Background: Variations in testing for Clostridium difficile infection (CDI) may hinder patient care, increase

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Abstract Background Descriptions of coronavirus disease 2019 (COVID-19) have focused on the nonpregnant adult population. This study aims to describe the clinical characteristics and perinatal outcomes of COVID-19 in pregnancy. Methods We searched databases from December 2019 to 30 April 2020. Eligible studies reported clinical characteristics, radiological findings, and/or laboratory testing of pregnant women during infection. Data were pooled across studies using a random-effects model. Results Twenty-four studies (136 women) were included. The most common symptoms were fever (62.9%) and cough (36.8%). Laboratory findings included elevated C-reactive protein (57%) and lymphocytopenia (50%). Ground-glass opacity was the most common radiological finding (81.7%). Preterm birth rate was 37.7% and cesarean delivery rate was 76%. There was 1 maternal death. There were 2 fetal COVID-19 cases. Conclusions The clinical picture in pregnant women with COVID-19 did not differ from the nonpregnant population; however, the rate of preterm birth and cesarean delivery are considerably higher than international averages.

Synthesis of a polysaccharide adhesin by icaADBC-encoded enzymes is currently the best-understood mechanism of staphylococcal biofilm development. In four methicillin-resistant Staphylococcus aureus isolates, environmental activation of icaADBC did not always correlate with increased biofilm production. Moreover, glucose-mediated biofilm development in these isolates was icaADBC independent. Apparently, an environmentally regulated, ica-independent mechanism(s) of biofilm development exists in S. aureus clinical isolates.Production of a polysaccharide adhesion, termed polysaccharide intercellular adhesion or polymeric N-acetylglucosamine, by ica operon-encoded enzymes is currently the best-understood mechanism of staphylococcal biofilm development (18, 19). Although the majority of clinical Staphylococcus aureus isolates contain the ica operon (2, 7, 10, 11), the expression of the ica operon and biofilm production are tightly regulated under in vitro conditions (20). In the laboratory, CO 2 levels, anaerobicity, glucose, and osmotic stress can all influence ica operon expression and/or biofilm development (1,8,14,22). Cramton et al. (7) demonstrated that deletion of the ica operon in S. aureus ATCC 35556 resulted in impaired polysaccharide intercellular adhesion/polymeric N-acetylglucosamine production and a biofilm-negative phenotype. However, a recent study demonstrated that mutation of the ica locus in S. aureus strain UAMS-1 had little impact on biofilm formation in vitro or in vivo (5). In addition, Lim et al. (17) recently identified a new gene, rbf (regulator of biofilm formation), which was required for biofilm formation in S. aureus but did not regulate ica operon expression. It is not clear whether these findings apply to clinical as well as reference isolates.To investigate the contribution of the ica locus to biofilm development in S. aureus clinical isolates, the environmental regulation of biofilm development by NaCl and glucose was investigated in four ica-positive, methicillin-resistant strains (BH1S, BH1P, BH1Y, and BH1CC) recovered from intensive care unit patients (Table 1). Biofilm assays using Nunclon tissue culture-treated (⌬Surface) 96-well polystyrene plates (Nunc, Denmark) were performed as described previously (5, 15). Biofilm formation was increased four-to eightfold in all four of these isolates when grown in brain heart infusion (BHI) medium supplemented with glucose compared to BHI alone (Fig. 1A). In contrast, growth in BHI supplemented with NaCl failed to induce biofilm in these isolates (Fig. 1A).To examine the contribution of ica operon expression to the biofilm phenotype of these isolates, we used reverse transcriptase PCR (RT-PCR) as described previously (4-6, 12). The methicillin-resistant S. aureus (MRSA) isolate BH1CC was grown in BHI medium and in BHI medium supplemented with NaCl, glucose, or both NaCl and glucose (Fig. 1B). The addition of NaCl to the growth medium activated ica operon expression in BH1CC even though this ica activation was not associated with any incr...

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Staphylococcus epidermidis and Staphylococcus aureus are common causes of biofilm-mediated prosthetic device-related infection. The polysaccharide adhesion mechanism encoded by the ica operon is currently the best understood mediator of biofilm development, and represents an important virulence determinant. More recently, the contributions of other virulence regulators, including the global regulators agr, sarA and sigmaB, to the biofilm phenotype have also been investigated. Nevertheless, little has changed at the bedside; the clinical and laboratory diagnosis of device-related infection can be difficult, and biofilm resistance frequently results in failure of therapy. This review assesses the way in which advances in the understanding of biofilm genetics may impact on the clinical management of device-related infection.

IMPORTANCE Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. OBJECTIVE To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. DATA SOURCES The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. STUDY SELECTION Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. MAIN OUTCOMES AND MEASURES The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. RESULTS Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). CONCLUSIONS AND RELEVANCE Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB, increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.