Secondary Infections In Patients Research Articles

Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience.

PurposeCritically ill coronavirus disease 2019 (COVID-19) patients need hospitalization which increases their risk of acquiring secondary bacterial and fungal infections. The practice of empiric antimicrobial prescription, due to limited diagnostic capabilities of many hospitals, has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation in India. This study reports the prevalence and profiles of secondary infections (SIs) and clinical outcomes in hospitalized COVID-19 patients in India.Patients and MethodsA retrospective study of secondary infections in patients admitted in intensive care units (ICUs) and wards of ten hospitals of the Indian Council of Medical Research (ICMR) AMR surveillance network, between June and August 2020, was undertaken. The demographic data, time of infection after admission, microbiological and antimicrobial resistance data of secondary infections, and clinical outcome data of the admitted COVID-19 patients were collated.ResultsOut of 17,534 admitted patients, 3.6% of patients developed secondary bacterial or fungal infections. The mortality among patients who developed secondary infections was 56.7% against an overall mortality of 10.6% in total admitted COVID-19 patients. Gram-negative bacteria were isolated from 78% of patients. Klebsiella pneumoniae (29%) was the predominant pathogen, followed by Acinetobacter baumannii (21%). Thirty-five percent of patients reported polymicrobial infections, including fungal infections. High levels of carbapenem resistance was seen in A. baumannii (92.6%) followed by K. pneumoniae (72.8%).ConclusionPredominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warrants extra caution to improve the infection control practices and practice of antimicrobial stewardship interventions not only to save patient lives but also prevent selection of drug-resistant infections, to which the current situation is very conducive.

Circulating mitochondrial N-formyl peptides contribute to secondary nosocomial infection in patients with septic shock

Secondary infections typically worsen outcomes of patients recovering from septic shock. Neutrophil [polymorphonuclear leukocytes (PMNs)] migration to secondarily inoculated sites may play a key role in inhibiting progression from local bacterial inoculation to secondary infection. Mitochondrial N-formyl peptide (mtFP) occupancy of formyl peptide receptor-1 (FPR1) has been shown to suppress PMN chemotaxis. Therefore, we studied the association between circulating mtFPs and the development of secondary infection in patients with septic shock. We collected clinical data and plasma samples from patients with septic shock admitted to the intensive care unit for longer than 72 h. Impacts of circulating nicotinamide adenine dinucleotide dehydrogenase subunit-6 (ND6) upon clinical outcomes were analyzed. Next, the role of ND6 in PMN chemotaxis was investigated using isolated human PMNs. Studying plasma samples from 97 patients with septic shock, we found that circulating ND6 levels at admission were independently and highly associated with the development of secondary infection (odds ratio = 30.317, 95% CI: 2.904 to 316.407, P = 0.004) and increased 90-d mortality (odds ratio = 1.572, 95% CI: 1.002 to 2.465, P = 0.049). In ex vivo experiments, ND6 pretreatment suppressed FPR1-mediated PMN chemotactic responses to bacterial peptides in the presence of multiple cytokines and chemokines, despite increased nondirectional PMN movements. Circulating mtFPs appear to contribute to the development of secondary infection and increased mortality in patients with septic shock who survive their early hyperinflammatory phase. The increased susceptibility to secondary infection is probably partly mediated by the suppression of FPR1-mediated PMN chemotaxis to secondary infected sites.

Clinical and etiological analysis of co‐infections and secondary infections in COVID‐19 patients: An observational study

BackgroundCo‐infections, secondary bacterial or fungal infections, are important risk factors for poor outcomes in viral infections. The prevalence of co‐infection and secondary infection in patients infected with SARS‐CoV‐2 is not well understood.AimsTo investigate the role of co‐infections and secondary infections in disease severity of hospitalized individuals with COVID‐19.Materials and MethodsA retrospective study was carried out between 11 January 2020 and 1 March 2020 among 408 laboratory confirmed COVID‐19 patients in China. These patients were divided into three groups based on disease severity: mild or moderate, severe, or critically ill. Microbiological pathogens in blood, urine, and respiratory tract specimens were detected by the combination of culture, serology, polymerase chain reaction, and metagenomic next‐generation sequencing (mNGS).ResultsThe median age of participants was 48 years (IQR 34–60 years). Fifty‐two patients (12.7%) had at least one additional pathogen, 8.1% were co‐infected, and 5.1% had a secondary infection. There were 13 Mycoplasma pneumoniae cases, 8 Haemophilus influenzae cases, 8 respiratory viruses, and 3 Streptococcus pneumoniae cases, primarily detected in mild and moderate COVID‐19 patients. Hospital‐acquired infection pathogens were more common in critically ill patients. Compared to those without additional pathogens, patients with co‐infections and/or secondary infections were more likely to receive antibiotics (p < 0.001) and have elevated levels of d‐dimer (p = 0.0012), interleukin‐6 (p = 0.0027), and procalcitonin (p = 0.0002). The performance of conventional culture was comparable with that of mNGS in diagnosis of secondary infections.ConclusionCo‐infections and secondary infections existed in hospitalized COVID‐19 patients and were relevant to the disease severity. Screening of common respiratory pathogens and hospital infection control should be strengthened.

Secondary Infections in Patients with Severe COVID-19

In critically ill patients with severe COVID-19, nosocomial infections must be differentiated from COVID-19–induced inflammation. Two European studies

Elucidation of the hetero-dimeric binding activity of LasR and RhlR proteins with the promoter DNA and the role of a specific Phe residue during the biosynthesis of HCN synthase from opportunistic pathogen Pseudomonas aeruginosa.

Pseudomonas aeruginosa is an opportunistic human pathogen. It causes secondary infections in patients suffering from cancer and other immunological disorders. The pathogenicity of the organism is dependent on the ability of the organism to code for hydrogen cyanide (HCN), the synthesis of which is mediated by HCN synthase enzyme. HCN synthase is encoded by hcnABC operon. The transcription of the operon is controlled by a complex interplay between the proteins LasR and RhlR. Till date, there is no report that deals with the binding interactions of the RhlR-LasR heterodimer with the promoter DNA region of the hcnABC operon. We, for the first time, tried to analyse the binding modes of the RhlR-LasR heterodimer with the promoter DNA regions. From our work, we could predict the importance of a specific amino acid residue Phe214 from RhlR which might be considered to have the desired specificity to bind to the promoter DNA. Therefore, the amino acid Phe214 may be targeted to develop suitable ligands to eradicate the spread of secondary infections by Pseudomonas aeruginosa.

Tuberculosis infection status and risk factors among health workers: an updated systematic review.

Tuberculosis (TB) infection is a common occupational risk for health workers (HWs) and poses a threat to the patients under their care and to other HWs. Hence, the development of a prevention strategy is crucial. We conducted a study to understand the status and risk factors of TB infection among HWs. The existing literature was searched for all published reports from 1 August 2010 to 31 December 2018, related to TB among HWs according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) study participants working in a health care facility; (2) TB cases diagnosed by medical professionals; (3) original research articles; and (4) English reports in a peer-reviewed journal. We finally included 61 studies from 642 articles searched initially. The TB infection rate in HWs was higher than that of the general population. Based on 39 studies, the prevalence of TB in HWs (tuberculin skin test positive) was 29.94%. In contrast, the global burden of latent TB infection was 23.0% (95% uncertainty interval: 20.4%–26.4%) in 2014. The risk factors of TB among HWs were aging, long duration of employment, nursing professionals, lack of Bacillus Calmette-Guerin vaccination, and low body mass index. HWs have an increased risk for TB infection, which can cause secondary infections in patients or other HWs. An effective prevention strategy must be developed to enable early diagnosis and prompt treatment.

563. Tocilizumab in the Treatment of Critical COVID-19 Pneumonia

BackgroundThe anti-interleukin-6 receptor monoclonal antibody tocilizumab has been proposed as a treatment for COVID-19 pneumonia although the efficacy remains unknown.MethodsPatients with COVID-19 confirmed by nasal swab PCR for SARS-CoV-2 who were admitted to Stony Brook University Hospital in Suffolk County, New York between March 10th and April 2nd and received tocilizumab while undergoing mechanical ventilation in any intensive care unit were retrospectively analyzed from data available in the electronic medical record. Baseline characteristics and clinical outcomes were compared to mechanically ventilated patients admitted during the same time period who received standard hospital protocol.ResultsForty-five patients received tocilizumab compared to seventy controls. Mean dose of tocilizumab given was 4.8mg/kg and mean time to receipt from initial intubation was 2.5 days. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and SOFA scores were similar between the two cohorts (Table 1). Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 versus 3.0, p = 0.01) and higher temperature (38.7 C versus 38.2 C, p = 0.004) than controls. There was no significant association between receipt of tocilizumab and the rate of extubation within fourteen days (44.4 percent versus 34.2 percent; OR = 1.53, 95% C.I. 0.71 – 3.30), discharge from hospital (51.1 percent versus 40.0 percent; OR = 1.568, 95% C.I. 0.737 – 3.337), or mortality (31.1 percent versus 41.4 percent; OR = 0.639, 95% C.I. 0.290 – 1.4407) (Table 2). Patients who were administered tocilizumab within two days of intubation had increased likelihood of extubation within fourteen days compared to those who were treated later (OR = 3.50, 95% C.I. 1.01 – 12.18). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 versus 25.7, OR = 1.1736, 95% C.I. = 0.507 – 2.714).Table 1: Patient Demographics and Baseline Characteristics Table 2: Primary Outcomes ConclusionTocilizumab was not associated with a significant improvement in rate of extubation, hospital discharge, or reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine whether earlier treatment may result in improved outcomes.Disclosures All Authors: No reported disclosures

Current Evidence of Interleukin-6 Signaling Inhibitors in Patients With COVID-19: A Systematic Review and Meta-Analysis.

Background: Interleukin-6 (IL-6) is known to be detrimental in coronavirus disease 2019 (COVID-19) because of its involvement in driving cytokine storm. This systematic review and meta-analysis aimed to assess the safety and efficacy of anti-IL-6 signaling (anti-IL6/IL-6R/JAK) agents on COVID-19 based on the current evidence. Methods: Studies were identified through systematic searches of PubMed, EMBASE, ISI Web of Science, Cochrane library, ongoing clinical trial registries (clinicaltrials.gov), and preprint servers (medRxiv, ChinaXiv) on August 10, 2020, as well as eligibility checks according to predefined selection criteria. Statistical analysis was performed using Review Manager (version 5.3) and STATA 12.0. Results: Thirty-one studies were included in the pooled analysis of mortality, and 12 studies were identified for the analysis of risk of secondary infections. For mortality analysis, 5630 COVID-19 cases including 2,132 treated patients and 3,498 controls were analyzed. Anti-IL-6 signaling agents plus standard of care (SOC) significantly decreased the mortality rate compared to SOC alone (pooled OR = 0.61, 95% CI 0.45–0.84, p = 0.002). For the analysis of secondary infection risk, 1,624 patients with COVID-19 including 639 treated patients and 985 controls were included, showing that anti-IL-6 signaling agents did not increase the rate of secondary infections (pooled OR = 1.21, 95% CI 0.70–2.08, p = 0.50). By contrast, for patients with critical COVID-19 disease, anti-IL-6 signaling agents failed to reduce mortality compared to SOC alone (pooled OR = 0.75, 95% CI 0.42–1.33, p = 0.33), but they tended to increase the risk of secondary infections (pooled OR = 1.85, 95% CI 0.95–3.61, p = 0.07). A blockade of IL-6 signaling failed to reduce the mechanical ventilation rate, ICU admission rate, or elevate the clinical improvement rate. Conclusion: IL-6 signaling inhibitors reduced the mortality rate without increasing secondary infections in patients with COVID-19 based on current studies. For patients with critical disease, IL-6 signaling inhibitors did not exhibit any benefit.

Tocilizumab in the treatment of critical COVID-19 pneumonia: A retrospective cohort study of mechanically ventilated patients

ObjectivesThe purpose of this study is to evaluate clinical outcomes in patients with critical COVID-19 pneumonia requiring invasive mechanical ventilation who were treated with tocilizumab DesignSingle-center retrospective cohort study SettingStony Brook University Hospital, a 600-bed academic tertiary medical center in Suffolk County, New York ParticipantsConsecutive patients with COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) who were admitted to Stony Brook University Hospital between March 10 and April 2 2020 and required mechanical ventilation in any intensive care unit during their hospitalization ExposureTreatment with tocilizumab while intubated Main OutcomeOverall mortality 30 days from the date of intubation ResultsForty-five patients received tocilizumab compared to seventy controls. Baseline demographic characteristics, inflammatory markers, treatment with corticosteroids, and sequential organ failure assessment (SOFA) scores were similar between the two cohorts. Patients who received tocilizumab had significantly lower Charlson co-morbidity index (2.0 vs 3.0,P = 0.01) than controls. There was a trend towards younger mean age in the tocilizumab exposed group (56.2 vs 60.6; P = 0.09). In logistic regression analysis there was no reduction in mortality associated with receipt of tocilizumab (odds ratio (OR) 1.04; 95% CI, 0.27–3.75). There was no observed increased risk of secondary infection in patients given tocilizumab (28.9 vs 25.7; OR 1.17; 95% CI, 0.51–2.71). ConclusionWhen controlling for age, severity of illness, and co-morbidities, tocilizumab was not associated with reduction in mortality in this retrospective cohort study of mechanically ventilated patients with COVID-19 pneumonia. Further studies are needed to determine the role of tocilizumab in the treatment of COVID-19.

Risk Factors and Outcomes of Hospitalized Patients With Severe Coronavirus Disease 2019 (COVID-19) and Secondary Bloodstream Infections: A Multicenter Case-Control Study.

BackgroundCoronavirus disease 2019 (COVID-19) has become a global pandemic. Clinical characteristics regarding secondary infections in patients with COVID-19 have been reported but detailed microbiology, risk factors and outcomes of secondary bloodstream infections (sBSI) in patients with severe COVID-19 have not been well described.MethodsWe performed a multicenter, case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from March 1, 2020 to May 7, 2020 at three academic medical centers in New Jersey, USA. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI).ResultsA total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percent oxygen saturation on room air, have septic shock and be admitted to the intensive care unit compared to the controls. In-hospital mortality was higher in those with a sBSI versus controls (53.1% vs 32.8%, p=0.0001).ConclusionsWe observed hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSI in severe COVID-19.

Carbapenemase-producing Enterobacterales causing secondary infections during the COVID-19 crisis at a New York City hospital.

BackgroundPatients with COVID-19 may be at increased risk for secondary bacterial infections with MDR pathogens, including carbapenemase-producing Enterobacterales (CPE).ObjectivesWe sought to rapidly investigate the clinical characteristics, population structure and mechanisms of resistance of CPE causing secondary infections in patients with COVID-19.MethodsWe retrospectively identified CPE clinical isolates collected from patients testing positive for SARS-CoV-2 between March and April 2020 at our medical centre in New York City. Available isolates underwent nanopore sequencing for rapid genotyping, antibiotic resistance gene detection and phylogenetic analysis.ResultsWe identified 31 CPE isolates from 13 patients, including 27 Klebsiella pneumoniae and 4 Enterobacter cloacae complex isolates. Most patients (11/13) had a positive respiratory culture and 7/13 developed bacteraemia; treatment failure was common. Twenty isolates were available for WGS. Most K. pneumoniae (16/17) belonged to ST258 and encoded KPC (15 KPC-2; 1 KPC-3); one ST70 isolate encoded KPC-2. E. cloacae isolates belonged to ST270 and encoded NDM-1. Nanopore sequencing enabled identification of at least four distinct ST258 lineages in COVID-19 patients, which were validated by Illumina sequencing data.ConclusionsWhile CPE prevalence has declined substantially in New York City in recent years, increased detection in patients with COVID-19 may signal a re-emergence of these highly resistant pathogens in the wake of the global pandemic. Increased surveillance and antimicrobial stewardship efforts, as well as identification of optimal treatment approaches for CPE, will be needed to mitigate their future impact.

Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors

ObjectivesThe aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). MethodsThis was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine–Gray models to assess factors associated with risk of secondary infections. ResultsAmong 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4–21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11–3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21–2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04–6.05). ConclusionsPatients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.

ПОКРАЩЕННЯ ПРОФІЛАКТИКИ ВТОРИННОГО ІНФІКУВАННЯ ОПІКОВИХ РАН ПАЦІЄНТІВ З ТЕРМІЧНИМИ УШКОДЖЕННЯМИ ШКІРНИХ ПОКРИВІВ

Опікові пошкодження є видом травматизму, що зустрічається на сьогодні найчастіше.&#x0D; Мета – покращити профілактику вторинного інфікування у хворих із термічними опіками шкірних покривів І та ІІа ступенів шляхом застосування сучасних інноваційних полімерних покриттів.&#x0D; Матеріал і методи. В основу роботи покладені результати спостережень за 30 хворими з опіковими ураженнями шкірних покривів І та ІІа стадій. В основну групу входило 15 хворих, котрим при перев’язці додатково застосовували полімерні плівки, а у контрольній групі (15 хворих) використовували при перев’язці традиційні марлеві вологовисихаючі пов’язки. Застосована нами біодеградуюча полімерна плівка «Біодеп-нано» (Пат. № 110594 Україна, МПК 2016.01) у своєму складі містить желатин, полівініловий спирт, молочну кислоту, гліцерин та нанорозмірний оксид цинку (30 нм) й виготовляється як «Засіб гігієнічно-профілактичний. Біодеградуюча полімерна плівка «Біодеп-нано» 50 г згідно з ТУ У 20.4-2950221612-001:2017».&#x0D; Результати. Отримані дані мікробіологічного дослідження продемонстрували, що у 14 хворих основної групи (93 %), рівень бактерій був нижче значення 105 КУО/мл протягом усього терміну спостереження, що є непатогенним значенням, рівень бактерій поступово зменшувався. У 1 хворого (7 %) рівень висіяного St. Aureus був вище 16´105 КУО/мл.&#x0D; Загоєння опіку І ст. у основній групі відбувалось на (8,2±0,7) добу, а у контрольній групі – на (10,5±1,4) добу, що обумовлено вторинним інфікуванням у контрольній групі. У пацієнтів з ІІа стадією опіку загоєння відбувалось на (16,4±1,8) добу, а у пацієнтів з контрольної групи – на (18,7±1,6) добу.&#x0D; Висновок. Використання ранових покриттів на пінній основі, порівняно з використанням традиційного лікування, продемонструвало високу ефективність як у лікуванні, так і в профілактиці вторинного інфікування ран.

The results of experimental-clinical study of healing of burn wounds and prevention of their complications under the influence of nano-containing biodegradable polymer technologies

Burns cause high rates of morbidity and mortality worldwide. Improper initial treatment or delayed initial treatment can have adverse consequences for further wound healing. Goal. To study the effect of biodegradable polymer films «biodep-nano» on the healing of burns of the skin and prevention of complications. The aim of the study was to investigate the effect of our developed biodegradable polymer film «biodep-nano», which is additionally saturated with hydrated fullerene C60 on the healing of severe suppurative burns in animal experiments and the effectiveness of this film in the prevention of secondary infection in patients with mild burns. Material and methods. Simulation of skin burns was performed on 50 adult white Wistar rats weighing an average of 300.0 g, St.Aureus was injected under the scab, after 3 days the scab was removed surgically and the wound was cleaned with a biodep-nano film, the material was replaced every 2 days. with planimetric, microbiological and pathomorphological examination on the 3rd, 7th, 14th and 21st day. In the conditions of the burn department of Ivano-Frankivsk OKL, the biodegradable polymer film “biodep nano” introduced into production was used to prevent secondary infection of burn wounds. Results. When using the film developed by us, the area decreased by 21.6 % on the 3rd day, by 44.5 % on the 7th day, by 67.8 % on the 14th day. By 21 days there was a complete closure of the wound defect. The results of the microbiological study indicate that the level of contamination of burn wounds after application of the studied film of zinc nanooxide decreased during treatment and on the 3rd day to (4.3±3.3)*105 CFU/ml, which is the level of bacteria that is not pathogenic. After the 14th day, the pathogen was not sown and the wounds healed well. The obtained data showed that in group I where the film was used, the secondary infection was 11 % lower, which in turn showed a shorter wound healing time, which was 2 days less than in group II. Conclusions. The biodegradable material developed by us reliably protects burn wounds from accidental infection, is safetyless, elastic, and in experimental research demonstrated high medical properties in relation to the purulent burn wounds of IIIb century.

External ventricular drain related complications-whether continuous csf drainage via ommaya reservoir is the answer?

External ventricular drainage (EVD) is one of the commonest procedures in neurosurgical practice to manage acute hydrocephalus. We evaluated the infectious and non-infectious complications associated with a modified technique for EVD using an Ommaya reservoir. Ommaya reservoir was placed in all patients who required EVD placement for CSF drainage. CSF drainage was achieved using a needle placed in a non-coring fashion percutaneously into the Ommaya reservoir to achieve CSF drainage externally. CSF was monitored for signs of infection regularly using CSF biochemistry and cultures. CSF infection was defined by a positive culture or a secondary infection in patients with already infected CSF. 59 patients required continuous CSF drainage during the study period from January 2014 to June 2017. 46 (77.96%) patients had non-infected CSF at time of starting drainage and 13 (22.03%) patients required external CSF drainage for primarily infected CSF. The study period had a total of 793 CSF drainage days (Range 3-64 days) with an average of 13.4 days per patient. The cumulative rate of new infection was 5.08%. No ventricular catheter blockage or dislodgement was seen in any of the patients. External ventricular drainage through an Ommaya chamber is a safe and effective method and can be used to reduce the catheter related complications like infection, catheter blockage and dislodgement.

Результати експериментально-клінічного дослідження загоєння опікових ран та запобігання їх ускладнень під впливом нановмісних біодеградуючих полімерних технологій

Burns cause high rates of morbidity and mortality worldwide. Improper initial treatment or delayed initial treatment can have adverse consequences for further wound healing. Goal. To study the effect of biodegradable polymer films «biodep-nano» on the healing of burns of the skin and prevention of complications. The aim of the study was to investigate the effect of our developed biodegradable polymer film «biodep-nano», which is additionally saturated with hydrated fullerene C60 on the healing of severe suppurative burns in animal experiments and the effectiveness of this film in the prevention of secondary infection in patients with mild burns. Material and methods. Simulation of skin burns was performed on 50 adult white Wistar rats weighing an average of 300.0 g, St.Aureus was injected under the scab, after 3 days the scab was removed surgically and the wound was cleaned with a biodep-nano film, the material was replaced every 2 days. with planimetric, microbiological and pathomorphological examination on the 3rd, 7th, 14th and 21st day. In the conditions of the burn department of Ivano-Frankivsk OKL, the biodegradable polymer film “biodep nano” introduced into production was used to prevent secondary infection of burn wounds. Results. When using the film developed by us, the area decreased by 21.6 % on the 3rd day, by 44.5 % on the 7th day, by 67.8 % on the 14th day. By 21 days there was a complete closure of the wound defect. The results of the microbiological study indicate that the level of contamination of burn wounds after application of the studied film of zinc nanooxide decreased during treatment and on the 3rd day to (4.3±3.3)*105 CFU/ml, which is the level of bacteria that is not pathogenic. After the 14th day, the pathogen was not sown and the wounds healed well. The obtained data showed that in group I where the film was used, the secondary infection was 11 % lower, which in turn showed a shorter wound healing time, which was 2 days less than in group II. Conclusions. The biodegradable material developed by us reliably protects burn wounds from accidental infection, is safetyless, elastic, and in experimental research demonstrated high medical properties in relation to the purulent burn wounds of IIIb century.

CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF MYCOBACTERIOSIS IN PATIENTS WITH HIV INFECTION

The aim: to analyze the cases of mycobacteriosis in the population of people living with HIV, identified in the infectious diseases hospital in Saint-Petersburg over the past decade.Materials and methods. 90 cases of patients with HIV and mycobacteriosis, who were treated at the clinical infectious diseases hospital named after S.P.Botkin in the period from 2005 to 2017 were analyzed. Distribution of cases by year and etiology was performed. The inclusion criteria were the presence of HIV, culturally confirmed diagnosis of mycobacteriosis. Exclusion criteria: detection of non-tuberculosis mycobacteria without species identification. Two groups were distinguished: mycobacteriosis caused by mycobacterium avium (83 patients) and mycobacteriosis caused by other non-tuberculosis mycobacteria (7 cases). The distribution of patients by sex, age, aspects of epidemiological anamnesis was performed, the main clinical forms were characterized. Sources of bacterial excretion in mycobacteriosis in patients with HIV infection were recorded.Results. Since 2012, there has been an increase in the frequency of mycobacteriosis detection in patients with HIV: the growth of nosology over the past five years, on average, was 57% per year. Group Mycobacterium avium complex was characterized mainly by sexual path of HIV transmission (68,7%), the average age was 35 years, one third of patients were employed at the time of detection of the disease (35%). 11 persons (13,3 per cent) reported a history of being in prison, only four (4,8 per cent) were active drug users. In the group of patients with mycobacteriosis caused by other non-tuberculosis mycobacteria, the hemocontact pathway of HIV transmission prevailed (57,1%), the penitentiary history was 28,6%. In more than half of the cases, the leading source of bacterial excretion was the material of the upper respiratory tract.Conclusion. There is a steady increase in mycobacteriosis in the structure of secondary infections in patients with HIV. The leading etiological agent was mycobacterium avium, patients with this pathology has preserved social status, sexually transmitted infection. Mainly developed generalized forms of the process, the most frequent source of bacterial excretion according to this sample was the material of the respiratory tract.

Butenolide, a Marine-Derived Broad-Spectrum Antibiofilm Agent Against Both Gram-Positive and Gram-Negative Pathogenic Bacteria

Bacterial biofilm can cause nosocomial recurrent infections and implanted device secondary infections in patients and strongly promotes development of pathogenic drug resistance in clinical treatments. Butenolide is an effective anti-macrofouling compound derived from a marine Streptomyces sp., but its antibiofilm efficacy remains largely unexplored. In the present study, the antibiofilm activities of butenolide were examined using biofilms formed by both Gram-positive and Gram-negative pathogenic model species. Four Escherichia coli strains, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA) were used as targets in antibiofilm assays that examined the effects of butenolide, including the following: (i) on bacterial growth; (ii) in inhibiting biofilm formation and eradicating mature biofilm; (iii) on biofilm structures. In addition, the synergistic effect between butenolide with tetracycline was also examined. Butenolide not only effectively inhibited the biofilm formation but also eradicated pre-formed biofilms of tested bacteria. Fractional inhibitory concentration index (FICI) indicated that butenolide was a potential tetracycline enhancer against E. coli, P. aeruginosa, and MRSA. These results indicated that butenolide may hold a great potential as an effective antibiofilm agent to control and prevent biofilm-associated infections in future clinical treatments.

Simultaneously Mounted Pro- and Anti-inflammatory Host Response Relates to the Development of Secondary Infections in Patients with Sepsis.

Simultaneously Mounted Pro- and Anti-inflammatory Host Response Relates to the Development of Secondary Infections in Patients with Sepsis.

Secondary infections after cytotoxic chemotherapy in patient with hematological malignancies.

This study was initiated to investigate the risk factors of secondary infections in febrile neutropenic patients following chemotherapy, and to evaluate the clinical, microbiological, and mortality outcomes of these infections. An evaluation was done on all patients with hematological malignancy who developed a febrile neutropenic episode (FNE) after cytotoxic chemotherapy in the Department of Hematology, Akdeniz University Faculty of Medicine, between January 2007 and December 2008. A total of 294 primary FNEs that responded to the initial empirical or targeted treatment were included in the study, and secondary infections developed after 72 (24.5%) of 294 primary FNEs. Risk factors for secondary infections were determined as acute leukemia as the underlying disease, salvage chemotherapy for refractory/relapse diseases, prolonged neutropenia (10 days and over), Multinational Association of Supportive Care in Cancer (MASSC) score < 21, and fungal infection during the primary episode. The mortality rate of patients who developed secondary infections was significantly higher compared to patients without secondary infections (27.8% and 5.4%, respectively; p = 0.001). The development of secondary infections in patients with hematological malignancy was not very rare. Greater concern should be shown for these infections to increase patient survival rates.