GERMS

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Open AccessCommunication

Barriers to Disinfection of Mobile Touch Screen Devices Amongst a Multidisciplinary Team in Intensive Care Units at a Tertiary Hospital

by Christoffel J. Opperman, Farheen Khan, Jenna L. Piercy and Nazlee Samodien

GERMS 2021, 11(2), 329-336; https://doi.org/10.18683/germs.2021.1270 - 2 Jun 2021

Cited by 3

Abstract

Mobile touch screen devices (MTSDs), including smartphones and tablets, are commonly used in Intensive Care Units (ICUs) [...] Full article

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Open AccessCommunication

SARS-CoV-2 Infection Among Primary Healthcare Workers: A Cross-Sectional Study

by Hamda Abdulla A/Qotba, Ehab Hamed, Ahmed Sameer Alnuaimi, Azza Awad Saad, Gheyath K. Nasrallah, Abdulla Abdulrahman Alnaama and Mohamed Ahmed Syed

GERMS 2021, 11(2), 324-328; https://doi.org/10.18683/germs.2021.1269 - 2 Jun 2021

Abstract

Healthcare workers (HCWs) are critical to the healthcare system and are at an increased risk of SARS-CoV-2 infection [...] Full article

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Open AccessCase Report

Immune Thrombocytopenic Purpura Secondary to COVID-19—Case Report

by Andra Elena Petcu, Irina Magdalena Dumitru, Roxana Carmen Cernat, Carmen Ilie Șerban, Aurelia Hangan, Elena Ghiță, Nicoleta Dorina Vlad, Mirela Dumitrașcu, Adriana Teodora Câmpeanu and Sorin Rugină

GERMS 2021, 11(2), 319-323; https://doi.org/10.18683/germs.2021.1268 - 2 Jun 2021

Cited by 1

Abstract

Introduction: Thrombocytopenia is common in SARS-COV-2 infection, and about a quarter of cases have moderate thrombocytopenia. Severe thrombocytopenia is less common and is associated with severe forms of COVID-19. The pathogenesis of this thrombocytopenia appears to be complex, the immune mechanism being incriminated. [...] Read more.

Introduction: Thrombocytopenia is common in SARS-COV-2 infection, and about a quarter of cases have moderate thrombocytopenia. Severe thrombocytopenia is less common and is associated with severe forms of COVID-19. The pathogenesis of this thrombocytopenia appears to be complex, the immune mechanism being incriminated. Immune thrombocytopenic purpura (ITP) is one of the severe complications of COVID-19 and has an increased risk of mucosal or cutaneous bleeding. Case report: We present the case of a 72-year-old woman admitted to the hospital with moderate COVID-19 who developed severe thrombocytopenia 13 days after the onset of COVID symptoms. Nine days after admission, her platelets decreased from 149 × 10⁹/L to 3 × 10⁹/L and numerous patches appeared on the skin and mucous membranes. She was responsive to corticosteroids and platelet transfusion, after five days, the platelet level returned to normal. Conclusions: Close hematological monitoring of patients with COVID is necessary to prevent severe complications. Even if this patient did not receive immunoglobulins, corticosteroid therapy and platelet administration led to a favorable outcome. Full article

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Open AccessCase Report

Lemierre’s Syndrome by Bacillus circulans, Fusobacterium nucleatum and Staphylococcus aureus with Involvement of the Internal and External Jugular Vein

by Diego Fernando Severiche-Bueno, Diego Alejandro Insignares-Niño, David Felipe Severiche-Bueno, María Teresa Vargas-Cuervo and Fabio Andrés Varón-Vega

GERMS 2021, 11(2), 314-318; https://doi.org/10.18683/germs.2021.1267 - 2 Jun 2021

Cited by 4

Abstract

Introduction: Lemierre’s syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is [...] Read more.

Introduction: Lemierre’s syndrome refers to the septic thrombophlebitis of the internal jugular vein, secondary to a pharyngeal infection. Although it mainly affects the internal jugular vein, isolated cases have been described of involvement of the external jugular vein. The main etiological agent is Fusobacterium necrophorum. Case report: A 27-year-old male, previously healthy, presented with a 7-day history of sore throat and fever. He was diagnosed with Lemierre’s syndrome, coinfection by Bacillus circulans, F. nucleatum and Staphylococcus aureus with an atypical presentation due to the involvement of the external jugular vein and the internal jugular vein. Conclusions: As far as we are aware, we present the first case of Lemierre’s syndrome with these characteristics. Full article

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Open AccessCase Report

Hepatic Tuberculosis: Myriad of Hues

by Arup Choudhury, Jayendra Shukla, Gaurav Mahajan, Day Krishna Jha, Pankaj Gupta and Vishal Sharma

GERMS 2021, 11(2), 310-313; https://doi.org/10.18683/germs.2021.1266 - 2 Jun 2021

Cited by 4

Abstract

Introduction: Gastrointestinal tuberculosis is an important form of extrapulmonary tuberculosis but liver involvement is uncommon. Hepatic tuberculosis can manifest in variable manners including as a space occupying lesion, diffuse infiltration by granulomas (granulomatous hepatitis) and as liver abscess. Hepatic tuberculosis is usually associated [...] Read more.

Introduction: Gastrointestinal tuberculosis is an important form of extrapulmonary tuberculosis but liver involvement is uncommon. Hepatic tuberculosis can manifest in variable manners including as a space occupying lesion, diffuse infiltration by granulomas (granulomatous hepatitis) and as liver abscess. Hepatic tuberculosis is usually associated with lesions elsewhere but the diagnosis is often not considered because of rarity. Case report: We report two cases of hepatic involvement by tuberculosis: one in the form of liver abscess and the other having multiple hypodense hepatic lesions along with peritoneal involvement. The presence of ascites, visceral scalloping and multiple hypodense lesions resulted in a diagnostic confusion with disseminated malignancy but GeneXpert Ultra (Cepheid, USA) helped in making the diagnosis. Discussion: Hepatic tuberculosis should be considered in the differential diagnosis of hepatic space occupying lesions and abscesses. This is especially important in TB endemic regions and in patients where there is involvement of other organs especially the lungs. Conclusions: Newer microbiological modalities including GeneXpert Ultra could help in making a diagnosis of hepatic tuberculosis. Full article

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Open AccessCase Report

Hafnia alvei Pneumonia: From Bees to Human Beings

by Diego Fernando Severiche-Bueno, María Teresa Vargas-Cuervo, Luis Medina-Lee, Gabriel Oliver-Hernandez, Kenny Buitrago-Toro, Diego A Insignares and Rafael Conde-Camacho

GERMS 2021, 11(2), 306-309; https://doi.org/10.18683/germs.2021.1265 - 2 Jun 2021

Abstract

Introduction: Hafnia alvei is an enterobacteria that is a common inhabitant of the gastrointestinal flora of bees, birds, fish, and mammals. In humans this enterobacteria has been recovered from the oropharynx and the gastrointestinal tract but it has been rarely reported as a [...] Read more.

Introduction: Hafnia alvei is an enterobacteria that is a common inhabitant of the gastrointestinal flora of bees, birds, fish, and mammals. In humans this enterobacteria has been recovered from the oropharynx and the gastrointestinal tract but it has been rarely reported as a pathogen and usually identified as hospital-acquired enterobacteria. Case report: We describe a case of a 57-year-old woman, previously healthy, with a 7-day history of cough with brown sputum, sudden onset of chills, subjective fever, malaise, and pleuritic pain in the right hemithorax. A diagnosis of community-acquired pneumonia (CAP) was suspected and empiric antibiotic treatment was started. However, the patient showed no response and developed hemoptysis. A diagnosis of CAP by Hafnia alvei was confirmed with bronchoalveolar lavage and the patient was treated with i.v. cefepime 2 g TID with a good response. Conclusions: We presented a case of community-acquired pneumonia by Hafnia alvei in a previously healthy patient that, as far as our knowledge reaches, is the third reported case of CAP secondary to this pathogen. Full article

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Open AccessReview

Perspectives on Passive Antibody Therapy and Peptide-Based Vaccines Against Emerging Pathogens Like SARS-CoV-2

by Marco Palma

GERMS 2021, 11(2), 287-305; https://doi.org/10.18683/germs.2021.1264 - 2 Jun 2021

Cited by 3

Abstract

The current epidemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is raising awareness of the need to act faster when dealing with new pathogens. Exposure to an emerging pathogen generates an antibody response that can be used for preventing and treating [...] Read more.

The current epidemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is raising awareness of the need to act faster when dealing with new pathogens. Exposure to an emerging pathogen generates an antibody response that can be used for preventing and treating the infection. These antibodies might have a high specificity to a target, few side effects, and are useful in the absence of an effective vaccine for treating immunocompromised individuals. The approved antibodies against the receptor-binding domain (RBD) of the viral spike protein of SARS-CoV-2 (e.g., regdanvimab, bamlanivimab, etesevimab, and casirivimab/imdevimab) have been selected from the antibody repertoire of B cells from convalescent patients using flow cytometry, next-generation sequencing, and phage display. This encourages use of these techniques especially phage display, because it does not require expensive types of equipment and can be performed on the lab bench, thereby making it suitable for labs with limited resources. Also, the antibodies in blood samples from convalescent patients can be used to screen pre-made peptide libraries to identify epitopes for vaccine development. Different types of vaccines against SARS-CoV-2 have been developed, including inactivated virus vaccines, mRNA-based vaccines, non-replicating vector vaccines, and protein subunits. mRNA vaccines have numerous advantages over existing vaccines, such as efficacy, ease of manufacture, safety, and cost-effectiveness. Additionally, epitope vaccination may constitute an attractive strategy to induce high levels of antibodies against a pathogen and phages might be used as immunogenic carriers of such peptides. This is a point worth considering further, as phage-based vaccines have been shown to be safe in clinical trials and phages are easy to produce and tolerate high temperatures. In conclusion, identification of the antibody repertoire of recovering patients, and the epitopes they recognize, should be an attractive alternative option for developing therapeutic and prophylactic antibodies and vaccines against emerging pathogens. Full article

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Open AccessReview

Periodontal Disease in Seropositive Rheumatoid Arthritis: Scoping Review of the Epidemiological Evidence

by Nik-Madihah Nik-Azis, Nurulhuda Mohd, Badiah Baharin, Mohd Shahrir Mohamed Said, Fazalina Mohd Fadzilah and Nor Hazla Mohamed Haflah

GERMS 2021, 11(2), 266-286; https://doi.org/10.18683/germs.2021.1263 - 2 Jun 2021

Cited by 8

Abstract

The link between periodontal disease (PD) and rheumatoid arthritis (RA) has been hypothesized to lie in the anti-cyclic citrullinated protein antibody (ACPA) molecules present in seropositive RA. This review aimed to discuss how RA and specifically ACPA-positive RA link to PD, and appraise [...] Read more.

The link between periodontal disease (PD) and rheumatoid arthritis (RA) has been hypothesized to lie in the anti-cyclic citrullinated protein antibody (ACPA) molecules present in seropositive RA. This review aimed to discuss how RA and specifically ACPA-positive RA link to PD, and appraise the epidemiological evidence on the relationship between ACPA-positive RA and PD. Articles were searched following the PRISMA guideline across the MEDLINE, Web of Science, Scopus and Cochrane Library databases. A total of 21 articles met the inclusion criteria of reporting the epidemiological data on the different ACPA status of the subjects with RA and PD (or periodontitis) parameters. A discrepancy is noted in the epidemiological evidence on the difference in the prevalence and severity of PD between ACPA-positive and ACPA-negative RA patients. Although the link between RA and PD is mostly discussed in terms of ACPA, reports on the different manifestations of PD between the two RA subsets remains inconclusive. Full article

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Open AccessArticle

COVID-19 Deaths and Associated Demographic Factors in Central Java, Indonesia

by Dwi Sutiningsih, Nur Azizah Azzahra, Yulianto Prabowo, Aris Sugiharto, Mufti Agung Wibowo, Endah Sri Lestari and Estri Aurorina

GERMS 2021, 11(2), 255-265; https://doi.org/10.18683/germs.2021.1262 (registering DOI) - 2 Jun 2021

Abstract

Introduction: To date, the total number of COVID-19 deaths is still increasing, including in Central Java, with the third-highest total number of deaths in Indonesia. There are still limited studies related to the cases of COVID-19. Thus, this study’s objective was to provide [...] Read more.

Introduction: To date, the total number of COVID-19 deaths is still increasing, including in Central Java, with the third-highest total number of deaths in Indonesia. There are still limited studies related to the cases of COVID-19. Thus, this study’s objective was to provide an overview of the characteristics of 4359 COVID-19 death cases in Central Java. Methods: This research used a cross-sectional descriptive design with univariate, bivariate, and multivariate analysis involving secondary data acquired from a report by the Provincial Health Office of Central Java, recorded up to 13 December 2020. Results: The results showed that the highest frequencies of death cases were contributed from ≥60 years group (n = 1897 patients; 43.52%) and the male (n = 2497 patients; 57.28%) group. The case fatality rate (CFR) rose with age, and the highest CFR was recorded in the elderly (17.95%), males (7.60%), in Pati District (17.45%), while entrepreneur (14.64%) was the highest reported job. Furthermore, the eldest group (≥60 years) and males were more susceptible to die, with ORs 5.49 (95%CI: 5.15–5.86) and 1.61 (95%CI: 1.51–1.71), sequentially. The majority of death cases had comorbidities (65.79%), while the most prevalent reported comorbidities were diabetes (n=1387, 31.82%) and hypertension (n = 817, 18.74%). Meanwhile, patients of old age were more likely to associate comorbidity, p < 0.001, OR 1.664 (95%CI: 1.425–1.944). Conclusions: This study concludes that patients of older age and males may become more vulnerable than younger and females to experience death. Further study is required to measure the relationship between other characteristics of demographics, underlying medical conditions, and fatality. Full article

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Open AccessArticle

Comparative Performance of Commercial Amies Transport Media With and Without Charcoal for Neisseria gonorrhoeae Culture for Gonococcal Isolation and Antimicrobial Resistance Monitoring in Ukraine

by Iryna Boiko and Inna Krynytska

GERMS 2021, 11(2), 246-254; https://doi.org/10.18683/germs.2021.1261 - 2 Jun 2021

Cited by 1 | Viewed by 2

Abstract

Introduction: Culture is the only laboratory method that provides live gonococcal isolates for monitoring antimicrobial resistance. Many clinical settings do not have direct access to laboratories for the immediate processing of biological samples. Validated and quality-assured transport media are recommended to maintain the [...] Read more.

Introduction: Culture is the only laboratory method that provides live gonococcal isolates for monitoring antimicrobial resistance. Many clinical settings do not have direct access to laboratories for the immediate processing of biological samples. Validated and quality-assured transport media are recommended to maintain the viability of Neisseria gonorrhoeae. Methods: In total, 103 clinical samples were divided into two groups: 51 samples were stored in Amies agar gel medium containing charcoal and 52 samples were stored in agar gel medium without charcoal. All samples were stored at 4°C for 0.5-6 h and then transported in a thermo-protected box within 0.17-0.25 h to the laboratory of Ternopil Regional STI Clinic (Ukraine). Results: The recovery rate was significantly higher for charcoal-containing Amies medium than for charcoal-free Amies medium (86.27%, 44/51 vs. 59.62%, 31/52). A higher rate of specimens transported in charcoal-containing Amies medium was isolated within 24 h (84.31%, 43/51), whereas most isolates from charcoal-free Amies medium grew within 24 h (42.31%, 22/52) or 48 h (17.31%, 9/52). Growth beyond the first quadrant of the agar plate was registered for 59.09% (26/44) of charcoal-containing Amies samples, compared with only 19.35% (6/31) of charcoal-free Amies samples. Conclusions: A high rate of N. gonorrhoeae recovery after transport has considerable public health implications for establishing national antimicrobial susceptibility programs. Charcoal-containing Amies medium had higher viability rate, and it could be used for diagnostic and isolation purposes in future antimicrobial susceptibility studies. Continuous validation studies of transport medium for N. gonorrhoeae culture are needed. Full article

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Open AccessArticle

Antibiotic Resistance Pattern of Pseudomonas spp. from Patients in a Tertiary Hospital in South-West Nigeria

by Adesola Adejobi, Olabisi Ojo, Olubunmi Alaka, Babatunde Odetoyin and Anthony Onipede

GERMS 2021, 11(2), 238-245; https://doi.org/10.18683/germs.2021.1260 - 2 Jun 2021

Cited by 12 | Viewed by 1

Abstract

Introduction: Pseudomonads constitute critical agents of opportunistic infections in hospital settings particularly in immunocompromised patients and Pseudomonas aeruginosa is a major flagship member of these infectious agents. This study assessed the distribution of Pseudomonas spp. associated with infections in patients and their antibiotic [...] Read more.

Introduction: Pseudomonads constitute critical agents of opportunistic infections in hospital settings particularly in immunocompromised patients and Pseudomonas aeruginosa is a major flagship member of these infectious agents. This study assessed the distribution of Pseudomonas spp. associated with infections in patients and their antibiotic resistance patterns as part of an antibiotic stewardship intervention program and resistance surveillance. Methods: One hundred and fifty Pseudomonas spp. from different clinical specimens were obtained from the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife. Culture was carried out on MacConkey and blood agar while phenotypic characterization was done by Gram staining, oxidase, and catalase test. Species identification was done using MICROBACT^TM 24E bacterial identification kit and confirmed by 16S rDNA polymerase chain reaction (PCR) assay. Antibiotic susceptibility testing to eight antibiotics in four classes was done. Results: Pseudomonas aeruginosa was the most frequently occurring species (96.0%); P. putida (2.67%) and P. fluorescens (0.67%) were also identified as well as an isolate of Burkholderia pseudomallei (0.67%). The highest resistance rate among isolates was observed towards gentamicin (35.4%); piperacillin/tazobactam was the most active antibiotic. Multidrug-resistant (MDR) strains constituted 12.8% of the isolates and most MDR strains also displayed a high multiple antibiotic resistance index (MAR). Conclusions: Pseudomonas aeruginosa is emerging as a highly MDR pathogen in our hospital setting. This calls for the establishment of a surveillance system and antimicrobial stewardship programme in place. Furthermore, we propose a review of the current antibiotics prescription policy, and infection control programmes (ICPs) if we must control the spread of MDR-P. aeruginosa in this environment. Full article

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Open AccessArticle

Clinical Diagnosis of COVID-19. A Multivariate Logistic Regression Analysis of Symptoms of COVID-19 at Presentation

by Pedro E. Fleitas, Jorge A. Paz, Mario I. Simoy, Carlos Vargas, Rubén O. Cimino, Alejandro J. Krolewiecki and Juan P. Aparicio

GERMS 2021, 11(2), 221-237; https://doi.org/10.18683/germs.2021.1259 - 2 Jun 2021

Cited by 3 | Viewed by 1

Abstract

Introduction: The objective of this cross-sectional study was to describe the main symptoms associated with COVID-19, and their diagnostic characteristics, to aid in the clinical diagnosis. Methods: An analysis of all patients diagnosed by RT-PCR for SARS-CoV-2 between April and May 2020 in [...] Read more.

Introduction: The objective of this cross-sectional study was to describe the main symptoms associated with COVID-19, and their diagnostic characteristics, to aid in the clinical diagnosis. Methods: An analysis of all patients diagnosed by RT-PCR for SARS-CoV-2 between April and May 2020 in Argentina was conducted. The data includes clinical and demographic information from all subjects at the time of presentation (n=67318, where 12% were positive for SARS-CoV-2). The study population was divided into four age groups: pediatric (0-17 years), young adults (18-44 years), adults (45-64 years), and elderly (65-103 years). Multivariate logistic regression was used to measure the association of all symptoms and to create a diagnostic model based on symptoms. Results: Symptoms associated with COVID-19 were anosmia, dysgeusia, headache, low-grade fever, odynophagia, and malaise. However, the presentation of these symptoms was different between the different age groups. In turn, at the time of presentation, the symptoms associated with respiratory problems (chest pain, abdominal pain, and dyspnea) had a negative association with COVID-19 or did not present statistical relevance. On the other hand, the model based on 16 symptoms, age and sex, presented a sensitivity of 80% and a specificity of 46%. Conclusions: There were significant differences between the different age groups. Additionally, there were interactions between different symptoms that were highly associated with COVID-19. Finally, our findings showed that a regression model based on multiple factors (age, sex, interaction between symptoms) can be used as an accessory diagnostic method or a rapid screening of suspected COVID-19 cases. Full article

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Open AccessArticle

Antibiotic Resistance Profile and Detection of Degradative Enzymes by Enterobacteriaceae Isolated from Raw Goat Milk

by Gustavo Luis de Paiva Anciens Ramos and Janaína dos Santos Nascimento

GERMS 2021, 11(2), 211-220; https://doi.org/10.18683/germs.2021.1258 - 2 Jun 2021

Cited by 9 | Viewed by 1

Abstract

Introduction: Enterobacteriaceae are often reported as a typical bacterial population in raw milk from any mammalian origin. The frequent concern with bacteria, especially those related to this group of microorganisms, is their increasing resistance to antibiotics and the emergence of enzymes that degrade [...] Read more.

Introduction: Enterobacteriaceae are often reported as a typical bacterial population in raw milk from any mammalian origin. The frequent concern with bacteria, especially those related to this group of microorganisms, is their increasing resistance to antibiotics and the emergence of enzymes that degrade them. This study aimed to characterize isolates of Enterobacteriaceae from raw goat milk to expose associated safety problems and possible technological challenges. Methods: Isolates from 21 raw goat milk samples purchased in the State of Rio de Janeiro, Brazil, were identified by mass spectrometry, after isolation on Violet Red Bile Glucose agar. The isolates were subjected to evaluation of proteolytic, lipolytic, hemolytic, and biofilm producing activities. Furthermore, resistance profiles and production capacity of enzymes that degrade antimicrobials were evaluated. Results: Almost half of the 59 isolates (48%) belonged to the Enterobacter genus, with a significant prevalence of the Serratia (20%) and Klebsiella (11%) genera. The majority showed biofilm-producing activity (90%), while the activity of degradative enzymes was observed in approximately 20%. Few isolates were found with a profile of resistance to antimicrobials, with only one isolate of Klebsiella variicola being classified as multidrug-resistant. However, chromogenic culture media showed high production of extended-spectrum beta-lactamases and carbapenemases (54% and 46%, respectively), as a presumptive identification. Conclusions: A considerable degree of virulence was observed in the Enterobacteriaceae isolates, as well as the potential for undesirable technological damage. The characterization and identification of the isolates contributes to the improvement of the risk monitoring process of goat’s milk. Full article

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Open AccessArticle

An Outbreak of Ertapenem-Resistant, Carbapenemase-Negative and Porin-Deficient ESBL-Producing Klebsiella pneumoniae Complex

by Mihaela Matovina, Maja Abram, Davorka Repac-Antić, Samira Knežević and Marina Bubonja-Šonje

GERMS 2021, 11(2), 199-210; https://doi.org/10.18683/germs.2021.1257 - 2 Jun 2021

Cited by 9 | Viewed by 1

Abstract

Introduction: Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen with dynamic molecular epidemiology. This study presents a retrospective analysis of the distribution and antibiotic resistance patterns of ertapenem-resistant ESBL-producing K. pneumoniae strains recovered during an outbreak from 2012 to 2014 in a Croatian [...] Read more.

Introduction: Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen with dynamic molecular epidemiology. This study presents a retrospective analysis of the distribution and antibiotic resistance patterns of ertapenem-resistant ESBL-producing K. pneumoniae strains recovered during an outbreak from 2012 to 2014 in a Croatian University hospital. Methods: We aimed to estimate genetic relatedness of clinical isolates and underlying mechanisms that conferred the ertapenem-resistant phenotype. Results: Expression analysis of genes involved in the antibiotic resistance showed reduced expression of major non-selective porin channel OmpK35. Reduced expression of OmpK36 porin channel in isolates resistant to at least one more carbapenem, apart from the ertapenem, was found to a lesser degree. Pulsed-field gel electrophoresis analysis of genomic DNA revealed that almost all isolates belonged to the same genetic clone. Conclusions: Caution regarding ertapenem-resistant, carbapenemase-negative porin-deficient mutants of K. pneumoniae is required as they are widespread, and under selective pressure this could result in a local clonal outbreak. Full article

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Open AccessArticle

Update on the Resistance of Escherichia coli Isolated from Urine Specimens in a Moroccan Hospital: A Review of a 7-Year Period

by Elmostafa Benaissa, Nadia Elmrimar, Elmehdi Belouad, Youness Mechal, Mohammed Ghazouani, Fatna Bsaibiss, Yassine Benlahlou, Mariama Chadli, Nadia Touil, Abdelhay Lemnaouer, Adil Maleb and Mostafa Elouennass

GERMS 2021, 11(2), 189-198; https://doi.org/10.18683/germs.2021.1256 - 2 Jun 2021

Cited by 4

Abstract

Introduction: Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. [...] Read more.

Introduction: Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. coli isolates to major antibiotics, particularly those prescribed for urinary tract infections and study the occurrence and evolution of multi-resistant phenotypes. Methods: We conducted a retrospective study at the Bacteriological Department of the Mohammed V Military Hospital of Instruction, over a period of 7 years. All isolates of E. coli from inpatients and outpatients were included. Identification of bacterial isolates was based on culture, morphological and biochemical identification characteristics. Antibiotic susceptibility was studied using the Mueller Hilton agar diffusion method by using OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST/CA-SFM 2019. Results: The rate of resistance of E. coli isolates to 3^rd generation cephalosporins, imipenem and fluoroquinolones was 12%, 1% and 34%, respectively. The difference between the resistance rates of inpatient and outpatient E. coli isolates was statistically significant for most antibiotics (p<0.05). The rate of extended-spectrum beta-lactamase phenotype (ESBL) was 6.73%. The carbapenemase phenotype was 1.25%. The ESBL phenotype rate increased from 3% in 2012 to 11.16% in 2018. Conclusions: The progression of the ESBL phenotype in both hospital and community settings, due to the increase in the resistance rate to 3^rd generation cephalosporin, is prompting a review of the strategy for the therapeutic management of urinary tract infections with these molecules as probabilistic treatment. Full article

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Open AccessArticle

Knowledge, Perception, and Confidence of Healthcare Workers About COVID-19 Preventive Measures During the First Wave of the Pandemic: A Cross-Sectional Study from Egypt

by Omaima Elgibaly, Enas Daef, Shimaa A. Elghazally, Hebatallah M. Hassan, Rehab M. ElsaidTash, Shereen M. Bahgat, Neveen G. Elantouny, Amro A. Zarzour, Marwa M Ayesh Othman and Rehab H. El-Sokkary

GERMS 2021, 11(2), 179-188; https://doi.org/10.18683/germs.2021.1255 - 2 Jun 2021

Cited by 8

Abstract

Introduction: The ongoing coronavirus-disease-19 (COVID-19) pandemic had a variable history with differences in its various stages. This study evaluates the status of knowledge, perception, and confidence about COVID-19 preventive measures during the first wave of the COVID-19 pandemic among healthcare workers (HCWs) in [...] Read more.

Introduction: The ongoing coronavirus-disease-19 (COVID-19) pandemic had a variable history with differences in its various stages. This study evaluates the status of knowledge, perception, and confidence about COVID-19 preventive measures during the first wave of the COVID-19 pandemic among healthcare workers (HCWs) in Egypt. Methods: A cross-sectional study was conducted during the first wave of the COVID-19 pandemic, in July 2020, in Egypt. An-online-based questionnaire was used to collect data. It included items to record demographic data, and an assessment of knowledge, the perception of healthcare facilities preparedness, and HCW confidence about applying infection prevention measures. Results: A total of 465 responses were analyzed. HCWs' mean age was 36.76 ± 9.57 years, 94.2% (n=438) had an adequate level of knowledge, 31% (n=144) had an adequate perception level, and 39.4% (n=183) had an adequate confidence level. The main source of information was international organizations' websites 46.5% (n=216). The main barriers to applying preventive measures were the overcrowding of patient care areas 73.1% (n=339), and limited infection control supplies 68% (n=316). Factors associated with COVID-19 among HCWs were COVID-19 infected family members (OR: 5.86), inability to protect themselves and their families (OR: 5.73), uncertainty about the available hand hygiene supplies (OR: 3.76), male gender (OR: 3.07), and single HCWs (OR: 2.88). Conclusions: Although the majority reported an adequate knowledge level, lower rates of adequate perception and confidence were observed. Revision of preparedness plans in different facilities should be further studied. Psychological support and gender differences should be considered in response programs. Full article

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Open AccessArticle

Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting

by Tatjana Tot, Sara Kibel, Sanda Sardelić, Khalil Nemer, Ana Benčić, Jasmina Vraneš, Marija Krilanović, Marko Jelić, Marko Tripković, Marina Bubonja-Šonje and Branka Bedenić

GERMS 2021, 11(2), 163-178; https://doi.org/10.18683/germs.2021.1254 (registering DOI) - 2 Jun 2021

Cited by 5

Abstract

Introduction: Recently, a marked increase in the rate of colistin resistant Klebsiella pneumoniae was observed in Croatian hospitals and the outpatient setting. This prompted us to analyze the molecular epidemiology of these isolates and the mechanisms of spread. Methods: In total 46 [...] Read more.

Introduction: Recently, a marked increase in the rate of colistin resistant Klebsiella pneumoniae was observed in Croatian hospitals and the outpatient setting. This prompted us to analyze the molecular epidemiology of these isolates and the mechanisms of spread. Methods: In total 46 colistin-resistant K. pneumoniae isolates from five hospitals and the community were analyzed. The presence of genes encoding broad and extended-spectrum β-lactamases, plasmid-mediated AmpC β-lactamases and carbapenemases was determined by PCR. Plasmids were characterized by PCR based replicon typing. Isolates were genotyped by pulsed-field gel electrophoresis. Virulence traits such as hemolysins, hyperviscosity and resistance to serum bactericidal activity were determined by phenotypic methods. Results: High resistance rates were observed for cefuroxime, ceftazidime, cefotaxime, ceftriaxone and ertapenem, ciprofloxacin and gentamicin. The majority of OXA-48 producing isolates were resistant to ertapenem but susceptible to imipenem and meropenem. Nine strains transferred ertapenem resistance to E. coli recipient strain. Thirty-nine strains were phenotypically positive for ESBLs and harbored group 1 of CTX-M β-lactamases. OXA-48 was detected in 39 isolates, KPC-2 in four and NDM-1 in one isolate. The isolates belonged to six PFGE clusters. All isolates were found to be resistant to serum bactericidal activity and all except four strains positive for KPC, produced β-hemolysins. String test indicating hypermucosity was positive in only one KPC producing organism. Conclusions: The study demonstrated the ability of K. pneumoniae to accumulate different resistance and virulence determinants. We reported dissemination of colistin resistant K. pneumoniae in five hospitals, located in different geographic regions of Croatia and in the outpatients setting. mcr genes responsible for transferable colistin resistance were not found, indicating that resistance was probably due to chromosomal mutations. Full article

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Open AccessArticle

Seropositivity for Dengue and Leptospira IgM Among Patients with Acute Febrile Illness: An Indicator of Co-Infection?

by Biranthabail Dhanashree and Shalini Shenoy

GERMS 2021, 11(2), 155-162; https://doi.org/10.18683/germs.2021.1253 - 2 Jun 2021

Cited by 6

Abstract

Introduction: Presentation of febrile illness with nonspecific features, overlapping manifestations of dengue and leptospirosis, limited laboratory diagnostic tests, make the clinical diagnosis of pyrexia a challenge. The present study aimed to determine the prevalence of Leptospira and dengue IgM co-infection among acute febrile [...] Read more.

Introduction: Presentation of febrile illness with nonspecific features, overlapping manifestations of dengue and leptospirosis, limited laboratory diagnostic tests, make the clinical diagnosis of pyrexia a challenge. The present study aimed to determine the prevalence of Leptospira and dengue IgM co-infection among acute febrile illness patients. Methods: This is a retrospective hospital-based study which included patient data collected from June 2016 to May 2017. Inpatients' samples (n=2139) were tested for dengue and/or Leptospira IgM at the Microbiology Laboratory. Data like duration of fever, platelet count, hemoglobin, white blood cell count, erythrocyte sedimentation rate, results of liver and renal function tests, mode of treatment, were collected from medical records of laboratory-confirmed co-infection cases. Results: Among 1612 serum samples tested for dengue IgM by ELISA, 382 (23.7%) were positive, 17 equivocal and 1213 were negative. Of the 811 Leptospira IgM ELISA done, 119 (14.7%) were positive, 17 equivocal and 675 negative. Two hundred eighty-four samples were tested for both infections and nine (3.2%) were positive for both and 275 were negative. These nine patients positive for dual infections showed elevated transaminases, alkaline phosphatase, serum bilirubin, creatinine, and blood urea, thrombocytopenia and leukocytosis. They received effective antibiotics along with supportive treatment and were cured of the infection. Conclusions: The study emphasizes the possibility of leptospirosis and dengue co-infection (3.2%) and need for confirmation by a highly specific test like PCR. If co-infection is suspected, treatment with specific antibiotics for leptospirosis and supportive treatment for dengue is mandatory, with due attention to complexity of organ involvement. Full article

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Open AccessArticle

Prevalence, Chronological Trends and Predictors of Treatment Outcomes Among Patients with Tuberculosis in Southern Tunisia Across Two Decades (1995-2016)

by Mariem Ben Hmida, Houda Ben Ayed, Makram Koubaa, Maissa Ben Jmaa, Maroua Trigui, Fatma Hammemi, Tarak Ben Jmaa, Fatma Smaoui, Habib Feki, Jamel Damak and Mounir Ben Jemaa

GERMS 2021, 11(2), 147-154; https://doi.org/10.18683/germs.2021.1252 - 2 Jun 2021

Abstract

Introduction: Tuberculosis (TB) is a communicable disease common worldwide. Influencing factors in TB outcomes include socio-demographics, as well as disease-related and treatment-related factors. This study aimed to analyze the prevalence trends of unsuccessful treatment outcomes in Southern Tunisia during 1995-2016 and to identify [...] Read more.

Introduction: Tuberculosis (TB) is a communicable disease common worldwide. Influencing factors in TB outcomes include socio-demographics, as well as disease-related and treatment-related factors. This study aimed to analyze the prevalence trends of unsuccessful treatment outcomes in Southern Tunisia during 1995-2016 and to identify their risk factors. Methods: This was a retrospective study including all notified cases from the tuberculosis center reporting registers in Southern Tunisia between 1995 and 2016. Results: Overall, 2771 TB cases were notified. Unsuccessful treatment outcomes were noted in 196 cases (7%). Unsuccessful treatment outcome was associated with male gender (OR=1.4; p=0.023), elderly status (≥60 years, OR=2.3; p<0.001), joints and bones site (OR=2.2; p=0.002) as well as meningeal involvement (OR=2.4; p=0.023). Lymph node (OR=0.4; p<0.001) and therapy duration ≥6 months (OR=0.003; p<0.001) were statistically associated with lower rate of unsuccessful outcome. Multivariate regression analysis showed that elderly status (AOR=2.3; p<0.001), meningeal involvement (AOR=2.2; p<0.027) as well as bone and joints involvements (AOR=2; p=0.027) were independently associated with unsuccessful outcome. Trends analysis showed that the case-fatality rate significantly increased from 1995 to 2016 (Rho=0.4; p=0.032). Conclusions: The high prevalence of unsuccessful outcome suggested important inadequacies in the TB program. An effective strategy to improve therapeutic education of patients with TB is therefore urgently needed. Full article

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Open AccessEditorial

Forty Years of HIV

by Adrian Streinu-Cercel

GERMS 2021, 11(2), 146; https://doi.org/10.18683/germs.2021.1251 - 2 Jun 2021

Abstract

The history of HIV infection started more than 40 years ago [...] Full article

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GERMS, Volume 11, Issue 2 (06 2021) – 20 articles , Pages 146-336

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