Type Of Infection Research Articles

Artificial intelligence as an auxiliary tool in pediatric otitis media diagnosis

ObjectivesIn order to promote the use of AI technology as the auxiliary tool in pediatric otitis media diagnosis, we use the convolutional neural networks and deep learning for image classification and disease diagnosis. We also designed a Pediatric Otitis Media Classifier to analyze and classify the images for physicians. MethodsA pediatric otitis media classifier was designed for junior physicians (doctors who have been engaged in clinical practice for a short time) as an auxiliary diagnostic tool. To design this classifier for children with otitis media, we used a large number of images of acute otitis media (AOM), secretory otitis media (OME), and normal otoscope images to obtain the optimal convolutional neural network model. ResultsThe average recognition accuracies of the ZFNet and the TSL16 for classification were 97.87 % and 97.62 %, far exceeding the accuracy of human diagnosis. The results of using the Pediatric Otitis Media Classifier show that we can use the classifier to correctly identify the image types of child middle ear infections. ConclusionsWe developed the Pediatric Otitis Media Classifier for the successful automated classification of AOM and OME in children using otoscopic images. In contrast to the traditional diagnosis of pediatric otitis media, which relies heavily on the experience of doctors, the diagnostic accuracy of even experienced physicians is only approximately 80 %. With AI technology, we can improve the accuracy rate to over 98 %, which can effectively assist doctors in auxiliary diagnosis. It also reduces delayed treatment, antibiotic misuse, and unnecessary surgery caused by misdiagnosis.

Prolonged outpatient parenteral antimicrobial treatment: frequency and evolution over a six-year period in a Swiss University Hospital

BackgroundEmerging research indicates the potential for early transition from intravenous to oral antimicrobial therapy in certain infections. This trend may have implications for outpatient parenteral antibiotic therapy (OPAT) programs, as the demand for prolonged intravenous treatment could decrease. The objective of this study was to evaluate the frequency and evolution of OPAT courses of ≥ 14 days over the years and determine the medical justification for those prolonged treatments.MethodsAll patients treated intravenously for ≥ 14 days by the OPAT program at Lausanne University Hospital, Switzerland, between 2017 and 2022 were included in the study. Data were extracted from a prospectively established OPAT database. Prevalence of prolonged antibiotic treatment and its clinical and microbiological information were identified.ResultsDuring the study period, a total of 2,448 treatment courses were administered: 1,636 intravenous (IV) and 812 oral treatments. Of the IV treatments courses, 749 (36%) were of a duration of ≥ 14 days, without discernible trend over the 6-year study period. The most common type of infections needing prolonged treatment were bone and joint infections (31%), endovascular infections (18%), complicated intra-abdominal infections (15%), and urinary tract infections (11%), with only minor fluctuations in these proportions during the study period. Finally, the use of second-line antibiotics (piperacillin-tazobactam, carbapenems and vancomycin) did not increase over the years, suggesting that prolonged intravenous antibiotic therapy is not linked to an increase of anti-microbial resistance in our cohort.ConclusionsDespite the general trend towards shorter intravenous treatment courses in infectious diseases, our OPAT unit did not observe a decline in the use of prolonged intravenous antibiotic therapy between 2017 and 2022, suggesting that OPAT units will probably not see a decrease in their activities in the near future.

Multidrug-Resistant Urinary Tract Infections in Pregnant Patients and Their Association with Adverse Pregnancy Outcomes-A Retrospective Study.

Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities.

Intrauterine Infections and Preterm Birth: Literature Review

Objective: Premature birth is involved in the worldwide health sector problem and an important part challenge. This incidence rate continues to increase and currently, premature births occur in developing countries at 12.5% of all births. Infections within the uterus are associated with at least 40% of births occurring prematurely. Genitourinary tract infections can affect around 41% of women in their reproductive years worldwide may be affected, with 60-80% of these pregnancy-related infections being symptom-free. This article attempts to review the link relating intrauterine infections to premature birth. Data source: This study was taken from six electronic bibliographic databases, namely PubMed, Science Direct. ProQuest, Scopus, EBSCO and DOAJ employing the terms "intrauterine infection", or "premature delivery". Data from all journal articles, summarized according to the categories of the framework of concepts. The following summarization involves the compilation, analysis, and understanding of study data. Results: 10- 12% of intrauterine infections were found in pregnant women, and 20% of premature births were caused by intrauterine infections. The risk factors for this infection are known to be nullipara, lifestyle, and generally women of reproductive age who frequently change partners. There are several types of intrauterine infections, including Bacterial vaginosis, Chlamydia, Asymptomatic bacteriuria, Trihcomonas, and Syphilis. Conclusion: preterm birth has several risk factors, one of which is intrauterine infection that occurs during pregnancy. A quick and accurate diagnosis will help the process of treating intrauterine events in pregnant women to prevent preterm birth.

Hematologic cancers and infections: how to detect infections in advance and determine the type?

Infection is one of the leading causes of death in patients with hematologic cancers. Hematologic cancer patients with compromised immune systems are already susceptible to infections, which come on even more rapidly and are difficult to control after they develop neutrophil deficiencies from high-dose chemotherapy. After patients have developed an infection, the determination of the type of infection becomes a priority for clinicians. In this review, we summarize the biomarkers currently used for the prediction of infections in patients with hematologic cancers; procalcitonin, CD64, cytokines, and CD14 etal. can be used to determine bacterial infections, and (1-3)-β-D-glucan and galactomannan etal. can be used as a determination of fungal infections. We have also focused on the use of metagenomic next-generation sequencing in infections in patients with hematologic cancers, which has excellent clinical value in infection prediction and can detect microorganisms that cannot be detected by conventional testing methods such as blood cultures. Of course, we also focused on infection biomarkers that are not yet used in blood cancer patients but could be used as a future research direction, e.g., human neutrophil lipocalin, serum amyloid A, and heparin-binding protein etal. Finally, clinicians need to combine multiple infection biomarkers, the patient's clinical condition, local susceptibility to the type of infection, and many other factors to make a determination of the type of infection.

Antibiotic-associated neutropenia is marked by the depletion of intestinal Lachnospiraceae and associated metabolites in pediatric patients.

Prolonged antibiotic exposure causes dangerous hematologic side effects, including neutropenia, in up to 34% of patients. Murine studies established a link between the intestinal microbiota and hematopoiesis. To identify factors that predispose to neutropenia in pediatric patients, we evaluated changes in microbiota-derived metabolites and intestinal microbiota composition after prolonged courses of antibiotics. In this multi-center study, patients with infections requiring anticipated antibiotic treatment of two or more weeks were enrolled. Stool samples were obtained at the start and completion of antibiotics or at neutropenia onset (prospective arm). Some patients were enrolled in a retrospective arm in which a stool sample was collected at the time of neutropenia during antibiotic therapy and 2-4 weeks after completion of antibiotics with recovery of blood counts. We identified 10 patients who developed neutropenia on antibiotics and 29 controls matched for age, sex, race, and ethnicity. Clinical data demonstrated no association between neutropenia and the type of infection or antibiotic used; however, patients with neutropenia were admitted to the intensive care unit more often and received longer courses of antibiotics. Reduced intestinal microbiome richness and, specifically, decreased abundance of Lachnospiraceae family members correlated with neutropenia. Untargeted stool metabolomic profiling revealed several metabolites that were depleted exclusively in patients with neutropenia, including members of the urea cycle pathway, pyrimidine metabolism, and fatty acid metabolism that are known to be produced by Lachnospiraceae. Our study shows a relationship between intestinal microbiota disruption and abnormal hematopoiesis and identifies taxa and metabolites likely to contribute to microbiota-sustained hematopoiesis.

Human papillomavirus as a potential etiological factor and biomarker in bladder carcinogenesis: A molecular epidemiological study

Bladder cancer is a major public health concern, and the identification of novel biomarkers is crucial for improving its diagnosis and treatment. Human Papillomavirus (HPV) has been linked to various neoplasms, though its relevance to bladder cancer (BC) is hardly known. In this study, we aimed at evaluating the presence of HPV in bladder cancer tissues and determine its utility as a potential biomarker. Nested PCR, using consensus primers MY09/11, GP5+/6+ and reference plasmids targeting HPVs 16, 18, 33, 11, 6 and 31 were employed on 50 samples from patients with bladder carcinoma. Among the 50 bladder cancer patients analyzed, 23 (46 %) tested positive for HPV, while 27 (54 %) tested negative and significant association was identified between HPV infection and key clinical parameters including tumor stage (P = 0.031**), tumor grade (P = 0.007**) and muscle invasion (P = 0.046*). High-risk HPV genotypes, specifically type 16 was the most prevalent and was detected in 11 (47.8 %) of bladder cancer cases. Single HPV infection 18 (78.2 %) was more common than co-infection cases 5 (21.7 %), though no statistical significance was observed between infection type and patients' clinicopathological parameters. Our findings revealed a significant association between HPV infection and advanced tumor characteristics, particularly with higher tumor grade and pathological T-stage. High-risk HPV genotypes, notably types 16 and 18, were the most frequently observed, suggesting a potential role for high-risk HPV subtypes in bladder tumor progression. These findings underscore the possible contribution of HPV in bladder carcinogenesis and suggest that infection with the virus, particularly with high-risk strains, could serve as a valuable biomarker for early bladder cancer diagnosis and risk assessment. Targeting HPV in bladder cancer tissues may thus pave the way for HPV-based diagnostic and prognostic tools and tailored therapeutic approaches.

Clinical Characteristics of Abdominal Infections Caused by Raoultella Spp.: A Retrospective Study.

Background: In recent years, Raoultella spp. have attracted clinical attention as a new type of pathogen. The most common of human infection with Raoultella are bacteremia, urinary tract infections, abdominal infections, etc. Abdominal infection is a serious and complex infection problem. However, there have been no systematic reports of abdominal infections caused by Raoultella. The objective of this study was to explore the clinical characteristics of Raoultella abdominal infections and provide a reference for clinical practice. Methods: A review of publications on abdominal infections caused by the genus Raoultella between 2009 and 2024 is carried out. This review studied seven parameters: infection type, number of cases, gender, age, comorbidities, treatment, and outcome, and descriptive statistical methods were used to analyze the results. Results: A total of 40 cases (16 Raoultella ornithinolytica and 24 Raoultella planticola) were analyzed: 20 cases of biliary tract infection, 5 cases of liver infection, and 4 cases of peritonitis. Fever and abdominal pain were the main symptoms, and some patients present with multiple skin flushes, systemic erythema. Of the 40 cases, 92.5% of patients had underlying diseases. Among them, malignant disease, immunodeficiency, and invasive operations increase the risk of infection. On the basis of the drug susceptibility results, the preferred antibiotics are quinolone, third generations of cephalosporins, carbapenems, and aminoglycoside. Last, patients with abdominal infections caused by Raoultella spp. mostly have a good prognosis after early use of sensitive antibiotics. Conclusions: According to existing literature reports, the main type of abdominal infection caused by Raoultella is biliary tract infection, and most patients have other underlying diseases. Malignancy, immune deficiency, and invasive procedures are risk factors for bacterial infections. This review also emphasizes that Raoultella spp. is a rarely found opportunistic pathogen, which can cause a high incidence of healthcare-associated infections after invasive procedures.

Association between history of viral infections and melanoma mortality

BackgroundViral infections (VIs) have been linked to T-cell exhaustion, a state that impacts the immune system's ability to mount an effective anti-tumor response. This immunosuppressive effect may potentially worsen outcomes in melanoma patients. This study investigates the relationship between a history of VIs and melanoma-specific mortality, with the goal of understanding whether prior history of Vis contribute to an increased risk of mortality in melanoma patients. Materials and methodsA retrospective review of patients in the Utah Population Database (1997–2020) was done. There were 17,754 eligible melanoma patients, with 2286 also having a history of viral infections. Multivariable Cox proportional hazard models were used to assess the effect of VI on melanoma-specific mortality. ResultsHistory of VI was associated with a higher risk of melanoma-specific mortality (HR = 1.33, 95 % CI: 1.07–1.65, P = 0.01). No differences were observed in mortality among patients undergoing surgery and adjuvant immunotherapy. ConclusionsA history of viral infections was associated with higher melanoma-specific mortality. The mechanism of this association and relationship with different types of viral infections and duration of infections remain to be elucidated.

ОЦЕНКА И ПРОГНОЗИРОВАНИЕ РИСКА ПАЦИЕНТСКОГО НОН-КОМПЛАЕНСА В СИСТЕМЕ СПЕЦИАЛИЗИРОВАННОЙ ФАРМАЦЕВТИЧЕСКОЙ ПОМОЩИ НАСЕЛЕНИЮ С ОНКОЛОГИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

Cardiovascular, oncological and other diseases occupy a significant place in the structure of morbidity and causes of death of the population, the growth of which largely depends on lifestyle and risk factors. Identification of risk factors contributing to the development of cancer is one of the main achievements of epidemiology of the 21st century. Subsequent research helped scientists to build multifactorial algorithms for predicting the risks of cancer and mortality from them, which greatly facilitated the work of practitioners in the field of risk stratification. The above indicates that the research results of many foreign and domestic authors confirm that significant predictors of cancer are risk factors such as old age, pre-existing cancer in blood relatives, smoking, obesity, alcohol, certain types of viral infections, certain chemicals, ionizing radiation, including UV rays of the sun and others. It is known that reducing the influence of risk factors leads to a decrease in morbidity and mortality from cancer. An important condition in the treatment of oncological diseases is the rational and effective use of medicines. Pharmaceutical specialists play an active role in this process. In the treatment of long-term or lifelong diseases, such as cancer, great importance is attached to the process of daily pharmacotherapy, compliance with the rules of adherence to treatment or compliance. Thus, problems with patients performing medical appointments are based on a complex of factors, including psychological and behavioral ones, including patients' adherence to treatment.

Bone infection evolution

The present minireview aims to provide a context for imagination of the timespan for bone infection evolution from the origin of cellular bone tissue to modern orthopedic surgery. From a phylogenetic osteomyelitis-bracketing perspective, and due to the time of osteocyte origin, bacteria might have been able to infect the skeleton for approximately 400 million years. Thereby, bone infections happened simultaneously with central expansions of the immune system and development of terrestrial bone structure. This co-evolution might aid in explaining the many immune evasion strategies seen in the field of bone infections. Bone infection patients with long disease-free periods followed by sudden recurrence and anamnesis of long-term and low-grade infections indicate that bacteria can perform silent parasitism within bone tissue (parasitism; one organism lives on another organism, the host, causing it harm and is structurally adapted to it). The silence seems to be disturbed by immunosuppression and the present minireview shows that a compromised immune system has been associated with bone infection development across all species in the phylogenetic tree. Orthopedic surgery, including arthroplasty and osteosynthesis, favor introduction of bacteria and prosthesis/implant related infections are thus anthropogenic infections (anthropogenic; resulting from the influence of human beings on nature). In that light it is important to remember that the skeleton and immune system have not evolved for millions of years to protect titanium alloys and other metals, commonly used for orthopedic devices from bacterial invasion. Therefore, these relatively new orthopedic infection types must be seen as distinct with unique implant/prosthesis related pathophysiology and immunology.

O USO DE ANTIBIOTICOTERAPIA PROFILÁTICA NO CENTRO CIRÚRGICO: Uma revisão sistemática de literatura

Healthcare-associated infections (HAIs) are one of today's major public health problems, with a major impact on healthcare. Within this type of infection, surgical site infections are those that have a high prevalence and require special attention from health services. One of the alternatives for preventing this type of infection is the use of antibiotic prophylaxis. It is part of a set of measures that aim to reduce surgical site infection rates, providing greater quality and safety in the surgical process. Due to the relevance of the topic, the objective of the present study was to discuss the impressions of the literature regarding antibiotic prophylaxis. Carried out through a systematic literature review, nine studies were identified that met the research criteria. Based on the literature, it was found that, together with other preventive measures, antibiotic therapy represents an important strategy to provide greater safety and quality for surgical care. Despite its recognized importance, there is still resistance from many professionals to carry it out, or even that it is carried out in violation of care protocols. Even so, the results obtained reinforce the importance of using antibiotic prophylaxis for adequate surgical care, although it must be considered that in addition to this process, surgical safety requires that all other preventive measures be adopted for cases of surgical site infection, ensuring adequate patient care.

Complicated skin and skin structure infections in alcoholics, a retrospective cohort study

Background Alcoholism increases the risk of skin and skin structure infections (SSSIs). Furthermore, in complicated SSSIs (cSSSIs) alcoholism is associated with delayed treatment response and a higher risk of blood culture positivity, suggesting poor outcomes. In pneumonia and bacteremia alcoholism is linked with higher mortality, longer hospital treatment and more ICU treatment. Methods We conducted a population-based retrospective cohort study including all cases of complicated skin and skin structure infections (n = 460) treated in Gothenburg, Sweden and Helsinki, Finland from 2008 − 2011. Patients were stratified as alcoholics (9%) and non-alcoholics (91%) and patient and disease factors, treatment, and outcomes were compared. Results Alcoholics were comparatively younger and more often male, with more liver diseases. We observed higher rates of bacteraemia, intensive care unit admission, surgical intervention, and clinical failure in alcoholics. Alcoholism was associated with longer length of stay and more interdepartmental transfers. We did not observe differences in infection type or time from symptom onset to diagnosis. Mortality was low and equivalent in alcoholics and non-alcoholics. Conclusions Alcoholism is associated with increased cSSSI disease severity and resource utilisation.

Clinical characteristics of patients with granulomatous lobular mastitis associated with Corynebacterium parakroppenstedtii infection and drug sensitivity analysis of the isolated strains

BackgroundIt is presently considered that Corynebacterium especially Corynebacterium kroppenstedtii (CK) infection, is one of the important causes of granulomatous lobular mastitis (GLM). However, the pathogen of mastitis in the past two years has been identified as a newly discovered Corynebacterium. But it is unclear whether the pathogen associated with the occurrence of GLM is also this bacterium.MethodsGLM female patients with positive bacterial culture in pus specimens from February 2023 to February 2024 who were identified as CK infection by mass spectrometer were selected as the research objects in this study, and the clinical isolates were identified by 16S rDNA sequencing technology to identify the specific pathogen of GLM-related bacterial infection. Subsequently, the clinical characteristics of the patients were compared with those of GLM patients without bacterial infection during the same period, to explore the effect of this particular type of Corynebacterium infection on disease development in GLM patients. Finally, we tested the minimum inhibitory concentration (MIC) values of antibiotics when inhibiting these separation strains in vitro through the E-Test experiment, to evaluate their medicine sensitivity.ResultsA total of 31 GLM patients initially diagnosed with Corynebacterium kroppenstedtii (CK) infection via MALDI-TOF MS were enrolled in the study. However, subsequent 16S rDNA sequencing revealed that 28 isolates (90.32%) were actually identified as the newly recognized Corynebacterium parakroppenstedtii (CPK). This discovery challenges the conventional belief that CK is the primary pathogen of GLM, suggesting instead that CPK is the predominant pathogen associated with GLM bacterial infections. Comparative analysis of the clinical characteristics between the two groups revealed a significantly higher recurrence rate among CPK-infected GLM patients compared to those without CPK infection, along with elevated prolactin levels (P < 0.05). The sensitivity test results indicated high sensitivity of the isolates to vancomycin, linezolid, and rifampicin.ConclusionIn conclusion, this study highlights that Corynebacterium kroppenstedtii strains isolated from GLM specimens were Corynebacterium parakroppenstedtii, serving as the primary pathogen closely linked to GLM’s occurrence. CPK infection significantly increases the risk of recurrence in GLM patients, with elevated prolactin levels potentially playing a pivotal role in this process. In clinical antimicrobial treatment, antimicrobials other than penicillin and ciprofloxacin may be empirically administered when sensitivity test results are inconclusive.

First trimester maternal infections and offspring congenital heart defects: a systematic review and meta-analysis

Abstract Background Maternal infections early in pregnancy have been proposed as playing a role in the development of congenital heart defects. We aimed to summarise contemporary evidence regarding the association between first-trimester maternal infection and risk of offspring congenital heart defects. Methods For this systematic review and meta-analysis, we searched Medline and Embase for studies reporting associations of at least one measure of maternal infection during pregnancy and offspring congenital heart disease in humans and published in English between January 1, 1990 and February 13, 2024. Studies were eligible for inclusion if they reported rates of offspring congenital heart defects among both infected and non-infected mothers, and included a minimum of 50 offspring with congenital heart defects. We stratified associations by type of infection and type of heart defect when data from at least two studies were available. We used inverse variance weighted random-effect meta-analyses to pool the estimates. In main analyses, we pooled crude estimates from studies reporting maternal infections during the first trimester of pregnancy. We performed sensitivity analyses to include studies that i) investigated infections later in pregnancy or at unspecified time-points, and ii) adjusted for potential confounders such as maternal age, socioeconomic status, or ethnicity. Findings: We identified 11 studies (7 case control studies, 4 cohort studies) with data from 1,805,115 pregnancies. Nine of these studies assessed maternal infectious status through self-reported questionnaires or medical records, two used laboratory antibody testing and three reported on specific infectious pathogens. Studies reported on various types of bacterial and viral infections, including influenza, urinary tract infections, cytomegalovirus, herpes simplex virus, or chlamydia, with varying effect sizes. Ten studies reported a positive association between maternal infection variables and offspring congenital heart defects, with a pooled odds ratio (OR) and 95% confidence interval of 1.56 (1.27, 1.91) across all types of infections. Associations differed by individual subtype of congenital heart defects, with ORs ranging from 1.28 (0.89, 1.85) for pulmonary atresia to 1.75 (1.23, 2.49) for ventricular septal defects. Sensitivity analyses that included infections measured later in pregnancy, or adjusted rates for potential confounders, showed broadly similar trends but attenuated effect sizes. Interpretation: First trimester maternal infections are associated with increased risk of congenital heart defects. Associations appear to vary by type of infection and type of congenital heart defect, and to extend beyond infections commonly tested for during routine pregnancy screening. Larger-scale studies are warranted to confirm these findings using laboratory antibody testing and investigating how these associations vary by specific pathogens and subtypes of congenital heart defects.

Use of specialist health care among Norwegian-born children with one immigrant parent

Abstract Background An increasing number of children grow up with one immigrant and one native born parent. We know little about health in this group. Our aim was to compare the risk of receiving diagnoses of physical health conditions in specialist health care among Norwegian-born children with one immigrant parent compared to Norwegian background children. Methods Data from Medical Birth Registry of Norway were linked to data from the Norwegian Patient Registry (diagnoses in specialist health care), and Statistics Norway (parental country of origin, education, and household income). We estimated hazard ratios (HR) with Cox proportional hazard regressions, with Norwegian background children as reference category, adjusted for sex, birth year, parental education, and household income. Results Children with an immigrant parent had lower hazards than Norwegian background children of diagnoses of most types of infections, but higher hazards of some, including tuberculosis, and skin infections. They also had higher hazards than Norwegian background children of receiving diagnoses of obesity and other nutritional deficiencies, and skin diseases, but lower hazards for other conditions, including chronic lower respiratory disease, disease of the digestive system, and visual or hearing impairment. The hazards of diagnoses of any neurological condition, sleeping disorders and epilepsy were lower among children with an immigrant mother, but higher among those with an immigrant father. Differences between children with one immigrant parent and Norwegian background could not be explained by differences in parental education or household income. Conclusions Children of one immigrant parent do not overall use specialist health care for physical health issues more than other children. Key messages • Awareness of diagnoses given most frequently to children of one immigrant parent can help promote timely diagnoses and adequate use of services, which is important for prevention of later illness. • Barriers to health care use among children of immigrants should be further researched.

Hand hygiene intervention in the prevention of healthcare associated infections

Abstract Background Healthcare associated infections are a major cause of morbidity and mortality in intensive care units. Observance hand hygiene is singled out as a key element in interruption of these infections. The present study aimed to assess whether hand hygiene intervention program in intensive care unit at the Sahloul University Hospital of Sousse is able to decrease healthcare associated infections. Methods We carried out a pre-experimental study among patients hospitalized in seven intensive care units at the Sahloul University Hospital of Sousse during two distinct periods of 3 months, the first in 2019 and the second in 2021. During these two periods, we monitored only patients hospitalized in the ICU for more than 48 hours and incidence of healthcare associated infections was compared. Healthcare associted infections were defined as infections occurred at least 48 hours after admission to the intensive care units. The hand hygiene promotion intervention, done during the year 2020, was based on 3 axes (training sessions, procedures writing and professional practicesevaluation). Results Incidence of healthcare associated infections decreased significantly in post-intervention (p = 0.000). The decrease of Ventilator-associated pneumonia was significantly higher than other types of infections(p = 0.042). Extended Spectrum B-Lactamase Producing Enterobacteriaceae infections and Ceftazidim resistant Pseudomonas Aeruginosa infections decreased significantly in after intervention (p = 0.000). Conclusions The results of our study showed that improved hand hygiene resulted in a reduction in healthcare associated infections. Key messages • Observance hand hygiene is singled out as a key element in interruption of healthcare associated infections. • Improved hand hygiene resulted in a reduction in healthcare associated infections.

Characterizing CRP dynamics during acute infections.

C-reactive protein (CRP) is a common proxy of inflammation, but accurate characterizations of its dynamics during acute infections are scant. The goal of this study was to examine C-reactive protein (CRP) trajectories in hospitalized patients with viral infections, confirmed bacteremia (stratified by Gram-negative or Gram-positive bacteria), and non-bacteremic infections/inflammations, considering antibiotic treatment. Electronic medical records from Tel Aviv Sourasky Medical Center (July 2007-May 2023) were analyzed. Patients with blood cultures or positive viral tests were included. CRP levels were modeled using generalized additive mixed-effects models (GAMMs) and observed up to 150h after initial infection diagnosis. Patients with initial CRP levels > 31.9 were excluded, to remove individuals already in a highly active inflammatory process. The shapes of the CRP curves were characterized and peak CRP as well as area under the CRP curve were the primary variables of interest. Viral infections had the lowest and flattest CRP curves. Non-bacteremic infections showed intermediate levels, while bacteremia (especially Gram-negative under antibiotic treatment) had the highest CRP peaks. For instance, peak CRP ranged from 15.4mg/L in viral infections without antibiotics to 140.9mg/L in Gram-negative bacteremia with antibiotics. CRP trajectories significantly differ based on infection type and antibiotic treatment. Frequent CRP measurement could be a valuable diagnostic and risk stratification tool in hospitalized patients.

Examining Cycle Threshold values in Repeat SARS-CoV-2 Cases: A Retrospective Analysis in Ireland

Abstract Background Effective public health management during the COVID-19 pandemic requires accurate differentiation between re-infections and residual viral RNA detections in repeat positive cases. This study investigates cycle threshold (CT) trends in repeat SARS-CoV-2 cases to discern between persistent viral remnants and active infections. Collaboration between contact tracing and laboratories is essential for shaping robust public health strategies. Methods A retrospective analysis was conducted on 427 individuals with repeat positive PCR tests. Data was collected at a contact tracing centre from March to August 2021. Key variables including age, gender, and biomedical markers (test intervals, CT values) were examined. Regression and correlation techniques assessed CT trends and their implications. Results Younger individuals (&amp;lt;60 years) occasionally exhibited significantly lower CT values in subsequent tests, suggesting potential re-infections, while older adults generally displayed higher CT values indicative of residual RNA. These age-specific CT trends were statistically significant and instrumental in refining testing protocols and isolation guidelines. Further analysis is expected to strengthen these findings Conclusions Collaborative approaches between contact tracing and laboratories are vital in shaping robust public health strategies for distinguishing between types of repeat infections. Revision of health policies is imperative to prevent unnecessary isolation and optimise healthcare workforce allocation during ongoing transmission periods. Key messages • Decisive decision-making skills are crucial in managing repeat SARS-CoV-2 infections. • Revised health policies align testing and isolation practices with empirical CT data, enhancing public health efficacy.

Evaluation of oxidative stress biomarkers for differentiating bacterial and viral infections: a comparative study of glutathione disulfide (GSSG) and reduced glutathione (GSH)

Background and aims. This study evaluates the potential of oxidative stress biomarkers, specifically glutathione disulfide (GSSG) and reduced glutathione (GSH), for differentiating bacterial and viral infections. Oxidative stress plays a crucial role in the immune response, and glutathione is a key regulator of cellular redox balance. The aim was to assess whether differences in GSH and GSSG levels could be used as diagnostic markers for infection type. Methods. A chemiluminescence-based method evaluated GSH and GSSG as potential biomarkers for distinguishing between bacterial and viral infections. The GSH and GSSG concentrations were analyzed across bacterial, viral, and control groups. Results. Our data revealed significant differences in the GSH/GSSG ratio between the analyzed groups, with bacterial infections showing higher oxidative stress markers compared to viral infections. A combined analysis of GSH and GSSG concentrations, visualized through heatmaps and ROC curves, improved diagnostic accuracy, with clustering patterns distinguishing infection types. Conclusions. These findings suggest that the GSH/GSSG ratio could be used as a biomarker in distinguishing between bacterial and viral infections, offering potential clinical applications for more accurate diagnosis. Further research is required to validate these results in larger cohorts and to explore the underlying mechanisms of oxidative stress in pathogen-specific immune responses.