Culture-independent susceptibility determination of E. coli isolated directly from patients' urine using FTIR and machine-learning.

One of the most common human bacterial infections is the urinary tract infection (UTI). The main cause of UTI is Escherichia (E.) coli bacteria (∼75%). Because most of the bacteria are resistant to many antibiotics as a result of their indiscriminate overuse, it is extremely important, for effective treatment, to identify the infecting bacteria and to determine, as quickly as possible, their susceptibility to antibiotics. Classical methods require at least 48 hours for determining bacterial susceptibility. In this study, 1798 E. coli isolates from different UTIs were isolated directly from patients' urine, measured by Fourier transform infrared (FTIR) microscopy and analyzed by machine learning algorithms for simultaneous identification and susceptibility determination within 40 minutes since receiving the urine samples. Our results show that it is possible to identify the bacteria at the species level with an accuracy of ∼95% and to determine their susceptibility to different antibiotics with an accuracy ranging from 75% to 83%.

Determination of Klebsiella pneumoniae Susceptibility to Antibiotics Using Infrared Microscopy.

Klebsiella pneumoniae (K. pneumoniae) is one of the most aggressive multidrug-resistant bacteria associated with human infections, resulting in high mortality and morbidity. We obtained 1190 K. pneumoniae isolates from different patients with urinary tract infections. The isolates were measured to determine their susceptibility regarding nine specific antibiotics. This study's primary goal is to evaluate the potential of infrared spectroscopy in tandem with machine learning to assess the susceptibility of K. pneumoniae within approximately 20 min following the first culture. Our results confirm that it was possible to classify the isolates into sensitive and resistant with a success rate higher than 80% for the tested antibiotics. These results prove the promising potential of infrared spectroscopy as a powerful method for a K. pneumoniae susceptibility test.

Rapid detection of Klebsiella pneumoniae producing extended spectrum ß lactamase enzymes by infrared microspectroscopy and machine learning algorithms.

Antimicrobial drugs have played an indispensable role in decreasing morbidity and mortality associated with infectious diseases. However, the resistance of bacteria to a broad spectrum of commonly-used antibiotics has grown to the point of being a global health-care problem. One of the most important classes of multi-drug resistant bacteria is Extended Spectrum Beta-Lactamase-producing (ESBL+) bacteria. This increase in bacterial resistance to antibiotics is mainly due to the long time (about 48 h) that it takes to obtain lab results of detecting ESBL-producing bacteria. Thus, rapid detection of ESBL+ bacteria is highly important for efficient treatment of bacterial infections. In this study, we evaluated the potential of infrared microspectroscopy in tandem with machine learning algorithms for rapid detection of ESBL-producing Klebsiella pneumoniae (K. pneumoniae) obtained from samples of patients with urinary tract infections. 285 ESBL+ and 365 ESBL-K. pneumoniae samples, gathered from cultured colonies, were examined. Our results show that it is possible to determine that K. pneumoniae is ESBL+ with ∼89% accuracy, ∼88% sensitivity and ∼89% specificity, in a time span of ∼20 minutes following the initial culture.

The impact of gender on early scientific publication and long-term career advancement in Israeli medical school graduates.

BACKGROUND: Many medical schools and residency programs incorporate research projects into their curriculum, however most remain unpublished. Little is known on the long-term effect of early-career publication, especially in female graduates. METHODS: We collected data on physicians 15-20 years after graduation (representing a mid-career point), and analysed data on early publication, publication volume and impact according to graduates' gender and professional characteristics. Physicians were divided into those who never published, early-publishers (EP) who published within 2 years of graduation and late-publishers (LP). We analysed and compared the demographics, publication volume, publication quality as well as current mid-career position. RESULTS: Of 532 physicians, 185 were EP (34.8%), 220 were LP (41.3%), 127 (23.9%) never published, 491 (92.2%) became specialists and 122 (22.3%) achieved managerial position. Of the 405 who published, the average number of publications was 20.3 ± 33.0, and median (IQR) 9(19). H-index was significantly higher in EP, males, surgical specialists, and those holding a managerial position. Male gender was associated with higher publication rate (OR = 1.742; 95% CI 1.193-2.544; P = 0.004). Using quantile regression, female gender was negatively associated with the number of publications in Q50-Q95. Surgical specialty and managerial position were positively associated with publications in Q25 to Q75 and early publication in Q25 and Q75. CONCLUSIONS: We found a strong association between EP and the number, impact, and quality of publications throughout their academic career. This study illuminates the need for further investigations into the causes of gender discrepancies. We should invest in support programs encouraging early high quality research projects for young physicians and female graduates.

Detection of Extended-Spectrum ß-Lactamase-Producing Escherichia coli Using Infrared Microscopy and Machine-Learning Algorithms.

The spread of multidrug resistant bacteria has become a global concern. One of the most important and emergent classes of multidrug-resistant bacteria is extended-spectrum ß-lactamase-producing bacteria (ESBL-positive = ESBL+). Due to widespread and continuous evolution of ESBL-producing bacteria, they become increasingly resistant to many of the commonly used antibiotics, leading to an increase in the mortality associated with resulting infections. Timely detection of ESBL-producing bacteria and rapid determination of their susceptibility to appropriate antibiotics can reduce the spread of these bacteria and the consequent complications. Routine methods used for the detection of ESBL-producing bacteria are time-consuming, requiring at least 48 h to obtain results. In this study, we evaluated the potential of infrared spectroscopic microscopy, combined with multivariate analysis for rapid detection of ESBL-producing Escherichia coli ( E. coli) isolated from urinary-tract infection (UTI) samples. Our measurements were conducted on 837 samples of uropathogenic E. coli (UPEC), including 268 ESBL+ and 569 ESBL-negative (ESBL-) samples. All samples were obtained from bacterial colonies after 24 h culture (first culture) from midstream patients' urine. Our results revealed that it is possible to detect ESBL-producing bacteria, with a 97% success rate, 99% sensitivity, and 94% specificity for the tested samples, in a time span of few minutes following the first culture.

Using Infrared Spectroscopy and Multivariate Analysis to Detect Antibiotics' Resistant Escherichia coli Bacteria.

Bacterial pathogens are one of the primary causes of human morbidity worldwide. Historically, antibiotics have been highly effective against most bacterial pathogens; however, the increasing resistance of bacteria to a broad spectrum of commonly used antibiotics has become a global health-care problem. Early and rapid determination of bacterial susceptibility to antibiotics has become essential in many clinical settings and, sometimes, can save lives. Currently classical procedures require at least 48 h for determining bacterial susceptibility, which can constitute a life-threatening delay for effective treatment. Infrared (IR) microscopy is a rapid and inexpensive technique, which has been used successfully for the detection and identification of various biological samples; nonetheless, its true potential in routine clinical diagnosis has not yet been established. In this study, we evaluated the potential of this technique for rapid identification of bacterial susceptibility to specific antibiotics based on the IR spectra of the bacteria. IR spectroscopy was conducted on bacterial colonies, obtained after 24 h culture from patients' samples. An IR microscope was utilized, and a computational classification method was developed to analyze the IR spectra by novel pattern-recognition and statistical tools, to determine E. coli susceptibility within a few minutes to different antibiotics, gentamicin, ceftazidime, nitrofurantoin, nalidixic acid, ofloxacin. Our results show that it was possible to classify the tested bacteria into sensitive and resistant types, with success rates as high as 85% for a number of examined antibiotics. These promising results open the potential of this technique for faster determination of bacterial susceptibility to certain antibiotics.

Detection of antibiotic resistant Escherichia Coli bacteria using infrared microscopy and advanced multivariate analysis.

Bacterial resistance to antibiotics is becoming a global health-care problem. Bacteria are involved in many diseases, and antibiotics have been the most effective treatment for them. It is essential to treat an infection with an antibiotic to which the infecting bacteria is sensitive; otherwise, the treatment is not effective and may lead to life-threatening progression of disease. Classical microbiology methods that are used for determination of bacterial susceptibility to antibiotics are time consuming, accounting for problematic delays in the administration of appropriate drugs. Infrared-absorption microscopy is a sensitive and rapid method, enabling the acquisition of biochemical information from cells at the molecular level. The combination of Fourier transform infrared (FTIR) microscopy with new statistical classification methods for spectral analysis has become a powerful technique, with the ability to detect structural molecular changes associated with resistivity of bacteria to antibiotics. It was possible to differentiate between isolates of Escherichia (E.) coli that were sensitive or resistant to different antibiotics with good accuracy. The objective computational classifier, based on infrared absorption spectra, is highly sensitive to the subtle infrared spectral changes that correlate with molecular changes associated with resistivity. These changes enable differentiating between the resistant and sensitive E. coli isolates within a few minutes, following the initial culture. This study provides proof-of-concept evidence for the translational potential of this spectroscopic technique in the clinical management of bacterial infections, by characterizing and classifying antibiotic resistance in a much shorter time than possible with current standard laboratory methods.

Ethnic Diversity and Increasing Resistance Patterns of Hospitalized Community-Acquired Urinary Tract Infections in Southern Israel: A Prospective Study.

BACKGROUND: Little is known about the incidence of urinary tract infections (UTI) in the dispersed Bedouin population. UTIs are routinely treated empirically according to local resistance patterns, which is important when evaluating the risk factors and antibiotic resistance patterns in the Bedouin population. OBJECTIVES: To analyze risk factors, pathogens, and antibiotic resistance patterns of UTIs in the Bedouin population compared to the general population in southern Israel. To compare data from this study to that from a previous study conducted at our center. METHODS: We prospectively followed all patients hospitalized with community acquired UTIs during a 4 month period at Soroka Medical Center. We also compared results from this study to those from a study conducted in 2000. RESULTS: The study comprised 223 patients: 44 Bedouin (19.7%), 179 (80.3) non-Bedouin; 158 female (70.9%), 65 male (29.1). The Bedouin were younger (51.7 vs. 71.1 years of age, P < 0.001) and had a lower Charlson Comorbidity Index (2.25 vs. 4.87, P < 0.001). Enterobacteriaceae were the most common pathogens identified, and Escherichia coli (E. coli) was the most common with 156 (70%) strains identified, followed by Klebsiella spp. with 29 (13%), Proteus spp. with 18 (8%), pseudomonas with 9 (4%), and other bacteria including enterococci with 11 (5%). The prevalence of E. coli increased significantly from 56% in 2000 to 70% in this study. We also noted an increase in community acquired extended spectrum beta lactamase (ESBL) pathogens from 4.5% in 2000 to 25.5% in the present study. No statistically significant difference was observed between the Bedouin and general populations in the causal pathogens, resistance to antibiotics, length of therapy, and readmission rate within 60 days. CONCLUSIONS: The Bedouin population hospitalized for UTIs is younger and presents with fewer co-morbidities. Isolated pathogens were similar to those found in the general population as was the presence of drug resistant infections. Overall, a substantial percentage of pathogens were resistant to standard first-line antibiotics, driving the need to change from empiric therapy to aminoglycoside therapy.

Prevalence and characteristics of fibromyalgia among HIV-positive patients in southern Israel.

OBJECTIVES: Fibromyalgia and chronic pain have previously associated with HIV infection for over two decades. We aimed to evaluate the prevalence of FMS symptoms in an ethnically heterogeneous population of HIV-infected individuals in southern Israel, applying the proposed new diagnostic criteria for diagnosis of fibromyalgia symdrome (FMS). METHODS: 156 HIV-positive patients followed at the AIDS clinic of the Soroka University Medical Center (SUMC) who gave written informed consent were recruited in the trial. FMS was diagnosed based on the widespread pain index (WPI) and the Symptom Severity Score (SSS) comprising the modified 2011 diagnostic criteria for FMS. CD4 levels ad viral load were obtained. RESULTS: One hundred and thirty-nine patients (89.1%) were receiving HAART (Highly Active Antiretroviral Therapy). A total of 22 patients (14.1%) were found to fulfill current criteria for diagnosis of FMS. FMS-criteria positive individuals were slightly younger than criteria-negative individuals (40.3±9.2 vs. 42.6±11.9, p=0.39), but this difference did not reach statistical significance. There was no significant difference between the groups regarding gender, family status, religion, occupation or education. No correlation was found between CD4 and viral load levels and symptoms of FMS. CONCLUSIONS: Despite the dramatic improvement in management of HIV, FMS symptoms remain highly prevalent among these patients and are not directly correlated with indices of active disease. FMS is an important clinical issue to address among patients suffering from HIV infection.

[BRUCELLA MELITENSIS (BM) BACTEREMIA IN HOSPITALIZED ADULT PATIENTS IN SOUTHERN ISRAEL].

BACKGROUND: Southern Israel is endemic for Brucella melitensis (BM) infection. AIMS: This study aims to describe clinical manifestations and laboratory abnormalities in hospitalized adults with BM-bacteremia and to assess the relationship between various laboratory parameters, outcomes and complications of brucellosis. METHODS: This is a retrospective study. All BM bacteremic patients hospitalized in the Soroka University Medical Center (SUMC) during 2006-2011 were included. Demographic, clinical data and laboratory results were collected from the medical records. RESULTS: A total of 114 patients were included in the study, mostly of Bedouin-Arab origin (92%). The average age was 44 years (±18.4) and included 62 females (54%) of whom 11 were pregnant. Most of the subjects were exposed to sheep or their milk or meat products. The main symptoms included fever, arthralgia, myalgia, headache, and low back pain. Complications were present in 22 patients (19%): arthritis and osteomyelitis (59%), spontaneous abortion (36% of pregnant woman), endocarditis and epididymitis. The incidence of complications was correlated to anemia and leukopenia (p=0.03) and to a low neutrophil count (p=0.009). A decrease of albumin by one unit correlated with an increased hospitalization length by 1.9 days; older age also correlated with a prolonged stay. Complications were present in 45% of pregnant women vs. 10% in non-pregnant women (p=0.011. Relapse occurred in nine patients (8%); only one of these received adequate antibiotic treatment. CONCLUSIONS: MB-bacteremia in southern Israel occurs mainly in Bedouin-Arabs after exposure to sheep or their products. Older age and low albumin levels increase hospitalization. Leukopenia, mainly low neutrophil count, and low thrombocyte count can predict complications. Pregnant women have a higher incidence of complications. Relapse is rare under adequate antibiotic treatment.

[Prevalence of sexually transmitted diseases (STD) in HIV positive women in southern Israel].

BACKGROUND: Co-infection of HIV and other sexualLy transmitted diseases (STDs) is common. The Centers for Disease Control and Prevention (CDC) recommends routine yearly screening for STDs in HIV carriers. There is only scarce data on the prevalence of STD in HIV positive individuals in Israel and no current recommendations on this issue are available. OBJECTIVES: To evaluate the prevalence of STDs, in HIV positive females attending the HIV Clinic at the Soroka University Medical Center in Beer Sheva and to compare prevalence and risk factors for STDs between HIV female carriers of Ethiopian and non-Ethiopian origin. METHODS: Eighty five HIV-positive women were enrolled in the study. Demographic data and sexual behavior were obtained and medical records were reviewed. Cervical swabs for Neisseria gonorrhoeae, Herpes simplex 1 and 2, Ureaplasma urealyticum and Mycoplasma hominis and serum samples for hepatitis B, C and syphilis were obtained. RESULTS: Thirty two of the study participants (37.6%) had at least one STD and in eleven cases (12.9%) two or more STDs were found. Ureaplasma urealyticum was the most frequent pathogen (29.4%). Prevalence for Mycoplasma hominis, HSV1 and 2, Neisseria gonorrhoeae, syphilis and HBV was low. Despite significant differences in sexual behavior between women of Ethiopian and non-Ethiopian origin there were no differences in the prevalence of STDs in the two groups. HCV was significantly more prevalent in women of non-Ethiopian origin, due to high use of intravenous drugs in this group. There was no correlation between CD4 levels and the prevalence of STDs in both groups. DISCUSSION AND CONCLUSION: A relatively low prevalence of STDs among female HIV carriers was found, despite low condom use. The exclusion of males in this study may have contributed to this. The most frequent pathogen found in this study was asymptomatic Ureaplasma urealyticum (29.4%). As this pathogen may cause premature delivery and fetal death it seems important to routinely screen HIV-positive fertile women for its presence. A nationwide multicenter study of HIV-positive females and males is needed in order to establish the prevalence of STDs in this population in Israel and to recommend a screening policy.

Rapid determination of Proteus mirabilis susceptibility to antibiotics using infrared spectroscopy in tandem with random forest.

Bacterial infections cause serious illnesses that are treated with antibiotics. Currently used methods for detecting bacterial antibiotic susceptibility consume 48-72 h, leading to overuse of antibiotics. Thus, many bacterial species have acquired resistance to a broad range of available antibiotics. There is an urgent need to develop efficient methods for rapid determination of bacterial susceptibility to antibiotics. The combination of machine learning and Fourier-transform infrared (FTIR) spectroscopy has generated a promising diagnostic approach in medicine and biology. Our main goal is to examine the potential of FTIR spectroscopy to determine the susceptibility of urinary tract infection-Proteus mirabilis to a specific range of antibiotics, within about 20 min after 24 h culture and identification. We measured the infrared spectra of 489 different P. mirabilis isolates and used random forest to analyze this spectral database. A classification success rate of ~84% was achieved in differentiating between the resistant and sensitive isolates based on their susceptibility to ceftazidime, ceftriaxone, cefuroxime, cefuroxime axetil, cephalexin, ciprofloxacin, gentamicin, and sulfamethoxazole antibiotics in a time span of 24 h instead of 48 h.

Fast identification and susceptibility determination of E. coli isolated directly from patients' urine using infrared-spectroscopy and machine learning.

For effective treatment, it is crucial to identify the infecting bacterium at the species level and to determine its antimicrobial susceptibility. This is especially true now, when numerous bacteria have developed multidrug resistance to most commonly used antibiotics. Currently used methods need âˆ¼ 48 h to identify a bacterium and determine its susceptibility to specific antibiotics. This study reports the potential of using infrared spectroscopy with machine learning algorithms to identify E. coli isolated directly from patients' urine while simultaneously determining its susceptibility to antibiotics within âˆ¼ 40 min after receiving the patient's urine sample. For this goal, 1,765 E. coli isolates purified directly from urine samples were collected from patients with urinary tract infections (UTIs). After collection, the samples were tested by infrared microscopy and analyzed by machine learning. We achieved success rates of âˆ¼ 96% in isolate level identification and âˆ¼ 84% in susceptibility determination.

Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel.

Despite the progress in contemporary antiretroviral therapy (ART) and the continuous changes in treatment guidelines, virological failure (VF) is still an ongoing concern. The goal of this study was to assess factors related to VF after first-line ART. A longitudinal cohort retrospective study of individuals on first-line ART diagnosed with HIV-1 in 2010-2018 and followed-up for a median of two years was conducted. Demographics, baseline and longitudinal CD4 counts, treatment regimens, adherence and VF were recorded. The Cox proportional hazards regression and mixed models were used. A cohort of 1130 patients were included. Overall, 80% were males and 62% were Israeli-born individuals. Compared to individuals diagnosed in 2010-2014, when treatment was initiated according to CD4 levels, those diagnosed in 2015-2018 were older and had lower baseline CD4 counts. VF was recorded in 66 (5.8%) patients. Diagnosis with CD4 <200 cells/mmᶟ with AIDS-defining conditions (HR = 2.75, 95%CI:1.52-4.97, p < 0.001) and non-integrase strand transfer inhibitor regimens (non-INSTI, HR = 1.80, 95%CI:1.01-3.24, p = 0.047) increased VF risk. No impact of baseline resistance was observed. We concluded that the early detection of HIV-1 infection and usage of INSTI-based regimens are recommended to reduce VF.

Tuberculosis in African refugees from the Eastern Sub-Sahara region.

BACKGROUND: The southern region of Israel has recently experienced an influx of African refugees from the Eastern Sub-Sahara desert area. These influxes have led to a significant increase in incidence of tuberculosis (TB) in that region. OBJECTIVES: To review the data of African refugees diagnosed with TB between January 2008 and August 2010 at a tertiary care regional hospital. RESULTS: Twenty-five TB cases were diagnosed, 22 of which presented with pulmonary TB, 3 with extra-pulmonary TB (EPTB), and 7 with combined pulmonary and EPTB. Only one case had concomitant human immunodeficiency virus (HIV) infection and multidrug-resistant TB. Fifteen patients underwent extensive radiological investigations including chest, abdominal and spine computed tomography, 1 was reviewed by magnetic resonance imaging, and 9 underwent tissue biopsy. Eighteen patients were admitted as suspected TB and 4 as suspected pneumonia or pulmonary infiltrates that could have been defined as suspected TB. All 24 HIV-negative cases were sensitive to first-line drugs for TB, except for one case that was resistant to streptomycin and one to rifampicin. All patients responded well to first-line therapy. The average duration of hospitalization was 8.7 days (range 1-36). Following diagnosis 23 patients were transferred to a quarantine facility. CONCLUSIONS: We identified overutilization of medical resources and invasive procedures. For African refugees from the eastern Sub-Sahara who were HIV-negative and suspected of having TB, a sputum acid-fast smear and culture should have been the primary investigative tools before initiating treatment with four drugs (first-line), and further investigations should have been postponed and reserved for non-responders or for patients for whom the culture was negative. Physicians should maintain a high index of suspicion for EPTB in this population.

Infra-red spectroscopy combined with machine learning algorithms enables early determination of Pseudomonas aeruginosa's susceptibility to antibiotics.

Pseudomonas (P.) aeruginosa is a bacterium responsible for severe infections that have become a real concern in hospital environments. Nosocomial infections caused by P. aeruginosa are often hard to treat because of its intrinsic resistance and remarkable ability to acquire further resistance mechanisms to multiple groups of antimicrobial agents. Thus, rapid determination of the susceptibility of P. aeruginosa isolates to antibiotics is crucial for effective treatment. The current methods used for susceptibility determination are time-consuming; hence the importance of developing a new method. Fourier-transform infra-red (FTIR) spectroscopy is known as a rapid and sensitive diagnostic tool, with the ability to detect minor abnormal molecular changes including those associated with the development of antibiotic- resistant bacteria. The main goal of this study is to evaluate the potential of FTIR spectroscopy together with machine learning algorithms, to determine the susceptibility of P. aeruginosa to different antibiotics in a time span of ∼20 min after the first culture. For this goal, 590 isolates of P. aeruginosa, obtained from different infection sites of various patients, were measured by FTIR spectroscopy and analyzed by machine learning algorithms. We have successfully determined the susceptibility of P. aeruginosa to various antibiotics with an accuracy of 82-90%.

Men who have sex with men, risk behavior, and HIV infection: integrative analysis of clinical, epidemiological, and laboratory databases.

BACKGROUND: Centralized data collection and analytic tools facilitate tracing HIV transmission trends at the patient-population level with increasing resolution, complementing behavioral studies while avoiding sampling biases. By several measures, the rate of HIV infection among men who have sex with men (MSM) in Israel increased in the past several years more rapidly than was expected. We describe features of the data that connect this increase to behavioral changes. METHODS: We retrospectively analyzed data from the national HIV reference laboratory and the national HIV and sexually transmitted infections registries. We examined changes in selected epidemiologic and clinical parameters and in the pattern of drug-resistant virus transmission among MSM in Israel. In particular, virus isolates from 296 MSM (23.8% of all MSM who received a diagnosis) were genotyped, drug-resistance conferring mutations were characterized, and phylogenetic trees were constructed. RESULTS: Compared with earlier years, during 2007-2009 MSM were more often infected with drug-resistant virus before treatment initiation, were coinfected with syphilis, and received a diagnosis during acute retroviral syndrome. Phylogenetic analysis suggested frequent transmission of drug-resistant HIV by drug-treated individuals to >1 partner. Secondary transmission of resistant virus by drug-naive patients is also consistent with the phylogenetic patterns. In addition, non-B HIV subtypes began to appear among MSM. CONCLUSIONS: Together, our findings suggest that the sexual behavior of MSM, both HIV-infected and uninfected, has become riskier, contributing to the number of those seeking early clarification of status, to syphilis comorbidity, and to the spread of drug resistance. These findings call for action by public health planners and community-based organizations aimed at increasing awareness of the risks, bringing a change in attitude and establishing safe sex norms.

The prevalence of human papillomavirus and cervical cytology abnormalities in women infected with human immunodeficiency virus in southern Israel.

BACKGROUND: Concomitant human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection increases both HPV persistence and the risk of invasive cervical cancer. An estimation of HPV prevalence among HIV-positive women in Israel would contribute to improving care for this population and preventing morbidity and mortality related to cervical cancer. OBJECTIVES: To determine the prevalence of HPV infection and cervical cytology abnormalities, and to assess the possible influence of HIV infection on HPV carriage in HIV-positive women attending the Infectious Disease Clinic at Soroka University Medical Center. METHODS: The study population included 84 HIV-seropositive women. They were examined by a gynecologist and screened for HPV genotyping, and Pap smears were obtained for cervical cytology. Demographic, behavioral, and HIV infection variables were also recorded and analyzed. RESULTS: Forty-nine (58.3%) of the study participants were HPV-positive; 34 of them had oncogenic genotypes. Young age (< 16 years) at first sexual intercourse was the only variable significantly associated with HPV infection (P < 0.05). Abnormal cervical cytology was present in 17 women (20.3%); 21 women were referred to colposcopy, which was abnormal in 9 (10.7%). CONCLUSIONS: The prevalence of HPV carriage among HIV-positive woman in our study was slightly higher than published elsewhere. The prevalence of pathological cervical cytology was much higher than in the general population. An extremely high prevalence of pathological colposcopies requiring further treatment was found. Screening for HPV and premalignant changes in the uterine cervix is highly recommended in the HIV-seropositive population. We suggest that colposcopy be considered part of the routine workup in HIV-seropositive woman.

Epidemiology and Transmitted HIV-1 Drug Resistance among Treatment-Naïve Individuals in Israel, 2010-2018.

Despite the low prevalence of HIV-1 in Israel, continuous waves of immigration may have impacted the local epidemic. We characterized all people diagnosed with HIV-1 in Israel in 2010-2018. The demographics and clinical data of all individuals (n = 3639) newly diagnosed with HIV-1 were retrieved. Subtypes, transmitted drug-resistance mutations (TDRM), and phylogenetic relations, were determined in >50% of them. In 39.1%, HIV-1 transmission was through heterosexual contact; 34.3% were men who have sex with men (MSM); and 10.4% were people who inject drugs. Many (>65%) were immigrants. Israeli-born individuals were mostly (78.3%) MSM, whereas only 9% of those born in Sub-Saharan Africa (SSA), Eastern Europe and Central Asia (EEU/CA), were MSM. The proportion of individuals from SSA decreased through the years 2010-2018 (21.1% in 2010-2012; 16.8% in 2016-2018) whereas those from EEU/CA increased significantly (21% in 2010-2012; 27.8% in 2016-2018, p < 0.001). TDRM were identified in 12.1%; 3.7, 3.3 and 6.6% had protease inhibitors (PI), nucleotide reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) TDRM, respectively, with the overall proportion remaining stable in the studied years. None had integrase TDRM. Subtype B was present in 43.9%, subtype A in 25.2% (A6 in 22.8 and A1 in 2.4%) and subtype C in 17.1% of individuals. Most MSM had subtype B. Subtype C carriers formed small clusters (with one unexpected MSM cluster), A1 formed a cluster mainly of locally-born patients with NNRTI mutations, and A6 formed a looser cluster of individuals mainly from EEU. Israelis, <50 years old, carrying A1, had the highest risk for having TDRM. In conclusion, an increase in immigrants from EEU/CA and a decrease in those from SSA characterized the HIV-1 epidemic in 2010-2018. Baseline resistance testing should still be recommended to identify TDRM, and improve surveillance and care.

An outbreak of varicella in staff nurses exposed to a patient with localized herpes zoster.

An outbreak of varicella occurred in an internal medicine ward. The outbreak comprised 3 nurses, 2 of whom were directly exposed to an immunocompetent patient with localized herpes zoster. Our observation provides an argument for airborne precautions in hospitalized patients with localized herpes zoster.