Beta-hemolytic Streptococci Research Articles

Infections and obsessive-compulsive disorder - results from a systematic review and meta-analysis

IntroductionObsessive-compulsive disorder (OCD) is a psychiatric disorder affecting 1.3% of the population worldwide where both genetic and environmental factors, such as perinatal events and neuroinflammation, are thought to contribute to the etiology of the disorder. In the past, the description of clinical entities such as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS), in which an acute neuropsychiatric syndrome with prominent obsessive-compulsive features emerges in children infected with group-A beta-hemolytic streptococcus (GABHS), sparked the hypothesis that infections may be a risk-modifying factor for the development of OCD. Along with streptococcal infections, other pathogens such as Toxoplasma gondii have been implicated in the pathophysiological models of the disorder, although causal associations have not been established for any of beforementioned pathogens.ObjectivesTo perform a systematic review and meta-analysis about the presence of biological evidence of infection in patients diagnosed with OCD.MethodsWe conducted a systematic review and a meta-analysis (PROSPERO registration CRD42021223415) by performing a standardized electronic database search in MEDLINE/PubMed, Web of Science, Embase and Scopus. Search was conducted on 17/10/2022. Eligible papers included case-control and cohort studies using a comparator group, that tested for specific biomarkers providing evidence of infection in patients diagnosed with OCD; exclusion criteria included studies without quantitative or qualitative measures of infection, case reports, systematic or scope reviews, and animal studies. Selection process was conducted according to PRISMA 2020 statement guidelines. Study quality was assessed through Newcastle-Ottawa Quality Assessment Scale.ResultsWe identified 8911 records through the search after duplicate removal. A total of 22 studies met inclusion criteria after selection process, and 15 were eligible for meta-analysis. Most evidence concerned Toxoplasma gondii (10 studies), and patients with OCD appear to have higher odds of being infected compared to controls, with a meta-analytic odds ratio of 2.39 (95% IC 1.60-3.58), when comparing 467 patients with 5411 controls. However, most studies were methodologically heterogeneous, which compromises the interpretation of meta-analytic results. Information regarding other agents, including GABHS, Borna disease virus and Toxocara canis was gathered but due to an insufficient number of papers it was not possible to perform a meta-analysis for each of them.ConclusionsOur work suggests that albeit exhaustively reported in the literature, there is no strong evidence of the over-representation of biomarkers of infection in patients with OCD compared to control volunteers. Methodologically robust studies are needed to further test this hypothesis.Disclosure of InterestNone Declared

Time to positivity of blood cultures in bloodstream infections with Streptococcus dysgalactiae and association with outcome

Purpose Invasive infections with Streptococcus dysgalactiae predominantly occur in persons of older age with substantial morbidity and mortality. Time to positivity from blood cultures (TTP) has been shown to be a prognostic indicator in bloodstream infections caused by other beta-haemolytic streptococci. This study aimed to determine any possible association between TTP and outcome in invasive infections due to S. dysgalactiae. Materials and methods Episodes of S. dysgalactiae bacteraemia, that occurred during 2015–2018 in the Region of Skåne, Sweden, were identified through the laboratory database and retrospectively studied. Any association with TTP and the primary outcome, death within 30 days and the development of sepsis or disease deterioration within 48 hours from blood culturing as secondary outcomes were investigated. Results Among the 287 episodes of S. dysgalactiae bacteraemia, 30-day mortality rate was 10% (n = 30). Median TTP was 9.3 h (interquartile range 8.0–10.3 h). Median TTP was statistically significantly shorter in patients who died within 30 days compared to surviving patients (7.7 vs 9.3 h, p = .001, Mann–Whitney U test). Short TTP(≤ 7.9 h) was still associated with 30-day mortality when adjusting for age, (OR 4.4, 95% CI 1.6–12.2, p = .004). Associations between secondary outcomes and levels of TTP were not observed. Conclusion TTP may be an important prognostic indicator for 30-day mortality in patients with bloodstream infections due to S. dysgalactiae.

Genomic characterization of beta-haemolytic streptococci isolated from prosthetic joint infections.

Prosthetic joint infection (PJI) is an increasing concern for the medical profession, as higher numbers of arthroplasty surgeries lead to rising PJI-related costs. Streptococcal PJIs constitute approximately 10% of PJIs, but their genetic features and characteristics remain largely unexplored. Little is known about antimicrobial resistance (AMR) rates, whether some sequence types (ST) dominate, and whether certain virulence-associated genes are overrepresented. We used whole-genome sequencing of Streptococcus dysgalactiae (n=22), Streptococcus agalactiae (n=10) and S.pyogenes (n=1) to elicit genomic data on 33 beta-haemolytic streptococci isolated from PJIs in Region Örebro county, Sweden. Relatedness was inferred based on single nucleotide polymorphisms in S.dysgalactiae and S.agalactiae. The genomic data were screened for virulence-associated genes available in the Virulence Factor Database. All isolates were screened for both phenotypic and genotypic resistance. The S.dysgalactiae and S.agalactiae isolates were genetically diverse, although 32% of S.dysgalactiae isolates (n=7) were ST20. The speS and PI-2A genes were less represented in these isolates among virulence-associated genes, and AMR was more frequently observed in S.agalactiae. We conclude that PJIs caused by beta-haemolytic streptococci are not dominated by genetically similar beta-haemolytic streptococci. There were distinct inter-species differences in AMR between S.agalactiae and S.dysgalactiae.

Antimicrobial resistance of endometrial bacterial isolates collected from UK Thoroughbred mares between 2014 and 2020.

Antimicrobial resistance (AMR) is important in equine reproduction, as antimicrobials have historically been widely used in the management of breeding mares. However, evidence of the characteristics of AMR in uterine isolates is limited in the UK. The objective of this retrospective study was therefore to describe temporal changes in AMR patterns of bacteria isolated from the endometrium of Thoroughbred broodmares in south-east England between 2014 and 2020. Endometrial swabs were processed for microbiology and antimicrobial susceptibility testing (AST). For frequently isolated bacteria, changes in AMR patterns over time were assessed using a logistic regression model. From 18,996 endometrial swabs, 30.5% were positive for microbial culture. AST was performed on 2091 isolates, representing 1924 swabs collected from 1370 mares located at 132 premises. Beta-haemolytic Streptococcus (BHS, 52.5%) and Escherichia coli (25.8%) were most frequently isolated. In BHS, resistance to enrofloxacin (p = 0.02), nitrofurazone (p < 0.001) and oxytetracycline (p < 0.01) increased significantly between 2014 and 2020, while resistance to trimethoprim-sulfamethoxazole (p < 0.001) decreased. In E. coli, resistance to nitrofurazone increased (p = 0.04) and resistance to gentamycin (p = 0.02) and trimethoprim-sulfamethoxazole (p < 0.001) decreased. Variations in the specimen collection protocols might have affected the frequency of isolates detected. Between 2014 and 2020, AMR changed in this bacterial population. However, there was no significant increase in resistance to penicillin (99.6% BHS susceptible), gentamycin (81.7% E. coli susceptible) or ceftiofur.

Acute Rheumatic Fever (ARF) in a patient of Chronic Mucocutaneous Syndrome or Mucocutaneous Candidiasis having Diarrhea and Skin Rash

Acute Rheumatic fever (ARF) is the most common cause of acquired heart disease in the developing world. It is an immunological reaction to group A beta-hemolytic streptococcus Pyogenes. It occurs 2-4 weeks after group A streptococcal pharyngitis due to the development of antistreptococcal antibodies that cross-react with antigens in various tissues of the body, especially cardiac and basal ganglia neuronal antigens. Clinical features of acute rheumatic fever include fever, joint pain, myocarditis, nodules in subcutaneous tissue, Erythema Marginatum, and chorea. Patients with immunodeficiency like mucocutaneous candidiasis are especially prone to recurrent mucocutaneous infections (tonsillopharyngitis, thrush, skin abscess), which can predispose to acute rheumatic fever and subsequent development of rheumatic heart disease over the years. Keywords: Acute rheumatic fever, chronic mucocutaneous syndrome, skin rash,

Streptococcus pyogenes carriage acquisition, persistence and transmission dynamics within households in The Gambia (SpyCATS): protocol for a longitudinal household cohort study

Background Streptococcus pyogenes (StrepA) causes a significant burden of disease globally from superficial infections to invasive disease. It is responsible for over 500,000 deaths each year, predominantly in low- and middle-income countries (LMIC). Superficial StrepA infections of the skin and pharynx can lead to rheumatic heart disease, the largest cause of StrepA-related deaths in LMIC. StrepA can also asymptomatically colonise normal skin and the pharynx (carriage), potentially increasing infection risk. Streptococcus dysgalactiae subsp. equisimilis (SDSE) carriage is also common in LMIC and may interact with StrepA. This study aims to investigate StrepA and SDSE carriage and infection epidemiology, transmission dynamics and naturally acquired immunity within households in The Gambia. Methods A longitudinal household observational cohort study will be conducted over one year. 45 households will be recruited from the urban area of Sukuta, The Gambia, resulting in approximately 450 participants. Households will be visited monthly, and available participants will undergo oropharyngeal and normal skin swabbing. Incident cases of pharyngitis and pyoderma will be captured via active case reporting, with swabs taken from disease sites. Swabs will be cultured for the presence of group A, C and G beta-haemolytic streptococci. Isolates will undergo whole genome sequencing. At each visit, clinical, socio-demographic and social mixing data will be collected. Blood serum will be collected at baseline and final visit. Oral fluid and dried blood spot samples will be collected at each visit. Mucosal and serum anti-StrepA antibody responses will be measured. Outcome This study will report StrepA and SDSE clinical epidemiology, risk factors, transmission dynamics, and serological responses to carriage and infection. Detailed social mixing behaviour will be combined with phylogenetic relatedness to model the extent of transmission occurring withing and between households. The study will provide data to help meet global strategic StrepA research goals.

The Epidemiology of Influenza Virus Infection and Group A Streptococcal Pharyngitis in Children Between 2011 and 2018 in an Outpatient Pediatric Clinic.

Background The frequency of influenza virus infections and group A beta-hemolytic streptococcus (GAS) pharyngitis varies according to populations. We aimed to investigate the frequency of influenza virus and streptococcal pharyngitis infections in a pediatric outpatient cohort with many pediatric admissions in Istanbul. Materials and methods Children with upper respiratory tract infection (URTI) symptoms between 2011 and 2018 who underwent rapid diagnostic tests for influenza virus or streptococcal infection were evaluated retrospectively. Results Thetotal number of pediatric cases admitted between 2011 and 2018 was 185,228, of which 119,928 were under five years oldand 66,300 were children over five years old. The mean frequency of the influenza virus was 1,283 per 100,000 children, and the mean frequency of streptococcal pharyngitis was 1,764 per 100,000 children. The frequency of influenza has increased over the years. The frequency of streptococcal infection is higher in children over five years of age, and its frequency has decreased in this group. Conclusions Thefrequency of influenza virus infection and GAS pharyngitis varies according to years and seasons. Winter and spring were the seasons with the most frequent positive influenza virus and GAS pharyngitis. Although influenza frequency increased annually, this phenomenon was not observed in the frequency of GAS pharyngitis.

The increasing incidence of invasive infections caused by Streptococcus pyogenes in Europe

At the end of the year 2022, it was reported in some Euro­pean countries an increase in the incidence of invasive in­fec­tion/disease caused by Streptococcus pyogenes (group A beta-hemolytic Streptococcus; GAS), especially in case of children younger than 10 years old, in which fatalities oc­curred. It is worth mentioning that the GAS strains isolated in these cases didn’t have special particularities, such as the emergence of a new strain, and an increase of GAS re­sis­tance to antibiotics wasn’t revealed, either. Through this article, we intend to issue a warning regarding the risks of invasive streptococcal infection, reviewing some im­por­tant aspects on the etiology, diagnosis, treatment and pre­ven­tion of these infections.

Chapter 18 - Pediatric neuropsychiatric disorders with motor and nonmotor phenomena

The concept of pediatric autoimmune neuropsychiatric disorders associated with group A beta-hemolytic streptococcus (PANDAS) has become seminal since first introduced more than two decades ago. At the time of this writing, most neurologists, pediatricians, psychiatrists, and general pediatricians will probably have heard of this association or treated an affected child with PANDAS. The concept of an acute-onset, and typically self-limited, postinfectious autoimmune neuropsychiatric disorder resembling PANDAS manifesting vocal and motor tics and obsessive-compulsive disorder has broadened to other putative microbes and related endogenous and exogenous disease triggers. These disorders with common features of hypometabolism in the medial temporal lobe and hippocampus in brain 18fluorodeoxyglucose positron emission tomography fused to magnetic resonance imaging (FDG PET-MRI), form a spectrum: with the neuropsychiatric disorder Tourette syndrome and PANDAS with its well-defined etiopathogenesis at one end, and pediatric abrupt-onset neuropsychiatric syndrome (PANS), alone or associated with specific bacterial and viral pathogens, at the other end. The designation of PANS in the absence of a specific trigger, as an exclusionary diagnosis, reflects the current problem in nosology.

Алгоритм диагностики и лечения парафарингеальных абсцессов у детей

Parapharyngeal abscesses (PPA) are a pressing problem in modern pediatric otorhinolaryngology. The disease is quite rare and difficult to diagnose and treat. Objective. To develop an algorithm for the diagnosis and treatment of parapharyngeal abscesses in children. Materials and methods. Medical histories, CT scan data, surgical protocols were retrospectively studied in children discharged from the otolaryngology department of the Morozov Children’s City Clinical Hospital in the period from January 1, 2015, to December 31, 2022, with a diagnosis of J39,0 (ICD-10) Retropharyngeal and parapharyngeal abscess. Results. The study included 183 children with parapharyngeal abscess. The typical manifestations include a triad of symptoms: sore throat, forced head position, fever and symptoms of intoxication. If PPA is suspected, all patients are advised to undergo a contrast-enhanced CT scan of the neck. We analyzed the frequency of detection of PPA at various levels of the pharynx, which helps determine treatment tactics. Conservative treatment of PPA is possible if it is small in size (up to 20 mm in diameter). 30 patients (16,4%) were successfully treated conservatively; the majority – 153 (83,6%) patients required opening of the abscess. The main bacterial pathogen identified when inoculating material obtained from PPA was group A beta-hemolytic streptococcus. Conclusion. Based on the experience of treating PPA in 183 children, an algorithm for diagnosis and selection of surgical or conservative treatment was proposed.

Острый постстрептококковый гломерулонефрит у детей — реальность и парадоксы. Обзор литературы

Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated disease associated with nephritogenic strains of group A beta-hemolytic streptococcus. The epidemiology of APSGN varies in different countries, due to the influence of social, racial, demographic, and climatic conditions. In the modern spectrum of progressive diseases, APSGN occupies a modest place, yielding to other immune glomerulopathies. The prevalence rate has been declining in recent decades due to the decrease in pyoderma, however, it remains endemic to the French Polynesians and Australian Aborigines. The review defines the features of the immunological processes of this disease: nephritogens were identified at the site of the formation of immune complexes (streptococcal plasmin receptor and streptococcal pyrogenic exotoxin B). An assessment of the clinical profile of patients with APSGN (mostly asymptomatic course with a self-limiting (self-limiting) outcome) was carried out. The role of genomic surveillance in tracking potential markers of APSGN is emphasized. Risk factors for the development of kidney damage were identified — hypoalbuminemia, hypocomplementemia, and an increase in inflammatory markers. The paper considers the factors that determine the prognosis in patients, presents the main approaches to treatment (predominantly symptomatic therapy, with the exception of severe and atypical cases of the disease). It is concluded that APSGN remains one of the reasons for the development of AKI in different countries of the world. The article gives recommendations on long-term follow-up of children after APSGN. The purpose is to analyze the prevalence and identify the factors contributing to OPSGN; to determine the specifics of the disease immunological processes of the (immunocomplexity, autoimmunity); to evaluate the clinical profile, diagnostic methods and features of OPSGN treatment; to discuss the possible progression of the disease and whether PSGN is associated with chronic kidney disease (CKD).

Expression profile in Leishmania major exposed to Staphylococcus aureus and group A beta-hemolytic Streptococcus.

The interaction of Leishmania spp. with microbiota inside the midgut vector has significant output in pathogenesis. This study aimed to identify the profile of Leishmania majorgene expression of LACK, gp63, and hsp70after exposure to Staphylococcus aureusand group A beta-hemolytic Streptococci (GABHS). Leishmania major (MRHO/IR/75/ER) promastigotes were exposed with S. aureus, with GABHS, and with both GABHS and S. aureus at 25°C for 72 h. The gene expression analysis of Lmgp63, Lmhsp70,and LmLACKwas assessed using SYBR Green real-time PCR by ΔΔCt. All experiments were repeated in triplicate. Statistical analysis was done using two-way ANOVA. A P-value less than 0.05 was considered significant. Lmgp63 was expressed in the group exposed to GABHS with 1.75-fold lower than the control group (p=0.000). The LmLACK had expression in both groups exposed with GABHS and GABHS with S. aureus with 2.8 and 1.33-fold more than the control group, respectively (p=0.000). The Lmhsp70 gene expression was reported in the group exposed with GABHS with relative quantification of 5.7-fold more than the control group. This study showed that the important genes encoding LACK, gp63, and hsp70 changed their expression after exposure to the S. aureus and GABHS.

Bullous scabies, the light shed on etiopathogenesis and treatment: report of five paediatric cases.

Bullous scabies (BS) is an infrequent and atypical presentation of scabies, with a predilection for elderly males. The mechanism of BS is not fully understood; superinfection, friction due to pruritus, autoeczemation, direct injury from mite's lytic enzymes, cross-reactivity of scabies protein with basal membrane zone antigens are considered to be possible reasons. To define clinical features of paediatric BS cases, which is an extremely rare subtype of scabies. This is a retrospective study of paediatric BS cases seen at two tertiary care centres. Previously described bacterial culture, antibiogram and follow-up records were investigated retrospectively. Confirmed scabies cases, according to the "International Alliance for the Control of Scabies (IACS)" with bullae were included. All cases were treated with 10% sulfur ointment for 3 consecutive days, two cycles. Households of cases were also treated simultaneously. Systemic antibiotics were added to patients with elevated acute phase reactants according to the antibiogram results. Informed consent was obtained from patients' parents. Five BS cases were included. Three cases were male, two cases were female. Four cases had staphylococcus aureus, one had group-A beta haemolytic streptococcus positive bullae culture. All cases achieved a rapid complete resolution of symptoms after topical 10% sulfur ointment. Paediatric BS is an extremely rare entity of scabies. Bacterial superinfection plays a key role in bullae formation. 10% sulfur ointment is a highly effective treatment option for paediatric BS.

Foodborne streptococcal tonsillopharyngitis outbreak in a hospital.

Group A beta-haemolytic streptococci (GAS), which are responsible for most cases of acute bacterial tonsillopharyngitis, are transmitted from person to person and may rarely cause foodborne outbreaks. This study aims to report the epidemic caused by GAS in our hospital and to draw attention to the explosive outbreaks of the bacteria. Acute tonsillopharyngitis was seen in 201 of 450 hospital employees who ate in the hospital cafeteria on 4-5 June 2015. GAS was detected in 106 (68%) of 157 cases and in 40 (63.5%) of 62 throat culture samples. The attack rate was 44.7%. The most suspected source of the outbreak was a food handler who had been showing signs of streptococcal tonsillopharyngitis for six days, and perhaps the food prepared by these staff. It should not be forgotten that GAS can cause explosive outbreaks by infecting food through hand lesions or mouth secretions of food service personnel.

Case Study: Abnormal Presentation of Infective Endocarditis With Streptococcus Canis and Chiari Network

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis and treatment with targeted antimicrobial therapy and consideration of early surgical intervention are vital to the evaluation and treatment of IE. Though Staphylococci, Streptococci, Enterococci, HACEK organisms amount for the majority of IE, some atypical organisms including group G Streptococci such as S. canis have been reported to carry high mortality and hospitalization risk in patients with bacteremia. S. canis is a group G beta-hemolytic Streptococci which normally resides on the skin and mucosal surfaces of dogs. This Case Report shines light on the versatility of microorganisms that can cause IE in a patient with underling Chiari network, and the risk of morbidity and mortality with such species highlighting the importance of early diagnosis and treatment.

1843. Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection due to Streptococcus species

Abstract Background Effectiveness of oral antibiotics for transition of therapy in uncomplicated bloodstream infections (BSI) due to Streptococcus species remains unclear. This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in patients with uncomplicated BSI due to Streptococcus species compared to standard intravenous (IV) only therapy. Methods Adult patients with uncomplicated BSI due to Streptococcus species from April 2016 through June 2020 in 7 hospitals within Prisma Health in South Carolina were evaluated. Patients who died within 7 days of BSI were excluded to reduce the impact of survival bias. Multivariate Cox proportional hazards regression was used to examine time to treatment failure, defined as a composite of all-cause mortality and BSI recurrence within 90 days. Results A total of 222 patients with Streptococcus species BSI were included in the analysis. Overall, the median age was 62 years, and 116 (52.3%) were men. Beta-hemolytic streptococci (87; 39.2%) were the most common bloodstream isolates, followed by S. pneumoniae (76; 34.2%) and viridans group streptococci (59; 26.6%). Among this cohort, 99 patients received only IV antibiotics, and the remaining 123 received partial oral therapy. The median duration of therapy in both groups was 14 days, and median duration of IV antibiotics prior to oral transition was 4 days. Most patients in the partial oral group were transitioned to either oral beta-lactams (62; 50.4%) or fluoroquinolones (47; 38.2%). Of the IV only group, 46 (46.5%) required outpatient IV antibiotics. Treatment failure rates were 12.0% and 4.4% in the IV only and partial oral therapy groups, respectively (p=0.04). After adjustments for age, chronic comorbidities, and initial response to therapy within the first 72-96 hours, there was no difference in the risk of treatment failure in the partial oral compared to IV only group (hazards ratio 0.55, 95% CI 0.19-1.64; p=0.28). Conclusion Transitioning patients from IV to oral antibiotics may be a reasonable strategy in the management of uncomplicated BSI due to Streptococcus species. Partial oral therapy does not seem to have a higher treatment failure rate than standard IV only therapy and may spare many patients from outpatient IV antibiotics. Disclosures All Authors: No reported disclosures.

430. Oritavancin Activity Against Gram-positive Pathogens Causing Bloodstream Infections in Hematology/Oncology and Transplant Units in US Medical Centers (2010-2019)

Abstract Background Patients undergoing hematologic, oncologic, and/or transplant treatment are at risk for infections. Appropriate antimicrobial management is crucial for patients with suspected or confirmed bloodstream infections (BSI). We evaluated the in vitro activity of oritavancin (ORI) and comparators against Gram-positive (GP) isolates causing BSI in patients from hematology/oncology and transplant units (HTU) in US medical centers. Methods 1,217 isolates (1/patient) were consecutively collected from HTU patients in 33 US hospitals during 2010-2019. Isolates were identified by MALDI-TOF and/or standard microbiological testing methods, and susceptibility (S) tested by CLSI reference broth microdilution in a central laboratory. CLSI breakpoints were applied. Results Enterococcus spp. (overall, 36.1%; E. faecium [EFM], 20.2%; E. faecalis [EF], 14.3%) and S. aureus (SA, 35.7%; 36.4% methicillin-resistant [MRSA]) were the most common organism groups, followed by coagulase-negative Staphylococcus (CoNS; 11.8%; 76.4% MR), Viridans group streptococci (VHS; 9.6%), and beta-haemolytic streptococci (BHS; 3.5%). ORI inhibited 96.7%/98.9% of EFM/EF at ≤0.12mg/L (S breakpoint for vancomycin [VAN]-S EF). Ampicillin (100.0%S), linezolid (LZD; 100.0%S), daptomycin (DAP; 98.3%S), and VAN (97.1%S) were also active against EF. Only ORI (96.7%S) and LZD (100.0%S) remained active against EFM. A VRE phenotype and elevated daptomycin MIC (2-4 mg/L) were noted in 72.8% and 55.3% of EFM, with ORI inhibiting 95.5% and 95.6% of these isolates at ≤0.12mg/L, respectively. ORI displayed equivalent MIC50/90 (0.03/0.06 mg/L) values against MSSA (99.3%S) and MRSA (99.4%S). ORI inhibited 95.5% of MRCoNS at ≤0.12mg/L (SA breakpoint). VAN, DAP, and LZD remained active against MRSA and MRCoNS. ORI was also active against BHS (MIC50/90, 0.03/0.25 mg/L; 95.2%S) and VGS (MIC50/90, 0.015/0.25 mg/L; 96.6%S) as was VAN (100.0%), DAP (100.0%), and LZD (100.0%/99.1%S, respectively). Conclusion VRE EFM, MRCoNS, and MRSA rates were generally high in BSI GP isolates recovered from patients in HTU. ORI was highly active and inhibited &amp;gt; 95% of isolates at MIC of ≤ 0.12mg/L from this unique collection, including R subsets such as VAN-R EFM, EFM displaying elevated DAP MIC (2-4 mg/L), MRSA, and MRCoNS. Disclosures Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Dee Shortridge, PhD, AbbVie: Grant/Research Support|JMI Laboratory: Employee|Melinta: Grant/Research Support|Menarini: Grant/Research Support|Shionogi: Grant/Research Support Helio S. Sader, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Pfizer: Grant/Research Support Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Office for Assistant Secretary of Defense for Health Affairs: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Spero Therapeutics: Grant/Research Support.

214. The impact of preservation fluid culture on graft site arteritis: a systematic review and metanalysis.

Abstract Background The role of culturing the graft preservation fluid (PF) is controversial and its impact on graft arteritis development remains unclear. Methods Systematic literature search retrieving all-languages observational studies comparing SOT recipients with culture positive PF versus culture negative PF. Graft site arteritis within 180 days from transplant was selected as primary outcome. Data were independently extracted using a pre-specified form, and quality of included studies was independently assessed according to ROBINS-I tool for observational studies. Meta-analysis was performed using Mantel-Haenszel random-effect models. Results 2,492 articles were screened, and twenty-one observational studies (N=2,208 positive PF vs. 4,458 negative) were included in the meta-analyses. Among positive PF, 857 (38.8%) were classified as high-risk group pathogens (fungi, Gram negative, Enterococcus spp., beta-hemolytic streptococci and Staphylococcus aureus) and 1,351 (61.2%) as low-risk (mostly coagulase negative Staphylococci) pathogens. A significant higher risk of graft arteritis was found in SOT recipients with a PF yielding a high-risk pathogen (odds ratio [OR] 18.43, 95%CI 7.83-43.40), with low heterogeneity (I²=2.24%). Similar results were found considering separately high-risk bacteria (OR 12.02, 95%CI 4.88-29.60) and fungi (OR 71.00, 95%CI 28.07–179.56), with no heterogeneity (I²=0%), and in the subgroup analyses of liver (OR 16.78, 95%CI 2.95–95.47) and kidney (OR 19.90, 95%CI 4.78–82.79) recipients. However, data about diagnostic features of graft arteritis were very limited, indeed for only 11 of the 93 events histological or microbiological results were reported. Conclusion Our results may support the performance of PF culturing and a preemptive diagnostic or therapeutic management upon isolation of high-risk pathogen. Further studies based on reliable diagnosis of graft arteritis are needed to confirm our findings. Disclosures All Authors: No reported disclosures.

ОСОБЕННОСТИ ТЕЧЕНИЯ ОСТРЫХ ОДОНТОГЕННЫХ ВОСПАЛИТЕЛЬНЫХ ПРОЦЕССОВ ЧЕЛЮСТЕЙ ВДЕТСКОМ ВОЗРАСТЕ

The goal.Studying the clinical course’s features of acute odontogenic inflammatory processes of the jaws in children, describing species composition of pathogens, determination sensitivity to antibiotics of various groups in acute odontogenic inflammatory processes of the jaws in childhood. Materials and methods.The case histories of 900 patients were analyzed, microbiological research methods were carried out (microscopic examination of clinical samples with Gram staining, culture method, determination of the sensitivity of theisolated pathogen to antimicrobial drugs).Results.The most common odontogenic inflammatory processes of the jaws were observed in children aged 4–5 years. In48,85 % of cases in a milk bite and in 67,92 % of cases in a permanent bite, the cause of the development of an odontogenic inflammatory process was complicated caries of the mandibular molars. 56% of children had a general condition. The leading causative agent of the inflammatory process of the jaws was in 65,6 % of cases hemolytic streptococcus. In other cases, Streptococcus Viridans(6,1 %), pneumococci (4,3 %), candida (3 %), Staphylococcus aureus(2,8 %), Moraxella cataralis(1,2 %), etc. were detected in the mixed microflora of purulent exudate. The drugs of choice for empirical antibiotic therapy for odontogenic inflammatory process caused by beta-hemolytic streptococcus group A are vancomycin (antibiotic sensitivity –99 %), fluoroquinolones (antibiotic sensitivity –98 %), beta-lactams (antibiotic sensitivity –91 %). The highest percentage of resistance of this microflora was noted to macrolides (41 %), and to clindamycin (33 %). The rapid spread of the purulent-inflammatory process in the maxillofacial region in acute odontogenic processes in children, the resistant microflora of the odontogenic purulent focus require a competent approach when providing emergency care.Conclusions.The obtained has great practical importance for the choice of rational antibiotic therapy.

Increase in middle ear infections of Streptococcus pyogenes etiology among patients of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in correlation with world reports

Introduction. Beta-hemolytic streptococcus is one of the most common causes of out-of-hospital infections. It can cause local or general infections of varying severity, most commonly in the throat, paranasal sinuses, ear and skin. Some infections are invasive in nature. In the last months of 2022, an alarming increase in infections caused by Streptococcus pyogenes, including invasive infections, has been observed in many countries in Europe and around the world compared to previous years. Aim. The purpose of this study was to compare the number of hospitalized patients with acute otitis media and acute mastoiditis of S. pyogenes etiology in the first six months of 2023 with hospitalizations for the same reason in the previous 5 years, and to assess the correlation with the observed worldwide trend of an increase in the number of observed beta-hemolytic streptococcus type A infections. Material and methods. A retrospective analysis of the data of patients diagnosed with acute otitis media and acute mastoiditis of S. pyogenes etiology hospitalized in the Department of Pediatric Otolaryngology in the first six months of 2023 was carried out, and their number was compared with patients hospitalized for the same reason in the previous 5 years. Results. Between January 2023 and the end of June 2023, 15 patients with acute otitis media were hospitalized in the Department of Pediatric Otolaryngology, in which S. pyogenes was isolated by bacteriological examination. Purulent leakage from the ear was observed in 10 patients. Isolated otitis media was diagnosed in 4 patients. In 10 children, AOM was complicated by acute mastoiditis, which was confirmed by CT scan. The most severe complication was sepsis of GAS etiology. Intravenous antibiotic therapy and surgical treatment were implemented in all patients, achieving a cure. From 2018 to 2022, the number of patients hospitalized for the same reason was significantly lower each year. Conclusions. The number of patients hospitalized in the Department of Otolaryngology in the last two months of 2022 and in the first six months of 2023 due to AOM, as well as AOM complicated by mastoiditis, in which the etiologic agent turned out to be S. pyogenes confirmed the observed worldwide trend towards an increase in the incidence of GAS. GAS-induced AOM is characterized by greater local aggressiveness, manifested by a higher incidence of tympanic membrane perforation, as well as mastoiditis with bone destruction. The primary antibiotic used to treat GAS infections is penicillin, with sensitivity to penicillin also implying sensitivity to all beta-lactam antibiotics. The treatment of GAS with intratemporal complications in the form of acute mastoiditis caused by S. pyogenes, especially progressing with bone destruction, requires combined antimicrobal therapy with surgical treatment.