A Review of Cold Atmospheric Pressure Plasmas for Trauma and Acute Care

Despite the high overall survival rates of severely injured military and civilian personnel requiring trauma and acute care, the challenges of treating infections and healing-resistant wounds have grown. Exposure to unknown environmental pathogens at the wound, including parasites and antibiotic resistant microorganisms, hinders timely and effective treatment using traditional techniques. Cold atmospheric pressure plasma (CAPP) provides a promising biophysical tool to address these issues by applying physically created modalities that cannot be circumvented by bioresistance to inactivate microorganisms and enhance wound healing. CAPPs generate charged particles and numerous reactive oxygen species (ROS) and reactive nitrogen species (RNS) that act on biological cells and tissues, often through plasma membrane interactions. This review fills a gap in the plasma medicine literature by specifically focusing on applying CAPPs for acute trauma, such as surgery, wound treatment, and disinfection. After briefly highlighting the areas of opportunity for improving acute trauma treatment and the fundamentals of CAPP generation, this review details emerging applications of CAPPs for enhanced wound healing, burn treatment, transdermal delivery, and surgical applications. We also discuss CAPP optimization through novel device design and synergistic combination with traditional treatment technologies to transition this biophysical technology to the battlefield and acute care settings.

The Special Issue: Transmission and Detection of Food and Environmental Pathogens

To progress towards a full comprehension of the risk caused by pathogenic microorganisms transmitted via food and environmental routes, extensive information on the prevalence, the mechanisms of contamination, and the survival of pathogens is required, particularly to assist with the development of effective systems to reduce contamination, and to formulate procedural control measures, such as the implementation of food safety criteria [...]

780. Carbapenem-resistant Enterobacteriaceae (CRE) Contamination of In-room Sinks in a New Bed Tower

Background Time from opening of a new bed tower to CREcontamination of patient room hospital sinks is poorly understood. Methods A 26-bed patient care unit in a new bed tower was opened on 7/18/2020. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing (CP) CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CP-CRE. In-room sinks were located opposite the patient headwall in each patient room and were cultured monthly beginning 9/14/2020 for 3 months. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tailpipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the p-trap water was sampled with sterile tubing attached to a 50mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex medias and incubated at 37°C for 24 hours. Carbapenem resistance genes (NDM1, KPC, IMP, VIM and OXA48) were detected by multiplex PCR and species were confirmed using MALDI-TOF. Environmental pathogens with intrinsic carbapenem resistance and no detected carbapenem-resistance genes were excluded. Results Generally, patients admitted to study rooms were similar across samplings (Table 1). No CP-CRE-positive patients were identified from weekly screening or clinical cultures from the opening of the unit through the end of the study. On the first sampling we discovered KPC-positive Enterobacter cloacae complex on a drain cover (1,400 CFU) and two environmental pathogens housing IMP or KPC genes. On the second sampling we discovered five environmental pathogens housing IMP or KPC genes. On the third sampling we discovered two environmental pathogens housing the IMP gene in p-traps (Figure 1). Table 1. Patient Characteristics Figure 1. Bacterial species and carbapenem-resistance genes found over time Conclusion In a new bed tower open for 58 days with no evidence of CRE positive patients, CRE and CRE genes were discovered in in-room sinks in clinically important (KPC) and environmental pathogens (KPC, IMP). We observed transient colonization of sink drains with potentially important pathogens during a short observation period. Observation over longer time is required to determine transient versus persistent colonization and risk factors for persistent drain colonization. Disclosures All Authors: No reported disclosures

Fecal Markers of Environmental Enteric Dysfunction and their Relation to Faltering Growth in a Sample of Egyptian Children

BACKGROUND: Chronic malnutrition is a long-term health condition that has threatening effects on children’s health. Environmental enteric dysfunction (EED) is a subclinical disorder affecting the small intestine that may occur due to exposure to environmental pathogens and toxins. AIM: The present research was intended to detect the value of fecal biomarkers of intestinal epithelial damage alpha-1anti-trypsin (AAT) and intestinal inflammation Myeloperoxidase (MPO) and Neopetrin (NEO), also to quantify their association with faltering growth in stunted and underweight children. PATIENTS AND METHODS: This case–control study included 105 children with moderate malnutrition as a case group and 100 children of normal body weight and height as a control group. Quantification of fecal markers levels of intestinal permeability AAT and intestinal inflammation (NEO and MPO) along with serum micronutrients levels (iron and zinc) in children with malnutrition in comparison to controls. RESULTS: Fecal markers of intestinal permeability AAT and intestinal inflammation NEO had statistically significant higher levels in children with malnutrition, while serum micronutrients (iron and zinc) had statistically significant lower levels in children with malnutrition. CONCLUSION: Faltering growth is associated with elevated fecal markers of intestinal permeability AAT and intestinal inflammation NEO. EED may be a cause for faltering growth.

Case of flexor tenosynovitis caused by Mycobacterium arupense

Mycobacterium arupense is a member of the Mycobacterium terrae complex (MTC) that is implicated in bone and joint infections, among others. This group of environmental pathogens can be found in soil, reclaimed and drinking water systems, rodents, fish tanks and bioaerosols in duck houses. Interestingly, while M. arupense is genotypically closely related to the other agents in the MTC, antibiotic susceptibility of these mycobacteria can vary widely and empiric antibiotic therapy is controversial. Our case report contributes to the very limited literature on M. arupense tenosynovitis—as only six cases have been reported since 2008—and sheds light on different courses of treatment. While previous cases have been successfully treated, a streamlined course of therapy for M. arupense tenosynovitis is still needed.

A Fetus with Congenital Microcephaly, Microphthalmia and Cataract Was Detected with Biallelic Variants in the OCLN Gene: A Case Report

Microcephaly and microphthalmia are both rare congenital abnormalities, while concurrently, these two are even rarer. The underlying etiology would be complex interplaying between heterogeneous genetic background and the environmental pathogens, particularly during critical periods of early tissue development. Here, we reported a prenatal case with microcephaly, microphthalmia, and bilateral cataracts detected by ultrasonography and confirmed by autopsy. Various routine infection-related tests and invasive genetic testing were negative. Whole genome sequencing of fetus and parents revealed OCLN gene defects may be associated with these multiple congenital abnormalities.

A case report of Nocardia spp. infective endocarditis in an injection drug user

Background Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals. Case presentation A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice. Conclusions This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.

Etiology of Bovine Mastitis

Mastitis in dairy animals is the primary concern of dairy farmers, which is the most common disease that causes huge economic losses in the dairy industry. The economic losses due to mastitis are from a reduction in milk yield, condemnation of milk with antibiotic residues, veterinary treatment costs, and death. In addition, some mastitis pathogens also cause serious human diseases associated with the contamination of milk or milk products with bacteria or their toxins. Bovine mastitis is mainly caused by a wide range of environmental and contagious bacterial mastitis pathogens. Contagious pathogens are those whose main reservoir is the infected udder. Contagious pathogens mainly spread among animals during milking process whereas environmental pathogens spread from environment to udder at any time. The source of the environmental pathogens is the surrounding environment of an animal. The major contagious pathogens include Staphylococcus aureus, Streptococcus agalactiae, and Mycoplasma spp. and the minor contagious pathogens include Corynebacterium bovis and others. Major environmental pathogens include coliform bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp. and Citrobacter spp.), environmental streptococci (Strep. dysgalactiae, Strep. uberis). This chapter covers detailed review of published data on contagious and environmental pathogens responsible for bovine mastitis.

Comparative Analysis of Fecal Microbiomes From Wild Waterbirds to Poultry, Cattle, Pigs, and Wastewater Treatment Plants for a Microbial Source Tracking Approach

Fecal pollution in coastal areas is of a high concern since it affects bathing and shellfish harvesting activities. Wild waterbirds are non-negligible in the overall signal of the detectable pollution. Yet, studies on wild waterbirds’ gut microbiota focus on migratory trajectories and feeding impact on their shape, rare studies address their comparison to other sources and develop quantitative PCR (qPCR)-based Microbial Source Tracking (MST) markers to detect such pollution. Thus, by using 16S rRNA amplicon high-throughput sequencing, the aims of this study were (i) to explore and compare fecal bacterial communities from wild waterbirds (i.e., six families and 15 species, n = 275 samples) to that of poultry, cattle, pigs, and influent/effluent of wastewater treatment plants (n = 150 samples) and (ii) to develop new MST markers for waterbirds. Significant differences were observed between wild waterbirds and the four other groups. We identified 7,349 Amplicon Sequence Variants (ASVs) from the hypervariable V3–V4 region. Firmicutes and Proteobacteria and, in a lesser extent, Actinobacteria and Bacteroidetes were ubiquitous while Fusobacteria and Epsilonbacteraeota were mainly present in wild waterbirds. The clustering of samples in non-metric multidimensional scaling (NMDS) ordination indicated a by-group clustering shape, with a high diversity within wild waterbirds. In addition, the structure of the bacterial communities was distinct according to bird and/or animal species and families (Adonis R2 = 0.13, p = 10–4, Adonis R2 = 0.11, p = 10–4, respectively). The Analysis of Composition of Microbiomes (ANCOM) showed that the wild waterbird group differed from the others by the significant presence of sequences from Fusobacteriaceae (W = 566) and Enterococcaceae (W = 565) families, corresponding to the Cetobacterium (W = 1427) and Catellicoccus (W = 1427) genera, respectively. Altogether, our results suggest that some waterbird members present distinct fecal microbiomes allowing the design of qPCR MST markers. For instance, a swan- and an oystercatcher-associated markers (named Swan_2 and Oyscab, respectively) have been developed. Moreover, bacterial genera harboring potential human pathogens associated to bird droppings were detected in our dataset, including enteric pathogens, i.e., Arcobacter, Clostridium, Helicobacter, and Campylobacter, and environmental pathogens, i.e., Burkholderia and Pseudomonas. Future studies involving other wildlife hosts may improve gut microbiome studies and MST marker development, helping mitigation of yet unknown fecal pollution sources.

Dissemination and Characteristics of High-Level Erythromycin-Resistant Enterococcus Faecalis From Bulk Tank Milk of Dairy Companies in Korea

Background: Enterococci are environmental pathogens that can cause bovine mastitis and macrolides are widely used for the treatment of bovine mastitis caused by staphylococci and streptococci/enterococci. The aim of this study was performed to compare the phenotypic and genotypic characteristics of high-level erythromycin-resistant (HLER) Enterococcus faecalis (E. faecalis) collected from bulk tank milk of four dairy companies (A, B, C, and D) in Korea. Results: Although isolates from company D showed the highest prevalence of E. faecalis, the prevalence of HLER E. faecalis in company A (73.1%) and C (57.0%) was significantly higher than company D (33.9%) (P < 0.05). A total of 149 HLER E. faecalis isolates showed high rates of resistance to tetracycline (93.3%), followed by doxycycline (70.0%), and chloramphenicol (48.3%). In the distribution of macrolides resistance genes, 147 (98.7%) isolates carried ermB gene alone, and two isolates carried both ermA and ermB genes. No isolates carried ermC, msrA, msrC, or mef genes. In the distribution of other resistance genes, 72 (48.3%) and 60 (40.3%) isolates carried both tetM and tetL genes, and tetM gene alone, respectively, and 38 (25.5%) isolates carried optrA gene. For aminoglycosides resistance genes, the prevalence of both aac(6′)Ie-aph(2″)-la and ant(6′)-Ia genes (43.0%) was the highest. Moreover, 104 (70.0%) isolates harbored Int-Tn gene carrying the Tn916/1545-like transposon. Although the distribution of ermB gene showed no significant difference between the dairy companies, the prevalence of other resistance genes and transposons showed a significant difference between the dairy companies (P < 0.05). Virulence genes, such as ace (99.3%), cad1 and efaA (each 98.7%), and gelE (83.9%), were also highly conserved in the 149 HLER E. faecalis isolates. Conclusions: Our results indicated that HLER E. faecalis isolates from bulk tank milk showed significant differences in phenotypic and genotypic characteristics between the dairy companies. In addition, the prevalence of resistance genes and virulence factors was also high in HLER E. faecalis isolates.