Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India.

Background: Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials: This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results: The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion: This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. How to cite this article: Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244-1252.

Frequency-based haplotype reconstruction from deep sequencing data of bacterial populations.

Clonal populations accumulate mutations over time, resulting in different haplotypes. Deep sequencing of such a population in principle provides information to reconstruct these haplotypes and the frequency at which the haplotypes occur. However, this reconstruction is technically not trivial, especially not in clonal systems with a relatively low mutation frequency. The low number of segregating sites in those systems adds ambiguity to the haplotype phasing and thus obviates the reconstruction of genome-wide haplotypes based on sequence overlap information.Therefore, we present EVORhA, a haplotype reconstruction method that complements phasing information in the non-empty read overlap with the frequency estimations of inferred local haplotypes. As was shown with simulated data, as soon as read lengths and/or mutation rates become restrictive for state-of-the-art methods, the use of this additional frequency information allows EVORhA to still reliably reconstruct genome-wide haplotypes. On real data, we show the applicability of the method in reconstructing the population composition of evolved bacterial populations and in decomposing mixed bacterial infections from clinical samples.

Evaluation of the toxicity of 5-aryl-2-aminoimidazole-based biofilm inhibitors against eukaryotic cell lines, bone cells and the nematode Caenorhabditis elegans.

Previously, we have synthesized several series of compounds based on the 5-aryl-2-aminoimidazole scaffold, which showed a preventive activity against microbial biofilms. We here studied the cytotoxicity of the most active compounds of each series. First, the cytostatic activity was investigated against a number of tumor cell lines (L1210, CEM and HeLa). A subset of monosubstituted 5-aryl-2-aminoimidazoles showed a moderate safety window, with therapeutic indices (TIs) ranging between 3 and 20. Whereas introduction of a (cyclo-)alkyl chain at the N1-position strongly reduced the TI, introduction of a (cyclo-)alkyl chain or a triazole moiety at the 2N-position increased the TI up to 370. Since a promising application of preventive anti-biofilm agents is their use in anti-biofilm coatings for orthopedic implants, their effects on cell viability and functional behavior of human osteoblasts and bone marrow derived mesenchymal stem cells were tested. The 2N-substituted 5-aryl-2-aminoimidazoles consistently showed the lowest toxicity and allowed survival of the bone cells for up to 4 weeks. Moreover they did not negatively affect the osteogenic differentiation potential of the bone cells. Finally, we examined the effect of the compounds on the survival of Caenorhabditis elegans, which confirmed the higher safety window of 2N-substituted 5-aryl-2-aminoimidazoles.

Epidemiology and Clinical Features of Burkholderia Bacteremia at a Hospital in India.

Burkholderia spp. are opportunistic pathogens that cause infection in patients with disrupted immunity. The study intended to demonstrate the epidemiology and clinical features associated with Burkholderia spp. bacteremia. This retrospective study was performed to assess the clinical and laboratory characteristics of patients whose blood cultures were growing Burkholderia spp. and, based on their underlying comorbidities, were subjected to survival analysis from January 2022 to December 2022 at a university hospital in northern India. Three hundred patients with Burkholderia spp. bacteremia were included in this study conducted over 1 year. The mean age of the patients was 33.86 years with a male predominance of 56.67% (170/300, 56.67%). Underlying malignancies (207/300, 69.0%) were the most common clinical diagnosis, and catheter in situ (300/300, 100.0%) was the most common risk factor. Burkholderia cenocepacia (244/300, 81.33%) was the most common Burkholderia spp. isolated. All isolates were highly susceptible to minocycline. Kidney disease (P = 0.029), hypertension (P = 0.005), type 2 diabetes mellitus (P = 0.039), and respiratory disease (P <0.001) in patients were significantly associated with death owing to Burkholderia spp. bacteremia, whereas patients with malignancies (P <0.001) and undergoing treatment were significantly associated with a better outcome when the microorganism was susceptible to empirical antibiotics. The presence of indwelling devices, mechanical ventilation (P <0.001), and a hemodialysis catheter (P = 0.026) were statistically significant risk factors associated with poor outcomes.

Investigating anti-inflammatory actions of marine algal compound against lipoxygenase concentrating on therapeutic applications through computational approach.

Inflammation is the preliminary response given to any possible harmful stimuli including infections, injury or stress by immune system where neutrophils and macrophages gets activated and produces mediators, such as nitric oxide and cytokines that serves as biomarkers of inflammation. Lipoxygenases are enzymes that peroxidises lipids and are involved in the pathogenesis of several diseases including inflammatory diseases. These are oxidative enzymes comprising a non-heme iron atom in active site and are convoluted in inflammatory reactions. Fucoidan is sulphated polysaccharide that has numerous pharmacological implications. Implications of fucoidan on inflammatory diseases are still an objective of rigorous research. Therefore, this study focusses on investigating lipoxygenase inhibitory activities of fucoidan. The mechanism of lipoxygenase inhibitory activities of fucoidan was studied via molecular docking and molecular dynamics simulations. The docking score produced by the binding of the fucoidan to the lipoxygenase was - 6.69 kcal/mol whereas, the docking score in case of Aspirin and Zileuton were -5.8 kcal/mol and -7.0 kcal/mol and it was found that fucoidan makes hydrogen bonds with lipoxygenase protein through polar amino acid glutamine at GLN 514. The results obtained from molecular dynamics simulations proposed the development of a stable complex between fucoidan and lipoxygenase due to the establishment of favourable interactions with amino acid residues and indicated efficient results when compared with Aspirin and Zileuton. This study suggested that fucoidan had anti-inflammatory potentials and thus can be used as a promising drug candidate against inflammation.Communicated by Ramaswamy H. Sarma.

Respiratory bacterial co-infections and their antibiotic resistance pattern in COVID-19 patients at a tertiary care centre in India.

Introduction: Patients with coronavirus disease-2019 (COVID-19) are prone to develop respiratory bacterial infections irrespective of their need for mechanical ventilatory support. Hypothesis/Gap Statement: Information about the incidence of concomitant respiratory bacterial infections in COVID- 19 patients from India is limited. Aim: This study aimed to determine the incidence of concomitant respiratory bacterial pathogens and their drug resistance in these patients. Methodology: A prospective study was performed by including patients who were admitted to our tertiary care centre from March 2021 to May 2021 to evaluate secondary bacterial respiratory co-infections in patients via real-time PCR (RT-PCR)-confirmed cases of COVID-19 disease caused by SARS CoV-2. Results: Sixty-nine culture-positive respiratory samples from patients with COVID-19 were incorporated into this study. The most commonly isolated bacterial microorganisms were Klebsiella pneumoniae (23 samples, 33.33 %) and Acinetobacter baumannii (15, 21.73 %), followed by Pseudomonas aeruginosa (13, 18.84 %). Among the microorganisms isolated, 41 (59.4 %) were multidrug-resistant (MDR) and nine (13 %) were extensively drug-resistant (XDR). Among the Gram-negative bacteria isolated, K. pneumoniae showed high drug resistance. Fifty carbapenem-resistant microorganisms were isolated from the patients included in our study. Concerning the hospital stay of the patients enrolled, there was an increased length of intensive care unit stay, which was 22.25±15.42 days among patients needing mechanical ventilation in comparison to 5.39±9.57 days in patients on ambient air or low/high-flow oxygen. Conclusion: COVID-19 patients need increased length of hospitalization and have a high incidence of secondary respiratory bacterial infections and high antimicrobial drug resistance.

In-vitro Activity of Isepamicin against Gram-negative Bacteria in Comparison to Other Aminoglycosides Routinely used at a Teaching Hospital in Northern India.

Background Isepamicin is a 1-N-S-a-hydroxy-b-aminopropionyl derivative of gentamicin B and the spectrum of pathogenic microorganisms covered by it and its effectiveness is similar to that of amikacin except the action of aminoglycoside inhibitor enzymes is ineffectual on it. Material and Methods We performed a prospective study in the Bacteriology section of the Department of Microbiology at a 1,600-bedded hospital in Northern India from Jan 2022 to March 2022. Isepamicin was tested for susceptibility against gram-negative bacteria, identified by routine biochemicals and matrix-assisted-desorption/ionization -time of flight-mass spectrometry (MALDI-TOF-MS) assay. The antibiotic susceptibility testing for each of the isolates was performed by Kirby Bauer's disc diffusion method, according to the CLSI 2019 guidelines. Results The majority of isolates were obtained from blood samples (50, 39.1%). Among the non-inducible Enterobacteriaceae , Escherichia coli was least susceptible to amikacin (8/27, 29.63%) and most susceptible to isepamicin (18/27, 66.67%). Klebsiella pneumoniae followed the same pattern of susceptibility as E. coli and was least susceptible to Amikacin (20/46, 43.48%) and most susceptible to isepamicin (24/46, 52.17%). Enterobacter cloacae (6/7, 85.71%) was most susceptible to both amikacin and isepamicin, followed by 71.43% (5/7, 71.43%) susceptibility to gentamicin and tobramycin each. Enterobacter aerogenes was equally 53.33% (8/15) susceptible to all antibiotics. Pseudomonas aeruginosa was the most susceptible isolate to all antibiotics (18/21, 85.71%). Conclusion Isepamicin is a potential antimicrobial agent for treating an array of gram-negative bacteria-associated infections and shows better in vitro activity than older aminoglycoside agents.

Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India.

Background: Blockage of the biliary tract is commonly caused by malignant tumors leading to deranged liver function, responsible for poor prognosis and a high rate of bacteriobilia leading to mortality. Material and methods: We collected retrospective data from the hospital information system and laboratory registers in our department from 2021 to 2022 to evaluate biliary infections in patients with hepato-pancreatico-biliary and associated intraabdominal malignancies. Result: A total of 118 (118/234, 50.43%) patients' bile samples were estimated in this study. Patients' average age was 53.02 ± 13.49 years, with more patients below the age of 65 years among those with infected bile samples. Eight patients were infected by 102 pathogenic microorganisms. The most common pathogenic microorganism responsible for biliary infection in patients with abdominal malignancies was Escherichia coli (38/102, 37.25%) followed by Klebsiella pneumoniae (21/102, 20.59%) and Enterococcus spp. (18/102, 17.65%). Underlying comorbidities like diabetes mellitus, hypothyroidism, hypoproteinemia, chronic liver disease, immunosuppression, chronic kidney disease, increased hospital stay, admission to the intensive care unit (ICU), and presence of percutaneous transhepatic biliary drain were statistically significant risk factors for isolation of multidrug-resistant pathogenic bacteria. Conclusion: Our study guided physicians in identifying the associated demographic characteristics, risk factors, and the spectrum of pathogens responsible for bacteriobilia in abdominal cancer patients along with the antibiotic resistance pattern among these isolates and better selection of antibiotics and antibiotic prophylaxis for patients at risk of developing biliary tract infections with multidrug-resistant pathogens. How to cite this article: Kar M, Dubey A, Patel SS, et al. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepato-Gastroenterol 2023;13(1):10-17.

Investigating anti-inflammatory and apoptotic actions of fucoidan concentrating on computational and therapeutic applications.

Fucoidan is linked to a variety of biological processes. Differences in algae species, extraction, seasons, and locations generate structural variability in fucoidan, affecting its bioactivities. Nothing is known about fucoidan from the brown alga Dictyota bartayresiana, its anti-inflammatory properties, or its inherent mechanism. This study aimed to investigate the anti-inflammatory properties of fucoidan isolated from D. bartayresiana against LPS-induced RAW 264.7 macrophages and to explore potential molecular pathways associated with this anti-inflammatory effects. Fucoidan was first isolated and purified from D. bartayresiana, and then, MTT assay was used to determine the effect of fucoidan on cell viability. Its effects on reactive oxygen species (ROS) formation and apoptosis were also studied using the ROS assay and acridine orange/ethidium bromide fluorescence labelling, respectively. Molecular docking and molecular dynamics simulation studies were performed on target proteins NF-κB and TNF-α to identify the route implicated in these inflammatory events. It was observed that fucoidan reduced LPS-induced inflammation in RAW 264.7 cells. Fucoidan also decreased the LPS-stimulated ROS surge and was found to induce apoptosis in the cells. Molecular docking and molecular dynamics simulation studies revealed that fucoidan's potent anti-inflammatory action was achieved by obstructing the NF-κB signalling pathway. These findings were particularly noteworthy and novel because fucoidan isolated from D. bartayresiana had not previously been shown to have anti-inflammatory properties in RAW 264.7 cells or to exert its activity by obstructing the NF-κB signalling pathway. Conclusively, these findings proposed fucoidan as a potential pharmaceutical drug for inflammation-related diseases.

Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India.

Context: Knowledge of epidemiology of bacterial isolates and their anti-biograms in hospital settings is necessary for prompt empirical anti-microbial therapy of neonatal sepsis. Aims: To study risk factors, bacteriological profiles, and anti-biograms of blood culture isolates of both early and late onset neonatal sepsis. Settings and Design: It is a prospective observational study conducted from January 2020 till July 2021 at our tertiary care center. Material and Methods: Neonates (0-28 days) admitted to this neonatal intensive care unit clinically suspected with sepsis were subjected to blood cultures, and the isolates were identified both biochemically and by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system. Antibiotic susceptibility testing (AST) was performed as per CLSI guidelines. Statistical Analysis: Chi-square test was used. Results: Out of 280 suspected cases of neonatal sepsis, 43 (15.3%) cases showed positive blood culture. Of these, the majority (30, 69.8%) had late-onset neonatal sepsis. Major pre-disposing risk factors were pre-term birth and a low birth weight (26, 60.5%). Gram-negative bacteria and Gram-positive bacteria were isolated in 25 (58.1%) and 18 (41.9%) blood cultures, respectively. Klebsiella pneumoniae (37.5%) was the most predominant pathogen in both early-onset (23.1%) and late-onset (46.7%) sepsis. Coagulase negative Staphylococcus (34.8%) was the second most common organism and was more common in late onset (23.2%) neonatal sepsis. A high level of antibiotic resistance was noted in Klebsiella pneumoniae isolates, even to amikacin (76.5%) and carbapenems (66.7%). Conclusion: Increased resistance in bacterial isolates of neonatal sepsis emphasizes the need of AST of bacterial isolates for proper antibiotic administration.

Outbreak of colistin resistant, carbapenemase (bla NDM, bla OXA-232) producing Klebsiella pneumoniae causing blood stream infection among neonates at a tertiary care hospital in India.

Infections caused by multi-drug resistant Klebsiella pneumoniae are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by K. pneumoniae are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant K. pneumoniae among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all K. pneumoniae isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly bla NDM-1, bla NDM-5 and bla OXA-232 besides extended-spectrum ß-lactamases however the colistin resistance gene mcr-1, mcr-2 and mcr-3 could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of K. pneumoniae ST101 from filtered incubator water, harboring bla NDM-5, bla OXA-232 and ESBL genes (bla CTX-M) but was negative for the mcr genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community.

Clinico-epidemiological characteristics of the biliary samples and their antibiotic susceptibility pattern at a teaching hospital in Northern India.

Introduction: Bile is deemed a sterile fluid, with the presence of clinical conditions like cholelithiasis, cholecystitis, previous biliary interventions, biliary strictures, and so on, leading to bile stasis, and increases the chances of bacteriobilia. In this study, we recognize the bacterial spectrum of microorganisms isolated from bile samples, diagnostic parameters, and antibiotic sensitivity patterns. Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2021 to 2022 to evaluate biliary infections in patients who underwent surgical procedures related to the biliary tract and associated organs. Results: A total of 234 patients' bile samples were included in our study. The mean age of patients was 48.04 ± 14.74 years, with more patients below the age of 65 years among those with infected bile samples. One hundred and sixty-three (163/234, 69.66%) patients infected by 209 pathogenic microorganisms were recognized. The most common microorganism isolated was Escherichia coli (83/209, 39.71%), followed by Pseudomonas aeruginosa (37/209, 17.7%). Acinetobacter baumannii and Klebsiella pneumoniae isolate owed to more than 90% penicillin, extended-spectrum beta-lactamase, carbapenem, and fluoroquinolone resistance among all isolates. Length of hospital stay, malignant obstruction, and chronic kidney disease were identified as statistically significant risk factors that lead to the isolation of multi-drug-resistant isolates from bile culture. Conclusion: We recognized the spectrum of pathogens causing biliary tract infections at our center along with the antibiotic resistance pattern to guide and facilitate prompt and appropriate treatment by primary health care professionals and family medicine practitioners.

Clinical presentations and microbiological analysis of cerebrospinal fluid samples in cases of suspected bacterial meningitis patients attending a 1600 bedded teaching hospital from 2019 to 2022: A retrospective study.

Background: Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. Material and Methods: This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Results: Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0-20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. Conclusion: We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners.

Characteristics of Chryseobacterium bacteremia, associated risk factors and their antibiotic susceptibility pattern at a university hospital: a descriptive, retrospective study.

Introduction: Chryseobacterium species are emerging bacteria capable of causing nosocomial infections in immunocompromised patients or patients with indwelling medical devices. Hypothesis/ Gap statement: Information about the incidence of Chryseobacterium bacteremia from worldwide literature is limited. Aim: We aimed to recognize the clinical characteristics, frequency of distribution of different Chryseobacterium species isolates, and their antimicrobial susceptibility profile from bloodstream infections. Methods: We performed a retrospective cohort study to identify all isolates of Chryseobacterium species from bloodstream infection from January 2018 to November 2022 at a university hospital in North India. Results: We identified 42 non-duplicate isolates of Chryseobacterium species from bloodstream infection in the duration of our study. Mean age of the patients was 48.35±16.63 years. Men (22/42, 52.2 %) were more commonly affected in comparison to women (20/42, 47.6 %) but the difference was not significant. The most common species identified was C. indologenes (40/42, 95.24 %) followed by C. gleum (2/42, 4.76 %). The co-morbidities commonly encountered in our study were chronic kidney disease (21/42, 50.0 %) followed by diabetes mellitus (12/42, 28.6 %) and chronic obstructive pulmonary disease (8/42, 19.05 %). All patients had intravenous access to medications or fluid management via a central or peripheral line and mechanical ventilation was observed in 39 (39/42, 92.86 %) patients. All the isolates were susceptible to minocycline (100 %), followed by doxycycline (97.6 %) and trimethoprim-sulfamethoxazole (95.2 %). Conclusion: Chryseobacterium species are capable of causing pneumonia, bacteremia and urinary tract infection in immunocompromised patients. Early diagnosis and prompt treatment with appropriate antibiotics can prevent progression to septicemia.

One year experience of Achromobacter bacteremia at a tertiary care hospital in Northern India.

Introduction: Achromobacter is a Gram-negative, motile, obligate aerobic and non-fermentative bacterium. It is an emerging pathogen in the hospital environment as it is frequently found in various solutions. Hypothesis/Gap Statement: Information about the incidence and risk factors of Achromobacter bacteremia from India is limited. Aim: We conducted this study to identify the risk factors and underlying conditions predisposing to bacteremia by Achromobacter spp. and analyse the antibiotic resistance pattern of the isolates. Methodology: We performed a retrospective observational study where automated blood cultures positive for Achromobacter spp. were assessed for clinical characteristics and antibiotic susceptibility patterns from January 2022 to December 2022 in the microbiology laboratory of a tertiary care centre in Northern India. Results: A total of 14 cases (14/2435, 0.57 %) of Achromobacter spp. were identified from bloodstream infections in one year. The mean age of the patients was 37.59±23.17 years with a male predominance (8/14, 57.1 %). All patients were managed on intravenous antibiotics and intravenous access as peripheral line catheters and only 5(5/14, 35.7 %) patients were managed on central line catheters. The isolates were found highly susceptible to ticarcillin-clavulanic acid (14/14, 100.0 %) followed by fluoroquinolones (12/14, 85.72 %) and trimethoprim-sulphamethoxazole (12/14, 85.72 %). Only 57.14 % (8/14, 57.14 %) of the patients were susceptible to piperacillin-tazobactam. The all-cause 40 day mortality was observed in 35.7 % (5/14, 35.7 %) with two deaths that were directly attributable to sepsis. Conclusion: This study provides insight into the incidence of Achromobacter bacteremia at our centre and the necessary antibiotic therapy to combat it.

Characteristics of Bacterial Colonization and Urinary Tract Infection after Indwelling of Double-J ureteral Stent and Percutaneous Nephrostomy Tube.

Introduction: Infections associated with catheter in the upper urinary tract (CUUT), which include the double-J stent and the percutaneous nephrostomy (PCN) tube, get particularly infected in patients with specific risk factors for developing an infection. Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2019 to 2021 to evaluate infections in patients with catheter in the upper urinary tract. Result: A total of 200 pus samples of double-J stent (96 pus samples) and PCN tube (104 pus samples) were included in our study. Among patients with nephrostomy tube, the most frequently isolated microorganisms were Escherichia coli, followed by Pseudomonas spp. In those with a double-J stent, Pseudomonas aeruginosa, followed by E. coli were the most commonly isolated microorganisms. We found 55.72% of cases of Enterobacteriaceae-producing carbapenemases in patients with a percutaneous catheter. 66.07% of Enterobacteriaceae in patients with double-J and nephrostomy stents are extended-spectrum beta-lactamase-producing bacteria. The percentage of cultures with multiple-drug resistance (MDR) microorganisms was 38.54% in patients with double-J stents and 37.75% in nephrostomy tubes. The presence of prior urinary tract infection (P = 0.010), presence of urinary catheter before admission (P = 0.005), increased time with single urinary catheter in-situ (P < 0.001), and increased length of hospital stay (P = 0.036) were risk factors for isolation of MDR microorganisms. Conclusion: Pseudomonas spp. and Pseudomonas aeruginosa are commonly infecting both the CUUT. E. coli infections are more commonly infecting the nephrostomy tubes. MDR microorganisms are frequent, mainly in patients with prior urinary tract infection, presence of urinary catheter before admission, and prolonged use of a single catheter.

Comparative Evaluation of Chitosan Chlorhexidine Mouthwash in Plaque Control: A Preliminary Randomized Controlled Clinical Trial.

AIMS: The purpose of the present study was to compare the effect of a new mouth wash formulation consisting of chlorhexidine and chitosan on dental plaque and its reduction to that of chlorhexidine or chitosan alone. MATERIALS AND METHODS: This study was a single-blind randomized clinical trial with a parallel group design of 3 months duration. Patients (20-40 years) who fulfilled the inclusion and exclusion criteria were assigned equally to group 1: chlorhexidine (0.2%), group 2: chitosan (0.5%) or group 3: chlorhexidine - chitosan combination group. The clinical parameters were recorded at baseline, 6weeks and at 3months. All patients received thorough oral prophylaxis and were instructed to rinse with 10ml of mouthwash twice daily for 1 minute. RESULTS: The combination of chitosan and chlorhexidine showed a statistically significant reduction (p less than0.05) in plaque indices from baseline at all time intervals when compared to that of chlorhexidine or chitosan alone. CONCLUSIONS: Our study demonstrates that by unifying the properties of chitosan and chlorhexidine may result in a superior antiplaque effect than that of chlorhexidine alone.

A MYST family histone acetyltransferase, MoSAS3, is required for development and pathogenicity in the rice blast fungus.

Histone acetylation has been established as a principal epigenetic regulatory mechanism in eukaryotes. Sas3, a histone acetyltransferase belonging to the largest family of acetyltransferase, MYST, is the catalytic subunit of a conserved histone acetyltransferase complex. To date, the functions of Sas3 and its orthologues have been extensively studied in yeast, humans and flies in relation to global acetylation and transcriptional regulation. However, its precise impact on development and pathogenicity in fungal plant pathogens has yet to be elucidated. Considering the importance of Sas3 in H3K14 acetylation, here we investigate the roles of its orthologue in the rice blast fungus, Magnaporthe oryzae (Pyricularia oryzae). Unlike a previously reported Sas3 deletion in yeast, which led to no remarkable phenotypic changes, we found that MoSAS3 deletion alone had a profound effect on fungal growth and development, including asexual reproduction, germination and appressorium formation in M. oryzae. Such defects in pre-penetration development resulted in complete loss of pathogenicity in the deletion mutant. Furthermore, genetic analysis of MoSAS3 and MoGCN5 encoding a Gcn5-related N-acetyltransferase family histone acetyltransferase suggested that two conserved components of histone acetylation are integrated differently into epigenetic regulatory mechanisms in the yeast and a filamentous fungus. RNA-seq analysis of ΔMosas3 showed two general trends: many DNA repair and DNA damage response genes are up-regulated, while carbon and nitrogen metabolism genes are down-regulated in ΔMosas3. Our work demonstrates the importance of MYST family histone acetyltransferase as a developmental regulator and illuminates a degree of functional variation in conserved catalytic subunits among different fungal species.

Genomic Insights into Nematicidal Activity of a Bacterial Endophyte, Raoultella ornithinolytica MG against Pine Wilt Nematode.

Pine wilt disease, caused by the nematode Bursaphelenchus xylophilus, is one of the most devastating conifer diseases decimating several species of pine trees on a global scale. Here, we report the draft genome of Raoultella ornithinolytica MG, which is isolated from mountain-cultivated ginseng plant as an bacterial endophyte and shows nematicidal activity against B. xylophilus. Our analysis of R. ornithinolytica MG genome showed that it possesses many genes encoding potential nematicidal factors in addition to some secondary metabolite biosynthetic gene clusters that may contribute to the observed nematicidal activity of the strain. Furthermore, the genome was lacking key components of avermectin gene cluster, suggesting that nematicidal activity of the bacterium is not likely due to the famous anthelmintic agent of wide-spread use, avermectin. This genomic information of R. ornithinolytica will provide basis for identification and engineering of genes and their products toward control of pine wilt disease.

Epigenetic regulation of development and pathogenesis in fungal plant pathogens.

Evidently, epigenetics is at forefront in explaining the mechanisms underlying the success of human pathogens and in the identification of pathogen-induced modifications within host plants. However, there is a lack of studies highlighting the role of epigenetics in the modulation of the growth and pathogenicity of fungal plant pathogens. In this review, we attempt to highlight and discuss the role of epigenetics in the regulation of the growth and pathogenicity of fungal phytopathogens using Magnaporthe oryzae, a devastating fungal plant pathogen, as a model system. With the perspective of wide application in the understanding of the development, pathogenesis and control of other fungal pathogens, we attempt to provide a synthesized view of the epigenetic studies conducted on M. oryzae to date. First, we discuss the mechanisms of epigenetic modifications in M. oryzae and their impact on fungal development and pathogenicity. Second, we highlight the unexplored epigenetic mechanisms and areas of research that should be considered in the near future to construct a holistic view of epigenetic functioning in M. oryzae and other fungal plant pathogens. Importantly, the development of a complete understanding of the modulation of epigenetic regulation in fungal pathogens can help in the identification of target points to combat fungal pathogenesis.