Staphylococcus Aureus Bacteriuria as a Predictor of In-Hospital Mortality in Patients with Staphylococcus Aureus Bacteremia. Results of a Retrospective Cohort Study

Staphylococcus aureus bloodstream infection (SA-BSI) is an infection with increasing morbidity and mortality. Concomitant Staphylococcus aureus bacteriuria (SABU) frequently occurs in patients with SA-BSI. It is considered as either a sign of exacerbation of SA-BSI or a primary source in terms of urosepsis. The clinical implications are still under investigation. In this study, we investigated the role of SABU in patients with SA-BSI and its effect on the patients' mortality. We performed a retrospective cohort study that included all patients in our university hospital (Charité Universitätsmedizin Berlin) between 1 January 2014 and 31 March 2017. We included all patients with positive blood cultures for Staphylococcus aureus who had a urine culture 48 h before or after the first positive blood culture. We identified cases while using the microbiology database and collected additional demographic and clinical parameters, retrospectively, from patient files and charts. We conducted univariate analyses and multivariable Cox regression analysis to evaluate the risk factors for in-hospital mortality. 202 patients met the eligibility criteria. Overall, 55 patients (27.5%) died during their hospital stay. Cox regression showed SABU (OR 2.3), Pitt Bacteremia Score (OR 1.2), as well as moderate to severe liver disease (OR 2.1) to be independent risk factors for in-hospital mortality. Our data indicates that SABU in patients with concurrent SA-BSI is a prognostic marker for in-hospital death. Further studies are needed for evaluating implications for therapeutic optimization

High prevalence of anti-HCV antibodies in two metropolitan emergency departments in Germany : a prospective screening analysis of 28,809 patients

Background and Aims: The prevalence of hepatitis C virus (HCV) antibodies in Germany has been estimated to be in the range of 0.4–0.63%. Screening for HCV is recommended in patients with elevated ALT levels or significant risk factors for HCV transmission only. However, 15–30% of patients report no risk factors and ALT levels can be normal in up to 20–30% of patients with chronic HCV infection. The aim of this study was to assess the HCV seroprevalence in patients visiting two tertiary care emergency departments in Berlin and Frankfurt, respectively. Methods: Between May 2008 and March 2010, a total of 28,809 consecutive patients were screened for the presence of anti-HCV antibodies. Anti-HCV positive sera were subsequently tested for HCV-RNA. Results: The overall HCV seroprevalence was 2.6% (95% CI: 2.4–2.8; 2.4% in Berlin and 3.5% in Frankfurt). HCV-RNA was detectable in 68% of anti-HCV positive cases. Thus, the prevalence of chronic HCV infection in the overall study population was 1.6% (95% CI 1.5–1.8). The most commonly reported risk factor was former/current injection drug use (IDU; 31.2%) and those with IDU as the main risk factor were significantly younger than patients without IDU (p<0.001) and the male-to-female ratio was 72% (121 vs. 46 patients; p<0.001). Finally, 18.8% of contacted HCV-RNA positive patients had not been diagnosed previously. Conclusions: The HCV seroprevalence was more than four times higher compared to current estimates and almost one fifth of contacted HCV-RNA positive patients had not been diagnosed previously

In situ measurements of explosive compound dissolution fluxes from exposed munition material in the Baltic Sea

Underwater munitions containing millions of tons of toxic explosives are present worldwide in coastal marine waters as a result of unexploded ordnance and intentional dumping. Dissolution flux of solid explosives following corrosion of metal munition housings controls exposure of biological receptors to toxic munition compounds (MC; including TNT: 2,4,6-Trinitrotoluene, RDX: 1,3,5-Trinitro-1,3,5-triazinane, and DNB: 1,3-Dinitrobenzene). Very little is known about the dissolution behavior of MC in the marine environment. In this work, we exploit a unique marine study site in the Baltic Sea with exposed solid explosives to quantify in situ MC dissolution fluxes using dissolved MC gradients near the exposed explosive surface, as well as benthic chamber incubations. The gradient method gave dissolution fluxes that ranged between 0.001 and 3.2, 0.0001 and 0.04, and 0.003 and 1.7 mg cm-2 d-1 for TNT, RDX, and DNB, respectively. Benthic chamber incubations indicated dissolution fluxes of 0.0047-0.277, 0-0.11, and 0.00047-1.45 mg cm-2 d-1 for TNT, RDX, and DNB, respectively. In situ dissolution fluxes estimated in the current study were lower than most dissolution rates reported for laboratory experiments, but clearly demonstrated that MC are released from underwater munitions to the water column in the Baltic Sea

Quantification of munition compounds in the marine environment by solid phase extraction – ultra high performance liquid chromatography with detection by electrospray ionisation – mass spectrometry

Highlights • High resolution mass spectrometry used to detect munition compounds. • Isotope dilution used for accurate quantification of TNT. • Seven explosives and metabolites detected in seawater at ng L−1 concentrations. • Ten explosives and metabolites detected in marine biota from a contaminated site. Abstract As a consequence of World War II, large amounts of munition have been deposited in coastal waters. Deterioration of the mines and bombs is resulting in a release of munition compounds (MCs) like trinitrotoluene to the surrounding marine environment, with potential implications to ecosystems. Analytical methods have thus far been unable to detect these compounds reliably in seawater. We present a highly sensitive method for the analysis of MCs in the marine environment. We combine preconcentration and sample clean up by solid phase extraction with separation and detection by ultra-high performance liquid chromatography – electrospray ionisation – mass spectrometry (UHPLC-ESI-MS) for the detection of MCs dissolved in filtered (< 0.2 µm) seawater. For biota, dried and ground samples were extracted in acetonitrile and analysed after simple dilution. Eleven MCs were detected by UHPLC-ESI-MS with limits of detection between 0.01 and 25 pg. For the first time, we used heavy isotopes of trinitroluene and dinitrobenzene to improve quantification in environmental samples. We detected 7 MCs in waters sampled at a known munition disposal site in the Baltic Sea after a 1000-fold preconcentration and using an injection volume of 25 µL. Trinitrotoluene and dinitrobenzene were the most abundant MCs, occurring at concentrations between 0.1 and 11.8 ng L−1. We observed 10 MCs at concentrations up to 24 µg g−1 dry weight in benthic organisms sampled from the site. The enhanced sensitivity of our method allowed us to detect MCs at concentrations relevant for assessment and management of munitions disposal sites in the marine environment

Spread, Behavior, and Ecosystem Consequences of Conventional Munitions Compounds in Coastal Marine Waters

Coastal marine environments are contaminated globally with a vast quantity of unexploded ordnance and munitions from intentional disposal. These munitions contain organic explosive compounds as well as a variety of metals, and represent point sources of chemical pollution to marine waters. Most underwater munitions originate from World Wars at the beginning of the twentieth century, and metal munitions housings have been impacted by extensive corrosion over the course of the following decades. As a result, the risk of munitions-related contaminant release to the water column is increasing. The behavior of munitions compounds is well-characterized in terrestrial systems and groundwater, but is only poorly understood in marine systems. Organic explosive compounds, primarily nitroaromatics and nitramines, can be degraded or transformed by a variety of biotic and abiotic mechanisms. These reaction products exhibit a range in biogeochemical characteristics such as sorption by particles and sediments, and variable environmental behavior as a result. The reaction products often exhibit increased toxicity to biological receptors and geochemical controls like sorption can limit this exposure. Environmental samples typically show low concentrations of munitions compounds in water and sediments (on the order of ng/L and μg/kg, respectively), and ecological risk appears generally low. Nonetheless, recent work demonstrates the possibility of sub-lethal genetic and metabolic effects. This review evaluates the state of knowledge on the occurrence, fate, and effect of munition-related chemical contaminants in the marine environment. There remain a number of knowledge gaps that limit our understanding of munitions-related contaminant spread and effect, and the need for additional work is made all the more urgent by increasing risk of release to the environment

Risk factors for nosocomial SARS-CoV-2 infections in patients: results from a retrospective matched case–control study in a tertiary care university center

Background: Factors contributing to the spread of SARS-CoV-2 outside the acute care hospital setting have been described in detail. However, data concerning risk factors for nosocomial SARS-CoV-2 infections in hospitalized patients remain scarce. To close this research gap and inform targeted measures for the prevention of nosocomial SARS-CoV-2 infections, we analyzed nosocomial SARS-CoV-2 cases in our hospital during a defined time period. Methods: Data on nosocomial SARS-CoV-2 infections in hospitalized patients that occurred between May 2020 and January 2021 at Charite university hospital in Berlin, Germany, were retrospectively gathered. A SARS-CoV-2 infection was considered nosocomial if the patient was admitted with a negative SARS-CoV-2 reverse transcription polymerase chain reaction test and subsequently tested positive on day five or later. As the incubation period of SARS-CoV-2 can be longer than five days, we defined a subgroup of "definite" nosocomial SARS-CoV-2 cases, with a negative test on admission and a positive test after day 10, for which we conducted a matched case-control study with a one to one ratio of cases and controls. We employed a multivariable logistic regression model to identify factors significantly increasing the likelihood of nosocomial SARS-CoV-2 infections. Results: A total of 170 patients with a nosocomial SARS-CoV-2 infection were identified. The majority of nosocomial SARS-CoV-2 patients (n = 157, 92%) had been treated at wards that reported an outbreak of nosocomial SARS-CoV-2 cases during their stay or up to 14 days later. For 76 patients with definite nosocomial SARS-CoV-2 infections, controls for the case-control study were matched. For this subgroup, the multivariable logistic regression analysis revealed documented contact to SARS-CoV-2 cases (odds ratio: 23.4 (95% confidence interval: 4.6-117.7)) and presence at a ward that experienced a SARS-CoV-2 outbreak (odds ratio: 15.9 (95% confidence interval: 2.5-100.8)) to be the principal risk factors for nosocomial SARS-CoV-2 infection. Conclusions: With known contact to SARS-CoV-2 cases and outbreak association revealed as the primary risk factors, our findings confirm known causes of SARS-CoV-2 infections and demonstrate that these also apply to the acute care hospital setting. This underscores the importance of rapidly identifying exposed patients and taking adequate preventive measures

Isoforms of Retinol binding protein 4 (RBP4) are increased in chronic diseases of the kidney but not of the liver

<p>Abstract</p> <p>Background</p> <p>The levels of retinol-binding protein 4 (RBP4) – the carrier protein for Vitamin A in plasma – are tightly regulated under healthy circumstances. The kidney, the main site of RBP4 catabolism, contributes to an elevation of RBP4 levels during chronic kidney disease (CKD) whereas during chronic liver disease (CLD) RBP4 levels decrease. Little is known about RBP4 isoforms including apo-RBP4, holo-RBP4 as well as RBP4 truncated at the C-terminus (RBP4-L and RBP4-LL) except that RBP4 isoforms have been reported to be increased in hemodialysis patients. Since it is not known whether CLD influence RBP4 isoforms, we investigated RBP4 levels, apo- and holo-RBP4 as well as RBP4-L and RBP4-LL in plasma of 36 patients suffering from CKD, in 55 CLD patients and in 50 control subjects. RBP4 was determined by ELISA and apo- and holo-RBP4 by native polyacrylamide gel electrophoresis (PAGE). RBP4-L and RBP4-LL were analyzed after immunoprecipitation by mass spectrometry (MALDI-TOF-MS).</p> <p>Results</p> <p>RBP4 isoforms and levels were highly increased in CKD patients compared to controls (P < 0.05) whereas in CLD patients RBP4 isoforms were not different from controls. In addition, in hepatic dysfunction RBP4 levels were decreased whereas the amount of isoforms was not affected.</p> <p>Conclusion</p> <p>The occurrence of RBP4 isoforms is not influenced by liver function but seems to be strongly related to kidney function and may therefore be important in investigating kidney function and related disorders.</p

Prevalence and morbidity of intestinal helmiths and protozoans in a fishing community in Northeastbrazil and adverse effects after antihelminthic treatment

Intestinale Helminthen und Protozoen sind ein bedeutendes Gesundheitsproblem in Nordostbrasilien, vor allem bei den sozial schwach gestellten Bewohnern. Es gibt allerdings nur wenige Daten über die Prävalenz intestinaler Helminthen und Protozoen im Bundesstaat Alagoas. Ebenso fehlen Informationen über die mit Helminthen und Protozoen assoziierte Morbidität und die Nebenwirkungen verschiedener Antiparasitika. In der vorliegenden Studie wurde deshalb die alters- und geschlechtsspezifische Prävalenz und Morbidität intestinaler Helminthen und Protozoen in Feliz Deserto untersucht. Nach Durchführung einer Massenbehandlung mit antiparasitären Medikamenten wurde die Assoziation der Nebenwirkungen mit bestimmten Medikamenten und Erregern geprüft. Insgesamt war die Prävalenz intestinaler Parasiten in der Studienbevölkerung mit 76% sehr hoch. Die Prävalenz intestinaler Helminthen lag bei 70,5%, die von Protozoen bei 27%. Kinder und Jugendliche (unter 20 Jahren) waren signifikant häufiger mit intestinalen Helminthen und Protozoen infiziert als Erwachsene, die Prävalenz betrug in dieser Altersgruppe knapp 90%. Im höheren Alter (>20 Jahre) waren immer noch ca. 60% der Bewohner von Feliz Deserto mit intestinalen Parasiten infiziert. A. lumbricoides und T. trichiura hatten einen Prävalenzpeak bei den 5-9 Jährigen (63 bzw. 52%), bei Hakenwürmern wurde die maximale Prävalenz bei den 14-19 Jährigen (52%) nachgewiesen. Überraschend war die Präsenz von S. mansoni (9%), da Feliz Deserto bislang nicht als Endemiegebiet für Schistosomiasis bekannt war. G. lamblia wurde bei Kleinkindern unter 5 Jahren am häufigsten (25%) gefunden. E. histolytica/E. dispar wurde bei 13% der Bewohner nachgewiesen. Die Helminthenspezies S. stercoralis, H. nana, E. vermicularis waren selten, Taenien wurden bei keinem Bewohner nachgewiesen. Geschlechtsspezifische Unterschiede waren vor allem bei Hakenwürmern auffällig. Männer waren sowohl in der Gesamtbevölkerung, als auch im Alter von 10-19 Jahren signifikant häufiger mit Hakenwürmern infiziert. In der Gesamtbevölkerung konnte jedoch kein geschlechtsspezifischer Unterschied hinsichtlich der Häufigkeit von intestinalen Parasitosen gefunden werden. Die Morbidität in der der Bevölkerung Feliz Deserto war hoch. Knapp 80% hatten kontinuierliche oder intermittierende Beschwerden. Am häufigsten wurden abdominelle Schmerzen beklagt (50%). Nebenwirkungen nach der antihelminthischen Therapie waren selten. Es konnte kein Unterschied – weder in der Anzahl noch in der Qualität der Nebenwirkungen - zwischen den drei Medikamentengruppen nachgewiesen werden. Die in dieser Studie nachgewiesene hohe Prävalenz von intestinalen Helminthen und Protozoen fordert die Durchführung von regelmäßigen Entwurmungsmaßnahmen, beispielsweise im Rahmen von Massenchemotherapien.Intestinal parasites are an important public health problem: worldwide, more than two billion people are chronically infected with intestinal parasites, and an estimated 300 million people present symptoms due to parasite infection, including impaired physical and cognitive performance. In the northeast of Brazil, intestinal parasites are a common problem. However, no studies exist, assessing the prevalence of intestinal parasites in Alagoas, a poor region in the Northeast of Brazil. The aim of this study was to asses the prevalence of intestinal helminths and protozoa in a small village in Alagoas, the parasites related morbidity in the community and adverse effects due to antihelminthic treatment. Therefore, stool samples were analysed using the formalin ether concentration method and inhabitants were asked for chronic symptoms which could be related with intestinal parasitic infection. Finally, antihelminthic treatment was performed and people were asked for adverse effects afterwards. Infections with intestinal parasites were found in 76% of the participants. No significant difference was observed between male and females. Highest prevalence was observed in school aged children (5-19 years). However, prevalence of intestinal parasites remained high also in the elderly (>20years) inhabitants (50-60%). A. lumbricoides was found most frequently (55%) followed by A. duodenale and T. trichiura (38% and 32% respectively). Due to transmission, faecal-oral parasites had a prevalence peak in young children (5-9 years) while in the transcutaneous parasites, highest prevalence was observed in elder children (10-19 years). Morbidity was high; nearly 80% revealed chronic symptoms potentially associated with the prevalence of intestinal parasites. The most frequent symptom was abdominal pain (50%). Antihelminthic treatment was well tolerated, and side effects did not differ significantly between people treated with Ivermectin, Albendazol or Mebendazol. Most complained by the participants was abdominal discomfort (22%), while all other adverse events appeared in less than 5%. These data – the high prevalence of intestinal parasites,the high morbidity in the population and the good tolerability of antihelminthic treatment - imply the necessity of regular antihelminthic mass treatments in high endemic areas. Preventive programms should not only target on schoolchildren but include all age-group, also to minimize the risk of a reinfection