Clinical Efficacy and Safety Analysis of Tigecycline in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Combined with Multidrug-Resistant Acinetobacter baumannii Infection

Objective:To study the clinical efficacy and safety of tigecycline in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)combined with multidrug-resistant Acinetobacter baumannii infection.Methods:113 patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection were recruited between January 2021 and January 2023,and given tigecycline treatment.The total effective rate,lung function indexes,related biochemical index levels,and the incidence rate of adverse reactions were observed after the treatment.Results:After the treatment,100 patients were cured,1 case with apparent effect,2 cases were effective,10 cases were ineffective,and the total effective rate was 91.15%.The post-treatment CRP(21.22±3.35 mg/L),PCT(3.18±1.11 ng/L),CRE(76.36±9.24μmol/L),and ALT(37.76±6.99 U/L)were significantly improved as compared to the pre-treatment(P<0.05).After treatment,10 cases of vomiting(8.85%),13 cases of nausea(11.50%),4 cases of diarrhea(3.53%),1 case of abdominal pain(0.88%),and 2 cases of allergy(1.77%)were observed in 113 patients.Conclusion:Tigecycline therapy for patients with acute exacerbation of COPD combined with multidrug-resistant Acinetobacter baumannii infection not only has significant therapeutic efficacy but also has a high degree of safety.

Distribution of pathogenic bacteria and antimicrobial sensitivity of eye infections in Suzhou

AIM:To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs.METHODS:The clinical data of 155 patients were retrospectively collected in this study,and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed.RESULTS:Among the 155 patients(age from 12 to 87 years old,with an average age of 57,99 males and 56 females)with eye infections(160 eyes:74 in the left eye,76 in the right eye and 5 in both eyes,all of which were exogenous),71(45.81%)strains were gram-positive bacteria,23(14.84%)strains were gram-negative bacteria and 61(39.35%)strains were fungi.Gram-positive bacteria were highly resistant to penicillin and erythromycin(78.87%and 46.48%respectively),but least resistant to vancomycin at 0.Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole(100%and 95.65%respectively),but least resistant to meropenem at 0.Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences(P<0.05)in the resistance of both to cefoxitin,cotrimoxazole,levofloxacin,cefuroxime,ceftriaxone and ceftazidime,and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria.The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva,cornea,aqueous humor or vitreous body and other eye parts.Besides,Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections.CONCLUSION:Gram-positive bacteria are the dominant bacteria in eye infections,followed by gram-negative bacteria and fungi.Considering the resistance of gramnegative bacteria to multiple drugs,monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.

Analysis of Influencing Factors and Predictive Models of Multidrug-resistant Bacterial Infection in Severe Patients

Objective:To investigate the influencing factors of multi-drug resistant bacterial infections in patients with severe disease and establish a predictive model.Methods:207 infected patients in our hospital from 2018 to May 2020 were selected for the study,of which 73 carried drug-resistant bacteria.Results:The risk factor network of people infected with multidrug resistant bacteria is higher than that of people infected with non-multidrug resistant bacteria,and the interaction between risk factors of the former is stronger.Conclusion:Antibiotics must be used appropriately after surgery.When the elderly was abnormal in indicators such as fever and procalcitonin in the ward,they should be considered as high-risk groups of MDRO infection.They need special care and preventive measures.

Five-year analysis of isolated pathogens and antibiotic resistance of ocular infections from two large tertiary comprehensive hospitals in east China

AIM:To analyze the spectrum of isolated pathogens and antibiotic resistance for ocular infections within 5y at two tertiary hospitals in east China.METHODS:Ocular specimen data were collected from January 2019 to October 2023.The pathogen spectrum and positive culture rate for different infection location,such as keratitis,endophthalmitis,and periocular infections,along with antibiotic resistance were analyzed.RESULTS:We included 2727 specimens,including 827(30.33%)positive cultures.A total of 871 strains were isolated,530(60.85%)bacterial and 341(39.15%)fungal strains were isolated.Gram-positive cocci(GPC)were the most common ocular pathogens.The most common bacterial isolates were Staphylococcus epidermidis(25.03%),Staphylococcus aureus(7.46%),Streptococcus pneumoniae(4.59%),Corynebacterium macginleyi(3.44%),and Pseudomonas aeruginosa(3.33%).The most common fungal genera were Fusarium spp.(12.74%),Aspergillus spp.(6.54%),and Scedosporium spp.(5.74%).Staphylococcus epidermidis strains showed more than 50%resistance to fluoroquinolones.Streptococcus pneumoniae and Corynebacterium macginleyi showed more than 90%resistance to erythromycin.The percentage of bacteria showing multidrug resistance(MDR)significantly decreased(χ^(2)=17.44,P=0.002).CONCLUSION:GPC are the most common ocular pathogens.Corynebacterium macginleyi,as the fourth common bacterium,may currently be the local microbiological feature of east China.Fusarium spp.is the most common fungus.More than 50%of the GPC are resistant to fluoroquinolones,penicillins,and macrolides.However,the proportion of MDR strains has been reduced over time.

Impact of multidrug resistance on the management of bacterial infections in cirrhosis

Patients with cirrhosis have an increased risk of infection and differently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and death(up to 50%in-hospital mortality).Infections by multidrug-resistant organisms(MDRO)have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact.About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years.MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution.An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition(community acquired,healthcare associated or nosocomial).Furthermore,regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology.Antibiotic treatment is the most effective measure to treat infections caused by MDRO.Therefore,optimizing antibiotic prescribing is critical to effectively treat these infections.Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality.On the other hand,the supply of new agents to treat these infections is very limited.Thus,specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.

Epidemiologic Profile Urinary Tract Infections: Experience of the Microbiology Laboratory of the University Hospital Mohamed VI in Tangier

Urinary tract infection is one of the most common bacterial infections in humans. The urine cytobacteriological examination is the key test for its diagnosis. This work aims to Evaluate the prevalence of urinary tract infection at the Microbiology Laboratory of the University Hospital Mohamed VI in Tangier and to highlight its epidemiological and bacteriological characteristics. It was a descriptive study with retrospective data collection which took place from January 2021 to June 2022, at the Microbiology Laboratory of the university hospital Mohamed VI in Tangier. It covered all urine cytobacteriological examinations (ECBU) during the study period. We identified 77 cases of urinary tract infections out of 300 requests for (ECBU), that is a positivity rate of 25 %. The mean age was 55 years. The male gender was predominant. The epidemiological profile of the isolated strains was dominated by Enterobacteriaceae 81 %, followed by Gram-positive cocci 11 % and non-fermenting gram-negative bacteria 8 %. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli 42 %, Klebsiella pneumoniae 20 %, Enterobacter cloacae 9 %, Staphylococcus aureus 6 %, Pseudomonas aeruginosa 5 % and Acinetobacter baumannii 3%. Most of the analyzed organisms showed resistance, especially to the beta-lactam antibiotic;the enterobacteria strains isolated had revealed resistance to amoxicillin: 74%, to amoxicillin-clavulanic acid in 40% of cases, and to third-generation cephalosporins in 24%. In terms of resistance mechanisms, 11 % of the Enterobacteriaceae were extended-spectrum β-lactamase producers and 9 % of the specimens were identified as carbapenemase producers. Of the Staphylococcus aureus strains isolated, 75% were resistant to meticillin. The Glycopeptides and linezolid were the most active molecules on these isolated strains. 15% of Enterococcus species isolated in our laboratory were resistant to glycopeptides (vancomycin and teicoplanin).

Urinary Tract Infection in Pediatric Emergency Department of Mohamed VI Hospital in Marrakech: Epidemiological Profile and Antibiotic Resistance

Background: Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics. The aim of our work was to establish the epidemiological and bacteriological profile of UTIs in children and then to study the sensitivity of the bacterial strains isolated to antibiotics. Materials and methods: This is a retrospective descriptive study over 3 years (2019-2022), including all cytobacteriological examination of urine (CBEU), performed in children aged 3 months to 14 years, admitted and treated for UTI, in the pediatric emergency department of Mohamed VI University Hospital. Results: A total of 239 children were included in our study. The mean age was 26 months. The sex ratio was 1.08. Escherichia coli was the most isolated bacterial strain in 79% of samples. The tested strains showed a high level of sensitivity to susceptibility rate toward amikacin (91%) and ciprofloxacin (100%) and whereas the level of resistance was high to the most current recommended antibiotics, mainly beta-lactams. Management was based, in severe forms of pyelonephritis, dual antibiotic therapy based on Third-generation cephalosporins combined with gentamycin. Favorable outcome was noted in 94% of children. Conclusion: Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens is strongly recommended. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

BACKGROUND The survival of microorganisms on textiles and specifically on healthcare profes-sionals’(HCP)attire has been demonstrated in several studies.The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients.AIM To evaluate the presence,survival and transmission of different multidrug-resistant bacteria(MDRB)from HCP attire onto skin.METHODS Three MDRB[methicillin-resistant Staphylococcus aureus(MRSA);vancomycin-resistant Enterococcus faecium(VRE);carbapenem-resistant Klebsiella pneumoniae,(CRKP)]were inoculated on textiles from scrubs(60%cotton-40%polyester)and white coat(100%cotton)at concentrations of 108 colony-forming units(CFU),105 CFU,and 103 CFU per mL.The inoculation of swatches was divided in time intervals of 1 min,5 min,15 min,30 min,1 h,2 h,3 h,4 h,5 h,and 6 h.At the end of each period,textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media.Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations,for the whole length of the 6-h experiment.RESULTS MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study.VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h,while showing no growth at 103 CFU/mL.CRKP was recovered from 108 CFU/mL for 6 h,up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL.CONCLUSION Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations.The fact that all MDRB can be sustained and transferred to skin even at lower concentrations,supports that textiles are implicated as vectors of bacterial spread.

Association between HLA-DR Expression and Multidrug-resistant Infection in Patients with Severe Acute Pancreatitis

Multidrug-resistant （MDR） bacterial infection is a common complication of severe acute pancreatitis （SAP）. This study aimed to explore the association between human leukocyte antigen-antigen D-related （HLA-DR） expression and multidrug-resistant infection in patients with SAP. A total of 24 SAP patients who were admitted to Nanjing Drum Tower Hospital between May 2015 and December 2016 were enrolled in the study. The percentages of CD4^＋, CD8^＋, natural killer （NK）, and HLA-DR （CD14＋） cells and the CD4^＋/CD8^＋ cell ratio on days 1, 7, 14, and 28 after admission were determined by flow cytometry. Eighteen patients presented with the symptoms of infection. Among them, 55.6% patients （10/18） developed MDR infection. The most common causative MDR organisms were Enterobacter cloacae and Acinetobacter baumannii. The CD4＋/CD8＋ cell ratio and the percentage of NK cells were similar between patients with non-MDR and patients with MDR infections. In patients without infection, the HLA-DR percentage was maintained at a high level throughout the 28 days. Compared to the patients without any infection, the HLA-DR percentage in patients with non-MDR infection was reduced on day 1 but increased and reached similar levels on day 28. In patients with MDR infection, the HLA-DR percentage remained below normal levels at all-time points. It was concluded that persistent down-regulation of HLA-DR expression is associated with MDR bacterial infection in patients with SAP.

De novo design of highly efficient type-Ⅰphotosensitizer based onπ-conjugated oligomer for photodynamic eradication of multidrug-resistant bacterial infections

Traditional photosensitizers show limited singlet oxygen generation in hypoxic infection lesions,which greatly suppress their performance in antibacterial therapy.Meanwhile,there still is lack of feasible design strategy for developing hypoxia-overcoming photosensitizers agents.Herein,radical generation ofπ-conjugated small molecules is efficiently manipulated by an individual selenium(Se)substituent.With this strategy,the first proof-of-concept study of a Se-anchored oligo(thienyl ethynylene)(OT-Se)with high-performance superoxide radical(O_(2)^(·-))and hydroxyl radical(·OH)generation capability is present,and achieves efficient antibacterial activities towards the clinically extracted multidrug-resistant bacteria methicillin-resistant S.aureus(MRSA)and carbapenem-resistant E.coli(CREC)at sub-micromolar concentration under a low white light irradiation(30 mW/cm^(2)).The water-dispersible OT-Se shows a good bacteria-anchoring capability,biocompatibility,and complete elimination of multidrug-resistant bacteria wound infection in vivo.This work offers a strategy to boost type-I photodynamic therapy(PDT)performance for efficient antibacterial treatments,advancing the development of antibacterial agents.

Efficacy and Safety of Three Anti-infective Therapeutic Regimens for the Multidrug-resistant Acinetobacter Baumannii Infection:ASystematic Review and Meta-analysis

Background: Due to extensive use of antibiotics, multidrug resistance of Acinetobacter baumannii (A.b) infection has become one of the major challenges in clinic, which is difficult to treat and have a high mortality rate. Based on this, we must take pro active measures against antimicrobial resistance by improving the efficacy. To provide a high-quality clinical evidence, a meta-analysis was conducted to compare the efficacy and safety of three anti-infection therapeutic regimens for the treatment of multidrug resistance of Acinetobacter baumannii(MRAB) infection. Methods: A meta-analysis of 36 randomized controlled trials, comprising approximately 3014 patients, was conducted to compare the efficacy and safety of three anti-infection therapeutic regimens for the treatment of MRAB infection. The clinical response rate and microbiological response rate between cefbperazone-sulbactam group and tigecycline plus cefbperazone-sulbactam group were RR=1.33, 95% CI= 1.27-1.39 and RR=1.72, 95% CI=1.55-1.90, respectively;Cefoperazone-sulbactam group and tigecycline plus isepamicin group were RR=1.29, 95% CI=1.19-1.39 and RR=1.59, 95% CI=1.37-1.84, respectively. Results: There was no significant difference between tigecycline plus cefbperazone-sulbactam group and tigecycline plus isepamicin group in the clinical response rate or microbiological response rate. Neither was there any adverse events (AEs) among the three regimens. Conclusion: Our finding suggested that tigecycline combined with cefbperazone-sulbactam or isepamicin may be performed with more efficacy than cefoperazone-sulbactam monotherapy in MRAB infections treatment.

Impact of Multidisciplinary Collaborative Intervention on Isolation Implementation in Prevention and Control of Multi-drug Resistance Infection

Objective Contact precautions,especially the initiation of isolation,are important measures to prevent and control multidrug-resistant organisms(MDROs).However,the implementation in clinical practice remains weak.This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection,and determine the factors that affect the implementation of isolation measures.Methods A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1,2018.The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected.Then,the issuance of isolation orders was retrospectively analyzed.Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation.Results The overall issuance rate of isolation orders was 61.21%,which increased from 33.12%to 75.88%(P<0.001)after the implementation of the multidisciplinary collaborative intervention.The intervention(P<0.001,OR=0.166)was a promoting factor for the issuance of isolation orders,in addition to the length of stay(P=0.004,OR=0.991),department(P=0.004),and microorganism(P=0.038).Conclusion The isolation implementation remains far lower than policy standards.Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors,thereby promoting the standardized management of MDROs,and providing reference for further improving the quality of hospital infection management.

Causative Microorganisms Isolated from Patients with Intra-Abdominal Infections and Their Drug Resistance Profiles:An 11-Year(2011–2021)Single-Center Retrospective Study

Objective To investigate the distribution and antimicrobial susceptibility of causative microorganisms recovered from patients with intra-abdominal infections(IAIs).Methods A total of 2,926 bacterial and fungal strains were identified in samples collected from 1,679 patients with IAIs at the Peking Union Medical College Hospital between 2011 and 2021.Pathogenic bacteria and fungi were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Antimicrobial susceptibility testing(AST)was performed using the VITEK 2 compact system and the Kirby–Bauer method.AST results were interpreted based on the M100-Ed31 clinical breakpoints of the Clinical and Laboratory Standards Institute.Results Of the 2,926 strains identified,49.2%,40.8%,and 9.5%were gram-negative bacteria,gram-positive bacteria,and fungi,respectively.Escherichia coli was the most prevalent pathogen in intensive care unit(ICU)and non-ICU patients;however,a significant decrease was observed in the isolation of E.coli between 2011 and 2021.Specifically,significant decreases were observed between 2011 and 2021 in the levels of extended-spectrumβ-lactamase(ESBL)-producing E.coli(from 76.9%to 14.3%)and Klebsiella pneumoniae(from 45.8%to 4.8%).Polymicrobial infections,particularly those involving co-infection with gram-positive and gram-negative bacteria,were commonly observed in IAI patients.Moreover,Candida albicans was more commonly isolated from hospital-associated IAI samples,while Staphylococcus epidermidis had a higher ratio in community-associated IAIs.Additionally,AST results revealed that most antimicrobial agents performed better in non-ESBL-producers than in ESBL-producers,while the overall resistance rates(56.9%–76.8%)of Acinetobacter baumanmii were higher against all antimicrobial agents than those of other common gram-negative bacteria.Indeed,Enterococcus faecium,Enterococcus faecalis,S.epidermidis,and S.aureus were consistently found to be susceptible to vancomycin,teicoplanin,and linezolid.Similarly,C.albicans exhibited high susceptibility to all the tested antifungal drugs.Conclusion The distribution and antimicrobial susceptibility of the causative microorganisms from patients with IAls were altered between 2011 and 2021.This finding is valuable for the implementation of evidence-based antimicrobial therapy and provides guidance for the control of hospital infections.

Bacterial infections in cirrhosis: A critical review and practical guidance

Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis.

Bacterial infection after liver transplantation

Infectious complications are major causes of morbidity and mortality after liver transplantation,despite recent advances in the transplant field.Bacteria,fungi,viruses and parasites can cause infection before and after transplantation.Among them,bacterial infections are predominant during the first two months posttransplantation and affect patient and graft survival.They might cause surgical site infections,including deep intra-abdominal infections,bacteremia,pneumonia,catheter-related infections and urinary tract infections.The risk factors for bacterial infections differ between the periods after transplant,and between centers.Recently,the emergence of multi-drug resistant bacteria is great concern in liver transplant(LT)patients.The instructive data about effects of infections with extended-spectrum beta lactamase producing bacteria,carbapenem-resistant gram-negative bacteria,and glycopeptide-resistant gram-positive bacteria were reported on a center-by-center basis.To prevent posttransplant bacterial infections,proper strategies need to be established based upon center-specific data and evidence from well-controlled studies.This article reviewed the recent epidemiological data,risk factors for each type of infections and important clinical issues in bacterial infection after LT.

Ocular bacterial infections at a tertiary eye center in China: a 5-year review of pathogen distribution and antibiotic sensitivity

AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections.METHODS: This study applied a retrospective analysis of 3690 bacterial isolates from ocular specimens, which were obtained from the conjunctiva, cornea, aqueous humor, vitreous body, and other ocular sites of the patients at Shandong Eye Institute in northern China from January 2013 to December 2017. The parameters assessed mainly included the distribution of isolated bacteria and the results of susceptibility tests for antibiotics. In the analysis of antibiotic sensitivities, the bacteria were divided into four groups according to gram staining, and statistical methods were used to compare their antibiotic sensitivities. RESULTS: Among the 3690 isolated bacterial strains, Staphylococcus epidermidis(2007, 54.39%) accounted for the highest proportion. As for the total isolates, their sensitivity rate to gatifloxacin was up to 90.01%, with four types of gram-stained bacteria being all highly sensitive to it, but their sensitivity rate to levofloxacin was only 51.91%. The sensitivity rate of gram-negative bacilli(G-B) to levofloxacin was 83.66%, significantly higher than the other three types of gram-stained bacteria(P<0.05). Gram-positive cocci (G+C, 97.95%) and gram-positive bacilli(G+B, 97.54%) were more sensitive to vancomycin than gram-negative cocci(G-C, 70.59%) and G-B(68.57%;P<0.05). For fusidic acid, the sensitivity rates of G+C(89.83%) and G+B(73.37%) were significantly higher than that of G-B(29.83%;P<0.05). The gram-negative bacteria's sensitivity rate to cefuroxime was as low as 59.25%, but only G-B was less sensitive to cefuroxime(57.28%), while G-C was still highly sensitive(89.29%). The sensitivity rate of gram-positive bacteria to moxifloxacin was as high as 80.28%, but only G+C was highly sensitive to moxifloxacin(81.21%), while G+B was still less sensitive(32.00%). CONCLUSION: Staphylococcus epidermidis is the predominant isolate in all ocular specimens with bacteria. Gatifloxacin is more suitable for topical prophylactic use than levofloxacin in ophthalmology when necessar y. Vancomycin and fusidic acid both have better effects on gram-positive bacteria than gram-negative bacteria. More accurate antibiotic sensitivity analysis results can be obtained when a more detailed bacterial classification and more appropriate statistical methods are performed.

Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies

Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment(third-generation cephalosporins, e.g., ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.

Catheter-Associated Bacteria Urinary Tract Infection and Antibiotic Susceptibility Pattern in a Tertiary Hospital, in Ghana

Background: This study seeks to identify the prevalence of catheter associated urinary infection and the type of bacteria that are associated with this infection, as well as the antibiotic susceptibility patterns of the organisms isolated. This would guide the choice of antibiotics when there is catheter associated urinary tract infection. Method: From 1 November 2015-31 April 2016 a cross-sectional study was conducted among patients with urinary catheter in-situ. Urine samples collected were processed and cultured on CLED agar plates. Pure colonies of isolated organism were Gram and Biochemically characterized. A disc diffusion antibiotic susceptibility determined by Kirby-Bauer disc diffusion method was performed on each uropathogen isolated. Data obtained was cleaned, analyzed and presented. Result: There were 122 study subjects of which, 73 (59.8%) were males and 49 (40.2%) were females. Their median age was 42.5 (range 33 - 65) years. Significant bacterial growth was obtained in 88 (72.1%) of the urine specimen cultured of which males constituted 48 (54.5%) and females 40 (45.5%). The most prevalent uropathogens isolated were Escherichia coli 41 (46.6%), Klebsiella spp. 18 (20.6%), Pseudomonas aeruginosa 10 (11.4%), Enterobacter spp. 6 (6.8%) and Staphylococcus aureus 5 (5.8%). Bacterial isolates showed some susceptibility to Amikacin 73 (83.0%), Levofloxacin 34 (38.6%) and Ciprofloxacin 26 (29.5%) respectively. The uropathogens were least susceptible to Gentamicin 3 (3.4%), Ampicillin 3 (3.4%) and Cefuroxime 1 (1.1%) respectively. Conclusion: Catheter associated bacterial urinary tract infection (CABUTI) is prevalent at the Tamale Teaching Hospital. Micro bacterial isolates demonstrated substantial decrease in susceptibility to antibiotics commonly used. Understanding the local antibiotic susceptibility pattern could guide the choice of antibiotics used in treating CABUTI.

COVID-19 Coronavirus: Is Infection along with <i>Mycoplasma</i>or Other Bacteria Linked to Progression to a Lethal Outcome?

Most patients with COVID-19 disease caused by the SARS-CoV-2 virus recover from this infection, but a significant fraction progress to a fatal outcome. As with some other RNA viruses, co-infection or activation of latent bacterial infections along with pre-existing health conditions in COVID-19 disease may be important in determining a fatal disease course. Mycoplasma spp. (M. pneumonaie, M. fermentans, etc.) have been routinely found as co-infections in a wide number of clinical conditions, and in some cases this has progressed to a fatal disease. Although preliminary, Mycoplasma pneumoniae has been identified in COVID-19 disease, and the severity of some signs and symptoms in progressive COVID-19 patients could be due, in part, to Mycoplasma or other bacterial infections. Moreover, the presence of pathogenic Mycoplasma species or other pathogenic bacteria in COVID-19 disease may confer a perfect storm of cytokine and hemodynamic dysfunction, autoimmune activation, mitochondrial dysfunction and other complications that together cannot be easily corrected in patients with pre-existing health conditions. The positive responses of only some COVID-19 patients to antibiotic and anti-malaria therapy could have been the result of suppression of Mycoplasma species and other bacterial co-infections in subsets of patients. Thus it may be useful to use molecular tests to determine the presence of pathogenic Mycoplasma species and other pathogenic bacteria that are commonly found in atypical pneumonia in all hospitalized COVID-19 patients, and when positive results are obtained, these patients should treated accordingly in order to improve clinical responses and patient outcomes.