Trends and antibiotic susceptibility patterns of diarrhoeal pathogens - an experience of fourteen years in Southern India
INTRODUCTION:
Enteric pathogens contribute largely to morbidity in a developing country like India. Early and prompt diagnosis of diarrhoeal diseases can reduce the mortality rate particularly in children. The pattern of sensitivity to antimicrobials for the common pathogens can vary from time to time. The present study was conducted to study the pathogen distribution and antimicrobial susceptibility pattern during the study period (January 2010 to December 2023).
HYPOTHESIS/GAP STATEMENT:
Studying the changing trend in the antimicrobial sensitivity pattern of diarrhoeal pathogens over a decade can help to plan future treatment options.
AIM:
This study was undertaken to provide insight into the changing pattern of pathogen distribution and antimicrobial susceptibility of enteric pathogens over 14 years.
METHODS:
A retrospective observational cohort analysis was conducted on all the stool pathogens isolated from the samples received in the Microbiology department of a tertiary care hospital from the year 2010 to 2023. The demographic details stool microscopy culture reports and antimicrobial susceptibility patterns were noted.
RESULTS:
18336 stool specimens were received in the Microbiology laboratory between January 2010 to December 2023. A total of 591 Salmonella 471 Shigella181 Vibrio and 80 Aeromonas species were isolated. 93% of Salmonella species 89% of Shigella species and 95 % of Vibrio species were susceptible to Ceftriaxone.91% of Aeromonas isolates were susceptible to Chloramphenicol. Some major parasites were also observed on microscopy.
CONCLUSION:
Timely diagnosis of diarrhoeal pathogens can be life-saving for patients belonging to extremes of age. Pathogens can exhibit a changing susceptibility pattern to antibiotics which should be regularly observed to plan future therapy.
Effect of CHIKV capsid protein nucleolar localisation on host gene modulation
Host cell nuclear localisation of alphaviral proteins has been shown to be important for host transcriptional shut off antagonising type I interferon induction and inhibiting the antiviral response. Our previous studies demonstrate that mutation of the nucleolar localisation sequence (NoLS) of chikungunya virus (CHIKV) capsid protein significantly attenuates CHIKV replication. However the reason for this attenuation remains unclear. In this study we investigated the impact of CHIKV capsid protein on host gene expression using Nanostring analysis and determined whether nucleolar localisation of capsid protein is required for host gene modulation. Little significant change in differential gene expression (adjusted p value <0.05) was observed in Capsid-WT-EGFP and mutant Capsid-NoLS-EGFP transfected HEK293T cells compared to mock EGFP transfected cells. To explore minor changes to host gene modulation in response to capsid protein differential gene expression analysis was performed under a reduced arbitrary threshold (unadjusted P value < 0.01). Results suggest that expressed as a recombinant protein CHIKV capsid has limited impact on host gene expression regardless of its ability to localise to the nucleolus. Results further suggest that attenuation of CHIKV resulting from mutation of the capsid protein NoLS is largely dependent on viral rather than host factors.
Multiple novel Caliciviruses identified from stoats (Mustela erminea) in the United Kingdom
The Caliciviridae family comprising positive-sense RNA viruses is characterised by its non-enveloped small virions broad host range and notable tendency for host switching. These viruses are primarily associated with gastroenteric disease though they can lead to haemorrhagic or respiratory infections. Our study employed a metagenomics analysis of faecal samples from Stoats (Mustela erminea) identifying two novel Calicivirus species tentatively named Stoat vesivirus and Stoat valovirus. Stoat vesivirus was identified in three samples (ST008 ST006 ST004) exhibiting a genome wide nucleotide identity of approximately 92%. The complete coding sequences of these samples were 8471 (ST004) and 8322 (ST006) nucleotides in length respectively. Each comprised three open reading frames (ORF) closely resembling the Vesivirus mink calicivirus (China/2/2016) with 70-72% similarity in ORF1 61-62% in ORF2 and 71% in ORF3. Phylogenetic analysis robustly supported Stoat vesivirus as belonging within the Vesivirus genus. The second Calivicirus (Stoat valovirus) detected solely in sample ST008 was 6527 nucleotides in length and with complete coding sequences present. It shared highest similarity with St-Valerien swine virus and Marmot norovirus HT16 showing 39.5% and 38.8% protein identity with ORF1 and 43.3% and 42.9% for VP1. Phylogenetic analysis suggested that while Stoat valovirus is borderline for new genus demarcation criteria with greater than 60% divergence at ORF1 it clusters basally within the Valovirus genus supporting its inclusion in this genus.
First Case Report of Disseminated Gonococcal Arthritis in Newfoundland & Labrador
Introduction: Disseminated gonococcal infections (DGIs) are a rare but often debilitating complication of N. gonorrhoeae infections. Often presenting as arthritis-dermatitis syndrome true suppurative joint infections are an even more rare form of DGI. Here we present the first known case of DGI in Newfoundland and Labrador in over 10 years.
Case report: A 50-year-old man who is known to inject drugs with multiple housing and social challenges presented to the emergency department with a two-day history of an isolated painful erythematous knee. After being assessed by orthopedics and undergoing an operative debridement intraoperative cultures grew N. gonorrhoeae. He was treated with IV ceftriaxone and his course in hospital was complicated by inadequate pain control and a lack of stable housing.
Conclusion: DGIs while rare need to remain on any clinician’s differential for septic arthritis given the increasing prevalence of gonorrheal infections in Canada and in Newfoundland and Labrador. In addition patients who are at risk of delaying accessing care such as people who inject drugs and unhoused individuals are at higher risk of complicated hospital stays.
Modelling SARS-CoV-2 infection in a human alveolus microphysiological system
The COVID-19 pandemic has highlighted the importance of physiologically relevant in vitro models to assist preclinical research. Here we describe the adaptation of a human alveolus microphysiological system (MPS) model consisting of primary human alveolar epithelial and lung microvascular endothelial cells to study infection with SARS-CoV-2 at Biosafety Level 3 (BSL3) facility. This infection model recapitulates breathing-like stretch and culture of epithelial cells at the air-liquid interface (ALI) and resulted in clinically relevant cytopathic effects including cell rounding of alveolar type 2 cells (AT2) and disruption of the tight junction protein occludin (OCLN). Viral replication was confirmed by immunocytochemical nucleocapsid staining in the epithelium and increased shedding of SARS-CoV-2 virus within two days post-infection associated with changes in innate host immune responses. Together these data demonstrate that under the experimental conditions used in this work this human alveolus MPS chip can successfully model SARS-CoV-2 infection of human alveolar lung cells.
Epidemiological and virological characteristics of people living with HIV on antiretroviral treatment for more than six months in virological failure in Brazzaville, Republic of Congo
Introduction Virological failure is one of the major causes of treatment failure and better management of HIV infection requires understanding and controlling the factors that contribute to this phenomenon. The main objective was to characterize the patients of the active file of the Brazzaville Outpatient Treatment Center in virological failure in order to identify predictive factors that lead to virological failure.
Methods This was a cross-sectional study conducted between June and December 2020. Patients enrolled were HIV-1 infected patients from the Brazzaville Outpatient Treatment Center receiving a potent combination therapy for at least 6 months but experiencing virological failure. Viral load was determined with the automated Abbott Real-time HIV-1 m2000rt System. Sociodemographic and clinical data were collected from a computerized patient record software called Santia. Statistical analysis was performed to identify independent predictors of virological failure.
Results A total of 109 patients with virological failure were recruited. The median age of the patients was 45 years (IQR: 37-52 years) and women were more represented (74%). More than half of the patients had WHO stage IV HIV and the median duration on ARV treatment was 96 months. The most followed treatment regimen was AZT+3TC+EFV (or NVP) with 48% while the median viral load was 12985 copies/mL.
Conclusion In our study we did not identify any sociodemographic or clinical variables predictive of virological failure. However we felt that it would be desirable to carry out a study with temporal follow-up and the possibility of sequencing in order to identify the different circulating genotypes and resistance mutations.
HIV-DRIVES: HIV Drug Resistance Identification, Variant Evaluation, & Surveillance Pipeline
The global prevalence of resistance to antiviral drugs combined with antiretroviral therapy (cART) emphasizes the need for continuous monitoring to better understand the dynamics of drug-resistant mutations to guide treatment optimization and patient management as well as check the spread of resistant viral strains. We have recently integrated next-generation sequencing (NGS) into routine HIV drug resistance (HIVDR) monitoring with key challenges in the bioinformatic analysis and interpretation of the complex data generated while ensuring data security and privacy of patient information. To address these challenges here we present HIV-DRIVES (HIV Drug Resistance Identification Variant Evaluation and Surveillance) an NGS-HIVDR bioinformatics pipeline that has been developed and validated using Illumina short-reads FASTA and Sanger ab1.seq files.
Reducing Blood Culture Contamination Rates: Introduction of a Combined Education and Skin Antisepsis Intervention
Background Blood culture contamination (BCC) is an important quality concern in clinical microbiology as it can lead to unnecessary antimicrobial therapy in patients and increased workload for laboratory scientists. The Clinical Laboratory and Standards Institute recommend BCC rates to be <3% and recently updated guidelines have set a new goal of 1%. The aim of this project was to design and implement interventions to reduce BCC rates at our institution.
Methods We introduced a combined education and skin antisepsis intervention in a large Model 4 academic teaching hospital in the South of Ireland. BD ChloraPrep™ skin antisepsis applicators (2% chlorhexidine gluconate/70% isopropyl alcohol) licensed for use for blood culture collection were introduced replacing Clinell® (2% chlorhexidine gluconate/70% isopropyl alcohol) wipes. In addition a multimodal education programme was designed and delivered. This consisted of a video demonstrating the recommended blood culture collection technique using the new applicators as well as simulation training for all interns. The video was uploaded to the intranet as an educational resource available to all staff.
Results The interventions were implemented in July 2022 and BCC rates pre- and post-intervention were calculated. The average BCC rate for the 12 months preceding the intervention (July 2021-July 2022) was 2.56% with highest rates in the emergency department. This compared to an average rate of 2.2% in the 12 months post-intervention (July 2022-July 2023). In comparing the two rates the reduction in BCC rates between the two periods was not statistically significant (p=0.30).
Conclusion Overall BCC rates reduced but the difference between the two periods did not reach statistical significance. The resource intensive nature of providing regular and timely feedback of contamination rates and the larger impact of in–person education and training over virtual modalities may explain the modest reduction. Further investments in these areas particularly in the emergency department will be necessary to further reduce rates in line with new recommendations.
Virucidal activity of olanexidine gluconate against SARS-CoV-2
Antiseptics have been used for infection control against SARS-CoV-2. Ethanol (EtOH) was effective against SARS-CoV-2 while chlorhexidine gluconate (CHG) was less effective. Therefore there may be differences in virucidal activity between classes of antiseptic agents. Aim: In this study we evaluated the efficacy of antiseptics against SARS-CoV-2 and identified effective agents for infection control. Methods: The following antiseptics were used in this study: 1.5% olanexidine gluconate (OLG); 80% EtOH; 1% sodium hypochlorite (NaClO); 0.2% benzalkonium chloride (BKC); 1% povidone-iodine (PVP-I); 0.5% 1% and 1.5% chlorhexidine gluconate (CHG); and 0.5% alkyldiaminoethylglycine hydrochloride (AEG). Virucidal activity was evaluated at 0 30 s 1 2 and 3 min according to EN14476. Results: After 30 s of exposure 1.5% OLG 80% EtOH 1% NaClO 0.2% BKC and 1% PVP-I inactivated SARS-CoV-2 below the detection limit. In contrast the virus was survived in 0.5% CHG 1% CHG and 0.5% AEG after 3 min of exposure. However the virucidal activity of 1.5% CHG was insufficient after 30 s of exposure. Conclusion: This study showed that the virucidal activity against SARS-CoV-2 differs depending on the class of antiseptic agent. Despite belonging to the same class of biguanide antiseptics OLG was more effective against SARS-CoV-2 than CHG.
Gummatous mitral valve endocarditis from tertiary syphilis
A 50-year old Romanian gentleman presented with fever myalgia and 30kg weight loss. He was treated for syphilis previously after acquiring it from his ex-wife 16 years ago. On examination there was a pansystolic murmur in the axilla and the patient had an ataxic gait. Blood tests showed raised inflammatory markers. However standard investigations for infective endocarditis including multiple blood cultures serological titres for fastidious organisms and antibody tests were negative.
CT of the chest abdomen and pelvis demonstrated hepatosplenomegaly with multiple splenic infarcts. MRI of the head with contrast showed multiple punctate enhancement in the bilateral hemispheres with leptomeningeal enhancement. Transthoracic echocardiogram demonstrated large vegetation leading to severe mitral regurgitation. Serum treponemal antibodies were positive; TPPA was positive at 1:1280 and RPR: 1:4 Treponemal IgM was negative; lumbar puncture syphilis serology was negative. The patient was treated with an extensive period of intravenous antibiotics in addition to a prosthetic metallic valve replacement where unusual ragged calcified valvular tissue was observed.
Tertiary syphilis is a difficult diagnosis to confirm since it can often be indolent and occur in areas of the body where they may go unnoticed. In our case a diagnosis of syphilitic endocarditis was made from a combination of the history an initial increase in size of the lesion following antibiotic therapy and observation of likely gumma on the mitral valve during surgery. In such cases surgery in addition to optimal antimicrobial therapy is necessary for effective treatment.
Antimicrobial activity of CO2 and Er:YAG lasers against Staphylococcus aureus and Escherichia coli
The antimicrobial effect of CO2 and Erbium-doped yttrium aluminium garnet (Er:YAG) lasers against Escherichia coli Staphylococcus aureus and a mixed culture of both organisms was assessed. Bacterial isolates were exposed to lasers utilising a range of parameters. Both lasers demonstrated a reduction in bacterial viability with increased number of passes and increased power. Against the individual bacterial cultures the CO2 laser demonstrated greater a reduction in bacterial numbers with higher density and pulse durations. At a lower power and pulse duration the CO2 laser demonstrated a complete reduction against combined bacterial species with increased passes. Use of the Er:YAG laser against the individual bacterial species demonstrated that the reduction in bacterial viability was increased with an increased overlap. The Er:YAG laser was the most effective at reducing the bacterial co-cultures and was influenced by the power overlap and number of passes. Throughout this study S. aureus was more difficult to eradicate than E. coli. The findings from this work showed promising antimicrobial effects of both the CO2 and Er:YAG lasers and demonstrates that the use of such instruments is one potential avenue to be explored to develop effective novel therapies to reduce bacterial viability in infections.
Bacillus subtilis comparative genomics
As a producer of industrial enzymes and secondary metabolites Bacillus subtilis is generally considered to be more beneficial for humans animals and notably industry. Consequently it is imperative to investigate various Bacillus spp at the genome level. The comparative genomics of Bacillus spp is the subject of this manuscript. Wherein various Bacillus spp genomes were collected and examined. The sources of the bacteria included fermented foods soil and liquid wastes. A wide range of bioinformatics resources and tools were used in the study for genome annotation assembly and comparison. The isolate B. subtilis S2 is closely linked to the B. subtilis SRCM103571 and B. subtilis SRCM104005 species cluster according to the phylogenetic tree analysis. The WGS is also unique in that it produces two bacteriocins Sublancin and Subtilosin A according to antiSMASH & BAGEL-4 analysis. Subsequent investigation revealed that it has the fewest rRNA -just nine-and tRNA -72. However at 4438 it has the highest number of genes which makes the S2 strain distinct at the genome level. We conclude by noting the different nature of B. subtilis S2.
Phenotypic Characterization of Carbapenem-Resistant Enterobacteriaceae in Presumptive Tuberculosis Patient across One Health Interface
Introduction: Globally Nigeria remains one of the 30 countries highly burdened with tuberculosis (TB) TB/Human immunodeficiency virus and multidrug-resistant TB (MDR-TB). Objective: This study aimed to characterize carbapenem-resistant Enterobacteriaceae (CRE) in presumptive tuberculosis patients across one health interface. Methods: Sixty-six sputum samples from presumptive tuberculosis patients fecal samples of animals loitering the hospital and environmental soil samples were collected and characterized. Isolated Enterobacteriaceae were screened for multidrug resistance and characterized for carbapenemase production. Result: Fifty-seven enterobacteriaceae were isolated from 66 samples of sputum fecal and soil samples. The frequency of occurrence of Klebsiella pneumoniae was 66.7% and 100% in sputum and fecal samples respectively while 60% of the soil sample was Proteus mirabilis. Multidrug resistance was exhibited with ceftizidime showing the highest resistance of 100% augumentin (95.7%) and nitrofurantoin (59.6%) in sputum samples. Animal and fecal samples showed similar resistance patterns to antibiotics with gentamicin cefixime augementin and nitrofurantin. Majority (70.2%) were carbapenemase-producing Enterobacteriaceae while only 34% were producing metallo-beta lactamase from sputum samples. Conclusions: The interconnectivity and frequency of CRE occurrence was found to be high in this study across the three pillars of One Health.
Bacteriological profile of community peritonitis operated in a Moroccan Hospital
Introduction. Peritonitis is characterized by acute inflammation of the peritoneum often resulting from digestive organ perforation or intra-abdominal septic focus. It may be either of infectious or noninfectious origin. The germs involved are those of the digestive flora (Enterobacteriaceae and Anaerobic) while gram-positive cocci and yeasts can be isolated in nosocomial infections. Our study aims to isolate and identify the germs involved in community-acquired peritonitis in order to assess their susceptibility to the antibiotics available in our Country.
Methods. This is a retrospective study of bacteriological profile of community peritonitis in Rabat Morocco. A total of 150 adult patients with peritonitis were admitted and samples were collected intraoperatively for bacteriological examination between July 1 2022 and April 30 2023.
Results. Among the 150 patients 101 (67.8%) were males and 48 (32.2%) were females with sex/ratio of 2.1. The mean age of the patients was 40.5 years +/- 20.12. The distribution of germs was dominated by Escherichia coli (44%). Overall 70% of Escherichia coli isolated had a resistance to Ampicillin but no resistance to Ampicillin has been reported by Enterococcus.
Discussion. In the present study we were interested in the bacteriological profile of community peritonitis in order to adapt the antibiotic therapy to our bacterial ecology. Our findings indicate a concerning trend of increasing resistance among Escherichia coli to the commonly used Amoxicillin/Clavulanic Acid combination in our clinical setting.
Conclusion. Consequently there is a need to reassess the empiric antibiotic prescribed for the management of community-acquired peritonitis.
Microbiota of healthy dogs demonstrate a significant decrease in richness and changes in specific bacterial groups in response to supplementation with resistant starch, but not psyllium or methylcellulose, in a randomized cross-over trial.
Even though dietary fibers are often used as prebiotic supplements in dogs the effect of individual types of fibers on canine microbiota composition is unknown. The objective of this study was to assess changes in fecal microbiota richness diversity and taxonomic abundance with 3 different fiber supplements in dogs. These were psyllium husk resistant starch from banana flour and methylcellulose. They were administered to 17 healthy dogs in a cross-over trial after transition to the same complete feed. Fecal scores and clinical activity indices were recorded and fecal samples collected before and at the end of supplementation as well as 2 weeks after each supplement (washout). Illumina NovaSeq paired-end 16S rRNA gene sequencing was performed on all samples. After quality control and chimera removal alpha diversity indices were calculated with QIIME. Differences in specific taxa between groups were identified using Metastats. Methylcellulose significantly increased fecal scores but had no effect on microbiota. Psyllium resulted in minor changes of specific taxa abundance but with questionable biological significance. Resistant starch reduced microbiota richness and resulted in the most abundant changes in taxa mostly a reduction in short-chain fatty acid producing genera of the Bacillota phylum with an increase in genera within the Bacteroidota Pseudomonadota Actinomycetota and Saccharibacteria. In conclusion while psyllium and methylcellulose led to few changes in the microbiota composition the taxonomic changes seen with resistant starch may indicate a less favorable composition. Based on this the type of resistant starch used here cannot be recommended as a prebiotic in dogs.
Investigating the impact of temperature on growth rate of the root rot fungus, Gymnopus fusipes
Gymnopus fusipes is an understudied root rot pathogen associated with multiple tree species and is linked to episodes of oak decline across the United Kingdom and Europe. Although the reported distribution of G. fusipes is broad many observations rely solely on visual identification of fruiting bodies which can be unreliable and lack confirmation by molecular and/or isolation data to verify this broad ecological range. Given the paucity of information regarding the true ecological distribution of G. fusipes it is difficult to predict and model the potential distribution of the species under both current and future climate scenarios. In this study to determine the growth capabilities of G. fusipes across a range of ecologically relevant temperatures five geographically diverse isolates of G. fusipes were grown at five different temperatures ranging from 4˚C to 37˚C to determine the optimal temperature for G. fusipes growth and to establish whether geographically diverse isolates exhibit local adaptation to temperature tolerance. Incubation temperature had a significant effect on G. fusipes growth rate with 25˚C representing the optimum (p < 0.001). Isolates had differing growth rates at each of the temperatures with an isolate from the UK having the highest overall growth rate across all five temperatures tested (p < 0.001) and at the optimum increased by a mean value of over 4915 mm2. Local adaptation to temperature tolerance was not found in the isolates tested. These data demonstrate the optimal incubation temperature for future laboratory studies on G. fusipes and provide the first data on the growth rate of this pathogen across ecologically relevant climate ranges that may inform land managers modellers and policy makers in predicting the current and potentially future geographical limits of this widespread root rot pathogen.
Fannyhessea vaginae causing bacteraemia and vertebral osteomyelitis: first report of invasive disease in a male
Introduction. Fannyhessea vaginae (formerly Atopobium vaginae) is an anaerobic organism commonly associated with female genital flora with rare cases of invasive disease reported in females.
Case report. We discuss the case of an 81-year-old male who presented with an acute history of back pain and signs of urinary tract infection in the context of intermittent self-urinary catheterisation. Multiple blood cultures grew Fannyhessea vaginae with a later finding of lumbar vertebral osteomyelitis as the cause of back pain. Treatment was commenced with ampicillin later switched to ceftriaxone with improvement of acute signs of infection.
Conclusion. Gram positive anaerobic organisms including Fannyhessea vaginae are possibly under-recognised causes of urinary tract particularly in older males. These bacteria may prove challenging to grow in standard protocols for urine culture; anaerobic or extended incubation could be considered particularly in complicated cases of urinary tract infection without an identifiable pathogen.
Disseminated hydatidosis an unusual presentation: A case report
Hydatidosis also known as cystic Echinococcosis is a widespread zoonosis caused by a tapeworm of the genus Echinococcus. It presents a significant public health concern particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon even in regions where it is endemic with an incidence ranging from 1 to 8%. The definitive diagnosis relies on parasitological method. In this work we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology-mycology laboratory of “The Ibn Sina University Hospital”. This is a 21-year-old patient residing in a rural area who presented with heaviness-type pain in the right hypochondrium accompanied with nausea and vomiting. During the examination the patient mentioned the contact with dogs. Abdominal radiography (Ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology. After 9 months of treatment with albendazole the patient underwent surgery for excision of the cysts shown on the x-ray as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination along with the viability test revealed the presence of hooks and scolex of non-viable Echinococcus granulosus. Disseminated hydatidosis is a rare but serious presentation and the positive diagnosis relies on several epidemiological clinical radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient's prognosis.
Clinical Presentation and Outcome of Enteric Fever in Adult Patients with Cancer; A Perspective from Pakistan
Introduction:
Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients.
Methodology:
This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with Salmonella typhi or paratyphi A B or C. We examined clinical presentation laboratory parameters antimicrobial resistance complications and outcomes. Additionally we explored the effects of chemotherapy comorbidities type of malignancy and patient age on complications and mortality.
Results:
Salmonella typhi was the most prevalent organism (72.2%) followed by Salmonella paratyphi A (22.2%) and B (5.5%). Non-resistant isolates constituted 51.5% multi-drug resistant (MDR) isolates accounted for 20% extensively drug resistant (XDR) for 14.4% and ESBL-producing for 15.5% of all enteric fever infections.. Enteric fever-associated complications were observed in 21.1% of cases. Chemotherapy in the preceding month did not affect mortality nor did age gender or malignancy type. However comorbidities were statistically significant for mortality (p-value 0.03). A total of 8.8% of patients required ICU care and the all-cause 30-day mortality rate was 13.3%
Conclusion:
Enteric fever remains prevalent in our geographical region. Unlike Non-Typhoidal Salmonella (NTS) enteric fever does not behave differently in an immunocompromised population including cancer patients.
Methods to assess porous and non-porous antibacterial, antifungal and antiviral surfaces in relation to touch and droplet transfer in medical and transport applications: a gap analysis and suggested approaches.
To help assess whether a potentially antimicrobial material surface or coating provides antimicrobial efficacy a number of standardised test methods have been developed internationally. Ideally these methods should generate data that supports the materials efficacy when deployed in the intended end-use application. These methods can be categorised based on their methodological approach such as suspension tests agar plate/zone diffusion tests surface inoculation tests surface growth tests or surface adhesion tests. To further support those interested in antimicrobial coatings to make appropriate decisions on their method selection this paper brings together an exhaustive list of methods (for porous and non-porous materials) exploring the methodological (e.g. microorganism) and environmental (e.g. temperature and relative humidity) parameters to test bacteria fungi and viruses. This analysis demonstrates that methods that test either fungi or viruses are generally lacking whilst methods that test bacteria fungi and viruses are not designed to simulate end-use/lack realistic conditions. As such a number of applications for antimicrobial activity across medical touch screens medical textiles and gloves and transport seat textiles are explored providing guidance on modifications to existing methods that may better simulate the intended end-use of antimicrobial materials.