APR January/February 2022 - 15

« MICROBIOLOGY
aggressively with broad-spectrum antibiotics are highly susceptible to
invading pathogens such as Clostridium difficile, the cause of chronic
diarrhea (Mullish and Williams, 2018).
What are the relative risks associated with neonates, infants, children,
young adults and the elderly? Can chronological age be cited as a risk
factor in terms of immunological function? In general, infants less than
1 year old and the elderly greater than 75 years old are included in
high-risk groups.
Old age is not solely the consequences of
wear and tear, as once believed, but both our
genes and the environment in fact regulate
aging. It is characterized by deregulated nutrient-sensing,
genomic instability, telomere
attrition, loss of protein homeostasis, epigenetic
alterations, mitochondrial dysfunction,
cellular senescence, stem cell exhaustion, and
intracellular communication. Most pertinent
to microbial infection in humans are cellular
senescence, stem cell exhaustion, immunesenescence,
and inflammation (Singh et al,
2019). Table 1 describes the different elements
contributing to the immunological response
to microbial infection. Newborns have innate
immunology and develop adaptive immunology
as they are vaccinated or exposed to community
infections (Simon et al, 2015).
Should non-sterile products used during
invasive medical interventions, e.g., central
line
catherization,
surgery,
mechanical
ventilation, wound dressing, etc. contain
a warning of potential infection or be
marketed as single-use sterile products? The
recent infection outbreak associated with
ultrasound transmission gel is instructive
(FDA recall notification).
Table 1. Elements contributing to immunological protection
against infection (Janeway's Immunobiology 2017)
Anatomic Barriers
Skin, oral mucosa,
respiratory epithelium,
and intestine
Complement
System
C3, defensins,
reglllγ
Innate System
Macrophages,
granulocytes,
natural killer cells
Adaptive
System
Β cells/antibodies,
T cells
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Waste
The Canadian
manufacturer Eco-Med recalled multiple
batches of widely-distributed non-sterile
gel that was contaminated with a member
of the Burkholderia cepacia complex that
caused blood stream infection when used
in conjugation with an invasive surgical
procedure (FDA Letter to Health Care
Providers 2021). According to the CDC, the
recalled ultrasound gel was most likely used to
guide ultrasonography using the placement
of central and peripheral intravenous
catheters or transcutaneous procedures like
paracentesis. At the time of writing, the cause
of the contamination has not been established,
but based on the experience of the author, the
lack of microbial control of the purified water
system, poor equipment cleaning practices,
and an inadequate antimicrobial preservative
system would be prime candidates.
TSI is top-choice to:
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| 15
»
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APR January/February 2022

Table of Contents for the Digital Edition of APR January/February 2022

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