Sex Specific Differences in Nosocomial Infections in Patients with Decompensated Liver Cirrhosis

Background and aims: There are considerable differences between males and females regarding the etiology, progression and outcome of liver diseases. Infections are a frequent and severe complication in these patients. This study aimed to examine sex specific differences in the incidence and clinical course of nosocomial infections in patients with decompensated liver cirrhosis.Methods: A number of 555 consecutive patients with decompensated liver cirrhosis and ascites were analyzed. The patients were followed up for the incidence of nosocomial infections, acute kidney injury (AKI), acute-on-chronic liver failure (ACLF) as well as liver transplantation and death (LTx-free survival). Results: A number of 285 patients (111 women and 174 men) developed a nosocomial infection. Incidence was numerically lower in men (p=0.076). While the frequency of a nosocomial spontaneous bacterial peritonitis was similar between males and females, the incidence of a nosocomial urinary tract infection was significantly higher in women (p<0.001). No sex specific differences were documented regarding the outcome of an infection as indicated by a similar incidence of, AKI, ACLF as well as LTx-free survival.Conclusion: There seem to be no major differences in the incidence and outcome of nosocomial infections between male and female patients.

Factors associated with nosocomial urinary tract infections in maternity wards of public hospitals in Lubumbashi in DR Congo

Introduction: Nosocomial urinary tract infection represents between 30 and 50% of all these nosocomial infections. It occupies the first place and constitutes the third entry point for bacteremia. The objective of our study was to identify the risk factors associated with nosocomial urinary tract infections in maternity wards of public hospitals in Lubumbashi. Method: We carried out an analytical cross-sectional study in which the population consisted of parturients who did not have a urinary tract infection on admission. The urine samples were taken and analyzed in the laboratory of the university clinics of Lubumbashi. A case of nosocomial urinary tract infection was defined according to the WHO definition. To collect this urine, the parturients did it themselves after a health education session. Two samples were taken, one at the entry and the other at the exit of the parturient from the maternity hospital. The univariate analysis used the prevalence ratio as an indicator of risk with a 95% confidence interval and the bivariate analysis included all risk factors that had a significance level p ˂ 0.05 by a regression model binary logistics. Results: Out of the total of 1240 parturients selected and who were distributed in seven maternities of public hospitals in the city of Lubumbashi. It was noted that women who gave birth at HGR Kampemba were up to ten times more likely to develop nosocomial urinary tract infection than those who did at HGR Kisanga. An association was observed between delivery with complications (p = 0.032), long length of stay (p <0.001), delivery with surgical intervention (p <0.001) and antibiotic therapy (p = 0.020). Conclusion: Nosocomial urinary tract infections were varied depending on the characteristics of health structures, characteristics of parturients and health care. It is necessary to improve the hospital hygiene of the personnel, the hospital environment and the materials as well as a good policy of use of the antibacterials.

Incidence, Causative Organisms and Pattern of Drug Resistance of Nosocomial Urinary Tract Infection in Patients with Liver Cirrhosis

Background: The nosocomial urinary tract infections (UTIs) creates a major health problem in hospitals all over the world. Objectives: We aimed in this study to determine the incidence of nosocomial UTIs in our cirrhotic patients, identification of the most common pathogens responsible for nosocomial UTIs and identification of the pattern of drug resistance. Methodology: 366 cirrhotic patients were studied within one year. Patients with apparent clinical manifestations of any UTI at time of admission were excluded. All patients were subjected to clinical evaluation, abdominal ultrasound examination, and laboratory investigations including complete blood picture, renal function tests, liver function tests and urine analysis at time of admission. Urine samples were collected from the infected patients for both bacterial and fungal cultures and drug sensitivity testing. Results: The frequency of nosocomial UTIs in cirrhotic patients was 7.1%. The most significant risk factor was urinary catheterization (OR=189.0). Gram negative bacilli were the first cause (46%) of nosocomial urinary tract infection followed by fungi (36%). The sensitivity revealed that the most sensitive antibiotic for both Gram positive and Gram negative cocci was Gatifloxacin. The most sensitive antifungal for candida albicans was Nystatin. Conclusion: The frequency of nosocomial UTIs in cirrhotic patients was not low. Malnutrition and urinary catheterization were the most significant risk factors. Urinary fungal infection was not rare and must be in mind. Both bacterial and fungal cultures and their sensitivity to antibacterial and antifungal drugs were very important to improve the survival rate of patients.

Enterococci: An Important Nosocomial Pathogen

Enterococci, particularly Enterococcus faecalis and Enterococcus faecium, are an important cause of nosocomial infections and have become a major issue worldwide. Nosocomial infections due to vancomycin resistant Enterococci (VRE) occur frequently. A significant increase in prevalence of VRE has been reported recently in many countries. Enterococci are second most frequent cause of nosocomial urinary tract infection, bacteremia and infective endocarditis. They are also related to etiology of intra-abdominal an pelvic infections, gastrointestinal infections and oral infections. The ability of Enterococci to survive in adverse conditions, presence of virulence factors and possession of intrinsic and acquired antibiotic resistance traits poses a therapeutic challenge. Due to high level of multidrug resistance in VRE, Enterococcus has become an important organism in health based settings.

Co-transfer of plasmid-mediated blaAmpC and fluoroquinolone resistance genes in Klebsiella pneumoniae isolates causing nosocomial urinary tract infection

Background: Klebsiella pneumoniae is a pathogen that frequently causes nosocomial urinary tract infection (UTI), and the prevalence of plasmid-mediated resistance determinants among clinical isolates of K. pneumoniae leads to the appearance of resistance to antibiotics. The aim of this study was to investigate the prevalence of plasmid-mediated quinolone resistance (PMQR) genes in acquired AmpC (ac-AmpC) β‑lactamase‑producing K. pneumoniae isolates from patients with nosocomial UTI and to characterize the transmissibility of plasmids co-harbouring blaAmpC and PMQR genes.Methods: From January 2017 to June 2018, we collected 46 AmpC-producing K. pneumoniae isolates causing nosocomial UTI from a tertiary care hospital in China. β-lactamase, PMQR and virulence genes were detected by PCR and sequencing. Clonal relatedness was assessed using ERIC-PCR and multilocus sequence typing (MLST). Plasmids carrying multiple blaAmpC and PMQR genes were characterized by PCR-based replicon typing (PBRT) and S1-PFGE. Conjugation and electroporation experiments were carried out to assess resistance transfer mediated by plasmids. Overlapping PCR was used to map the genetic context of the blaAmpC genes. Results: In the studied isolates, non-susceptibility of third-generation cephalosporin and fluoroquinolone was very high (>80%). blaCMY-2, blaDHA-1, and quinolone resistance gene (qnr) were detected in 11, 41 and 33 isolates, respectively. Among the isolates, 6 strains co-harboured multiple AmpC and qnrB genes. The blaAmpC and qnrB genes from these six isolates were co-transferrable to recipients via conjugation or electroporation, with IncFIA, IncFIB and IncA/C being the dominant replicons (sizes from ~78 to 217 kb). Forty-six isolates were categorized into 25 ERIC types, and the 6 isolates harbouring multiple blaAmpC and qnrB genes belonged to ST1/STnew1. The conserved genetic structures in blaCMY-2 and blaDHA-1 were identical to those described in the pNF4656 and pSAL-1 plasmids, respectively.Conclusion: This work reports that qnrB is highly prevalent in AmpC-producing K. pneumoniae isolates and illustrates the emergence of plasmids co-harbouring multiple acquired blaAmpC and qnrB genes in K. pneumoniae causing UTI in China. We determined that the IncFIA, IncFIB and IncA/C plasmids carrying blaAmpC with qnrB resistance genes and several mobile genetic elements mediate the local prevalence in K. pneumoniae UTI. The genetic context of blaAmpC was highly conserved.

Draft Genome Sequence of Enterococcus faecium CL-6729, a Clinical Isolate Showing Constitutive Vancomycin Resistance

Here, we present the draft genome sequence of an unusual Enterococcus faecium isolate (CL-6729) showing constitutive expression of the VanA type of vancomycin resistance. The isolate was recovered from a patient with a nosocomial urinary tract infection in Brazil.