Chlamydia pneumoniae in Community-acquired Pneumonia: Seven Years of Experience

Antibiotic Abuse and Antimicrobial Resistance in Hospital Environment: A Retrospective Observational Comparative Study

Background and Objectives: Antimicrobial resistance represents a serious problem, and it may be life-threatening in the case of severe hospital-acquired infections (HAI). Antibiotic abuse and multidrug resistance (MDR) have significantly increased this burden in the last decades. The aim of this study was to investigate the distribution and susceptibility rates of five selected bacterial species (E. coli, K. pneumoniae, P. aeruginosa, S. aureus and E. faecium) in two healthcare settings located in the Apulia region (Italy). Materials and Methods: Setting n.1 was a university hospital and setting n.2 was a research institute working on oncological patients. All the enrolled patients were diagnosed for bacterial HAI. The observation period was between August and September 2021. Clinical samples were obtained from several biological sources, in different hospital wards. Bacterial identification and susceptibility were tested by using the software VITEC 2 Single system. Results: In this study, a higher incidence of multi-drug-resistant K. pneumoniae was reported (42,2% in setting n.1 and 50% in setting n.2), with respect to the Italian 2019 statistics report (30.3%). All the isolates of E. faecium and S. aureus were susceptible to linezolid. All the bacterial isolates of P. aeruginosa and most of K. pneumoniae were susceptible to ceftazidime–avibactam. Amikacin and nitrofurantoin represented a good option for treating E. coli infections. Multidrug-resistant (MDR) P. aeruginosa, methicillin-resistant S. aureus (MRSA) and vancomycin-resistantE. faecium (VRE) had a lower incidence in the clinical setting, with respect to E. coli and K. pneumoniae. Conclusions: The data obtained in this study can support clinicians towards a rational and safe use of antibiotics for treating the infections caused by these resistant strains, to enhance the overall efficacy of the current antibiotic protocols used in the main healthcare environments.

Rebalancing the Oral Microbiota as an Efficient Tool in Endocrine, Metabolic and Immune Disorders

The current treatment and prevention procedures of oral disorders follow a very targeted approach considering mouth and its structures as a system that is completely independent, than the rest of the body. The main therapeutic approach is to keep the levels of oral bacteria and hygiene in an acceptable range compatible with oral-mouth health, completely separated from systemic microbial homeostasis (eubiosis vs dysbiosis). This can negatively impact the diagnosis of a more complex systemic disease and its progression. Dysbiosis occurs as a consequence of imbalance in oral and gut microbiota which leads to cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, and Alzheimer's disease, as reported in current literature. Likewise, there is a need to highlight and develop a novel philosophical approach in the treatments for oral diseases that will necessarily involve nonconventional approaches.

Mesenchymal Stem Cells: The Secret Children’s Weapons against the SARS-CoV-2 Lethal Infection

Due to the promising effects of mesenchymal stem cells (MSCs) in the treatment of various diseases, this commentary aimed to focus on the auxiliary role of MSCs to reduce inflammatory processes of acute respiratory infections caused by the 2019 novel coronavirus (COVID-19). Since early in 2020, COVID-19, a consequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly affected millions of people world-wide. The SARS-CoV-2 infection in children appears to be an unusual event. Despite the high number of affected adult and elderly, children and adolescents remained low in amounts, and marginally touched. Based on the promising role of cell therapy and regenerative medicine approaches in the treatment of several life-threatening diseases, it seems that applying MSCs cell-based approaches can also be a hopeful strategy for improving subjects with severe acute respiratory infections caused by COVID-19.

Global Prevalence of Chlamydial Infections in Reptiles: A Systematic Review and Meta-Analysis

Background and Objectives: Chlamydia spp. are potential zoonotic pathogens that can infect a wide range of animal hosts. In reptiles, Chlamydia can cause hepatitis, pneumonitis, and conjunctivitis and it can cause high mortality in young animals. The objectives of this study were to estimate the pooled prevalence of chlamydial infections in reptiles and to assess the trend of these infections over time. Materials and Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were retrieved from PubMed, Scopus, and Web of Science. The retrieved studies were screened for eligibility. Then, important data were extracted from the included studies. A random effects model was used for all analyses. Subgroup analysis was used to assess heterogeneity for orders of reptiles, continents where the studies were conducted, and types of specimens. Cumulative meta-analysis and meta-regression were used to determine the trend of the prevalence over time. The quality of each included study was evaluated. Results: Of 106 studies (with a total of 2607 samples), 20 met the inclusion criteria and were included in the meta-analysis. The pooled prevalence of chlamydial infections in reptiles was 23.5% (95% confidence interval [CI]: 15.4-34.0). The trend of chlamydial infections increased from 1990 to 2008; thereafter, it was almost stable at slightly over 20%. The most commonly reported Chlamydia spp. were Chlamydia psittaci, Chlamydia pneumoniae, Chlamydia pecorum, and Chlamydia caviae. Among reptiles, the prevalence of chlamydial infections was highest in crocodiles (57.3% [95% CI: 32.5-78.9]). Among continents, the prevalence of chlamydial infections was highest in Australia (68.6% [95% CI: 36.8-89.1]). Conclusions: Based on the included studies, the prevalence of chlamydial infections in reptiles was high, especially in crocodiles. Because C. psittaci and C. pneumoniae are commonly found in reptiles and are well-known zoonotic pathogens, they should be of concern for human health.

Management of Endodontic and Periodontal Lesions: the Role of Regenerative Dentistry and Biomaterials

Regenerative dentistry represents a novel interdisciplinary approach involving biomaterials, several molecules and mesenchymal stem cells (MSCs), preferably derived from oral tissues. The pivotal role of MSCs depends on the fact that they can differentiate into different cell lineages and have the strategic role to release bioactive substances that stimulate the renewal and regeneration of damaged tissues. The role of regenerative dentistry is promising in all the branches of dentistry: the most intriguing application is related to the management of endodontic and periodontal defects, overcoming the surgical approach and the implantology as a consequence of a poorly efficient therapeutic plan.

Chlamydiaceae: Diseases in Primary Hosts and Zoonosis

Bacteria of the Chlamydiaceae family are a type of Gram-negative microorganism typified by their obligate intracellular lifestyle. The majority of the members in the Chlamydiaceae family are known pathogenic organisms that primarily infect the host mucosal surfaces in both humans and animals. For instance, Chlamydia trachomatis is a well-known etiological agent for ocular and genital sexually transmitted diseases, while C. pneumoniae has been implicated in community-acquired pneumonia in humans. Other chlamydial species such as C. abortus, C. caviae, C. felis, C. muridarum, C. pecorum, and C. psittaci are important pathogens that are associated with high morbidities in animals. Importantly, some of these animal pathogens have been recognized as zoonotic agents that pose a significant infectious threat to human health through cross-over transmission. The current review provides a succinct recapitulation of the characteristics as well as transmission for the previously established members of the Chlamydiaceae family and a number of other recently described chlamydial organisms.

A positive association of peripheral arterial occlusive disease (PAD) andChlamydophila (Clamydia) pneumoniae

The relationship between Chlamydophila pneumoniae (Cp) infection and peripheral arterial occlusive disease (PAD) was studied by analyzing clinical samples from 95 patients with PAD and 100 controls. The following investigations were conducted: IgG and IgA against lipopolysaccharide (LPS) and against purified Cp-specific antigens from elementary bodies (EB) with ELISA; anti-EB IgG, with MIF; Cp DNA in arterial biopsy and peripheral blood mononuclear cells with heminested PCR; LPS with ELISA; and bacteria culture in HEp-2 cells from arterial biopsy. A significantly higher ratio of anti-EB IgG was detected in patients. There were no significant differences in anti-LPS IgG, anti-LPS IgA and anti-EB IgA between cases and controls. Cp DNA findings in the vascular wall biopsy showed significant differences between cases and controls. We obtained results that significantly involve Cp infection with PAD through the detection of anti-EB IgG from serum and bacterial DNA from arterial biopsy.

Aetiology and Clinical Presentation of Mild Community-Acquired Bacterial Pneumonia

A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, and antibody testing for Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in paired serum samples. One hundred thirteen patients were evaluable for clinical presentation and 109 for aetiological diagnosis. At least one pathogen was detected in 62.4% patients. The most common causative agents were Mycoplasma pneumoniae in 24.8%, Chlamydia pneumoniae in 21.1%, and Streptococcus pneumoniae in 13.8% of patients. Dual infection was detected in 8.3% of patients. Most patients suffered from cough, fatigue, and fever. Patients with atypical aetiology of pneumonia differed from those with typical bacterial pneumonia or pneumonia of unknown aetiology in age, presence of dyspnea, and bronchial breathing on lung auscultation. Patients with pneumococcal, chlamydial, and mycoplasmal infections differed in age, risk class, presence of dyspnea, bronchial breathing, and proteinuria. There was an overlap of other clinical symptoms, underlying conditions, and laboratory and radiographic findings among the groups of patients classified by aetiology. Since patients with mild community-acquired pneumonia exhibit similar clinical characteristics and, moreover, since a substantial proportion of cases are attributable to atypical bacteria, broad-spectrum antibiotic treatment seems to be recommended.