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Introduction: Burn wound infections remain a significant cause of morbidity and mortality in patients admitted to burn units. Burn wounds serve as a susceptible site for opportunistic colonisation by endogenous and exogenous organisms due to local and systemic immunosuppression. The bacterial infection profile changes over time in hospitalised patients which increases the risk of systemic invasion. Aim: To determine the temporal changes in the bacterial profile of burn wound infections and identify the risk factors associated with invasive infections. Materials and Methods: A prospective cohort study of patients with burn injuries was conducted over 15 months in the burns unit of a tertiary care hospital in Mumbai, Maharashtra, India. Since, it was a time bound prospective cohort study, samples from all patients admitted with burn wounds between June, 2018 and September, 2019 were considered as study participants (n=131). Wound swabs were obtained from patients upon admission and subsequently at regular intervals. Bacterial isolates were identified and their antibiotic susceptibility patterns were determined. Data were analysed to identify temporal changes in the bacterial profile to determine the risk factors associated with invasive infections. Results: A total, of 131 patients with burn injuries were included. A total of 503 swabs were collected, of which 373 (74.2%) showed bacterial growth; five (1.34%) were contaminants and were excluded from analysis. Gram-negative bacteria were the predominant isolates in the first week, whereas gram-positive organisms predominated from the second week onwards. The most common organism isolated was Pseudomonas aeruginosa (n= 100, 27.17%) followed by Staphylococcus aureus (n=84, 22.83%), Acinetobacter baumannii (n=74, 20.11%), and Klebsiella pneumoniae (n=65, 17.66%). A total of 74 blood culture specimens were collected from 47 patients suspected of having invasive infections based on clinical signs and symptoms of systemic infection clinically. Of these, 37 patients (78.7%) were culture positive. Mortality was noted in 28 patients (28/31, 90.32%) in the group with invasive infections. Upon calculating the Odds Ratio (OR), risk factors found to be associated with invasive infections included a higher degree and depth of burns and a longer hospital stay. Conclusion: The shift from gram-negative to gram-positive bacteria and the increasing resistance over time highlight the importance of ongoing surveillance and appropriate antimicrobial stewardship measures in the management of burn wound infections. [ABSTRACT FROM AUTHOR]

Purpose: Fungal rhinosinusitis is a significant and growing health concern in arid regions, with an increasing incidence over recent decades. Without timely and appropriate management, it can lead to severe complications, including potential intracranial spread. This study aims to establish efficient and rapid diagnostics for non-invasive fungal rhinosinusitis (FRS), addressing the challenge of its difficult-to-culture diagnosis. Methods: Twenty-eight patients suspected of FRS were studied using endoscopic sinus surgery to obtain tissue samples for histopathology, direct microscopy, fungal culture, quantitative PCR (qPCR) and metagenomic next-generation sequencing (mNGS) detection. A patented qPCR targeting prevalent Aspergillus species was evaluated. Results: The patient cohort had a male-to-female ratio of 9:14, with disease duration up to 50 years. Histopathologically, 23 out of 28 cases were positive. Fungal culture exhibited a sensitivity of 21.74%, with one false positive. qPCR and mNGS showed 100% sensitivity and specificity, with a 100% consistency rate for identification at the species level (23/23), and potential detection of cases with co-infections. The most common pathogen was A. flavus, followed by A. fumigatus and A. niger. Two cases involved mixed infections of A. fumigatus and A. flavus. Conclusion: qPCR and mNGS proved effective in rapidly identifying fungi from fresh sinus tissue that are challenging to culture, surpassing conventional methods. However, further evaluation and optimization with a larger cohort of patients are necessary. Histopathology is still recommended to confirm the clinical significance of the detected fungal species. [ABSTRACT FROM AUTHOR]

Background: Group B streptococcus (GBS) causes neonatal invasive disease, mainly sepsis and meningitis. Understanding the clinical characteristics, laboratory tests, and antibiotic resistance patterns of GBS invasive infections provides reliable epidemiological data for preventing and treating GBS infections. Methods: Clinical characteristics and laboratory test results from 86 patients with neonatal invasive disease (45 cases of early-onset disease [EOD] and 41 cases of late-onset disease [LOD]) recruited from Fujian Maternity and Child Health Hospital between January 2012 and December 2021 were analyzed. Results: The number of neonates with invasive GBS infections declined for 10 years. Respiratory symptoms, the first clinical presentation in EOD, were predominant (71.1%), including groan, tachypnea, and cyanosis, whereas LOD more often presented with fever (78%). Pneumonia was the most common complication (57.0%). There were 35 patients (77.8%) with pneumonia and 18 patients (40.0%) with respiratory failure in the EOD cases, which were more than those in LOD cases. Neonates in the EOD cases were more prone to myocardial damage, cerebral injury, and metabolic acidosis than those in the LOD cases. The proportion of purulent meningitis (63.4%) and anemia (29.3%) in LOD was higher than those in EOD. White blood cell count of the EOD group was higher than that of the LOD group, whereas the proportion of patients with leukopenia was lower in the EOD group (24.4%) than in the LOD group (46.3%). All the GBS strains were susceptible to penicillin, ampicillin, linezolid, quinupristin, vancomycin, or tigecycline. Erythromycin and clindamycin resistance rates were 82.6% and 84.9%, respectively. A D-test revealed 48.6% iMLSB phenotype (inducible clindamycin resistant), and cMLSB phenotype (47.3%), L-phenotypes (2.7%), and M-phenotypes (1.4%) were also found. Conclusions: The number of cases of neonatal invasive GBS infections has decreased in recent years. Patients with invasive GBS-EOD infections have insidious onset symptoms and should be diagnosed early based on clinical symptoms and laboratory examination results. GBS strains are resistant to erythromycin and clindamycin, which is not suitable for prophylactic and empirical treatment in the neonatal population in this region. [ABSTRACT FROM AUTHOR]

A global increase in the incidence of invasive group A Streptococcus (iGAS) infections was observed after lifting of COVID-19 related restrictions in 2022, and type M1 UK dominated in many countries. After seasonal declines in iGAS incidence during the summer of 2023, simultaneous, rapid expansion of a previously rare emm type 3.93 was seen beginning in November, increasing to 20% of all cases in England and 60% of all cases in the Netherlands within 4 months. emm3.93 was associated with iGAS in children 6-17 years of age and with increased risk for pneumonia or pleural empyema and meningitis in both countries. No excess risk of death was identified for emm3.93 compared with other types. Genomic analysis of historic and contemporary emm3.93 isolates revealed the emergence of 3 new clades with a potentially advantageous genomic configuration. Our findings demonstrate the value of molecular surveillance, including long-read sequencing, in identifying clinical and public health threats.