Common Causative Organism Research Articles

The clinical utility of tissue polymerase chain reaction, tissue culture and tissue histology in blood culture-negative infective endocarditis in South Africa – insights from the Groote Schuur Hospital Infective Endocarditis Registry

Background. Infective endocarditis (IE) poses significant diagnostic and therapeutic challenges, especially in cases of blood culture-negative infective endocarditis (BCNIE). Among patients undergoing surgery for IE, valve tissue may be evaluated for additional microbiological information by performing a broad-range 16S rDNA polymerase chain reaction (PCR) test, tissue culture and tissue histopathology. In patients with BCNIE, these diagnostic tests may identify the causative agents, guide further clinical management and improve local IE-related epidemiological data. The clinical utility of additional analysis of explanted tissue in a local South African (SA) setting has yet to be described. Objectives. To assess the clinical utility of performing PCR, culture and histopathology on the tissue of surgically explanted valves in BCNIE patients in an SA public sector hospital. We assess their diagnostic yield and treatment impact in a cohort of BCNIE patients treated with empirical antibiotic regimens. Methods. We analysed data from the Groote Schuur Hospital (GSH) Infective Endocarditis Registry, a prospective observational study of adult patients with infective endocarditis. Participants for this analysis were selected based on clinical and pathological criteria for IE and negative blood cultures. All participants were treated between January 2017 and March 2021. Results. During the study period, we identified 165 IE cases, 57 (34.5%) of which were blood-culture negative. BCNIE patients had a mean (standard deviation) age of 40.2 (13.4) years, and 41 (71.9%) were male. Twenty-seven of the 57 BCNIE patients underwent cardiac surgery and had tissue analysis performed. Tissue PCR identified an aetiological agent in 17/27 (63%) cases, with Bartonella spp. (12/27, 44%) being the most common organism. Tissue culture was positive in 3/27 (11%) cases, but the organisms identified were thought to reflect sample contamination. Tissue histopathology was performed in 22/27 (81.5%) cases and provided macroscopic confirmation of IE, but did not identify any specific organisms in any of the specimens. Only a small subset of the overall BCNIE cohort (11/57 (19.3%)) had serum serology for Bartonella spp. and Coxiella spp. performed, and 5/11 (45.5%) were positive for Bartonella spp. There was a 100% concordance rate between positive serum serology and tissue PCR. Tissue PCR impacted the antimicrobial regimen in 20/27 (74%) cases. Tissue culture and tissue histopathology did not influence antibiotic regimens in any patients. Conclusion. In this single-centre study, perioperative serum serological testing was underutilised in BCNIE. Tissue PCR was valuable in determining the aetiology of BCNIE, and influenced management. Tissue culture and histopathology had a poor yield and added little value in identifying the microbiological cause of BCNIE. Finally, the most common BCNIE causative organism identified by additional non-culture testing in our setting is Bartonella spp.

P-793. Long-term Outcomes of Mycobacterium avim complex Pulmonary Disease in Kyushu, Japan: A Retrospective Multicenter Study

Abstract Background Recently, the number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has increased worldwide. The most common causative organism in Japan is the Mycobacterium avium complex (MAC). The incidence of MAC pulmonary disease (MAC-PD) is higher than that in other countries, and deaths from MAC-PD are increasing. Complex cases involving radiological fibrocavitary patterns and pulmonary aspergillosis have been reported as poor prognostic factors; however, available evidence is limited. To address this gap, we initiated a retrospective, multicenter study in Kyushu, Japan, focusing on the long-term prognosis of patients five years after the diagnosis of MAC-PD. The primary objective of this study was to investigate the factors that influence the outcomes of these patients by employing data accessible at the time of their initial diagnosis. Methods This was a retrospective cohort study of patients aged ≥ 18 years with newly diagnosed NTM-PD who visited 18 medical centers in Kyushu, Japan, between 2010 and 2017. Patient data were collected from medical records by respiratory experts and recorded using the EDC. Results The study enrolled 1317 patients with NTM-PD, of whom 1214 had MAC-PD. Patients with insufficient information were excluded, and 856 patients were analyzed: 546 (63.8%) with a non-cavitary nodular bronchiectatic (NB) pattern and 194 (22.7%) with a cavitary NB or fibrocavitary pattern. 107 (12.5%) died from all-cause by 5 years after diagnosis and 137 (16.0%) by 10 years; in the group that died after 5 years, the following were detected as risk factors in multivariate analysis: male sex (OR = 2.90, 95% confidential interval 1.84-4.56), age ≥ 70 (OR = 2.20, 95%CI 1.33-3.63), lobes with cavities ≥ 2 lobes (OR = 2.16, 95%CI 1.07-4.36), albumin < 3.5 g/dL (OR = 3.68, 95%CI 2.29-5.91), and oral corticosteroids (OR 1.97, 95%CI 1.04-3.73). Conclusion Male sex and fibrocavitary patterns have been reported to be poor prognostic factors for MAC-PD. In our study, we found that cavitary formation in more than two lobes, lower albumin levels, and oral corticosteroids were newly considered poor prognostic factors. We believe that our findings may help determine treatment induction and predict the prognosis of MAC-PD. Disclosures Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees

P-919. Epidemiology of Cerebral Sinovenous Thrombosis in Children with Acute Bacterial Intracranial Infection: a Single-Institution Retrospective Study

Abstract Background Cerebral sinovenous thrombosis (CSVT) is a known complication of acute bacterial intracranial infection. The objective of this study is to determine the annual proportion of, risk factors for, and outcomes in children with CSVT secondary to acute bacterial intracranial infection.Figure 1:Annual proportion of CSVT in children with acute bacterial intracranial infection between Jan 1, 2015 and December 31, 2022 Methods Retrospective single-center cohort study of children age 1-18 years hospitalized at a tertiary care children’s hospital for acute bacterial intracranial infection between 01/01/2015 and 02/01/2023. Cases were identified by discharge ICD codes for “meningitis,” “meningoencephalitis,” “subdural empyema,” “epidural abscess,” and “brain abscess.” Medical charts were manually screened to ascertain the diagnosis and to abstract relevant clinical data. Multivariate models were built to examine risk factors for CSVT. Results One hundred and three patients were included. Median age was 10.2 [5.9,12.7] years. 31/103 (30%) had CSVT. Annual proportion of CSVT did not vary; however, the total number of cases of intracranial infection rose during the study period. Patients with CSVT were no different from those without CSVT by demographics, vaccination status, neurologic signs or symptoms at presentation, or causative organisms. Non-pneumococcal streptococcus species were the most common causative organisms, found in 37/103 (36%) children. Need for neurosurgical intervention (aOR=11.6, p=0.027), need for ENT intervention (aOR=6.1, p=0.013), temporal location of infection (aOR=7.9, p=0.004), and concurrent mastoiditis (aOR=29.5, p=0.004) were associated with CSVT. The sigmoid sinus (55%, 17/31), transverse sinus (42%, 13/31), jugular vein (45%, 14/31), and superior sagittal sinus (45%, 14/31) were the most common locations for CSVT. Two patients (6%) had venous infarction; one (3%) had venous hemorrhage. A higher proportion of children with CSVT had behavioral concerns (p=0.020) and learning concerns (p=0.025) than children without CSVT. Conclusion CSVT is common in acute bacterial intracranial infection. Consider empiric surveillance in children with acute bacterial intracranial infection with mastoiditis, temporal location of infection, and/or those who require surgical intervention. Outcomes in this population should be further explored. Disclosures All Authors: No reported disclosures

Skin colonization by pathogenic bacteria as a risk factor for neonatal sepsis.

Neonatal sepsis continues to be a leading cause of mortality among the NICU admitted neonates. The most common causative organisms have been proven to be hospital-acquired organisms. This study was planned with aim of understanding the pathological colonization of neonatal skin and associated risk factors as well as finding a possible correlation between blood culture isolates and neonatal skin colonizers and their antimicrobial resistance patterns. This prospective cohort study was conducted at a tertiary care centre in Northern India from January 2021 to June 2022. The study participants were 50 pre-term neonates and 50 term neonates, who were born in our hospital and subsequently admitted to the NICU. Skin swabs, taken from 5 body sites within 24h of birth and at discharge, were cultured for isolation of pathological bacteria. Neonates were followed-up during their hospital stay for observing any occurrence of blood culture positive sepsis. Out of 100 neonates, 31 pre-term and 28 term neonates were colonized within 24h of birth while almost all were colonized by discharge. Posterior auricular fossa was the most colonized site. Coagulase Negative Staphylococcus (n=195) and Escherichia coli (n=51) were the most common isolates. Risk factors found to be significantly associated with colonization were low birth weight (<2500g), premature rupture of membranes (PROM), invasive mechanical ventilation and positive urine and vaginal cultures of mothers. Neonates with culture positive sepsis also had colonization with MDROs. Neonatal skin colonization and their antimicrobial resistance rates increased over the course of hospital stay, having a possible contribution towards culture positive sepsis.

Effect of Staphylococcal Decolonization Regime on Post-Craniotomy Meningitis.

Post craniotomy meningitis (PCM), an uncommon complication following craniotomy can be categorized as either bacterial meningitis (BM) or aseptic meningitis (AM) based on the results of CSF culture. Staph. aureus is a common causative organism. Some patients who are nasal carriers of these organisms have been shown to be at a higher risk of acquiring surgical site infections (SSI) following general or gynecological surgeries. Staphylococcal decolonization regime (SDR), using chlorhexidine gluonate (CHG) showers and application of mupirocin ointment to the anterior nares, is an attempt to reduce the load of these bacteria in a patient prior to surgery. SDR targeted at those proven to be nasal carriers of staphylococcal bacteria, has shown to reduce SSI following general surgery, gynecological surgery and cardio-thoracic surgery. However, its effectiveness in reducing PCM has been poorly investigated. In a review of the literature on the use of SDR in patients undergoing craniotomy, we found only one study where the authors used CHG showers but in a non-targeted fashion (all patients rather than only carriers). They showed a reduction in the incidence of both AM and BM following craniotomy compared to historical controls, but the study had a confounder in the form of a change of the prophylactic antibiotic used. While there is no high quality evidence that SDR is effective in reducing PCM, its relatively low cost, easy implementation and few and mild side effects, would make it attractive to adopt in patients undergoing craniotomy.

Enteric pathogens implicated in acute infectious diarrhea among young children in resource-limited region with rapidly growing population: a hospital-based cross-sectional study.

Acute infectious diarrhea is among the leading causes of morbidity and mortality worldwide, particularly in developing countries and among children younger than 5 years of age. To determine the causative microorganisms in diarrhea and elucidate their epidemiological trajectory among children younger than 5 years of age to establish successful preventive measures. This cross-sectional study was conducted in Al-Musayyib District, Babil Governorate, Iraq, using data from January 2023 to January 2024 provided by the information system of Ibn Saif Children's Hospital and Al-Musayyib General Hospital. Data from 300 children under 5 years of age with infectious diarrhea were collected to determine the causative pathogens. Patient data including sex, age, treatment, and post-treatment clinical condition, were collected from the hospital archive and analyzed. Overall, 56% of males and 44% of females had diarrhea. The 1-2-year age group was the most susceptible to diarrhea (33.3%). This rate gradually decreased with age, reaching 9.9% in the 4-5-year age group. Furthermore, bacteria were the causative organisms in 43% of cases, followed by viruses, parasites, and fungi at 24.7%, 12%, and 7.7%, respectively. Mixed infections were detected in 12.6%. Post-treatment, 89.7% of patients completely recovered, 8% experienced physiological disorders, and 2.3% died. Bacteria were the most common causative organisms of infectious diarrhea among children younger than 5 years of age. Children in the 1-2-year age group were the most commonly affected. This study highlights that diarrhea continues to threaten the lives and well-being of children.

Epidemiology, microbiological profile and susceptibility pattern of uropathogens from a tertiary care hospital in central India

Urinary tract infections (UTIs) are the second most common infection in the community, whereas in hospitals, they are the most common healthcare-associated infections. Monitoring factors like the most common causative organisms and their susceptibility pattern is essential for tailored management and practicing antimicrobial stewardship. This study was done to determine the epidemiology, microbiological profile, and susceptibility pattern of uropathogens to make better antibiotic policy.: This was a retrospective descriptive study done at the Department of Microbiology, Pt. JNM Medical College, Raipur, Chhattisgarh in which analysis of the culture isolates obtained from urine samples received between January 2022 to December 2022 was performed.: Out of 2893 urine samples, 784 (27.1%) showed significant growth on culture. Females were more affected than males with male to female ratio being 1:2.3. Most common causative organism found in our study was (41.9%) followed by species (23.9%), non-albicans species(11.09%) and (10.3%). isolates showed 100% susceptibility to fosfomycin; 93% for nitrofurantoin, and 93% for carbapenems. In the case of isolates of the susceptibility percentage for nitrofurantoin and carbapenems were 59% and 82% respectively. In isolates were 100% susceptible to Teicoplanin and Fosfomycin, 82% for Nitrofurantoin.: followed by species the most common uropathogen. Nitrofurantoin and Fosfomycin were the most effective antibiotics against uropathogens.

The Incidence of Infection Following Open Tibia Fractures in Low-Income Countries: A Systematic Review

Introduction: Open tibial fractures (OTFs) are common in low-income countries (LICs), primarily caused by road traffic collisions. High rates of infection in OTFs contribute to prolonged recovery, disability, and economic loss. Identifying infection rates and causative organisms is essential for improving outcomes and guiding antibiotic treatment in LICs. This systematic review aimed to determine the incidence of surgical site infections (SSIs) following OTF treatment in LICs and identify the most prevalent microorganisms involved. Methods: Following PRISMA and Cochrane guidelines, a systematic review was conducted using five databases. Eligible studies included randomised controlled trials, cohort studies, and case series investigating OTFs in LICs. Studies with fewer than ten participants, military medical resources, or those from high-income countries were excluded. Data were extracted for infection rates, causative organisms, and treatment modalities, with a meta-analysis performed using a random effects model to calculate incidence in person-years. Results: Five studies, including two retrospective cohorts, two prospective cohorts, and one RCT, were analysed. The overall infection incidence was 23.21 per 100 person-years (95% CI: 9.19; 58.62). Subgroup analysis showed a slightly lower incidence of 21.88 per 100 person-years for surgical interventions. A high degree of heterogeneity (I² = 91%) was noted. Common causative organisms were not consistently reported. Conclusion: The incidence of SSIs following OTFs in LICs is high, particularly in severe fractures. Establishing a baseline infection rate is critical for future studies to evaluate treatment efficacy and improve outcomes in resource-limited settings. Further research should focus on standardising definitions and reporting of infections to reduce heterogeneity.

Catheter-associated urinary tract infections – A review

Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired infections and contribute to significant morbidity and mortality in patients. They can cause symptoms such as fever, hematuria, pain, and acute confusion. The most common causative organism is Escherichia coli. The treatment of CAUTIs is often dependent on the urine cultures and sensitivities. CAUTIs account for a significantly large number of hospital-acquired infections. They are often preventable with the right education and management. In obstetrics and gynecology, it is important to have a policy of taking catheters out as soon as feasible to reduce the risk of UTIs as well as health-care costs. In this review we discuss the pathophysiology, treatment, and prevention strategies of CAUTIs and current evidence based perspective.

P32 A case of disseminated pneumococcal infection with musculoskeletal manifestations

Abstract Introduction Septic arthritis should be the first consideration in any patient presenting with a hot, swollen joint. Infection may affect one or more joints, and bacteria typically enter the joint through direct inoculation, haematogenous seeding, or spread from adjacent soft tissue or bone infection. Staphylococcus aureus is the most common causative organism. Streptococcus pneumoniae is an uncommon cause of septic arthritis, accounting for approximately 5% of cases. We present the case of a 78-year-old male with no significant medical history who presented with a polyarticular pattern of joint inflammation related to disseminated pneumococcal infection. Case description The patient presented with a one week history of gradual onset pain and swelling in the right knee and right wrist. He was previously well and remained physically active. He was a non-smoker, drank moderate alcohol and had no history of intravenous drug use. He had no current or preceding infective symptoms, including respiratory tract symptoms, nor history of trauma or recent foreign travel. Examination revealed a warm right knee effusion with restricted range of movement. There was swelling of both wrists (right more than left), both second metacarpophalangeal joints and the left ankle. There were no heart murmurs or peripheral stigmata of endocarditis. He was afebrile and haemodynamically stable. Admission blood tests showed WBC 21 x109/L, neutrophils 18 x109/L, CRP 369 mg/L, urate 452 µmol/L and procalcitonin 3.84 µg/L. Rheumatoid factor was 25.3 IU/mL with negative anti-CCP. Knee X-ray showed significant medial compartment osteoarthritis. Hand and wrist X-rays were unremarkable. Synovial fluid aspirate from the right knee grew Streptococcus pneumoniae and calcium pyrophosphate crystals were also seen on polarised light microscopy. Blood cultures were positive for the same organism. The patient underwent arthroscopic washout of the knee and was treated with colchicine and intravenous amoxicillin. He was taken to theatre for a right wrist washout, however the wrist was found to be clean and dry intraoperatively. He had two further washouts of the right knee and repeat intraoperative samples and blood cultures were negative. Additional screening for HIV, syphilis and myeloma was negative. Transthoracic echocardiogram showed no vegetations. CT chest showed basal atelectasis but no focal consolidation. Left hand and wrist MRI showed extensor compartment tenosynovitis and second metacarpophalangeal joint synovitis. His antibiotics were switched to intravenous ceftriaxone and oral doxycycline. He clinically improved and was discharged with a plan to complete a 6-week course with outpatient review. Discussion Streptococcus pneumoniae is an uncommon cause of septic arthritis, responsible for approximately 5% of all cases, but more often causes polyarticular infection than other organisms. This may be related to higher rates of bacteraemia in patients with pneumococcal septic arthritis. In one review of 190 cases of pneumococcal septic arthritis, polyarticular infection was present in 36% of patients and 72% had concomitant bacteraemia (compared with rates of approximately 20% polyarticular infection and 30-50% bacteraemia for septic arthritis overall). The joints most commonly affected are the knee, followed by the hip, shoulder, ankle and elbow. The original focus of infection is most commonly pneumonia or meningitis, but up to 50% of patients have no identifiable extra-articular source of infection. Pneumococcal septic arthritis more commonly affects patients with predisposing risk factors, such as rheumatoid arthritis, osteoarthritis, joint prosthesis, alcoholism, myeloma and other malignancies, diabetes and immunosuppression. Our patient had no specific predisposing medical conditions other than knee osteoarthritis, and his age was likely to be his main risk factor. It is also important to note that septic arthritis in the elderly can present atypically, with insidious onset and absence of fever or other signs of systemic infection. This was the case in our patient, who despite bacteraemia and markedly elevated inflammatory markers, did not otherwise appear floridly septic or unwell. Our patient presented with a polyarticular pattern of joint inflammation, although joint infection was only ultimately confirmed in the right knee. Also notable was the presence of calcium pyrophosphate crystals in the aspirate. One might theorise whether the infection might have triggered a reactive polyarthropathy or concurrent crystal arthritis. It is well recognised that septic arthritis and crystal arthritis can coexist in the same patient. The case also highlights the value in sampling multiple joints and taking blood cultures in such patients. Key learning points • Polyarthritis does not exclude the possibility of septic arthritis • Joint aspiration should be performed in all patients presenting with a hot, swollen joint • In cases of polyarthritis, consideration should be given to aspiration of all affected joints and taking blood cultures, particularly in the elderly and patients with predisposing risk factors for septic arthritis • Septic arthritis can present atypically in the elderly, with the absence of fever and other typical signs of systemic infection

Navigating the Complexity of Thalamic Abscess: A Systematic Review of Case Studies and Evidence-Based Management.

Thalamic abscesses are rare, life-threatening conditions and represent only a few percent of the total cases of brain abscesses. Due to their deep location and critical involvement of sensory and motor pathways, they remain one of the most challenging entities to diagnose and manage. Despite advances in neuro-imaging and neurosurgical techniques, thalamic abscess continues to be a challenge or question in clinical practice regarding optimum treatment modality. Given the nature of the description, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were retrieved after extensive searches in PubMed and Scopus with specified inclusion criteria: isolated thalamic abscesses that needed surgical interventions. The reporting quality was assessed according to CARE (CAse REports) guidelines, while data on clinical presentation and diagnostic approach were extracted. Thirty-three cases with the diagnosis of thalamic abscess were reviewed. The most common presentations included headache, hemiparesis, and altered sensorium. CT and MRI were the common diagnostic tools for these patients; stereotactic aspiration was the most common surgical intervention performed. Streptococcus species were the most common causative organisms. At follow-up, the majority of patients had a good outcome with complete or near-complete recovery. There were rare complications, such as hydrocephalus and recurrence, and mortality was low. Thalamic abscesses are infrequent but have a good prognosis in case of appropriate diagnosis and treatment with stereotactic aspiration and appropriate antibiotic therapy. The present systematic review points out the need for adopting an individual approach to treatment and for further studies that could provide better information on diagnostic and therapeutic strategies regarding this severe disease.

Etiology of septic arthritis in children of Qatar.

Septic arthritis is an orthopedic emergency and if not evaluated and treated appropriately, it can lead to poor clinical outcomes. Previously several studies have been performed to identify the etiology of septic arthritis in the pediatric population in developed countries. The main objective of our study was to identify the etiology of septic arthritis in children in Qatar in previously healthy and fully vaccinated children. We performed retrospective chart analysis of children presenting to our emergency department between July 2018 and June 2024, who were diagnosed and treated with septic arthritis. The study was conducted at a level 1 pediatric trauma center and the only children's hospital in the country. We used ICD 9 and ICD 10 codes to identify such cases. After using predefined exclusion criteria, children with positive blood cultures, blood titers for Brucella and/or synovial cultures were included in the analysis. Clinical symptoms and signs, ultrasound findings, and culture results were tabulated using descriptive statistics. A total of 45 patients were included. The median age of children was 5 years (interquartile range [IQR] 2-10 years). Majority (60%) were male. The most common clinical findings were limping/limitation of joint movement (100%), fever (80%), and swelling of joints (58%). The median C-reactive protein and erythrocyte sedimentation rate were 94mg/L and 47mm/h. The knee and hip were the most common joints affected. The most common causative organisms were Staphylococcus aureus (56%), Streptococcus pyogenes (13%), and Brucella (11%). Pre-intervention imaging, such as ultrasound and/or magnetic resonance imaging, was performed in 95% of patients. All patients recovered without any complications. One of the limitations of our study is that cases of Kingella kingae septic arthritis may be underreported as polymerase chain reaction (PCR) analysis of synovial fluid was not performed on all patients. Gram-positive cocci, especially S. aureus, remains the most common cause of septic arthritis in vaccinated children. We also identified Gram-negative bacilli as causative organisms in our study. We suggest including empiric coverage for both Gram- and Gram-negative bacilli when treating children with suspected septic arthritis till culture results are available.

Management and outcome of intracranial fungal infections in children and adults in Africa: a scoping review

IntroductionIntracranial fungal infections’ (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa.MethodsThis scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review.ResultsOf the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%).ConclusionMost IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.

Clinical and Etiology Presentations of Keratitis Caused by Mixed Infectious Agents (Bacteria and Fungi)

Introduction: Microbiological studies following the culture of corneal infiltrates are the gold standard for determining the etiology of infectious keratitis caused by bacteria or fungi; however, even if a culture of the corneal ulcer is obtained. Purpose: To investigate the predisposing factors and clinical and Etiology presentations of keratitis caused by mixed infectious agents (bacteria and fungi). Methods: This was a prospective study of cases with mixed bacterial and fungal keratitis, done between July to December 2022 in Department of Ophthalmology, Netraloy Eye Care Center, Thanthania, Bogura Sadar, Bogura, Bangladesh. Sixty (60) cases of mixed bacterial and fungal keratitis were identified. Samples (corneal swabs and scrapings) were collected aseptically from corneal ulcer patients. Isolation and identification of the microbial agents and antimicrobial susceptibility testing were done in the Microbiology and Pathology departments. Results: 38 cases (63.3%) were men, and the mean age was 54.2±9.3 years. The affected people were mostly (50; 83.3%) residing in the rural areas. 34 patients (56.7%) were involved in agricultural activities. The people of 41- 60 years of age were particularly prone to this disease (40; 66.7%). The most common predisposing factor for mixed keratitis was a history of ocular trauma (42; 70%) and 28 patients (46.7%) had a history of trauma with vegetative matter. The incidence of the disease was highest in the monsoon season, between June to September (32; 53.3%). The most common causative bacterial organisms was Staphylococcus aureus (26;43.3%) followed by Pseudomonas secies (10;16.7%) and among fungal organisms was Aspervgillus fumigates (22;36.7%) followed by Fusarium species (12;20%). Conclusion: The identification of the etiology and the predisposing factors of corneal ulcers in this region are important for the prevention and early treatment of the disease. Usually, patients with mixed bacterial and fungal keratitis have poor prognosis. Thus, when the infectious keratitis is running an atypical course or found unresponsive to the initial medical treatment, the possibility of a mixed infection by bacterial and fungal organisms should be considered.

658 Treatment Outcomes Among Patients with Recurrent Urinary Tract Infections Using a Multidisciplinary Management approach in a Complex UTI Clinic: A 20-Months’ Experience

Abstract Aim Our aim was to assess the treatment outcomes among patients with recurrent UTIs managed in a novel multidisciplinary complex UTI clinic started by Department of Urology at a single tertiary care centre, over a 20-month period. Method In view of persistently increasing burden and prevalence of antibiotic resistance associated with UTIs, a multidisciplinary complex UTI clinic, is started by Urologists supported by specialist nurses and microbiologists was started in April 2021. A prospectively maintained database of 176 patients {(median age 57.4 years (14-89 years) and (Male:Female ratio of 1:10)} who were referred to our clinic, within a 20-month period was reviewed. Patient demographics, urine culture results (causative bacterial organism and antibiotic sensitivities), investigations performed, and treatment outcomes were recorded. Pre-treatment QoL (Quality of Life) and post-treatment PGI-I (Patient global impression of improvement Scale) Score were measured. Results Escherichia Coli (69%) was identified as the most common causative organism. 30% patients had multi-resistant bacterial organism on urine culture. Abnormal Flexible cystoscopy, Renal Tract USS, CT Urogram was reported in 14%, 13% and 11% respectively. All patients received information on general cystitis prevention measures. 46 (26%) required intra-vesical treatment (Gentamicin 12%, Amikacin 1% and Glycosaminoglycans 13%). 71% patients remained infection free on follow up. Pre-treatment 64% patients reported significant impact on their QoL. 88.6% (94) of the 106 patients, followed up after the completion of treatment had good improvement on PGI-I scale (Table 1). Conclusions A dedicated complex UTI clinic service with multidisciplinary treatment approach can be efficient in managing recurrent UTIs.

Recurrent Hydatid Disease of Temporal Bone and Skull Base: A Case Report and Literature Review.

Hydatid disease is a parasitic infestation caused by Echinococcus granulosus. The disease is rare in the head and neck region with varying presentations. We present a rare case of recurrent hydatid disease of the temporal bone with intracranial involvement; and the treatment thereof. Hydatid disease is endemic in few parts of the world, its occurrence in head and neck region is very rare. The commonest causative organism is E. granulosus giving rise to cystic hydatid disease. Most of the former are asymptomatic, but can give rise to symptoms because of their mass effects or rupture. Our case is a 38year male presenting to ENT department with recurrent left ear discharge, giddiness, headache and facial palsy having operated elsewhere twice in the past. The patient was investigated by Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) of temporal bones, head and neck regions. Which showed soft tissue attenuation of middle ear cleft and multiple cystic lesions in the middle and posterior cranial fossae indicating intracranial extension of disease. We operated for left subtotal petrosectomy with vestibular labyrinthectomy. During the perioperative period he was treated with Albendazole. Patient remains clinically and radiologically asymptomatic (post surgery 1year) till date of this manuscript submission. Hence, we report the recurrent hydatid cyst in the temporal bone and skull base, which was managed by combination of surgical and medical treatment.

Incidence, Risk Factors, Short-term Outcomes, and Microbiome of Ventilator-associated Pneumonia in Very-low-birth-weight Infants: Experience at a Single Level III Neonatal Intensive Care Unit.

Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in neonates on invasive mechanical ventilation, resulting in high morbidity and mortality. The objective of this study is to determine the incidence, risk factors, short-term outcomes and microbiome associated with VAP in very-low-birth-weight (VLBW) infants born at <32 weeks of gestational age (GA). Retrospective study of intubated VLBW infants born at <32 weeks of GA admitted to the Los Angeles General Medical Center neonatal intensive care unit from July 2015 to July 2021 who had routine tracheal aspirate cultures obtained. Neonates were retrospectively classified into 3 groups, confirmed VAP, suspected VAP and no VAP, for comparison of risk factors, outcomes and airway microbial colonization. Eighty-seven infants met inclusion criteria with a mean GA of 26.1 ± 1 weeks and mean birth weight of 812 ± 281 g. The incidence of VAP was 7.8 per 1000 ventilator days, and the most common causative organisms were Gram-positive organisms (39%), predominantly coagulase-negative Staphylococcus. Duration of postnatal dexamethasone exposure predicted VAP compared to no VAP (coefficient, 0.31; 95% CI 0.03-0.59; P = 0.03) after adjusting for duration of intubation, surfactant use and antenatal steroid exposure. Infants with VAP had higher rate of grade 2/3 bronchopulmonary dysplasia (P = 0.03) and longer hospital stay (P = 0.04). VAP occurs at a high rate in VLBW infants who are exposed to prolonged dexamethasone use. It is predominantly caused by Gram-positive organisms.

Efficacy of cartridge-based nucleic acid amplification test (CBNAAT) in comparison with line probe assay and liquid culture in the evaluation of tubercular lymph node abscess.

Tuberculosis (TB) remains the number one cause of adult deaths by a curable infectious disease. Mycobacterium tuberculosis bacilli (MTB) is the most common causative organism isolated from mycobacterial lymphadenitis. Accurate and speedy diagnosis is required, especially in paucibacillary extrapulmonary TB. In this study, we compared the efficacy of CBNAAT with line probe assay and liquid culture in the evaluation of tubercular lymph node abscesses. This is a hospital-based observational cross-sectional study conducted at Gandhi Medical College and Hospital, Secunderabad, TS, in patients who presented with lymph node abscesses over a period of 18 months after obtaining clearance from the ethics committee and obtaining informed consent. Each sample was evaluated and analyzed in association with the clinical findings, AFB staining, CBNAAT, LPA, and AFB culture, and the results were compared. Fifty patients with TB lymph node abscess diagnosed through FNAC were included in the present study. AFB smear was positive in 29 samples, CBNAAT was positive in 43 samples, LPA was positive in 44 samples, and liquid culture was positive in 39 samples. CBNAAT could detect TB in 16 smear-negative cases, 10 liquid culture-negative cases, and one LPA-negative case. In our study, CBNAAT was more effective in diagnosing TB lymph node abscess than AFB smear. No significant results were obtained when comparing CBNAAT with LPA and liquid culture. This study demonstrates excellent diagnostic accuracy of the Xpert MTB/RIF test in patients with tuberculous lymphadenitis, with a sensitivity of 86%, specificity of 83.33%, negative predictive value of 95.56%, and positive predictive value of 58.82%. Thus, it can be a rule in testing for lymph node TB. These efforts will contribute to the attainment of the TB elimination goal.

Surgery for Active Infective Endocarditis on Mitral Valve: Anatomical, Surgical, and Disease Factors as Long-Term Outcome Modifiers.

Background and Objectives: Determinants of long-term outcomes after surgery for native mitral valve endocarditis have not been thoroughly investigated. The aim of this study was to assess anatomical, disease, and surgical risk factors for long-term mortality and need of reintervention, in patients undergoing mitral valve surgery for active endocarditis. Materials and Methods: Patients who underwent surgery for active native mitral valve endocarditis at three academic centres, between 2000 and 2022, were analysed. The primary outcome was long-term survival. The secondary outcome was the freedom from mitral reoperation. Survival curves were constructed with Kaplan-Meier methodology. Multivariable Cox regression was used to identify demographic, anatomical, disease, and surgical factors associated with late mortality and reoperation. Results: 335 consecutive patients with active mitral endocarditis were analysed. Two hundred and one patients (70.5%) had infection confined to the valve cusp whereas 89 (25.6%) had invasive disease extended to the annulus and surrounding tissues. Preoperative neurological events occurred at the diagnosis in 52 cases. Streptococci were the most common causative organisms followed by Staphylococcus aureus, Coagulase-negative Staphylococcus, and Enterococcus. Valve repair was performed in 108 patients (32.2%). Survival at 5 and 10 years was 70.1% and 59.2%, respectively. Staphylococcus emerged as an independent predictor of late mortality, along with age, chronic obstructive pulmonary disease, and previous cardiac surgery. Survival was considerably reduced in patients with S. aureus compared with those without (log rank p < 0.001). The type of surgery (repair vs. replacement) did not emerge as a risk factor for late mortality and reoperation. Seventeen patients underwent mitral reoperation during the follow-up. The 5- and 10-year freedom from reoperation was 94.7% and 91.8%, respectively. Conclusions: Active mitral valve endocarditis remains a life-threatening disease with impaired survival. While lesion characteristics influenced surgical decision-making and intraoperative management, their impact on long-term survival and freedom from reintervention appears to be moderated by other factors such as infecting pathogens and patient comorbidities.

Clinical, microbiologic, and treatment outcomes of dematiaceous fungal keratitis - A retrospective study.

Dematiaceous fungi, the third most common causative organism of fungal keratitis, constitute 3.5% to 43.5% of fungal keratitis worldwide. Several studies on filamentous fungi ( Aspergillus and Fusarium ) are available as opposed to that on dematiaceous fungal keratitis. This study aims to describe the profile of dematiaceous fungal keratitis in South India. This institutional cohort study on culture-proven dematiaceous fungal keratitis was performed in a single ophthalmology referral center in South India for a 6-year period. Records were analyzed for demographic, clinical, microbiological, and treatment outcomes for 3 months from the date of presentation. This study comprised 312 cases involving dematiaceous fungal keratitis (DFK). During the study period, DFK accounted for 10% of microbial keratitis and 24.6% of fungal keratitis cases. The mean (standard deviation) age was 54 (14) years. Males were commonly affected (73.4%). Keratitis was ≤1/3 rd depth in 47.8% of cases. Fifty-four cases (17.3%) demonstrated surface pigmentation, and 69 cases (22.1%) had endothelial plaque. Curvularia spp. (99 eyes, 31.7%) was the most common fungal isolate among the speciated fungi. Topical medications resulted in the healing of 63.5% of cases. A total of 193 cases (79%) healed, and 49 cases had to undergo therapeutic penetrating keratoplasty (TPK). Early TPK was performed for 20 cases (40.8%). Seventeen eyes (34.6%) maintained clear grafts at the end of 3 months. In this extensive study on DFK, we report a high incidence of this group of fungal keratitis. We found an excellent healing rate in our cohort of patients.