Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

Multidrug resistant organism infections in patients with COVID-19:risk factors and outcomes

Background:Coronavirus disease 2019(COVID-19)has now spread to most countries and regions of the world.Risk factors associated with multi-drug resistant organism(MDRO)infections in patients with COVID-19 have not been well studied yet.In the present study,we aimed to identify the risk factors associated with the MDRO infections and their impact on in-hospital mortality of COVID-19 patients.Methods:This retrospective cohort study was conducted between December 2019 and April 2020 at two tertiary hospitals in Wuhan,China.Data of cases were collected through electronic medical records system.This study was focused on cases with bacterial culture records.Risk factors and outcomes associated with MDRO infections were analyzed using logistic regression model.Results:Of the 2891 patients,370 patients have bacterial culture results,and MDROs were isolated in 38 patients.Respiratory tract infections(67.3%)were the most common hospital acquired infections.Variables independently associated with MDRO infections were dyspnea at admission(odds ratio(OR)4.74;95%confidence interval(CI)2.06-10.88;P<0.001),intensive care unit(ICU)admission(OR 5.02;95%CI 1.99-12.63;P<0.01),and invasive mechanical ventilation(OR 5.13;95%CI 2.15-12.27;P<0.001),adjusted for age and gender.MDROs infection was also a significant risk factor of death for the patients,adjusted for age,gender,severity of illness,ICU admission and mechanical ventilation(OR 1.12,95%CI:0.43-2.96,P=0.817).Conclusion:In our study,dyspnea at admission,ICU admission and invasive mechanical ventilation were associated with the presence of MDRO infections,and clinicians should be alert in MDRO infections in COVID-19 hospitalized patients.

Analysis of Multi-Drug Resistant Organism Surveillance and Antimicrobial Resistance Early Warning in a Hospital in 2022

Objective:To determine the clinical distribution of multi-drug resistant organism(MDRO)in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the application of broad-spectrum antibiotics in clinical treatment and reducing the occurrence of nosocomial infection.Methods:Retrospective screening and analysis were conducted on the pathogenic strains of hospitalized patients in our hospital in 2022.Results:A total of 2,769 strains of pathogenic bacteria and 390 strains of MDRO were detected and isolated in our hospital in 2022;the detection rate of MDRO was 14.08%.A total of 516 strains(18.64%)Klebsiella pneumoniae(KP)and 62 strains(12.02%)of carbapenem-resistant Klebsiella pneumoniae(CR-KP)were detected;436 strains(15.75%)of Escherichia coli(ECO)were detected,including 8 strains(1.83%)of CR-ECO;342 strains(12.35%)of Pseudomonas aeruginosa(PA)and 116 strains(33.92%)of CR-PA were detected;there were 194 strains(7.01%)of Acinetobacter baumannii(AB),among which 125 strains(64.43%)were CR-AB;there were 291 strains(10.51%)of Staphylococcus aureus,among which 79 strains(27.15%)of methicillin-resistant Staphylococcus aureus(MRSA)were detected;78 strains(2.82%)of Enterococcus faecalis were detected,and vancomycin-resistant enterococcus(VRE)was not detected.The first five MDROs were CR-AB,CR-PA,MRSA,CR-KP,and CR-ECO.The top five departments with the highest MDRO detection rate in 2022 were the ICU(37.44%),the Pulmonology Department(ward 13;31.03%),the Department of Rehabilitation(ward 5;6.67%),the Department of Neurosurgery(ward 11;4.62%),and the Department of General Surgery(ward 10;3.59 The resistance rate of antibacterial drugs is divided into four levels for early warning:30%to 40%,41%to 50%,51%to 75%,and 75%or more.Conclusion:Our hospital should strengthen the monitoring of antimicrobial resistance warning related to MDRO and the abuse of antimicrobial drugs.Based on the results of drug sensitivity and antimicrobial resistance warning,the use of antibiotics should be standardized in clinical practice to reduce nosocomial infection。

Rational surface charge engineering of haloalkane dehalogenase for boosting the enzymatic performance in organic solvent solutions

Biocatalysis in organic solvents(OSs)has numerous important applications,but native enzymes in OSs often exhibit limited catalytic performance.Herein,we proposed a computation-aided surface charge engineering strategy to improve the catalytic performance of haloalkane dehalogenase DhaA in OSs based on the energetic analysis of substrate binding to the DhaA surface.Several variants with enhanced OS resistance were obtained by replacing negative charged residues on the surface with positive charged residue(Arg).Particularly,a four-substitution variant E16R/E93R/E121R/E257R exhibited the best catalytic performance(five-fold improvement in OS resistance and seven-fold half-life increase in 40%(vol)dimethylsulfoxide).As a result,the overall catalytic performance of the variant could be at least 26 times higher than the wild-type DhaA.Fluorescence spectroscopy and molecular dynamics simulation studies revealed that the residue substitution mainly enhanced OS resistance from four aspects:(a)improved the overall structural stability,(b)increased the hydrophobicity of the local microenvironment around the catalytic triad,(c)enriched the hydrophobic substrate around the enzyme molecule,and(d)lowered the contact frequency between OS molecules and the catalytic triad.Our findings validate that computationaided surface charge engineering is an effective and ingenious rational strategy for tailoring enzyme performance in OSs.

Assessment of colistin resistance in Gram negative bacteria from clinical samples in resource-limited settings

Objective:To find a proper method to assess colistin resistance in multidrug resistant Gram negative bacteria(MDR-GNB)on a routine basis in resource limited settings.Methods:Clinical samples were processed.MDR-GNB were identified and were examined for colistin resistance by colistin broth elution method,colistin agar method,and colistin disk elution screening method.Broth microdilution method was used the gold standard.Results:A total of 10235 clinical samples were processed,in which 857(8.4%)MDR-GNB were identified.The very significant errors,categorical agreement,major errors,positive predictive values,negative predictive values,specificity and sensitivity of all the phenotypic methods were 5.5%,0%,94.4%,100%,99.6%,100%and 94.4%,respectively for the detection of colistin resistance.The colistin elution screening method was cheap and easy to perform with similar results to broth microdilution method.Conclusions:All the evaluation methods for colistin resistance showed similar results.So the laboratories can choose any method for detection of colistin resistance.However,we recommend colistin disk elution screening method because,it is easy and cheap and can be performed in limited resources.

Room-Temperature Organic Negative Differential Resistance Device Using CdSe Quantum Dots as the ITO Modification Layer

Room-temperature negative differential resistance （NDR） has been observed in different types of organic materials. However, detailed study on the influence of the organic material on NDR performance is still scarce. In this work, room-temperature NDR ＆ observed when CdSe quantum dot （QD） modified ITO is used as the electrode. Furthermore, material dependence of the NDR performance is observed by selecting materials with different charge transporting properties as the active layer, respectively. A peak-to-valley current ratio up to 9 is observed. It is demonstrated that the injection barrier between ITO and the organic active layer plays a decisive role for the device NDR performance. The influence of the aggregation state of CdSe QDs on the NDR performance is also studied, which indicates that the NDR is caused by the resonant tunneling process in the ITO/CdSe QD/organic active layer structure.

Diclofop-methyl affects microbial rhizosphere community and induces systemic acquired resistance in rice

Diclofop-methyl（DM）,a widely used herbicide in food crops,may partly contaminate the soil surface of natural ecosystems in agricultural area and exert toxic effects at low dose to nontarget plants.Even though rhizosphere microorganisms strongly interact with root cells,little is known regarding their potential modulating effect on herbicide toxicity in plants.Here we exposed rice seedlings（Xiushui 63） to 100 μg/L DM for 2 to 8 days and studied the effects of DM on rice rhizosphere microorganisms,rice systemic acquired resistance（SAR） and rice-microorganisms interactions.The results of metagenomic 16 S rDNA Illumina tags show that DM increases bacterial biomass and affects their community structure in the rice rhizosphere.After DM treatment,the relative abundance of the bacterium genera Massilia and Anderseniella increased the most relative to the control.In parallel,malate and oxalate exudation by rice roots increased,potentially acting as a carbon source for several rhizosphere bacteria.Transcriptomic analyses suggest that DM induced SAR in rice seedlings through the salicylic acid（but not the jasmonic acid） signal pathway.This response to DM stress conferred resistance to infection by a pathogenic bacterium,but was not influenced by the presence of bacteria in the rhizosphere since SAR transcripts did not change significantly in xenic and axenic plant roots exposed to DM.The present study provides new insights on the response of rice and its associated microorganisms to DM stress.