Enhanced CAUTI Risk due to Strong Biofilm Forming MDR Bacteria in Indwelling Urinary Catheters

The achievement of modern medicine is due to development and extensive use of indwelling biomedical devices like urinary catheters, heart valves, Vascular bypass grafts, ocular lenses and artificial joints, among others. Untreated nosocomial infections due to urinary catheter- biofilms pose great health risk to patients. This study focuses on the isolation, molecular identification, antibiotic susceptibility profiling and physicochemical characterization of strong biofilm producers from indwelling urinary catheters. Out of 34 isolates 19 strong biofilm producers were segregated using Microtitre plate and Congo red agar methods. Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Morganella morganii and Enterococcus faecalis, which are common causative agents of Catheter-Associated Urinary Tract Infection (CA-UTI) were identified by molecular characterization and phylogenetic analyses. All strong biofilm formers were multi drug resistant by modified Kirby- Bauer method and Multiple Antibiotic Resistance (MAR) index was also calculated Further physicochemical characterization included hydrophobicity and autoaggregation assays. All the strong biofilm producers exhibited multiple antibiotic resistance. More than 60 per cent of the selected strains were strongly hydrophobic. No significant connection between autoaggregation and hydrophobicity was observed. All the characteristics of these strains including biofilm formation, multiple antibiotic resistance, hydrophobicity and auto aggregation abilities made them strong candidates for CA-UTI.

Fibrosing Mediastinitis

Fibrosing mediastinitis is an uncommon thoracic disorder characterized by the extensiveproliferation of fibrous tissue in the mediastinum. This disorder frequently develops followingHistoplasma capsulatum infection with involvement of mediastinal lymph nodes. The fibroustissue can invade and compress mediastinal structures, including vessels, large airways, andthe esophagus. These patients may present with cough, sputum production, and dyspneadepending on location and extent of fibrosis. The radiographic presentation depends on thetype and extent of obstruction. Diagnosis requires computed tomography with angiography,ventilation-perfusion scans, and pulmonary function tests. Management depends on thestructures involved and the extent of infiltration and/or compression. Possible approachesinclude the use of endobronchial stents, intravascular stents, vascular bypass grafts, andthe resection of nonfunctional pulmonary tissue. Extensive surgical procedures are usuallynot warranted. These patients usually do not respond to antifungal or anti-inflammatorymedications. Several patients have responded to rituximab, and this drug is a possibleconsideration in patients with ongoing inflammation in the mediastinum.