bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biofilm profile of Candida isolated from clinical specimens at a Tertiary Care hospital in India
Authors: Samaddar Arghadip , Tendolkar Uma , Baveja Sujata 
Published: March 2020

Introduction

Candida species are a leading cause of infections in immunocompromised hosts. Usage of indwelling medical devices provides ample opportunity for Candida biofilms to set up a nidus for infection that is not easily amenable to conventional antifungal therapy.
Materials and Methods
A total of 100 Candida isolates from patients with suspected candidiasis were tested for production of biofilm. Based on clinical history, 62% of the patients were found to have clinically significant infection with Candida while in 38% of the patients, Candida isolates represented commensals. Biofilm production was detected and graded by visual (test tube) and spectrophotometric (microtiter plate) methods.

Results
Fifty five percent of the Candida isolates produced biofilm. Biofilm producing abilities of clinically significant isolates (80%) was found to be significantly higher than commensals (20%). Biofilm positive Candida isolates were most commonly obtained from blood (34.5%). Biofilm production in non-albicans Candida (67.9%) was found to be significantly higher than C. albicans (38.6%). Majority of the biofilm positive Candida isolates produced Grade 2 (moderate) biofilm. Candida tropicalis accounted for maximum biofilm production comprising 20% Grade 4, 53.8% Grade 3 and 50% Grade 2 biofilm. Concordance in grading between the two methods was observed in 72.7% of the isolates. Spectrophotometric method was found to be more sensitive than visual method for detection of Candida biofilm.

Conclusion
The importance of studying Candida biofilms is to ascertain new therapeutics and techniques to manage these infections clinically and improve the outcome as these are associated with high morbidity, mortality and resistance to antifungal drugs.
Pulmonary infection due to Acrophialophora fusispora in a patient with underlying mixed connective tissue disease and chronic pulmonary aspergillosis
Authors: Samaddar Arghadip , Sharma Anuradha 
Published: March 2020

BACKGROUND
Acrophialophora fusispora is an emerging opportunistic fungus rarely implicated in human infections. Here, we report the first case of pulmonary infection due to A. fusispora from India.
CASE DESCRIPTION
A 59-year-old male, farmer by occupation was admitted to AIIMS, Jodhpur, Rajasthan, India, with complaints of cough and expectoration of yellowish sputum for last one month and gradually progressive shortness of breath for 20 days. He had past history of pulmonary tuberculosis and was a known case of COPD for last five years. He was diagnosed with mixed connective tissue disease (MCTD) for which he had been receiving treatment with azathioprine and prednisolone for 3 months. CECT of chest revealed cystic bronchiectatic changes with findings suggestive of aspergilloma. Serum Aspergillus fumigatus specific IgG levels were elevated suggestive of chronic pulmonary aspergillosis (CPA). He was tested positive for influenza A (H1N1) by RT-PCR and received treatment with oral oseltamivir but to no clinical benefit. Culture of sputum on two subsequent occasions showed growth of a fungus which was identified as Acrophialophora fusispora based on characteristic microscopic morphology and rDNA ITS sequencing. Treatment with oral itraconazole showed marked symptomatic improvement. He was discharged from the hospital with oral itraconazole to be continued for 6 months. Follow-up visit after 3 months showed significant clinical and radiological improvement.
CONCLUSION
Molecular sequencing can reliably identify A. fusispora which is crucial for initiating specific antifungal therapy. Further studies are encouraged to determine the prevalence of such infections so as to plan optimal management and improve patient outcomes.
The power is in our hands: a QI project for sustainable hand hygiene
Authors: Mohammadi-Zaniani Ghazaleh , Wales Lucy 
Published: March 2020

Background
Methicillin Sensitive Staphylococcus Aureus (MSSA) is a commensal associated with hospital acquired infection (HAI). MSSA HAI is associated with significant morbidity, and hand hygiene has been identified as a prominent component of HAI prevention strategies.

Methods
A project using Quality Improvement methodology was devised to improve rates within the surgical department: a locally identified MSSA HAI hotspot. Baseline monitoring was done using WHO checklists and departmental education presented on hand hygiene. Continued weekly auditing and feedback was carried out by the multidisciplinary team (MDT) on one ward over a four-month period, and adherence was prompted by verbal reminders and departmental education. A long-term strategy was employed for regular monitoring with a nominated member of the MDT to maintain improvements.

Results
Baseline audit revealed adherence of 10-52% for registrar-led rounds, and 22-62% for consultant-led, across the 5 points of hand hygiene. Particular weakness was noted before patient contact and entry to clinical areas, which was addressed with departmental education. Initial adherence after education was low (6-38%), but subsequent improvement was seen the following month (74-93%). Some of this was maintained over the final two months of data collection (50%-100%), and a PDSA cycle was employed to address this variability. As such, an MDT-wide monitoring schedule was put in place at the end of the data collection period.

Conclusion
This QI project sought to achieve sustainable change in adherence to hand hygiene. An MDT-wide system of monitoring and education effected this, and may prove an effective strategy in similar inpatient settings.
Epidemiology of paediatric infection a 10 year experience on the Gold Coast, Queensland, Australia
Authors: Fairbairn William 
Published: March 2020

Introduction
The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The hip and knee are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. In clinical practice, the diagnosis of septic arthritis is based on isolation of causative organism from the joint fluid or positive blood cultures plus clinical and/or radiological signs and symptoms consistent with septic arthritis.
Methods
A retrospective analysis was undertaken of paediatric joint infections presenting to the Gold Coast Orthopaedic Department between January 2008 and December 2017.

Results
A total of 155 children < 17 years old fulfilled the recruitment criteria for inclusion. 93 patients were excluded for coding issues, incorrect diagnosis and multiple encounters of the same patient with different medical teams.
Of the 62 patients in the cohort the hip was the most common joint involved (23) following by knee (16), elbow (8), ankle (6), foot (5), shoulder (2) and wrist (2). Two of the organisms were confirmed from ward aspirates and 59 from intraoperative samples. Of the microbes identified aseptic was the most common (48%) followed by MSSA (29%), step pyogenes (5%), MRSA (3%), strep pneumonia (3%), pseudomonas (3%), kingella kingae (3%), serratia marcescens (3%), haemophilus parainfuenzae (2%).

Conclusion
This study is the first to publish the epidemiological profile of paediatric joint infections on the Gold Coast Australia and highlights the most common identified pathogens but also highlights the variety of organisms implicated in the condition.
Improving Antibiotic Prescribing for UTIs in Renal Impairment
Authors: Nicolson Andrew , Aiyegbusi Oshorenua , Baggott Amy 
Published: March 2020

Background:
Urinary Tract Infections (UTIs) are the most common bacterial infections in the elderly. First line antibiotic therapy includes Trimethoprim and Nitrofurantoin, both of which should be used with caution in renal impairment. The project aim was to improve antibiotic prescribing in UTIs for patients with renal impairment.

Methods:
Initially an online questionnaire was sent to prescribers working in Forth Valley Hospital to ascertain their knowledge of antibiotic prescribing in renal failure. Quantitative data was obtained reviewing Trimethoprim and Nitrofurantoin prescriptions over 1 month (19/02/19-19/03/19) using HEPMA electronic prescribing system. These results were cross matched with patients renal function collected from SciStore database.

Results:
Despite 95% of medical staff having experience of prescribing in renal failure, 35% of those still did not feel confident in prescribing the correct antibiotic dosage with 90% of the opinion that prescribing guidance was necessary. Quantitative data showed that 12.9% (28/217) of patients treated with either trimethoprim or nitrofurantoin had renal impairment. Of these 79% had an Acute Kidney Injury and 71% a degree of Chronic Kidney Injury. 78% of the patients on Trimthoprim had an AKI and 38% of these developed hyperkalaemia. Those prescribed Nitrofurantoin 100% of this group had a concurrent Acute on Chronic Kidney Disease.

Conclusion:
79% of patients prescribed Trimthoprim or Nitrofurantoin had a degree of renal impairment leading to potential undertreatment or renal damage in the patient. As a result NHS Forth Valley has now updated prescribing guidelines regarding UTI treatment in patients with renal impairment advising alternative antibiotic therapy.
Effects of Bacteriophage on Inhibition and Removal of Multispecies Biofilms of Escherichia coli O157 and Non-O157
Authors: Zhang Yu , Hoang Minh Duc , Masuda Yoshimitsu , Honjoh Ken-ichi , Miyamoto Takahisa 
Published: March 2020

Shiga toxin-producing Escherichia coli, especially E. coli O157 is an important foodborne pathogen capable ofcoexisting in multispecies biofilms found in almost all the natural environments. Biofilm cells are usually more resistant than planktonic cells against environmental stresses. Thus, E. coli O157 in biofilms is a serious food safety concern. This study describes the characterization of a bacteriophage FP43 isolated from bovine intestine and the ability of FP43 to inhibit and remove multi species biofilms of E. coli O157 strain 196 and non-O157 strain 104. Phage FP43 has a short latent period of 15 min and a large burst size of 98 PFU/cell, with great stability at temperatures ranging from 4 to 60°C and pH from 4 to 9.
To evaluate the effects of FP43 on E. coli,in microplate, biofilm formation was determined by crystal violet stainingas well as viable counts of biofilm and planktonic cells by conventional plating method. Phage FP43 decreased biofilm adhesionof E. coli cells with equal proportions of E. coli O157 and non-O157 by 82.4%. Viable counts were also reduced by 2.76 and 2.85 log in E. coli O157 and total biofilm cells after 6-h infection, respectively, compared with control. In planktonic cells, E. coli O157 and total counts decreased by 3.44 and 3.62 log after a 4-h phage treatment, respectively. Moreover, after a 6-h exposure to phage FP43, more than 60% of established biofilms were removed, and E. coli O157 and total viable counts in biofilm were decreased by 2.07 and 1.93 log, respectively. These findings suggest that phage FP43 seems to be a potential agent against E. coli O157 in multi species biofilms.
Escherichia coli blood stream infection in cancer patients: a multicentre, multidisciplinary collaborative audit to identify risk factors in order to target preventative strategies for improvement of patient care and outcomes
Authors: Cattini Pat , Chadwick Paul , Thirkell Gary , McManamon Catriona , Kretzer Deborah , Davies Frances , Stewart Eilidh 
Published: March 2020

Background

Escherichia coli is a common cause of blood stream infections (BSI) in the UK. Published figures for E. coli BSI show higher rates in specialist cancer centres than in other hospitals, but the aetiology in oncology patients is not fully understood.
Methods
Five UK cancer centres coll aborated to review how E. coli affects oncology patients. A key part of this work has been an audit of all cases of E.coli BSI in patients in 2019 that met UK HCAI surveillance definitions. A multidisciplinary team of clinicians, nurses and pharmacists designed the audit to include >60 variables which may affect cancer patients.

Results
The risk factors for E. coli BSI among these cancer patients showed marked differences from those seen in the general UK population. The affected population was younger; there was higher rate of hospital-onset infections ; and, taking into account a number of healthcare interactions, the potential for healthcare associated infections was much higher. There was also a higher associated 30-day mortality and high rates of antimicrobial resistance in BSI isolates. Common univariate risk factors associated with BSI included use of SACT, neutropaenia, presence of acute kidney injury, presence of an invasive device, antimicrobial therapy, use of PPIs and a lack of independent hydration. By contrast, haematopoietic stem cell transplantation, mucositis and recent surgery were less common associations.

Conclusion
This audit demonstrates differences between risk factors seen in cancer patients with E.coli BSI and may explain why rates are higher in cancer centres.
It’s not the tool you use. It’s how you use it
Authors: Flint Molly , Hettle David , Hamilton Fergus 
Published: March 2020

Background
Worldwide, several clinical screening tools (including EWS, SOFA, qSOFA, SIRS and CURB65) are used on admission to identify patients at risk of sepsis-related mortality. However their ability to accurately predict mortality remains controversial. The purpose of this study was to evaluate whether the predictive performance of these tools is affected by the timing of their use.
Methods
A systematic literature search was performed using PubMed, identifying studies in adult patients with a suspected admission diagnosis of infection, sepsis or pneumonia, in which screening tools were used to predict mortality. Meta-regression analysis was performed on included studies to identify factors affecting the tool’s ability to predict mortality, with a focus on score timing.

Results
From 3901 abstracts screened, 49 studies met inclusion criteria, comprising 421,006 patients and 13 clinical screening tools. No significant difference was found between any predictive tool and mortality. Of all variables considered (size of study, setting, diagnostic group, timing), only the timing related to admission affected predictive value of the tool. Studies that reported using purely physiological measures were less sensitive, marginally more specific, but had generally poorer predictive ability than those which included additional biochemical measures.

Conclusion
Clinicians must recognise that the performance of clinical screening tools is largely related to when they are used, not the individual tool. Given such tools are used on admission to identify risk of sepsis-related mortality, future studies must consider admission scores rather than those further into patients’ admission, to avoid over-reporting any tool’s predictive ability.
Snorting Staphylococcus Aureus
Authors: Belfield Amy , Schwab Uli 
Published: March 2020

Rates of cocaine use in the UK remain high and Physicians need to be familiar with pleuropulmonary complications associated with illicit use. Respiratory symptoms (e.g cough productive of carbonaceous material/chest pain/dyspnoea/haemoptysis/wheeze) are quite common after cocaine exposure and can lead to barotrauma/asthma/ischaemic-airways-necrosis/pneumonia/interstitial-lung-disease/pulmonary-hypertension, not only after smoking volatilized crack cocaine and the combustion products/associated substances (tobacco/heroin/talc).
Proposed mechanisms that cause this, relate to the effect of cocaine on alveolar macrophages, intermixed substances and bacterial contamination.
A normally well, HIV-negative female who habitually snorts cocaine, presents with 40C°fever, chest pain and sweats. Although a smoker, she denies IVDU/smoking crack-cocaine. CXR shows a 5.5 cm thick walled left upper lobe lung abscess, associated with surrounding ground-glass consolidation, broadly based on the anterior pleura, but originating in the lung, infiltrating the anterior chest wall with reactive intercostal muscle changes on CT. She had no evidence of, nor risk factors for S. Aureus bacteraemia such as skin disorder, prosthetic devices, or immunosuppression. S. Aureus was isolated only on transcutaneous aspiration of abscess. Good therapeutic clinical/biochemical/radiological response to 6 weeks of antibiotics via OPAT.
Nasal insufflation of cocaine may cause lung complications such as lung abscess via primary infection of the lung rather than haematogenous spread. This may be due to contamination of cocaine when mixing it with other substances or the effects of cocaine on alveolar macrophages.
Evaluation of molecular rapid diagnosis of enteric bacterial infection in patients with diarrhoeal disease and its clinical and infection control impact at a large district hospital, UK
Authors: Mehta Grishma , Kandil Hala 
Published: March 2020

Introduction:
Acute diarrhoeal syndromes are usually self-limiting, but diagnostic testing and treatment may be required in some instances. Stool cultures require a significant level of technologist expertise and are labour intensive. The BD MAX™ Enteric Bacterial Panel detects over 90% of bacteria causing infectious gastroenteritis and provide rapid diagnosis. The aim of this study is to assess the diagnostic and clinical value of this rapid diagnostic tool.

Methods:
Fresh stool samples received from 68 patients were cultured according to SMI methods, and by BD MAX™ Enteric. Further 25 frozen samples were processed by both methods. Any discrepancies between the two methods where sent to reference laboratory for confirmation.

Results:
Five samples (4 fresh and one frozen) were excluded from the study due to PCR inhibition. The turnaround time was 48 hours and 4-5 days for negative and positive culture respectively. BD MAX™ Enteric provided same day result. The sensitivity of BD MAX™ Enteric was 100% for fresh samples but this was reduced to 66% if performed on frozen samples. The rapid availability of negative results guided further clinical investigation and management. While the positive results allowed timely implementation of infection control management and guided antibiotic decision process.

Conclusion:
BD MAX™ is sensitive and provides same-day results. This allowed implementation of infection control measures in timely manner and guided further patient management. However, as this panel is restricted to bacterial causes of diarrhoea, if PCR there will be a need for further testing to exclude other possible infectious causes
Awareness of Primary Health Care Providers about Vaccination in Eastern regions of Ukraine
Authors: Voloshyna Iryna , Lapii Fedir 
Published: March 2020

Background. A dramatic drop in routine immunization coverage is observed in Ukraine during recent years. Ukraine has the lowest rate of vaccination in Europe that imposes a high risk of communicable diseases on a population. More than 56.000 people sickened with measles from 2018-2019 yrs. Although Primary Health Care providers (PHCPs) in Ukraine play an important role in administering vaccines to their patients the data about PHCP's awareness regarding immunization are lacking.
Methods. A self-administered survey among 265 PHCPs (44 doctors, 221 nurses) was conducted during Public Health Trainings from 01 March to 31 April 2019 in three Eastern Ukrainian regions (Zaporizhia, Dnipro, Kharkiv). The level of basic knowledge on vaccines schedule, safety and efficacy of vaccination, communication skills ect (totally ten statements and ten questions) were evaluated.
Results. Overall 264 (99.6%) PHCPs highlighted the obvious need in strengthening evidence-based knowledge related to immunization topics and communication skills. Right answers regarding safety and efficacy of vaccines were obtained in 21% participants, 47% PHCPs had doubts for vaccine's safety and contradictions. Only 8% of participants were convinced in aspects of effective communication. Physicians had higher knowledge scores in routine vaccines schedule (32; 73%), compared to nurses (105; 47.5%), p=0.0016; but did not differ in aspects of vaccine's safety: 16% among physicians’ vs 17% among nurses (p>0,05).
Conclusion. The majority of PHCPs in Eastern regions of Ukraine have concerns about vaccines safety and efficacy, as well as lack of communication knowledge. Effective continuing evidence-based education of providers may help address these concerns.
Cast the net wide: Assessing the root causes of malaria transmission through the knowledge, attitude and practice of treated inpatients in rural western Uganda
Authors: Davies Peter , Tanner Maia , Jemari Bwambale , Henderson-Howat Susanna 
Published: March 2020

Introduction
Despite significant progress malaria entails a significant public health concern in western Uganda. This qualitative cross-sectional study explores the knowledge, attitude and practice pertaining to malaria in rural Uganda.

Methods
With ethical approval from the management committee fifty patients were recruited between March-May 2018 at Kagando Hospital, western Uganda. Those with evidence of malaria transmission were recruited, at random prior to discharge, from the medical, paediatric (parents) and maternity wards. Participants were consented and briefed by a translator prior to answering a standardised semi-structured questionnaire. Answers were anonymised before being tabulated and analysed electronically.

Results
Participants were commonly, primary-school educated, subsistence farmers (56%). Knowledge of symptoms, mosquito breeding sites and feeding habits was generally good, yet dichotomous causes of malaria were common (mosquito n=43 and“unsafe drinking water” n=25). Malaria was “normal” to 40% of respondents and 92% acknowledge that it “kills”. Ten-percent accessed herbalists and 74% self-medicated with 30% admitting to not completing the treatment. Eighty-two percent of patients received governmental net donation but household use was variable and often infrequent. Indoor residual spraying (IRS) was practiced by two participants with just 30% aware of it. Stagnant water was present in 46% of communities without any knowledge of community spraying.

Conclusions
Participants demonstrated reasonable knowledge on vector/disease characteristics and treatment. Net access was within governmental target level but household practice was highly variable. Notably there was almost no IRS and no targeted spraying. A more integrated approach to vector control could represent an appealing strategy.