Septic Infection Research Articles

Combination of Phycocyanin, Zinc, and Selenium Improves Survival Rate and Inflammation inthe Lipopolysaccharide-Galactosamine Mouse Model.

Sepsis is related to systemic inflammation and oxidative stress, the primary causes of death in intensive care units. Severe functional abnormalities in numerous organs can arise due to sepsis, with acute lung damage being the most common and significant morbidity. Spirulina, blue-green algae with high protein, vitamins, phycocyanin, and antioxidant content, shows anti-inflammatory properties by decreasing the release of cytokines. In addition, zinc (Zn) and selenium (Se) act as an antioxidant by inhibiting the oxidation of macromolecules, as well as the inhibition of the inflammatory response. The current study aimed to examine the combined properties of Zn, Se, and phycocyanin oligopeptides (ZnSePO) against lipopolysaccharide-D-galactosamine (LPS-GalN)-induced septic lung injury through survival rate, inflammatory, and histopathological changes in Balb/c mice. A total of 30 mice were allocated into three groups: normal control, LPS-GalN (100ng of LPS plus 8mg of D-galactosamine), LPS-GalN + ZnSePO (ZnPic, 52.5µg/mL; SeMet, 0.02µg/mL; and phycocyanin oligopeptide (PO), 2.00mg/mL; at 1h before the injection of LPS-GalN). Lung tissue from mice revealed noticeable inflammatory reactions and typical interstitial fibrosis after the LPS-GalN challenge. LPS-GalN-induced increased mortality rate and levels of IL-1, IL-6, IL-10, TGF-β, TNF-α, and NF-κB in lung tissue. Moreover, treatment of septic mice LPS-GalN + ZnSePO reduced mortality rates and inflammatory responses. ZnSePO considerably influenced tissue cytokine levels, contributing to its capacity to minimize acute lung injury (ALI) and pulmonary inflammation and prevent pulmonary edema formation in LPS-GalN-injected mice. In conclusion, ZnSePO treatment enhanced the survival rate of endotoxemia mice via improving inflammation and oxidative stress, indicating a possible therapeutic effect for patients with septic infections.

The use of antimicrobial biomaterials as a savior from post-operative vascular graft-related infections: A review

Cardiovascular diseases rank first in mortality and morbidity. There are various treatments for replacing a blood vessel artificially, such as autologous graft implantation, bio-engineered vascular graft implantation, etc. Due to the external medical intervention or immunocompromised state in the patients, there are high chances of septic infection at the site of implantation. This increases the risk of blood-related infections in these patients. Thus, it is imperative to avoid the spread of infection and to destroy the infection-causing microorganisms by incorporating an antimicrobial agent in the implantable biomaterial. For instance, use combination of minocycline, chlorhexidine, and rifampin was impregnated on Dacron, and PTFE (polytetrafluoroethylene) vascular grafts showed a 100% patency rate and increased antibiotic activity than the counterparts. This review summarises various methods of incorporating antimicrobial agents in the biomaterial for developing an antimicrobial vascular graft.

THE SIGNIFICANCE OF METICYLIN-RESISTANT STAPHYLOCOCCUS IN THE DEVELOPMENT OF SEPTIC INFECTIONS (IN THE MODEL OF PULMONARY INFLAMMATION/DESTRUCTION)

Septic infections caused by methicillin-resistant Staphylococcus (MRS) are one of the most important challenges for modern medicine. The results of the study showed that MRS strains isolated from patients with pulmonary inflammation/destruction had much higher rates of antibiotic resistance compared to methicillin-sensitive Staphylococcus strains (MSS). At the same time, the clinical and socio-economic impact of patients with pulmonary inflammation with MRS is more significant compared to that of patients with MSS, requiring more expensive treatment over a longer period of time (13.81 days vs. 7.05 days) and more days of hospitalization (18.4 days vs. 11.3 days), including in the intensive care units (9.23 days vs. 2.25 days), as well as increased lethality (8.6% vs. 2.5 %).

Acute kidney injury in group A streptococcal bacteraemia: incidence, outcome and predictive value of C-reactive protein

Background A ubiquitous human pathogen, Streptococcus pyogenes (Group A Streptococcus, GAS) causes infections from mild pharyngitis to severe septic infections. Acute kidney injury (AKI) is a condition of prompt decline of renal function. The aim of the present study was to report the incidence and outcome of AKI in GAS bacteraemia and to evaluate the diagnostic value of serum C-reactive protein as an indicator of AKI. Methods All adult patients with GAS bacteraemia treated at Turku University Hospital from 2007 to 2018 were identified and their patient records were scrutinised. Results Of 195 included patients, 38 (19.5%) had AKI stage 1, 20 (10.3%) AKI stage 2 and 26 (13.3%) AKI stage 3 and 111 (56.9%) did not have AKI. The adjusted seven-day mortality was significantly higher in AKI stages 2 and 3 compared to the non-AKI group (15% and 19% vs. 3.6%; p = .046 and .006, respectively). Of the survivors, 95.8% met the criteria of renal recovery at discharge. The higher the AKI stage, the higher was the mean serum CRP level on admission. The optimal cut-off for CRP to identify patients with AKI stage 2 or 3 was ≥244 mg/l (sensitivity 82.6% and specificity 75.8%). Conclusions AKI is common in patients with GAS bacteraemia and the severity of AKI correlates with the CRP level on admission. The mortality of patients with GAS bacteraemia and AKI is significantly higher than of patients without AKI. Most survivors, however, show renal recovery. Key Message AKI is common in group A Streptococcal bacteraemia and increases mortality compared to bacteraemia alone. However, renal recovery is also common. A high CRP level on admission correlates significantly positively with the degree of severity of AKI.

Sugar-rich larval diet promotes lower adult pathogen load and higher survival after infection in a polyphagous fly.

ABSTRACTNutrition is a central factor influencing immunity and resistance to infection, but the extent to which nutrition during development affects adult responses to infections is poorly understood. Our study investigated how the nutritional composition of the larval diet affects the survival, pathogen load and food intake of adult fruit flies, Bactrocera tryoni, after septic bacterial infection. We found a sex-specific effect of larval diet composition on survival post-infection: survival rate was higher and bacterial load was lower for infected females raised on a sugar-rich larval diet than for females raised on a protein-rich larval diet, an effect that was absent in males. Both males and females were heavier when fed a balanced larval diet compared with a protein- or sugar-rich diet, while body lipid reserves were higher for those that had consumed the sugar-rich larval diet compared with other diets. Body protein reserves were lower for flies that had been raised on the sugar-rich larval diet compared with other diets in males, but not females. Both females and males shifted their nutrient intake to ingest a sugar-rich diet when infected compared with sham-infected flies without any effect of the larval diet, suggesting that sugar-rich diets can be beneficial to fight off bacterial infection as shown in previous literature. Overall, our findings show that nutrition during early life can shape individual fitness in adulthood.

Postoperative imaging of the hip

To assess postoperative imaging of the hip joint regarding possible complications, it is indispensable to have in-depth knowledge of commonly used surgical techniques, access routes, and the implanted materials. While radiography is used to evaluate the position of foreign material and to rule out periprosthetic fractures that have occurred intraoperatively, follow-up examinations might show signs of material failure, aseptic loosening, prosthesis infections, or the occurrence of heterotopic ossifications. If radiographic findings are ambiguous, computed tomography (CT) may be used to clarify findings, whereas magnetic resonance imaging (MRI) is helpful to identify intra- and periarticular soft tissue pathologies such as surgery-associated cartilage and ligament damage, muscle insufficiency, or metallosis. To guide clinical decision making in common postoperative complications, various classification systems are available, e.g., for periprosthetic fractures, aseptic loosening, or heterotopic ossification. However, the differentiation between aseptic material loosening and septic endoprosthesis infection remains challenging if based on imaging alone. The assessment of postoperative hip imaging should be closely linked to the respective surgical technique and the implanted foreign material, whereby different probabilities of specific complications can be derived.

Distribution and Drug Resistance of Pathogenic Bacteria and Prognosis in Patients with Septicemia Bloodstream Infection with Renal Insufficiency

ObjectiveThe aim of this study was to investigate the distribution and drug resistance of pathogenic bacteria and the prognosis of patients with sepsis bloodstream infection with renal insufficiency.MethodsOne hundred and twelve patients with septicemic bloodstream infection with renal insufficiency and 112 patients with septic bloodstream infection without renal insufficiency were selected as study group and control group, respectively. We compare the distribution of pathogenic bacteria, analyze the drug resistance of major bacteria, and compare the efficacy, the incidence of septic shock, duration of mechanical ventilation, hospitalization time, and duration of antimicrobial drug administration between the two groups.ResultsA total of 140 pathogenic strains were isolated from blood cultures in the study group, and 136 strains were isolated from blood cultures in the control group. The sepsis bloodstream infection was mainly caused by Gram-negative bacteria, accounting for 59.42% (164/276). Among the gram-negative bacteria, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii had higher resistance rates to levofloxacin, ceftazidime, piperacillin sodium tazobactam, and amikacin. Among the gram-positive bacteria, Streptococcus pneumoniae, Enterococcus, and Staphylococcus aureus had high resistance rates to clindamycin, cefazolin, penicillin G, gentamicin, azithromycin, and levofloxacin. The rate of extended spectrum β-lactamase (ESBLs)-producing enterobacteria and multi-drug resistant Pseudomonas aeruginosa (MDR-PA) infection was significantly higher in the study group than in the control group; there was no difference in multi-drug resistant Acinetobacter baumannii (MDR-AB), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) between the two groups. The duration of hospitalization and the duration of antimicrobial drug administration were longer in the study group than in the control group.ConclusionThe pathogenic bacteria in patients with sepsis bloodstream infection with renal insufficiency are mainly Gram-negative bacteria, are more difficult to be cured, have a longer course of treatment, and need to use antibacterial drugs for a long time.

Secondary bacterial infections are a leading factor triggering New Onset Atrial Fibrillation in intubated ICU Covid-19 ARDS patients

BackgroundCardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, more often in Intensive Care Unit (ICU) patients, yet causality has not been virtually explored. Moreover, non-Covid ICU patients frequently present AF, sepsis being the major trigger. We aimed to examine whether sepsis or other factors-apart from Covid-19 myocardial involvement-contribute to elicit New Onset AF (NOAF) in intubated ICU patients. MethodsConsecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, laboratory findings (troponin as well), severity of illness and ARDS were compared between NOAF and control group (no AF) on admission. In NOAF patients, echocardiographic findings, laboratory and secondary infection data on the AF day were compared to the preceding days and/or ICU admission data. ResultsAmong 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. Left ventricular global longitudinal strain was impaired (<16.5%) in 63% vs 78% in the two groups, respectively. The right ventricle was mildly dilated, and pericardial effusion was present in 52 vs 43%, respectively. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICUday. A septic secondary infection episode occurred in 89.5% of the patients in the NOAF group ( vs 41.6% in the control group (p < 0.001). In fact, NOAF occurred concurrently with a secondary septic episode in 84.2% of the patients. Sepsis presence was the only factor associated to NOAF occurrence (OR 16.63, p = 0.002). Noradrenaline, lactate and inflammation biomarkers gradually increased in the days before AF (all p < 0.05). Echocardiographic findings did not change on NOAF occurrence. ConclusionSecondary infections seem to be major contributors for NOAF occurrence in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.

Macrophage-derived exosomal aminopeptidase N aggravates sepsis-induced acute lung injury by regulating necroptosis of lung epithelial cell

Sepsis-induced acute lung injury (ALI) is a serious sepsis complication and the prevailing cause of death. Circulating plasma exosomes might exert a key role in regulating intercellular communication between immunological and structural cells, as well as contributing to sepsis-related organ damage. However, the molecular mechanisms by which exosome-mediated intercellular signaling exacerbate ALI in septic infection remains undefined. Therefore, we investigated the effect of macrophage-derived exosomal APN/CD13 on the induction of epithelial cell necrosis. Exosomal APN/CD13 levels in the plasma of septic mice and patients with septic ALI were found to be higher. Furthermore, increased plasma exosomal APN/CD13 levels were associated with the severity of ALI and fatality in sepsis patients. We found remarkably high expression of APN/CD13 in exosomes secreted by LPS-stimulated macrophages. Moreover, c-Myc directly induced APN/CD13 expression and was packed into exosomes. Finally, exosomal APN/CD13 from macrophages regulated necroptosis of lung epithelial cells by binding to the cell surface receptor TLR4 to induce ROS generation, mitochondrial dysfunction and NF-κB activation. These results demonstrate that macrophage-secreted exosomal APN/CD13 can trigger epithelial cell necroptosis in an APN/CD13-dependent manner, which provides insight into the mechanism of epithelial cell functional disorder in sepsis-induced ALI.

C Reactive Protein and Procalcitonine as Diagnostic Markers in Critically Ill Patients with Suspected Sepsis

Abstract The primary aim of this retrospective study was to estimate significance of determining C-reactive protein and procalcitonine for a diagnosis of sepsis in adult patients in early triage. Also, the aim of this study was to measure the sensitivity of the SIRS criteria, PCT and CRP levels and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the Emergency Department (ED) triage. All patients were divided into two groups according to specific criteria for defining sepsis. First group (SIRS+ group) of patients were patients with clinically and/or laboratory confirmed sepsis (or systemic inflammatory response syndrome (SIRS) to bacterial infection with different localization). For confirmation of the SIRS we consider positive two or more clinical criteria (≥2 clinical criteria). The SIRS criteria use the clinical criteria of the Surviving Sepsis Campaign (SSC) for the SIRS, comprising at least two of the following criteria: HR &gt; 90/min, RR &gt; 20/min and temperature &lt; 36° or ≥ 38.3°C and the next laboratory parameters such as leucocytosis &gt; 15x109/L, leucopenia &lt; 4x109/L, &gt; 10% immature leucocytes. Second group of patients were patients with the SIRS negative criteria as a diagnostic tool (SIRS- group). We have founded that the CRP showed high sensitivity but no specificity in patients with sepsis, but on the other side, the PCT as a diagnostic marker showed a high sensitivity and high specificity in these patients. Also, the PCT is in positive correlation with the SIRS criteria, which could be of a clinical significance in early diagnosis of septic infections.

MP09-01 THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN TRANSPERINEAL PROSTATE BIOPSY: A SYSTEMATIC REVIEW AND METANALYSIS

You have accessJournal of UrologyCME1 May 2022MP09-01 THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN TRANSPERINEAL PROSTATE BIOPSY: A SYSTEMATIC REVIEW AND METANALYSIS Spyridon Basourakos, Mark Alshak, Patrick Lewicki, Emily Cheng, Michael Tzeng, Antonio DeRosa, Matthew Allaway, Ashley Ross, Edward Schaeffer, Hiten Patel, Jim Hu, and Michael Gorin Spyridon BasourakosSpyridon Basourakos More articles by this author , Mark AlshakMark Alshak More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Emily ChengEmily Cheng More articles by this author , Michael TzengMichael Tzeng More articles by this author , Antonio DeRosaAntonio DeRosa More articles by this author , Matthew AllawayMatthew Allaway More articles by this author , Ashley RossAshley Ross More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Hiten PatelHiten Patel More articles by this author , Jim HuJim Hu More articles by this author , and Michael GorinMichael Gorin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy (TPB) is associated with a significantly lower risk of infectious complications as compared to the transrectal approach. In fact, the risk of infectious complications with TPB is so low that the utility of administering peri-procedure antibiotics with this procedure has come under question. Thus, we performed a systematic review and metanalysis to assess for differences in the rates of infectious complications (septic, non-septic, overall) after TPB performed with and without administration of antibiotic prophylaxis. METHODS: Three electronic databases (PubMed, EMBASE and MEDLINE) were searched, and studies were included if they included men who underwent TPB, were published after January 2000, included information on periprocedural antibiotic administration, and reported post-biopsy complications. Preferred Reporting Items for Systematic Reviews and Metanalyses and Agency for Healthcare Research and Quality guidelines were utilized. RESULTS: A total of 106 unique studies describing 112 cohorts of patients were identified where 98 (37,805 men) received antibiotic prophylaxis and 14 (4,772 men) did not receive antibiotic prophylaxis. All men were included in the analysis of septic complications. In total there were 19 (0.05%) episodes of sepsis in the group of antibiotics. The event rate was similar to the no antibiotic group, in which only 4 (0.08%) patients experienced sepsis (p=0.2). For overall infections (septic plus non-septic), there were 58 (1.22%) events versus 403 (1.35%) among 29,880 men with evaluable data who did and did not receive antibiotic prophylaxis, respectively (p=0.8). Restricting to our analysis to studies with a comparable number of biopsy cores, there remained no difference in the rates of sepsis between groups. In this analysis we also observed a small but statistically significant lower risk of infectious complications with antibiotic administration (0.55 vs. 1.22%, p<0.01). CONCLUSIONS: The likelihood of septic infections after TPB is low with and without antibiotic prophylaxis. The omission of periprocedural antibiotics with this procedure stands to benefit patients by avoiding potential drug reactions. Furthermore, this practice is in line with calls throughout the medical community for improved antibiotic stewardship. Source of Funding: Jim Hu receives research support from the Dow Wallace Fund of the New York Community Trust and salary support from NIH CA241758, PCORI CER-2019C1-15682 and CER-2019C2-17372 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e135 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spyridon Basourakos More articles by this author Mark Alshak More articles by this author Patrick Lewicki More articles by this author Emily Cheng More articles by this author Michael Tzeng More articles by this author Antonio DeRosa More articles by this author Matthew Allaway More articles by this author Ashley Ross More articles by this author Edward Schaeffer More articles by this author Hiten Patel More articles by this author Jim Hu More articles by this author Michael Gorin More articles by this author Expand All Advertisement PDF DownloadLoading ...

Inhibition of Neutrophil Extracellular Traps Formation by Cl-Amidine Alleviates Lipopolysaccharide-Induced Endometritis and Uterine Tissue Damage.

Simple SummaryThe progression of several inflammatory diseases, including endometritis, has been proven to be enhanced by the process of neutrophil extracellular traps (NETs) formation in pathogenesis. Therefore, averting the formation of NETs could be an effective method to combat endometritis. Cl-amidine has been reported to treat certain inflammatory diseases, but its therapeutic role in combating endometritis remains an enigma as it may likely attenuate NETs formation. Hence, we investigate the potential of NETs formation in the pathogenesis of endometritis using rats and the probable therapeutic indices of Cl-amidine against endometritis. It was revealed that LPS induced endometritis in rats, and the formation of NETs was detected in the rats’ inflamed uterine tissues. The treatment with Cl-amidine showed the regression of LPS-induced endometritis and protection against uterine tissue damage. Cl-amidine effectively reduced the expression of specific proteins that could enhance the formation of NETs, thereby attenuating the inflammatory response to LPS-induced endometritis in rats. Our research showed that Cl-amidine possesses potentially therapeutic properties against endometritis.Endometritis is a common disease that affects the production in dairy cows and leads to severe losses in the dairy industry. Neutrophil extracellular traps (NETs) formation promotes pathogenic invasions of the lumen of the tissue, leading to inflammatory diseases such as mastitis, pancreatitis, and septic infection. However, research that could show the relationship between NETs and endometritis is scarce. Cl-amidine has been shown to ameliorate the disease squealing and clinical manifestation in various disease models. In this study, we investigated the role of NETs in LPS-triggered endometritis in rats and evaluated the therapeutic efficiency of Cl-amidine. An LPS-induced endometritis model in rats was established and found that the formation of NETs can be detected in the rat’s uterine tissues in vivo. In addition, Cl-amidine treatment can inhibit NETs construction in LPS-induced endometritis in rats. Myeloperoxidase (MPO) activity assay indicated that Cl-amidine treatment remarkably alleviated the inflammatory cell infiltrations and attenuated the damage to the uterine tissue. The Western blot results indicated that Cl-amidine decreased the expression of citrullinated Histone H3 (Cit-H3) and high-mobility group box 1 protein (HMGB1) protein in LPS-induced rat endometritis. The ELISA test indicated that Cl-amidine treatment significantly inhibited the expression of the pro-inflammatory cytokines IL-1β, IL-6, and TNF-α. The NETs were determined by Quant-iTTMPicoGreen dsDNA kit®, which indicated that Cl-amidine significantly inhibited the NETs in rat serum. All results showed that Cl-amidine effectively reduced the expression of Cit-H3 and HMGB1 proteins by inhibiting the formation of NETs, thereby attenuating the inflammatory response to LPS-induced endometritis in rats. Hence, Cl-amidine could be a potential candidate for the treatment of endometritis.

The Necessity of Individualized Treatment for Sepsis-Associated Disseminated Intravascular Coagulation by Infected Organ.

ObjectiveSeveral studies have shown that anticoagulation can improve survival outcomes in patients with sepsis-associated disseminated intravascular coagulation (DIC). A guideline from Japan in 2020 suggested two therapeutic agents for sepsis-associated DIC treatment: antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparation. In 2021, our preliminary study proposed that different organs of septic infection might lead to distinct treatment outcomes following different therapies against DIC. In this study, we created a subanalysis on the influence of AT replacement therapy and rTM preparations on overall survival (OS) by comparing two causative organs: biliary and respiratory tract infections.Patients and MethodsThis retrospective cohort study in a single institution involved patients with sepsis-associated DIC treated by either AT or rTM who were categorized based on sources of infection. The two groups defined for this study were biliary (n = 62) and respiratory tract infection (n = 84). To assess the clinical efficacy of AT and rTM, 30-day OS was examined using a stepwise variable selection for a Cox proportional hazards model.ResultsThe analysis of factors influencing OS by each group showed that rTM preparation remained a significant factor in the biliary tract infection group (HR 0.306, 95% CI 0.133–0.706). In the respiratory tract infection group, the score of the Acute Physiology and Chronic Health Evaluation II (HR 1.109, 95% CI 1.051–1.170), polymyxin B hemoperfusion (HR 0.390, 95% CI 0.161–0.944), and AT replacement therapy (HR 0.510, 95% CI 0.261–0.997) were established as significant factors.ConclusionThis study revealed that the OS of patients with biliary tract and respiratory tract infections differed depending on the DIC therapeutic agent. Based on these results, we could suggest that it is necessary to develop individualized treatment strategies for septic infections, taking into consideration the differences in the infected organs.

Generalized infections of putative oral origin in Helsinki University Hospital in 2012 to 2017.

Bacteria entering the bloodstream through oral mucosa cause bacteremia, which can lead to septic or distant infections. The underlying factors and need for dental treatment in patients referred for oral examination because of septic infection were investigated. It was expected that general diseases and poor socioeconomic status of patients would increase the risk of bacteremia. This descriptive retrospective study included patients (N = 128) referred from medical clinics of the Helsinki University Hospital (HUH), during 2012 to 2017, to the Department of Oral and Maxillofacial Diseases due to bacteremia suspected to be of oral origin. Data were extracted from medical and dental records according to the World Health Organization International Classification of Diseases (ICD-10) for systemic or remote infections. Different groups were formed using modified Skapinakis classification for socioeconomic status (SES), from I (high) to V (low). Underlying medical conditions were retrieved according to McCabe classification: healthy, nonfatal, ultimately fatal, and rapidly fatal diseases. The data were analyzed using the statistical software package SPSS (IBM). Patients were referred most often from the Departments of Infectious Diseases and Internal Medicine. Because of infection, 12 patients needed aortic or mitral valve operations. Many of the patients were intravenous drug users. However, the majority of patients presented McCabe class I, indicating no systemic disease. The main SES was intermediate III. Tooth extraction was the principal mode of treatment. No demographic background variables were identified to explain increase of the risk for bacteremia except that most patients were men with untreated dental problems. Contrary to the authors' expectation, poor SES and underlying diseases did not seem to link to the outcome. However, untreated dental infections present an evident risk for life-threatening septic complications also in generally healthy individuals.

Functional vulnerability of liver macrophages to capsules defines virulence of blood-borne bacteria.

Many encapsulated bacteria use capsules to cause invasive diseases. However, it remains largely unknown how the capsules enhance bacterial virulence under in vivo infection conditions. Here we show that the capsules primarily target the liver to enhance bacterial survival at the onset of blood-borne infections. In a mouse sepsis model, the capsules enabled human pathogens Streptococcus pneumoniae and Escherichia coli to circumvent the recognition of liver-resident macrophage Kupffer cells (KCs) in a capsular serotype-dependent manner. In contrast to effective capture of acapsular bacteria by KCs, the encapsulated bacteria are partially (low-virulence types) or completely (high-virulence types) "untouchable" for KCs. We finally identified the asialoglycoprotein receptor (ASGR) as the first known capsule receptor on KCs to recognize the low-virulence serotype-7F and -14 pneumococcal capsules. Our data identify the molecular interplay between the capsules and KCs as a master controller of the fate and virulence of encapsulated bacteria, and suggest that the interplay is targetable for therapeutic control of septic infections.

Искусственная вентиляция легких как фактор риска развития внутрибольничной пневмонии у пациентов отделения анестезиологии и реанимации кардиохирургического стационара

Hospital-acquired pneumonia (HAP) is the most common purulent septic infection among patients treated in intensive care units (ICUs) at cardiac surgery hospitals. Risk factors that can cause HAP, in particular, contribution made by artificial ventilation (AV) have not been studied enough. Our objective was to examine an epidemiological role played by AV in HAP occurrence among children and adults treated in the intensive care unit at a cardiac surgery hospital. We examined health records of 5318 patients (503 children and 4815 adults) who had a cardiac surgery due to congenital heart diseases or acquired cardiovascular disorders over 1 year. HAP was identified according to the epidemiological standards for case definition. Besides, we took into account pre-nosologic HAP cases, that is, patients already having certain pathological symptoms typical for purulent septic infections, but still, even combined, these symptoms were not enough to diagnose a typical HAP case in accordance with the standard case definition. Data were statistically analyzed by calculating the χ2 goodness-of-fit test. We established that most HAP cases occurred among patients of a cardiac surgery hospital who were being treated in the intensive care unit after a surgery. We proved AV to be the leading risk factor causing HAP. Higher incidence rates of HAP were detected among children in comparison with adults. We showed that Klebsiella pneumoniaе was the primary infectious agent that caused HAP. Particularly, background respiratory diseases and diseases of the central nervous system were proven to be endogenous risk factors of developing HAP among patients treated in the ICU at a cardiac surgery hospital.

Artificial ventilation as a risk factor causing hospital-acquired pneumonia (hap) in patients treated in the intensive care unit of a cardiac surgery hospital

Hospital-acquired pneumonia (HAP) is the most common purulent septic infection among patients treated in intensive care units (ICUs) at cardiac surgery hospitals. Risk factors that can cause HAP, in particular, contribution made by artificial ventilation (AV) have not been studied enough. Our objective was to examine an epidemiological role played by AV in HAP occurrence among children and adults treated in the intensive care unit at a cardiac surgery hospital. We examined health records of 5318 patients (503 children and 4815 adults) who had a cardiac surgery due to congenital heart diseases or acquired cardiovascular disorders over 1 year. HAP was identified according to the epidemiological standards for case definition. Besides, we took into account pre-nosologic HAP cases, that is, patients already having certain pathological symptoms typical for purulent septic infections, but still, even combined, these symptoms were not enough to diagnose a typical HAP case in accordance with the standard case definition. Data were statistically analyzed by calculating the χ2 goodness-of-fit test. We established that most HAP cases occurred among patients of a cardiac surgery hospital who were being treated in the intensive care unit after a surgery. We proved AV to be the leading risk factor causing HAP. Higher incidence rates of HAP were detected among children in comparison with adults. We showed that Klebsiella pneumoniaе was the primary infectious agent that caused HAP. Particularly, background respiratory diseases and diseases of the central nervous system were proven to be endogenous risk factors of developing HAP among patients treated in the ICU at a cardiac surgery hospital.

Применение препарата Грандазол для профилактики и лечения гнойных инфекций в колоректальной хирургии

В статье приведены материалы по изучению применения комбинированного препарата Грандазол в сравнении с раздельным использованием левофлоксацина и орнигила для лечения гнойной патологии параректальной области и профилактики инфекционных осложнений в раннем послеоперационном периоде у колопроктологических больных, перенесших абдоминальные оперативные вмешательства. Проанализирована эффективность препарата Грандазол у 122 пациентов. Результаты исследования свидетельствуют о высокой антибактериальной эффективности, возможности использования препарата Грандазол в качестве препарата выбора для лечения гнойных инфекций перианальной области и профилактики инфекционных осложнений у колопроктологических больных, перенесших полостные оперативные вмешательства.

Спектр протимікробних властивостей настоянок лікарських рослин

У статті обговорені біологічні властивості рослинних препаратів, що не є настільки широко використовуваними в практичній медицині, тому їх призначення при гнійно-септичних інфекціях не могло спричинити поширеної стійкості до них. Метою роботи було встановлення та порівняння спектра протимікробних властивостей настоянок лікарських рослин для формування резерву нових джерел протимікробних засобів, одними з яких можуть бути екстракти з рослин. Скринінг протимікробних властивостей іn vitro провели для 12 рослинних настоянок на 15 тест-штамах мікроорганізмів. Виявлено наявність протимікробних властивостей у настоянок лікарських рослин, найпереконливіші результати відзначені в настоянок арніки гірської, ехінацеї пурпурової та евкаліпту. Щодо референтних штамів мікроорганізмів, мінімальна інгібуюча та мінімальна бактерицидна концентрації яких коливались від 1 : 128 до 1 : 32, помірна активність відзначена у настоянок м’яти перцевої та софори японської з показниками від 1 : 32 до 1 : 8. У свою чергу, спектр протимікробних властивостей виявився широким до колекційних штамів, що було прогнозованим, але на особливу увагу заслуговують результати, отримані з дослідження впливу на клінічні штами мікроорганізмів, які є поліантибіотикорезистентними. Так, протимікробна активність настоянок рослинного походження зменшувалась на одне розведення щодо кожного чутливого виду, а інколи співпадала, що свідчить про відсутність стійкості до даних препаратів і визначає як рівномірно чутливі референтні колекційні та клінічні штами до екстрактів рослин. Отримані результати продемонстрували, що екстракти рослин є потенційним резервом для формування нових джерел протимікробних засобів, особливо стосовно антибіотикорезистентних клінічних штамів мікроорганізмів, які формуються під постійним впливом синтетичних і напівсинтетичних препаратів.

Risk Factors of Septic Metastatic Infection among Patients with Klebsiella pneumoniae Liver Abscess in Singapore: A Case-Control Study.

Metastatic infection resulting from Klebsiella pneumoniae liver abscess (KPLA) results in high mortality and morbidity. This study aimed to determine the risk factors associated with metastatic infection among patients with KPLA in Singapore. A retrospective case-control analysis among adult patients admitted to the National University Hospital with KPLA between 2013 and 2017 was conducted. Univariate and multivariate regression analysis was conducted. Of the 116 KPLA patients, 38.8% had pulmonary metastatic infection. Length of hospital stay (P = 0.001) and intensive care unit admissions (P = 0.044) were significantly longer and greater, respectively, among the patients with metastatic infection. Sepsis-induced hypotension (adjusted odds ratio [AOR], 4.88; 95% CI, 1.1-21.69), breathlessness (AOR, 5.10; 95% CI, 1.42-18.27), and abscess size (AOR, 1.02; 95% CI, 1.01-1.03) were associated independently with septic metastatic infection. Patients with KPLA who had breathlessness and larger abscess size are at a greater risk of septic metastatic infection.