Blood Culture-positive Patients Research Articles

Time to Positive Blood Cultures Among Critically Ill Children Admitted to the PICU.

Our study aimed to assess the time to positivity (TTP) of clinically significant blood cultures in critically ill children admitted to the PICU. Retrospective review of positive blood cultures in patients admitted or transferred to the PICU. Large tertiary-care medical center with over 90 PICU beds. Patients 0-20 years old with bacteremia admitted or transferred to the PICU. None. The primary endpoint was the TTP, defined as time from blood culture draw to initial Gram stain result. Secondary endpoints included percentage of cultures reported by elapsed time, as well as the impact of pathogen and host immune status on TTP. Host immune status was classified as previously healthy, standard risk, or immunocompromised. Linear regression for TTP was performed to account for age, blood volume, and Gram stain. Among 164 episodes of clinically significant bacteremia, the median TTP was 13.3 hours (interquartile range, 10.7-16.8 hr). Enterobacterales, Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus pneumoniae were most commonly identified. By 12, 24, 36, and 48 hours, 37%, 89%, 95%, and 97% of positive cultures had resulted positive, respectively. Median TTP stratified by host immune status was 13.2 hours for previously healthy patients, 14.0 hours for those considered standard risk, and 10.6 hours for immunocompromised patients (p = 0.001). Median TTP was found to be independent of blood volume. No difference was seen in TTP for Gram-negative vs. Gram-positive organisms (12.2 vs. 13.9 hr; p = 0.2). Among critically ill children, 95% of clinically significant blood cultures had an initial positive result within 36 hours, regardless of host immune status. Need for antimicrobial therapy should be frequently reassessed and implementation of a shorter duration of empiric antibiotics should be considered in patients with low suspicion for infection.

Clinical, Laboratory, and Epidemiological Characteristics of Patients Diagnosed with Brucellosis: A Comprehensive Analysis

Introduction: This study aims to evaluate the demographic characteristics, clinical manifestations, laboratory findings, radiological features, and the relationship between brucella capture titers and blood culture positivity in patients followed up due to brucellosis.
 Methods: The medical records of 214 patients diagnosed with brucellosis, who were followed up at the infectious diseases clinic and/or outpatient clinic between January 2017 and December 2018, were retrospectively reviewed. Demographic and clinical characteristics of 118 included patients were recorded. Brucella capture tests and blood cultures were processed at bacteriology department of Dicle University Hospital Laboratory.
 Results: The mean age of the patients was 39.54±17.123 years. Fifty percent of the patients were male and 58.5% of the patients resided in rural areas. The most common complaints at presentation were fever (89%) and bone-joint pain (73.7%). The most frequent physical examination findings were fever (89%) and tenderness in bones and joints (73.7%). Elevated erythrocyte sedimentation rate was observed in 29.6% of patients, while elevated c-reactive protein levels were seen in 55.9% of the patients. The two most common hematological findings at the time of diagnosis were anemia with 45.8% and lymphomonocytosis with 26.3%. A statistically significant disparity was observed in the incidence of complications among patients displaying hematological manifestations, including anemia, leukopenia, and thrombocytopenia, associated with brucellosis (p

Trends in laboratory-confirmed bacterial meningitis (2012-2019): national observational study, England.

Bacterial meningitis is associated with significant morbidity and mortality worldwide. We aimed to describe the epidemiology, aetiology, trends over time and outcomes of laboratory-confirmed bacterial meningitis in England during 2012-2019. UK Health Security Agency routinely receives electronic notifications of confirmed infections from National Health Service hospital laboratories in England. Data were extracted for positive bacterial cultures, PCR-positive results for Neisseria meningitidis or Streptococcus pneumoniae from cerebrospinal fluid and positive blood cultures in patients with clinical meningitis. During 2012-19, there were 6554 laboratory-confirmed cases. Mean annual incidence was 1.49/100,000, which remained stable throughout the surveillance period (p=0.745). There were 155 different bacterial species identified, including 68.4% (106/1550) Gram-negative and 31.6% (49/155) Gram-positive bacteria. After excluding coagulase-negative staphylococci (2481/6554, 37.9%), the main pathogens causing meningitis were Streptococcus pneumoniae (811/4073, 19.9%), Neisseria meningitidis (497/4073, 12.2%), Staphylococcus aureus (467/4073, 11.5%), Escherichia coli (314/4073, 7.7%) and group B streptococcus (268/4073, 6.6%). Pneumococcal meningitis incidence increased significantly during 2012-9, while meningococcal, group A streptococcal and tuberculous meningitis declined. Infants aged <3 months had the highest mean incidence (55.6/100,000; 95% CI, 47.7-63.5) driven mainly by group B streptococci, followed by 3-11 month-olds (8.1/100,000; 95% CI 7.1-9.0), where pneumococcal and meningitis predominated. The 30-day case-fatality rate (CFR) was 10.0% (71/6554). Group A streptococcal meningitis had the highest CFR (47/85, 55.3%). The probability of surviving at 30 days was 95.3% (95% CI, 93.4-97.3%) for infants and 80.0% for older adults (77-84%). The incidence of bacterial meningitis has remained stable. The high CFR highlights a need for prevention through vaccination. PHE.

Absolute Neutrophil Count in Diagnosis of Neonatal Sepsis : A Hospital Based Cross Sectional Study

Background : Sepsis is the leading cause of neonatal death in developing countries. Delay in initiating treatment can considerably increase the morbidity and mortality. So early diagnosis is important.Traditional methods such as blood culture do not provide a rapid diagnosis. Absolute neutrophil count is one of the important hematological markers for diagnosis of sepsis. The purpose of the study to see the absolute neutrophil count in diognosis of neonatal sepsis.&#x0D; Materials and methods: This is a hospital based cross sectional study conducted from January to June 2014. A total of 100 sick neonates admitted in the Neonatal ward of Chattagram Maa Shishu O General Hospital (CMSOGH) with suspected neonatal sepsis (Based on history and physical examination) constituted the study population. Investigation sent for Absolute neutrophil count, C-reactive Protein (CRP) and blood culture. The collected data was analyzed by statistical software packages SPSS method version 15.&#x0D; Results: A total of 100 sick neonates of both sexes with suspected sepsis were enrolled in this study, out of which most of the patient showed neutropenia (66%), C-reactive protein positive 65% and blood culture positive 33%. Within the Creactive protein positive patients 78.8% patient had neutropenia (c2 =17.711, p= .001). From blood culture positive patients 85% showed neutropenia (c2 =8.510, p= 0.014).&#x0D; Conclusion: Neutropenia is a common hematological finding in neonatal sepsis along with other screening test and neutropenia is more significant than neutrophilia.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 66-70

Pharmacist involvement in blood culture follow up for patients discharged from the emergency department

Study objectiveThis study evaluates the time to attempted patient contact for positive blood cultures in patients discharged from the Emergency Department (ED) resulting when an Emergency Medicine (EM) pharmacist is on-duty compared to off-duty. MethodsThis single center, retrospective study included patients who were discharged from the ED and had subsequent positive blood cultures. Blood cultures were reviewed utilizing an algorithm previously approved and implemented by an interdisciplinary team in 2016. Standard practice was for the microbiology lab to notify the ED charge nurse of the positive blood culture, however, the algorithm placed the pharmacist as the responsible reviewer when on duty, leaving charge nurses and physicians as the responsible reviewers when a pharmacist was off duty and not on site. The primary outcome was time from ED notification of the positive gram stain of the blood culture to first attempted patient contact; we compared this outcome for cultures resulting when an EM pharmacist was on duty to those resulting when an EM pharmacist was off duty. Despite being off duty, a pharmacist may have reviewed these cultures if they remained unaddressed when the pharmacist returned on-site. In this case, the blood culture review was included in the off-duty cohort. Secondary outcomes included evaluation for appropriateness of the recommendation made to the patient during contact, 30-day infection-related readmission rates, patient's adherence to the recommendations, and barriers to patient contact. An infectious disease attending physician independently reviewed cases where the algorithm was not followed. ResultsA total of 127 patients identified by a query of our institution's database were screened against inclusion/exclusion criteria and 56 were excluded, leaving 71 patients for final analysis (54 and 17 in the on- and off-duty cohorts, respectively). Baseline demographics with respect to sex, age and risk factors for bacteremia were not different between groups, except there were more immunocompromised patients in the on-duty cohort (35.2%) compared to off-duty cohort (5.9%) [p = 0.01]. Median [IQR] time to first attempted patient contact was significantly shorter in the on-duty cohort at 0.8 h [0.4–2.8] vs 5.6 h [1.4–11.7] (p = 0.025). A pharmacist acted upon 93% of all cultures, including several resulting during off-duty hours. Secondary outcomes did not differ. Fourteen (25.9%) of on-duty cultures and six (35.3%) of off-duty cultures were deemed contaminants. Two recommendations in the off-duty group were inappropriate based on the infectious disease attending physician review. The lack of active voicemail was the main barrier to contacting a patient. ConclusionsIn patients discharged from the ED with subsequent positive blood cultures, time to attempted patient contact was significantly shorter when a pharmacist was on-duty. Our data emphasizes the importance of having a standardized practice in place to optimize ED patient care and outcomes and the benefit of a pharmacist's involvement in the process.

Blood culture and profile of inflammatory biomarkers among COVID-19 patients in an intensive care unit of a tertiary care hospital

Introduction and Aim: This is a retrospective study to analyse the pathogens causing bacteraemia in COVID-19 patients and its correlation with inflammatory biomarkers such as procalcitonin (PCT), C-reactive protein (CRP), total WBC counts (TC) and D-dimer. The objectives of this study were to evaluate the blood culture positivity rate, to identify the pathogens causing bacteraemia, to analyse their antibiogram and to assess the significance of inflammatory markers along with patient outcomes. Materials and Methods: This study included 165 COVID-19-positive patients admitted to the Intensive care unit (ICU) of a tertiary care hospital from June to September 2020. Blood culture, identification and antibiotic sensitivity testing (AST) were done using automated systems. Values of D-dimer, CRP, PCT and TC were obtained using immunoturbidimetric assay, chemiluminescent immunoassay, immunochromatographic testing and automated haematology analyser respectively. Results: Among 143 blood culture samples obtained from 122 COVID-19 positive patients, 80 flagged positive. Out of the 80 isolates obtained, 53 (66.25%), 17 (21.25%) and 10 (12.5%) were gram-positive bacteria, gram-negative bacteria and candida respectively. The blood culture positivity rate was 25.4%. Acinetobacter spp. and K. pneumoniae showed high levels of antibiotic resistance. Among 16 patients with elevated PCT, 15 (93.7%) patients showed positive blood cultures. CRP of &gt;5 mg/L and deranged total WBC counts were seen among all blood culture-positive patients. In 100 patients with elevated D-dimer, 54% (54/100) patients showed positive blood culture. Conclusion: From this study, we conclude that early identification of pathogens and initiation of appropriate antimicrobial therapy is crucial for managing sepsis associated with COVID-19 infection. PCT, CRP, TC and D-dimer can help as biomarkers in the management of COVID-19 patients with secondary bloodstream infections (BSI).

Secondary Infections in Patients with Extremely Severe COVID-19 During ECMO Therapy

Up to 70% of patients hospitalized for COVID-19 need respiratory support, up to 10% need high-flow oxygen therapy, non-invasive and invasive ventilation. However, standard methods of respiratory support are ineffective in 0.4-0.5% of patients. In case of potentially reversible critical refractory respiratory failure that patients may require ECMO. Management of patients with extremely severe COVID-19 associates with numerous clinical challenges, including critical illness, multiple organ dysfunction, blood coagulation disorders, requiring prolonged ICU stay and care, use of multiple pharmacotherapies including immunosuppressive drugs. Pharmacological suppression of immunity is associated with a significant increase in the risk of secondary bacterial and fungal infections. Currently, data on epidemiology of secondary infections in patients with COVID-19 undergoing ECMO is limited.Aim. To study the prevalence and etiology of secondary infections associated with positive blood cultures in patients with extremely severe COVID-19 requiring ECMO.Materials and methods. A single-center retrospective non-interventional epidemiological study including 125 patients with extremely severe COVID-19 treated with ECMO in April 2020 to December 2021.Results. Out of 700 blood culture tests performed in 125 patients during the study, 250 tests were positive confirming bacteremia/fungemia. Isolated pathogens varied depending on the duration of ECMO: gram-positive bacteria (primarily coagulase-negative staphylococci) dominated from the initiation of ECMO support; increased duration of ECMO associated with an increasing the proportion of pathogens common in ICU (Klebsiella pneumoniae and/or Acinetobacter baumannii with extensively drug resistant and pan-drug resistant phenotypes, and vancomycin-resistant Enterococcus faecium). When ECMO lasted more than 7-14 days, opportunistic pathogens (Candida species, Stenotrophomonas maltophilia, Providencia stuartii, non-diphtheria corynebacteria, Burkholderia species and others) prevailed as etiological agents.Conclusion. Longer duration of ECMO resulted in increasing the rates of infectious complications. In patients undergoing ECMO for more than 14 days, the microbiological landscape becomes extremely diverse, which hampers choosing an empirical antimicrobial therapy. Since potential pathogens causing secondary infections in patients during ECMO are difficult to predict, rapid identification of rare opportunistic pathogens and their sensitivity profile, followed by targeted administration of antimicrobials, seems most beneficial.

Long-term outcomes following transvenous lead extraction: Data from a tertiary referral center

BackgroundTransvenous lead extraction (TLE) has shown a safe and efficacy profile in the intraoperative and short-term setting; however, data on long-term outcomes are limited. ObjectiveThe purpose of this study was to assess long-term outcomes and prognostic factors in patients who underwent TLE. MethodsConsecutive patients with cardiac implantable electronic device (CIED) who underwent TLE between 2014 and 2016 were retrospectively studied. The primary outcome was the composite endpoint of death and repeated TLE stratified by infective/non-infective indication. Individual components of the primary outcome were also evaluated. ResultsOne hundred ninety-one patients were included in the analysis, 50% extracted for CIED-related infection. Complete procedural success was achieved in 189 patients (99%) with no major acute complications. After a median of 6.5 years, infection indication was associated with significantly lower event-free survival (67% vs. 83% non-infection group, adjusted hazard ratio [aHR] 1.97, 95% confidence interval [CI] 1.02–3.81, p = 0.04). All-cause mortality rate was higher in the TLE infection group (30% vs. 10%, p < 0.01). The rate of repeated TLE did not differ between groups (4% vs. 7%, p = 0.62). Among patients who had TLE for infection, the presence of vegetation (aHR 2.56; 95%CI 1.17–5.63, p = 0.02) and positive blood cultures (aHR 2.64; 95%CI 1.04–6.70, p = 0.04) were independently associated with the primary outcome. ConclusionPatients who underwent TLE for CIED-related infection exhibit a high mortality risk during long-term follow-up. Vegetation and positive blood cultures in patients with CIED-related infection are associated with a worse prognosis regardless of successful and uncomplicated TLE.

Diagnostic Accuracy of Cord and Venous Blood Procalcitonin in Relation to Neonatal Sepsis Screen

Background: Neonatal sepsis is an important cause of neonatal deaths globally. Diagnosis of neonatal sepsis is established based on the clinical status of the newborn and microbiological tests of sepsis screen. Mid-phase markers of inflammation such as C-reactive protein (CRP) and serum procalcitonin (PCT) are considered useful and sensitive for early diagnosis. Most of the studies evaluating serum cord blood PCT as a diagnostic marker for neonatal septicemia have been carried out in peripheral venous blood with smaller sample sizes with the inclusion of neonates without considering perinatal sepsis scores (PSSs). Objective: To compare the diagnostic accuracy of cord blood PCT with venous blood PCT, alone and as part of sepsis screening parameters. Study Design: This hospital-based, prospective diagnostic accuracy study aimed to evaluate the diagnostic accuracy of serum PCT alone and in combination with other diagnostic modalities for the detection of early-onset neonatal sepsis in cord blood and to compare the diagnostic utility of PCT with neonatal sepsis screening parameters in venous blood and was conducted at a tertiary care center. Categorical/nominal variables were expressed as numbers and percentages and were analyzed using the chi-square test. The receiver–operating characteristic curve was drawn to determine the area under the curve (with a 95% confidence interval) for various parameters for the diagnosis of sepsis. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and diagnostic accuracy were calculated by using a 2 × 2 contingency table. All statistical analyses were done using SPSS trial version 20. Participants: A total of 247 newborns delivered with positive PSSs were enrolled. Intervention: In neonates with a positive PSS, cord blood serum PCT, sepsis screen, and blood culture were sent at the time of birth. They were observed for 72 hours for signs and symptoms suggestive of sepsis. Results: Statistical analysis of cord blood serum PCT for detecting blood culture-positive patients showed that PCT has a sensitivity of 44.4%, specificity of 86.4%, PPV of 33.3%, and NPV of 91.1%. Overall diagnostic accuracy is 80.9% indicating that cord blood PCT is a good test for identifying these patients ( p &lt;.05). However, venous blood PCT failed to demonstrate similar results. Conclusion: Umbilical blood sampling protects neonates from the pain of venipunctures. Statistical comparison of cord blood PCT in relation to sepsis screen and/or blood culture and comparisons with the venous blood parameters in the same domains suggests better sensitivity and specificity than venous blood PCT. This early serological biomarker is valuable for early diagnosis and management while awaiting blood culture reports and helps in reducing the separation of neonates with suspected sepsis from their mother and thus helping in developmental supportive care.

A positive blood culture is associated with a lower haemoglobin increment in hospitalized patients after red blood cell transfusion.

Abundant clinical evidence supports the safety of red blood cell (RBC) concentrates for transfusion irrespective of storage age, but still, less is known about how recipient characteristics may affect post-transfusion RBC recovery and function. Septic patients are frequently transfused. We hypothesized that the recipient environment in patients with septicaemia would blunt the increase in post-transfusion blood haemoglobin (Hb). The main objective was to compare the post-transfusion Hb increment in hospitalized patients with or without a positive blood culture. A retrospective cohort study using data from the Transfusion Research, Utilization, Surveillance, and Tracking database (TRUST) was performed. All adult non-trauma in-patients transfused between 2010 and 2017 with ≥1 RBC unit, and for whom both pre- and post-transfusion complete blood count and pre-transfusion blood culture data were available were included. A general linear model with binary blood culture positivity was fit for continuous Hb increment after transfusion and was adjusted for patient demographic parameters and transfusion-related covariates. Among 210,263 admitted patients, 6252 were transfused: 596 had positive cultures, and 5656 had negative blood cultures. A modelled Hb deficit of 1.50 g/L in blood culture-positive patients was found. All covariates had a significant effect on Hb increment, except for the age of the transfused RBC. Recipient blood culture positivity was associated with a statistically significant but modestly lower post-transfusion Hb increment in hospitalized patients. In isolation, the effect is unlikely to be clinically significant, but it could become so in combination with other recipient characteristics.

Blood culture positivity in patients with acute appendicitis: A propensity score-matched prospective cohort study.

The prevalence of bacteremia in acute appendicitis is unknown. We aimed to assess prevalence and predictive factors of bacteremia in adult patients with appendicitis. In this prospective propensity score-matched cohort study, patients were recruited as part of one single-center prospective observational study assessing appendicitis microbiology in concurrence with two randomized controlled trials on non-operative treatment of uncomplicated acute appendicitis. All patients evaluated for enrollment in these three trials between April 2017 and December 2018 with both a confirmed diagnosis of appendicitis and available blood culture on admission were included in this study. Potential predictive factors of bacteremia (age, sex, body mass index (BMI), body temperature, C-reactive protein (CRP), leukocyte count, comorbidities, symptom duration, and appendicitis severity) were assessed. Prevalence of bacteremia was determined by all available blood cultures followed by propensity score matching using sex, age, BMI, CRP, leukocyte count, and body temperature of the patients without available blood culture. Out of the 815 patients with appendicitis, 271 patients had available blood culture and the prevalence of bacteremia was 12% (n = 33). Based on propensity score estimation, the prevalence of bacteremia in the whole prospective appendicitis cohort was 11.1%. Bacteremia was significantly more frequent in complicated acute appendicitis (15%; 29/189) compared with uncomplicated acute appendicitis (5%; 4/82) (p = 0.015). Male sex (p = 0.024) and higher body temperature (p = 0.0044) were associated with bacteremia. Estimated prevalence of bacteremia in patients with acute appendicitis was 11.1%. Complicated appendicitis, male sex, and higher body temperature were associated with bacteremia in acute appendicitis.

A prospective study to reduce turnaround time of microbiologically positive blood cultures in patients with sepsis in intensive care unit

PurposeTo determine the accuracy of direct microbial identification (dID) and antimicrobial susceptibility testing by EUCAST rapid antimicrobial susceptibility testing (rAST) methodology from positively flagged blood culture bottles (BCBs) as well as reduction in turnaround time (TAT) compared to standard methodology. MethodsIt was a hospital based, prospective cohort study conducted over a period of 21 months from March 2020 to November 2021 in which positively flagged blood culture bottles were simultaneously processed by dID ​+ ​rAST and by VITEK®-2 Compact system or Kirby-Bauer disk diffusion method. TAT was calculated as the time (hours) taken from receipt of sample in bacteriology laboratory to release of clinical reports with complete identification and susceptibility testing results in both methods. ResultsOf 301 dID ​+ ​rAST performed in study, 125 (41.5%) BCBs were identified as having one of the 8 reportable micro-organisms by EUCAST rAST standard. Amongst VITEK concordant BCBs with gram-negatives, mean reduction in TAT by dID ​+ ​rAST methodology was 23 ​± ​1.4 ​h. Amongst VITEK concordant gram-negatives, Categorical Agreement (CA) rates for any drug-bug combination were 94.4%, 94.5% and 93.6% and Very Major Error (VME) rates were 3.1%, 3.4% and 3.9% at 4-, 6- and 8-h reading time, respectively. ConclusionsEUCAST rAST methodology can generate susceptibility testing reports a day earlier if incorporated into the laboratory workflow. For resource-limited settings, implementing EUCAST rAST approach can be used effectively in early reporting, which can reduce antimicrobial use and improve patient outcomes by promoting timely escalation or de-escalation of empirical antibiotic therapy.

The kinetic profiles of copeptin and mid regional proadrenomedullin (MR-proADM) in pediatric lower respiratory tract infections.

Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers. This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling. Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001). Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.

A 12-year epidemiological study of Acinetobacter baumannii from blood culture isolates in a single tertiary-care hospital using polymerase chain reaction (PCR)-based open reading frame typing.

Acinetobacter baumannii is a causative agent of healthcare-associated infections, and the introduction and spread of A. baumannii that has acquired drug resistance within a hospital are serious healthcare problems. We investigated the transition of epidemic clones and the occurrence of outbreaks by molecular epidemiological analysis to understand the long-term behavior of A. baumannii within a single facility. A. baumannii isolates collected from blood-culture-positive patients between January 2009 and December 2020 were subjected to PCR-based open reading frame typing (POT) for species identification, clonal typing, and homology searches. Of the strains isolated from blood cultures, 49 were identified as A. baumannii and analyzed with POT. The POT#1=122 clones had different antimicrobial resistance profiles to the other POT clones, and strains belonging to this clone were dominant during outbreaks of multidrug-resistant Acinetobacter. Although the clonal diversity of A. baumannii decreased and its antimicrobial resistance increased during the outbreaks, clonal diversity and the in-hospital antibiogram improved at the end of the outbreaks. The POT#1=122 clone was not eliminated from the hospital during the study period. POT is a simple and suitable method for molecular epidemiological monitoring and can show the introduction, outbreak, and subsequent transition of an epidemic clone of A. baumannii.

Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p&gt;0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p&lt;0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

Presepsin as a biomarker for risk stratification for acute cholangitis in emergency department: A single-center study

BACKGROUNDAcute cholangitis is caused by bacterial infection and has high morbidity and mortality risk. The grade of cholangitis can guide clinical treatment from single antibiotic treatment to biliary drainage. With the introduction of white blood cell (WBC) count, C-reactive protein (CRP), and total bilirubin (T-Bil) into the diagnostic criteria and severity grading for acute cholangitis, the diagnosis rate and grading have significantly improved. However, early risk stratification assessments are challenging in the emergency department. Therefore, we hope to find an ideal predictive biomarker for cholangitis grade. Presepsin is a promising biomarker for the early diagnosis, severity, and prognosis of acute bacterial infections.AIMTo assess the grading value of presepsin in patients with acute cholangitis.METHODSThis clinical study was conducted at the Beijing Friendship Hospital, a 2000-bed teaching hospital with approximately 200000 emergency admissions per year. In this prospective observational study, 336 patients with acute cholangitis meeting the Tokyo Guidelines 2018 diagnostic criteria in the emergency department from May 2019 to December 2020 were analyzed. WBC count, CRP, procalcitonin (PCT), presepsin, T-Bil, and blood culture results were collected. The values were compared using the Pearson χ2 test, Fisher’s exact test, or Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC) of the value was examined using the Delong test. The correlations among the key research indicators were determined using Pearson correlation.RESULTSIn total, 336 patients were examined, which included 107, 106, and 123 patients classified as having mild, moderate, and severe cholangitis, respectively. WBC count, CRP, PCT, presepsin, T-Bil, direct bilirubin, and sequential organ failure assessment scores of moderate and severe cholangitis patients were higher than those of mild cholangitis patients (P = 0.000). The AUC of presepsin in predicting moderate acute cholangitis was 0.728, which was higher than that of CRP (0.631, P = 0.043) and PCT (0.585, P = 0.002), and same as that of WBC count (0.746, P = 0.713) and T-Bil (0.686, P = 0.361). The AUC of presepsin in predicting severe acute cholangitis was 0.715, which was higher than that of WBC count (0.571, P = 0.008), CRP (0.590, P = 0.009), PCT (0.618, P = 0.024), and T-Bil (0.559, P = 0.006). The presepsin levels in the positive blood culture group were higher (2830.8pg/mLvs1987.8pg/mL, P = 0.000), and the AUC of presepsin (0.688) proved that it was a good biomarker for predicting positive bacterial culture.CONCLUSIONPresepsin can predict positive blood culture in patients with acute cholangitis. It is superior to WBC count, CRP, PCT, and T-Bil for the risk stratification of acute cholangitis.

Safety of Autologous Hematopoietic Stem Cell Transplantation in Patients over 75 Years Old. Single Center Experience Serving a Minority Population

Background:Autologous hematopoietic stem cell transplant (auto-HSCT) is a commonly used treatment for multiple myeloma (MM) and for relapsed/refractory non-Hodgkin lymphomas (NHL) for patients who are <65 years old. However, the majority of new diagnoses of MM and NHL are in patients >65 years old, and nearly half of those are in patients >75 years old. While some studies have evaluated the use of auto-HSCT in older patients 65-75 years of age, there are few studies evaluating the relative safety of this treatment in patients above the age of 75 years. Such patients and their providers require outcome data of auto-HSCT in the elderly in order to help guide informed decision-making.Methods:We conducted a retrospective cohort study comparing short-term outcomes for auto-HSCT in patients >75 years old and 55-65 years old for the diagnosis of MM or NHL, who were conditioned with either melphalan or BEAM (carmustine, etoposide, cytarabine, melphalan) respectively.To identify patients, we used an internal database of auto-HSCT performed between 2005 - 2021. The study group included patients >75 years old. The control group included patients 55-65 years old that were matched to the study group patients by sex and time of transplant. Medical records were reviewed to gather data on demographics, pre-transplant functional status, transplant indication and conditioning regimen, length of stay, admission mortality, 30-day rehospitalization rate, ICU admission, neutropenic fever and infectious workup results, and time to WBC and platelet engraftment.The primary outcomes of the study were admission mortality, length of stay, time to WBC and platelet engraftment incidence, incidence of neutropenic fever, positive blood culture, ICU admission, and 30-day rehospitalization rate.Averages were calculated using medians and IQR. Admission mortality was evaluated using log rank test. P values were calculated using Fisher's test for categorical data and Wilcoxon rank sum test for continuous data. Significance was denoted by α =0.05.Results:We identified 43 patients aged >75 years old who underwent autologous stem cell transplant for multiple myeloma or lymphoma with melphalan or BEAM conditioning at Montefiore Medical Center between 2005-2021.Patient characteristics (Table 1) The earliest transplant in out cohort was in 12/2005 and the latest was in 3/2021. The median time between transplants of patients in the study and cohort groups was 14 [7.5, 24] days. 24 (55.8%) patients were female. The median age in the study group was 77.1 [76.2, 77.9] years old and 61.9 [57.4, 63.0] years old in the control group. Both groups predominantly included patients from minority populations: 55.8 and 46.5% were Spanish/Hispanic/Latino and 25.6% and 14.0% were African American, in study and control groups respectively. Multiple myeloma was the most common indication for auto-HSCT.Primary outcomes (Table 2) Admission mortality did not differ significantly between the groups, with only one death in the control group (p = 0.083). The length of stay was comparable at 18 [17, 22] days and 19 [16, 20] days (p = 0.2) for study and control groups, respectively.Time to WBC engraftment in the study group was 12 [11, 12] days and 11 [11, 12] days in the control group (p = 0.032). Time to platelet engraftment in the study group was 14 [12, 15] days and 12 [11, 14] days in the control group (p = 0.014). Although both time to WBC and platelet engraftment was significantly longer in the study group, the clinical significance of this finding is questionable, especially as it did not seem to prolong length of stay.There was no significant difference between incidence of neutropenic fever, or between incidence of positive blood cultures in patients with neutropenic fever. There was a non-statistically significant increase in the rate of ICU admissions in the study group vs control group 4/43 and 0/43 respectively (p=0.12). 30-day rehospitalization rate was comparable between the two groups.Conclusion:We did not find a statistically significant increase in morbidity or mortality for patients 75-80 years of age undergoing auto-HSCT compared with patients 55-65 years old. To our knowledge this is the largest cohort to date demonstrating the safety of auto-HSCT in this elderly population. [Display omitted] DisclosuresGritsman: iOnctura: Research Funding. Shastri: Onclive: Honoraria; GLC: Consultancy; Kymera Therapeutics: Research Funding; Guidepoint: Consultancy. Verma: Medpacto: Research Funding; Curis: Research Funding; Eli Lilly: Research Funding; Stelexis: Consultancy, Current equity holder in publicly-traded company; Novartis: Consultancy; Acceleron: Consultancy; Celgene: Consultancy; Stelexis: Current equity holder in publicly-traded company; Throws Exception: Current equity holder in publicly-traded company; Incyte: Research Funding; GSK: Research Funding; BMS: Research Funding.

Machine learning identification of specific changes in myeloid cell phenotype during bloodstream infections

The early identification of bacteremia is critical for ensuring appropriate treatment of nosocomial infections in intensive care unit (ICU) patients. The aim of this study was to use flow cytometric data of myeloid cells as a biomarker of bloodstream infection (BSI). An eight-color antibody panel was used to identify seven monocyte and two dendritic cell subsets. In the learning cohort, immunophenotyping was applied to (1) control subjects, (2) postoperative heart surgery patients, as a model of noninfectious inflammatory responses, and (3) blood culture-positive patients. Of the complex changes in the myeloid cell phenotype, a decrease in myeloid and plasmacytoid dendritic cell numbers, increase in CD14+CD16+ inflammatory monocyte numbers, and upregulation of neutrophils CD64 and CD123 expression were prominent in BSI patients. An extreme gradient boosting (XGBoost) algorithm called the “infection detection and ranging score” (iDAR), ranging from 0 to 100, was developed to identify infection-specific changes in 101 phenotypic variables related to neutrophils, monocytes and dendritic cells. The tenfold cross-validation achieved an area under the receiver operating characteristic (AUROC) of 0.988 (95% CI 0.985–1) for the detection of bacteremic patients. In an out-of-sample, in-house validation, iDAR achieved an AUROC of 0.85 (95% CI 0.71–0.98) in differentiating localized from bloodstream infection and 0.95 (95% CI 0.89–1) in discriminating infected from noninfected ICU patients. In conclusion, a machine learning approach was used to translate the changes in myeloid cell phenotype in response to infection into a score that could identify bacteremia with high specificity in ICU patients.

Group IIA secretory phospholipase 2 independently predicts mortality and positive blood culture in emergency department sepsis patients.

ObjectiveThe IIA isoform of phospholipase A2 is an acute phase reactant that increases in sepsis, although data regarding its prognostic value are limited. We hypothesized that group IIA secretory phospholipase A2 (sPLA2‐IIA) predicts sepsis mortality and positive cultures and sought to compare its predictive characteristics to lactate and procalcitonin.MethodssPLA2‐IIA and procalcitonin levels were measured at enrollment in emergency department patients with early severe sepsis and compared with lactate levels. The primary outcome was in‐hospital mortality. The secondary outcome was any positive culture with a sub‐group analysis of only blood‐culture positive patients. Optimum cut‐point was determined using receiver operating characteristics curves. A multivariable model was developed to test the independent prognostic value of elevated sPLA2‐IIA to predict mortality.ResultsOf the 192 patients in the cohort, 160, 153, and 158 had samples available for analysis of sPLA2‐IIA, procalcitonin, and lactate, respectively. A total of 21% of patients met the primary outcome of in‐hospital mortality. At a 100 ng/mL threshold for sPLA2‐IIA, adjusted odds to predict mortality were 3.78 (95% confidence interval = 1.14–12.56, P = 0.03). sPLA2‐IIA and procalcitonin were both elevated in culture‐positive patients; however, the difference was not statistically significant. sPLA2‐IIA was significantly higher in blood culture‐positive patients.ConclusionAn elevated level of sPLA2‐IIA was associated with increased mortality in sepsis patients. sPLA2‐IIA levels, unlike procalcitonin, also were significantly higher in blood culture‐positive patients.

Matrix metalloproteinase MMP-8, TIMP-1 and MMP-8/TIMP-1 ratio in plasma in methicillin-sensitive Staphylococcus aureus bacteremia.

BackgroundMatrix metalloproteinase-8 (MMP-8) and tissue inhibitor of metalloproteinases-1 (TIMP-1) have been shown to predict prognosis in sepsis. However, MMP-8 and TIMP-1 in Staphylococcus aureus bacteremia (SAB) lacks evaluation and their role in the pathogenesis of SAB is unclear.MethodsMMP-8 and TIMP-1 and MMP-8/TIMP-1 molar ratio were determined at days 3, 5 and 28 from positive blood cultures in patients with methicillin-sensitive SAB and the connection to disease severity and early mortality was determined.ResultsAltogether 395 SAB patients were included. Patients with severe sepsis or infection focus presented higher MMP-8 levels at day 3 and 5 (p<0.01). Higher day 3 and 5 MMP-8 levels were associated to mortality at day 14 and 28 (p<0.01) and day 90 (p<0.05). Day 3 MMP-8 cut-off value of 203 ng/ml predicted death within 14 days with an area under the curve (AUC) of 0.70 (95% CI 0.57–0.82) (p<0.01). Day 5 MMP-8 cut-off value of 239 ng/ml predicted death within 14 days with an AUC of 0.76 (95% CI 0.65–0.87) (p<0.001). The results for MMP-8/TIMP-1 resembled that of MMP-8. TIMP-1 had no prognostic impact. In Cox regression analysis day 3 or 5 MMP-8 or day 3 MMP-8/TIMP-1 had no prognostic impact whereas day 5 MMP-8/TIMP-1 predicted mortality within 14 days (HR, 4.71; CI, 95% 1.67–13.3; p<0.01).ConclusionMMP-8 and MMP-8/TIMP-1 ratio were high 3–5 days after MS-SAB diagnosis in patients with an infection focus, severe sepsis or mortality within 14 days suggesting that matrix metalloproteinase activation might play a role in severe SAB.