Common Pathogen In Patients Research Articles

Recent trends in antibiotic sensitivity and resistance patterns in infected wounds of burns patients presented to a tertiary care hospital.

Objective: To study the recent trends and patterns of antibiotic sensitivity and resistance in infected wounds of burns patient. Study Design: Cross sectional study. Setting: Burns and Plastic Surgery Canter, Peshawar, Pakistan. Period: July 30th to January 30th, 2023. Methods: In this cross sectional study we adopted convenience sampling technique. A total of 75 samples collected from patients fitted to our infected patients criteria and culture and sensitivity tests were performed using standard microbiological techniques. Results: Among the positive infected wound samples, Klebsiella Species were found in 23 (30.7%), Pseudomonas Aeruginosa in 16 (21.3%), Acinetobacter Species in 14(18.7%), Proteus Species in 8(10.7%), Citrobacter species in 5(6.6%), Staph. Aureus in 5(6.6%), Enterobacter species in 3(4%) and E.coli in 1(1.4%) of the positive cultures. Each pathogen showed varying degree of sensitivity and resistance patterns to different antibiotics tested. Conclusion: Klebsiella Species was the most common pathogen in patients with infected burns wounds. Meropenem, imipenem, Doripenem, Piperacillin/Tazobactum, Colistin, and Tigecyclin were found to be effective against the majority of the bacteria. Conversely, most of the bacterial strains exhibited resistance to commonly prescribed antibiotics such as co-amoxiclave, ampicillin, ceftriaxone, ciprofloxacin, cefotaxime and co-trimoxazole.

Determination of the qualitative composition of gingival microflora in patients with cementum caries, and periodontopathogens

The qualitative composition of the microflora of periodontal pockets and gingival fluid, the composition of periodontopathogens determined by the polymerase chain reaction (PCR) method, the main associations of microorganisms, parocementum caries, dental index were comparatively studiedin patients with external pathological resorption and patients from the comparison group.40 patients were selected for the study, 14 of them with cementum caries, 12 with external pathological root resorption, and 14 without damage to the root of the tooth were in the comparison group. According to the study, all patients with cementum caries and external pathological resorption had pathological processes in the periodontium. According to the results of the microbiological examination in different clinical conditions of the oral cavity, especially with different forms of damage to the periodontum and hard tissues of the teeth, the predominant microbial samples were studied.The study of the qualitative composition of the microflora revealed that the most common pathogens in patients with cementum caries were: Prevotellaintermedia, Tannerella forsythia, Porphyromonas gingivalis, Candida albicans, Treponemadenticola. In patients with external resorption, P. intermedia, Tr. denticola, C. albicans, T. forsythia, P. gingivalis Epstein-Barr viruses were found. These are periodontopathogenic microorganisms and have wide pathogenic properties.

Analysis of fracture-related infections from Swedish insurance claims between 2011 and 2021

Fracture-related infections (FRI) pose a serious complication with an incidence of 1–2%. This study aimed to analyze compensation claims submitted to The Swedish National Patient Insurance Company (LÖF) because of FRI after closed/open reduction and internal fixation (C/ORIF) in the four most common fracture sites (proximal humerus, distal radius, hip, ankle). Patients registered in the LÖF database with a suspected FRI between 2011 and 2021 were identified by matching International Classification of Diseases and procedural codes indicative of a combination of fractures to the proximal humerus, distal radius, hip and ankle, C/ORIF and infection. Medical records were reviewed for fracture sites, pathogens and complications. Data from the Swedish Fracture Register (SFR) were extracted to estimate the proportion of reported claims to the presumed number of FRI. Of 122 FRI identified in the LÖF database, 34 were after C/ORIF in the proximal humerus, 12 in the distal radius, 28 in the hip and 48 in the ankle. LÖF compensated 111 patients (91%). Median time from C/ORIF to an FRI was 3 weeks (interquartile range 2–6), and 95% of all FRI occurred within 1 year after C/ORIF. Staphylococcus aureus was the most common pathogen in patients with a distal radius, hip and ankle FRI. In contrast, Cutibacterium spp. were the most common aetiology in FRI of the proximal humerus. The total number of fractures treated with C/ORIF in the four fracture sites registered in the SFR during 2021 was 18,711. Most of the FRI patients were diagnosed within the first year after C/ORIF, and 91% of the patients received compensation. Given an expected FRI incidence of 1–2%, our estimates with extrapolated data from the SFR indicate that < 10% of affected patients applied for compensation.

A new application of multiplex PCR combined with membrane biochip assay for rapid detection of 9 common pathogens in sepsis.

Rapid and accurate identification of specific sepsis pathogens is critical for patient treatment and disease control. This study aimed to establish a new application for the rapid identification of common pathogens in patients with suspected sepsis and evaluate its role in clinical application. A multiplex PCR assay was designed to simultaneously amplify specific conserved regions of nine common pathogenic microorganisms in sepsis, including Acinetobacter baumannii, Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumonia, and Candida albicans. The PCR products were analyzed by a membrane biochip. The analytical sensitivity of the assay was determined at a range of 5-100 copies/reaction for each standard strain, and the detection range was 20-200 cfu/reaction in a series dilution of simulated clinical samples at different concentrations. Out of the 179 clinical samples, the positive rate for pathogens detected by the membrane biochip assay and blood culture method was 20.11% (36/179) and 18.44% (33/179), respectively. However, by comparing the positive rate of the nine common pathogens we detected, the membrane biochip assay tended to be more sensitive than the blood culture method (20.11% vs 15.64%). The clinical sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the membrane biochip assay were 92.9%, 93.2%, 72.2% and 98.6%, respectively. Generally, this multiplex PCR combined membrane biochip assay can be used to detect major sepsis pathogens, and is useful for early initiation of effective antimicrobial treatment, and is feasible for sepsis pathogens identification in routine clinical practice.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

2046. Local validation of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa prevalence in a community hospital: A cross-sectional retrospective cohort study

Abstract Background Current 2019 management guidelines for community-acquired pneumonia (CAP) recommend against using the category healthcare-associated pneumonia (HCAP) as a basis for selecting extended-spectrum therapy and recommend using site-specific prevalence data. This study aimed to identify the most common pathogens in patients admitted with the diagnosis of HCAP in our community hospital. Methods This cross-sectional retrospective cohort study included 560 adult patients admitted to our community hospital located in Evanston, Illinois, between January 1, 2017, and December 31, 2021, with the diagnosis of HCAP (ICD-10-CM code J18.9). We performed regression analyses to compare the prevalence and determine odds ratios (OR) with 95% CIs to compare percentages between our local data and previously reported US HCAP and CAP populations. Results Among 560 patients with an admitting diagnosis of HCAP in 5 years, 117 (20.9%) patients had a respiratory pathogen isolate. Of those, 58 (49.6%) were bacterial isolates, 51 (43.6%) were viral, 5 (4.3%) were viral and bacterial coinfections, and 3 (2.6%) were bacterial and fungal coinfections (Figure 1). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 12 (2.1%) patients, and Pseudomonas aeruginosa was identified in 9 (1.6%) patients, corresponding to 10.3% and 7.7% of patients with an identified respiratory pathogen, respectively. Other common pathogens were influenza virus, Enterobacterales (3 extended-spectrum beta-lactamase and one carbapenem-resistant), Streptococcus pneumoniae, and respiratory syncytial virus (Table 1). Compared to a large US public database of culture-positive HCAP (Kollef et al.), patients from our community hospital had a decreased risk for MRSA (vs. 262/988 [26.5%]: OR 0.23 (95% CI, 0.12 – 0.46; p &amp;lt; .001) and P. aeruginosa (vs. 250/998 [25.3%]: OR 0.25 (95% CI, 0.12 – 0.49; p &amp;lt; .001) among the culture-positive patients. These rates were also significantly lower than overall US CAP populations (Table 2).Figure 1.Isolated organisms in patients with healthcare-associated pneumonia in a community hospital in Evanston, Illinois.Table 1.Other common isolates among patients admitted with the diagnosis of HCAP in our community hospital.Abbreviations: HCAP, healthcare-associated pneumonia, MSSA, methicillin-susceptible Staphylococcus aureus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.Table 2.Prevalence of positive testing for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in our community hospital vs. the overall United States community. 1. Aliberti S, Reyes LF, Faverio P, et al. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis. 2016 Dec;16(12):1364-1376. doi: 10.1016/S1473-3099(16)30267-5. 2. Restrepo MI, Babu BL, Reyes LF, et al. Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients. Eur Respir J. 2018 Aug 9;52(2):1701190. doi: 10.1183/13993003.01190-2017. Abbreviations: CI, confidence intervals; MRSA, methicillin-resistant Staphylococcus aureus; OR, odds ratios. Conclusion The prevalence of MRSA and P. aeruginosa pneumonia in patients categorized as HCAP was low in our community hospital, and the rates were significantly lower than previously reported US rates. Extended-spectrum therapy in our institution should be individualized and not generalized. Disclosures All Authors: No reported disclosures.

Comparative Study of Bacteriological Profile in Infective Exacerbation of Chronic Obstructive Pulmonary Disease and Community-Acquired Pneumonia

Background: Community-acquired pneumonia is a differential diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD); further both have similar pathogenic spectra. Both the American Thoracic Society and the European Respiratory Society follow similar empirical antibiotic choices for the two conditions. However, there are some differences in the bacterial spectra between the two conditions, particularly when the severity of the disease differs. In the present study, we want to study the differences in the clinical features, bacteriological spectra, and antibiotic susceptibilities in patients with community-acquired pneumonia versus patients with COPD exacerbation and provide a scientific basis for antibiotic selection. Aims: 1. To analyze the differences in the pathogenic spectra and antibiotic sensitivity profile between COPD exacerbation and community acquired pneumonia. 2. To study the differences in the clinical features and outcomes of the two conditions. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 30 patients diagnosed with acute exacerbation of COPD and 30 patients diagnosed with community acquired pneumonia. Detailed history, physical examination, and standard laboratory tests were taken on admission. The presence of new consolidation on chest radiograph was recorded. Sputum specimens collected by expectoration and tracheal suctioning or bronchoalveolar lavage were analyzed by Gram staining and microscopy and also by culture. The isolates were also tested for antibiotic sensitivity. The severity of Chronic obstructive pulmonary disease (COPD) exacerbation was assessed by the DECAF score and the severity of the CAP group was assessed by the Pneumonia Severity Index. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: Out of 30 (100%) participants in each group, both pneumonia and COPD participants had higher percentage of male participants; 24 (80%) and 26 (86.7%) participants, respectively. The COPD-exacerbation group was significantly older than the community-acquired pneumonia group (63.20 ± 11.82 vs. 43.73 ± 16.58). Klebsiella pneumoniae, Pseudomonas, Streptococcus pneumoniae, and Escherichia Coli were the most commonly isolated species in COPD subjects, whereas S. pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and other organisms were more commonly isolated from pneumonia participants. The drug-resistance rates of S. pneumoniae to penicillin, macrolide and quinolone antibiotics commonly used empirically to treat community acquired pneumonia was 52.6%, 79% and 79% respectively. The sensitivity of Pseudomonas to Carbapenems was 50% and to fluoroquinolones was 16.7% while all the strains were found to be resistant to Aminoglycosides, Penicillin, Cephalosporins, and Macrolides. Conclusions: In our study, we found that K. pneumoniae was the most common pathogen in patients with an exacerbation of COPD while S. pneumoniae was the most common pathogen in patients with community acquired pneumonia. In our study the organisms responsible for community acquired pneumonia were largely resistant to penicillins, macrolides, and tetracyclines, which are the antibiotics of choice for empirical treatment. Similarly, in patients with exacerbation of COPD, the organisms isolated had a far greater degree of resistance to the above-mentioned antibiotics than that seen in our patients with pneumonia. We conclude that antibiotic regimens should be culture driven rather than empirical to be effective while also countering drug resistance.

Infection-Related Ventilator-Associated Complication and Possible Ventilator-Associated Pneumonia among Mechanically Ventilated Patients of Adult Medical and Surgical Intensive Care Units.

Objective An observational study was conducted to evaluate (1) the incidence rates of infection-related ventilator-associated complication (IVAC) and possible ventilator-associated pneumonia (PVAP) among mechanically ventilated patients of adult medical and surgical intensive care units (ICUs) and (2) the pathogen distribution in patients with PVAP. Materials and Methods The IVAC and PVAP rates of medical and surgical ICUs, between July 1, 2017, and June 30, 2021, per 1,000 mechanical ventilator (MV) days were calculated. The significance of difference in IVAC and PVAP rates between medical and surgical ICUs was calculated. The level of significance was set at less than 0.05. Results MV utilization ratios of adult medical and surgical ICUs were 0.32 and 0.26, respectively ( p < 0.001). About 8 and 7 episodes of IVAC and 14 and 6 episodes of PVAP were reported from adult medical and surgical ICUs, accounting for IVAC rates of 3.17 and 1.8 per 1,000 MV ( p > 0.05) and PVAP rates of 2.46 and 1.59 per 1,000 MV days in medical and surgical ICUs, respectively ( p > 0.05). Acinetobacter baumannii complex either singly or in combination was isolated in 11/20 PVAP cases. Conclusion IVAC and PVAP were more in medical compared with surgical ICUs. The most common pathogen in patients with PVAP was A. baumannii complex. More studies are warranted to monitor the significance of ventilator-associated event on patient outcomes.

THE FREQUENCY AND MICROBIOLOGICAL CHARACTERISTICS OF BACTERIA CAUSING SEPTIC SHOCK AT NGHE AN GENERAL FRIENDSHIP HOSPITAL

Abstract: Objectives: To determine the frequency and microbiological characteristics of bacteria causing septic shock in patients with positive blood culture results. Methods: Cross-sectional descriptive study. Results: Total 100 patients diagnosed with septic shock had positive blood culture results at Nghe An General Friendship Hospital from January 2020 to December 2020. The mean age was 67.06 ± 16.42 years old. There were 57 patients ≥ 65 years old, accounting for 57%, more common than patients &lt; 65 years old (43 patients with a rate of 43%). The proportion of Gram-negative bacteria (66%) was higher than Grampositive bacteria (34%). The respiratory tract infection (52%) was the most common source, followed by the intra-abdominal infection (23%) and the urinary tract infection (10%). E. coli was the most common pathogen (32%), followed by S. aureus (26%) and K. pneumoniae (11%). Among patients with diabetes and COPD, the most common pathogens were E. coli, S. aureus and Enterococcus faecalis. Most of the antibiotic groups were been resistant, especially cephalosporin antibiotics from 37.5% to 82.6%. Amikacin, fosmycin, vancomycin and linezolid groups were susceptible to bacteria. Conclusion: E. coli and S. aureus were two common pathogens in patients with septic shock. In particular, E. coli, S. aureus and Enterococcus faecalis were the common agents of septic shock among patients with diabetes and COPD. Amikacin, Fosmycin, Vancomycin and Linezolid groups were still susceptible to bacteria. Key words: septic shock, E. coli, S. aureus.

Microbiological analysis of patients with first and recurrent episodes of acute cholangitis in a middle-sized hospital: A single-center retrospective study in rural North Kyoto, Japan

BackgroundKnowledge of the bacterial spectrum involved in acute cholangitis is essential for adequate empiric antibiotic treatment. There is a lack of published data comparative data between patients with first and recurrent episodes of acute cholangitis. This study aimed to analyze the microbial spectrum in patients with first and second episodes of acute cholangitis. MethodsWe retrospectively assessed 251 patients with first episodes of acute cholangitis between January 2014 to September 2020. ResultsAt the first episode of acute cholangitis, the predominant strains belonged to Escherichia coli (17.9%), followed by Klebsiella spp. (15.5%), Enterobacter spp. (6.4%), and Enterococcus spp. (5.6%). During follow-up, acute cholangitis recurred in 109 patients; at the second episode, the predominant strains belonged to Enterococcus spp. (35.8%), followed by Klebsiella spp. (27.5%), Enterobacter spp. (22.9%), and Escherichia coli (15.6%). Enterococcus spp. were the most common pathogen in patients with second episode of acute cholangitis, regardless of whether the cholangitis was caused by a malignant tumor or a benign disease. ConclusionsUnlike in patients with a first episode of acute cholangitis, clinicians should consider empirical treatment with anti-enterococcal antibiotics in patients with recurrent episodes of acute cholangitis.

Clinical Characteristics of Patients and Whole Genome Sequencing-Based Surveillance of Escherichia coli Community-Onset Bloodstream Infections at a Non-tertiary Hospital in CHINA.

Background: Escherichia coli is the most common pathogens in patients with community-onset blood stream infections (COBSI). Knowledge of the epidemiology of this disease is crucial to improve allocation of health resources, formulate isolation strategies that prevent transmission, and guide empirical antibiotic therapy.Methods: This retrospective observational study examined patients with E. coli COBSI (EC-COBSI) at a non-tertiary hospital in China. Whole-genome sequencing and analysis of the isolates was performed. The relationships of clinical variables with antimicrobial resistance and the genetic background of the isolates were examined.Results: There were 148 isolates in patients with EC-COBSI. All isolates were susceptible to ceftazidime/avibactam, carbapenems, and tigecycline; 35.1% were positive for extended spectrum β-lactamase (ESBL+); and blaCTX–M–14 was the most common ESBL gene. Patients with ESBL- isolates were more likely to receive appropriate empiric treatment than those with ESBL+ isolates (61.5% vs. 91.4%, p < 0.001), but these two groups had similar mortality rates. The overall 30-day mortality rate was 9.5%. Phylogenetic analysis showed that the isolates were diverse, and that the main sequence types (STs) were ST95, ST131, and ST69. Intra-abdominal infection was the primary source of disease, and isolates from these patients had lower frequencies of virulence genes.Conclusion: The mortality rate of patients with EC-COBSI was unrelated to ESBL status of the isolates. Most isolates had low resistance to most of the tested antimicrobial agents. The isolates were diverse, and multiple strains were related. Prevention and control of EC-COBSI should target prevention of patient colonization and the living environment.

Clinical characteristics of children with airway malacia complicated by pneumonia

BackgroundAirway malacia is an important cause of noisy breathing, recurrent wheezing and respiratory infections, chronic coughing, and episodes of respiratory distress in young children. As the clinical manifestations of airway malacia are not common, many clinicians have insufficient understanding of this disease. So the purpose of this study is to summarize the pathogenic bacteria and clinical manifestations of airway softening complicated with pneumonia in children.MethodsChildren hospitalized with airway malacia complicated by pneumonia were eligible for enrollment from January 1, 2013 to December 31, 2019. Medical records of patients were reviewed for etiology, clinical characteristics, and laboratory examination results.ResultsA total of 164 pneumonia patients with airway malacia were admitted. The male-to-female ratio was 3:1. The age of patients ranged from 1 month to 4 years old. The median age was 6 (3–10) months. The most commonly detected pathogen were Mycoplasma pneumoniae (25/164, 15.24%), Streptococcus pneumoniae (18/164, 10.98%), and respiratory syncytial virus (16/164, 9.76%). Common signs among the 164 patients with confirmed airway malacia included cough (98.78%), wheezing (67.07%), fever (35.37%), intercostal retractions (23.17%), dyspnea (10.98%), cyanosis (11.11%), and crackles (50%). Compared with those without airway malacia, the incidence of premature delivery and mechanical ventilation was higher, and the duration of symptoms before admission (median, 13.5 d) and hospital stay (median 10.0 d) were longer. Of the children with pneumonia, 11.59% of those with airway malacia required supplemental oxygen compared with 4.88% of those without airway malacia (p < 0.05).ConclusionThe median age of children with airway malacia was 6 months. The most common pathogen in patients with airway malacia complicated by pneumonia was Mycoplasma pneumoniae. Patients with airway malacia complicated by pneumonia often presented with a longer disease course, more severe symptoms, and had delayed recovery.

Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection.

Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.

Incidences and reasons of postoperative surgical site infection after lumbar spinal surgery: a large population study.

The purpose of this study was to determine the incidences of postoperative acute surgical site infection (SSI) after lumbar spinal surgery and its possible reasons in our hospital during the past 9years. This is a retrospective study with a large sample size. The medical records of all included patients were reviewed, and patients with acute SSI were identified. The incidence and possible reasons of SSI were determined. A total of 7240 patients who underwent posterior lumbar spinal surgery were included in this study, and the total incidence of postoperative SSI was 1.53% (111/7240). Gram-negative bacteria were found to be dominant in postoperative wound infections after lumbar spinal surgery. And Escherichia coli were the most common pathogen in patients with SSI. The rate of postoperative SSI following lumbar spinal surgery was increased at first and then decreased during the past 9years. Additionally, from 2011 to 2014, it was mainly deep infection in these patients, and then was mainly superficial infection from 2015 to 2019. Patients with lumbar spinal stenosis had the highest incidence of postoperative SSI (2.39%, P < 0.001). There was also a significant difference for the number of SSI cases among different surgeons. Based on a large population analysis, Gram-negative bacteria were the most common pathogen in postoperative SSI after lumbar spinal surgery. And patients with lumbar spinal stenosis had the highest incidence of SSI. Increasing the intervention of Gram-negative may be an important step to reduce the postoperative SSI after lumbar spinal surgery.

The current state of immunization against Gram-negative bacteria in children: a review of the literature.

Gram-negative bacteria (GNB) are a major cause of infection worldwide and multidrug resistance in infants and children. The major pathogens include Klebsiella pneumoniae, Escherichia coli, Enterobacter spp., Pseudomonas aeruginosa and Acinetobacter baumannii. With new antibiotic options limited, immunization is likely to play a critical role in prevention. This review discusses their epidemiology, the current state of vaccine research and potential immunization strategies to protect children. A comprehensive review of the literature, conference abstracts along with web searches was performed to identify current and investigational vaccines against the major GNB in children. Phase I--III vaccine trials have been undertaken for the major Gram-negative bacteria but not in infants or children. E. coli is a common infection in immune-competent children, including neonatal sepsis. Several vaccines are in late-phase clinical trials, with some already licensed for recurrent urinary tract infections in women. Klebsiella spp. causes community-acquired and hospital-acquired infections, including sepsis in neonates and immunocompromised children although no vaccine trials have extended beyond early phase 2 trials. P. aeruginosa is a common pathogen in patients with cystic fibrosis. Phase 1--3 vaccine and monoclonal antibody trials are in progress, although candidates provide limited coverage against pathogenic strains. Enterobacter spp. and A. baumannii largely cause hospital-acquired infections with experimental vaccines limited to phase 1 research. The current immunization pipelines for the most prevalent GNB are years away from licensure. Similar to incentives for new antibiotics, global efforts are warranted to expedite the development of effective vaccines.

The efficiency of the polymerase chain reaction methods for the detection of common pathogens in patients with chronic obstructive pulmonary disease

The efficiency of the polymerase chain reaction methods for the detection of common pathogens in patients with chronic obstructive pulmonary disease

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study.

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.Electronic supplementary materialThe online version of this article (10.1007/s10096-020-03870-3) contains supplementary material, which is available to authorized users.

Role of Prophylactic Antibiotic Administration in Growth of Methicillin Resistant Staphylococcus Aureus in Rhinoplasty

Background: Septoplasty and septorhinoplasty are common surgical procedures in modern surgical practice. Pre or postoperative antibiotic administration has raised concerns about the possible increase in the antibiotic-resistant species. The aim of this study was to evaluate the role of postoperative antibiotic prophylaxis in increasing Methicillin-Resistant Staphylococcus Aaureus species (MRSA) in patients, who underwent septoplasty or septorhinoplasty in Loghman Hakim Hospital in Tehran, Iran.Methods: A total of 102 patients, who were planned to undergo septoplasty or septorhinoplasty, participated in this double-blind randomized clinical trial. The patients were divided into the case (n=60, mean age of 28.2 years) and control (n=38, mean age of 28.9 years) groups. Overall, 98 patients participated in the study. The case group received a preoperative injection of cephalothin (1g) and postoperative oral cephalexin regimen (500mg 4 times a day for 7 days). The control group only received a preoperative injection of cephalothin (1g). Vestibular nasal swab cultures were obtained preoperatively and on postoperative day 7. The samples were, then, quickly transferred to the laboratory and cultured on proper media. The results indicated that five MRSA species in the case group and tow MRSA species in the control group were present, postoperatively.Results: The findings of this study suggest that oral antibiotic prophylaxis may lead to a statically non-significant increase in MRSA infection in patients, who require this treatment. Conclusion: Further knowledge of the endogenous nasal flora and the microbiology of common pathogens in patients undergoing septorhinoplasty will help reduce the incidence of infectious complications to a greater level.

110. Clinical Outcomes of Patients with Secondary Bacteremia in the Omadacycline Phase 3 Acute Bacterial Skin and Skin Structure Infections and Community-Acquired Bacterial Pneumonia Studies

BackgroundLow serum concentrations of tetracycline antibiotics may raise concerns on their efficacy in patients with secondary bacteremia, especially in comorbid patients and in those with higher acuity of illness. Omadacycline (OMC), an aminomethylcycline antibiotic, showed noninferiority to linezolid (LZD) in two acute bacterial skin and skin structure infections (ABSSSI) studies (Omadacycline in Acute Skin and skin structure Infections Study [OASIS]-1 and -2), or to moxifloxacin (MOX) in a community-acquired bacterial pneumonia (CABP) study (Omadacycline for Pneumonia Treatment In the Community study [OPTIC]). This analysis considers clinical outcomes in patients with secondary bacteremia identified in these studies.MethodsBaseline blood cultures were taken from adult patients enrolled in Phase 3 randomized, double-blind clinical studies of OMC. Patients received ≥1 treatment dose: N = 1,347 ABSSSI (OMC n = 676; LZD n = 671); N = 774 CABP (OMC n = 386; MOX n = 388). Efficacy was evaluated by investigator assessment of clinical response at a post-treatment evaluation (PTE) 7–14 days (ABSSSI) or 5–10 days (CABP) after the last dose.ResultsBacteremia was confirmed in 63 patients (3%) across the three studies. Staphylococcus aureus was the most common pathogen in patients with ABSSSI (N = 30: OMC n/N = 7/13; LZD n/N = 9/17), with a median treatment duration of median 9 days (OMC) and median 10 days (LZD). Streptococcus pneumoniae was the most common pathogen in patients with CABP (N = 33; OMC n/N = 11/15; MOX n/N = 11/18), with a median treatment duration of 11 days (OMC) and 14 days (MOX). Clinical success was numerically comparable between treatment groups within each study (figure) after completion of therapy.ConclusionThe clinical successes of patients receiving OMC for ABSSSI or CABP with secondary bacteremia were comparable to results for LZD and MOX, respectively. Although limited by the small sample size, data from ABSSSI and CABP study patients with secondary bacteremia provide reassurance for the use of OMC. Real-world OMC data in patients with ABSSSI and CABP will be needed to assess outcomes in patients with additional comorbidities and/or higher acuity of illness. Disclosures All authors: No reported disclosures.

In vitro Antifungal Activity of Japanese Folk Herb Extractsagainst Trichophyton rubrum.

Folk herbs are vital to the Japanese health care system, with some being used to treat fungal skin infections. We tested folk herbs used in traditional Japanese medicine for in vitro antifungal activity against Trichophyton rubrum, the most common pathogen in patients with superficial dermatitis. Acetone, ethanol, methanol, water, and acetic acid extracts from 15 species of Japanese folk herbs (Bi-wa, Aka-me-gashiwa, Ta-mushi-ba, Yomogi, Shi-so, Ku-ko, So-ba, Yama-momo, Kuro-mo-ji, Ichi-ji-ku, Kaki-no-ki, Kuwa-no-ki, Kusa-gi, Chimaki-zasa, and I-bukijya-kou-sou) were evaluated for fungal growth inhibition, as measured by absorbance. Crude acetic acid extracts of Aka-me-gashiwa, Ta-mushi-ba, Yomogi, Ku-ko, Kaki-no-ki, and I-bukijya- kou-sou exhibited antifungal activity comparable to that of amphotericin B. Although the active compounds and underlying antifungal mechanisms are not known, the data contribute to the development of new and safe antifungal drugs, highlight new extraction methods for herbs, and support the traditional use of Japanese folk herbs against fungal infections.