Core-Proteomics-Based Annotation of Antigenic Targets and Reverse-Vaccinology-Assisted Design of Ensemble Immunogen against the Emerging Nosocomial Infection-Causing Bacterium Elizabethkingia meningoseptica

Elizabethkingia meningoseptica is a ubiquitous Gram-negative emerging pathogen that causes hospital-acquired infection in both immunocompromised and immunocompetent patients. It is a multi-drug-resistant bacterium; therefore, an effective subunit immunogenic candidate is of great interest to encounter the pathogenesis of this pathogen. A protein-wide annotation of immunogenic targets was performed to fast-track the vaccine development against this pathogen, and structural-vaccinology-assisted epitopes were predicted. Among the total proteins, only three, A0A1T3FLU2, A0A1T3INK9, and A0A1V3U124, were shortlisted, which are the essential vaccine targets and were subjected to immune epitope mapping. The linkers EAAK, AAY, and GPGPG were used to link CTL, HTL, and B-cell epitopes and an adjuvant was also added at the N-terminal to design a multi-epitope immunogenic construct (MEIC). The computationally predicted physiochemical properties of the ensemble immunogen reported a highly antigenic nature and produced multiple interactions with immune receptors. In addition, the molecular dynamics simulation confirmed stable binding and good dynamic properties. Furthermore, the computationally modeled immune response proposed that the immunogen triggered a strong immune response after several doses at different intervals. Neutralization of the antigen was observed on the 3rd day of injection. Conclusively, the immunogenic construct produces protection against Elizabethkingia meningoseptica; however, further immunological testing is needed to unveil its real efficacy.

Ventilator Associated Pneumonia in Pediatric Trauma Patients

Background: Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients. Methods: The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours. VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed. Results: A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%. Conclusions: A quarter of the pediatric trauma patients were diagnosed with VAP during the study period. No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis. Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.

The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data

Background Many factors contribute to the spreading of hospital-acquired infections (HAIs). Objective This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. Methods In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. Results The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. Conclusions The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

Hospital-acquired infection awareness and control practices among healthcare staff: an evaluation

Background/Aims Hospital-acquired infections pose a risk to the wellbeing of both patients and staff. They are largely preventable, particularly if hospital staff have adequate knowledge of and adherence to infection control policies. This study aimed to assess the knowledge, awareness and practice of hospital-acquired infection control measures among hospital staff. Methods A cross-sectional study was conducted among 71 staff members in a tertiary healthcare facility in Karnataka, India. The researchers distributed a questionnaire containing 33 questions regarding knowledge of hospital-acquired infections, awareness of infection control policies and adherence to control practices. The results were analysed using the Statistical Package for the Social Sciences, version 16.0 and a Kruskal–Wallis test. Results Respondents' mean percentage score on the knowledge of hospital-acquired infections section was 72%. Their mean percentage scores on the awareness and practice of infection prevention measures sections were 82% and 77% respectively. Doctors and those with more years of experience typically scored higher. Conclusion The respondents had an acceptable level of knowledge, awareness and adherence to infection control practices. However, continued training is essential in the prevention of hospital-acquired infections. The majority of the respondents stated that they were willing to undertake training in this area, and this opportunity should be provided in order to improve infection control quality.

Day case surgery

This chapter studies day case surgery. The definition of day case surgery is the planned day admission of a patient to hospital for a surgical procedure, after which there is subsequent successful and safe discharge back home on the same day. The main rationale behind day surgery is to get patients discharged home following their operations in a safe and timely manner instead of spending prolonged periods within the hospital as an inpatient. This has significant implications, including reducing hospital stay, hospital-acquired infection, and healthcare-related costs while also improving patient experience and service efficiency. Surgical, anaesthetic, and patient factors should be considered for successful day case surgery. The chapter then traces the history of day case surgery, before detailing the common day surgery procedures.

Use of a Semi-Automatic Text Message System to Improve Satisfaction with Wait Time in the Adult Emergency Department: A Cross-Sectional Survey Study (Preprint)

BACKGROUND Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of the waiting time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. OBJECTIVE We aimed to improve the perception of waiting time through the implementation of a semi-automatic text message (SMS) system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. METHODS We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire (UTAUT) for the caregiver perspective. We also monitored the frequency of system use with logs. RESULTS In total, 110 usable responses were collected (patients, 100; caregivers, 10). Findings revealed a very high level of patient satisfaction (97%), with most patients waiting outside the ED, but inside the hospital. Caregiver evaluation showed that it was very easy to use, but adoption of the system was more problematic because of the perceived additional workload associated with its use. CONCLUSIONS Although not suitable for all patients, our system allows those with a low severity sign to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only reduces the risk of hospital-acquired infection, but also improves the patient experience and was perceived as a real improvement. Further automation of the system needs to be explored in order to reduce caregiver workload and increase its utilization.

Comparison of the Value of SOFA and Pitt Bacteremia Scores in the Prognostic Evaluation of Patients With Hospital-acquired Klebsiella Pneumoniae Bloodstream Infection

This clinical research studied the value of SOFA score and Pitt bacteremia score in the prognosis assessment of patients with hospital-acquired Klebsiella pneumonia bloodstream infection. We conducted a retrospective analysis of 40 patients with hospital-acquired Klebsiella pneumoniae bloodstream infection in a tertiary hospital from January 2016 to December 2020. For these patients, the SOFA score and Pitt bacteremia score were used to evaluate the prognosis. Logistic regression was performed with the known prognosis results to obtain the best cut-off value, sensitivity, and specificity. Pitt bacteremia score [3 (3-4) points to 6 (5.5-7) points] and SOFA score [7 (6-10) points to 17 (13-17.5) points] in the survival group were lower than those in the death group (P<0.05). The SOFA score predicts the death of hospital-acquired Klebsiella pneumoniae bloodstream infection patients with a sensitivity of 80%, a specificity of 84%, and the area under curve(AUC) of SOFA score is 0.8960 (95% CI 0.7951-0.9969); Pitt bacteremia score predicts the hospital-acquired Klebsiella pneumoniae blood infection with a sensitivity of 86.67%, a specificity of 80%, and AUC of Pitt bacteremia score is 0.9413 (95% CI 0.8700- 1.000). Both the SOFA score and the Pitt bacteremia score have predictive value for the prognosis of patients with HAI (hospital acquired infection) Klebsiella pneumonia blood infection. However, the difference shows that the SOFA score has obvious accuracy and specificity in the prognosis of patients with HAI Klebsiella pneumoniae bloodstream infection, it is better than the Pitt bacteremia score and has greater application prospects in prognostic evaluation.

Effect of Trans-Cinnamaldehyde on preformed biofilm and biofilm formation of Escherichia coli isolated from urine specimens

Introduction Bacteria in most environments exist as communities of sessile cells in a selfproduced polymeric matrix known as biofilms. Biofilms are responsible for more than 80% of infections, including urinary tract infections (UTI). UTI is the most common hospital acquired infection, caused mainly by Escherichia coli (E.coli). E. coli can readily form biofilm in such infections, specially in the presence of indwelling urinary catheter. It’s difficult to eradicate bacteria in biofilms, since they are shielded from the host defense mechanisms as phagocytes and antibodies, as well as antibiotics. Searching for alternative or adjuvant substances for prevention and eradication of biofilm associated infections are therefore urgently needed. Aim of the work Studying the efficacy of the trans-cinnamaldehyde (TC) for preventing E. coli biofilm formation. Materials and methods Thirty isolates of E.coli were obtained from urine samples. To test the effect of TC on E.coli biofilm formation and preformed biofilms, microtitre plates (MTP) were inoculated with the isolated E.coli and were treated with different concentrations of TC and incubated at 37° C. A colorimetric assay was used to assess biofilm inhibition and inactivation and optical densities (OD) were compared before and after adding different TC concentrations. Results The mean OD of the isolated E.coli biofilms was 1.3 and significantly decreased when mixed with TC different concentrations. TC had high activity in inhibition of preformed E.coli biofilms, where no biofilm was detected on MTP treated with 1.25% and 1.5% TC. Conclusion TC inhibited the biofilm forming ability of E.coli isolates could fully inactivate formed biofilms, suggesting its possibility to be used as an anti-biofilm agent or adjuvant in preventing and treating UTI caused by biofilm producing E.coli.