Protocols for the Use of a Novel Biofilm-Disrupting Wound Irrigation Solution for Prevention of Surgical-Site Infections After Total Joint Arthroplasty

Surgical-site infections are potential complications of total joint arthroplasties. Many strategies, ranging from preoperative to postoperative, have been developed in an attempt to mitigate this morbidity. Biofilms have been implicated in difficulties of treatment. Therefore, antimicrobials have been increasingly used to combat these problems. In this report, we will summarize different protocols which utilize a new antimicrobial solution. Providing surgeons with an effective prevention option for these infections is crucial for positive outcomes and the continued advancement in the practice of total joint arthroplasty.

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Severe Invasive Disease Caused by Serotype 3 Streptococcus Pneumoniae in Italian Children

The effectiveness and impact of the 13-valent pneumococcal conjugate vaccine (PCV13) against invasive pneumococcal diseases (IPD) due to serotype 3 (ser3) has been questioned. However, the impact of PCV13 on different clinical presentations of ser3-IPD has not been studied so far. The impact of PCV13 on different clinical presentations of ser3-IPD in a population of Italian children aged 0–8 years was evaluated, comparing pre- and post-PCV13 introduction period. Real-time polymerase chain reaction (PCR) was used for the diagnosis and serotyping of IPD. During the observation period (1 January 2006–1 August 2018), ser3 was detected in 60/284 (21.1%) children under 8 with serotyped IPD. The incidence of sepsis and meningitis was 0.24 per 1,000,000 person-years (p-y) in pre-PCV13 and 0.02 per 1,000,000 p-y in post-PCV13. No cases occurred in vaccinated children. In the post-PCV13 period, case reduction was 13% for all ser3 IPD and 92% for sepsis and meningitis. Vaccination impact may be underestimated due to significant improvement in pneumococcal surveillance in post-PCVC13. Our data suggest a significant impact of PCV13 on meningitis and sepsis due to ser3 and a lower impact against pneumonia. While waiting for increasingly effective anti-pneumococcal vaccines, PCV13, which guarantees protection against the most severe clinical presentations of ser3-IPD, is currently the most effective prevention option available.

ACaulobacter crescentusMicrobicide Protects from Vaginal Infection with HIV-1JR-CSFin Humanized Bone Marrow-Liver-Thymus Mice

ABSTRACTOver 2 million people are infected with HIV-1 annually. Approximately half of these new infections occur in women residing in low-income countries, where their access to and control over HIV-1 preventative measures are often limited, indicating that female-controlled prevention options for HIV-1 are urgently needed. Microbicides that can be topically applied to the vaginal tract in advance of sexual activity represent a promising female-controlled prevention option for HIV-1. We have previously described the development of an HIV-1-specific microbicide using the surface or S-layer recombinant protein display capabilities of the nonpathogenic, freshwater bacteriumCaulobacter crescentus. RecombinantC. crescentusbacteria were created that displayed proteins that interfere with the HIV-1 attachment and entry process and that were able to provide significant protection of TZM-bl cells from infection with HIV-1 pseudovirus. These studies have been expanded to investigate if these recombinantC. crescentusbacteria are able to maintain efficacy with replication-competent HIV-1 and both TZM-bl cells and human peripheral blood mononuclear cells (PBMCs). In addition, we utilized the humanized bone marrow-liver-thymus (BLT) mouse model to determine if vaginal application of recombinantC. crescentusat the time of HIV-1JR-CSFinfection could provide protection from HIV-1 infection. RecombinantC. crescentusbacteria expressing Griffithsin, GB virus C E2 protein, elafin, α-1-antitrypsin, indolicidin, and the fusion inhibitor T-1249 were able to protect 40 to 75% of the BLT mice from vaginal infection with HIV-1JR-CSF, withC. crescentusbacteria expressing Griffithsin being the most effective. Taken together, these data suggest that aC. crescentus-based microbicide could be a safe and effective method for HIV-1 prevention.IMPORTANCEHuman immunodeficiency virus (HIV) disproportionally infects young women in sub-Saharan Africa. Current HIV-1 prevention options have had limited success among women, suggesting that alternative, female-controlled prevention options need to be developed. Microbicides that can be applied to the vaginal tract are a promising prevention option. In this study, we describe the testing of 15 potential candidates for inhibition of HIV-1 infection in a humanized mouse model of HIV-1 infection. Four of these candidates were able to provide significant protection from vaginal infection with HIV-1, with the most successful candidate protecting 75% of the mice from infection. This study describes the preclinical testing of a new strategy that could be a safe and effective option for HIV-1 prevention in women.

Unsupervised PrEP in routine practice: a new challenge?

Pre-exposure prophylaxis (PrEP) for the prevention of HIV infection with 300 mg daily tenofovir co-formulated with 200 mg emtricitabine is recommended as one prevention option for people who are at substantial risk of acquiring an HIV infection. We report the case of a 28-year-old man who has sex with men and who was referred to our unit for a primary HIV infection with positive p18, p24 and gp160 bands on Western blot analysis but with a low HIV plasma viral load. Although HIV misdiagnosis should always be considered in cases of atypical seroconversion pattern with a low viral burden, unsupervised PrEP should be systematically investigated.

Nipah Virus (NiV) Infection: Is Nepal Prepared for the Possible Outbreak?

After 20 years of the first Nipah Virus (NiV) outbreak in the world, it re-emerged as the outbreak in India. WHO has recognized NiV as a potent epidemic threat to human health. Both animal-to-human and human-to-human transmission of zoonotic NiV has been documented. Fruit bat of Pteropodidae family is the natural reservoir of the virus. Thus, the territorial habitat of these bats is the high risk zone of NiV outbreak. The symptoms are very nonspecific and the pathogenicity of NiV is yet to be fully understood. Diagnosis of NiV infection still relies on molecular techniques. Till date, no drugs or vaccines against NiV has been approved. Some research have presented arrays of the possible treatment and prevention option, but without sure shot implications. So, appropriate precautions are the only currently available prevention option. Nepal is yet to experience a NiV outbreak but that does not undermine the risk posed to the general population. High risk countries including Nepal should be well prepared to tackle the possible outbreak in future.