Colistin sulfate for decontamination of preservation fluid in kidney transplantation to decrease the incidence of donor-derived infections caused by multidrug-resistant Gram-negative bacteria.

BACKGROUND: Preservation fluid (PF) contamination, especially by multidrug-resistant (MDR) Gram-negative bacteria (GNB), poses a high risk of donor-derived infection (DDI) and severe clinical outcomes. We sought to determine whether the use of colistin sulfate to decontaminate PF in kidney transplantation can decrease the incidence of probable DDI (p-DDI) caused by MDR GNB. METHODS: In a retrospective study of 916 recipients who received deceased donation, 864 PF samples were collected and cultured, and microbiological contaminants were recorded with the recipients' clinical data and outcomes. From March 2016 to May 2019, 624 samples were decontaminated with ceftizoxime, and from June 2019 to March 2021, 240 samples were decontaminated with colistin sulfate. Between-group comparisons were performed to assess the ability of the two decontamination regimens to decrease the incidence of p-DDI, especially MDR GNB-related infection. RESULTS: The overall PF contamination rate was 54.51% (471/864), and 80 samples were positive for MDR GNB contamination. All p-DDIs occurred in the ceftizoxime group (p < 0.001), and 67.65% of p-DDIs were MDR GNB-related. In the ceftizoxime group, 23 of 61 cases of MDR GNB contamination led to related p-DDIs, while none occurred in the colistin sulfate group (p = 0.002). Among the 23 patients with p-DDIs, 5 died due to severe infection, and 2 experienced graft loss. CONCLUSIONS: The goal of decontamination should be to decrease the risk of MDR GNB-related p-DDI, and colistin sulfate could be an effective and feasible option.

The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: A cross-sectional study.

This study aimed to investigate the mental health status of nurses from low-risk areas of novel coronavirus (COVID-19) pandemic, its potential impact factors, and the main stressors under the normalized prevention and control in China. A mobile phone app-based survey was conducted among registered nurses in Jiangsu province via a region-stratified sampling method. The questionnaire consisted of items on the demographic characteristics of the nursing staff and their Depression, Anxiety, Stress Scale-21 (DASS-21) along with questions for self-assessment of stressors that are associated with COVID-19. STROBE guideline was used. Among 1803 nurses who were working in the low-risk areas in Jiangsu, 22.0%, 29.8%, and 16.1% of them reported moderate to extreme levels of depression, anxiety, and stress, respectively. Having 11-15 years of working experience and being a fixed-term contract nurse were associated with experiencing worse mental health outcomes while supporting-Wuhan working experience and having mental health preparation course training were independent factors that had beneficial impact on their psychological well-being afterward. In terms of source of pressure, a key finding of this study is that the main stressor among these nurses was the lack of patient's understanding and cooperation (71.2%) which calls for better psychosocial communication between nurses and patients. The present findings would provide information for other regions at low risk of COVID-19 and may aid the provision of support and interventions for the benefit of the psychological well-being of nurses who are exposed to life-threatening occupational risks and are more vulnerable to the pandemic than others.