Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study

Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy

INTRODUCTION

Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery.

METHODS

Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066).

RESULTS

The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition.

CONCLUSION

There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.

Characteristics and risk factors for extrapancreatic infection in patients with moderate or severe acute pancreatitis

Background

How to detect acute pancreatitis (AP) complicated with infection early and how to arrange the treatment time are still the main problems in the world. There are few reports on the potential relationship between extrapancreatic infections and AP. The purpose of this article was to investigate the characteristics, influencing factors and prognosis of extrapancreatic infection in AP patients with modified Marshall score ≥2 on admission.

Materials and methods

We retrospectively analyzed AP admitted to emergency intensive care unit of Ruijin hospital within 72 h of onset from September 2019 to December 2021. In addition to the patients' baseline data, sites of infection and microorganisms outside the pancreas were collected. Microbial cultures were used to identify infections of the respiratory tract, blood, abdominal cavity, biliary tract, urinary tract and clostridium difficile in feces.

Results

144 patients with AP were included, of which extrapancreatic infection accounted for 40.28%. C-reactive protein, procalcitonin, blood urea nitrogen, serum creatinine, oxygenation index, modified Marshall score, BISAP score and APACHE II score were significantly increased in the extrapancreatic infection group. The risk factors of extrapancreatic infection included blood urea nitrogen, Modified Marshall score and duration of mechanical ventilation. The positive rates of pathogenic bacteria in sputum culture, blood culture, ascites culture and bile culture were significantly higher than those in the 1-3 days after admission. The infection begins to worsen as early as 4-7 days after the onset of symptoms. Extrapancreatic infection is associated with pancreatic necrosis, the rate of laparotomy, length of hospital stay and in-hospital mortality.

Conclusion

Our research has confirmed the need to prevent and monitor extrapancreatic infection in the early stage.

Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control

Background

The systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.

Methods

A retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.

Results

A total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).

Conclusion

The adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.

Radiation synthesis and in vitro evaluation of the antimicrobial property of functionalized nanopolymer-based poly (propargyl alcohol) against multidrug-resistance microbes

Pathogenic microorganisms are responsible for many diseases in biological organisms, including humans. Many of these infections thrive in hospitals, where people are treated with medicines and certain bacteria resist those treatments. Consequently, this research article aims to develop efficient antimicrobial material-based conjugated and functionalized polypropargyl alcohol nanoparticles (nano-PGA) synthesized by gamma irradiation. The monomer of PGA was polymerized in various mediums (water (W), chloroform (Ch), and dimethylformamide (DMF)) without catalysts under the action of γ-rays, producing π-conjugated and colored functional nano-PGA polymers. Nano-PGA is a versatile polymer demonstrated here as suitable for creating next-generation of antimicrobial systems capable of effectively preventing and killing various pathogenic microorganisms. The novelty here is the development of polymeric nanostructures by changing the solvent and irradiation doses. The antimicrobial property of nano-PGA (nanostare-like antibody structure) was examined against different pathogenic bacteria and unicellular fungi. Nano-PGA-DMF exhibits significant antimicrobial potential against Staphylococcus aureus (S. aureus) (20.20 mm; zone of inhibition (ZOI), and 0.47 μg/mL; minimum inhibitory concentration (MIC), followed by Escherichia coli (E. coli) (14.50 mm; ZOI, and 1.87 μg/mL; MIC, and Candida albicans (C.albicans) (12.50 mm; ZOI, and 1.87 μg/mL; MIC). In antibiofilm results, the highest inhibition percentage of the synthesized nano-PGA-W, nano-PGA-Ch, and nano-PGA-DMF was documented for S. aureus (17.01%, 37.57%, and 80.27%), followed by E. coli (25.68%, 55.16% and 78.11%), and C.albicans (40.10%, 62.65%, and 76.19%), respectively. The amount of bacterial protein removed is directly proportional after increasing the concentration of nano-PGA-W, nano-PGA-Ch, and nano-PGA-DMF samples (at different concentrations) and counted to be 70.58, 102.89, and 200.87 μg/mL, respectively following the treatment with 1.0 mg/mL of each sample. It was found that the nano-PGA polymer prepared in DMF has better antimicrobial activity than one prepared in chloroform than in water.

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Background

Multidrug-resistant (MDR) Klebsiella pneumoniae infections, from pancreatic infections to bloodstream infections, influence the mortality of patients with acute pancreatitis (AP) on the condition of limited antibiotic choices. The aim of this study was to investigate the predictor of mortality among AP patients complicated with MDR-K. pneumoniae infections.

Methods

Seventy-one AP patients who occurred MDR-K. pneumoniae infections from August 1st, 2016 to August 1st, 2020 were enrolled. MDR-K. pneumoniae was defined as the K. pneumoniae strain non-susceptible to at least one agent in three or more antimicrobial categories. MDR-K. pneumoniae isolates were confirmed by Vitek-2 system. Antibiotic susceptibility test was carried out using a micro broth dilution method. Clinical characteristics and drug-resistance rates were retrospectively reviewed, and the predictors of mortality were evaluated by univariate and multivariate analyses.

Results

The mortality rate of AP patients complicated with MDR-K. pneumoniae infections reached 46.5% (33 of 71), and pancreas (n = 53) was the most common site of MDR-K pneumoniae strains. The drug resistance rates of MDR-K. pneumoniae were high to 11 of 12 common antibiotics (more than 50.0%) except of tigecycline (23.9%). The predictor independently associated with mortality was septic shock (hazard ratio 2.959, 95% confidence intervals 1.396 – 6.272, P = 0.005).

Conclusions

More attention should be paid for pancreatic MDR-K. pneumoniae infections among AP patients The predictor for mortality of AP patients complicated with MDR-K. pneumoniae infection is septic shock. Therefore, further clinical investigations should focus on areas against septic shock.