GERMS

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Open AccessCommunication

Rapid Decay of Anti-SARS-CoV-2 Antibodies in Infection-Naïve Healthcare Workers Four Months After Vaccination

by Maria Stamatopoulou, Vasileios Tsamadias, Theodosios Theodosopoulos, Stiliani Demeridou, George Kaparos, Nikolaos Memos, Manoussos Konstadoulakis and Stavroula Baka

GERMS 2021, 11(4), 625-629; https://doi.org/10.18683/germs.2021.1300 - 29 Dec 2021

Cited by 4 | Viewed by 32

Abstract

Since December 2019 humanity worldwide has faced one of the worse pandemics of the modern world caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [...] Full article

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Open AccessCase Report

Are We Losing Awareness of Other Infections Due to the Fear of Coronavirus Disease-2019 and Mis-C?

by Gökçen Erfidan, Özgür Özdemir Şimşek, Ahu Kara Aksay, Gülnihan Üstündağ, Seçil Arslansoyu Çamlar, Fatma Mutlubaş, Dilek Yılmaz Çiftdoğan, Belde Kasap Demir and Demet Alaygut

GERMS 2021, 11(4), 617-624; https://doi.org/10.18683/germs.2021.1299 - 29 Dec 2021

Cited by 5 | Viewed by 30

Abstract

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rarely seen severe complication of coronavirus disease-2019 (COVID-19). Although fever is one of the indispensable symptoms, other infections should be considered in the differential diagnosis during the pandemic. Case report: An 8-year-old [...] Read more.

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rarely seen severe complication of coronavirus disease-2019 (COVID-19). Although fever is one of the indispensable symptoms, other infections should be considered in the differential diagnosis during the pandemic. Case report: An 8-year-old and a 16-year-old female patient were admitted with fever, vomiting, headache. Both had fulfilled the criteria and were diagnosed with MIS-C. However, they both had remarkable persistent costovertebral angle tenderness, which was unexpected in MIS-C. In Case-1, urine analysis showed microscopic hematuria without pyuria, and urine culture showed no bacterial growth. Case-2 had microscopic hematuria and pyuria with Escherichia coli growth in urine culture. Contrast-enhanced computed tomography showed wedge-shaped hypodense multiple lesions in bilateral kidneys for Case-1, in the right kidney for Case-2. They diagnosed acute focal bacterial nephritis (AFBN). Conclusions: The diagnostic criteria of MIS-C can overlap with the symptoms of other severe septic infections such as AFBN, which is a rare urinary tract infection, diagnosed by imaging of localized renal inflammatory mass-like or wedge-shaped lesion. A detailed anamnesis and careful physical examination may help differential diagnosis. Full article

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Open AccessCase Report

Central Line Associated Bloodstream Infection Caused by Kodamaea ohmeri in a Young Child

by Amier Haidar, Farhana Khaja, Brian Simms, Amr Issam Elgehiny, Tracy Omoegbele and Nikita Khetan

GERMS 2021, 11(4), 614-616; https://doi.org/10.18683/germs.2021.1298 - 29 Dec 2021

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Abstract

Introduction: Kodamaea ohmeri, a yeast frequently mistaken for Candida, has emerged in recent years as an opportunistic fungal pathogen, showing a predilection towards patients with immunosuppression, or those with long-term central venous access. This report describes a central line associated [...] Read more.

Introduction: Kodamaea ohmeri, a yeast frequently mistaken for Candida, has emerged in recent years as an opportunistic fungal pathogen, showing a predilection towards patients with immunosuppression, or those with long-term central venous access. This report describes a central line associated bloodstream infection (CLABSI) due to K. ohmeri, in a young child, which was successfully treated. Case report: The patient is a 5-year-old male with a history of short gut syndrome, and total parenteral nutrition (TPN) dependence who presented to the emergency room with a two-day history of productive-cough, rhinorrhea, and fever. Antibiotic therapy was initiated with cefepime and vancomycin for suspected CLABSI. However, within the first twenty-four hours of his admission, his initial blood culture from his central venous catheter became positive for yeast so fluconazole was added due to suspicion of candidemia. During his admission, his initial central line and peripheral blood culture were later speciated as Kodamaea ohmeri, with susceptibilities to fluconazole (MIC: 4 μg/mL) and micafungin (MIC: 0.125 μg/mL). After evaluating the susceptibilities, he was transitioned to micafungin. Conclusions: This case report further acknowledges that while rare, K. ohmeri is an emerging pathogen that has the potential to be life threatening if not accurately identified and treated with the optimal, empiric antifungal therapy. Due to potentially high mortality and antifungal resistance, this yeast species should be on the differential in patients that present with a central venous catheter and/or other underlying risk factors. Favorable outcomes can be achieved by removing indwelling catheters and administering optimal antifungal therapy. Full article

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Open AccessCase Report

Native Valve Emphysematous Enterococcal Endocarditis: Expanding the Differential Diagnosis

by Steven Tessier, Anthony Durgham, Matthew Krinock, Amitoj Singh, Santo Longo and Sudip Nanda

GERMS 2021, 11(4), 608-613; https://doi.org/10.18683/germs.2021.1297 - 29 Dec 2021

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Abstract

Introduction: Emphysematous endocarditis is caused by the gas-forming organisms Citrobacter koseri, Escherichia coli, Clostridium species, and Finegoldia magna. We report the first case of emphysematous endocarditis caused by Enterococcus faecalis. Case report: An 82-year-old man presented with [...] Read more.

Introduction: Emphysematous endocarditis is caused by the gas-forming organisms Citrobacter koseri, Escherichia coli, Clostridium species, and Finegoldia magna. We report the first case of emphysematous endocarditis caused by Enterococcus faecalis. Case report: An 82-year-old man presented with fever and rapidly progressive shortness of breath. He was found to be in atrial fibrillation with rapid ventricular rates. Two-dimensional transthoracic echocardiography demonstrated severe mitral regurgitation. Subsequent two- and three-dimensional transesophageal echocardiogram revealed a large, highly mobile vegetation on the atrial surface of the anterior mitral leaflet with aneurysmal destruction of the lateral scallop requiring mitral valve replacement. Sequencing of the vegetation revealed Enterococcus faecalis, an anaerobic gram-positive coccus that, in rare cases, produces gas using a heme-dependent catalase. Histopathological analysis of the infected valve suggested interstitial gas accumulation, leading to the diagnosis of emphysematous endocarditis. Conclusions: E. faecalis-associated emphysematous endocarditis should be included in the differential diagnosis of valvular vegetation in patients with a rapidly progressing clinical course. When possible, histopathological analysis should be used alongside other imaging techniques to confirm the diagnosis of emphysematous endocarditis. This case also highlights the importance of collecting blood cultures prior to initiating antibiotic treatment. Full article

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Open AccessCase Report

A Rare Case of Campylobacter rectus Pyogenic Extensor Tenosynovitis

by James B. Doub

GERMS 2021, 11(4), 604-607; https://doi.org/10.18683/germs.2021.1296 - 29 Dec 2021

Cited by 2 | Viewed by 34

Abstract

Introduction: Pyogenic extensor tenosynovitis is a severe inflammatory process of the extensor compartment of the hand. Common pathogens involved in this condition are Streptococcus and Staphylococcus; however, in immunocompromised patients, rare pathogens can be implicated. Case report: Herein a rare [...] Read more.

Introduction: Pyogenic extensor tenosynovitis is a severe inflammatory process of the extensor compartment of the hand. Common pathogens involved in this condition are Streptococcus and Staphylococcus; however, in immunocompromised patients, rare pathogens can be implicated. Case report: Herein a rare case of a 61-year-old female who developed severe extensor tenosynovitis from Campylobacter rectus after a dog bite is presented. The patient required surgical debridement, four weeks of doxycycline and amoxicillin-clavulanate antibiotic therapy and physical therapy to successfully cure her C. rectus infection and preserve functionality. Conclusions: This case reinforces the virulence of microaerophilic pathogens, the need for multidisciplinary management in complex cases and alternative treatments with morbid obesity. As well, this case adds to the paucity of data with respect to this pathogen causing infections outside periodontal disease. Full article

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Open AccessCase Report

Fatal Cerebral Phaeohyphomycosis Caused by Cladophialophora bantiana Mimicking Tuberculous Brain Abscess

by Arghadip Samaddar, Ketan Priyadarshi, Shamanth A. Shankarnarayan, Anuradha Sharma, Mayank Garg, Twishi Shrimali and Anup K. Ghosh

GERMS 2021, 11(4), 597-603; https://doi.org/10.18683/germs.2021.1295 - 29 Dec 2021

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Abstract

Introduction: Cladophialophora bantiana, a neurotropic phaeoid fungus, is the primary agent of cerebral phaeohyphomycosis. The disease more commonly affects immunocompetent males and is associated with a high mortality rate. Case report: We report a case of brain abscess caused by [...] Read more.

Introduction: Cladophialophora bantiana, a neurotropic phaeoid fungus, is the primary agent of cerebral phaeohyphomycosis. The disease more commonly affects immunocompetent males and is associated with a high mortality rate. Case report: We report a case of brain abscess caused by Cladophialophora bantiana in a 50-year-old immunocompetent male who presented with headache for two months, weakness of both lower limbs for 15 days, and altered sensorium and aphasia for one day. Contrast-enhanced MRI of the brain showed multiple coalescent abscesses in the right basal ganglia and corpus callosum. Based on clinical and radiological suspicion of tuberculoma, treatment with antitubercular drugs was initiated. A month after discharge, the patient was re-admitted with history of loss of consciousness, altered sensorium, respiratory distress and aphasia. Brain CECT revealed multiple ring-enhancing lesions in the right basal ganglia with mass effect and a leftward midline shift. The patient underwent craniotomy and evacuation of abscess. Direct microscopy of pus aspirated from the lesions showed pigmented septate fungal hyphae, which was identified as C. bantiana in fungal culture. The patient was administered intravenous liposomal amphotericin B and voriconazole. However, he died due to multiple organ failure on day 19 after surgery. Conclusions: Fungal etiology should be considered in the differential diagnosis of intracranial space occupying lesions, regardless of the host immune status. An early diagnosis, together with aggressive medical and neurosurgical interventions are imperative for improving the survival in such patients. Full article

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Open AccessCase Report

A Case of Acute Suppurative Thyroiditis Caused by Streptococcus suis Infection

by Vitvala Jariyawattanarat, Prawat Chantharit, Chanika Sritara, Tharintorn Chansoon and Chutintorn Sriphrapradang

GERMS 2021, 11(4), 592-596; https://doi.org/10.18683/germs.2021.1294 - 29 Dec 2021

Cited by 4 | Viewed by 28

Abstract

Introduction: Acute suppurative thyroiditis (AST) is an uncommon but potentially life-threatening condition. The majority of AST cases are caused by bacterial infection. Streptococcus suis is a swine pathogen that mostly causes meningitis and septicemia. To date, AST caused by Streptococcus suis has [...] Read more.

Introduction: Acute suppurative thyroiditis (AST) is an uncommon but potentially life-threatening condition. The majority of AST cases are caused by bacterial infection. Streptococcus suis is a swine pathogen that mostly causes meningitis and septicemia. To date, AST caused by Streptococcus suis has not yet been reported. Case report: A 64-year-old Thai female presented with rapid enlargement of a preexisting large left thyroid nodule without compressive symptoms for one week. She had a fever and purulent discharge spontaneously drained from her fluctuated mass. Her thyroid function workup revealed elevated serum thyroid hormone levels with suppressed thyrotropin levels. Thyroid scan and uptake showed functioning thyroid tissue in the left lobe of the thyroid. Prompt antibiotic therapy and drainage were performed, and this led to significant improvement. However, thyroid cancer was suspected, and the patient underwent lobectomy. Pus cultures grew Streptococcus suis. She had a history of raw pork product consumption. Conclusions: This case highlights the importance of correct identification of pathogens for proper antibiotic therapy. AST caused by Streptococcus suis should be included in the differential diagnosis, especially in areas with a high prevalence of Streptococcus suis diseases. Full article

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Open AccessArticle

Urinary Tract Infections in Children: Clinical and Antimicrobial Resistance Data from Bucharest Area, Romania

by Victor Daniel Miron, Claudiu Filimon, Teodor Cabel, Roxana Ioana Mihăescu, Gabriela Bar, Denisa Leu and Mihai Craiu

GERMS 2021, 11(4), 583-591; https://doi.org/10.18683/germs.2021.1293 - 29 Dec 2021

Cited by 7 | Viewed by 40

Abstract

Introduction: Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children. Methods: We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother [...] Read more.

Introduction: Urinary tract infections (UTIs) are among the most common bacterial diseases of childhood with an increased frequency in infants and young children. Methods: We conducted a retrospective study of children diagnosed with UTI in the Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania between January 2017 and December 2019. We evaluated the patients’ clinical characteristics, laboratory parameters and the resistance profile of the identified uropathogens. Results: A total of 264 children were included in the analysis. Females (71.6%, n = 186) and infants (52.7%, n = 139) were more commonly affected. The recurrence rate was 27.7% and was positively associated with the presence of renal malformations. Age under 1-year, increased leukocyte and neutrophil counts, and elevated C-reactive protein were associated with hospitalization. E. coli (80.3%, n = 212) was the main etiological agent isolated, followed by Proteus mirabilis (9.8%, n = 26) and Klebsiella spp. (6.4%, n = 17). We identified increased resistance for all germs to common antibiotics used in pediatrics: ampicillin, amoxicillin/clavulanate, cefuroxime, ceftriaxone, and trimethoprim/sulfamethoxazole. Conclusions: We identified an increased resistance of uropathogens to antimicrobials commonly used in children. Reporting antimicrobial resistance from real-world clinical practice is necessary for accurate mapping and continuous updating of initial treatment recommendations until antibiogram results are received. In Romania and other countries, extensive studies are needed to follow up uropathogen resistance in both children and adults. Full article

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Open AccessArticle

Aerobic Bacteria Isolated from Diabetic Foot Ulcers of Egyptian Patients: Types, Antibiotic Susceptibility Pattern and Risk Factors Associated with Multidrug-Resistant Organisms

by Mervat Mashaly, Mohamed Abo El kheir, Mohamed Ibrahim and Wael Khafagy

GERMS 2021, 11(4), 570-582; https://doi.org/10.18683/germs.2021.1292 - 29 Dec 2021

Cited by 13 | Viewed by 35

Abstract

Introduction: Diabetic foot infection (DFI) is one of the common diabetic complications. Pathogens causing DFI and their antibiotic susceptibility vary with location. Therefore, empirical antibiotic therapy should be based on the pathogens that are most likely to be present. Aim: To identify [...] Read more.

Introduction: Diabetic foot infection (DFI) is one of the common diabetic complications. Pathogens causing DFI and their antibiotic susceptibility vary with location. Therefore, empirical antibiotic therapy should be based on the pathogens that are most likely to be present. Aim: To identify the frequent aerobic bacteria causing DFI with detection of their antibiotic susceptibility to help clinicians in our community choose the best empirical antibiotic for DFI. Methods: Swabs were collected from 104 diabetic foot ulcers (DFUs). Aerobic bacterial cultures were done followed by bacterial identification and antibiotic susceptibility testing on VITEK® 2 system. Extended-spectrum beta-lacatamase (ESBL) detection was performed phenotypically and confirmed by multiplex-PCR for bla_CTX-M, bla_TEM, and bla_SHV genes. Results: Aerobic bacterial infection was detected in 82/104 (78.8%) of the DFUs. Gram-negative bacilli (GNB) were isolated more frequently (56.1%) than Gram-positive cocci (GPC) (43.9%). The most common single-isolated bacteria were K. pneumoniae (26.8%), S. aureus and coagulase negative staphylococci (22% for each). The only significant independent predictors of DFI with GNB or GPC were long DM duration and frequent hospitalizations, respectively. The most active antibiotics were amikacin, tigecycline and meropenem for GNB, and linezolid and vancomycin for staphylococci. Multidrug-resistance prevalence was 95.1%. ESBL was detected in 52.6% of Enterobacteriaceae; the bla_CTX-M gene was the most common (90%), followed by bla_TEM (65%) and bla_SHV (35%). Peripheral neuropathy was the single independent predictor for DFI with ESBL producers (adjusted OR = 15.5). Conclusions: There is a notable local pattern of DFI bacteriology in our community. Our findings could be valuable in developing the future empirical treatment guidelines for DFIs. Full article

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Open AccessArticle

Multidrug-Resistant Community-Acquired Urinary Tract Infections in a Northern Region of Morocco: Epidemiology and Risk Factors

by Elmostafa Benaissa, Elmehdi Belouad, Youness Mechal, Yassine Benlahlou, Mariama Chadli, Adil Maleb and Mostafa Elouennass

GERMS 2021, 11(4), 562-569; https://doi.org/10.18683/germs.2021.1291 - 29 Dec 2021

Cited by 7 | Viewed by 48

Abstract

Introduction: Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study [...] Read more.

Introduction: Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study was to describe the bacterial epidemiology and to determine the risk factors for the acquisition of MDR in community urinary tract infections in our region. Methods: This was a retrospective case-control study conducted in the bacteriology laboratory of the Mohammed V Military Teaching Hospital over an 8-month period from 01 October 2015 to 31 May 2016. Cases were defined as patients with community-acquired urinary tract infection with MDR and controls were defined as patients with a urinary tract infection without MDR. Results: Out of 373 isolates, enterobacteria represented 80%. E. coli represented 59.2%, followed by K. pneumoniae at 15%. The rate of MDR represented 13.4% of which ESBL enterobacteria represented 12.1%. Univariate analysis showed a statistically significant association between male sex (p = 0.001), age > 65 years (p = 0.007), urban origin (p = 0.003), previous hospitalization within 3 months (p = 0.001) and antibiotic therapy within 6 months (p = 0.001) with MDR community-acquired urinary tract infection. On the other hand, multivariate analysis by logistic regression showed that age > 65 years (OR = 8.4, CI: 2.1–42), previous hospitalization within 3 months (OR = 13.4, CI: 3.3–140.2) and antibiotic therapy within 6 months (OR = 9.2, CI: 4.1–60.1) were significantly associated to MDR community-acquired urinary tract infection. Conclusions: The increase in resistance to enterobacteria in the community prompts a review of the list of antibiotics prescribed for probabilistic management of these infections in our region. Full article

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Open AccessArticle

Association of Specific Haplotype of Tumor Necrosis Factor-ɑ and Interleukin-1β Polymorphisms with Helicobacter pylori Infection and Gastric Carcinogenesis

by Fatemeh Nezamzadeh, Mahboobeh Asadyun, Amir Anbiyaiee, Mansour Sedighi, Abed Zahedi bialvaei, Younes Khalili, Hamed Ebrahimzadeh Leylabadlo and Aylin Esmailkhani

GERMS 2021, 11(4), 554-561; https://doi.org/10.18683/germs.2021.1290 - 29 Dec 2021

Cited by 3 | Viewed by 31

Abstract

Introduction: The Helicobacter pylori infection and cytokine-mediated inflammatory responses play significant roles in the pathogenesis of gastric cancer (GC). This study was performed to determine the association between the risk of GC and genetic polymorphisms in interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α). [...] Read more.

Introduction: The Helicobacter pylori infection and cytokine-mediated inflammatory responses play significant roles in the pathogenesis of gastric cancer (GC). This study was performed to determine the association between the risk of GC and genetic polymorphisms in interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α). Methods: The polymorphisms of IL-1β and TNF-α genes were analyzed by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) in 290 patients who underwent endoscopy. Infection with H. pylori was diagnosed by histological analysis, rapid urease test, and PCR of gastric biopsy samples. Quantitative real-time PCR was performed to determine the relative mRNA expression levels. Results: No significant difference was detected in allele frequency and genotype of all studied polymorphisms between chronic gastritis (CG), GC and healthy individuals. IL-1β mRNA was down-regulated in both gastritis (relative quantification (RQ) = 0.447) and the GC groups (RQ = 0.151). In contrast, the expression of TNF-α was up-regulated in the GC group (RQ = 2.817) compared to the gastritis group (RQ = 0.861). Conclusions: The studied single-nucleotide polymorphisms are not risk factors for development of CG and GC. However, H. pylori infection causes a huge increase in the TNF-α expression in GC patients. Full article

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Open AccessArticle

Bacterial Sexually Transmitted Infections and Syndromic Approach: A Study Conducted on Women at Moroccan University Hospital

by Safae Karim, Chahrazed Bouchikhi, Abdelaziz Banani, Hinde El Fatemi, Tiatou Souho, Sanaa Erraghay and Bahia Bennani

GERMS 2021, 11(4), 544-553; https://doi.org/10.18683/germs.2021.1289 - 29 Dec 2021

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Abstract

Introduction: In Morocco, a syndromic approach has been implemented for sexually transmitted infections (STIs) management. However, those infections can be asymptomatic and the use of the syndromic approach to their management can be inappropriate and lead to dissemination of infection. Therefore, it [...] Read more.

Introduction: In Morocco, a syndromic approach has been implemented for sexually transmitted infections (STIs) management. However, those infections can be asymptomatic and the use of the syndromic approach to their management can be inappropriate and lead to dissemination of infection. Therefore, it would be important to determine the epidemiology and risk factors of bacterial STIs (Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG)) in a Moroccan population and their association with symptoms to assess the appropriacy of the use of the syndromic approach. Methods: Cervical samples were collected from symptomatic and asymptomatic consenting women attending the University Hospital of Fez and were tested by PCR for NG, CT and MG using specific primers. We assessed the infection status and its association with different risk factors and genital STIs-related symptoms. Results: Of 809 tested for CT, NG and MG, 16.6% tested positive for at least one STI. Of the 134 participants who tested positive for at least one bacterial STI, 74.2% had no genital STIs-related symptoms. Moreover, the results showed a significantly high rate of NG and MG infections in asymptomatic women. However, the determined risk factors for NG, MG and CT infections were menopause (p = 0.002), oral contraception (p = 0.036) and a high number of parities (p = 0.048), respectively. Conclusions: This investigation shows a predominance of NG infection and a high prevalence of STIs in asymptomatic patients. These results highlight that the adopted syndromic approach will not be adapted in the management of these STIs. Thus, the implementation of a systematic diagnostic program in order to enhance their management is needed. Full article

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Open AccessArticle

Candida spp. Isolation from Critically Ill Patients’ Respiratory Tract. Does Antifungal Treatment Affect Survival?

by Petros Ioannou, Alexandra Vouidaski, Nikolaos Spernovasilis, Christina Alexopoulou, Andria Papazachariou, Eleni Paraschou, Aikaterini Achyropoulou, Sofia Maraki, George Samonis and Diamantis P Kofteridis

GERMS 2021, 11(4), 536-543; https://doi.org/10.18683/germs.2021.1288 - 29 Dec 2021

Cited by 7 | Viewed by 32

Abstract

Introduction: Isolation of Candida spp. from bronchial samples of patients on mechanical ventilation is common. Even though it may not always reflect infection, it may induce immunological changes that can facilitate bacterial pneumonia. In this case, antifungal treatment is of uncertain value. [...] Read more.

Introduction: Isolation of Candida spp. from bronchial samples of patients on mechanical ventilation is common. Even though it may not always reflect infection, it may induce immunological changes that can facilitate bacterial pneumonia. In this case, antifungal treatment is of uncertain value. This study examined the impact of antifungal treatment on the outcome of intensive care unit (ICU)-acquired respiratory tract infection (RTI) of critically ill, immunocompetent patients, with Candida isolation from their respiratory tract. Methods: This is a retrospective cohort study of adult patients hospitalized in the ICU of the University Hospital of Heraklion, Greece, from 2014 through 2016 with ICU-acquired RTI and Candida spp. isolated from their bronchial secretions. Data regarding medical history, demographics (gender, age), reason for ICU admission, previous antimicrobial use or hospitalization, SOFA and APACHE II score, clinical outcomes (primary clinical outcome: overall mortality during hospitalization; secondary clinical outcome: mortality during the ICU stay and duration of ICU and hospital stay) at the end of their ICU stay and at the end of their hospital stay were recorded and consequently evaluated. A logistic regression analysis model evaluated the effect of the recorded parameters in association with ICU mortality and overall mortality during hospitalization. Results: A total of 90 individuals were enrolled. Of them, 47 (52.2%) were treated with antifungals during their hospitalization around the time of Candida isolation. Patients treated with antifungals had higher SOFA and APACHE II scores, longer duration of stay in the ICU, more days on ventilator and higher total mortality during hospitalization. Multivariate logistic regression analysis identified antifungal use to be independently associated with total mortality during hospitalization. Conclusions: Antifungal use in patients with ICU-acquired RTI was associated with higher overall mortality as compared to those not receiving such agents. Full article

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Open AccessArticle

Antimicrobial Use Among Hospitalized Patients: A Multi-Center, Point Prevalence Survey Across Public Healthcare Facilities, Osun State, Nigeria

by Aaron O. Aboderin, Adeyemi T. Adeyemo, Ademola A. Olayinka, Adeniyi S. Oginni, Abolaji T. Adeyemo, Abayomi A. Oni, Olatunde F. Olabisi, Oluwaseun D. Fayomi, Anthony C. Anuforo, Abiodun Egwuenu, Omotayo Hamzat and Walter Fuller

GERMS 2021, 11(4), 523-535; https://doi.org/10.18683/germs.2021.1287 - 29 Dec 2021

Cited by 17 | Viewed by 30

Abstract

Introduction: In order to inform sub-national action plan for control of antimicrobial resistance (AMR) and benchmark interventions to improve antibiotic use, it is essential to define situations on antibiotic use using standardized tools. We sought to assess quality of antimicrobial prescription across [...] Read more.

Introduction: In order to inform sub-national action plan for control of antimicrobial resistance (AMR) and benchmark interventions to improve antibiotic use, it is essential to define situations on antibiotic use using standardized tools. We sought to assess quality of antimicrobial prescription across all government healthcare facilities with capacities for in-patient care in the first of the 36 states in Nigeria as part of ongoing state-wide situation analysis on AMR. Methods: A survey was conducted between 10–27 June 2019 using the WHO methodology for point prevalence survey on antibiotic use in hospitals. Data was collected from hospital administrators and records of hospitalized patients. Data analysis was done using Microsoft Excel 2010 (Redmond Washington). Results: Prevalence of antibiotic use amongst all 321 included patients was 76.6% (246/321). Of all indications recorded, the highest was surgical prophylaxis (96/260, 36.9%) for which there were multiple doses beyond 24 h in almost all cases (91/96, 94.8%). The largest volume of prescribing took place in the surgical wards, and the most common prescriptions were metronidazole (142/564, 25.2%), cefuroxime (104/564, 18.4%), and ceftriaxone (77/564, 13.7%). Overall, 46.3% of the antibiotics used belong to Access group, 53.5% to watch and only 0.2% to Reserve. Treatment in almost all instances 544/563 (96.6%) was empiric. Conclusions: The majority of patients received multiple antibiotics mostly without compliance to guidelines. There was low prescribing of Access antibiotics and excessive use of antibiotics in the Watch group. Antibiotics were used most commonly for surgical prophylaxis but inappropriately. Inappropriate use of antibiotics in this study underscores the crucial need for an action plan incorporating antimicrobial stewardship. Full article

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Open AccessArticle

Treatment Initiation or Switch to Bic/FTC/Taf – Real-World Safety and Efficacy Data from Two HIV Centers in Romania

by Oana Săndulescu, Mădălina Irimia, Otilia Elisabeta Benea, Mariana Mărdărescu, Liliana Lucia Preoțescu, Carmen Mihaela Dorobăț, Isabela Ioana Loghin, Irina Cristina Nicolau, Raluca Elena Jipa, Ramona Ștefania Popescu, Cristina Loredana Benea, Alina Cozma, Ioana Andreea Dărămuș, Victor Daniel Miron, Liviu Jany Prisăcariu, Adriana Florina Bahnă, Irina Nistor, Oana Manuela Secrieru, Silvas George, Andreea Bîrcă, Loredana Dobrea, Alexandra-Ștefana Șogorescu, Ioana Viziteu and Anca Streinu-Cercel Show full author list Hide full author list

GERMS 2021, 11(4), 512-522; https://doi.org/10.18683/germs.2021.1286 - 29 Dec 2021

Cited by 16 | Viewed by 39

Abstract

Introduction: Development of highly active antiretroviral therapy marked an important step forward in the management of people living with HIV and fixed dose combinations are now available to be used as modern antiretroviral regimens. The single-tablet regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was recently [...] Read more.

Introduction: Development of highly active antiretroviral therapy marked an important step forward in the management of people living with HIV and fixed dose combinations are now available to be used as modern antiretroviral regimens. The single-tablet regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was recently approved in Europe and included in international guidelines and recommendations. It became available in Romania in early 2021. We present the real-world results from a retrospective analysis of patients initiating BIC/FTC/TAF in two HIV centers in Romania. Methods: This retrospective analysis included patients treated with BIC/FTC/TAF (first-line or switch) in two HIV centers in Romania, one in Bucharest and one in Iași. We collected data on baseline patient characteristics, reasons for initiation of BIC/FTC/TAF and preliminary clinical and laboratory efficacy, safety and tolerability data. All assessments had been performed according to local practice. Statistical analyses were mostly descriptive and association analysis was performed to assess changes in laboratory parameters from baseline to data cut-off (October 2021). Results: In total, 122 patients were initiated on BIC/FTC/TAF in routine clinical practice from February to October 2021 in the two HIV centers, either as first-line or switch. The majority of patients were male (71%). The median age at baseline was 35.0 years (IQR 32.0–50.8 years). Overall, 91 patients (75%) were treatment-experienced and the most frequent reason for switch was treatment simplification (79%). The mean ± standard deviation follow-up duration on treatment with BIC/FTC/TAF was 101.6 ± 64.2 days until the cut-off date for this analysis. We found no significant changes in lipid values, blood glucose or liver enzymes, coupled with a significant decrease in viral load (p = 0.001). A low number of adverse events occurred during the treatment period (n = 4): two cases of fatigue and two gastrointestinal reactions. No patient discontinued BIC/FTC/TAF and the overall tolerability was good. Conclusions: The insights of the first report on BIC/FTC/TAF use in routine clinical practice in Romania provide an overview of effectiveness and safety to local clinicians treating this patient population. Full article

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Open AccessArticle

Prevalence of Antimicrobial Resistance in Gram-Negative Clinical Isolates from a Major Secondary Hospital in Kuwait: A Retrospective Descriptive Study

by Walid Q. Alali, Wadha AlFouzan and Rita Dhar

GERMS 2021, 11(4), 498-511; https://doi.org/10.18683/germs.2021.1285 - 29 Dec 2021

Cited by 10 | Viewed by 33

Abstract

Introduction: Building an antimicrobial resistance (AMR) surveillance system in a country requires analysis of available data on AMR in clinical isolates. This study’s objective was to determine the AMR prevalence of Gram-negative bacterial (GNB) isolates cultured from clinical specimens at a major [...] Read more.

Introduction: Building an antimicrobial resistance (AMR) surveillance system in a country requires analysis of available data on AMR in clinical isolates. This study’s objective was to determine the AMR prevalence of Gram-negative bacterial (GNB) isolates cultured from clinical specimens at a major general hospital in Kuwait. Methods: A retrospective descriptive study was conducted on AMR profiles of GNB clinical isolates (n = 5290) between January and December 2018. Data were extracted from the laboratory information system in the hospital. The GNB organisms (i.e., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were isolated from five main locations at the hospital (i.e., intensive care units [ICUs], surgical wards, medical wards, pediatric wards, and outpatient polyclinics). Results: Overall, high AMR prevalence (>50%) against ampicillin, cefuroxime, cefotaxime, ceftazidime, ciprofloxacin, and trimethoprim/sulfamethoxazole, were observed across the GNB organisms. However, low resistance prevalence (<10%) were observed against amikacin, ertapenem, meropenem, and piperacillin/tazobactam. In general, AMR prevalence in E. coli isolates from ICU, medical and surgical wards was significantly (p < 0.05) higher compared to other locations, whereas, AMR prevalence in P. aeruginosa isolates from pediatric ward was higher (p < 0.05) compared to other locations. The overall multidrug resistance (MDR) prevalence was 38.7% (95% CI: 37.4–40.0). The highest MDR prevalence was among E. coli isolates from respiratory specimens (48%); wounds, bones, or other tissues (47.7%); and body fluids (47.1%). Similarly, MDR prevalence in K. pneumoniae, P. aeruginosa, and A. baumannii isolated from respiratory specimens was significantly (p < 0.05) higher compared to other specimen types. The most frequent MDR phenotypes in the four GNB organisms and across the different specimen types included three antimicrobial drug classes: penicillins, cephalosporins, and fluroquinolones. Conclusions: Our findings demonstrate high AMR prevalence among common Gram-negative bacteria at this major hospital. Monitoring data on antimicrobial susceptibility of common bacterial organisms is critical for assessing trends in AMR at hospitals and for informing policy decisions. Full article

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Open AccessArticle

COVID-19 Health Literacy, Coping Strategies and Perception of COVID-19 Containment Measures Among Community Members in a Southwestern State in Nigeria

by Victor O. Ukwenya, Temiloluwa A. Fuwape and Olayinka S. Ilesanmi

GERMS 2021, 11(4), 478-497; https://doi.org/10.18683/germs.2021.1284 - 29 Dec 2021

Cited by 4 | Viewed by 31

Abstract

Introduction: This study aimed to describe COVID-19 health literacy, coping strategies and perception of COVID-19 containment measures among community members in a Southwestern state in Nigeria. Methods: A descriptive cross-sectional design was used to enroll 691 respondents from households in Akure, [...] Read more.

Introduction: This study aimed to describe COVID-19 health literacy, coping strategies and perception of COVID-19 containment measures among community members in a Southwestern state in Nigeria. Methods: A descriptive cross-sectional design was used to enroll 691 respondents from households in Akure, Ondo state using a multi-stage sampling technique. Data were collected using an interviewer-administered questionnaire between 1st and 9th October, 2020. Bivariate Chi-square tests were conducted on respondents’ COVID-19 health literacy while multivariate logistic analysis was performed on significant variables. Statistical significance levels were set at p < 0.05. Results: Respondents’ mean age was 29.93 ± 10.66 years, 352 (50.9%) were males. Also, 292 (49.7%) had high levels of trust in the World Health Organization regarding COVID-19 information, and 31 (33.3%) in the first wealth quintile had good health literacy (χ² = 10.459, p = 0.033). Respondents below 20 years were twice more likely to have good COVID-19 health literacy (OR = 2.304, 95%CI = 1.316–4.034, p = 0.004). Also, respondents aged 21–29 years were three times more likely to have good COVID-19 health literacy (OR = 2.587, 95%CI = 1.559–4.293, p ≤ 0.001). Conclusions: Available media platforms should be actively engaged by the national government to ensure that community members especially the rich are equipped with good health literacy. Full article

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Open AccessEditorial

COVID-19: The Pseudo-Environment and the Need for a Paradigm Change

by Richard A. Stein, Oana Ometa and Thomas R. Broker

GERMS 2021, 11(4), 468-477; https://doi.org/10.18683/germs.2021.1283 - 29 Dec 2021

Cited by 14 | Viewed by 35

Abstract

As the COVID-19 pandemic was gripping the world, attention coalesced around the cautiously optimistic prospect that at least one of the >150 vaccine candidates at various stages of development as of July 2020 would be successful [...] Full article

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GERMS, Volume 11, Issue 4 (12 2021) – 18 articles , Pages 468-629

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