IDENTIFICATION OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS USING TOUCHDOWN PCR AND PHENOTYPIC METHODS FROM PATIENTS AND HOSPITALS ENVIRONMENTS IN DIFFERENT IRAQI CITIES

The study was aimed to evaluate the prevalence of MRSA in some Iraqi hospitals and determine the most powerful methods for identification of MRSA, in order to achieve the, 278 samples were collected from different hospitals in Iraq in various intervals, 204 out of 287 were identified as Staphylococcus aureus by conventional cultural methods and microscopic characteristics and 177 isolates are identified as MRSA by using HiCrome MeReSa Agar Base medium, but 154 of 177 (87%) isolates are methicillin resistance in sensitivity test. MRSA isolates were highly resistant to β-lactam antibiotics and considered multidrug resistant (MDR) in percent of (94.9%). Touchdown PCR used to identify the isolates, 97.05% were identified as Staphylococcus aureus, while 80.88% as MRSA.

Comparison of MRD Detection in Autografts in Multiple Myeloma between Novel High-Sensitivity Euroflow-NGF and NGS

Background: Autologous stem cell transplantation (ASCT) remains the gold-standard treatment for multiple myeloma (MM). To date, we have reported the prognostic value of minimal residual disease (MRD) detection in autografts in an ASCT setting using EuroFlow next-generation flow (NGF) and next-generation sequencing (NGS) (Takamatsu et al., ASH 2018, 2020). The main problem with NGF is its lower sensitivity (2 × 10 -6) compared with that of NGS (<1 × 10 -6). Methods: We reanalyzed 11 autografts in which the MRD were negative on NGF but positive (n = 7) or negative (n = 4) on NGS (Takamatsu et al., ASH 2018, abstract #258) using 5-20 mL of autografts with NGF to increase the sensitivity of MRD detection. Additionally, we enrolled 9 patients with newly diagnosed MM, from whom 5-20 mL of apheresed autografts were cryopreserved. We included 20 patients with newly diagnosed MM. The median age at ASCT was 60 (range, 45-67) years, and the patients included 12 men and 8 women at International Staging System I (n = 3), II (n = 13), and III (n = 4), 6 of whom harbored high-risk chromosomal abnormalities, including t(4;14) (n = 3), t(14;16) (n = 1), del17p (n = 1), and t(4;14) and del 17p (n = 1). All patients received bortezomib-based chemotherapy for induction followed by melphalan at a dose of 200 mg/m 2 for conditioning before ASCT. Three patients received consolidation therapy with carfilzomib-lenalidomide-dexamethasone (n = 2) or bortezomib-lenalidomide-dexamethasone (n = 1), and 18 patients received lenalidomide (n = 16), thalidomide (n = 1), or thalidomide and lenalidomide (n = 1) maintenance. Frozen autografts (n = 20) were thawed for MRD assessment using NGF and NGS. The NGF method was based on a previous report (Flores-Montero et al., Leukemia 2017). NGS-based MRD assessment was performed using Adaptive's standardized NGS-MRD assay (Seattle, WA) (Ching et al., BMC Cancer 2020). The NGF method was modified to increase the sensitivity of MRD detection by capturing up to 6 × 10 7 cells. Results: Frozen autografts were used in this study; therefore, we performed a sensitivity test using a dilution of frozen/thawed primary MM cells in an autograft with NGF. The sensitivity test revealed a strong correlation between 5 × 10 -7 and 1 × 10 -4 MRD levels (Figure 1A; r = 0.999, P <0.0001). Next, MRD in autografts (n = 20) was evaluated using NGF and NGS. The sensitivity of NGS was 1.7 × 10 -7-8.7 × 10 -5 (median, 7 × 10 -7) using 2-4 mL of autografts; the sensitivity of NGF was 1.6 × 10 -7-3.7 × 10 -6 (median, 3 × 10 -7) using up to 20 mL of autografts based on the detection of ≥10 abnormal cells. MRD levels in autografts using NGF and NGS were correlated (Figure 1B; r = 0.979, P <0.0001). There was no discrepancy in the MRD negativity between both methods except for two cases (MRD-negative on NGF/positive on NGS [n = 2]). All high-risk chromosomal abnormality cases (n = 6) revealed MRD levels <10 -5 butonly three patients achieved MRD levels <10 -6. The best responses included 16 cases of a stringent complete response and 4 of a very good partial response. Three patients with positive MRD in the autograft exhibited progression. With a median follow-up period of 41 months after ASCT, the 3-year progression-free survival (PFS) was 90%, and the 3-year overall survival was 95%. There was no significant difference in the PFS based on the MRD levels between NGF and NGS. MRD negative cases tended to show better PFS than MRD positive ones (Figure 1C; P = 0.077 by NGF; P = 0.111 by NGS). Conclusion: The modified EuroFlow-NGF method may be used to assess MRD in frozen/thawed autografts, and its sensitivity may increase up to 5 × 10 -7, which is comparable to that of NGS. Figure 1 Figure 1. Disclosures Yamashita: Janssen: Honoraria; Bristol-Myers Squibb: Honoraria; celgene: Honoraria; Takeda: Honoraria. Nakao: Novartis Pharma: Honoraria; Symbio: Consultancy; Kyowa Kirin: Honoraria; Alexion Pharma: Research Funding. Takamatsu: Adaptive Biotechnologies, Eisai: Honoraria; SRL: Consultancy; Bristol-Myers Squibb: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding.

Epidemiological Investigation of Salmonella enterica Isolates in Children with Diarrhea in Chengdu, China

Background: Children with the immature intestinal immune system are prone to Salmonella infection through the fecal-oral route causing diarrhea. Non-typhoid Salmonella (NTS) is difficult to treat and eliminate due to its zoonosis. Salmonella typhi, including typhoid and paratyphoidA, B, and C, only infect humans and cause invasive infectious diseases. Salmonella typhi infection is serious and requires antibiotic treatment. The bacterial resistance caused by conventional antibacterial drugs brings great difficulties to treatment. Objectives: This study aimed to investigate the epidemiology of S. enterica in children with diarrhea in Chengdu, China. Methods: Fresh stool specimens or rectal swabs from 6656 children aged 1 day to 17 years with diarrhea were collected, cultured, identified, and tested for antimicrobial susceptibility. Analytical Profile index 20E was used for biochemical identification, and the Kirby-Bauer method was used for the bacterial sensitivity test. The whole process was conducted in accordance with the fourth edition of the National Clinical Examination procedures, and the drug sensitivity test was conducted in accordance with the Clinical and Laboratory Standards Institute 2020 guidelines. Results: A total of 649 Salmonella strains were isolated from 6656 children with suspected Salmonella infection, among which the isolation rates of NTS and S. typhi were 8.92% and 0.83%, respectively. The infection rate of S. typhimurium was the highest every year (74.88%). Salmonella infections are on the rise, especially typhimurium, Dublin, Typhi, and London. Paratyphi is unstable, presenting a phenomenon of transition and replacement (the male to female ratio:1.12:1). The infection rate was the lowest within 1 day and 6 months (P < 0.05). Salmonella mainly infected children under 3 years of age, and the positive rate was reported as 88.29%. Within June-September, the infection rate of Salmonella was the highest, with a positive rate of 72.73%. The isolated 649 Salmonella strains had good susceptibility to cefotaxime and ciprofloxacin (87.7% and 79.2%, respectively), almost no susceptibility to ampicillin, and a drug resistance rate of 92.9%. Conclusions: typhoid and paratyphoid vaccines should be considered together, and vaccines should focus on children under 3 years of age. Antibiotics should be rationally selected according to the drug sensitivity test and disease condition.

Contrast Sensitivity Measurement Tests and Methods

Contrast is a measure of the amount of lightness or darkness an object has in relationship to its background. Usually, it is described as Contrast Sensitivity (CS), which actually is the inverse of the contrast threshold. More often than not, stimulus set includes grating patterns of various sizes that are presented in a stationary manner or are dynamically presented by reversing the contrast at different rates. A variety of tests were developed, in order to asses and evaluate contrast sensitivity, in many different ways. A classical method, to check for contrast sensitivity, is the Pelli-Robson contrast sensitivity chart. The Bailey-Lovie contrast sensitivity chart is another letter chart that deals with differences in the number of letters read on the high and low contrast charts, with a main drawback, the necessity to follow the size of the letters. The Functional Acuity Contrast Test is designed to identify vision loss from a variety of disorders, many of which are not detected by high or low contrast Snellen Acuity tests. The MARS Letter Contrast Sensitivity Test shows good agreement with the Pelli-Robson test and possibly it may be the alternative to the Pelli-Robson chart, in clinical practice and research.

Surgical Site Infections; A Study of Incidence, Risk Factors and Causative Organisms in Emergency Abdominal Surgeries

Background Surgical site infection (SSI) is the most commonly reported nosocomial infection. Surgical site infections are responsible for increase in cost, morbidity, and mortality related to surgical operations. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs. Objectives To determine the incidence and factors responsible for, causative micro-organisms and effective antibiotics for surgical site infections following emergency abdominal operations. Patients and methods a total of 252 patients were enrolled in the current study and were retrospectively followed till the tenth day post-operatively. Data collection sheets were filled in for all the patients. If any symptom or sign of infection appear during this period then proper investigation was instituted for the diagnosis of infection and to assess the type and severity of the infection. If any collection of pus identified it was drained out and sent for culture and sensitivity test. Proper antibiotic was given to every patient both preoperative and post-operative periods. Antibiotic was changed where necessary after getting the report of culture and sensitivity test. Results Surveillance of SSIs in the current study revealed an SSI incidence of 21.4%. The most frequent organisms detected by wound swab cultures were E. coli (55.5%), followed by Klebsiella and coagulase negative staphylococci, with the emergence of resistant strains like MDR, AMPC, ESBL strains. Sensitivity to antiobiotics showed Colistin, Polymyxin B, Vancomycin and Tigecycline to be fully functional, next in sensitivity was piperacillin tazobactam, then meropenem, followed by imipenem and amikacin. SSI was found to be increased with the advancement in age, Smoking cigarettes and HCV positive cases. The fourth post-operative day was the commonest day for the occurrence of SSI with discharge from the wound being the most prevalent sign. Conclusion A surveillance system for SSI with feedback of appropriate data to surgeons and hospital authorities is highly recommended to reduce the SSI rate General Surgical Departments at Ain Shams Specialized Hospital - Police Hospital and other Departments as well.