A survey of tuberculosis infection control practices at the NIH/NIAID/DAIDS-supported clinical trial sites in low and middle income countries

BACKGROUND: Health care associated transmission of Mycobacterium tuberculosis (TB) is well described. A previous survey of infection control (IC) practices at clinical research sites in low and middle income countries (LMIC) funded by the National Institute of Allergy and Infectious Diseases (NIAID) conducting HIV research identified issues with respiratory IC practices. A guideline for TB IC based on international recommendations was developed and promulgated. This paper reports on adherence to the guideline at sites conducting or planning to conduct TB studies with the intention of supporting improvement. METHODS: A survey was developed that assessed IC activities in three domains: facility level measures, administrative control measures and environmental measures. An external site monitor visited each site in 2013–2014, to complete the audit. A central review committee evaluated the site-level survey and results were tabulated. Fisher’s exact test was performed to determine whether there were significant differences in practices at sites that had IC officers versus sites that did not have IC officers. Significance was assessed at p</=.05 RESULTS: Seven of thirty-three sites surveyed (22 %) had all the evaluated tuberculosis IC (TB IC) elements in place. Sixty-one percent of sites had an IC officer tasked with developing and maintaining TB IC standard operating procedures. Twenty-two (71 %) sites promptly identified and segregated individuals with TB symptoms. Thirty (93 %) sites had a separate waiting area for patients, and 26 (81 %) collected sputum within a specific well-ventilated area that was separate from the general waiting area. Sites with an IC officer were more likely to have standard operating procedures covering TB IC practices (p = 0.02) and monitor those policies (p = 0.02) and perform regular surveillance of healthcare workers (p = 0.02). The presence of an IC officer had a positive impact on performance in most of the TB IC domains surveyed including having adequate ventilation (p = 0.02) and a separate area for sputum collection (p = 0.02) CONCLUSIONS: Specific and targeted support of TB IC activities in the clinical research environment is needed and is likely to have a positive and sustained impact on preventing the transmission of TB to both health care workers and vulnerable HIV-infected research participants. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1579-y) contains supplementary material, which is available to authorized users

Variant analysis from bacterial isolates affirms DnaK crucial for multidrug resistance

Next-generation sequencing and associated computational analyses have become powerful tools for comparing the whole genomes and detecting the single nucleotide polymorphisms (SNPs) within the genes. In our study, we have identified specific mutations within the plausible drug resistant genes of eight multidrug resistant (MDR) bacterial species. Essentially, we have unearthed few proteins, involved in folding and enabling survival under stress, to be the most crucial ones from the network of the whole genome protein interactome (PIN) of these species. To confirm the relevance of these proteins to antibiotic resistance, variant analyses were performed on all the selected MDR species, isolated from patients’ samples in PATRIC database, against their respective reference genomes. The SNPs found in the patient isolates revealed the nucleotide changes from C to A on DnaK, thereby altering a single amino acid change that might lead to misfolding of proteins. Thus, we propose DnaK to be the best characterized bacterial chaperone having implications in multidrug resistance. To this end, to provide an alternative solution to tackle MDR, docking studies were performed with a phenaleno-furanone derivative which revealed the highest binding energy and inhibition against DnaK