Streptococcus Viridans Research Articles

Deep Neck Infections: The Effectiveness of Therapeutic Management and Bacteriological Profile

Background and Objectives: Deep neck infections (DNIs) are severe diagnoses that can cause serious complications. However, there are insufficient data to predict the evolution of this pathology. This study aims to review the microbiology of DNIs and to identify the factors that influence prolonged hospitalization. Materials and Methods: The present retrospective cohort observational analytical study analyzed 138 patients with DNIs who were diagnosed and received surgical treatment over a 8-year period. Results: Reduced lymphocyte percentages and increased neutrophil-to-lymphocyte ratios (NLRs) were significantly associated with complications (p < 0.001 and p = 0.0041, respectively). Laryngotracheal infections were significantly associated with complications (25.53%) (p = 0.0004). Diabetes mellitus (DM) and immunocompromised status were strongly associated with complications (p < 0.001 and p = 0.0056, respectively), establishing these conditions as significant risk factors. Patients with complications experienced substantially longer hospitalizations, with a mean duration of 24.9 days compared to 8.32 days in patients without complications (p < 0.001). Complications were observed in 47 patients (34.06%). The most common complications were airway obstruction, which occurred in 26 patients (18.84%), and mediastinitis, which was noted in 31 patients (22.46%). Patients requiring tracheotomy due to airway obstruction had 6.51 times higher odds of long-term hospitalization compared to those without airway obstruction (OR = 6.51; p < 0.001). Mediastinitis was associated with a 4.81-fold increase in the odds of prolonged hospitalization (OR = 4.81; p < 0.001). Monomicrobial infections were observed in 35.5% of cases, with no significant difference between the short-term (<2 weeks, 37.33%) and long-term (≥2 weeks, 33.33%) hospitalization groups (p = 0.8472). Conversely, polymicrobial infections were significantly associated with prolonged hospitalization, occurring in 20.63% of the long-term cases compared to 6.66% of the short-term cases (p < 0.001). The most common aerobic bacteria observed were Staphylococcus aureus (14.28%), Streptococcus constellatus (12.69%) and Streptococcus viridans (7.93%) during long-term hospitalization. Comparative analysis of the Kaplan–Meier survival curves based on the presence of infection revealed a significantly lower survival in cases with a positive culture. Conclusions: Deep neck infection has a complex pathology, whose therapeutic management remains a challenge in order to reduce the length of hospitalization and mortality.

Polymicrobial Infective Endocarditis with Stroke in a Patient with Metastatic Colorectal Cancer

A rare instance of infective endocarditis by Streptococcus viridans and Lactobacillus spp in an elderly patient with advanced colorectal cancer leading to an aortic valve abscess infectious emboli and stroke Our hypothesis is the gastrointestinal tract served as the probable entry route for the bacteria

Pathogenic spectrum of infective endocarditis and analysis of prognostic risk factors following surgical treatment in a tertiary hospital in China

BackgroundThis study aimed to summarize the pathogenic spectrum of infective endocarditis (IE) and analyze the risk factors for poor prognosis in surgical patients in a tertiary hospital in China.MethodsWe retrospectively included patients diagnosed with IE between January 2013 and January 2022. The pathogenic spectrum was summarized; the risk factors for early postoperative mortality and embolic events were analyzed using multivariate logistic regression.ResultsAmong 630 patients who underwent blood cultures, the positivity rate was 56.83%. The most prevalent pathogens were viridans streptococci, Staphylococcus aureus, enterococci, and coagulase-negative staphylococci (CoNS). The prevalence of viridans streptococci significantly increased in the surgically treated group, compared to the medically treated group (50.80% vs. 27.78%, P < 0.001), while that of CoNS decreased (5.60% vs. 12.04%, P = 0.034). There has been a declining trend in the blood culture positivity in recent years compared to earlier years (2018–2022 vs. 2013–2017 = 60.95% vs. 47.30%, P = 0.037), with an increasing trend in viridans streptococci and a decreasing trend in CoNS. Multivariate logistic regression analysis identified male gender, coronary artery disease, platelet count < 100 × 109/L, albumin < 35 g/L, elevated creatinine, and prosthetic valve as independent risk factors for early postoperative mortality. Risk factors for embolic events included recent cerebral infarction within 3 months, history of peripheral vasculopathy, and hemoglobin (Hb) < 90 g/L.ConclusionsViridans streptococci predominates as the most common IE pathogen, with its incidence rising recently, especially among surgical patients. Blood culture positivity is decreasing. Understanding risk factors for early postoperative mortality and embolic events is crucial for optimizing patient management and prognosis.Clinical trial numberNot applicable.

Monitoring of Antibiotic Resistance Patterns Within Al-Karak Governmental Hospital, Jordan, in 2022.

Background/Objectives: Antimicrobial resistance is considered one of the foremost global public health challenges, and its prevalence is increasing. In Jordan, particularly in Al-Karak Governorate, there is a lack of sufficient data on antimicrobial resistance to make accurate assessments. The main aim of the current study was to evaluate antibiotic resistance trends in clinical specimens from 2022 and assess antibiotic resistance patterns. The emphasis on the WHO antibiotic classification as Access, Watch, and Reserved (AWaRe) was adopted in the current study. Results: Among Gram-positive bacteria, Enterococcus faecalis exhibited 100% susceptibility to nitrofurantoin and 96% to vancomycin, Streptococcus viridans exhibited 100% susceptibility to teicoplanin, while CoNS (coagulase-negative Staphylococci) showed moderate resistance to Trimethoprim + Sulfamethoxazole (63%) and clindamycin (47%). Among Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae displayed high susceptibility to fosfomycin (E. coli: 95%, K. pneumoniae: 80%) and amikacin (E. coli: 93%, K. pneumoniae: 81%). Resistance was notable for trimethoprim + sulfamethoxazole (E. coli: 47%, K. pneumoniae: 53%) and nitrofurantoin (K. pneumoniae: 30%). Pseudomonas aeruginosa exhibited the highest proportion of XDR strains (15%), followed by K. pneumoniae (11%) and E. coli (4%), while PDR strains were found in P. aeruginosa (6%), K. pneumoniae (3%), and E. coli (0.6%). XDR was observed in 4% of CoNS and 3% of S. viridans (α), with Staphylococcus aureus exhibiting both XDR and PDR at 1%. Methods: A cross-sectional retrospective study of bacterial species and their antimicrobial susceptibility was carried out at a hospital in Al Karak, Jordan, from January to December of 2022, the study included 1187 isolates from all locations in Al-Karak Governmental Hospital. Conclusions: The significant prevalence of XDR and PDR strains in key pathogens, particularly P. aeruginosa and K. pneumoniae, underscores the need for a robust Antimicrobial Stewardship Program (ASP) and infection control measures at Al-Karak Governmental Hospital. High susceptibility in several Access group antibiotics (e.g., amikacin and nitrofurantoin) supports their prioritization in empirical therapy, while the emergence of resistance in Watch and Reserved antibiotics highlights the necessity for rational use. These findings are very important for adjusting the local strategies to lower the spread of resistant strains and improve clinical outcomes.

LAPORAN KASUS: ANALISIS KOMBINASI PENGGUNAAN HEPATOPROTEKTOR PADA CEDERA HATI KARENA INFEKSI BAKTERI STREPTOCOCCUS VIRIDANS

Streptococcus viridans is one of the bacteria that can cause Community-Acquired Pneumonia (CAP). CAP disease has a higher prevalence of non-alcohol-related fatty liver disease (NAFLD). Continuous increase in fat levels in the liver triggered by pneumonia can cause inflammation in the liver, it causes a rapid decline in liver function and results in increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin. The use of hepatoprotectors in conditions of impaired liver function is essential to improve liver cell regeneration and promote liver detoxification. One of the drugs and supplements that can act as a hepatoprotector is ursodeoxycholic acid (UDCA) and Curcuma. Here we report the use of hepatoprotector drugs in cases of Community-Acquired Pneumonia (CAP) disease due to Streptococcus viridans bacteria in patients without comorbidities with the results of liver function test examinations from the beginning of hospital admission, during treatment, until the patient is discharged. The purpose of our case report is to illustrate the effect of the combined use of UDCA and Curcuma drugs on liver injury due to Streptococcus viridans bacterial infection in order to prevent complications, morbidity, mortality and improve the quality of life of patients. Based on the case reports that we present, the combined use of UDCA and Curcuma drugs as hepatoprotectors can improve liver function with reduced parameters of AST, ALT, and total bilirubin levels.

Abstract 4138345: Incidence and Predictors of Infective Endocarditis in Bacteremic Patients

Background: Infective endocarditis (IE) is a serious disease, with a high mortality rate.There has been a shift in the composition of organisms causing infective endocarditis. We aimed to provide a contemporary incidence of IE among bacteremic patients stratified by bacterial pathogens. We also sought to evaluate the predictors of IE in bacteremic patients. Methods: We included patients at a large quaternary centre in Canada. All bacteremias during the period from 2014 to 2016 were identified and data was collected on the following variables – patient demographics, organism, comorbidities, pre-disposing factors, clinical findings, pertinent biochemistry, performance of echocardiography, and diagnosis of IE. Diagnosis of IE was made using the modified Duke’s criteria. Logistic regression was used to identify predictors of IE. Results: There were 1,708 patients with bacteremia included in this analysis. The mean age was 64.5±17.0 years old; 39.7% were females and 77.4% were community acquired bacteremia. In addition, 47.0% had hypertension, 29.9% had diabetes mellitus, 17.5% had chronic kidney disease and 25.2% were immunosuppressed. There were 102 (6.0%) patients with confirmed infective endocarditis (IE). The proportion of bacteremic patients who developed IE was 13.2% in 281 patients with methicillin-sensitive Staphylococcus aureus, 5.4% in 56 patients with methicillin-resistant S. aureus, 2.4% in 292 patients with S. epidermidis, 9.9% in 121 patients with Streptococcus viridans group, 16.5% in 91 patients with Enterococcus, 1.3% in 303 patients with Escherichia coli, 38.5% in 13 in patients with Streptococcus bovis, and 9.5% in 21 patients with Propionibacterium acnes. Predictors of IE were intravenous drug use (odds ratio [OR]=8.64, 95% confidence interval [CI] 3.50- 21.3; p&lt;0.0001), prosthetic heart valve (OR= 2.10, 95% CI 1.01- 4.39; p=0.049), structural heart disease (OR= 12.2, 95% CI 3.35- 44.67; p= 0.0002) and community acquired bacteremia (OR= 2.06, 95% CI 1.11- 3.82; p=0.02). CONCLUSIONS: Methicillin-sensitive Staphylococcus aureus is the commonest cause overall of IE followed by viridans group streptococcus. Streptococcus bovis and Enterococcus bacteremia have the highest incidence of IE. Knowledge of the incidence rates of IE among various pathogens may guide diagnostic testing such as pursuing more advanced imaging procedures for patients with increased risk of IE.

An Etiology of Sputum Culture Contamination and their Drugs Susceptibility Patterns among TB-suspected Patients at Epicentre Mbarara Research Centre, Uganda

Aims: Contamination in TB cultures is problematic as it allows the growth of non-target bacterial or fungal species in sputum samples, potentially concealing M. tuberculosis. This study aimed to determine the prevalence, characterization, and drug susceptibility patterns of contaminants in sputum cultures from TB-suspected patients. Methods: A laboratory-based cross-sectional study was conducted from October 2023 to June 2024 at the Epicentre Mbarara Research Centre, involving 81 sputum samples from TB-suspected patients. Conventional decontamination procedures were used, and both solid Lowenstein Jensen (LJ) and liquid Mycobacterium Growth Indicator Tube (MGIT) culture methods were applied. Standard culture techniques and physicochemical analyses were employed. Bacteria were incubated at 37°C in O2 and Co2 incubators, with growth observed within 24 to 48 hours and up to three days for yeast contaminants. Sabouraud Dextrose Agar cultures were monitored for two weeks for filamentous fungi. Antibiograms for bacterial isolates were determined using the Kirby-Bauer, while broth microdilution was used for fungal isolates. Results: Of 81 samples, 14(17.28%) were contaminated. The most common bacterial contaminants were Staphylococcus aureus, Bacillus subtilis, Streptococcus viridans, Staphylococcus epidermidis, and Escherichia coli. Fungal contaminants included Aspergillus flavus, Penicillium species, Candida albicans, Cryptococcus neoformans, and non-albican Candida species. High resistance to erythromycin (73%) and tetracycline (50%) was noted among bacterial isolates, with sensitivity to vancomycin (67%), gentamycin (60%), and chloramphenicol (58%). Yeast isolates showed (87.5%) susceptibility to itraconazole and (75%) to amphotericin B but (50%) resistance to 5-flucytosine. Mold isolates exhibited (100%) susceptibility to itraconazole, amphotericin B, and 5-flucytosine but complete resistance to caspofungin. Conclusion: The level of contamination in TB cultures was noted, and Staphylococcus aureus and Candida albicans were observed as the most common contaminants. Bacterial isolates resisted erythromycin and tetracycline, while fungal isolates were generally susceptible to itraconazole and amphotericin B. We recommend Strengthening decontamination and monitoring common resistant contaminants.

Evaluation of the Microbiology of Removed Punctal Plugs and Intracanalicular Devices.

The purpose of this observational study was to characterize the microorganisms colonizing punctal plugs and intracanalicular stents. Devices were removed from participants who previously underwent placement of punctal plugs for tear insufficiency and lacrimal stents for dacryocystorhinostomy and canalicular reconstruction procedures. After removal of the devices, they were cultured for organisms both with and without sonication to loosen any biofilms or adherent microorganisms. Primary outcome measures included culture positivity, identification of isolated microorganisms, recovery of microorganisms from culture after sonication, and clinical evidence of ocular infection. There were no cases of clinical infection. A total of 181 specimens were processed (174 punctal plugs, seven intracanalicular stents), of which 98 (54%) were culture positive. Of the punctal plugs, 92 (52.9%) were culture positive, including 42 with a single organism isolated, whereas 22 yielded two organisms, 7 yielded three organisms, and the remaining 21 yielded a polymicrobial culture with four or more organisms. The most common isolates from punctal plugs were coagulase negative staphylococci (27.6%), diphtheroids (16.4%), and streptococcus viridans (10.2%). Those plugs with polymicrobial culture results grew a mixture of organisms most consistent with skin or upper respiratory flora. Of the intracanalicular stents, 6 (85.6%) were culture positive. Punctal plugs and intracanalicular devices can become colonized with bacteria composed of oropharyngeal flora, skin flora, and other rare but potentially significant pathogens.

Epidemiological profile and mortality of infective endocarditis over the past decade: a systematic review and meta-analysis of 133 studies comprising 132,355 cases

Abstract Background Understanding the epidemiology of infective endocarditis (IE) is crucial in the context of an aging population, increased comorbidities, and the heightened occurrence of healthcare-associated cases. Comprehensive data on causative agents, affected valves, and associated mortality are essential for current clinical practice. Methods This systematic review was conducted according to the PRISMA guidelines. A random effects model meta-analysis was conducted. Eligible studies reporting outcomes on IE were identified through a search of the PubMed/Medline database from 2010 to 2021. Results One hundred-thirty-three studies with 132,584 patients from six continents were included in the analysis. The most common causative agents of IE were Staphylococci species in 36% of cases, followed by Streptococci species in 26% of cases and Enterococci species in 10% of cases. Of the studies providing further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans Streptococcus with an incidence of 12%. We found an in-hospital/30-day mortality of 17% (CI: 16%-19%) from 109 studies worldwide. In the subgroup analysis, the highest mortality rates were observed in Latin America 33% (CI: 28%-38%) and Africa 25% (CI: 21%-30%), while the lowest mortality rates were reported in Oceania 13% (CI: 8%-19%), followed by North America 14% (CI: 11%-18%), Asia 15% (CI: 12%-18%), and Europe 17% (CI: 16%-19%). The aortic valve was affected in 46% of cases, followed by the mitral valve in 43%. Tricuspid valve IE and multivalvular IE were identified in 7% and 14% of the cases, respectively. Conclusion Our study highlights the shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE in almost one third of cases. IE remains a highly morbid and fatal condition with high mortality rates even in tertiary and high-expertise centers worldwide. While left-sided IE is by far more common, right-sided IE and multivalvular IE are not rare entities and should be considered early in the differential of patients presenting with suspected IE to decrease the risk of future complications.Global burden of infective endocarditis.

An epidemiological update on infective endocarditis: a two-decade retrospective longitudinal analysis

Abstract Background Infective endocarditis (IE) is a rare yet serious condition affecting the heart valves and the endocardium. Despite advances in management, IE's incidence is on the rise, maintaining a mortality rate similar to that of the late 20th century. Notably, there has been a notable shift in the risk-factor profile, transitioning from traditional factors such as rheumatic heart disease and poor dental health to more iatrogenic causes such as prosthetic heart valves, cardiac devices, foreign body implants, haemodialysis, and immunosuppression. This shift impacts microbiological and imaging diagnosis. Purpose While IE has been extensively studied in the past, the evolving landscape prompts an epidemiological re-evaluation of vulnerable patient populations and the challenges in current diagnostic parameters. Our primary objective is to examine the trends in microbiological and imaging diagnostics over two decades and to compare them across native valve endocarditis (NVE), prosthetic valve endocarditis (PVE), and cardiac implantable electronic device-related IE (CIED-IE). Methods We conducted a retrospective analysis of longitudinal data encompassing 912 patients admitted with either a possible or definite IE diagnosis between 2001 and 2023. Results The incidence of IE increased over the study duration (p&amp;lt;0.01) with octogenarians most affected (21%). Iatrogenic risk factors were associated with nearly two-thirds (63%) of patients diagnosed with IE, while traditional risk factors were evident in almost one-eighth (13%). Blood culture-negative endocarditis increased over the study duration (81% versus73%, p&amp;lt;0.01) and Staphylococcus aureus (29%, p&amp;lt;0.01) became the dominant pathogen over Viridans Streptococcus (14%, p=0.001). Imaging with transthoracic (56% in 2004 versus 75% in 2023) and transoesophageal echocardiography (57% in 2004 versus 79% in 2023) had an increasing contribution in the diagnosis of IE over the two decades. The subgroup analysis found PVE and CIED-IE were more likely to have negative blood cultures (OR=3.7, CI [1.2-6.8] &amp; OR=4.9, CI [1.3-8]) compared to NVE (OR=0.04, CI [0.02-0.8]). PVE and CIED-IE were more likely to have inconclusive imaging (OR=3.7, CI [1.2-6.6] &amp; OR=2.2, CI [0.07-7.8]) compared to NVE (OR=0.63, CI [0.3-3.2]). Complications of stroke were higher in PVE (OR=3.5, CI [0.89-10]) compared to NVE which also had a lower stroke rate (OR=.16, CI [.04-.73]). PVE had more valvular insufficiency (OR=2.1, CI [0.6-4]) compared to NVE (OR=1.2, CI [0.9-6]). The 12-month mortality was no different across the entities (OR=0.3, CI [0.5-7.7] &amp; OR=.49, CI [0.14-1.8] &amp; OR=0.85, CI [0.3-2.4]). Conclusion Our study underscores the evolving nature of IE, now predominantly a healthcare-related disease. Diagnostic challenges persist due to the heterogeneity of the disease, with the emergence of distinct entities such as PVE and CIED-IE.Graphs: Blood culture &amp; echocardiographyForest plot: NVE vs PVE vs CIED-IE

Association of gut microbiota imbalance with risk of postoperative infections in patients with left ventricular assist device

Abstract Background Infections are the most common complications following left ventricular assist device (LVAD) implantation and associated with adverse events. Gut microbial imbalance may predispose to mucosal colonization with pathogens, resulting in a risk of subsequent serious infections. However, it remains unclear whether gut microbiota imbalance is associated with postoperative infections in patients with LVAD. Purpose The aim of this study was to investigate whether gut microbiota imbalance was associated with postoperative infections in patients with LVAD. Methods We prospectively examined 22 consecutive LVAD patients who were admitted to a university hospital for routine check-ups and had stool cultures taken between March 2022 and December 2023. All patients had no signs of infection. The patients were divided into two groups according to positive (normal bacterial flora and other bacteria including Streptococcus viridans, Klebsiella, or Extended-spectrum β-lactamase Escherichia coli; n = 7) and negative (normal bacterial flora only; n = 15) for stool culture. The primary outcome was serious infection requiring hospitalisation treated with intravenous antimicrobial agents. Results Patients were predominantly male (68%) and the median age was 49 (interquartile range [IQR] 29-58) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices, time on LVAD support, the history of infection, or antibiotics use within six months between the groups. During a median follow-up period of 316 days (IQR 242-559), the primary outcome occurred in seven patients (32%), including four hospitalisation for driveline infections, two pneumoniae and bacterial bloodstream infections, and one lung abscess and bacterial bloodstream infection. Kaplan–Meier analysis showed that the adverse events more frequently occurred in LVAD patients with positive for stool culture (P = 0.010) (Figure). A multivariable Cox regression analysis showed that positive for stool culture was independently associated with an increased subsequent risk of the primary outcome (hazard ratio 6.99, 95% confidence interval 1.17-41.7, P = 0.033), even after adjustments for age, male, body mass index, diabetes, INTERMACS profile, mechanical circulatory support, serum creatinine, serum albumin, and white blood cell count, which are known to be strong determinants of worse clinical outcomes in patients with LVAD. Conclusions In patients with LVAD, gut microbial imbalance was associated with subsequent serious infections. These findings suggest that the screening of stool culture might be useful for early identification of high-risk patients for infectious complication after LVAD implantation.

Risk factors for infectious endocarditis of prosthetic valves: a systematic review

Introduction: valve endocarditis is a major health challenge; its etiology is varied, and it can cause multiple complications or death.Objective: to identify risk factors for infective endocarditis in prosthetic valves. Methods: systematic and retrospective review of the available literature using records from Pubmed, Epistemonikos, Cochrane library, Uptodate.Results: in Argentina, from September 2013 to March 2016, 502 patients with infective endocarditis (IE) were studied in 48 medical centers. The majority were men (69,9 %) with a mean age of 60,7 years. The main risk factors were known underlying heart disease (45,36 %), diabetes (23,5 %), chronic renal failure (16,5 %), neoplastic disease (12,1 %) and history of previous IE (8,96 %). The most frequent predisposing events were endovascular (31,9 %) and dental (12,6 %) procedures. New causes of IE related to gastrointestinal pathologies were also identified.Conclusion: patients with IE have a high clinical risk profile and show increasing age over the decades. Staphylococcus aureus is the most frequent microorganism followed by Streptococcus viridans. The identification of independent predictors of in-hospital mortality continues to be a challenge due to the new agents that are identified or risk factors that are added over time; identifying them could help to establish behavioral modification strategies that lead to improved outcomes

Antibiotic Susceptibility among Infective Endocarditis Population: Syndromic Antibiogram Evaluation at Indonesian National Cardiovascular Center

Infective Endocarditis (IE) is a life-threatening disease with a high mortality rate (25%). Laboratory approaches to support the diagnosis of IE especially blood and/or cardiac vegetation culture, are crucial for providing definitive therapy. However, negative culture is frequently observed, therefore empirical use of antibiotics seems unavoidable and may lead to increasing antimicrobial resistance. This study aims to observe the prevalence of antibiotic susceptibility among the IE population using the WISCA approach. This retrospective study observed medical record data of all inpatients diagnosed with IE according to ICD-10 at Cardiovascular Center Harapan Kita Hospital (NCCHK) between January 2018 and December 2022. Patient data were combined with bacterial identification and antibiotic susceptibility test data from the laboratory information system, and evaluated based on period (year). A total of 67,858 inpatients and 1.1% (n=772) were diagnosed with IE. Successful culture growth (blood and/or cardiac vegetation specimen) was between 36.8% and 70% annually. Streptococcus viridans group (82/237, 34.6%) and Coagulase-negative Staphylococci (57/237, 24.1%) were dominantly observed among the IE population. Low susceptibility among Penicillin (34.3%) towards Gram-positive bacteria, as first-line treatment option in IE. Meanwhile, high susceptibility range was observed in Ceftriaxone (95.7%), Gentamicin (80.4%), Rifampicin (84.4%), and Vancomycin (98.7%) as second-line treatment in IE. Despite the low prevalence, the occurrence of antimicrobial resistance in IE has become a priority concern. Continuing the syndromic antibiogram is mandatory to assist the trend of empirical antibiotic usage and refine the established local treatment guidelines.

Infectious Complications in Pediatric Hematopoietic Stem Cell Transplantation Recipients in Northeast Mexico

Abstract Background Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for an increasing number of neoplastic and hematological diseases. However, these patients are at high risk of acquiring infections due to a complex interaction involving organ dysfunction, tissue damage, pathogen exposure, pathogen virulence, and the overall state of dynamic immunosuppression varying according to different phases of immunologic reconstitution after HSCT, and the need for immunosuppressants to prevent and treat non-infectious complications such as graft-versus-host disease (GVHD). Methods All patients under 16 years old who underwent HSCT at the “Dr. José Eleuterio González” University Hospital, a referral center in Northeast Mexico, from March 2019 to October 2023, were included. Clinical, epidemiological, and analytical characteristics of the patients and infectious episodes during pre-engraftment, early engraftment, and late engraftment periods were analyzed. Results In the studied period, a total of 75 patients underwent HSCT, of whom 52 (69%) experienced infectious events (IEs). A total of 136 IEs were documented, averaging 2.5 IEs per patient. Among these, 40% were viral infections, 33% bacterial, 6.6% fungal, 0.7% parasitic, and 19.3% were indeterminate. The most prevalent baseline diagnoses were acute lymphoblastic leukemia (52%), acute myeloid leukemia (19%), and aplastic anemia (12%). Seventy-two percent of the patients underwent a haploidentical stem cell transplantation, and the graft was sourced from peripheral blood stem cells in 75% of the population. Bacterial infections were predominant in the pre-engraftment period, whereas viral infections were more frequent in early and late engraftment. The distribution of these IEs by period is shown in Figure 1. Among bacterial infections, bloodstream infections (BSIs) accounted for 56%, followed by skin and soft tissue infections (14%) and gastroenteritis (13%). Of the 26 BSI events, 73% were caused by Gram-negative bacilli, including 8 cases of Escherichia coli (42%), 6 cases of Pseudomonas aeruginosa (32%), 2 cases of Klebsiella pneumoniae (11%), and 1 case each of Acinetobacter calcoaceticus, Salmonella enterica and Stenotrophomonas maltophilia (5%). 44% of these exhibited extended-spectrum beta-lactamase (ESBL), and 19% were carbapenem-resistant. The remaining 27% of BSI were caused by Gram-positive cocci: Staphylococcus epidermidis (43%), Streptococcus viridans group (29%), Staphylococcus aureus, and Rothia mulcilaginosa (14% each). 17% of all BSI were central line associated bloodstream infection (CLABSI). Among viral infections, cytomegalovirus (CMV) was the most frequent agent at 46%, followed by SARS-CoV-2 and BK virus at 14% and 11%, respectively. Among the fungal infections, we identified 9 cases of invasive fungal disease (IFD), four cases of possible IFD, two of probable IFD and three cases of proven IFD were identified, including one case each of mucormycosis (zygomycetes), Candida tropicalis fungemia, and Aspergillus niger pneumonia. Additionally, one case of intestinal giardiasis, was identified, accounting for 0.7% of the total. Conclusion Infections represent one of the major adverse events in patients undergoing HSCT. It is essential to understand the local epidemiology in each hospital center to tailor international guidelines to the available resources in each institution, which is crucial in improving strategies for preventing, detecting, and providing timely treatment for these infectious complications and their clinical outcomes. Figure 1. Distribution of infectious events among the post-HSTC periods.

Synergistic Effect of Aloe Vera L. Extract Methanolic With Some Antibiotics Against S. Aureus, E-Coli and Klebslia Isolated From the Eye Affected by Inflammation

The current study included the collection of (300) samples from (150) people from patients visiting Balad General Hospital and some private clinics in Balad District - Salah Al-Din Governorate, a sample was taken from both the right and left eyes using special dry and sterile cotton swabs that can be disposed of later, for the period ranging from November 2022 to January 2023, (235) positive samples for bacterial growth were obtained, constituting 78.3% of the total samples collected, positive growth samples were diagnosed depending on their morphological, farming and biochemical properties, and the diagnosis was confirmed for a number of them using the Vitek2 system technology. The results showed obtaining 140 isolates out of a total of (235) positive samples for the Gram stain by (59.6%), while the negative isolates of the Gram stain were (95) isolates and amounted to (40.4%) of the total isolates, S. aureus was 27.65% and E-coli 10.63%, while Klebsiella was 8.51% of the total bacterial isolates isolated from the eye, including (staphylococcus aureus, staphylococcus epidermidis, Bacillus, Streptococcus Viridians, Diphtheria, Pseudomonas aeruginosa, Klebsiella, E-coli, Neisseria). The results showed the synergistic effect of the alcoholic extract (methanol) of the aloe vera plant (Aloe Vera L.) with antibiotics a significant effect compared to methanol alcoholic extract alone, the results of the study also showed that the antibiotic Ciprofloxone synergistically with the alcoholic extract methanolic of the aloe vera plant (Aloe Vera L.) it had the highest effect already synergistically with most of the bacterial species under study.

Spontaneous bacterial peritonitis and soft tissue healing after tooth extraction in liver cirrhosis patients

The objective of this study was to identify the association between tooth extraction and occurrence of spontaneous bacterial peritonitis (SBP) and to assess delayed soft tissue healing of extraction sockets in patients with cirrhosis. One hundred nineteen participants awaiting liver transplantation who required tooth extraction were included. Seven days before the surgery, the patients underwent panoramic radiography and laboratory examinations. Soft tissue healing was evaluated 7 days after the tooth extraction and medical records were checked after 21 days for development of SBP. The relationship between predictive factors and outcomes was assessed by using multiple binomial logistic regression. One hundred ninety-five teeth were extracted, resulting in 146 alveolar wounds, in which the majority (47%) consisted of alveolar sockets of multirooted teeth. One participant was diagnosed with SBP (Escherichia coli [E. coli]) and another diagnosed with bacterascites (Streptococcus viridans [S. viridans] group), occurring 11 and 6 days after tooth extraction. Poor soft tissue healing was observed in 20 (13.7%) patients, which was correlated to 2 risk factors, that is, jaundice (P = .007, adjusted odds ratio [OR] = 4.91, 95% confidence interval [CI] = 1.56-15.47) and moderate neutropenia (P = .048, adjusted OR = 13.99, 95% CI = 1.02-192.07). No association was found between tooth extraction and SBP in patients with cirrhosis. The delayed soft tissue healing was related to jaundice (hyperbilirubinemia) and moderate neutropenia.

Endophthalmitis: a bibliometric study and visualization analysis from 1993 to 2023.

This study is designed to generalize and depict the research hotspots of endophthalmitis through bibliometric methods and software and analyze the evolutive tendency of the work on this severe disease over the past 30 years. This study employed a rigorous bibliometric approach. We identified all endophthalmitis-related literature by conducting a comprehensive search of the Science Citation Index Expanded database under the Web of Science Core Collection. The data was then analyzed and visualized using CiteSpace and VOSviewer, two widely recognized software tools in the field of bibliometrics. CiteSpace was used to analyze the country distributions, dual map overlay of journals, keyword bursts, and co-cited references. VOSviewer was employed to describe the authors and co-cited authors, the journals, the co-cited journals, and the keywords co-occurrence network. This robust methodology ensures the reliability and validity of the study's findings. A total of 2960 publications, including 2695 articles and 265 reviews, were included in this bibliometric study. There has been no shortage of endophthalmitis-related publications since 1993, with an apparent upward trend during recent years. Possible correlations with the COVID-19 pandemic are also analyzed. These studies were finished by 11,048 authors from 75 countries worldwide, with the United States in the lead. In the keyword co-occurrence network, except for the endophthalmitis term, cataract surgery becomes the keyword with the highest frequency. Different categories of endophthalmitis, including postoperative, post-injection, post-traumatic, and endogenous endophthalmitis, and antibacterial and anti-inflammatory therapies of infectious endophthalmitis, are discussed by categories. From the perspective of the timeline, postoperative and post-injection endophthalmitis were the dominant forms before and after the year 2000, respectively. Co-citation analyses reveal that the Endophthalmitis Vitrectomy Study (EVS) conducted in 1995 provides pivotal guidance for later research. Diverse pathogenic bacteria (e.g., Coagulase-negative Staphylococci, Propionibacterium acnes, Viridians Streptococci, and Bacillus cereus) or fungi (e.g., Candida, Aspergillus, and Fusarium) contribute to varying treatment principles and clinical prognosis, which should be taken seriously. In addition, intravitreal and intracameral antibiotics are the mainstay for treating and preventing infectious endophthalmitis, respectively. Our bibliometric analysis provides an overview of dynamic evolution and structural relationships in the research field of endophthalmitis. The displayed hotspots and developmental directions have reference values for future investigation.

Comparative evaluation of selected concentrations of sodium hypochlorite on the outcome of endodontic therapy among Ghanaians.

Endodontic treatment is one of the main dental treatments to manage inflamed or infected root canal systems of teeth. The success of endodontic treatment principally depends on eradicating microorganisms in the root canal by chemo-mechanical debridement with irrigation solutions like sodium hypochlorite (NaOCl). NaOCl has been used in concentrations ranging from 0.5% to 5.25%. This study determined the antimicrobial effectiveness of selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl in endodontic treatment. The study sites were the University of Ghana Dental School (UGDS) and Noguchi Memorial Institute for Medical Research (NMIMR). Sixty infected single-rooted single-canal teeth were used. Before (S1) and after (S2), root canal samples during the endodontic treatment with the selected concentrations of NaOCl were examined via anaerobic and aerobic cultures. The isolates were identified using Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS). All S1 samples were positive for cultivable bacteria. Fifty-three (53) different microbial species belonging to 20 different microbial genera were isolated. Streptococcus viridans was the most frequently isolated microbe. There were zero isolates in the root canals irrigated with 2.6% and 5.2% NaOCl. Two teeth had isolates in the groups irrigated with the lower concentrations (0.5% and 1.0%) of NaOCl. The persistent bacteria were one species each of Streptococcus mitis and Streptococcus oralis, respectively. Root canal treatments using chemo-mechanical preparation with the selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl were effective in significantly reducing the microbial load, and for the 5.2% and 2.6% concentrations, in eliminating all the microorganisms.

INVESTIGATION INTO THE IMPACT OF CARVCROL EXTRACTS ON BACTERIA ISOLATES FROM OSTEOMYLITIS AFTER SURGERY

Carvacrol is one of the most ancient medicinal herbs. Carvacrol contains different alkaloids, flavonoids and saponins. In present studies the antimicrobial activity of Carvacrol alcoholic extract against Gram-negative bacterial and Gram-positive bacterial were determined by the microtiter plate method. Gram-negative bacterial and Gram-positive bacterial strains isolated from osteomyelitis patients after surgery in Mosul city , A total of 60 samples were collected from various sources in Mosul hospitals, during the period from January 10, 2024 , to May 1, 2024. The Aim of this study is determining the effectiveness and effect of alcoholic extract of carvacrol on bacterial isolates taken from a Osteomyelitis after surgery. Bacterial culture results on blood agar, MacConkey agar and nutreint agar revealed 54 positive samples for bacterial growth. Among these, Staphylococcus aureus 22 isolates (32.8%), Pseudomonas aeruginosa 12 isolates (17.9%), Enterobacter cloacae 5 isolates (7.5%) Klebsiella pneumoniae 4 isolates (5.9%), Escherichia coli 4 isolates (5.9%), Proteus mirabilis 3 isolates (4.5%), Streptococcus viridans 3 isolates (4.5%), Corynebacterium spp 2 isolates (3%). As for the following bacterial isolates, each of them constituted one isolate out of a total of 67 isolates, at a rate of 1.5% for each: Providencia spp. , Acinetobacter spp., Staphylococcus saprophyticus , Klebsiella oxytoca , Enterococcus spp. , Enterococcus faecium , Citrobacter freundii , Streptococcus groups C , Bacillus cereus , Enterobacter spp. , Acinetobacter baumannii , Morganella morganii, using vitek-2. High-performance liquid chromatography (HPLC) analysis of Oregano plant revealed the presence of active compounds such as Carvacrol, thymol. Plant extracts from carvacrol demonstrated a substantial inhibitory effect. Results: study indicated that plant extracts exhibited higher inhibition than antibiotics. The minimum inhibitory concentration (MIC) while the results of the lowest inhibitory concentration of carvacrol for the bacterial species under study showed that it had an effect at a concentration of 615 µg/ml against Escherichia coli, 307.5 µg/ml for the species Corynebacterium stratium, Morganella morganii and Pseudomonas aeruginosa, and the least effect was 76.875 µg/ml on Staphylococcus aureus, it gave less results than the antibiotic used Carvacrol (Absorbance was measured at Wavelength 600) .

Ceftriaxone-resistant viridans streptococci bacteraemia among patients treated at a large comprehensive cancer care centre: a retrospective eighteen-year study.

Viridans streptococci (VS) are opportunistic oral commensals and a common cause of bacteraemia in neutropenic patients. In this retrospective single centre cohort study, we investigated the prevalence of ceftriaxone resistance in VS (CRO-R VS) blood isolates between January 2005 and December 2022 from patients treated at a tertiary care hospital. Blood culture isolates were identified using biochemicals and mass spectrometry. Susceptibility testing was performed by Kirby-Bauer and Epsilometer tests. Demographic data, clinical outcomes and antimicrobial use were assessed through electronic medical record review. Among 791 patients with VS bacteraemia, 31 (4%) had confirmed CRO-R VS bacteraemia over the 18-year period; 20/31 (65%) were patients also treated at the Fred Hutchinson Cancer Center and were the focus of this study. Of these 20 patients, 18 (90%) had a known haematologic malignancy; 14 (70%) had undergone haematopoietic cell transplant (HCT); 18 (90%) were neutropenic at the time of culture. Two (10%) patients died within 30 days of CRO-R VS bacteraemia. All the CRO-R isolates (20/20) were members of the Streptococcus mitis group, 12 were multi-drug resistant; all were susceptible to vancomycin. Most patients received vancomycin once blood cultures were positive for a Gram-positive organism. During the study period, the frequency of VS isolate susceptibility testing increased; however, there was no concomitant increase in the percentage of CRO-R isolates at our facility. These data are important in an era where cefepime monotherapy is often used and reinforces the importance of routine resistance testing among VS bacteraemia.