Significant Increase In Infections Research Articles

MECHANISMS OF FUNGAL RESISTANCE IN CANDIDA SPECIES AND THEIR GLOBAL IMPACT

INTRODUCTION: Most hospital-acquired infections are caused by Candida fungal species. Currently, infections stemming from various species of this fungus affect over 250,000 people annually, with mortality exceeding 50,000 individuals¹. OBJECTIVE: To examine the resistance mechanisms in Candida species and assess their worldwide impact. METHODS: This study employed a descriptive approach combining qualitative and quantitative analyses through a bibliographic review in the PubMed and Google Scholar databases. The search utilized the descriptors “resistance Candida”, “Candida”, “Candida antifungal resistance”, and “resistência cândida”. Seven articles — six international and one national — focused on fungal resistance were selected based on the eligibility criteria of being scientific studies published within the last five years. RESULTS: A significant increase in infections caused by various Candida species was observed¹. In the field of molecular biology, fungal resistance to antifungal agents is predominantly linked to several mechanisms, the most notable being resistance to azoles1,2,4, echinocandins1,2, and polyenes5. This resistance is driven by key adaptive mechanisms in these pathogens, including: overexpression of active sites, biofilm formation—particularly mature biofilms known as extracellular polymeric substances (EPS)6, alterations in the target enzyme lanosterol 14α-demethylase5,6, mutations in the FKS gene², and dysregulated expression of efflux pump-encoding genes (CDR1, CDR2, MDR1, and MDR2)5,6. Moreover, mutations in the ERG2, ERG3, ERG6, and ERG112,3,5 genes have been identified as contributors. These factors, whether acting independently or synergistically, present significant challenges in the treatment of Candida infections. DISCUSSION: Nosocomial infections caused by various Candida species have shown a global increase in incidence and prevalence. Species of the genus Candida represent a significant global health concern due to the emergence of new resistant strains and the presence of species better adapted to antifungal agents. This trend makes these infections challenging to treat, as resistance mechanisms may occur individually or in combination6. Consequently, there is an intrinsic relationship between the genomic plasticity of this fungal genus and the accumulation of mutations that contribute to fungal resistance2,3,5. CONCLUSION: Hospital-acquired infections caused by Candida are on the rise, exhibiting resistance mechanisms that complicate treatment. Advancing research into new therapies and raising awareness about the appropriate use of antifungal agents are crucial steps to effectively combat these infections and improve clinical outcomes.

Investigating the Effects of Microclimate on Arboviral Kinetics in Aedes aegypti

Aedes aegypti are indoor-dwelling vectors of many arboviruses, including Zika (ZIKV) and chikungunya (CHIKV). The dynamics of these viruses within the mosquito are known to be temperature-dependent, and models that address risk and predictions of the transmission efficiency and patterns typically use meteorological temperature data. These data do not differentiate the temperatures experienced by mosquitoes in different microclimates, such as indoor vs. outdoor. Using temperature data collected from Neiva Colombia, we investigated the impact of two microclimate temperature profiles on ZIKV and CHIKV infection dynamics in Ae. aegypti. We found that the vector mortality was not significantly impacted by the difference in temperature profiles. Further, we found that the infection and dissemination rates were largely unaffected, with only ZIKV experiencing a significant increase in infection at outdoor temperatures at 21 days post-infection (dpi). Further, there was a significant increase in viral titers in the abdomens of ZIKV-infected mosquitoes at 21 dpi. With CHIKV, there was a significant titer difference in the abdomens of mosquitoes at both 7 and 14 dpi. While there were differences in vector infection kinetics that were not statistically significant, we developed a simple stochastic SEIR-SEI model to determine if the observed differences might translate to notable differences in simulated outbreaks. With ZIKV, while the probability of secondary transmission was high (>90%) under both microenvironmental scenarios, there was often only one secondary case. However, CHIKV differences between microenvironments were more prominent. With over 90% probability of secondary transmission, at indoor conditions, the peak of transmission was higher (over 850 cases) compared to the outdoor conditions (<350 cases). Further, the time-to-peak for indoor was 130 days compared to 217 days for outdoor scenarios. Further investigations into microenvironmental conditions, including temperature, may be key to increasing our understanding of the nuances of CHIKV and ZIKV vectorial capacity, epidemiology, and risk assessment, especially as it affects other aspects of transmission, such as biting rate. Overall, it is critical to understand the variability of how extrinsic factors affect transmission systems, and these data add to the growing catalog of knowledge of how temperature affects arboviral systems.

Molecular Epidemiology of Carbapenemase-Producing Pseudomonas aeruginosa: An Iranian Referral Hospital-Based Study.

In recent years, there has been a significant increase in infections caused by carbapenemase-producing strains, with carbapenem-resistant Pseudomonas aeruginosa (CRPA) emerging as a priority pathogen according to the World Health Organization. This study aimed to evaluate the molecular epidemiology of CRPA isolated from patients referred to Children's Medical Center in Tehran, Iran. P. aeruginosa isolates collected from different children's wards were screened for common carbapenem-resistant genes by polymerase chain reaction (PCR). Genetic relatedness between isolates was assessed by pulsed-field gel electrophoresis (PFGE). The study included 133 participants, with 50% being male, and revealed a median age of 2 years (interquartile range: 6 months to 6 years). Carbapenem resistance was detected in 15% of cases (n = 20), with CRPA isolates predominantly found in the emergency ward (60%). The median age of patients with CRPA was significantly higher than those with carbapenem-susceptible P. aeruginosa (6 years vs. 1 year). PCR analysis revealed metallo-β-lactamase production in 45% of CRPA isolates (n = 9), with blaNDM being the most prevalent gene. PFGE analysis of the CRPA isolates identified three clusters (Cluster I, II, and III). Cluster I, comprising 65% of all isolates (n = 13), was predominantly found in the emergency ward. Notably, blaNDM-producing strains were prevalent in the emergency ward. Our study highlights the significant prevalence of CRPA in the emergency ward of our hospital and underscores the importance of targeted surveillance and infection control measures to curb its spread within health care settings.

898 Is Primary Total Hip Arthroplasty Safe in Recipients of Solid Organ Transplants, and What Are the Considerations? a Systematic Review and Meta-analysis

Abstract Aim Solid organ transplantation (SOT) is rising, with improvements in surgical technique and immunosuppressive therapy increasing patient survival. Age-related degeneration and long-term steroid therapy in SOT recipients lead to higher incidence of osteoarthritis and osteonecrosis. Total hip arthroplasty (THA) is offered electively for these indications. This meta-analysis assessed THA-related complications in SOT versus non-SOT recipients, reporting revision, infection rates, and all-cause mortality. Method This review was carried out using the PRISMA framework. A literature search of Medline, Embase, Transplant library, and Cochrane Library was carried out. Full text articles were screened. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest plots for Odds Ratio (OR). Results Literature search returned 1164 unique titles/s. 36 met inclusion criteria; 6 were retrospective cohort-studies. Meta-analysis of 5 studies showed no evidence of significant increase in revision rates with prior SOT, OR=0.67 (95%CI: 0.36-1.23, p=0.19). Meta-analysis of 6 studies showed no significant increase in infection (joint/surgical site) infection with prior SOT, OR=1.18 (95%CI: 0.40-3.50, p=0.77). Meta-analysis of 3 studies showed significant increase in all-cause mortality over 12 months post-arthroplasty, OR=1.99 (95%CI: 0.99-3.99, p=0.05). We report these summary statistics for the remaining case series. Conclusions We conclude that there is no significant increase in revision and infection rates for THA in SOT recipients. Consideration of a significant increase in all-cause mortality must be noted prior to offering this procedure to SOT recipients. Prospective studies are needed to assess risks/benefits of THA in SOT recipients.

Immunoglobulin Replacement Therapy During COVID-19 Pandemic: Practical and Psychological Impact in Patients with Antibody Deficiency.

The COVID-19 pandemic has impacted on how health services deliver care and the mental health of the population. Due to their clinical vulnerability, to reduce in-hospital attendances during the COVID-19 pandemic, modifications in immunoglobulin treatment regimens were made for patients with antibody deficiency. These patients were also likely to experience social isolation due to shielding measure that were advised. We aimed to investigate the impact of modifying immunoglobulin treatment regimen on infection and mental health burden during shielding restrictions. Patients on immunoglobulin replacement therapy (IGRT) responded to a standardised questionnaire examining self-reported infection frequency, anxiety (GAD-7), depression (PHQ-8), fatigue (FACIT), and quality of life during the pandemic. Infection frequency and immunoglobulin trough levels were compared to pre-pandemic levels. Patients who did not change treatment modality or those who received immunoglobulin replacement at home during the pandemic reported fewer infections. In patients who received less frequent hospital infusions, there was no significant increase in infections whilst immunoglobulin trough levels remained stable. There was no significant difference in anxiety, or depression scores between the treatment modality groups. Patients reported higher fatigue scores compared to the pre-COVID general population and in those discharged following hospitalisation for COVID. Changing immunoglobulin treatment regimen did not negatively impact infection rates or psychological wellbeing. However, psychological welfare should be prioritised for this group particularly given uncertainties around COVID-19 vaccination responsiveness and continued social isolation for many.

Investigation on the Epidemiology and Pathogenesis Characteristics of <i>Staphylococcus pseudintermedius</i>-Associated Veterinary Hospital Infections

A retrospective analysis of the diagnostic laboratory submissions from 2016 to 2020 was performed to assess the antibiotic resistance of Staphylococcus pseudintermedius and determine locations in the hospital which might be acting as environmental source(s). Previous studies have identified a significant increase in infections with S. pseudintermedius. Samples were taken from the hospital environment by swabbing areas in the intensive care unit and anesthesia preparation room and bacterial species identified. Isolates obtained from patients were then examined regarding the ability to form biofilm, an important phenotype on hospital-related infection. In addition, veterinary hospital associated strains of S. pseudintermedius were used to determine the bactericidal effect of the used disinfectant, applying the hospital current protocol, by comparing the efficacy against S. pseudintermediius and a strain of Staphylococcus aureus from a dog. The isolates identified were resistant to commonly used antibiotics such as enrofloxacin and cephalosporins, and 45% percent of those were methicillin resistant. The environmental survey in the hospital identified S. pseudintermedius in the pre-anesthesia area, although the isolate was killed by the current used disinfection protocol. A few disease associated bacteria were evaluated for biofilm formation in comparison to a dog isolate of Staphylococcus aureus, demonstrating strong ability to form biofilms.

The impact of COVID-19 on clinical outcomes of burn patients

Abstract Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517–2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798–4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351–4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326–4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

Musical practice to improve the quality of life in older people

The work that is presented, collects a small sample of older people who participated in a choral group, whose activity was interrupted by covid19. The activities of this group gradually recovered, as the contagions decreased. A series of tests were carried out on a small sample after having resumed musical activity, during the month of March 2022. After the significant increase in infections at the end of December 2022, musical activities were paralyzed and it was measured again with the same tests to the small participating sample in January 2022. The tests used were the WHOQOL-B (Quality of Life Test of the World Health Organization), HADS (Hospital Anxiety and Depression Scale) and the EAR (Scale of Rosemberg's self-esteem). Part of the results obtained are published, highlighting the importance that musical practice had regarding psychological health and interpersonal relationships.

The impact of the absence of musical practice in a group of older people

The work that is presented collects a small sample of older people who participated in a choral group, whose activity was interrupted by covid19. The activities of this group gradually recovered, as the contagions decreased. A series of tests were carried out on a small sample after having resumed musical activity, during the month of March 2022. After the significant increase in infections at the end of December 2022, musical activities were paralyzed and it was measured again with the same tests to the small participating sample in January 2022. The results pointed to the relevant need for musical practice, since the evaluations were much lower in the post test.

The Process of Filopodia Induction during HPV Infection.

Human Papillomavirus 16 (HPV16) infects mucosal and epithelial cells and has been identified as a high-risk HPV type that is an etiologic agent of human cancers. The initial infectious process, i.e., the binding of the virus particle and its entry into the host cell, has been studied extensively, although it is not fully understood. There is still a gap in understanding the steps by which the virus is able to cross the plasma membrane after receptor binding. In this study, we demonstrate that after HPV16 comes into contact with a plasma membrane receptor, there are cytoskeletal changes resulting in an increase of filopodia numbers. This increase in filopodia numbers was transient and was maintained during the first two hours after virus addition. Our data show that there is a statistically significant increase in infection when filopodia numbers are increased by the addition of drug and virus simultaneously, and a decrease in virus infection when filopodia formation is inhibited. We describe that HPV16 binding results in the activation of Cdc42 GTPase that in turn results in an increase in filopodia. siRNA directed at Cdc42 GTPase resulted in a statistically significant reduction of infection and a corresponding lack of filopodia induction.

547 Clinical Outcomes for Burned Patients with Covid-19

IntroductionThe COVID-19 epidemic has affected all aspects of medical care including a reduction in elective procedures, however, the incidence of burns and treatment for this condition has continued undaunted. Some of these patients were also diagnosed with COVID-19 infection, but it is unclear what effect, if any the SARS-CoV 2 virus has on patients recovering from a burn injury. In this study we examined the outcomes of burned patients with a concomitant diagnosis of SARS-CoV 2 virus.MethodsWe examined a de-identified database of patient electronic medical records across 55 health care associations containing over 75 million patients. ICD 10 codes were used to identify those with thermal or chemical burns from January 1, 2020 to July 31, 2021 and those also diagnosed with Sars-CoV 2 virus infection within 1 month of injury. We found 49,501 patients suffered burns during the study time period; of these 474 patients (0.96%) also experienced a concomitant COVID-19 infection. We compared outcomes based on ICD 10 and CPT codes.ResultsWe found no significant increase in mortality between groups during the study period. However, we did find a significant increase in infections, pneumonia, respiratory failure and sepsis in those with Sars-CoV infection (p< 0.05). However, there was no significant increase in ventilator management days (p >0.05) In terms of wound healing, patients with COVID-19 also experienced significantly more excision and grafting procedures and had a higher incidence of hypertrophic scarring (p< 0.05).ConclusionsCOVID-19 infection is well known to worsen respiratory outcomes, but in burned patients was also associated with an increase in other infections and poorer wound outcomes. These outcomes may emanate from a change in inflammatory status for patients with the SAR-CoV 2 virus infection. This is the first broad-based study to examine outcomes of burn victims with concomitant SARS-CoV 2 infection. Further investigation is indicated as more long-term data becomes available.

Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation.

IntroductionCoronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved.ObjectiveThis first in a two-part series on COVID-19 updates provides a focused overview of the presentation and evaluation of COVID-19 for emergency clinicians.DiscussionCOVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. Several variants exist, including a variant of concern known as Delta (B.1.617.2 lineage) and the Omicron variant (B.1.1.529 lineage). The Delta variant is associated with higher infectivity and poor patient outcomes, and the Omicron variant has resulted in a significant increase in infections. While over 80% of patients experience mild symptoms, a significant proportion can be critically ill, including those who are older and those with comorbidities. Upper respiratory symptoms, fever, and changes in taste/smell remain the most common presenting symptoms. Extrapulmonary complications are numerous and may be severe, including the cardiovascular, neurologic, gastrointestinal, and dermatologic systems. Emergency department evaluation includes focused testing for COVID-19 and assessment of end-organ injury. Imaging may include chest radiography, computed tomography, or ultrasound. Several risk scores may assist in prognostication, including the 4C (Coronavirus Clinical Characterisation Consortium) score, quick COVID Severity Index (qCSI), NEWS2, and the PRIEST score, but these should only supplement and not replace clinical judgment.ConclusionThis review provides a focused update of the presentation and evaluation of COVID-19 for emergency clinicians.

Association between Inhaled Corticosteroid Use and SARS-CoV-2 Infection: A Nationwide Population-Based Study in South Korea.

BackgroundAlthough it is known that inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, its influence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Thus, the aim of this study was to investigate the association between ICS use and the positivity of SARS-CoV-2 infection among patients with chronic respiratory diseases.MethodsNationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15, 2021 were obtained from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test.ResultsAmong 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed no significant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66–1.03). Moreover, there were no associations between the positivity of infection and the dose or type of ICS prescribed.ConclusionPrior ICS use did not increase the positivity for SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect this positivity.

The Impact of Tocilizumab Treatment for Cytokine Release Syndrome on the Incidence of Blood Stream Infections after Peripheral Blood Haploidentical Hematopoietic Cell Transplantation

Introduction: Cytokine release syndrome (CRS) is a potentially fatal systemic inflammatory response that can occur in patients undergoing haploidentical hematopoietic cell transplantation (haplo-HCT). IL-6 inhibitors, such as tocilizumab, are effective therapy in moderate to severe cases. Several studies have shown there to be a significant increase in infections with the use of tocilizumab in patients with rheumatoid arthritis, where it is given on a long term basis unlike in the post-haplo-HCT setting, where tocilizumab is rarely given for more than a few days. Severe CRS has been associated with increased infection risk in prior studies. However, the effect of anti-IL-6 therapy on infection risk has not been well established in the early haplo-HCT setting.In this study, we examined the effect of tocilizumab for treatment of CRS on the incidence of blood stream infections (BSIs) in the early post peripheral blood haplo-HCT setting.Patients and Methods: We performed a retrospective analysis of 235 patients who underwent T cell-replete peripheral blood haplo-HCTs from 2013 to 2020, stratified on CRS grade (graded by Lee criteria) and tocilizumab administration, for incidence of BSI. Positive blood cultures during days +2 to +28 post-haplo-HCT were included. Patients with positive blood cultures during the immediate peri-transplant period (days -5 to +1) were excluded as infection preceded CRS and tocilizumab administration. Patients who had positive blood cultures within 48 hours of CRS diagnosis were excluded as sepsis cannot be distinguished from CRS.Results: The overall incidence of bloodstream infection was 17% with 41 out of the total 235 patients having positive blood cultures. Patients with mild CRS had lower incidence of infection than patients with severe CRS (OR 0.31, 95% CI 0.13-0.74, p=0.0086). In the tocilizumab group, 31% (15/49) of patients had positive blood cultures compared with 14% (26/186) in the non-tocilizumab group (OR 1.61, 95% CI 0.30-8.60, p=0.58). However, after controlling for CRS grade, tocilizumab administration was not associated with higher rates of BSIs for any grade of CRS.Conclusions: Severe CRS after haplo-HCT is associated with higher risk of early BSI. However, tocilizumab therapy does not further increase risk of BSI in the early post-haplo-HCT setting. These data suggest that tocilizumab, a potentially life saving therapy, can be given without increasing risk of blood stream infections after haplo-HCT. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Investigating the relationship of schools reopening to increases in COVID-19 infections using event study methodology: The case of the Delta variant.

Hypothesis: School reopening had a significant impact on COVID-19 infection rates across USA states. Eight states with fully reopened public schools were studied. States who did not previously have stay-at-home orders for a minimum of 30days were excluded from the study so that increases in infection rates would be solely due to the economies of reopening. This study used event study methodology with a 30-day estimation window. This allowed us to determine if increases in COVID-19 infection rates were significant following schools reopening. Eight states were analyzed, and seven of the states had positive and significant COVID-19 infection increases. The other state's increase was negative and significant. This study found that reopening of schools had an initial 5-day increase in COVID-19 infections in seven of eight states whose data were examined. With schools being re-opened nationwide in Fall 2021, this indicates that with the Delta variant there is an expected significant increase in infections.

Therapeutic Significance of microRNA-Mediated Regulation of PARP-1 in SARS-CoV-2 Infection.

The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 (2019-nCoV) has devastated global healthcare and economies. Despite the stabilization of infectivity rates in some developed nations, several countries are still under the grip of the pathogenic viral mutants that are causing a significant increase in infections and hospitalization. Given this urgency, targeting of key host factors regulating SARS-CoV-2 life cycle is postulated as a novel strategy to counter the virus and its associated pathological outcomes. In this regard, Poly (ADP)-ribose polymerase-1 (PARP-1) is being increasingly recognized as a possible target. PARP-1 is well studied in human diseases such as cancer, central nervous system (CNS) disorders and pathology of RNA viruses. Emerging evidence indicates that regulation of PARP-1 by non-coding RNAs such as microRNAs is integral to cell survival, redox balance, DNA damage response, energy homeostasis, and several other cellular processes. In this short perspective, we summarize the recent findings on the microRNA/PARP-1 axis and its therapeutic potential for COVID-19 pathologies.

The Impact of Narrowing Perioperative Antibiotic Prophylaxis for Left-Ventricular-Assist Device Implantation

Background: Left-ventricular-assist device (LVAD)–related infections occur in 20%–40% of LVAD recipients and may result in up to 10% of LVAD-related deaths. Optimal surgical infection prophylaxis for LVAD implantation is not well defined. Our institution historically used a 4-drug surgical infection prophylaxis regimen of fluconazole, ciprofloxacin, rifampin, and vancomycin as recommended by the device manufacturer. In January 2020, a 2-drug surgical infection prophylaxis regimen of vancomycin and cefazolin was implemented to reduce broad-spectrum antibiotic use while preserving gram-positive coverage. The primary objective of this study was to compare LVAD-associated infection rates before and after changing surgical infection prophylaxis. Methods: A retrospective review of patients who underwent LVAD implantation between January 2018 and January 1, 2021, was performed. Definitions of LVAD-associated infections and non-LVAD infections were based on the International Society for Heart and Lung Transplantation guidelines. Infection rates at 2 weeks and 30 days after implantation and 30-day mortality were compared between the 4-drug surgical infection prophylaxis regimen (January 2018–December 2019) and the 2-drug regimen (January 2020–January 2021). Additional data collected included demographics, cause of cardiomyopathy, type of infection, and causative organism. Results: In total, 51 patients were in the 4-drug surgical infection prophylaxis group and 23 patients were in the 2-drug surgical infection prophylaxis group. Baseline characteristics between the groups were similar. The cause of cardiomyopathy in both groups was predominantly nonischemic (67% vs 70%, = .81), and most patients received a Heartmate III device (84% vs 100%, P = .06). There was no statistical difference between infection rates in the 4-drug and 2-drug prophylaxis groups at 2 weeks or 30 days (Table 1). The 30-day mortality rate was 4% in the 4-drug group versus 13% in the 2-drug group (P = .17). No deaths were due to infections. Gram-negative and fungal LVAD–associated infections were rare: 4% versus 4% (P = .99) for gram-negative infections and 2% versus 0% (P = .99) for fungal infections. The most commonly isolated organisms were Staphylococcus aureus and coagulase-negative Staphylococcus in both groups. Pneumonia was the most common infection in both groups (Figure 1). Conclusions: We did not observe a significant increase in infection or mortality with narrowing of perioperative antibiotics. However, these results should be interpreted cautiously given the small sample size. Larger studies are needed to confirm these findings.Funding: NoDisclosures: None

Covid-19 1 year on: The challenge for low-middle income countries.

Covid-19 1 year on: The challenge for low-middle income countries.

Bacteriocins: An Overview of Antimicrobial, Toxicity, and Biosafety Assessment by in vivo Models.

The world is facing a significant increase in infections caused by drug-resistant infectious agents. In response, various strategies have been recently explored to treat them, including the development of bacteriocins. Bacteriocins are a group of antimicrobial peptides produced by bacteria, capable of controlling clinically relevant susceptible and drug-resistant bacteria. Bacteriocins have been studied to be able to modify and improve their physicochemical properties, pharmacological effects, and biosafety. This manuscript focuses on the research being developed on the biosafety of bacteriocins, which is a topic that has not been addressed extensively in previous reviews. This work discusses the studies that have tested the effect of bacteriocins against pathogens and assess their toxicity using in vivo models, including murine and other alternative animal models. Thus, this work concludes the urgency to increase and advance the in vivo models that both assess the efficacy of bacteriocins as antimicrobial agents and evaluate possible toxicity and side effects, which are key factors to determine their success as potential therapeutic agents in the fight against infections caused by multidrug-resistant microorganisms.

Performance of a pre-administration infection screening questionnaire in patients with rheumatoid arthritis administered biological disease-modifying antirheumatic drugs.

Pre-administration screening of active infections is imperative for the safe use of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). However, a standardized screening method is lacking. We therefore implemented a novel systematic screening method with a simple predetermined questionnaire on infections and assessed its effectiveness. We retrospectively reviewed medical records of individuals for whom intravenous bDMARDs were administered for RA from January 2016 to April 2019. We evaluated the performance of the new screening method based on physicians' assessments. In addition, a survey was administered to nurses, regarding their assessment of the usefulness of this new screening. The incidence of infections was also assessed. A total of 1636 cases underwent this new screening. The new screening method showed high sensitivity (0.97) and specificity (0.89) with a negative predictive value of 99.9%, as determined based on the physician's decision. Administration of bDMARDs was postponed in 37 (2.5%) patients, and there was only one case in which the screening failed to note an active infection. The nurses' survey demonstrated high agreement (87.5%) about the usefulness of this screening on the grounds of clarity, simplicity, ease, and time-saving effects. There was no significant increase in infections after implementation of this method. Systematic screening with a predetermined simple questionnaire is effective as an infection screening method, with a high negative predictive value. This approach contributes to high satisfaction of nurses and a time-efficient practice by focusing on screen-positive cases without increasing infections.