Pus Culture Research Articles

The antibiogram of pus cultures in federal tertiary care hospital, Islamabad and its utility in antimicrobial stewardship.

Antimicrobial resistance has emerged as a significant global health threat. Infections caused by Multi Drug-Resistant (MDR) bacteria pose formidable challenges in terms of treatment options and patient outcomes. Pus cultures serve as crucial diagnostic tools in identifying the agents responsible for various infections, and their antimicrobial susceptibility patterns which help in establishment of empirical therapy guidelines. This study was conducted to determine the pathogen and its susceptibility pattern from pus cultures and to generate antibiogram in our tertiary care setting. It was a cross-sectional study, conducted for a period of six months, from July 2022 to December 2022, in the Pathology Department of Pakistan Institute of Medical Sciences (PIMS). Out of total 2507 samples received, 1242 (49.5%) showed positive culture. Among the 1242 positive samples, 364 were Gram positive cocci (GPCs) and 878 were Gram negative rods (GNRs). Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolate (23%) followed by Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (16.9%), Enterobacter spp. (15.5%) and Escherichia coli (14.2%). Vancomycin was found to be highly effective (100%) against MRSA. GPCs were highly susceptible to linezolid (98%) while GNRs showed high level of sensitivity to colistin (96%) and tigecycline (92%). The generation of a local antibiogram specific to the hospital setting is essential to effectively manage infections empirically and preserve the efficacy of existing antibiotics. By implementing antimicrobial stewardship practices based on a better understanding of antibiotic susceptibility patterns, we can contribute to the mitigation of antibiotic resistance and improve patient outcomes.

Child Liver Abcess: Study of 12 Cases in the Pediatric Ward of the District Hospital of Bamako

Hepatic abscess is a suppurative collection developed in a neoformed hepatic cavity as a result of the invasion and multiplication of micro-organisms. The prognosis depends on early diagnosis and rapid treatment. The aim of the study was to determine the clinical, biological, ultrasound and therapeutic characteristics of liver abscesses in children aged between 1 month and 15 years hospitalised in the Paediatrics Ward of the District Hospital in Commune V, Bamako. This was a retrospective descriptive study which took place from January 2017 to December 2020, i.e. a period of 4 years, and a prospective study from January 2019 to December 2020, including all children aged between 1 and 15 years in whom the diagnosis of liver abscess had been confirmed by liver ultrasound. Out of 2756 children hospitalised during the study period from January 2017 to December 2020, i.e. a période of 4 years, 12 patients were diagnosed with liver abscess, i.e. a frequency of 0.43% or 4 cases/1000 admissions, with a female predominance of 58.3%, i.e. a sex ratio of 0.7. The mean age was 57 ± 34 months, with extremes of 16 and 120 months. The main reason for consultation was abdominal pain associated with fever, accounting for 75% of patients. Pus culture was positive for Staphylococcus Aureus in one patient (8%). Amebic serology was positive in 33% of patients. Ultrasound revealed a predominance of single abscesses located in the right lobe of the liver in 42% of patients. However, 92% of patients were cured, with an average hospital stay of 12 days, ranging from 2 to 19 days. Liver abscesses uncommon in our context, an early diagnosis and management can improve the prognosis.

Musculoskeletal melioidosis in a 33-year-old farmer presenting with the right leg cellulitis: A case report from North India

Melioidosis, caused by Burkholderia pseudomallei, has been described as “the great mimicker” due to its varied clinical presentation. Musculoskeletal melioidosis is a rare presentation of this disease, and here we report a 33-year-old male, farmer from Madhya Pradesh, who presented with fever for 2 months and right leg swelling for 25 days. He was treated elsewhere as cellulitis and managed with intravenous antibiotics and fasciotomy. Magnetic resonance imaging knee and leg showed diffuse osteomyelitis of the upper tibia with similar tiny foci and sinus tract present. A diagnosis of the right knee septic arthritis with multifocal osteomyelitis was made. Focal pus culture grew pansensitive B. pseudomallei. He was started on Inj. Meropenem and oral cotrimoxazole tablet. He also underwent right tibial debridement, sequestrectomy, and saucerisation. He was discharged after initial therapy and has improved significantly on follow-up. This case highlights a very common clinical condition caused by a rather uncommon etiological agent and therefore renumerates the importance of insightful clinical suspicion with appropriate use of investigations and treatment options to prevent further morbidity and mortality.

Microbiology and Antimicrobial Susceptibility in Adult Dacryocystitis.

To investigate the microbiology and antimicrobial susceptibility of dacryocystitis in adults and identify the changing trends over time in Taiwan. This is a single-centered, retrospective study. We retrospectively reviewed adult patients with dacryocystitis from January 2012 to December 2021 in a tertiary medical center in Taiwan. The pathogens and in vitro antimicrobial susceptibility of the pus cultures from the lacrimal sac were collected. Thirty-five cultures in acute and 211 cultures in chronic dacryocystitis were collected. Of the 220 isolates, a similar proportion of gram-positive (44%) and gram-negative (43%) aerobes were demonstrated in chronic dacryocystitis and more gram-negative aerobes (50%) than gram-positive aereobes (41%) in acute dacryocystitis. The most common pathogens were methicillin-resistant Staphylococcus aureus (MRSA; 28.1%) and Pseudomonas aeruginosa (28.1%) in acute dacryocystitis, while coagulase-negative Staphylococci was the most common micro-organism in chronic dacryocystitis. The effective antibiotics for gram-positive aerobes were vancomycin (100%), moxifloxacin (88%) and trimethoprim/sulfamethoxazole (78%). Meropenem (95%), amikacin (93%), and levofloxacin (91%) were sensitive to more than 90% of gram-negative aerobes in current study. High resistant species were also isolated in our cohort. More gram-negative pathogens and more resistant species are rising in adult dacryocystitis. Understanding the bacteriology and antimicrobial susceptibility of the region is crucial for the empirical antibiotic selection in clinical practice.

Case series of calcaneal osteomyelitis in patients with melioidosis

Background: Melioidosis is an emerging infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei, which can lead to a range of clinical manifestations including acute septicaemia and chronic localized infections. Osteomyelitis is an uncommon but well-recognized complication of melioidosis, with the calcaneus being a relatively rare site of involvement. Case Description: The authors present a case series of three patients with calcaneal osteomyelitis caused by B. pseudomallei infection. All three patients presented with non-specific symptoms like fever and weight loss, followed by localized ankle/foot pain and swelling. Diagnosis was made based on imaging findings (radiographs and MRI) and isolation of Burkholderia pseudomallei from blood or pus cultures. Treatment involved a combination of initial intravenous antibiotic therapy (meropenem or ceftazidime) for 4-6 weeks, followed by oral trimethoprim-sulfamethoxazole for 6 months. One patient required surgical drainage of a plantar abscess. All patients had a favourable clinical outcome with resolution of osteomyelitis on follow-up imaging. Conclusion: Calcaneal osteomyelitis is a rare but potentially serious complication of melioidosis. Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for favourable outcomes. Clinicians should maintain a high index of suspicion for osteomyelitis in patients with melioidosis, especially in patients from endemic areas as well as in patients with risk factors like diabetes. Close follow-up and monitoring for potential relapse or reactivation are essential, particularly in immunocompromised individuals.

A Cross-sectional Study of Cutaneous Manifestations in Overweight and Obese Children

Abstract Background: Overweight and obesity are a major public health problem and are now considered to be a global epidemic. The skin is one of the main organs to be affected due to metabolic abnormalities in obesity. The various cutaneous manifestations of obesity are directly related to the age of onset, duration, and severity of the underlying disease. Aims: The aim of this study is to determine the frequency and pattern of cutaneous manifestations in overweight and obese children. Materials and Methods: The present study was a cross-sectional study conducted among 150 overweight and obese children (according to the World Health Organization definition), of age group 5–19 years (school-going children) attending the dermatology and pediatrics outpatient department. The study utilized a prestructured pro forma to record demographic profile, weight, height, and body mass index; the different cutaneous manifestations were noted in overweight and obese children. Relevant investigations such as pus culture, potassium hydroxide (KOH) preparation, and skin biopsy were done wherever indicated. Results: Most of the patients were overweight (82%). Males (61.33%) outnumbered females (38.67%) in our study. Majority of the patients had acanthosis nigricans (74.67%), followed by striae distensae (32.67%), acne vulgaris (20%), and dermatophytosis (17.33%). Hidradenitis suppurativa was found in two children, and cellulite in one child. Conclusion: As obesity and its effects on the skin in school-going children are understudied by dermatologists and pediatricians, a proper examination and diagnosis of different cutaneous manifestations of obesity in children will further help in preventing multiple comorbidities in future.

Spinal Tuberculosis: An Exhaustive Diagnosis.

The most common organ affected due to tuberculosis (TB) is the lungs. Extrapulmonary TB is less common. Musculoskeletal organs are affected in around 8% of all tubercular patients, of which the spine is affected in almost half of the patients. The criteria for diagnosing spinal TB are quite difficult and we use an array of investigations for the same. A retrospective study was carried out in the Neurosurgery and Microbiology Department at IMS and SUM Hospital between January 2021 and November 2023, and data were collected and tabulated in an Excel sheet. One hundred patients with spinal TB were evaluated, and their age, sex, samples sent, diagnostic investigation, duration of diagnosis from hospital admission, histopathology results, and surgical intervention (done or not) were recorded. The best investigation done to diagnose spinal TB was imaging and surgical/computed tomography (CT)-guided biopsy. The earliest result to diagnose spinal TB was histopathology. The yield of positivity in pus culture, smear microscopy, and true nucleic acid amplification test (NAAT) was found to be low even though sensitivity was on the higher side. Even though we have an array of investigations for diagnosing spinal TB, the best and the earliest diagnosing test was imaging plus CT-guided biopsy. The confirmation is made in the biopsy. Finding acid-fast bacteria (AFB) and NAAT tests are additional beneficial tests to supplement the diagnosis. Hence, we can conclude that sending for tests like AFB in pus, NAAT, and GeneXpert is a wastage of biological samples and delays in diagnosis.

Back Abscess and Cellulitis due to Multidrug-Resistant Staphylococcus aureus Infection in Previously Healthy Neonate

We report a case of a nine-day-old male baby who was born term, spontaneously with normal birth weight, a history of forty-eight hours of premature rupture of membrane, and no history of early-onset sepsis. He suffered from fever followed by a small red bump on his back, which worsened, extended, and became an ulcer in the right axilla. The pediatric surgeon performed the debridement and modern wound care without a skin graft. The pus culture isolated. Staphylococcus aureus, resistant to oxacillin and at least three other non-?-lactam antibiotics. We then administered vancomycin for fourteen days. The patient was discharged after thirty-one days of hospitalization. Multidrug-resistant Staphylococcus aureus infection in neonates can manifest as severe progressive skin and soft tissue disease. However, proper management could deal with the prognosis.

Disseminated Cryptococcosis Involving Skin and Lung in an Immunocompromised Patient After Kidney Transplantation: A Case Report

Cryptococcus neoformans can cause detrimental cryptococcosis and other severe complications, especially in immunocompromised populations. Disseminated cryptococcosis in organ transplantation patients is extremely rare and often involves lungs, brains, skin, nails, and other organs. In this paper, we report a rare disseminated cryptococcosis case involving skin and lung that presented with recurrent dark brown abscesses and nodules in an immunocompromised female after kidney transplantation. The K-Set detection result of Cryptococcus capsular polysaccharide in serum is positive. The identification of pus culture by Autof MS 1000 indicates that the patient was infected with Cryptococcus neoformans var. grubii. In addition to treatment using liposomal amphotericin B, fluorocytosine, and fluconazole, local extraction of pus and simultaneous injection of liposomal amphotericin B into skin lesions were performed. This comprehensive treatment method proved effective, as the patient recovered from fever and skin symptoms. The innovative treatment may contribute to helping more disseminated cryptococcosis patients.

Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature

BackgroundKlebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients.Case presentationA 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital.ConclusionIn cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.

Fistula development after anal abscess drainage—a multicentre retrospective cohort study

PurposeAnal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery.MethodsThis was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records.ResultsA total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946–1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50–5.06) and ischioanal (OR 2.48, 95CI 1.36–4.47) abscesses, Crohn’s disease (OR 5.96, 95CI 2.33–17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47–7.01) or repeat surgery (OR 5.96, 95CI 2.33–17.2), E. coli-positive pus cultures (OR 4.06, 1.56–11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57–6.71).ConclusionSeveral significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.

Cellulitis caused by Roseomonas mucosa in a child: a case report

BackgroundRoseomonas mucosa (R. mucosa) is a pink-pigmented, Gram-negative short rod bacterium. It is isolated from moist environments and skin, resistant to multiple drugs, including broad-spectrum cephalosporins, and a rare cause of infection with limited reports. R. mucosa mostly causes catheter-related bloodstream infections, with even fewer reports of skin and soft tissue infections.Case presentationA 10-year-old boy received topical steroid treatment for sebum-deficient eczema. A few days before the visit, he was bitten by an insect on the front of his right lower leg and scratched it due to itching. The day before the visit, redness, swelling, and mild pain in the same area were observed. Based on his symptoms, he was diagnosed with cellulitis. He was treated with sulfamethoxazole/trimethoprim, and his symptoms improved. Pus culture revealed R. mucosa.ConclusionsWe report a rare case of cellulitis caused by R. mucosa. Infections caused by rare organisms that cause opportunistic infections, such as R. mucosa, should be considered in patients with compromised skin barrier function and regular topical steroid use. Gram stain detection of organisms other than Gram-positive cocci should be considered.

Acute, Chronic, and Latent Infection with (Re)Activation Melioidosis

Melioidosis can present as an acute as well as chronic disease and can be fatal. Type 2 diabetes mellitus is one of the most common risk factors for acquiring this infectious disease.We present a case of a 36-year-old diabetic male patient who presented in March 2022 with acute severe melioidosis and later developed chronic melioidosis. He did not take complete treatment and presented again in January 2023 with features of Latent infection with reactivation. The blood and pus culture showed positive results for Burkholderia pseudomallei (B. pseudomallei). The use of granulocyte colony-stimulating Factor (G-CSF) in addition to antimicrobial treatment with meropenem and later ceftazidime therapy played an effective role in the recovery of the patient. In this case report we present the acute and chronic manifestations with which he reported along with management of the case, review the literature on the impaired immunity in type 2 diabetic patient in melioidosis, latent infection with (re)activation, the suggested role of G-CSF and antimicrobial therapy.

Distribution and antimicrobial sensitivity pattern of multidrug-resistant Pseudomonas aeruginosa from the clinical specimen in Aceh, Indonesia

The development of P. aeruginosa resistance to antibiotics is increasing globally due to the inappropriate use of antibiotics. This retrospective descriptive study aimed to determine the distribution of multidrug resistant P. aeruginosa (MDRPA) and its antimicrobial sensitivity profiles. Data were taken from the bacterial identification and antibiotic sensitivity testing of clinical specimens in Aceh Provincial Referral Hospital from July 2017 to June 2019, where the VITEK® 2 Compact automatic device was used for the identification. In total, there were 307 P. aeruginosa isolates analyzed in this study. The results of this study revealed that 54.39% of P. aeruginosa isolates were multidrug resistant. The MDRPA were mostly found in sputum and pus cultures (41.91% and 23.95%, respectively). Based on the wardroom as the source, most samples came from the internal medicine unit, intensive care unit, and surgical unit with prevalence of 27.54%, 25.74%, and 20.35%, respectively. High proportion of infected patients were male (52.09%) and aged 56–65 years (23.95%). P. aeruginosa showed the highest sensitivity rate to amikacin (77.1%), followed by meropenem (74.4%), ceftazidime (70.1%), levofloxacin (65.1%), tobramycin (64.9%), piperacillin-tazobactam (64.3%), and gentamicin (61.4%). In conclusion, our data suggest that the MDRPA infection is prevalent in Aceh Province and Amikacin is recommended as the highest standard of therapy for MDRPA.

Microbial isolates and antibiotic sensitivity in patients hospitalized with odontogenic infections at a tertiary center over 10 years.

This study investigated causative strains and their antibiotic sensitivity in patients who were hospitalized for maxillofacial odontogenic infections at a tertiary center in South Korea over the past 10 years with the aim of providing guidelines for the selection of appropriate empirical antibiotics. Patients with head and neck fascial space abscesses due to odontogenic infections who underwent incision and drainage surgery with pus culture tests between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery, Dankook University Hospital were included. The bacterial isolates and antibiotic sensitivity of each strain were analyzed for 2013-2022, 2013-2017, and 2018-2022. The affected fascial spaces were classified into primary, secondary, and deep neck spaces. In the 192 patients included in this study, 302 strains were detected. Viridans streptococcus had the highest frequency (51.7%), followed by Prevotella spp. (16.9%), Staphylococcus spp. (5.6%), and Klebsiella pneumoniae (4.6%). The identification rate of viridans streptococcus significantly increased from 41.8% in 2013-2017 to 60.9% in 2018-2022. Viridans streptococcus showed an antibiotic sensitivity of 80.5% to ampicillin; the sensitivity to penicillin antibiotics decreased over the study period. Antibiotic susceptibility was approximately 94% for third-generation cephalosporins. K. pneumoniae, which was identified at a high percentage in patients with deep neck space infection, showed increasing antibiotic resistance to most antibiotics over the study period. Viridans streptococcus was identified in head and neck fascial space abscesses with the highest frequency. Empirical antibiotics should be effective against this strain; penicillin antibiotics are considered inappropriate. For effective treatment of deep neck space abscesses, bacterial culture and antibiotic sensitivity tests performed as soon as possible are essential.

A rare case of acute osteomyelitis in a 13-year-old with physeal involvement

Osteomyelitis of epiphyses in adolescents is a rare finding. We evaluate one such case in which high degree of clinical suspicion and prompt surgical intervention yielded good functional results. This is a case report of 13-year-old girl diagnosed with osteomyelitis of right knee. MRI is suggestive of physeal involvement. Physeal involvement makes the management very challenging. Surgical intervention was planned to reduce bacterial load and minimize possibility of damage to knee joint (articular cartilage and joint capsule). Lateral and posterior compartment of leg was decompressed, fibular osteotomy done, drilling in tibial epiphyseal and metaphyseal region of tibia done avoiding any injury to growth plate. Pus for culture and sensitivity and specific antibiotics started with monitoring of blood parameters for infection like ESR, CRP, TLC. Patient taken up for second debridement after one week of index surgery. After 6 weeks of intravenous antibiotic patient discharged in afebrile state with reduced values of blood parameters and acceptable range of knee movement. Lower extremity functional scoring (LEFS) of 45/80 i. e., 56.83 % at the end of 4 months. Good functional outcome at the end of 1 year. Early clinical suspicion with prompt investigation, surgical and medical management gives promising result.

Life-threatening complication of retropharyngeal abscess in an infant: a case report

BackgroundDeep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess.Case presentationWe report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture.ConclusionIn retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist.

Classification of Chemotherapy-Induced Febrile Neutropenic Episodes Into One of the Three Febrile Neutropenic Syndromes.

Introduction Febrile neutropenia is a commonly encountered medical emergency in patients undergoing cancer treatment and can delay and modify the course of treatment and even lead to dire outcomes, including death. The cause of fever in a post-chemotherapy-induced neutropenic patient can be confusing to treating physicians. A review of the literature demonstrated that blood culture results could determine the cause of febrile neutropenia in only approximately 10% to 25% of patients. The objective of our study was to measure the incidence of positive blood cultures, urine cultures, and other body fluid cultures resulting in chemotherapy-induced neutropenia and further classify fever episodes into three neutropenic fever syndromes, such as microbiologically documented, clinically suspected, or unknown causes of fever, respectively. Methods We conducted a prospective observational study on 399 chemotherapy-induced neutropenic fever episodes with the aim of classifying them into one of the three neutropenic syndromes. Wetried to document the cause of the fever in these patients. We also noted the type of cancer treatment regimen they were on and correlated their clinical profile with their body fluid cultures, including blood cultures, urine cultures, and other body fluid cultures. We then categorized each fever episode into one of three neutropenic syndromes. Results We studied 399 febrile neutropenic episodes. We were able to microbiologically document the cause of fever in 39% of the cases, and we obtained growth in 51 out of 399 blood cultures (13%), which was comparable to the available literature, and urine culture showed growth in 62 out of 399 cultures (16%), while other body cultures such as pus culture, bile culture, and bronchioalveolar lavage cultures collectively showed growth in 42 out of 399 episodes (10%). The most common bacteria isolated in both blood and urine cultures were Escherichia coli. Cumulatively, including blood, urine, and body fluid cultures, we were able to classify 39% (155 out of 399 cases) of febrile neutropenic episodes as microbiologically documented. The cause of fever was clinically suspected by means of careful history taking and an extensive physical examination in 31% (125 out of 399) without growth evidence in blood cultures, urine cultures, or any other body fluid culture. The cause of fever remained unknown in 119 cases (30%) of patients and was classified under the unknown cause of fever. Conclusions We conclude by stating that the study of fever in a neutropenic patient should include a thorough history and clinical evaluation of blood, urine, and other body fluid cultures instead of solely relying on blood culture results. We recommend further classifying patients into one of the three neutropenic fever syndromes, such as those that are microbiologically documented, clinically suspected, or unknown. Our blood cultures were able to give us a 13% positivity rate, whereas microbiologically, we were able to isolate an organism likely causing feverin 39% of patients. The cause of fever was suspected clinically in 31% of patients, but we were unsuccessful in microbiologically documenting any culture growth in blood, urine, or any other body fluid culture. The cause of fever remained a mystery and unknown to us without any microbiological or clinical cues in 119 cases (30%) of febrile neutropenic episodes.

Clinical features and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen

Objective: To investigate the clinical characteristics, serogroups and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen. Methods: Retrospective cohort study. The clinical manifestations, treatment, prognosis, serogroups and antimicrobial resistance of 29 hospitalized children with invasive non-typhoid Salmonella infection confirmed by blood, cerebrospinal fluid, bone marrow and other sterile body fluids or deep pus culture at the Department of Infectious Diseases, the Department of Orthopedics and the Department of General Surgery in Xiamen Children's Hospital from January 2016 to December 2021 were analyzed. According to the clinical diagnosis criteria, the patients were divided into sepsis group and non-sepsis group (bacteremia and local suppurative infection). The inflammatory markers, serogroups distribution and drug resistance were compared between the two groups. Comparison between groups using Mann-Whitney U test and χ2 test. Results: Among the 29 cases, there were 17 males and 12 females, with an onset age of 14 (9, 25) months, and 10 cases (34%) of patients were younger than 1 year old, 15 cases (52%) under 1 to 3 years old, and 4 cases (14%) greater than or equal 3 years old. The onset time of 25 cases (86%) was from April to September. The diseases included 19 cases (66%) septicemia (2 of which were combined with suppurative meningitis), 10 cases (34%) non-sepsis group, including 7 cases bacteremia and 3 cases local suppurative infection (2 cases of osteomyelitis, 1 case of appendicitis with peritonitis). The clinical manifestations were fever in 29 cases (100%), diarrhea and abdominal pain in 18 cases (62%), cough and runny nose in 10 cases (34%). Eighteen cases (62%) were cured and 11 cases (38%) were improved by effective antibiotics treatment. C-reactive protein in sepsis group was significantly higher than that in non-sepsis group (25.2 (16.1, 56.4) vs. 3.4 (0.5, 7.5) mg/L, Z=-3.81, P<0.001).The serogroups of C, B and E were the most prevalent among non-typhoid Salmonella isolates, accounting for 10 cases (34%), 9 cases (31%) and 7 cases (24%) respectively. Antibacterial drug sensitivity test showed that the sensitivity rates of imipenem, ertapenem and piperaciratazobactam were all 100% (31/31), those of ceftazidime, ceftriaxone, and cefepime were 94% (29/31), 94% (29/31) and 97% (30/31) respectively. The drug resistance rates of ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole were 51% (16/31), 48% (15/31) and 48% (15/31) respectively, those of cefazolin, cefotetan, tobramycin, gentamicin and amikacinwere all 100% (31/31). There were no significant differences in the drug resistance rates of ceftazidime, ceftriaxone, aztreonam, ampicillin-sulbactam, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin between the sepsis group and the non-sepsis group (χ2=0.31,0.31,0.00,0.02,0.02,0.02,0.26, all P>0.05). Conclusions: Invasive non-typhoid Salmonella infection in children at Xiamen mainly occurred in infants younger than 3 years old.The main clinical manifestations are fever, abdominal pain and diarrhea. C-reactive protein can be served as the laboratory indicators for indicating sepsis. The third generation of cephalosporins is recommended as the first choice for treatment.

A study to assess the efficacy of local applicants to prevent complications of diabetic foot

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue. Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease. Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51–60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation.