI, 1.01–1.56; p = 0.04; I2 = 0%), but not in other non-RA IRD populations. There was no increased risk of total infections (RR: 1.14; 95% CI, 0.98–1.34; p = 0.10; I2 = 0%) or serious infections (RR: 0.76; 95% CI, 0.11–5.15; p = 0.78; I2 = 0%) in all included IRDs. Conclusively, methotrexate use in IRDs is associated with a higher risk of all infections in RA, but not in other non-RA (IRD) populations. There is no increased risk of serious infections.

Kinetics of T‐cell subset reconstitution following treatment with bendamustine and rituximab for low‐grade lymphoproliferative disease: a population‐based analysis

Delayed lymphocyte and T-cell immune reconstitution following bendamustine-rituximab (BR) for indolent non-Hodgkin lymphoma (iNHL) has been described, but no information is available for chronic lymphocytic leukaemia (CLL). We present a population-based retrospective analysis of immune reconstitution and risk of infection following BR. Outcomes included timing/correlates of CD4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (n=295),with a median age of 65years (range 33-92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080mg/m2 (range 140-1440mg/m2 ). CD4/CD8/CD19/NK subsets were available for 148 patients. Median follow-up was 24months. Median times to lymphocyte count (ALC) recovery (≥1×109 /l) and CD4+ recovery (≥0·2×109 /l) were 26 and 24months, respectively. Bendamustine total dose >1080mg/m2 (hazard ratio [HR] 0·4; 95% confidence interval [CI]: 0·2-0·8), end-of-treatment ALC ≤0·4×109 /l (HR 0·53; 95% CI: 0·3-0·9) and CD4+ <0·1×109 /l 1-year post-BR (HR 0·03; 95% CI: 0·008-0·15) were covariables for delayed CD4+ recovery. ALC-recovery ≥1×109 /l was an unreliable predictor of CD4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). CD4+ lymphopenia >3years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% CI: 1·4-6·9). CD4+ recovery after BR is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring CD4+ following BR could identify patients at high risk of delayed infections.

Evaluation of Romyelocel-L Myeloid Progenitor Cells to Decrease Infections in De Novo AML Patients Receiving High-Dose Ara-C-Based Induction Therapy

Evaluation of Romyelocel-L Myeloid Progenitor Cells to Decrease Infections in De Novo AML Patients Receiving High-Dose Ara-C-Based Induction Therapy

2103. Clinical Profile of Patients with Burkholderia cepacia complex Bacteremia and Contaminated Ultrasound Gel as Possible Source of Infection

Background Burkholderia cepacia complex (Bcc) is Gram-negative bacteria commonly affecting those with cystic fibrosis, causing pneumonia and also a nosocomial pathogen. We looked at the clinical profile and possible source of Bcc bacteremia in patients without cystic fibrosis, admitted to a tertiary care hospital in South India.MethodsRetrospective chart review was done of patients with Bcc bacteremia over the period 2012–2017. Patient risk factors, outcome, sensitivity profile were looked into. Possible sources for Bcc were analysed.ResultsTwenty-two patients with Bcc bacteremia were identified during this period. Age of patients ranged from 16 months to 83 years, averaging 47 years. 89.5% were nosocomial; 77.3% had indwelling vascular catheter, either CVC, dialysis catheter or permacath. When 30 days mortality was looked at, 17 patients survived and five patients expired. Those who expired had high Pitt’s bacteremic score (scoring done either prior to or within 48 hours of positive culture). Four patients had underlying pneumonia, among whom two patient’s respiratory sample grew Bcc, three also had underling vascular catheters. Sensitivity pattern of Bcc was noted as follows- trimethoprim sulfamethoxazole was uniformly sensitive (100%), ceftazidime was sensitive in 86.5%, minocycline in 73% of isolates. Meropenem was tested in 19 and was found sensitive in 15 isolates (79%), fluoroquinolone was tested only in eight isolates and was sensitive in 7.As majority was CLABSI, the bundle compliance and common products used for cvc were audited. Feedback and training for bundle compliance were given. The ultrasound gel, even the unopened bottle used for cvc insertion grew Bcc. Despite sterile cover around the probe after the application of contaminated gel, an associated risk was considered and was replaced with sterile gel sachet. At 3 months follow-up there is no further incidence of Bcc bacteremia, though longer follow-up is needed.Conclusion Bcc bacteremia is found to be an important nosocomial pathogen, commonly associated with intravascular catheters with 22.7% mortality in this study. Cotrimoxazole was 100% sensitive. Good infection control practices, including early removal of unnecessary catheters are important to prevent Bcc CLABSI. Ultra sound gels can harbour Bcc and poses a serious risk of infection.Disclosures All authors: No reported disclosures.

Do Low-Risk Febrile Infants Aged ≤60 Days Need a Lumbar Puncture?

The widely used Rochester and Philadelphia criteria for assessing risk for serious bacterial infection in young febrile infants were developed over 30

The frequency of infections in patients with juvenile idiopathic arthritis on biologic agents: 1-year prospective study.

The most effective and concurrently the safest treatment regimen selection is important to provide early control of juvenile idiopathic arthritis (JIA) and to have an acceptable quality of life. The effectivity of biologic agents as well as standard disease-modifying drugs is well documented in treatment of JIA. In spite of their high benefit, these drugs have the risk of serious infections. Herein, we conducted a prospective study to investigate the infectious complications of biologic agents in patients diagnosed with JIA. Patients on biologic treatment regimen were examined by the pediatric infectious disease specialist in every 2months during 1-year long. Throughout the study period, 57% (n:175) of the patients developed infection and 43% (n:132) of them completed this period without any infection. Upper respiratory tract infections which were treated in outpatient clinic were the most common infection. Only three serious infections (two pneumonia, one pleural effusion), which required hospitalization, developed. The infection rate was highest in systemic JIA and lowest in enthesitis-related arthritis (p < 0.001). The total rate of infection development after 1-year period was lowest for etanercept; it was highest for the patients on infliximab treatment (p < 0.001). We comment that the altered immune system of JIA can be responsible from the serious infections irrespective of immunosuppressive therapy. Biologic agents can be safely used in JIA evaluating the loss and benefit statement.

Incidence of Infectious Adverse Events in Patients With Rheumatoid Arthritis and Spondyloarthritis on Biologic Drugs-Data From the Brazilian Registry for Biologics Monitoring.

BackgroundThe safety profile of biologic drugs might present substantial regional differences. Since 2009, the Brazilian Society of Rheumatology has maintained BIOBADABRASIL (Brazilian Registry for Biologic Drugs), a registry for monitoring of biologic therapies in rheumatic diseases.ObjectivesThe aim of this study was to verify the incidence rate (IR) of serious infections in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients on biologic drugs.MethodsBIOBADABRASIL prospectively included patients with rheumatic diseases who started the first biologic drug or a synthetic disease-modifying antirheumatic drug as a parallel control group. This study focuses on serious infectious adverse events (SIAEs) in RA and SpA patients on biologic drugs compared with controls, from January 2009 to June 2015. Time of exposure was set from initiation of the drug to the date of last administration or censorship. Serious infectious adverse events IR was calculated per 1000 patient/years with 95% confidence interval (CI).ResultsA total of 1698 patients (RA, 1121; SpA, 577) were included, 7119 patient/years. Serious infectious adverse events were more common among patients on tumor necrosis factor inhibitors (TNFi's) than controls (adjusted IR ratio, 2.96 [95% CI, 2.01–4.36]; p < 0.001). Subsequent TNFi was associated with a higher SIAEs incidence when compared with first TNFI (adjusted IR ratio, 1.55 [95% CI, 1.15–2.08]; p = 0.004). Serious infectious adverse events were associated with age and corticosteroids intake. Serious infectious adverse events were more frequent in the respiratory tract in all subgroups.ConclusionsIn BIOBADABRASIL, biologic drugs, especially the subsequent TNFi, were associated with a higher risk of serious infections compared with synthetic DMARDs. Corticosteroid intake and age represented risk factors for SIAEs. Constant monitoring is required to follow the safety profile of drugs in the clinical setting of rheumatic conditions in Brazil.

Characterization and Changes of Lymphocyte Subsets in Baricitinib-Treated Patients With Rheumatoid Arthritis: An Integrated Analysis.

ObjectiveBaricitinib is an orally administered inhibitor of JAK1 and JAK2 that has been shown to be effective in treating rheumatoid arthritis (RA). This study was undertaken to analyze changes in lymphocyte cell subsets during baricitinib treatment and to correlate these changes with clinical outcomes.MethodsAn integrated analysis was conducted by pooling data from 3 completed phase III trials comparing placebo with baricitinib treatment (RA‐BEAM, RA‐BUILD, and RA‐BEACON) and 1 ongoing long‐term extension study (RA‐BEYOND) in patients with active RA (n = 2,186).ResultsBaricitinib treatment was associated with an early transient increase in total lymphocyte count at week 4, which returned to baseline by week 12. Transient changes within normal reference ranges in T cells and subsets were observed with baricitinib treatment, up to week 104. B cells and relevant subpopulations increased after 4 weeks of baricitinib treatment, with no further increases noted through 104 weeks of treatment. Natural killer (NK) cells temporarily increased after 4 weeks of baricitinib treatment, before decreasing below baseline levels and then stabilizing over time. With baricitinib treatment, few correlations were observed between changes in lymphocyte subsets and clinical end points, and most correlations were also observed within the placebo group. A modest potential association between low NK cell numbers and treatment‐emergent infections was observed in the baricitinib 4 mg/day treatment group, but not for serious infections or herpes zoster.ConclusionOverall, these findings demonstrate that changes in lymphocyte subsets were largely within normal reference ranges across the baricitinib phase III RA clinical program and were not associated with increased risk of serious infections.

Risk of Serious Infections Associated with Biologic Agents in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analyses

To assess whether treatment with biologic response modifying agents during clinical trial study periods increases the risk of serious infections in children with juvenile idiopathic arthritis (JIA). A systematic literature review using Medline, Embase, Cochrane library, and the clinical trial registry was performed up to July 2017. Random effects meta-analyses were used to compare rates of serious infections in children with JIA given biologic agents compared with controls, and the pooled relative risk calculated. Subanalyses were performed for different biologic agent classes. In total, 19 trials accounting for 21 individual studies were included (11 for tumor necrosis factor-alpha inhibitors [n = 814 patients], 3 for interleukin-6 inhibitors [n = 318], 6 for interleukin-1 inhibitors [n = 353], and 1 for selective T-lymphocyte costimulation modulators [n = 122]). Patients (68% female) had a mean age of 10.8 years. Seventeen serious infections were reported among 810 children receiving biologic agents and 15 among 797 controls. The most frequent infections were bronchopulmonary and varicella. No statistically significant difference in risk of serious infections was found between children receiving biologic agents compared with control groups (pooled relative risk = 1.13; 95% CI [0.63, 2.03]) during the trial study periods. The risk remained nonsignificant when evaluating the different classes of biologic agents separately. However, the analyses were underpowered to detect differences in the risk of serious infections overall or differences between classes of biologic agents. In this systematic review and meta-analyses, serious infections were uncommon and not significantly increased among patients with JIA receiving biologic agents compared with controls. However, the analyses were underpowered and study periods were relatively short. Ongoing careful monitoring for serious infections remains necessary for all patients with JIA, and particularly those receiving biologic agents.

Bacterial Infection Risk by Viral Coinfection Status in Young Febrile Infants

Febrile infants aged less than 60 days are at increased risk for serious bacterial infection (SBI) compared with older infants. To examine the

Point-of-care CRP matters: normal CRP levels reduce immediate antibiotic prescribing for acutely ill children in primary care: a cluster randomized controlled trial

Objective: Antibiotics are prescribed too often in acutely ill children in primary care. We examined whether a Point-of-Care (POC) C-reactive Protein (CRP) test influences the family physicians’ (FP) prescribing rate and adherence to the Evidence Based Medicine (EBM) practice guidelines.Design: Cluster randomized controlled trial.Setting: Primary care, Flanders, Belgium.Intervention: Half of the children with non-severe acute infections (random allocation of practices to perform POC CRP or not) and all children at risk for serious infection were tested with POC CRP.Subjects: Acutely ill children consulting their FP.Main outcome measure: Immediate antibiotic prescribing.Results: 2844 infectious episodes recruited by 133 FPs between 15 February 2013 and 28 February 2014 were analyzed. A mixed logistic regression analysis was performed. Compared to episodes in which CRP was not tested, the mere performing of POC CRP reduced prescribing in case EBM practice guidelines advise to prescribe antibiotics (adjusted odds ratio (aOR) 0.54 (95% Confidence Interval (CI) 0.33–0.90). Normal CRP levels reduced antibiotic prescribing, regardless of whether the advice was to prescribe (aOR 0.24 (95%CI 0.11–0.50) or to withhold (aOR 0.31 (95%CI 0.17–0.57)). Elevated CRP levels did not increase antibiotic prescribing.Conclusion: Normal CRP levels discourage immediate antibiotic prescribing, even when EBM practice guidelines advise differently. Most likely, a normal CRP convinces FPs to withhold antibiotics when guidelines go against their own gut feeling. Future research should focus on whether POC CRP can effectively identify children that benefit from antibiotics more accurately, without increasing the risks of under-prescribing.Key pointsWhat is previously known or believed on this topic•Antibiotics are prescribed too often for non-severe conditions. Point-of-care (POC) C-reactive Protein (CRP) testing without guidance does not reduce immediate antibiotic prescribing in acutely ill children in primary care.What this research adds•FPs clearly consider CRP once available: normal CRP levels discourage immediate antibiotic prescribing, even when EBM practice guidelines advise differently. Most likely, a normal CRP convinces FPs to withhold antibiotics when guidelines go against their own gut feeling.•Future research should focus on whether POC CRP can effectively identify children that benefit from antibiotics more accurately, without increasing the risks of under-prescribing.

Histoplasmosis in Inflammatory Bowel Disease Patients on Tumor Necrosis Factor-a Medications

Introduction: The advent of tumor necrosis factor (TNF)-a antagonist therapy has transformed the management of inflammatory bowel disease (IBD); however, these medications carry a boxed warning from the Food and Drug Administration (FDA) for risk of serious infection. We aimed to study the invasive fungal infection, histoplasmosis, in the setting of TNF-a blocker therapy. Methods: We performed a retrospective review of patients with IBD receiving TNF-a therapy who developed disseminated or pulmonary histoplasmosis during the time period January 2001 - May 2018. Patients with indications for TNF-a drugs other than ulcerative colitis or Crohn's disease were excluded. The medical records of patients were reviewed for demographics, medications, symptoms, diagnosis, treatment, and outcomes including mortality. IBD was diagnosed by biopsy, radiographic, or endoscopic evidence of disease. Results: We identified 49 patients (age range 19-74; average 42 years) with a confirmed diagnosis of histoplasmosis while receiving TNF-a inhibitors. Infliximab and adalimumab were the most commonly used. A majority of patients had Crohn's disease. The diagnosis of histoplasmosis was confirmed by multiple modalities with serology being the most frequently obtained. The most common lab finding besides anemia was elevated alkaline phosphatase. For antifungal treatment, amphotericin was given in 17 cases as the initial agent. Itraconazole, the drug of choice for histoplasmosis, was given in all 49 patients. Treatment duration ranged from 3-15 months. Treatment location was split evenly between inpatient (49%) and outpatient (51%) locations with 6 patients (12%) requiring ICU-level care. Average length of stay was 15.4 days (range 2-56 days). TNF-a therapy was continued in 7 patients concurrently with azole therapy and 17 patients resumed TNF-a medication after completing treatment for histoplasmosis. There was 1 histoplasmosis recurrence. Median follow-up was 3.2 years. A total of 3 deaths occurred (6%). Conclusion: Disease outcomes were mostly favorable. Many patients were young with few or no comorbidities and were able to resume biologic therapy; however, those treated inpatient had an extended length of stay > 2 weeks on average indicative of the severity of histoplasmosis. Recurrence after resumption of anti-TNF-a therapy was low. Practitioners should be vigilant for disseminated fungal infections in this patient population.671 Figure 1 No Caption available.

Anti-Tumour Necrosis Factor Therapy for Inflammatory Bowel Diseases Do Not Impact Serious Infections after Arthroplasty.

There is a paucity of data on the safety of joint replacement surgery in patients with inflammatory bowel disease [IBD], including those on tumour necrosis factor-alpha inhibitors [anti-TNF]. We explored the risk of serious infections in this population. A retrospective case-control study [2006-2014] was performed using the MarketScan Database. All patients aged 18-64 years with an International Classification of Diseases code for IBD and an IBD-specific medication, with ≥ 6 months of enrollment prior to hip, knee or shoulder replacement surgery, were included. Ten non-IBD controls were frequency-matched to each case on length of enrollment, year and the joint replaced. Primary outcome was serious infection [composite of joint infection, surgical site infection, pneumonia, sepsis] within 90 days of the operation. Cox proportional hazards models were used to assess the association of IBD and IBD medications with serious infection. More patients with IBD [N = 1455] had serious infections than controls [3.2% vs 2.3%, p = 0.04], but not after controlling for comorbidities (hazard ratio [HR], 1.3; 95% confidence interval [CI], 0.95-1.76). Among IBD patients, corticosteroids were associated with increased risk of serious infection [HR, 4.6; 95% CI, 2.2-9.8; p < 0.01] while anti-TNFs were not. Opioids were also associated with increased risk of infection [HR, 1.5; 95% CI, 1.2-1.8; p < 0.01]. After controlling for comorbidities, IBD patients were not at increased risk of serious infection following joint replacement. Corticosteroids, but not anti-TNFs or immunomodulators, were associated with increased risk of serious infections in IBD patients.

Risk of serious infection among patients receiving biologics for chronic inflammatory diseases: Usefulness of administrative data

Risk of hospitalized infections under biologics among patients suffering from chronic inflammatory autoimmune diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PSA), or psoriasis was investigated using administrative data. The hospital discharge records database, the medical prescription database, and the database of exemptions from medical charges were linked at the individual patient level. A cohort of patients diagnosed with RA, SA, PSA, and severe psoriasis from 2006 to 2017 was identified and followed-up to either the end of 2017 or hospitalization with the main discharge diagnosis of infection, death, or they moved out of the region. Multiple Cox regression was used to estimate the hazard ratio (HR) of hospitalization associated with bDMARDs and adjusting for age, sex, Charlson’s Comorbidity Index, calendar year, prescription of steroids, and use of csDMARDs. Use of bDMARDs was treated as a time-dependent variable. A total of 5596 patients diagnosed with RA, AS, or PSA/severe psoriasis were included in the cohort. Overall, 289 (4.2%) were hospitalized due to infection. Time to first use of biological drugs was significantly associated with a 55% increased risk of hospitalization for infections. Thus, large cohorts from administrative databases are useful to support observations from registries and clinical trials. Patients with chronic autoimmune inflammatory diseases are at risk of serious infections when starting biologics. This risk is higher in the elderly or those with comorbidities. Upper and lower respiratory tract infections are the most common infections. Our findings support prevention policies such as vaccination.

Long-acting Opioid Use and the Risk of Serious Infections: A Retrospective Cohort Study.

Although evidence from animal and human studies indicates opioid analgesics increase susceptibility to infections, it is unclear whether the risk varies by specific opioid. We compared the risk of serious infection among patients initiating long-acting opioid analgesics with and without previously reported immunosuppressive properties. We conducted a retrospective cohort study of Tennessee Medicaid enrollees age ≥18 years initiating long-acting opioids (1995-2015). Hospitalizations for serious infection were identified using validated coding algorithms. We used multivariable Poisson regression models to calculate adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) to compare the infection risk among patients using long-acting opioids with known immunosuppressive properties (morphine, fentanyl, methadone) to the infection risk among patients using long-acting opioids without known immunosuppressive properties (oxycodone, oxymorphone, tramadol) accounting for demographics, opioid dose, comorbidities and pain conditions, medication use, frailty indicators, and healthcare encounter history using exposure propensity scores. We further compared users of individual long-acting opioids to long-acting morphine users (considered the prototypical immunosuppressive opioid). Among the 61 240 patients initiating opioids with immunosuppressive properties and 22 811 patients initiating opioids without immunosuppressive properties, we identified 1906 serious infections. Nonimmunosuppressive opioid users had a lower rate of infections than immunosuppressive opioid users (aIRR:0.78 [CI: 0.66-0.91]). Among individual opioids, oxycodone users had a lower rate of infection than morphine users (aIRR:0.73 [CI: 0.60-0.89]). There were no significant differences in the infection risk between other opioids and morphine. The risk of serious infections among long-acting opioid users varies by opioid type. Providers should carefully consider the risk of serious infections when making pain management decisions.

Acute lung injury on-chip: building a disease predictive model that emulates alveolar biomechanics

In hemodialysis (HD) patients, higher lipid levels are associated with lower mortality. Lipid-lowering therapy does not reduce all-cause mortality or cardiovascular (CV) mortality. Lipoproteins play a role in the innate immune system. Our objective was to determine whether protection from infection might counterbalance adverse CV outcomes associated with lipoproteins.We examined associations between serum apolipoprotein (Apo) A1, B, C2, C3, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol and triglyceride levels and infectious mortality or hospitalization, CV mortality or hospitalization, and all-cause mortality in 433 prevalent HD patients. Cox models with time-varying apolipoprotein concentrations collected every 6 months for up to 2 years were used for analyses.Median follow-up time for all-cause mortality was 2.7 years (25th–75th percentile range: 2.2–3.4 years). One hundred seventy-nine (41%) patients had an infection-related event. In multivariable models, higher Apo B and LDL were associated with lower risks of infection-related outcomes (hazard ratio Apo B 0.92 [95% confidence interval 0.86–0.99 per 10 mg/dL, P = .03]; hazard ratio LDL 0.93 [95% confidence interval 0.87–1.00 per 10 mg/dL, P = .05]). Sixty-three (15%) participants had a CV-related event. No significant associations were observed between lipoproteins and CV outcomes. Eighty-seven (20%) participants died. Higher Apo A1, Apo B, and Apo C3 were associated with lower risks of all-cause mortality. There was no interaction between the use of lipid-lowering medication and any of the outcomes.Associations of lipoproteins with lower risk of serious infection accompanied by no significant association with CV events may help to explain the paradoxical association between lipids and survival and lack of benefit of lipid-lowering therapies in HD.

Antibacterial Activity of Honey Against Staphylococcus Aureus and Pseudomonas aeruginosa Isolated from Infected Wound

Wound infections have been recognized as the most critical problem especially in the presence of foreign materials that increase the risk of serious infection even with relatively small bacterial infection. This study was carried out to determine the antibacterial activity of honey against clinical isolates of Staphylococcus aureus and Pseudomonas aeruginosa obtained from infected wounds. Different concentrations of honey extract (25, 50, 75 and 100 v/v) were tested using agar well diffusion method to determine their antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa isolated from infected wounds of patients attending Muhammad Abdullahi Wase Specialist Hospital, Kano. The antibacterial activity of the honey showed that the honey demonstrated antimicrobial activity against the test isolates with higher activity in Staphylococcus aureus (with average zone of inhibition of 15.90mm) than Pseudomonas aeruginosa (14.63mm). The minimum inhibitory concentration (MIC) of the extract from this study ranges from 6.25 – 50mg/ml while the minimum bactericidal concentration (MBC) of the extracts ranges from 25 – 50mg/ml. Statistical analysis of the results showed that there is no significant different in the activity of honey against the isolates at p<0.05. Based on the results of this study, it is concluded that honey is active against wound bacterial isolates and can be used as a therapy for wound infection.

Occurrence and Antibiotic Resistance of Enterobacteriaceae in Acute Leukemia Patients.

Acute leukemia (AL) is a heterogeneous group of malignant hematopoietic diseases and is divided into two basic types: acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients with these diseases are highly immunosuppressed and therefore at a high risk of serious infections. This study aimed to perform active surveillance of enterobacteria, which cause these infections, and to determine their antibiotic resistance in patients with AL who were hospitalized at the Hemato-Oncology Center of University Hospital Olomouc. This study involved 49 patients with AL, of whom 37 had AML (16 women and 21 men) and 12 had ALL (6 women and 6 men). The mean age of the patients was 50.5 years. Samples of clinical material were obtained over 12 months (September 2015 to August 2016) and subjected to standard microbiological examinations. Bacterial strains were identified by MALDI-TOF MS, and their antibiotic susceptibility was established by microdilution method. A total of 292 samples were obtained from patients with AL. Some of these samples were excluded from analysis to prevent the inclusion of identical strains from the same patient. Consequently, 146 clinical samples obtained from the following nine types of clinical materials were analyzed - throat swabs (n = 47), stools (n = 40), urine (n = 33), hemocultures (n = 11), buccal swabs (n = 5), perianal swabs (n = 4), wound swabs (n = 3), sputum (n = 2), and puncture fluid (n = 1). The most prevalent enterobacteria was Escherichia coli (n = 42), followed by Klebsiella spp. (n = 46), specifically Klebsiella pneumoniae (n = 34) and Klebsiella oxytoca (n = 12), and Enterobacter cloacae (n = 19). The most of enterobacteria were highly resistant to many tested antibiotics. Antibiotic-resistant enterobacteria colonize patients with hemato-oncological diseases and can cause serious infections. These antibiotic-resistant microorganisms are a serious and frequent problem. These findings together with the high level of immunosuppression mean that patients with hemato-oncological diseases are at a high risk of developing serious infections and consequently active surveillance is crucial.

Psoriasis and infection. A clinical practice narrative.

The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on risk assessment for that patient, taking into account the infection being treated, the risk of recurrent infection, any interventions that can modify the risk and the need for psoriasis control. Live vaccines (e.g. MMR, varicella, zoster and yellow fever) are generally contraindicated in patients with psoriasis on immune-modulatory agents, but this depends on the degree of immune suppression and individual risk factors. Wound healing in psoriasis is normal. Treatment with infliximab, adalimumab, etanercept, methotrexate and ciclosporin can safely be continued through low-risk surgical procedures. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.

Risk of serious infection in healthcare workers with inflammatory bowel disease: a case-control study of the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID).

Whether healthcare workers with inflammatory bowel disease (IBD) are at increased risk of severe infection due to daily pathogen exposure is controversial. To assess the risk of severe infection in healthcare workers with IBD in a large multicentre case-control study. The study population comprised 482 healthcare workers with IBD from 17 centres who were matched for gender, age, disease subtype and year of diagnosis to 482 controls (non-healthcare workers with IBD). The study period was between the date of diagnosis of IBD and June 2016. Severe infection was defined as any community-acquired infection that required hospitalisation. With a median follow-up of 9.3 years, 139 severe infections were recorded among cases and controls, including 30 Clostridium difficile infections, 33 severe viral infections, nine tuberculosis infections, 21 community-acquired pneumonia and 46 others. No difference was observed between healthcare workers and controls regarding the overall incidence rates of severe infection. An increased risk of tuberculosis was noted in healthcare workers. In multivariate analysis in the entire study population, severe infection was associated with current exposure to corticosteroids (OR = 3.05, 95% CI [2.06-4.52], P < 0.001), immunosuppressants (OR = 1.98, 95% CI [1.38-2.84], P < 0.001) and anti-TNF agents (OR = 2.93, 95% CI [2.02-4.27], P < 0.001) and reduced with Crohn's disease (OR = 0.63, 95% CI [0.43-0.91], P = 0.01). Healthcare workers with IBD do not have an increased risk of severe infection compared with other patients with IBD, except for tuberculosis. Screening for tuberculosis exposure should be assessed in this high-risk population when treated with anti-TNF agents.