Anaerobic Infections Research Articles

Capabilities and limitations of antibacterial and complex surgical treatment of inflammation-purulent limb lesion

Purpose of the study. The effectiveness of limb inflammation-purulent lesions (LIPL) treatment on the base of own experience was estimate.Material and methods. 190 patients were treated for LIPL, including:1. Acute LIPL – 142 cases, namely: acute complication of diabetes mellitus (phlegmon, arthrosteopathy, tissue necrosis) was found in 119, acute thrombophlebitis against the background of post-thrombophlebitis syndrome 5, lymphangitis against the background of a chronic limb wound in 5, erysipelas in 4, inflammation after manicure/pedicure at 4, scratching a cat at 3, an injection of fish bone at 3, a bite of a parasite in 2 and a bite of a dog in 2 patients.2. Chronic LIPL was observed in 48 patients who were followed up for 4 months to 13 years. The cause of repeated visits was the formation of a chronic wound/ulcer of the foot or lower leg (35 cases), the re-occurrence of acute inflammation – 13 cases. The background disease was diabetes mellitus in18 post-thrombophlebitis syndrome complicated by lymphostasis in 17, cancer in 7, systemic collagenosis in 4, and HIV infection in 2 patients.Results and discussion. Complicated wound healing occurs in 39,5% cases of surgeries on acute inflammation and in 37% cases in chronic. Among 104 patients with foot surgery antibiotic treatment was ineffective in 48,1%, high amputation incidence estimates 3,8%. After primary high amputation complicated wound healing estimates 21,7%. By combination of aimed and prolonged antibacterial treatment and full-fledged fasciotomy it was possible to ceased anaerobic non gas producing infection and hand compartment-syndrome.Conclusions. 1. In the case of non-effective antibacterial treatment of the LIPL requires reassessment of the pathogen and the appointment of an appropriate antibiotic, while determining the need for surgical intervention.2. Dangerous to patient’s life are anaerobic non gas producing infection, which demands instant clindamycin treatment, and sepsis, which demands clindamycin or/and carbapenem treatment.In-time surgery, fasciotomy or limb amputation in the case of such infections needed beside of this.3. Slow wound cleansing and granulations formation, which lead to prolonged infection and its antibiotic resistance supposed to patient extra examination for revealing concomitant disease and it stabilization.

2183. Survival Impact and Clinical Predictors of Anaerobic Bloodstream Infection

BackgroundFew controlled studies are available for the outcome and risk factor analysis of anaerobic bloodstream infection (BSI). We conducted a cohort study to identify the clinical predictors and survival impact of anaerobic BSI as compared with aerobic BSI.MethodsConsecutive emergency department patients in a tertiary medical center with laboratory confirmed BSI between 2015 and 2016 were prospectively enrolled. We compared demographics, comorbidity, and sources of infection between anaerobic and aerobic BSI. We then constructed a multivariable logistic regression model to identify independent risk factors for anaerobic BSI. The survival impact of anaerobic BSI was evaluated by propensity score-matched analysis.ResultsWe identified 1,166 episodes of BSIs during the 2-year study period, of which 61 (5.2%) were anaerobic BSI. Clinical variables predicted anaerobic BSI with moderate discrimination (optimism corrected C statistic = 0.75). Significant predictors included metastatic cancer (OR 6.03, 95% CI 2.78–13.09), intra-abdomen infection (OR 3.92, 95% CI 1.47–10.45), liver abscess (OR 2.65, 95% CI 1.26–5.62), skin and soft-tissue infection (OR 2.40, 95% CI 1.13–5.08) as the positive predictors. Urinary tract infection (OR 0.15, 95% CI 0.04–0.62), diabetes mellitus (OR 0.38, 95% CI 0.18–0.78), or thrombocytopenia (OR 0.33, 95% CI 0.18–0.60) were identified as the negative predictors of anaerobic BSI. Anaerobic BSI were not associated with worse prognosis in either adjusted (HR 1.08, 95% CI 0.68–1.72) or PS-matched analysis (HR 1.50, 95% CI 0.61–3.67).ConclusionAnaerobic BSI accounted for a significant proportion (approximately 1 in 20) of community-onset BSI. Clinical predictors identified in this study may help guide the prescription of empiric anti-anaerobe antibiotics. The apparent adverse outcome associated with anaerobic BSI may be explained by the underline comorbidity, high-risk infection site, and inadequate initial antibiotics. Disclosures All authors: No reported disclosures.

Pneumocephalus as a complication of multidrug-resistant Klebsiella Pneumoniae bacteremia in patient with acute myeloid leukemia

Pneumocephalus indicates air in the cranial cavity and commonly results from craniofacial trauma and neurosurgical procedures. Infections can rarely cause pneumocephalus through formation of brain abscess, or as complication of chronic otitis media, or meningitis. Patients might present with headache, fever, change in mental status and diagnosis is confirmed by Brain CT scan. A 51 years old male diagnosed with acute myeloid leukemia (AML) and admitted for fourth cycle of consolidation chemotherapy. He developed prolonged febrile neutropenia and septic shock and multi-organ failure due to Klebsiella Pneumoniae MDR bacteremia. Patient had persistent bacteremia despite being on Meropenem, Colisten, Levofloxacin, Caspofungin, Tigecycline. Due to profound thrombocytopenia, he had severe pulmonary hemorrhage and bilateral diffuse subarachnoid hemorrhage. Repeated CT brain angiography later showed extensive pneumocephalus with finding suggestive of brain death. Ethical approval for case report obtained. Meningitis associated with pneumocephalus is rare and has been reported in gas-forming organisms such as E. coli, Klebsiella Pneumoniae, Bacteroides, mixed aerobic and anaerobic species and streptococcus infection. Treating the underlying meningitis might results in resolution of pneumocephalus, although fatal outcomes were reported. Pneumocephalus secondary to Klebsiella Pneumoniae meningitis is uncommon and one case reported successful treatment using meropenem and amikacin for MDR Klebsiella Pneumoniae meningitis associated with pneumocephalous resulting from chronic otitis media. Pneumocephalus associated with MDR K. pneumonia bacteremia is very rare and had high mortality rate especially in setting of febrile neutropenia with multi-organ failure. Intracerebral hemorrhage in setting of persistent bacteremia might increase the risk of pneumocephalus.

Analysis of Ornidazole Injection in Clinical Use at Post-marketing Stage by Centralized Hospital Monitoring System.

This study aims to analyze the clinical use of ornidazole injection at the post-marketing stage by centralized hospital monitoring system method, and investigate its widespread use in patients, in order to regulate and guide the rational drug use, improve the drug specificity and provide a basis for drug therapy. The study adopts a prospective, multi-center, large sample size, centralized hospital monitoring system. We selected five leading hospitals in Hubei province, and observed the inpatients who received the ornidazole injection from July 1, 2015 to October 31, 2015. The basic information of patients was recorded, as well as the drug use and adverse events. The statistical analysis was performed based on these data. A total of 4396 individuals were enrolled in this study, most of them were middle-aged female patients and the ornidazole injection was mainly used as prophylactic prior to surgery to prevent the infections, and surgical treatment of anaerobic infections, abdominal infections and pelvic infections. The irrational drug use existed mainly in the prescribing and administration process, including unreasonable dosing frequency, rapid intravenous drip speed and extended duration of drug use. Eleven cases of adverse reactions were collected during the monitoring, incidence rate of adverse reactions was 2.5‰; adverse drug reactions occurred within 30 min. The study results fully reflected the usage of ornidazole injection in the real world. Based on the study, we calculated the adverse reaction incidence of ornidazole and identified the risk factors which may affect the safety of ornidazole injection. Study results strongly recommend that the manufacturers should publish standards for inpatient use and doctors should prescribe with caution accordingly.

NECROTIZING CAVITARY LUNG MASS IN PATIENT WITH AIDS: A RARE MANIFESTATION OF PNEUMOCYSTIS JIROVECII PNEUMONIA

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Pulmonary infections in immunocompromised hosts encompass a wide differential diagnosis. Of the possible etiologies, Pneumocystis jirovecii presents as a rare cause of necrotizing cavitary pneumonia, particularly in patients with advanced HIV and AIDS. CASE PRESENTATION: A 50-year-old male patient presented with progressively worsening cough productive of green blood-tinged sputum of 2-week duration, associated with pleuritic chest pain, night sweats, and diarrhea. Past medical history was significant for AIDS due to HIV-1 with CD-4 count 73/mm3 not on antiretroviral therapy. He was admitted to an outside hospital two months prior for similar symptoms, and chest x-ray at that time demonstrated no acute process (figure 1A). On presentation he was tachycardic, tachypneic, and afebrile. Oxygen saturation was 98-100% on room air. Physical examination revealed inspiratory crackles on right upper lung field auscultation with associated dullness to percussion, tenderness in the epigastrium and right upper quadrant of the abdomen, and oral thrush. CXR demonstrated diffuse airspace opacification throughout the right upper lobe (RUL), with internal lucent areas consistent with cavitation (figure 1B). A follow-up chest computed tomography (CT) with intravenous contrast demonstrated cavitation of the RUL, with cystic spaces and air fluid levels (figure 2,3). Sputum culture was grossly contaminated with oropharyngeal flora. Three consecutive acid-fast bacilli (AFB) sputum smears were initially negative. Pneumocystis qualitative PCR was positive, with B-D glucan assay (Fungitell) of 239 pg/mL (ref range: <60 pg/mL). Histoplasma urine antigen was negative. Cryptococcus serum testing was negative. A bronchoscopy with bronchoalveolar lavage (BAL) demonstrated findings consistent with necrotizing cavitary pneumonia. Pneumocystis was again identified on qualitative PCR. Anaerobic and aerobic culture, AFB culture, Nocardia, Legionella, and fungal culture were negative. No malignant cells were visualized. After 4 weeks of incubation, the AFB culture from sputum sampling on admission demonstrated Mycobacterium avium complex (MAC) growth in 1 of 3 samples consistent with contamination. DISCUSSION: This case highlights the complexity of cavitary pulmonary lesion diagnosis in an patient with AIDS. The diagnosis of Pneumocystis pneumonia (PCP) was made through sputum and BAL qualitative PCR testing, with fungitell assay testing. The atypical radiographic presentation necessitated exclusion of alternate diagnoses. The possibility of superimposed anaerobic infection was not entirely ruled out, however the location of cavitation with multiple negative cultures on sputum and BAL sampling made this less likely. CONCLUSIONS: Pneumocystis jirovecii can present as a necrotizing cavitary pneumonia, and increased awareness regarding this atypical and rare presentation is critical for accurate diagnosis and prompt management. Reference #1: Gadkowski, LB., Sout, J. Cavitary Pulmonary Disease. Clin Microbiol Rev. 2008 Apr; 21(2): 305-333. https://doi.org/10.1128/CMR.00060-07 DISCLOSURES: No relevant relationships by Odaliz Abreu Lanfranco, source=Web Response No relevant relationships by Sophia Binz, source=Web Response No relevant relationships by Raef Fadel, source=Web Response No relevant relationships by Daniel Ouellette, source=Web Response No relevant relationships by Aula Ramo, source=Web Response

Prevalence and susceptibility pattern of anaerobic bacteria isolated from wound swabs in Clinical Centre University of Sarajevo

Objectives: Anaerobic bacteria may cause numerous infections in different locations through human body. Those infections can be life-threatening with significant mortality. Wounds represent a suitable habitat for colonization of anaerobic bacteria. Their proliferation contributes to moist and warm environment, hypoxic and necrotic tissue.Methods:A retrospective study was conducted at the Clinical Centre University of Sarajevo from 2015-2017. The study involved wound swab samples, sampled from hospitalized patients. The anaerobic bacteria were isolated using standard procedures.Results: During the period from 01.01.2015. to 31.12.2017, 8386 samples were analyzed on anaerobic bacteria and 872 (10.4%) of specimen were positive. In 2015, 332 (15%) specimens were positive, while during 2016 and 2017, 244 (7,8%) and 296 (9.9%) respectively. Bacteroides spp. was the most common isolate during three year period: 2015-227 (55.5%); 2016-139 (48%); 2017-161 (42,5%). It was followed by Peptococcus spp.: 2015-70 (17.1%); 2016-40 (13.9%); 2017-66 (17.4%), Clostridium spp.: 2015 – 32 (7.8%); 2016-21 (7.3%); 2017- 35 (9.2%), Fusobacterium spp.: 2015 – 49 (11.9%); 2016-32 (11.1%); 2017- 45 (11.9%).VITEK 2 Compact has identified to the level of species 48 isolates which were in pure culture.The largest number of anaerobic bacteria were isolated from the samples received from the Abdominal surgery. The overview of antimicrobial sensitivity showed highest sensitivity to metronidazole (99,9%) and carbapenems (99,9%), respectively.Conclusions The most commonly isolated anaerobic bacteria was Bacteroides spp.Highest number of positive isolates was from abdominal surgery since intra-abdominal infections reflect the microflora of the resected organ. Metronidazole remains the antibiotic of choice in the treatment of anaerobic infections.

Actinomycosis of maxillary antrum presenting as nasal polypi: a rare case

&lt;p class="abstract"&gt;Actinomycosis is a rare anaerobic bacterial infection that presents in the form of cervicofacial, pulmonary, thoracic and abdominopelvic infections. It is usually caused by &lt;em&gt;Actinomyces israelii &lt;/em&gt;which are a part of normal flora of aerodigestive tracts. They are opportunistic pathogens and cause infections which have odontogenic origin in oral cavity. Cervicofacial actinomycosis accounts for more than half of the cases and commonly affects the mandible. We are reporting a case of actinomycosis of left maxillary antrum presenting as a nasal polypi in a young man. He had presented with nasal discharge and yellowish crusts from left nasal cavity. Diagnostic nasal endoscopy revealed yellowish polypoidal mass arising from the left middle meatus. CT PNS showed soft tissue density mass measuring 3.7×4.3×4.1 cms in left maxillary antrum extending through and obliterating osteomeatal complex extending into left ethmoidal sinus. Patient underwent Functional endoscopic sinus surgery. The yellowish polypoidal mass in left nasal cavity was attached to the floor of the maxillary antrum by a thin stalk and had filled up the antrum. Histopathology of the specimen revealed inflammatory polyp with actinomycosis. Patient had an uneventful recovery and was put on long term antibiotics and regular follow up.&lt;/p&gt;

Comparison of 16S Ribosomal RNA Targeted Sequencing and Culture for Bacterial Identification in Normally Sterile Body Fluid Samples: Report of a 10-Year Clinical Laboratory Review.

As 16S ribosomal RNA (rRNA)-targeted sequencing can detect DNA from non-viable bacteria, it can be used to identify pathogens from clinical samples even in patients pretreated with antibiotics. We compared the results of 16S rRNA-targeted sequencing and culture for identifying bacterial species in normally sterile body fluid (NSBF): cerebrospinal, pericardial, peritoneal and pleural fluids. Over a 10-year period, a total of 312 NSBF samples were evaluated simultaneously using 16S rRNA-targeted sequencing and culture. Results were concordant in 287/312 (92.0%) samples, including 277 (88.8%) negative and 10 (3.2%) positive samples. Of the 16 sequencing-positive, culture-negative samples, eight showed clinically relevant isolates that included Fusobacterium nucleatum subsp. nucleatum, Streptococcus pneumoniae, and Staphylococcus spp. All these samples were obtained from the patients pretreated with antibiotics. The diagnostic yield of 16S rRNA-targeted sequencing combined with culture was 11.2%, while that of culture alone was 6.1%. 16S rRNA-targeted sequencing in conjunction with culture could be useful for identifying bacteria in NSBF samples, especially when patients have been pretreated with antibiotics and when anaerobic infection is suspected.

Higher proportion of low-virulence anaerobic bacterial infection in young patients with intervertebral disc herniation.

Intervertebral disc (IVD) degeneration caused by the latent infection of low-virulence anaerobic bacteria (LVAB) is a hot research topic. The present study analyzed and compared the positive rate of LVAB within IVDs of patients of different ages. IVD samples were intraoperatively retrieved from 176zpatients with disc herniation and subjected to microbiological culture. Subsequently, all the patients were classified into 3 groups based on their ages as follows: Group A (age <30 years), group B (age from 30 to 50 years) and group C (age >50 years) and the positive rates of LVAB were compared among the three groups. The severity of IVD degeneration was also assessed by measuring intervertebral height. Of the 176 cultured discs, 39 samples had bacterial growth, while 6 of them were suspiciously contaminated. Follwoing the exclusion of the 6 suspicious samples, 31 samples were Propionibacterium acnes and 2 samples were coagulase-negative Staphylococci of the remaining 33 samples, The bacterial positive rates were significantly higher in younger patients, with 34.4% (11/32), 25.5% (13/51) and 10.3% (9/87) in group A, B and C, respectively. More importantly, the bacterial-positive samples had a significantly lower disc height compared with the negative samples in groups A and B. Therefore, it can be reasonably concluded that younger patients have a much higher prevalence of LVAB infection in herniated IVDs and a greater severity of IVD degeneration when infected by bacteria. The LVAB may have a strong association with IVD degeneration, particularly in young patients.

Cervical anaerobic vertebral osteomyelitis following surgical tracheotomy: a case report

BackgroundWe report a rare case of anaerobic vertebral osteomyelitis associated with surgical tracheotomy which has never been reported to the best of our knowledge.Case presentationA healthy 39-year-old man was admitted to intensive care for a severe brain trauma injury where a surgical tracheotomy was performed. He was discharged to a rehabilitation centre after 54 days hospital stay. During rehabilitation, he developed progressive and febrile tetraplegia associated with cervical pain, requiring an intensive care readmission. A polymicrobial anaerobic bloodstream infection was revealed and magnetic resonance imaging diagnosed cervical vertebral osteomyelitis. Both the type of anaerobic micro-organisms found and the timing of the symptoms strongly suggest that the surgical tracheotomy was responsible for this rare case of cervical vertebral osteomyelitis. The patient was successfully treated by a prolonged antimicrobial therapy and by surgical laminectomy.ConclusionsTracheotomy may generate anaerobic bacteraemia and related osteomyelitis in the specific setting of severe trauma patients. Clinicians should consider anaerobic vertebral osteomyelitis when they are confronted with a febrile tetraplegia after tracheotomy.

In vitro Reconstitution of the Biosynthetic Pathway to the Nitroimidazole Antibiotic Azomycin

Nitroimidazoles are one of the most effective ways to treat anaerobic bacterial infections. Synthetic nitroimidazoles are inspired by the structure of azomycin, isolated from Streptomyces eurocidicus in 1953. Despite its foundational role, no biosynthetic gene cluster for azomycin has been found. Guided by bioinformatics, we identified a cryptic biosynthetic gene cluster in Streptomyces cattleya and then carried out in vitro reconstitution to deduce the enzymatic steps in the pathway linking l-arginine to azomycin. The gene cluster we discovered is widely distributed among soil-dwelling actinobacteria and proteobacteria, suggesting that azomycin and related nitroimidazoles may play important ecological roles. Our work sets the stage for development of biocatalytic approaches to generate azomycin and related nitroimidazoles.

Worse lung cancer outcome in patients with lower respiratory tract infection confirmed at time of diagnosis

BackgroundPulmonary malignancy is one of the most frequent and fatal cancers in older patients. As data on lower respiratory tract infection (LRTI) and the outcome of lung cancer are scarce, our objective was to determine the impact of LRTI on therapeutic possibilities and one‐year mortality.MethodsPatients undergoing bronchoscopy in 2017 who had bronchial microbial sampling at the time of the lung cancer diagnosis (n = 143) were included. Group 1 (LRTI+) included patients with confirmed infection (n = 74) while Group 2 (LRTI‐) included patients without infection (n = 69). Clinical characteristics, pathogen profile and one‐year survival were analyzed.ResultsAge, gender, TNM stage, histology type, comorbidities or underlying lung disease did not differ among groups. The most common LRTI pathogens included aerobic (n = 49), anaerobic (n = 14) and fungal (n = 26) infections. Chemo/immune/target therapy alone, or in combination with radiotherapy were significantly less frequently used, whilst palliative care was more common in Group 1 (LRTI+). Multiple pathogen LRTI patients were significantly older, less frequently diagnosed with adenocarcinoma and had worse performance status compared to solitary pathogen LRTI patients. One‐year median survival was 274 days (235 vs. 305 days Group 1 vs. Group 2). Risk factors for increased one‐year mortality included performance status ≥2 (OR 30.00, CI 95% 5.23–313.00), performance status 1 (OR 11.87, CI 95% 4.12–33.78), male gender (OR 4.04, CI 2.03–8.04), LRTI with multiple pathogens (OR 2.72, CI 1.01–6.81) and nonadenocarcinoma histology (OR 2.26, CI 1.15–4.56).ConclusionLRTIs in lung cancer patients, especially multiple pathogen infections, are associated with less oncotherapeutic possibilities and significant risk for lower one‐year median survival.

In vitro Reconstitution of the Biosynthetic Pathway to the Nitroimidazole Antibiotic Azomycin

AbstractNitroimidazoles are one of the most effective ways to treat anaerobic bacterial infections. Synthetic nitroimidazoles are inspired by the structure of azomycin, isolated from Streptomyces eurocidicus in 1953. Despite its foundational role, no biosynthetic gene cluster for azomycin has been found. Guided by bioinformatics, we identified a cryptic biosynthetic gene cluster in Streptomyces cattleya and then carried out in vitro reconstitution to deduce the enzymatic steps in the pathway linking l‐arginine to azomycin. The gene cluster we discovered is widely distributed among soil‐dwelling actinobacteria and proteobacteria, suggesting that azomycin and related nitroimidazoles may play important ecological roles. Our work sets the stage for development of biocatalytic approaches to generate azomycin and related nitroimidazoles.

The Microbiology Characteristics of Infected Branchial Cleft Anomalies.

ObjectivesTo investigate the microbiology profile of infected branchial cleft anomalies compared to deep neck infection and explore the influence of age on culture findings.Study DesignA retrospective case control study.SettingA single tertiary medical center.Subjects and MethodsPatients treated for branchial cleft anomalies between 2006 and 2016 were included. Demographic data, disease and treatment parameters, and microbiology profile, including bacteria classification, antibiotics resistance patterns, and number of pathogens, were analyzed.ResultsOf 278 cases treated for branchial cleft anomalies, we have analyzed 69 cases with infection and pathogen identification. The proportion of monobacterial infections was higher (70.6% vs 44.3%; P = .003; odds ratio [OR], 3.02) and the proportion of Streptococcus species infection was lower (48.9% vs 77.2%; P = .001; OR, 0.282) among the infected branchial cleft cases compared to deep neck infections. Anaerobic bacteria infection did not differ between groups (17.8% and 16.5%, respectively). There was a nonsignificant tendency toward more resistant bacterial strains among the infected branchial clefts (15.6% vs 6.3%; P = .118; OR, 2.726). There was no difference between the bacterial profile of patients younger or older than 16 years.ConclusionsThe microbiology profile of infected branchial cleft anomalies is not age related and is different from that of deep neck infections. We demonstrate a relatively high frequency of monobacterial infections, relatively lower streptococcal infection rates, and a substantial contribution by resistant species and anaerobes. Empiric antibiotic treatment should cover Streptococcus species, including penicillin-resistant species, as well as clindamycin-resistant anaerobes.

A Review on the Role of Lipid in Selected Apicomplexan, Anaerobic, Kinetoplastid and Intestinal Parasitic Infections.

A Review on the Role of Lipid in Selected Apicomplexan, Anaerobic, Kinetoplastid and Intestinal Parasitic Infections.

Acute cholangitis: Diagnosis and management.

Acute cholangitis is an infection of the bile and biliary tract which in most cases is the consequence of biliary tract obstruction. The two main causes are choledocholithiasis and neoplasia. Clinical diagnosis relies on Charcot's triad (pain, fever, jaundice) but the insufficient sensitivity of the latter led to the introduction in 2007 of a new score validated by the Tokyo Guidelines, which includes biological and radiological data. In case of clinical suspicion, abdominal ultrasound quickly explores the biliary tract, but its diagnostic capacities are poor, especially in case of non-gallstone obstruction, as opposed to magnetic resonance cholangiopancreatography and endoscopic ultrasound, of which the diagnostic capacities are excellent. CT scan is more widely available, with intermediate diagnostic capacities. Bacteriological sampling through blood cultures (positive in 40% of cases) and bile cultures is essential. A wide variety of bacteria are involved, but the main pathogens having been found are Escherichia coli and Klebsiella spp., justifying first-line antimicrobial therapy by a third-generation cephalosporin. Systematic coverage of Enterococcus spp. and anaerobic infections remains debated, and is usually recommended, in case of severity criteria for Enterococcus severity levels, or anaerobic bilio-digestive anastomosis for anaerobes. Presence of a biliary stent is the only identified risk-factor associated with infections by multidrug-resistant pathogens. Along with antimicrobial therapy, endoscopic or radiological biliary drainage is a crucial management component. Despite improved management, mortality in cases of acute cholangitis remains approximately 5%.

Anaerobic bacteriological profile of brain abscess in a tertiary care center in southern India

Brain abscess accounts for 8% of all intracranial insults in developing countries. Anaerobic infections are missed in most cases due to difficult isolation techniques. This study was done to determine the anaerobic bacteriological profile of brain abscess, their distribution according to sociodemographic variables, anatomical location, management and the outcome during the subjects' stay in a neurosciences’ speciality hospital. We included 190 cases of confirmed anaerobic brain abscess from the year 1998–2017. The median age was 22 years with more males (73% of 190 cases) than females. The Bacteroides spp. were the most common (64%) anaerobic organisms isolated followed by Gram positive anaerobic cocci (51%). While 67% of the samples showed purely anaerobic bacteria on culture, remaining were mixed. Chronic suppurative otitis media (CSOM) was the most common predisposing factor.

Microbiology of paediatric deep neck space infection

ObjectivesTo study the organisms and resistance profiles in the pediatric population of patients with deep neck space infection in a developing nation so as to aid in determining relevant, appropriate and effective antimicrobial empiric treatment. To describe the socioeconomic demographics of pediatric patients affected and the predominant age-related subtypes of deep neck space infections in an African population compared to those affected worldwide. MethodsA retrospective review of patients aged younger than 16 years of age, with deep neck space infections over a 5,5-year period was conducted at a tertiary hospital in Johannesburg, South Africa. Diagnosis of deep neck space infection was determined by clinical, radiographic and laboratory findings. All patients received abscess drainage via either needle aspiration or surgical drainage using a sterile technique. Aerobic and anaerobic bacterial cultures and cultures for Mycobacterium tuberculosis were performed. Duration of hospitalization was used as an indicator of treatment response. Results were recorded, and statistical analysis was performed. ResultsA total of 107 children with deep neck space infection were included in the study, with 121 pus specimens retrieved. The male: female ratio was 1.14:1, with a total of 57 males and 50 females, demonstrating a slight male predominance. Mean age was 5.8 years (range 2months–15years). There was no significant difference in duration of hospitalization in children less than 2 years and children older than 2 years of age. The submandibular space was the most common affected site (73.9%). Analysis of the 121 pus specimens demonstrated an identifiable organism in 71% (n = 86) of cases, with no bacterial growth in 29% (n = 35) of specimens. Staphylococcus aureus was the most predominant organism cultured, with a prevalence of 65% of positive pus cultures. 100% of these organisms were sensitive to cloxacillin, and 100% were resistant to penicillin/ampicillin. With respect to positive pus cultures, there was an overall organism sensitivity to cloxacillin of 67% and overall resistance to penicillin/ampicillin of 76%. MRSA, TB and anaerobic bacterial infection have a much lower incidence than aerobic bacterial infection. Risk factors identified in our study include anemia and HIV. ConclusionChildren across all age groups are affected by deep neck space infection in a low socioeconomic environment. Risk factors identified include anaemia and HIV infection. The incidence of TB and anaerobic infection is lower than expected. There is a high level of antimicrobial resistance to penicillin seen in our study, predominantly due to Staphylococcus aureus infection. These organisms are however sensitive to Cloxacillin, which is a cost-effective beta-lactam antibiotic. We therefore recommend empiric treatment with cloxacillin and metronidazole to cover for anaerobic bacterial infection and de-escalation if necessary once culture results are available.

Acute pericarditis and mediastinal lymph node abscess developing after endobronchial ultrasound guided transbronchial needle aspiration

A 27-year-old man was diagnosed with inflammatory myofibroblastic tumor, and multiple lymph node and subcutaneous metastases. After several administrations of anti-tumor therapy, he underwent mediastinal lymph node biopsy using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to confirm tumor relapse. Five weeks later, he complained of chest pain, then rapidly developed shock due to acute pericarditis. Although he was treated with antibiotics for anaerobic bacterial infection and cardiac drainage, mediastinal lymph node abscess and pericarditis did not improve. After the surgical procedure, his physical condition dramatically improved and he was treated with another molecularly targeted therapy. Pericarditis associated with EBUS-TBNA is extremely rare. In this case, salvage was achieved by surgical drainage of the lymph node abscess and pericarditis, and long survival was obtained with further administration of anti-tumor treatment.

A Case of Aplastic Anemia Associated With Long-Term Metronidazole Use

Metronidazole is a nitroimidazole antibacterial agent that is highly effective for the treatment of protozoal and anaerobic infections. Metronidazole is known to cause hematologic adverse effects, including a reversible mild neutropenia; in rare circumstances, thrombocytopenia has been associated with metronidazole treatment. We present a case of aplastic anemia related to the extended use of metronidazole.