Estimating the cost of antibiotic use on future collateral resistance: a retrospective comparison of cefuroxime versus cefazolin and amoxicillin/clavulanate

Background: Quantitative estimates of collateral resistance induced by antibiotic use are scarce. This study compared the effects of treatment with amoxicillin/clavulanate or cefazolin, compared to cefuroxime, on future resistance to ceftazidime among hospitalized patients. Methods: A retrospective analysis of patients with positive bacterial cultures hospitalized in an Israeli hospital during 2016-2019 was conducted. Patients were restricted to those treated with either amoxicillin/clavulanate, cefazolin, or cefuroxime and re-hospitalized with a positive bacterial culture during the following year. A 1:1 matching was performed for each patient in the amoxicillin/clavulanate and cefazolin groups, to a single patient from the cefuroxime group, yielding 185:185 and 298:298 matched patients. Logistic regression and g-formula (standardization) were used to estimate the odds ratio (OR), risk difference (RD), and number needed to harm (NNH). Results: Cefuroxime induced significantly higher resistance to ceftazidime than amoxicillin/clavulanate or cefazolin: the marginal OR was 1.76) 95%CI 1.16-2.83) compared to amoxicillin/clavulanate, and 1.98 (95%CI 1.41- 2.8) compared to cefazolin; The RD was 0.118 (95%CI 0.031-0.215) compared to amoxicillin/clavulanate, and 0.131 (95%CI 0.058-0.197) compared to cefazolin. We also estimated the NNH: replacing amoxicillin/clavulanate or cefazolin with cefuroxime would yield ceftazidime-resistance in one more patient for every 8.5 (95% CI 4.66-32.14) or 7.6 (95% CI 5.1-17.3) patients re-hospitalized in the following year. Conclusions: Our results indicate that treatment with amoxicillin/clavulanate or cefazolin is preferable to cefuroxime, in terms of future collateral resistance. The results presented here are a first step towards quantitative estimations of the ecological damage caused by different antibiotics.

DMBT1 expression and neutrophil-to-lymphocyte ratio during necrotizing enterocolitis are influenced by impaired perfusion due to cardiac anomalies

Background Deleted in malignant brain tumors 1 (DMBT1) is involved in innate immunity and epithelial differentiation. It has been proven to play a role in various states of inflammation or hypoxia of fetal gastrointestinal and pulmonary diseases. Discrimination of pathogenesis in necrotizing enterocolitis (NEC) based on cardiac status improves the understanding of NEC in different patient subgroups. We aimed at examining DMBT1 expressions regarding their association with cardiac status leading to impaired intestinal perfusion, intraoperative bacteria proof, and a fulminant course of NEC. Methods Twenty-eight patients with NEC were treated surgically between 2010 and 2019 at our institution. DMBT1 expression was examined in intestinal sections using immunohistochemistry to detect DMBT1 protein. Associations of clinical parameters and DMBT1 expression were analyzed. Results We examined DMBT1 levels in 10 patients without cardiac defects and 18 patients with persisting ductus arteriosus (PDA) and congenital heart defects (CHD). Compared to patients without cardiac malformations, DMBT1 levels tended to score higher in patients with PDA/CHD (p = 0.2113) and were negatively correlated with C-reactive protein in these infants (p = 0.0172; r = − 0.5533). The number of DMBT1-expressing macrophages was elevated in the PDA/CHD-subgroup (p = 0.0399). Ratios of neutrophils and monocytes to lymphocytes were significantly higher in infants with PDA/CHD (p = 0.0319 and 0.0493). DMBT1 expression was significantly associated with positive bacterial culture of intraoperative swabs (p = 0.0252) and DMBT1 expression of the serosa was associated with a fulminant course of NEC (p = 0.0239). Conclusions This study demonstrates that DMBT1 expression may be influenced by cardiac anomalies with an impaired intestinal perfusion in the neonatal intestine. NEC in PDA/CHD infants is associated with more DMBT1-positive macrophages and a significantly elevated neutrophil-to-lymphocyte ratio.

Clinical Application of Vacuum Sealing Drainage for the Treatment of Deep Burn Wounds

Background This study aimed to determine the effect of the clinical application of vacuum sealing drainage (VSD) on the treatment of deep burn wounds. Methods This single-blind, randomized, controlled study included patients who were admitted to our hospital with deep burns from January 2018 to December 2020; the patients were randomly divided into the VSD and control (CON) groups. The number of days from treatment to skin grafting; survival rate of the first skin graft; rate of positive bacterial culture; visual analog scale (VAS) pain score; and durations of wound healing, antibiotic drug use, and hospitalization were analyzed and compared between the groups. Results The application of VSD significantly shortened the number of days from treatment to skin grafting ( P < .05); improved the survival rate of the first skin graft in patients with severe burns ( P < .05); reduced the rate of positive bacterial culture ( P < .05); reduced the VAS pain score ( P < .05); and shortened the durations of wound healing ( P < .05), antibiotic drug use ( P < .05), and hospitalization ( P < .05). Conclusion Vacuum sealing drainage had a good clinical effect on the recovery of deep burn wounds.

A Study of Bacteriological Profile of Pleural Fluid and Antibiogram of Isolates at Pandit Dindayal Upadhyay Medical College Andhospital College, Rajkot

Background: The bacteriology of thoracic empyema has been changing since the introduction of antibiotics. Gram stain and culture has for decades been the “gold standard” for the detection of microorganisms in pleural fluid samples. The present retrospective study was designed to review our experience with the microbial causes of empyema and their antibiotic sensitive patterns. The knowledge of likely prevalent strains along with their antimicrobial sensitive pattern helps in the framing of antibiotic policy and better management of patients. Materials and Methods: This descriptive study was including 500 cases suspected of bacteriological infection of pleural fluid in patients admitted in ward of PDU Government Hospital, Rajkot. The performa include serial number, register number, age, sex, ward, clinical features of patients and investigation. All the samples were inoculated into Blood agar and MacConkey agar and Nutrient agar. All the plates were incubated aerobically at 370 C and results were read after 24 hours. If no growth present it is further incubated for next 24 hours. One smear was prepared on clean glass slide, then air dried and was heat fixed. Gram staining was done by standard technique. Results: This study include 500 cases of pleural effusion from January 2015 to July 2016, out of which 87 cases show positive Bacterial culture growth and 232 cases were adenosine deaminase positive. In total 87 positive bacterial cultures, 20(22%) show bacterial pathogens in gram stain. Total positive culture found in 17.4%. Among them; most common Bacteria isolated was Pseudomonas aeruginosa in 40 (45%) patients, this was followed by Klebsiella pneumonaie in 21 (24%), Staphylococcus aureus in 10 (11.49%), Acinetobacter spp. in 4 (4.59%), Proteus spp.in 3 (3.44%) and Providencia in 1 (1.14%). Conclusion: Pleural space infection continues to be prevalent in our country particularly in the lower socioeconomic strata due to the delay in seeking medical care, inappropriate antibiotics and dosages and duration of antibiotic treatment. All gram positive bacteria isolate were 100% sensitivity to Rifampicin, Vancomycin, Linezolid.

A comparison of demographic, epidemiological and clinical characteristics of hospital influenza-related viral pneumonia patients

Background Through the comparison of the demographic, epidemiological, and clinical characteristics of hospital human influenza (influenza A (H1N1) pdm09, H3N2, and B)-related and hospitalized avian-origin influenza A (H7N9)-related viral pneumonia patients, find the different between them. Methods A retrospective study was conducted in hospitalized influenza-related viral pneumonia patients. Results Human influenza A-related patients in the 35–49-year-old group were more than those with B pneumonia patients (p = 0.027), and relatively less in the ≥ 65-year-old group than B pneumonia patients (p = 0.079). The proportion of comorbid condition to human influenza A pneumonia was 58%, lower than B pneumonia and H7N9 pneumonia patients (78% vs. 77.8%; p = 0.013). The proportion of invasive mechanical ventilation (IMV), lymphocytopenia, elevated lactate dehydrogenase to hospitalized human influenza A-related viral pneumonia patients was higher than B pneumonia patients (p < 0.05), but lower than H7N9 pneumonia patients (p < 0.05). In the multivariate analysis, pulmonary consolidation (odds ratio (OR): 13.67; 95% confidence interval (CI) 1.54–121.12; p = 0.019) and positive bacterial culture (sputum) (OR: 7.71; 95% CI 2.48–24.03; p < 0.001) were independently associated with IMV, while shock (OR: 13.16; 95% CI 2.06–84.07; p = 0.006), white blood cell count > 10,000/mm3 (OR: 7.22; 95% CI 1.47–35.58; p = 0.015) and positive bacterial culture(blood or sputum) (OR: 6.27; 95% CI 1.36–28.85; p = 0.018) were independently associated with death in the three types hospitalized influenza-related viral pneumonia patients. Conclusions Hospital influenza B-related viral pneumonia mainly affects the elderly and people with underlying diseases, while human influenza A pneumonia mainly affects the young adults; however, the mortality was similar. The hospitalized human influenza A-related viral pneumonia patients was severer than B pneumonia patients, but milder than H7N9 pneumonia patients. Pulmonary consolidation and positive bacterial culture (sputum) were independently associated with IMV, while shock, white blood cell count > 10,000/mm3, and positive bacterial culture (blood or sputum) were independently associated with death to three types hospitalized influenza-related viral pneumonia patients.

Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopedic Foot and Ankle Surgery

Background: There is no consensus as to which skin antiseptic solution is most effective at reducing infection following orthopedic foot and ankle surgery. The purpose of this study is to determine if the addition of a dilute povidone-iodine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold. Methods: In this prospective, randomized controlled trial, 242 subjects undergoing orthopedic foot and ankle surgery were randomized to one of 2 groups. The control group received our standard 2-step skin antiseptic preparation of an alcohol scrub (step 1) followed by chlorhexidine/alcohol paint (step 2). The intervention group received a 3-minute dilute povidone-iodine soak and scrub followed by that same standard 2-step skin preparation. Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups. Results: Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups ( P > .05 for each). There was no difference in bacterial growth rates between groups (26.8% growth in the intervention group vs 26.9% growth in the control group, P = .991). Conclusion: The hallux nailfold is one of the most difficult to sterilize areas prior to orthopedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a 3-minute dilute povidone-iodine soak and scrub to a standard skin preparation with alcohol and chlorohexidine. Level of Evidence: Level I, randomized controlled trial.

Effect of Weeping Teats on Intramammary Infection and Somatic Cell Score in Dairy Goats

Mastitis is the most common disease affecting dairy goats and causing economic losses. Although it is accepted that increased somatic cell count (SCC) is mainly a response to infection, its reliability for subclinical mastitis detection in goats is controversial. Indeed, many physiological and extrinsic variables can increase SCC, including breed, parity, age, stage of lactation, seasonal variations, and milking methods. In some animals, milk-secreting tissue is present in the wall of the teat and, in some instances, milk can filter through pores in the skin to the udder surface. This condition is known as “weeping teat” (WT). In these animals, mammary tissue might be prone to develop bacterial infections, although limited information is provided. Weeping teat seems to have a genetic background and is reported to be especially found in goat breeds selected for high milk production. Moreover, it is observed a genetic correlation between WT and decreased milk yield as well as increased somatic cell scores (SCS). Since information on this topic is very limited, this study aimed at investigating any possible relationship between WT, high SCC, and the presence of bacteria in goat milk. Alpine goat farms in Northern Italy were selected based on the presence of WT. Each herd was divided into two age-matched groups, identified as case (WT+) and control (WT–). Half-udder milk samples were collected aseptically at three timepoints; bacteriological analysis was performed, and SCC were determined and transformed in SCS. There was a positive association between SCS and the presence of bacteria in milk (P = 0.037) overall, whereas WT udder defect was associated with positive bacterial culture in just one herd (P = 0.053). Thus, this herd was further investigated, repeating the sampling and the analysis on the following year. The positive association between high SCS and the presence of bacteria in milk was then confirmed (P = 0.007), whereas no association with WT condition was found. These results indicate that WT defect is usually unrelated to both the outcome of milk bacterial culture and SCS. As a side outcome, we could confirm the role of bacterial infection in increasing SCS.

Case Report: About a Case of Hyperammonemia Syndrome Following Lung Transplantation: Could Metagenomic Next-Generation Sequencing Improve the Clinical Management?

Background:Mycoplasma hominis and Ureaplasma spp. are responsible for opportunistic infections in transplant patients, sometimes causing a life-threatening hyperammonemia syndrome. Both pathogens are not identified with standard microbiology techniques, resulting in missed or delayed diagnosis. We present a clinical case that illustrates the added value that next-generation sequencing (NGS) may offer in the diagnosis of respiratory infections in immune-compromised patients.Results: A 55 years-old man with idiopathic pulmonary fibrosis underwent double lung transplantation. He received antibiotic prophylaxis with piperacillin-tazobactam and azythromycin. At day 4 post-transplantation (PTx), the patient presented an acute respiratory distress. A broncho-alveolar lavage (BAL) was performed. At day 5 PTx, the patient presented a status epilepticus due to diffuse cerebral oedema. Serum ammonia concentration was 661 μg/dL. BAL bacterial culture was negative. Because of the clinical presentation, special cultures were performed and identified 100.000 CFU/mL of M. hominis and Ureaplasma spp. and specific PCRs were positive for M. hominis and Ureaplasma parvum. Antibiotic therapy was shifted to therapeutic dose of azithromycin and doxycycline; within 48 h ammonia serum concentrations returned to normal but the coma persisted several weeks, followed by a persistent frontal lobe syndrome. A follow-up BAL was performed on day 11 Ptx. The Mycoplasma/Ureaplasma culture was negative, yet the specific PCRs remained positive. Bacterial culture found 100 CFU/mL of Staphylococcus aureus and viral culture was positive for Herpes Simplex Virus-1. These results were confirmed by metagenomic next-generation sequencing (mNGS). In the bacterial fraction, the majority of reads belonged to Corynebacterium propinquum (34.7%), S. aureus (24.1%) and Staphylococcus epidermidis (17.1%). Reads assigned to M. hominis, Ureaplasma urealyticum and parvum represented 0.71, 0.13, and 0.04% of the bacterial fraction and corresponded to 6.9 × 103, 9.7 × 102, and 3.7 × 102 genome equivalents per mL of BAL fluid, respectively. These results are in favor of a cure of the atypical infection.Conclusions: mNGS offered added diagnostic and quantitative values compared to PCR tests, which can remain positive after resolved infections. The initiation of appropriate antibiotic therapy would have occurred earlier on, possibly resulting in a better clinical outcome if mNGS had been performed in a routine fashion.

Characterization and in vitro susceptibility profile of bacterial samples harvest from canine chronic otitis

This study aimed to identify which are the most frequent bacteria evolved in cases of chronic otitis in dogs in the metropolitan region of Curitiba, as well to determine their in vitro antimicrobial susceptibility. Data of positive bacterial culture from dogs affected by chronic or recurrent otitis were compiled from the records of the veterinary hospital of Pontifícia Universidade Católica do Paraná, Curitiba, southern Brazil. In a period of 16 months, a total of 83 bacterial cultures were performed, resulting in 192 isolates. All isolates were submitted to antimicrobial susceptibility tests, based on the Kirby-Bauer technique using 17 drugs from 8 antibiotic classes (?-lactams, aminoglycosides, lincosamides, macrolides, polypeptides, quinolones, tetracyclines, and amphenicols). The five most frequent bacterial isolates were Staphylococcus spp. (58.32%), Proteus spp. (14.58%), Escherichia coli (9.90%) and Pseudomonas spp. (8.33%). The four most effective antibiotics were amikacin (13.29%), neomycin (24.47%), gentamicin (25.52%) and tobramycin (26.70%); however, these aminoglycosides may cause ototoxicity, and their use should be restricted when the tympanic membrane is intact. Quinolones also showed antimicrobial effectiveness, with 29.17% of the isolates showing resistance to ciprofloxacin and 29.69% to enrofloxacin. According to the results, it can be concluded that aminoglycosides and quinolones were effective against microorganisms of canine chronic otitis.

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-positive and -negative US Patients with a Positive Bacterial Culture: a Multicenter Evaluation from March to November 2020

Background Increased utilization of antimicrobial therapy has been observed during the coronavirus disease 2019 pandemic. We evaluated hospital outcomes based on the adequacy of antibacterial therapy for bacterial pathogens in US patients. Methods This multicenter retrospective study included patients with ≥24 hours of inpatient admission, ≥24 hours of antibiotic therapy, and discharge/death from March-November 2020 at 201 US hospitals in the BD Insights Research Database. Included patients had a test for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and a positive bacterial culture (gram-positive or gram-negative). We used generalized linear mixed models to evaluate the impact of inadequate empiric therapy (IET), defined as therapy not active against the identified bacteria or no antimicrobial therapy in the 48 hours following culture, on in-hospital mortality and hospital and intensive care unit (ICU) length of stay (LOS). Results Of 438,888 SARS-CoV-2 tested patients, 39,203 (8.9%) had positive bacterial cultures. Among patients with positive cultures, 9.4% were SARS-CoV-2 positive, 74.4% had a gram-negative pathogen, 25.6% had a gram-positive pathogen, and 44.1% received IET for the bacterial infection. The odds of mortality were 21% higher for IET (odds ratio 1.21 [95% confidence interval (CI), 1.10–1.33]; P&lt;.001) compared with adequate empiric therapy. IET was also associated with increased hospital LOS(16.1 [95% CI, 15.5–16.7] vs 14.5 [95% CI 13.9–15.1] days; (P&lt;.001). Both mortality and hospital LOS findings remained consistent for SARS-CoV-2-positive and -negative patients. Conclusions Bacterial pathogens continue to play an important role in hospital outcomes during the pandemic. Adequate and timely therapeutic management may help ensure better outcomes.