Wound Specimens Research Articles

Multi-facility Containment of a Multidrug-resistant Acinetobacter Baumannii Outbreak – January 2018–july 2018

BACKGROUND Pan-nonsusceptible (pan-NS) organisms require aggressive containment per current guidance. On January 1, 2018, the state public health laboratory (SPHL) alerted the state health department (SHD) to a pan-NS Acinetobacter baumannii at Hospital A. Patient A was admitted to Hospital A from a skilled nursing facility with ventilated residents (vSNF) and shared a bathroom with patient B, who later developed pan-NS A. baumannii infection. Prior to the vSNF, patient A was admitted at a long-term acute care hospital (LTACH). The SHD in conjunction with the Centers for Disease Control and Prevention (CDC) and the facilities identified and contained transmission over the next six months. METHODS SHD infection preventionists conducted in-person infection control assessments and addressed gaps with written feedback and phone calls. Admission screening and every two week point prevalence surveys (PPS) were done at the LTACH and vSNF. PPS continued until two consecutive negative rounds with no new cases. Screening was performed from rectal, sputum and wound specimens. Pan-NS cases demonstrated intermediate or resistant interpretations to all antibiotics tested; multidrug-resistant cases showed susceptibility to one antibiotic tested. Isolates were sent to CDC for whole genome sequencing (WGS) and OXA-23 testing. RESULTS During January 31–June 27, 2018, the vSNF and LTACH performed six and ten PPS, respectively. PPS and admission screens identified 12 cases, eight of which had OXA-23. WGS showed molecular evidence of transmission in the vSNF. SHD found no hand hygiene monitoring, no contact precaution signage, inconsistent use of personal protective equipment, and inadequate disinfection in the vSNF. LTACH observations included inadequate equipment disinfection. Sustained implementation of recommended infection prevention practices was observed. In June, both facilities had cessation of transmission. CONCLUSIONS An effective containment response to a multi-facility outbreak was facilitated by the SHD, SPHL, CDC and the impacted facilities.

A cutaneous Anthrax outbreak in Koraput District of Odisha-India 2015

BackgroundCutaneous anthrax in humans is associated with exposure to infected animals or animal products and has a case fatality rate of up to 20% if untreated. During May to June 2015, an outbreak of cutaneous anthrax was reported in Koraput district of Odisha, India, an area endemic for anthrax. We investigated the outbreak to identify risk factors and recommend control measures.MethodWe defined a cutaneous anthrax case as skin lesions (e.g., papule, vesicle or eschar) in a person residing in Koraput district with illness onset between February 1 and July 15, 2015. We established active surveillance through a house to house survey to ascertain additional cases and conducted a 1:2 unmatched case control study to identify modifiable risk factors. In case control study, we included cases with illness onset between May 1 and July 15, 2015. We defined controls as neighbours of case without skin lesions since last 3 months. Ulcer exudates and rolled over swabs from wounds were processed in Gram stain in the Koraput district headquarter hospital laboratory.ResultWe identified 81 cases (89% male; median age 38 years [range 5–75 years]) including 3 deaths (case fatality rate = 4%). Among 37 cases and 74 controls, illness was significantly associated with eating meat of ill cattle (OR: 14.5, 95% CI: 1.4–85.7) and with close handling of carcasses of ill animals such as burying, skinning, or chopping (OR: 342, 95% CI: 40.5–1901.8). Among 20 wound specimens collected, seven showed spore-forming, gram positive bacilli, with bamboo stick appearance suggestive of Bacillus anthracis.ConclusionOur investigation revealed significant associations between eating and handling of ill animals and presence of anthrax-like organisms in lesions. We immediately initiated livestock vaccination in the area, educated the community on safe handling practices and recommended continued regular anthrax animal vaccinations to prevent future outbreaks.

Molecular feature of lasB gene of Pseudomonas aeruginosa isolated from different clinical sources

The study was carried out through a period from June to November 2017 from out-patients and in-patients of Al-Hussein Teaching Hospital in Thi-Qar province South of Iraq. A sum of 132 specimens from the hospital facility condition and different clinical samples of various patients were randomly collected and analyzed for diagnosis of Pseudomonas aeruginosa. These clinical specimens were included wound, burn, ear swabs, urine and sputum specimens. Every single specimen was screened to detect of P. aeruginosa by culturing on suitable media, and 36 isolates of P. aeruginosa were distinguished through biochemical tests and using API 20NE system for confirmation the isolates. All P. aeruginosa isolates were tested against nine antimicrobial discs in vitro. They revealed that having different classes and the results demonstrated that variable resistance to the anti-microbial agents. In attempting to the recognizable proof of P. aeruginosa having the DNA, Polymerase chain reaction (PCR) was utilized in light of particular groundwork for 16S rRNA genetic marker. The results demonstrated that PCR has observed to be quick and sensitive and particular for recognizable proof of P. aeruginosa. Furthermore, 16S rRNA was utilized as confirmation feature, while lasB detected as virulence gene also to utilize as pathogenesis quality of the bacteria.

Evaluation of antimicrobial prophylaxis use and rate of surgical site infection in surgical ward of Wachemo University Nigist Eleni Mohammed Memorial Hospital, Southern Ethiopia: prospective cohort study

BackgroundSurgical site infection (SSI) is the foremost infection in the overall patient population, affecting up to 66% of operated patients and with a frequency up to nine times more than in developed countries. This study aimed to determine the rate, associated factors of surgical site infection, and identification of causative agents and their antimicrobial susceptibility in surgical ward of Wachemo University Nigist Eleni Mohamed Memorial Hospital (WUNEMMH), Southern Ethiopia.MethodProspective cohort study involving 255 patients who underwent surgical procedure in WUNEMMH from January 1 to September 1, 2017. We extracted data from medical chart, operational and anesthesia note by direct observation and interviewer administered semi-structured questionnaire which was validated. We collected wound specimens and processed it based on standard operating procedure, and disc-diffusion antibiotic susceptibility test was done. Data analysis was done using SPSS version 22.0. Factors significantly associated were identified using logistic regression model at P-value < 0.05 and 95%CI.ResultForty-two patients (16.5%) developed SSIs. The most causative organism of surgical site infection was Klebsiella pneumoniae (60%).Ciprofloxacin and ceftriaxone were sensitive antibiotics. Surgery waiting time more than 7 days [ARR = 2.48 (95%CI(1.28–4.79),P = 0.007], Operation time more than 1 h.[ARR = 2.13(95%CI(1.18–3.86),P = 0.012], and administering antibiotic before 1 h of operation [ARR = 5.05(95%CI(1.79–14.21),P = 0.002], smoking [ARR = 8.01 (95% CI (2.15 29.84),P = 0.002] were independently associated with surgical site infections.ConclusionThe rate of SSI was relatively high. Klebsiella pneumoniae was found to be the most causative agent for SSI. Organisms causing SSI were sensitive to commonly used antimicrobial agents in WUNEMMH.

Regulation mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice

Objective: To explore the regulatory mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice. Methods: E2F1 gene knockout heterozygotes C57BL/6 mice and wild-type C57BL/6 mice were introduced and self-reproduced. Two weeks after birth, E2F1 gene knockout homozygotes mice and wild-type mice were identified by polymerase chain reaction (PCR). Twelve identified 6-8 weeks old male E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were selected respectively according to the random number table and set as E2F1 gene knockout group and wild-type group. A full-thickness skin defect wound was made on the back of each mouse. On post injury day (PID) 2 and 7, 6 mice in each group were selected according to the random number table and sacrificed, and the wound tissue was excised. The expression of CD68 and CD206 double positive M2 macrophages was observed by immunofluorescence method, and the percentage of CD206 positive cells was calculated. The protein expression of CD206 was detected by Western blotting. The mRNA expression of arginase 1 was detected by real-time fluorescent quantitative reverse transcription PCR (RT-PCR). Wound tissue specimens of the two groups on PID 7 were obtained, and the protein and mRNA expressions of peroxisome proliferator-activated receptor gamma (PPAR-γ) were detected by Western blotting and real-time fluorescent quantitative RT-PCR respectively. The above-mentioned experiments were repeated four times. Three specimens of wound tissue of mice in wild-type group on PID 7 were obtained to detect the relationship between E2F1 and PPAR-γ by co-immunoprecipitation and Western blotting, and this experiment was repeated two times. Data were processed with unpaired t test. Results: The size of PCR products of E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were 227 and 172 bp respectively, which were the same as those of the designed DNA fragments. On PID 2 and 7, the number of CD68 and CD206 double positive M2 macrophages in the wound tissue of mice in E2F1 gene knockout group was more than that of wild-type group, and the percentages of CD206 positive cells in the wound tissue of mice in E2F1 gene knockout group were (0.234±0.032)% and (0.584±0.023)% respectively, which were significantly higher than (0.129±0.017)% and (0.282±0.071)% of wild-type group (t=3.29, 3.54, P<0.05). On PID 2 and 7, the protein expression of CD206 in the wound tissue of mice in E2F1 gene knockout group were 1.00±0.23 and 1.63±0.26 respectively, which were significantly higher than 0.43±0.06 and 0.97±0.08 of wild-type group (t=2.41, 2.45, P<0.05). On PID 2 and 7, the mRNA expressions of arginase 1 in the wound tissue of mice in E2F1 gene knockout group were 0.482±0.105 and 0.195±0.031 respectively, which were significantly higher than 0.163±0.026 and 0.108±0.017 of wild-type group (t=3.04, 2.86, P<0.05). On PID 7, the protein and mRNA expressions of PPAR-γ in the wound tissue of mice in E2F1 gene knockout group were 0.61±0.12 and 0.51±0.13 respectively, which were significantly higher than 0.20±0.04 and 0.20±0.04 of wild-type group (t=3.36, 2.86, P<0.05). On PID 7, detection of the wound tissue of mice in wild-type group showed that PPAR-γ had unidirectional effect on E2F1. Conclusions: E2F1 transcription factor affects the polarization of M2 macrophages by inhibiting the expression of PPAR-γ, thereby inhibiting the healing process of full-thickness skin defect wounds in mice.

Clinical Context-Specific Staphylococcus aureus Susceptibilities May Differ Substantially and Be Obscured by Aggregate Antibiograms

AbstractAggregate data in institutional antibiograms may not accurately represent major pathogens' antibiotic susceptibility patterns in important clinical scenarios. In this analysis of Staphylococcus aureus isolates between 2013 and 2016 at the Women and Children's Hospital of Buffalo, methicillin and clindamycin susceptibility rates of S. aureus differed significantly from aggregate data when stratified by wound specimen and osteoarticular infection (OAI) isolates. Clindamycin susceptibility of methicillin-resistant S. aureus (MRSA) in wound specimens was higher than published antibiograms, whereas the proportion of MRSA and total clindamycin susceptibility in OAI was relatively lower, which impacts empiric antibiotic decision-making. With S. aureus antibiotic susceptibility patterns shifting and differences by infection type, as well as geographic location, pediatric facilities are encouraged to perform local reviews and emphasize specimen and clinical-context rather than aggregate antibiograms.

Molecular Detection of Biofilm-Producing &amp;lt;i&amp;gt;Staphylococcus aureus&amp;lt;/i&amp;gt; Isolates from National Orthopaedic Hospital Dala, Kano State, Nigeria

This study evaluated biofilm formation and antibiotic susceptibility in 36 clinical S. aureus isolates recovered from orthopaedic patients and detected the presence of intercellular adhesion and adhesin genes. Staphylococcus aureus was isolated from nasal swab, wound and urine specimens collected from orthopaedic patients in National Orthopaedic Hospital Dala, Kano over a period of three months. The isolates were identified using rapid identification kit for Staphylococcus species. The antibiotics susceptibility of the isolates was determined using modified disc diffusion method. Phenotypically, the biofilm formation was assessed using the Congo red agar method and microtitre plate assay. Polymerase chain reaction (PCR) analysis was used to detect biofilm-associated genes and characterize the isolates. The isolation rate of S. aureus from the samples (n = 134) was 26.8%, mainly from nasal swab (36%) and wound swab (36%). A total of 19 (52.7%) of the isolates showed positive for slime production. Majority of the isolates 29/36 (81.6%) were biofilm positive with only 2 (5.5%) and 5 (13.8%) as strong biofilm-formers and moderate biofilm-formers respectively. Molecular evaluation of the biofilm-associated genes in 12 S. aureus isolates revealed the prevalence of bbp genes (25%), clfA genes (16.6%) and the icaA (8.3%). None of the isolates harboured the fnbA and cna genes. There is no significant difference (P > 0.05) in the antibiotic resistance pattern between biofilm-positive and biofilm-negative S. aureus isolates. This result revealed that phenotypically most of the S. aureus isolates were biofilm formers but few of them chromosomally harbour the biofilm-associated genes.

Morphological justification of the effectiveness of ultrasonic cavitation with 0.2

Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

Antimicrobial-resistant pathogens in Canadian ICUs: results of the CANWARD 2007 to 2016 study.

To describe the microbiology and antimicrobial resistance patterns of cultured samples acquired from Canadian ICUs. From 2007 to 2016, tertiary care centres from across Canada submitted 42938 bacterial/fungal isolates as part of the CANWARD surveillance study. Of these, 8130 (18.9%) were from patients on ICUs. Susceptibility testing guidelines and MIC interpretive criteria were defined by CLSI. Of the 8130 pathogens collected in this study, 58.2%, 36.3%, 3.1% and 2.4% were from respiratory, blood, wound and urine specimens, respectively. The top five organisms collected from Canadian ICUs accounted for 55.4% of all isolates and included Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (10.6%), Escherichia coli (10.4%), Streptococcus pneumoniae (6.5%) and Klebsiella pneumoniae (6.4%). MRSA accounted for 20.7% of S. aureus collected, with community-associated (CA) MRSA genotypes increasing in prevalence over time (P < 0.001). The highest susceptibility rates among MRSA were 100% for vancomycin, 100% for ceftobiprole, 100% for linezolid, 99.7% for ceftaroline, 99.7% for daptomycin and 99.7% for tigecycline. The highest susceptibility rates among E. coli were 100% for tigecycline, 99.9% for meropenem, 99.7% for colistin and 94.2% for piperacillin/tazobactam. MDR was identified in 26.3% of E. coli isolates, with 10.1% producing an ESBL. The highest susceptibility rates among P. aeruginosa were 97.5% for ceftolozane/tazobactam, 96.1% for amikacin, 94.7% for colistin and 93.3% for tobramycin. The most active agents against Gram-negative bacilli were the carbapenems, tigecycline and piperacillin/tazobactam. Against Gram-positive cocci, the most active agents were vancomycin, daptomycin and linezolid. The prevalence of CA-MRSA genotypes and ESBL-producing E. coli collected from ICUs increased significantly over time.

719. The Respiratory Pathogen Panel and Antibiotic Utilization in the Emergency Department

BackgroundThe multiplex polymerase chain reaction respiratory pathogen panel (RPP) is used frequently in emergency departments (EDs) for the rapid identification of viruses and atypical bacteria of the respiratory tract. Its clinical value is unclear, as numerous studies have demonstrated that its use has a limited impact on antibiotic prescribing. We aimed to describe the relationship between RPP results and antibiotic prescribing rates for ED patients in our large academic medical center.MethodsWe retrospectively analyzed the charts of 1,061 patients aged 18–90 who were treated and released from two EDs from January 1, 2015 to January 31, 2018 and underwent RPP testing. Patients with evidence of bacterial infection were excluded based on RPP detection of atypical bacteria and microbiological analysis of blood, urine, wound, and sputum specimens. The results of the RPP and the rates of subsequent respiratory pathogen-directed antibiotic prescribing (including ED and outpatient pharmacy orders) were compared.ResultsAntibiotic prescription rates were 21.5% in patients who tested negative for any respiratory virus, compared with 14.5% in patients who tested positive (OR 0.70, P < 0.01). When positive RPPs were subdivided based on virus type (influenza and non-influenza) and compared with negative RPPs, only influenza-detection was associated with a significant reduction in antibiotic prescriptions (Table 1).ConclusionIn our study population, the presence of a respiratory virus detected by the RPP was correlated with a significant decrease in antibiotic prescribing. This effect was largely driven by influenza detection. This demonstrates that at our institution, the RPP may have a role in reducing unnecessary antibiotic utilization, but providers need further guidance in the interpretation of non-influenza respiratory virus positivity.Table 1. Antibiotic Prescription Rates by RPP Result, Subdivided by Virus Type RPP Result N No. of Patients Given Antibiotics Odds Ratio (95% CI) P-value Negative 628135 (21.5%)Reference Positive 43363 (14.5%)0.70 (0.56–0.88)<0.01 Influenza*16920 (11.8%)0.49 (0.30–0.81)<0.01 Non-influenza virus(es)26443 (16.3%)0.71 (0.49–1.04) 0.08*Includes RPPs that were positive for multiple viruses if influenza was present.Disclosures All authors: No reported disclosures.

The clinical dynamic changes of macrophage phenotype and function in different stages of human wound healing and hypertrophic scar formation.

The pathogenesis of hypertrophic scar (HS) is still poorly understood. Macrophages, especially the polarisation of that to M1 or M2, play a pivotal role in control of the degree of scar formation. Profiling of macrophage phenotypes in human specimens during long-term period of wound healing and HS formation may provide valuable clinical evidence for understanding the pathology of human scars. Human wound and HS specimens were collected, the macrophage phenotype was identified by immunofluorescence, and biomarkers and cytokines associated with M1 and M2 macrophages were detected by RT-PCR. The correlation between the macrophage phenotype and HS characteristics was analysed by linear regression analyses. We found excessive and persistent infiltration by M1 macrophages around the blood vessels in the superficial layer of the dermis at early wound tissues, whereas M2 macrophages predominated in later wound tissues and the proliferative phase of HS and were scattered throughout the dermis. The density of M1 macrophages was positively correlated with mRNA expression levels of tumour necrosis factor-alpha (TNF-α) and IL-6. The density of M2 macrophages was positively correlated with ARG1 and negatively correlated with the duration of HS. The sequential infiltration by M1 macrophage and M2 macrophages in human wound and HS tissues was confirmed.

Consensus recommendation: Indications and methods for microbiological wound diagnostics

Abstract Aim To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described. Method An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented. Results The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs. The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds. Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed. Conclusion Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.

Bacteriologic analysis of bone biopsy from diabetic foot infections within a VA patient population

Diabetic patients with foot infections were evaluated over a 5-year period from April 2005 to March 2010. Cultures were obtained from 92 patients after surgical debridement. All of the patients were classified as “severe” diabetic foot infections (DFIs) and PEDIS grade 4. Wound specimens were collected by bone biopsy and sent to San Francisco VA Medical Center Microbiology Department for aerobic and anaerobic cultures. Among the 92 cases, the study resulted in a total of 410 pathogens, which 203 pathogens were from bone cultures and 207 pathogens were from soft tissue cultures. 74% of cases were polymicrobial and 26% had growth of a single organism. Staphylococcus aureus presented in 49.35% of bone cultures and 55.38% of soft tissue cultures, Streptococcus species presented in 44.16% and 36.92% respectably and roughly 33% of both bone and soft tissue had staphylococcus coagulase negative present. Gram-negative organisms occurred in 25% of all cultures taken. Pseudomonas accounted for 15% of soft tissue infections but only 1.3% bone cultures. MRSA was found in 17.39% of cultures and VRE was seen in 4.34% of all culture results. Staphylococcus aureus was the most prevalent organisms seen. This study presents a comprehensive microbiological survey of diabetic patients with DFIs within the San Francisco VA Medical Center and this study will help guide physicians to improve clinical outcomes of DFIs by using proper antibiotics.

Microbiological diagnostic criteria of infectious inflammatory complications after total knee replacement in the aspect of periprosthetic joint infection (PJI) pathogenesis

Background. The system of accurate microbiological diagnostics of PJI for timely identification of infectious inflammatory complications after total joint replacement and distinguishing between PJI and aseptic infection has not been yet defined which is associated with the pathogenesis of PJI. &#x0D; The Aim of the study is to define valuable microbiological diagnostic criteria for PJI and estimate diagnostic value of various clinical specimens with the account to pathogenetic features of infectious complications after primary total knee replacement. &#x0D; Material and Methods. We analyzed 412 specimens of various clinical origin obtained from 182 patients with deep PJI after primary total knee replacement treated at the Research Institute of Traumatology, Orthopedics and Neurosurgery of Razumovsky Saratov State Medical University in 2014-2018, both retro- and prospectively. &#x0D; Results and Discussion. Fistula, aspirate and superficial wound specimens taken from the joint cavity have not been proven to have any diagnostic value for PJI. Optimized microbiological algorithm included prolonged culture time, the complex of 3-5 tissue bioptate cultures and implant sonication which allowed obtaining more valuable results for PJI diagnostics. Tissue bioptates and lavage fluid specimens tests were the most sensitive methods for PJI diagnostics with sensitivity of 81% and 95% and specificity of 96% and 97% respectively, especially in case of coagulase-negative Staphylococcus and Gram-negative bacteria frequently appearing in the biofilm form at PJI. &#x0D; Conclusions. Complex assessment of obtained results and optimization of microbiological methods allow obtaining sufficient diagnostic accuracy of PJI.

In vitro Antibacterial Activity of Organic Extracts of Aloe barbadensis against Multi-drug resistant Pseudomonas aeruginosa Isolated from Wound Specimens

Objectives: In order to investigate alternate therapeutic option, this study was carried out to assess the in vitro antibacterial activity of gel extract of Aloe barbadensis against multiple antibiotic resistant Pseudomonas aeruginosa isolated from wound specimens.&#x0D; Methods: A total of 180 different wound specimens collected in a hospital, were subjected to isolate and identify P. aeruginosa by cultural methods. Antibiotic susceptibility testing was done by Kirby- Bauer disc diffusion method to screen multidrug resistant isolates. A. barbadensis extracts were prepared using aqueous and organic solvents and their in vitro inhibitory action was evaluated by agar well diffusion methods.&#x0D; Results: Out of total, 38 (21.1%) of the wound specimens showed the occurrence of P. aeruginosa, among which 15 (39%) isolates were multi-drug resistant. Organic extracts of various concentrations (0.2 - 0.8 v/v %) inhibited 66.7% of MDR and all non-MDR (n = 23) P. aeruginosa with zone of inhibition ranging from 9.5 ±1.0 to 21.3 ± 2.2 mm but not by aqueous extract. A positive Pearson’s correlation (r=0.983) was found between antibacterial effect and concentrations of the extracts. The antibacterial activity of organic extracts was statistically associated with antibiotic resistance profile of the organism (p&lt;0.05).&#x0D; Conclusion: Organic extracts of A. barbadensis revealed variable in vitro inhibitory action against both MDR and non-MDR P. aeruginosa isolated from wound specimens. Although further confirmation is needed, aloe gel extract may be applied as an alternate treatment option.

Methicillin Resistant Staphylococcus aureus Isolated from Wound Infections

Objectives: The aim of this study was to determine the prevalence of methicillin resistant Staphylococcus aureus (MRSA) and antibiotic resistance pattern of the isolates from wound infections.&#x0D; Methods: A total of 706 wound specimens including pus and wound swab were analyzed in the laboratory of B and B Hospital, Lalitpur from May to October 2014. The specimens were cultured on Blood Agar and Mannitol Salt Agar plates and incubated at 37°C for 24 hours. Antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method. Strains resistant to cefoxitin (30mcg) with inhibition zone ≤ 21mm were identified as MRSA.&#x0D; Results: Out of 366 bacterial isolates, 90 (24.6%) were S. aureus and among them 16.7% were MRSA and 54.4% multi-drug resistant (MDR). All isolates were sensitive to vancomycin and most of the isolates were sensitive to cefoxitin (83.3%). High rate of resistance was observed towards penicillin (98.9%) and ampicillin (86.7%). All MRSA isolates and 52.9% of methicillin sensitive S. aureus (MSSA) were MDR.&#x0D; Conclusion: MRSA incidence is increasing in the population, and therapeutic measures are few and accompanied by diverse side effects. It is noteworthy to state that vancomycin is still the first line drug although vancomycin-resistant strains have been reported.

Co-occurrence of Anaerobes in Human Chronic Wounds

Chronic wounds are wounds that have failed to heal after 3months of appropriate wound care. Previous reports have identified a diverse collection of bacteria in chronic wounds, and it has been postulated that bacterial profile may contribute to delayed healing. The purpose of this study was to perform a microbiome assessment of the Wound Healing and Etiology (WE-HEAL) Study cohort, including underlying comorbidities less commonly studied in the context of chronic wounds, such as autoimmune diseases, and investigate possible relationships of the wound microbiota with clinical healing trends. We examined chronic wound specimens from 60 patients collected through the WE-HEAL Study using 16S ribosomal RNA gene sequencing. A group of co-occurring obligate anaerobes was identified from taxonomic analysis guided by Dirichlet multinomial mixtures (DMM) modeling. The group includes members of the Gram-positive anaerobic cocci (GPAC) of the Clostridia class (i.e., Anaerococcus, Finegoldia, and Peptoniphilus) and additional strict anaerobes (i.e., Porphyromonas and Prevotella). We showed that the co-occurring group of obligate anaerobes not only co-exists with commonly identified wound species (such as Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas, Corynebacterium, and Streptococcus), but importantly, they could also predominate the wound microbiota. Furthermore, examination of clinical comorbidities of the WE-HEAL specimens showed that specific obligate and facultative anaerobes were significantly reduced in wounds presented with autoimmune disease. With respect to future healing trends, no association with the wound microbiome community or the abundance of individual wound species could be established. In conclusion, we identified a co-occurring obligate anaerobic community type that predominated some human chronic wounds and underrepresentation of anaerobes in wounds associated with autoimmune diseases. Possible elucidation of host environments or key factors that influence anaerobe colonization warrants further investigation in a larger cohort.

Investigation of characteristics of residents in RCHEs associated with MRSA colonization after implementation of infection control training program

Background: Residential care homes for the elderly (RCHEs) are considered potential reservoirs for transmission of Methicillin-resistant Staphylococcus aureus (MRSA). Infection control strategies have been introduced in RCHEs to curb the spread of MRSA. However, the effectiveness of these strategies in reducing MRSA is questionable. MRSA has remained prevalent in economically well-developed regions such as UK and the US despite the implementation of multiple intervention programs. We aim to investigate the characteristics of residents associated with MRSA colonization after implementation of common infection control strategies. Methods & Materials: Residents from selected RCHEs in Kwai Tsing and Tsuen Wan district in New Territories West, Hong Kong were recruited from March 2011 to April 2012. They were interviewed about their health condition and nasal specimens for MRSA screening twice in the study period, with 2-13 months apart. Additional wound specimens were also collected if wounds were identified. Infection control intervention was represented by healthcare staff training and education in the study RCHEs between two screening tests. We defined subjects as being colonized with MRSA if either nasal or wound specimen was tested positive. A multivariable random-effect regression model on follow-up MRSA colonization status was applied. Results: A total of 1832 residents from 32 RCHEs were recruited. The overall point prevalence of MRSA colonisation during the follow-up (after implementation of the training program) was 14.5%(265/1832). Upon adjusting for age, the model which best describes the association between follow-up MRSA colonization and health condition of residents includes the following characteristics: Low mobility indicated by Barthel Index 50 or below (adjusted OR = 1.79;1.23,2.60), presence of skin conditions (adjusted OR = 7.72;4.15,14.36), use of medical device (adjusted OR = 2.25;1.55, 3.24) and presence of MRSA at baseline (OR = 5.23;3.81,7.19). Conclusion: We identified a strong association between health conditions of residents and MRSA colonization. MRSA colonization among residents with low mobility suggested that the service setting and environmental contamination may possibly be sources of MRSA transmission. Device care should be a crucial component in the strategic plan, as shown by the association of colonisation with the use of the medical device. Our findings highlighted the importance of the evaluation of intervention strategies for informing infection control policies.

Molecular feature of lasB gene of Pseudomonas aeruginosa isolated from different clinical sources

The study was carried out through a period from June to November 2017 from out-patients and in-patients of Al-Hussein Teaching Hospital in Thi-Qar province South of Iraq. A sum of 132 specimens from the hospital facility condition and different clinical samples of various patients were randomly collected and analyzed for diagnosis of Pseudomonas aeruginosa. These clinical specimens were included wound, burn, ear swabs, urine and sputum specimens. Every single specimen was screened to detect of P. aeruginosa by culturing on suitable media, and 36 isolates of P. aeruginosa were distinguished through biochemical tests and using API 20NE system for confirmation the isolates. All P. aeruginosa isolates were tested against nine antimicrobial discs in vitro. They revealed that having different classes and the results demonstrated that variable resistance to the anti-microbial agents. In attempting to the recognizable proof of P. aeruginosa having the DNA, Polymerase chain reaction (PCR) was utilized in light of particular groundwork for 16S rRNA genetic marker. The results demonstrated that PCR has observed to be quick and sensitive and particular for recognizable proof of P. aeruginosa. Furthermore, 16S rRNA was utilized as confirmation feature, while lasB detected as virulence gene also to utilize as pathogenesis quality of the bacteria.

Prevalence, trend and antimicrobial susceptibility of Methicillin Resistant Staphylococcus aureus in Nigeria: a systematic review.

Evidence to demonstrate the prevalence and trend of Methicillin Resistant Staphylococcus aureus (MRSA) infection in Nigeria is scarce. This review evaluates the prevalence, trend and antimicrobial susceptibility of clinical MRSA isolates reported in published studies. Electronic search (PubMed, Scopus and Google scholar) was conducted using the following search terms: "MRSA OR Methicillin Resistant Staphylococcus aureus AND Nigeria." Reference list of selected studies was scanned to identify more studies. Studies published between 2007 and 2017 that tested at least 30 non-duplicate S. aureus isolates were selected. An independent reviewer extracted data from the studies using a standardized form. Twelve studies were included in this review. Overall, prevalence of MRSA infection increased from 18.3% (2009) to 42.3% (2013). The prevalence of MRSA infection was less than 50% in all the regions during the period under review. There was a decline in the prevalence of MRSA infection in the North-East (from 12.5% to 8.0%) between 2007 and 2012, and an increase in the South-West (from 20.2% to 47.4%) between 2006 and 2010. Wound, blood and urine specimens had the highest proportion of MRSA isolates. Non-susceptibility of MRSA strains to cotrimoxazole and tetracycline was greater than 85%. Prevalence of MRSA infection in Nigeria is rising, albeit regional variations. Non-susceptibility to commonly prescribed, orally available and inexpensive antibiotics was high. Antimicrobial resistance surveillance system, infection control, and antimicrobial stewardship interventions are recommended.