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Zheng C, Li D, Wang Y, Wang L, Huang Y, Yao J. Risk factors and genetic characteristics of the carriage of hypervirulent and carbapenem-resistant Acinetobacter baumannii among pregnant women. Front Microbiol 2024; 15:1351722. [PMID: 38572236 PMCID: PMC10987950 DOI: 10.3389/fmicb.2024.1351722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 04/05/2024] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii (CRAB) and its emerging evolutionary branch toward hypervirulence have been neglected in pregnancy. Methods From September 2020 to August 2021, an active surveillance culture program encompassed 138 randomly selected pregnant women, with five subjected to sample collection at two different time points. The clinical characterization was explored through statistical analysis. Whole-genome sequencing, a Galleria mellonella infection model, and a global database were used to investigate the genetic characterization, pathogenicity, evolutionary history, and phylogenetic relationships of the isolates. Results Of the 41 CRAB isolates obtained, they were divided into four ClustersRS and an orphan pattern. ClusterRS 1 (n = 31), with eight complex types in pregnancy, was also the dominant ClusterRS globally, followed by ClusterRS 13 (n = 5), identified as hypervirulent KL49 CRAB, exhibiting phylogeographical specificity to Guangdong. A maternal carriage CRAB rate of 26.09% (36/138) was revealed, with half of the isolates representing novel complex types, prominently including CT3071, as the first KL7 isolates identified in Shenzhen. Both KL49 and KL7 isolates were most commonly found in the same participant, suggesting potential intraspecific competition as a possible reason for CRAB infection without carriers during pregnancy. The independent risk factors for carriers were revealed for the first time, including advanced maternal age, gestational diabetes mellitus, and Group B Streptococcus infection. Conclusion The significant carriage rate and enhanced virulence of CRAB during pregnancy emphasize the imperative for routine surveillance to forestall dissemination within this high-risk group, especially in Guangdong for ClusterRS 13 isolates.
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Affiliation(s)
- Chao Zheng
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Bacteriology and Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, China
- School of Materials and Environmental Engineering, Shenzhen Polytechnic University, Shenzhen, China
| | - Defeng Li
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yinglan Wang
- Department of Obstetrics and Gynecology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Lisheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yuting Huang
- Bacteriology and Antibacterial Resistance Surveillance Laboratory, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
- Department of Head and Neck Surgery, Cancer Hospital Chinese Academy of Medical Sciences Shenzhen Center, Shenzhen, China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People’s Hospital (The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
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Sreenivas A, Lewis L, Purkayastha J, Lakshmi R V, Mathew M. Standardizing Minimally Invasive Tissue Sampling of Postmortem Brain Using Bard Monopty Needle in Newborns with Neurological Injury. Fetal Pediatr Pathol 2024; 43:94-110. [PMID: 38200700 DOI: 10.1080/15513815.2023.2301448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Minimally invasive tissue sampling of the brain in newborns using the Bard Monopty needle helps to diagnose various neurological conditions by obtaining relevant brain cores. We designed a modified procedure to provide maximum diagnostic utility in brain tissue biopsies. METHOD Twenty newborns underwent postmortem minimally invasive tissue sampling of the brain through the anterior fontanelle and posterior approach, using the engraved lines on the needle labeled from mark 0 to 13. The cores were correlated with conventional autopsy findings. RESULTS Meninges were best obtained at marks 0 and 1 from the anterior fontanelle and mark 1 from posterior fontenelle in 85% of cases. Periventricular brain parenchyma was best obtained from mark 3 and mark 1 from anterior and posterior fontanel, respectively in 90% cases. The sampling success in obtaining brain cores was 100%. DISCUSSION This modified technique increases the yield of meninges and brain tissue in newborns and aids in diagnosis.
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Affiliation(s)
- Athira Sreenivas
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Leslie Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jayashree Purkayastha
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vani Lakshmi R
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Mary Mathew
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Devarajalu P, Kumar J, Dutta S, Attri SV, Kabeerdoss J. Gut microbiota of preterm infants in the neonatal intensive care unit: a study from a tertiary care center in northern India. Front Microbiol 2024; 15:1329926. [PMID: 38389529 PMCID: PMC10881769 DOI: 10.3389/fmicb.2024.1329926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Disruptions of the gut microbiota of preterm infants admitted to the neonatal intensive care unit (NICU) during the first 2 weeks of life are of critical importance. These infants are prone to various complications, including necrotizing enterocolitis (NEC) and sepsis. Studying the gut microbiota will improve outcomes in preterm infants. In the present study, we examined the gut microbiota of preterm infants admitted to the NICU in the first month of life. Methods Neonates admitted to the NICU were recruited, and stool samples were collected weekly from the seventh day of the infant's life until the 30th day of life. DNA was extracted using a DNeasy Powersoil DNA isolation kit. 16S rRNA gene sequencing targeting the V3-V4 region was performed using the MiSeq platform. Sequenced reads were processed on DADA2 pipeline to obtain an amplicon sequence variant (ASV) table. All bioinformatic and statistical analyses were performed using different packages in the R statistical framework. Results Fourteen preterm infants were recruited, and 48 samples were collected. Alpha diversity metrics, observed ASV count, and Shannon index were found to have no differences in any clinical variables. Permutational multivariate analysis of variance (PERMANOVA) showed discrimination of neonates by gestational age and administration of probiotics. Differential abundance analysis showed a decreased abundance of Bifidobacterium Breve in extremely preterm infants (gestational age <28 weeks) compared to moderate preterm infants (gestational age 29-32 weeks). Supplementation with probiotics decreased Acinetobacter and increased Bifidobacterium in the gut of preterm neonates regardless of gestational age. Conclusion Gestational age and probiotic supplementation alter the gut microbiota of preterm infants admitted to the NICU.
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Affiliation(s)
- Prabavathi Devarajalu
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jogender Kumar
- Newborn Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Newborn Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jayakanthan Kabeerdoss
- Pediatric Biochemistry Unit, Department of Pediatrics, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Kallapur MG, Ghanchi NK, Harakuni SU, Somannavar MS, Ahmed I, Fogleman E, Hwang K, Kim J, Saleem S, Goudar SS, Tikmani SS, Dhaded SM, Guruprasad G, Yasmin H, Yogeshkumar S, McClure EM, Goldenberg RL. Group B streptococcal prevalence in internal organs and placentas of deceased neonates and stillbirths in South Asia. BJOG 2023; 130 Suppl 3:53-60. [PMID: 37530593 DOI: 10.1111/1471-0528.17614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Group B streptococcus (GBS) has been associated with adverse pregnancy outcomes, but few prospective studies have assessed its prevalence in low- and middle-income country settings. We sought to evaluate the prevalence of GBS by polymerase chain reaction (PCR) in internal organ tissues and placentas of deceased neonates and stillbirths. DESIGN This was a prospective, observational study. SETTING The study was conducted in hospitals in India and Pakistan. POPULATION Pregnant women with stillbirths or preterm births were recruited at delivery, as was a group of women with term, live births, to serve as a control group. METHODS A rectovaginal culture was collected from the women in Pakistan to assess GBS carriage. Using PCR, we evaluated GBS in various tissues of stillbirths and deceased neonates and their placentas, as well as the placentas of live-born preterm and term control infants. MAIN OUTCOME MEASURES GBS identified by PCR in various tissues and the placentas; rate of stillbirths and 28-day neonatal deaths. RESULTS The most obvious finding from this series of analyses from India and Pakistan was that no matter the country, the condition of the subject, the tissue studied or the methodology used, the prevalence of GBS was low, generally ranging between 3% and 6%. Among the risk factors evaluated, only GBS positivity in primigravidae was increased. CONCLUSIONS GBS diagnosed by PCR was identified in <6% of internal organs of stillbirths and neonatal deaths, and their placentas, and control groups in South Asian sites. This is consistent with other reports from South Asia and is lower than the reported GBS rates from the USA, Europe and Africa.
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Affiliation(s)
- Mangala G Kallapur
- Bapuji Educational Association's J.J.M. Medical College, Davangere, Karnataka, India
| | | | - Sheetal U Harakuni
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | | | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - Jean Kim
- RTI International, Durham, North Carolina, USA
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | - Sangappa M Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Gowdar Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Davangere, Karnataka, India
| | | | - S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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Goldenberg RL, Goudar SS, Kavi A, Krebs NF, Derman RJ, Saleem S, McClure EM. Improving maternal, neonatal and child health outcomes in low-resource settings: Translating research evidence to practice - report from The Third International Conference on Maternal, Newborn and Child Health. BJOG 2023; 130 Suppl 3:4-7. [PMID: 37530445 PMCID: PMC11232062 DOI: 10.1111/1471-0528.17609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Affiliation(s)
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
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Goldenberg RL, Saleem S, Goudar SS, Moore J, Guruprasad G, Kulkarni V, Dhaded SM, Tikmani SS, Nausheen S, Masheer S, Kallapur MG, Ghanchi NK, Harakuni SU, Ahmed I, Hwang K, Yogeshkumar S, Somannavar MS, Yasmin H, Kim J, Bann CM, Silver RM, McClure EM. The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review. BJOG 2023; 130 Suppl 3:26-35. [PMID: 37592743 DOI: 10.1111/1471-0528.17635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/11/2023] [Indexed: 08/19/2023]
Abstract
The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.
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Affiliation(s)
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Janet Moore
- RTI International, Durham, North Carolina, USA
| | - Gowdar Guruprasad
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | | | | | - Mangala G Kallapur
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | | | - Sheetal U Harakuni
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Jean Kim
- RTI International, Durham, North Carolina, USA
| | - Carla M Bann
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
- RTI International, Durham, North Carolina, USA
| | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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