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.

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.

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging

BACKGROUND The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology.Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools,including ultrasonography(USG)and magnetic resonance imaging(MRI).AIM To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.METHODS Among 20 patients,50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study.Fascial space infection involvement was examined by USG and MRI.Results were compared for both and confirmed by microbiological testing.RESULTS Ultrasonography identified 42(84%)of 50 involved fascial spaces.Whereas MRI identified all 50(100%).USG could stage the infections from edematous change to cellulitis to complete abscess formation.CONCLUSION MRI was superior in recognizing deep fascial space infections compared to USG.However, USG is a significant addition and has a definite role in prognosticatingthe stage of infection and exact anatomic location in superficial space infections.

基于VOSviewer和CiteSpace实体器官移植术后真菌感染研究热点和趋势的可视化分析

目的 对国内外实体器官移植术后真菌感染的研究热点和趋势进行知识图谱可视化分析。方法 检索中国知网和Web of Science核心合集数据库建库至2023年7月收录的实体器官移植术后真菌感染相关文献,运用VOSviewer 1.6.16和CiteSpace 5.7.R5软件对发文量、作者、发文国家和关键词进行分析,并绘制比较国内外关键词的可视化图谱,以分析国内外的研究热点。结果 共纳入1 822篇文献,实体器官移植术后真菌感染相关研究发文量从2000年开始明显增加。中文文献中朱有华是国内发文量最多的作者。关键词聚类分析,中文文献有6个相关聚类。突现关键词检测得到中文文献中最近的研究热点主要集中在耶氏肺孢子菌肺炎、危险因素、临床药师和药学监护等方面。英文文献中Husain是发文量最多的作者。美国是发文量最多的国家,美国与其他国家合作关系最密切。关键词聚类分析,英文文献有4个相关聚类。突现关键词检测得到英文文献的研究热点则主要包括耶氏肺孢子菌肺炎、毛霉病、泊沙康唑、抗真菌药物管理和指南等。结论 我国的实体器官移植术后真菌感染研究正处于发展阶段。应结合国内外的研究热点,开展国内的抗真菌药物管理,并重视耶氏肺孢子菌肺炎、毛霉病等方面的研究,完善和细化国内的指南,以促进该领域的进一步发展和创新。

Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

A prokaryotic mycoplasma-like organism infection in the scallop Argopecten irradians

Intracytoplasmic infection with a prokaryotic mycoplasma-like organism （MLO） were characterized in the scallop Argopecten irradians, and the first report of such infection in this scallop was represented. Ultrastructurally these microorganisms are usually pleomorphic and variable in morphology and size, and appear in several cell types such as small spherical body, rod-shaped bodies and longer filament-shaped body. They lack a cell wall. These observations revealed that these types of the prokaryote showed some characteristics of a mycoplasma-like organism （MLO）. MLO reproduced in two ways： binary fission and budding. The results of isolation and purification showed that a large number of MLOs existed in the tissues of diseased scallops. The results of experimental infection revealed that the MLO is pathogenic to the scallop Argopecten irradians.

Analysis of Clinical Treatment Effect on Oromaxillo-facial Multispace Infection

[Objectives] To analyze the clinical treatment effect on oromaxillo-facial multi-space infection. [Methods] Based on the clinical data about 72 oromaxillo-facial multi-space infection cases from January 2016 to December 2016,the double-blind study was used to divide them into study group(36 cases) and control group(36 cases). As for the control group,36 patients with oromaxillo-facial multi-space infections were given the conventional treatment; as for the study group,36 patients were given the treatment of abscess incision and drainage combined with hyperbaric oxygen based on conventional treatment. The total effective rate and complication rate were compared between the two groups. [Results]The total effective rate and complication rate under the study group were higher than under the control group,and the difference was statistically significant( P < 0. 05). [Conclusions] The clinical treatment effect on oromaxillo-facial multi-space infection was very significant,and the treatment was worthy of promotion and application in clinical practice.

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early posttransplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa(P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.

Multidrug-resistant bacterial infections after liver transplantation: An ever-growing challenge

Bacterial infections are a leading cause of morbidity and mortality among solid organ transplant recipients.Over the last two decades,various multidrug-resistant(MDR)pathogens have emerged as relevant causes of infection in this population.Although this fact reflects the spread of MDR pathogens in health care facilities worldwide,several factors relating to the care of transplant donor candidates and recipients render these patients particularly prone to the acquisition of MDR bacteria and increase the likelihood of MDR infectious outbreaks in transplant units.The awareness of this high vulnerability of transplant recipients to infection leads to the more frequent use of broad-spectrum empiric antibiotic therapy,which further contributes to the selection of drug resistance.This vicious cycle is difficult to avoid and leads to a scenario of increased complexity and narrowed therapeutic options.Infection by MDR pathogens is more frequently associated with a failure to start appropriate empiric antimicrobial ther-apy.The lack of appropriate treatment may contribute to the high mortality occurring in transplant recipients with MDR infections.Furthermore,high therapeutic failure rates have been observed in patients infected with extensively-resistant pathogens,such as carbapenemresistant Enterobacteriaceae,for which optimal treatment remains undefined.In such a context,the careful implementation of preventive strategies is of utmost importance to minimize the negative impact that MDR infections may have on the outcome of liver transplant recipients.This article reviews the current literature regarding the incidence and outcome of MDR infections in liver transplant recipients,and summarizes current preventive and therapeutic recommendations.

从Place连接Space助推“机械原理”一流课程建设

基于教学实践,从教学内容、教学组织和双向评价这三个关键维度出发,分别在先进理论和现代设计方法、大规模在线教育和工程实践及教师评价“学”的过程和学生评价“教”的过程等重要方向建立连接,使课程体系从有限容量的线性place占位扩展到大容量现代化教学的多方向space占位。建设结果表明,多方向的space课程体系既能解决学生学习过程中的主动性、积极性问题,又能助推课程自身迭代,促使“机械原理”始终处于一流课程的领先地位。

Fatal visceral disseminated varicella-zoster virus infection in a renal transplant recipient:A case report

BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which leads to the failure of early diagnosis.CASE SUMMARY The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration.On admission,the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury.Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV,and real-time polymerase chain reaction for VZV was positive,with 1.2×10^(7) copies/mL.The final diagnosis was visceral disseminated VZV infection.Acyclovir and supportive therapy were started,but the patient died of severe visceral organ damage 16 h after admission.CONCLUSION Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.

Effect of Periodontal Infection on Birth Weight of Infants: A Clinical and Microbiological Study

Background: Maternal periodontal infection has been proposed to influence pre-term delivery and low birth weight infants through mechanisms involving inflammatory mediators or direct bacterial assault on the amnion. Thus, the aim of the present study was to assess the presence of periodontal pathogens in maternal periodontal infection and their effect on the birth weight of infants. Materials and Methods: The case-control study included 30 mothers with a singleton gestation and gestational age of >37 weeks. Data regarding the periodontal status, pregnancy outcome variables, hemoglobin levels (Hb%) and other factors that may influence adverse pregnancy outcomes were collected. A qualitative analysis of the predominant anaerobic organisms was conducted. The data was analysed using one-way ANOVA test and Scheffe’s test. Results: The microbiological results showed that prevalent colonies of organisms isolated from the experimental groups were of Bacteroides spp. (n = 3), Fusobacterium spp. (n = 3) and Peptostreptococcus spp. (n = 9). In the control group, Peptostreptococcus spp. (n = 15) were predominant. In the experimental group, it was seen that Bacteroides spp. (p = 0.003) and Fusobacterium spp. (p = 0.050) were statistically significant with the birth weight of the infant. The one-way ANOVA test showed that the birth weight of the infant was inversely proportionate with increase in severity of the periodontal disease. Scheffe’s test showed that presence of a periodontal pocket showed most significance to the birth weight of an infant as compared to presence of local factors or bleeding on probing. Conclusion: The study revealed that the gram negative organisms, Bacteroides spp. and Fusobacterium spp. were significantly associated with the low birth weight (LBW) of the infants, although there was not a significant difference in the clinical periodontal status between the experimental groups and the controls. It could be proposed that specific groups of pathogens may have a contributory role in the risk of LBW.

Update on Healthcare-Associated Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients

Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia especially with the recent escalating trend in the management of pediatric cancer patients towards intensified regimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics. Aim: Monitoring if a change has occurred in pattern of blood stream infections (BSI) in febrile neutropenic (FN) pediatric cancer patients. Methods: Surveillance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, and prolonged duration of episodes when compared to previous surveillance, with a p value of <0.001, 0.005, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, 6% in 2011 and 10% in 2006. Conclusion: The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and prolonged episodes.

Presepsin teardown- pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

AIM To evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections. METHODS Two hundred and sixteen patients with cirrhosis were enrolled. At admission, the presence of bacterial infections and level of plasma presepsin, serum C-reactive protein(CRP) and procalcitonin(PCT) were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality.RESULTS Present 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without(median, 1002 pg/m L vs 477 pg/m L, P < 0.001), increasing with the severity of infection [organ failure(OF): Yes vs No, 2358 pg/m L vs 710 pg/m L, P < 0.001]. Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP(AUC-ROC: 0.85, 0.85 and 0.66, respectively, P = NS for presepsin vs PCT and P < 0.01 for presepsin vs CRP). At the optimal cut-off value of presepsin > 1206 pg/m L sensitivity, specificity, positive predictive values and negative predictive values were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-d mortality rate was higher among patients with > 1277 pg/m L compared to those with ≤ 1277 pg/m L(46.9% vs 11.6%, P < 0.001). In a binary logistic regression analysis, however, only PCT(OR = 1.81, 95%CI: 1.09-3.01, P = 0.022) but neither presepsin nor CRP were independent risk factor for 28-d mortality after adjusting with MELD score and leukocyte count.CONCLUSION Presepsin is a valuable new biomarker for defining severe infections in cirrhosis, proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.

Model of Healthcare-Associated Infection Control in Primary Health Care Institutions:A Structural Equation Modeling

The purpose of this study was to construct the model of organization system,managemcnt,training and surveillance in healthcare-associated infection prevention and control(IC)of primary health care institutions and identify its efleet on patient safety and decreasing economic burden by standardizing IC.A cross-sectional survey was conducted with questionnaires.Data were collected from 268 primary health care institutions in Hubei province,China.Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling.The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels:root mean square error of approximation(RMSEA)=0.071;comparative fit index(CFI)=0.965;tucker lewis index(TLI)=0.956:weighted root mean square residual(WRMR)=1.014.The model showed that organization system had a direct effect on management(β=0.311.P<0.01),and training(β=0.365,P<0.01).Management and training played an intermediary role that partially promoted organization system impact on surveillance.Results also showed that institutional factors such as the number of physicians、the ninnber of nurses,the designated capacity of beds,the actual number of open beds and surgery trips had positive impacts on management(β=0.050,P<0.01;β=0.181,P<0.01;β-0.111.P<0.01;β=0.064,P<0.01;β=0.084,P=0.04);nd training(β=0.21,P=0.03;β=0.050,P=0.02;β=0.586.P=0.01;0=0.995,P=0.02;β=0.223.P=0.03).In conclusion.the model of organization system,managemcnt,training and surveillancc in IC of primary health care institutions is valuable tor guiding IC practice.

Application of Organic Growth Views in Residential Spaces

This paper explored relevant contents, methods and comprehensive efficiency of organic growth view in residential spaces based on personal experience, so as to fi gure out a new approach of residential space design with high economic efficiency, participation and sustainable connotations.

Hepatitis E virus infection in the liver transplant recipients:Clinical presentation and management

Hepatitis E virus(HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy. Current suggested approach to manage acute HEV involves modifying immunosuppression, especially discontinuing calcineurin inhibitors which are the preferred immunosuppressive agents post-orthotopic liver transplantation. The addition of ribavirin monotherapy has shown promising success rates in clearing HEV infection and is used commonly in reported cases.

MLP training in a self-organizing state space model using unscented Kalman particle filter

Many Bayesian learning approaches to the multi-layer perceptron （MLP） parameter optimization have been proposed such as the extended Kalman filter （EKF）. This paper uses the unscented Kalman particle filter （UPF） to train the MLP in a self- organizing state space （SOSS） model. This involves forming augmented state vectors consisting of all parameters （the weights of the MLP） and outputs. The UPF is used to sequentially update the true system states and high dimensional parameters that are inherent to the SOSS moder for the MLP simultaneously. Simulation results show that the new method performs better than traditional optimization methods.