Antibiotic therapy of Acinetobacter baumannii bloodstream infection in COVID-19 patients

Secondary bacterial infection is one of the important risk factors for the development of severe course and death in COVID-19. The rational choice of antibacterial therapy is based on the data of microbiological monitoring of pathogens of healthcare-associated infections. The aim of the study is to determine the main options for antibiotic therapy of Acinetobacter baumannii bloodstream infection in COVID-19 patients. Material and methods. A retrospective, single-centre, uncontrolled study of the incidence of A. baumannii bacteremia in COVID-19 patients treated at the City Clinical Hospital No. 52 in Moscow from October 2020 to September 2021 was performed. For each strain of A. baumannii sensitivity to the main antibacterial agents was determined. Genetic determinants of antibiotic resistance were studied by real-time multiplex polymerase chain reaction. The main therapeutic options for A. baumannii bloodstream infection were analyzed. Results and discussion. Bloodstream infections were diagnosed in 4.7% of hospitalized patients with COVID-19 (758/16 047). Gram-negative bacteria were the causative agents of bloodstream infections in 76% of cases. A. baumannii were isolated from the blood of 143 patients (0.89%). Detection of the pathogen in the blood of COVID-19 patients was associated with severe and extremely severe course of the disease. Most of the strains (93%) were isolated in the intensive care unit. The A. baumannii strains studied were carbapenem-resistant (CRAb) and phenotypically belonged to the XDR class. According to a PCR study, A. baumannii strains were producers of oxacillinases OXA-23, OXA-40, and OXA-51. Conclusion. The circulation of A. baumannii CRAb in intensive care units makes empiric therapy based on carbapenems irrational and ineffective. For the etiotropic therapy of A. baumannii bloodstream infection it is recommended to use combined antibiotic therapy regimens with the inclusion of polymyxin B and sulbactam.Copyright © Eco-Vector, 2022.

Impact of Gut Microbiota on Immunogenicity to Covid-19 Vaccines in Plwh

Background: Immune responses to SARS-CoV-2 vaccines in people living with HIV (PLWH) have been the focus of several recent studies. As the gut microbiome can influence vaccine immunogenicity, in this study we are the first to investigate whether the baseline gut microbiota can predict immune responses to the BNT162b2 SARS-CoV-2 vaccine in people living with HIV (PLWH) and healthy controls (HC). Method(s): Fecal samples were collected from PLWH (n=68) and HC (n=75) at baseline, prior to the first vaccine dose, to extract DNA for 16S rRNA sequencing. The individuals were part of the COVAXID Clinical trial, where humoral and cellular responses to SARS-CoV-2 vaccine were evaluated on day 35 after the first dose. Comprehensive bioinformatic tools were used for bacterial identification to further reveal the associations between gut microbiota and SARS-CoV-2 antibody, spike CD4+ T cell responses, and clinical parameters such as age, gender, CD4/CD8 ratio, and length of antiretroviral (ART) treatment. Result(s): At day 35 post vaccination, HC showed significantly higher spike IgG titers than PLWH (p=0.0001). Interestingly, both phylogenetic and alpha-diversity were negatively correlated with antibody titers, in the whole cohort and within groups. Similarly, individuals with low alpha-diversity had higher levels of spike specific CD4+T-cell responses. Agathobacter, Lactobacillus, Bacteroides, and Lachnospira were positively correlated with both antibody levels and spike-specific CD4+ T-cell responses while Methanobrevibacter, Marvinbryantia, Cloacibacillus, and Succinivibrio have a negative one. Within the PLWH group, the gut microbiota taxa associated with CD4+ counts, such as Lachnospira (p=0.002), Oscillibacter (p=0.019) and Flavonifractor (p=0.017), were found to be positively correlated with spike IgG levels. Additionally, the length of ART treatment and CD4/CD8 ratio displayed a positive association with bacterial diversity. Notably, different microbiome profiles and immune status in PLWH, affect their immune responses to vaccination. Conclusion(s): Our results show potential associations between gut microbiota diversity and spike IgG responses after COVID-19 vaccination. These findings were consistent in the whole cohort, albeit group differences between the microbiome compositions in PLWH and HC were observed. Based on our findings, we propose that microbiome modulation could optimize immunogenicity to SARS-Cov-2 vaccines.

Treatment of post-COVID-19 patients with chronic recurrent prostatitis: efficacy of recombinant interferon alpha-2b medications.

Introduction. The tactics of managing and treating patients with chronic recurrent bacterial prostatitis (CRBP) in some cases is a difficult-to-treat condition for a practicing urologist. This circumstance occurs because the disease has several predisposing factors, a complex and multifaceted pathogenesis, and certain difficulties in diagnosis and treatment. Objective. To study the effectiveness of recombinant interferon alpha-2b medications in post-COVID-19 patients with chronic recurrent prostatitis against the background of antibiotic multi-drug resistance of microorganisms verified in prostate secretion. Materials and methods. The treatment of 52 post-COVID-19 patients with CRBP was analyzed, divided into three therapy-dependent groups. Group 1 patients (n = 18) received antibiotic therapy (ABT): Levofloxacin 500 mg q.d. PO for 28 days. Group 2 patients (n = 18) underwent combined therapy: ABT supplemented with recombinant interferon alpha-2b with an antioxidant complex of vitamins E and C ("Viferon" rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. Group 3 patients (n = 16) received monotherapy with recombinant interferon alpha-2b with an antioxidant complex of vitamins E and C ("Viferon"rectal suppositories) 3.000.000 IU b.i.d. PR q12h for 28 days. The follow-up period was 6 months with monitoring of clinical and laboratory parameters assessed before treatment, after 1, 3 and 6 months from the start of therapy. Results. Based on the monitoring of the clinical picture and laboratory parameters, after 1 follow-up month, there was a significant decrease in the symptoms of the disease in all study groups. However, after 3 and 6 follow-up months, this trend was observed only in patients of groups 2 and 3 receiving recombinant interferon alfa-2b with an antioxidant complex (vitamins E and C). Conclusions. Strengthening the standard CRBP-therapy with recombinant interferon alpha-2b with an antioxidant complex of vitamins E and C makes it possible to normalize both clinical and laboratory parameters in most patients.Copyright © Rostovskii Gosudarstvennyi Meditsinskii Universitet. All rights reserved.

Secondary Bacterial Blood Stream Infections in Patients Hospitalized with COVID-19

Background. Nosocomial Bloodstream infection (nBSI) in COVID 19 patients is an emerging clinical concern for physicians. In this study, we aimed to assess the prevalence of BSI in COVID-19 patients admitted to our hospital, The Indus Hospital, Karachi, Pakistan. Methods. This retrospective study included the RT-PCR confirmed COVID-19 patients admitted to our hospital from March 2020 to December 2021. Demographics, the incidence of BSI, frequency of pathogens from the positive blood cultures, antibiotics resistance pattern, and frequency of Multidrug-Resistant Organisms (MDROs) were obtained from the hospital's electronic medical record. Blood cultures were performed using BD BACTEC. Bacterial identification was done by using Analytical Profile Index(API) whereas antimicrobial susceptibility testing of isolates was performed by the Kirby-Baur disk diffusion method and VITEK 2 COMPACT. Results. Our data showed that 25% of the patients admitted to our hospital developed BSI. The incidence of BSI was higher in males than in females (62.6% vs 37.4%) and most of the patients were in the age group of 46-60 years (n=93). Gram-negative pathogens were pre-dominantly identified, (50.67%), followed by yeast (12.9%), and Gram-positive pathogens (11.8%). Among these isolates, Acinetobacter sp. was the most commonly identified pathogen. Figure 1 shows the incidence of BSI and Figure 2 shows the distribution of all the pathogens identified from the positive blood cultures. Antibiotics resistance pattern showed a higher prevalence of MDROs. Among the MDROs, Acinetobacter sp. was highest in number (97.6%), followed by 66.6% of Pseudomonas, 63% of E.coli, 62% of S. aureus, 61.5% of Enterococcus, and 50% of Klebsiella sp. Conclusion. Our findings indicated the incidence of BSI in 25% of COVID-19 inpatients. There is a significant prevalence of MDROs among which compelling prevalence of Acinetobacter sp. was observed. The COVID-19 pandemic overburdened the already vulnerable health care systems and made it difficult to adhere to infection control practices leading to the emergence of MDROs. Moreover, timely initiation of empirical antibiotics could also reduce the incidence of BSI in patients. Lastly, further multicentered studies are needed for the evaluation of the incidence of BSI in our region.

Association of Vitamin D with Coronavirus Disease 2019 (Covid-19): A Review

Nutrition is essential for the function of the immune system and this relationship is currently being studied. In particular, vitamin D is a crucial immunonutrient that can also be obtained through the diet. Although the primary function of vitamin D appears to be calcium homeostasis, this vitamin also serves for immunomodulatory functions. The link between vitamin D deficiency and susceptibility to infections originated more than a century ago when vitamin D was used for the treatment of tuberculosis. The importance of vitamin D in cases of respiratory infection is supported by the fact that low levels of vitamin D are common in populations and low levels have been associated with a significantly increased risk of pneumonia. Vitamin D supplementation can improve innate immunity as well as adaptive immunity. The rapid global spread of COVID-19 has renewed interest in the possible role of vitamin D in modulating the immune response to respiratory infections. Copyright © 2021, SILAE (Italo-Latin American Society of Ethnomedicine). All rights reserved.

ANTIBIOTIC RESISTANCE PATTERNS IN INFECTIONS ASSOCIATED WITH HEALTH CARE IN A THIRD LEVEL CENTER WITH HOSPITAL RECONVERSION IN THE COVID-19 PANDEMIC

Objetive: Description of the different isolated microorganisms and their prevalence in infections associated with health care, in addition to determining their patterns of resistance to antibiotics in patients admitted with a confirmed or suspected diagnosis of COVID-19 in the Intensive Care Unit, during a third-level medical center with hospital reconversion. Method: Patient demographic data was obtained from the clinical record, with defined criteria. Antibiotic resistance patterns were evaluated as well as the identification of isolated bacteria in cultures of expectoration, pleural fluid, catheter tips. For bacterial identification and resistance mechanisms, automated equipment and phenotypic tests were used, following the CLSI (Clinical & Laboratory Standards Institute) criteria. Results: A total of 100 patients with bacterial infection added to the main COVID-19 picture were obtained, representing pneumonia, urinary tract infection, catheter infections and bacteremia. A total of 100 strains were isolated, of which 84 are Extremely Drug Resistant, 12 Multidrug Resistant and only 4 variable sensitivity. The bacteria with the highest prevalence is Staphylococcus aureus with, followed by Pseudonomas aeruginosa and Stenotrophomonas maltophilia. 100% of the patients admitted to the ICU (Intensive Care Unit) had death. Conclusion: The increase in resistance to antibiotics in the COVID-19 pandemic has set off alarms due to the complication that this brings, and the improper use of drugs as prophylaxis or attempted treatment only generates selective pressure that leads to an increase in resistance as observed in the isolated strains in this study, where the vast majority present enzymes as well as other resistance mechanisms that confer them to be XDR (Extremely Drug Resistant).

BLOODSTREAM INFECTIONS IN COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Many COVID-19 studies are about epidemiological and clinical features but information about secondary bacterial infections is limited. The present study was conducted to determine the prevalence and characteristics of bloodstream infections in COVID-19 patients admitted to a tertiary care academic health care organization. All blood samples were obtained from patients with COVID-19 admitted were included in the study. Blood cultures were performed using BD BACTEC ™ FX40, and the diagnosis and bacterial identification and antimicrobial sensitivity was performed by manual method. 2200 patients with COVID-19 were hospitalized during a 6-month study period in which 315 blood cultures were performed. Of these, 24 (7.61%) were positive. The median age of patients with positive blood culture was 38 years and included 13 males and 11 females. Seventeen patients (70.83%) needed intensive care in the ICU. Significant correlations with blood culture positivity have been noted with parameters such as admission to the ICU, availability of accommodation, basic illness and adverse clinical outcomes. Bloodstream infections prevalence in COVID-19 patients is low. However, antibiotic prophylaxis needs to be used with caution, and immediate discontinuation should be made based on clinical judgment.

Evaluation of bacterial co-infections in COVID-19 patients admitted in ICU

Background:COVID-19 is a new viral infection. Viral- bacterial co-infections are one of the biggest medical concerns, resulting in in- creased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients admitted to ICUs. Methods:A total 43 patients admitted to our ICUs were enrolled in this study. To detect COVID-19, real - time polymerase chain reac- tion was performed. Pleural fluid, blood & sputum samples were collected from symptomatic patients and then all the samples were processed and bacterial identification was done using standard microbiological techniques. Antimicrobial susceptibility testing was carried out based on the CLSI recommendations. Results:Of 43 COVID -19 patients, 26 (60.46%) patients were male & 17 (39.53%) patients were female, with a mean age of 65 years. The average ICU length of stay was approximately 20 days. Among all admitted patients, 31 patients were found positive for bacterial infections & 12 patients were negative. Most common isolates were Staphylococcus aureus (11) & Pseudomonas aeruginosa (8). Oth- ers were Acinetobacter baumanii (6), Klebsiella pneumoniae (3), Enterococcus species (2) & coagulase negative staphylococcus spe- cies. All of the staphylococcus aureus isolates were detected as methicillin- resistant staphylococcus aureus & out of which 1 was detected as vancomycin resistant staphylococcus aureus. All of the staphyloccus isolates were sensitive to linezolid & also they were sensitive to vancomycin except one isolate. All isolates of Pseudo- monas aeruginosa, Klebsiella pneumonia & Acinetobacter baumanii were 100% sensitive to Colistin & have shown different percentage of sensitivity to other antibiotics. All isolates of enterococcus & coagulase negative staphylococcus species were sensitive to gen- tamicin, linezolid & vancomycin. [Formula presented] Conclusions: Our findings emphasize the concern of superinfection in COVID-19 patients due to Staphylococcus aureus & Pseudomonas aeruginosa. Consequently it is important to pay attention to bacteri- al co-infections in critical patients positive for COVID-19.