Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases-International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (similar to 5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%-90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs' implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted. (C) 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences

Heterogeneity in patterns of survival of the invasive species Ipomoea carnea in urban habitats along the Egyptian Nile Delta

Plant traits are critical for understanding invasion success of introduced species, yet attempts to identify universal traits that explain invasion success and impact have been unsuccessful because environmenttrait- fitness relationships are complex, potentially context dependent, and variation in traits is often unaccounted for. As introduced species encounter novel environments, their traits and trait variability can determine their ability to grow and reproduce, yet invasion biologists do not often have an understanding of how novel environments might shape traits. To uncover which combination of traits are most effective for predicting invasion success, we studied three different urban habitat types along the Nile Delta in Egypt invaded by the Pink Morning Glory, Ipomoea carnea Jacq. (Family: Convolvulaceae). Over two years, we measured ten plant traits at monthly intervals along an invasion gradient in each habitat. No single trait sufficiently explained survival probability and that traits linked to invasion success were better predicted by the characteristics of the invaded habitat. While the measured traits did influence survival of I. carnea, the importance of specific traits was contingent on the local environment, meaning that local trait-environment interactions need to be understood in order to predict invasion

Heterogeneity in patterns of survival of the invasive species Ipomoea carnea in urban habitats along the Egyptian Nile Delta

Plant traits are critical for understanding invasion success of introduced species, yet attempts to identify universal traits that explain invasion success and impact have been unsuccessful because environment-trait-fitness relationships are complex, potentially context dependent, and variation in traits is often unaccounted for. As introduced species encounter novel environments, their traits and trait variability can determine their ability to grow and reproduce, yet invasion biologists do not often have an understanding of how novel environments might shape traits. To uncover which combination of traits are most effective for predicting invasion success, we studied three different urban habitat types along the Nile Delta in Egypt invaded by the Pink Morning Glory, Ipomoea carnea Jacq. (Family: Convolvulaceae). Over two years, we measured ten plant traits at monthly intervals along an invasion gradient in each habitat. No single trait sufficiently explained survival probability and that traits linked to invasion success were better predicted by the characteristics of the invaded habitat. While the measured traits did influence survival of I. carnea, the importance of specific traits was contingent on the local environment, meaning that local trait-environment interactions need to be understood in order to predict invasion

Richness, phylogenetic diversity, and abundance all have positive effects on invader performance in an arid ecosystem

In search of generalities in biological invasions, it is sometimes forgotten that invader success can be a function of both the diversity of the invaded community and the relatedness of the invader relative to community residents. Both qualities are likely to be especially important in stressful ecosystems, and identifying the species and community attributes that influence biological invasions can help direct management efforts in a sensitive ecosystem like those in arid regions. Pink Morning Glory, Ipomoea carnea Jaq. (Family: Convolvulaceae), is an annual vine native to Central and South America and is invasive in Egypt. We examined the performance of I. carnea at different densities in assembled communities of Egyptian annual native species. The native plant communities were manipulated to represent gradients of species richness and phylogenetic diversity and relatedness to I. carnea . We quantified the performance of I. carnea in these communities and examined the contribution of resident species richness, phylogenetic diversity, and phylogenetic relatedness to invader resistance. Our findings revealed that there was a positive relationship between invader performance and its mean phylogenetic distance to the resident species. Furthermore, species‐rich communities with more distantly related species positively contributed to invader performance in contrast to the classic biotic resistance hypothesis. Beyond these positive relationships, a positive density‐dependent effect of I. carnea on its performance was observed. We conclude that facilitative interactions are potentially important drivers promoting the successful invasion of the nonnative species I. carnea in water‐limited and harsh ecosystems. These results suggest that perhaps contrary to understanding from temperate systems, communities with a higher diversity of species could be more likely to be invaded by arid‐adapted species that are distantly related to natives. Thus, policy and management in arid regions should carefully consider reviewing the importation of nonnative species that are phylogenetically distinct and adapted to arid conditions and prioritizing their control once they are established

COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience

Patients with COVID-19 are at risk of developing secondary complications such as invasive pulmonary aspergillosis and mucormycosis. This is a retrospective study including all cancer children diagnosed with COVID-19-associated pulmonary fungal infection (CAPFI) during the period 2020–2021. A total of 200 patients were diagnosed with COVID-19, out of which 21 (10%) patients were diagnosed with CAPFI, 19 patients (90%) with COVID-aspergillosis (CAPA), and 2 (10%) patients with COVID-mucormycosis (CAM). Patients with CAPFI were classified using the “2020 ECMM/ISHAM consensus criteria”; proven in 2 (10%) patients, probable in 12 (57%), and possible in 7 (33%) patients. Although the hematological malignancy patients were already on antifungal prophylaxis, breakthrough fungal infection was reported in 16/21 (75%), 14 (65%) patients had CAPA while on echinocandin prophylaxis, while 2 (10%) patients had CAM while on voriconazole prophylaxis. Overall mortality was reported in 8 patients (38%) while CAPFI-attributable mortality was reported in 4 patients (20%). In conclusion, clinicians caring for pediatric cancer patients with COVID-19 should consider invasive pulmonary fungal infection, even if they are on antifungal prophylaxis, especially with worsening of the clinical chest condition. A better understanding of risk factors for adverse outcomes may improve clinical management in these patients

Functional similarity and dissimilarity facilitate alien plant invasiveness along biotic and abiotic gradients in an arid protected area

Two contradictory hypotheses have been put forth to forecast alien invasiveness: being either functionally similar, or dissimilar, to resident natives along environmental gradients. The ‘try-harder’ hypothesis predicts that alien plants will be functionally dissimilar to natives and should thus exhibit exaggerated trait values when compared to natives in respect to resource extraction or stress tolerance. In contrast, the ‘join- the-locals’ hypothesis, which is compatible with “environmental filtering”, predicts functional similarities among alien and native species in richer, but not in resource- limited environments. Here, we propose a framework that links the successful alien plant strategy, i.e. being functionally similar or dissimilar to natives, to the harshness of the environment and the availability of resources. We tested these two hypotheses using a trait-environment dataset of 33 alien and 130 native plants in 96 sites covering a gradient of soil resources (organic matter, nitrogen, soil moisture) in Saint- Katherine, an arid protected area in Egypt. We estimated 18 interaction coefficients between three candidate traits (specific leaf area, above-ground biomass, height) of alien and native plants as well as soil resources using linear mixed-effects models. Additionally, we calculated the mean and the hierarchical functional distance among aliens and natives along soil gradients. Our results revealed that in extreme resource- limited environments, aliens and natives were functionally similar and had relatively equal trait values consistent with environmental filtering, thus supporting the ‘join-the- locals’ hypothesis. However, in environments richer in resources, aliens and natives were functionally dissimilar with aliens exhibiting more exploitative trait values (taller, higher SLA and biomass) than natives, providing support for the ‘try-harder’ hypothesis. While demonstrated in only one arid system, results suggest that linking soil resource availability with functional divergence and convergence among native and alien plants could be used as an informative strategy to predict alien invasiveness. Hence, future studies should investigate the functional response of alien and native plants in different environments against different resource gradients to test for the generality of the patterns we found

Carbapenem-Resistant <i>Enterobacteriaceae</i> (CRE) among Children with Cancer: Predictors of Mortality and Treatment Outcome

Carbapenem-resistant Enterobacteriaceae (CRE) is an important emerging threat among pediatric cancer patients, with a high mortality rate. This retrospective study included all pediatric cancer patients with (CRE) bloodstream infections (BSIs) at a children’s cancer hospital in Egypt (2013–2017). Two hundred and fifty-four pediatric cancer patients with CRE BSI were identified; 74% had hematological malignancies, and 26% had solid tumors. Acute myeloid leukemia was the most common hematological malignancy (50%). The main clinical features for acquiring CRE-BSI were previous antibiotics exposure (90%), profound neutropenia (84%), prolonged steroid use (45%), previous colonization with a resistant pathogen (35%), ICU admission within 90 days (28%), and central venous catheter use (24%). E. coli was the most common isolated pathogen (56%), followed by Klebsiella pneumoniae (37%). All isolates were resistant to carbapenem with an MIC 8 μg/mL in 153 (55%). The overall mortality rate was 57%, and 30 day mortality was reported in 30%. Upon multivariate analysis, for the patients with Klebsiella pneumoniae BSI, carbapenem resistance with an MIC > 8 μg/mL and associated typhlitis or pneumonia were predictors of poor outcome. In conclusion, CRE-BSI is a major threat among pediatric cancer patients in limited resource countries with limited options for treatment. Antimicrobial stewardship for early detection through routine screening, adequate empirical treatment, and timely adequate therapy may impact the outcome for such high-risk patient groups

Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive and Psychiatric Dysfunction in Patients with Fibromyalgia: A Double-Blinded, Randomized Clinical Trial

Few randomized controlled trials have reported that repetitive transcranial magnetic stimulation (rTMS) has controversial results for managing multiple domains of fibromyalgia-related symptoms. This work aimed to evaluate the effect of low-frequency rTMS over the right dorsolateral prefrontal area (DLPFC) on the Fibromyalgia Impact Questionnaire (FIQ) concerning psychiatric and cognitive disorders. Forty-two eligible patients with fibromyalgia (FM) were randomized to have 20 sessions of active or sham rTMS (1 Hz, 120% of resting motor threshold with a total of 1200 pules/session) over the right DLPFC. All participants were evaluated at baseline, post sessions, and 3 months after sessions with the FIQ, Hamilton depression, and anxiety rating scales (HDRS and HARS), Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Tower of London test (TOL), the Trail Making, and Digit Span Tests. Both groups showed improvement in most rating scales at 1 and 3 months follow-up, with greater improvement in the active group, with significant correlation between FIQ cognitive rating scales, including RAVLT and TOL. Twenty sessions of low-frequency rTMS over the right DLPFC can improve FIQ scores regarding the psychiatric and cognitive symptoms of medicated patients with FM to a greater extent than sham. Changes in RAVLT and TOL correlated with changes in FIQ results

Mucormycosis in the Middle East and North Africa: Analysis of the FungiScope(R)registry and cases from the literature

Background Regional differences in the underlying causes, manifestations and treatment of mucormycosis have been noted in studies covering Europe, Asia and South America. Objectives To review cases of mucormycosis across the Middle East and North Africa (MENA) region in order to identify epidemiological, treatment and outcome trends in this region. Patients/Methods Cases of proven or probable invasive mucormycosis from the region were identified from the FungiScope(R)database and the medical literature. For each case, information on underlying condition, site of infection, pathogenic species, therapeutic intervention, type of antifungal therapy and outcome were analysed. Results We identified 310 cases of mucormycosis in the MENA region. The number of reported cases increased by decade from 23 before 1990 to 127 in the 2010s. In this region, the most common underlying conditions associated with mucormycosis were diabetes mellitus (49.7%) and conditions associated with immunosuppression (46.5%). The majority of patients received treatment with antifungals (93.5%), with a large proportion treated with both antifungals and surgery (70.6%). Overall mortality rates decreased from 47.8% before 1990 to 32.3% in the 2010s. Conclusions The number of reported cases of mucormycosis in the MENA region has risen over the past few decades, in line with increases in the number of patients with underlying conditions associated with this infection. Although the majority of patients received treatment with antifungal therapies and/or surgery, the associated mortality rate remains high and there is a clear need for more effective prevention and treatment strategies in the MENA region