Culture-positive Group Research Articles

Identifying risk factors for blood culture negative infective endocarditis: An international ID-IRI study

BackgroundBlood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. MethodsThe study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. ResultsBlood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963–0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970–4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564–6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012–2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599–4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE = 0.707 ± 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. ConclusionCaution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.

Changes in clinical parameters and inflammatory markers after blood culture collection facilitate early identification of positive culture in adult patients with COVID-19 and clinically suspected bloodstream infection.

We explored whether changes in clinical parameters and inflammatory markers can facilitate early identification of positive blood culture in adult patients with COVID-19 and clinically suspected bloodstream infection (BSI). This single-center retrospective study enrolled 20 adult patients with COVID-19 admitted to the intensive care unit who underwent blood culture for clinically suspected BSI (February 2020-November 2021). We divided patients into positive (Pos) and negative blood culture groups. Clinical parameters and inflammatory markers were obtained from medical records between blood culture collection and the first positive or negative result and compared between groups on different days. Patients in the positive culture group had significantly older age and higher D-dimer, immunoglobulin 6 (IL-6), and Sequential Organ Failure Assessment score as well as lower albumin (ALB). The area under the receiver operating characteristic curve (AUC) was 0.865 for IL-6, D-dimer and ALB on the first day after blood culture collection; the AUC was 0.979 for IL-6, IL-10, D-dimer, and C-reactive protein on the second day after blood culture collection. Changes in clinical parameters and inflammatory markers after blood culture collection may facilitate early identification of positive culture in adult patients with COVID-19 and clinically suspected BSI.

Diagnosis of external ventricular drainage related infections with real-time 16S PCR and third-generation 16S sequencing

Objective Investigate the performance of real-time 16S PCR and third-generation 16S sequencing in the diagnosis of external ventricular drain related infections (EVDRI). Methods Subjects with suspected EVDRI were prospectively included at Uppsala University Hospital. Subjects were included into three groups: subjects with negative CSF culture with and without antibiotic treatment and subjects with positive CSF culture, respectively. CSF was analysed with real-time 16S PCR and third-generation 16S sequencing. Real-time 16S PCR positivity/negativity and number of 16S sequence reads were compared between groups. For culture positive subjects, species identification in third-generation sequencing and routine culture was compared. Results 84 subjects were included. There were 18, 44 and 22 subjects in the three groups. Real-time PCR was positive in 17 of 22 subjects in the culture positive group and negative in 61 of the 62 subjects in the two culture negative groups. The sensitivity and specificity for real-time 16S PCR compared to culture was estimated to 77% and 98%, respectively. Species identification in 16S sequencing and culture was concordant in 20 of 22 subjects. The number of 16S sequence reads were significantly higher in the culture positive group than in both culture negative groups (p < 0.001). There was no significant difference in number of 16S sequences between the two culture negative groups. Conclusions Real-time 16S PCR predict culture results with sufficient reliability. Third-generation 16S sequencing could enhance sensitivity and species identification in diagnostics of EVD-related infections. False negative culture results appear to be uncommon in patients with suspected EVDRI.

Study of Empiric Antibiotic Prescription Patterns and Microbiological Isolates in Hemodynamically Stable and Unstable ICU Patients With Community-Acquired Sepsis.

Background: The efficacy of combination empiric antibiotic therapy for all intensive care unit (ICU) patients with community-acquired sepsis is a subject of ongoing debate in the era of increasing antibiotic resistance. This study was conducted to evaluate the patterns of antibiotic usage and microbial resistance in sepsis patients admitted to the ICU with both hemodynamically stable (HS) and unstable states and to analyze their clinical outcomes. Methods: In this observational study, patients aged 18 years and above who received antibiotics upon admission and had a culture report were included. These patients were categorized into the following groups: HS and hemodynamically unstable (HU), single or combined antibiotics group (more than one antibiotic used empirically to cover one or more groups of organisms), culture-positive and culture-negative group. The microbiological isolates were grouped according to their identified resistance patterns. The outcome parameters involved assessing the differences in empiric antibiotics use upon admission and microbial resistance with hemodynamic stability and investigating any associations with ICU and hospital outcomes. Results: The study included a total of 2675 patients, of which 70.3% were in the HS group, and 29.7% in the HU group. The use of combination antibiotics was significantly higher (p < 0 .0001) across all groups. Carbapenems were used more frequently in the single antibiotic group (p < 0 .001). The culture was positive in 27.8% (n = 747) of patients. A significantly higher number of patients in the HU group (p < 0 .001) were found to have carbapenem-resistant and multidrug-resistant organisms. The ICU and hospital mortality rates were significantly higher in the HU group (p < 0 .001), the culture-positive group with resistance (p < 0 .001), and the HS patients who received combination antibiotics. Conclusion: The usage of combination antibiotics, coupled with the presence of resistant organisms, emerged as an important variable in predicting ICU and hospital mortality rates in cases of community-acquired sepsis.

Suture Contamination During Arthroscopic Rotator Cuff Repair Is Associated With Significantly Higher Retear Rates in Magnetic Resonance Imaging: A Matched-Pair Analysis

PurposeTo evaluate the correlation between suture contamination and rotator cuff tendon retear after arthroscopic rotator cuff repair. MethodsPatients undergoing primary arthroscopic rotator cuff repair from April 1st, 2020 to September 30th, 2022 were enrolled. Those younger than 18 years, with a history of prior shoulder surgeries or shoulder infection episodes, or who declined participation, were excluded. A 5 cm section of the first-cut suture, originating from the anchor eyelet ends, in each rotator cuff repair surgery was subjected to bacteria culture and polymerase chain reaction (PCR) analysis. Patients with positive culture findings were matched 1:1 to those with negative culture reports based on age, sex, tear size as well as involved tendons, preoperative fatty infiltration grade (Goutallier grade) and preoperative muscle atrophy grade (Warner score). Postoperative rotator cuff tendon retear assessments were conducted at the 6-month mark using the Sugaya classification via magnetic resonance imaging. The Wilcoxon signed-rank test was used for matched-pair comparisons between the groups. ResultsA total of 141 patients (60 males and 81 females) with a mean age of 61.0 ± 8 years were finally enrolled. Twenty-six patients (18 males and 8 females) had a positive culture, while 115 patients (42 males and 73 females) had a negative culture. After the propensity score matching process, 24 culture-negative patients (16 males and 8 females) were selected as the culture-negative group. Age, fatty infiltration grade, and muscle atrophy grade were not significantly different between matched groups. The retear grade in the culture-positive group was found to be significantly higher than that in the culture-negative group (P = 0.020) under the matched-pair comparison. C. acnes. was the most prevalent bacterial species responsible for suture contamination. ConclusionsThe matched-pair analysis revealed that the presence of bacterial contamination on sutures was associated with a higher risk of retear in MRI following arthroscopic rotator cuff repair.

Efficacy and safety of two-stage revision for patients with culture-negative versus culture-positive periprosthetic joint infection: a single-center retrospective study

BackgroundThe safety and efficacy of two-stage revision for culture-negative PJI remain controversial. This study analyzed outcomes after two-stage revision in patients with culture-negative and culture-positive periprosthetic joint infection (PJI) during follow-up lasting at least two years.MethodsData were retrospectively analysed patients who underwent hip or knee revision arthroplasty from January 2008 to October 2020 at our medical center. The primary outcome was the re-revision rate, while secondary outcomes were the rates of reinfection, readmission, and mortality. Patients with culture-negative or culture-positive PJI were compared in terms of these outcomes, as well as survival time without reinfection or revision surgery, based on Kaplan‒Meier analysis.ResultsThe final analysis included 87 patients who were followed up for a mean of 72.3 months (range, 24–123 months). The mean age was 58.1 years in the culture-negative group (n = 24) and 59.1 years in the culture-positive group (n = 63). The two groups (culture-negative versus culture-positive) did not differ significantly in rates of re-revision (0.0% vs. 3.2%, p > 0.05), reinfection (4.2% vs. 3.2%, p > 0.05), readmission (8.4% vs. 8.0%, p > 0.05), or mortality (8.3% vs. 7.9%, p > 0.05). They were also similar in survival rates without infection-related complications or revision surgery at 100 months (91.5% in the culture-negative group vs. 87.9% in the culture-positive group; Mantel‒Cox log-rank χ2 = 0.251, p = 0.616).ConclusionThe two-stage revision proves to be a well-tolerated and effective procedure in both culture-negative and culture-positive PJI during mid to long-term follow-up.

Serial measurements of SIRS and SEP scores to identify unique phenotypes of sepsis.

Using scoring systems in discreet microbiologic cohorts in a serial fashion to identify unique phenotypes of sepsis remains unknown. Single-center, retrospective study that screened adults who triggered the hospital's SIRS (systemic inflammatory response syndrome) based sepsis alert into culture positive (Cx +) and culture negative (Cx-) groups. Subgroups were based on the location where the SIRS alert fired. SIRS scores and a novel score called SEP were calculated at t = 0 and at 3, 6, 12, and 24h before and after t = 0. Primary outcome was a difference in SIRS/SEP scores in Cx + or Cx- groups over time. Secondary outcomes were differences in total SIRS/SEP scores and the components constituting SIRS/SEP scores at various locations over time. The study contained 7955 patients who met inclusion criteria. Cx + and Cx- groups had increases in SIRS/SEP scores and at similar rates starting 6 hours before t = 0. Both culture groups had decreasing SIRS/SEP scores, at varying gradients compared to the change in SIRS/SEP scores seen prior to t = 0. This pattern in SIRS/SEP scores before and after t = 0 was consistent in all location subgroups. Statistically significant differences were seen in the overall SIRS/SEP scores for Cx + and Cx- groups at hours 6, 12, and 24 after t = 0, in the ED group at t = 24h after t = 0, the floor group at t = 0h, and in the step-down group at t = 3h after t = 0h. Microbiological cohorting and serial assessments may be an effective tool to identify homogenous phenotypes of sepsis.

Key microbial monitoring and clinical analysis of bloodstream infections and CRO colonization after hematopoietic stem cell transplantation in hematological patients

Objective: To investigate the distribution and clinical characteristics of pathogenic bacteria following hematopoietic stem cell transplantation (HSCT), as well as to provide a preliminary research foundation for key microbial monitoring, and clinical diagnosis and treatment of infections after HSCT in hematological patients. Methods: We retrospectively analyzed the clinical data of 190 patients who tested positive for microbial testing [G-bacteria blood culture and/or carbapenem-resistant organism (CRO) screening of perianal swabs] at our center from January 2018 to December 2022. Patients were divided into blood culture positive, perianal swab positive, and double positive groups based on the testing results. The three patient groups underwent statistical analysis and comparison. Results: The top four pathogenic bacteria isolated from sixty-three patients with G-bacteria bloodstream infection (BSI) were Escherichia coli (28 strains, 43.75% ), Klebsiella pneumonia (26 strains, 40.63% ), Pseudomonas aeruginosa (3 strains, 4.69% ), and Enterobacter cloacae (3 strains, 4.69% ). The top three pathogenic bacteria isolated from 147 patients with CRO perianal colonization were carbapenem-resistant Klebsiella pneumoniae (58 strains, 32.58% ), carbapenem-resistant Escherichia coli (49 strains, 27.53% ), and carbapenem-resistant Enterobacter cloacae (20 strains, 11.24% ). The 3-year disease-free survival (DFS ) and overall survival (OS) of double positive group patients were significantly lower compared to those in the blood culture and perianal swab positive groups (DFS: 35.6% vs 53.7% vs 68.6%, P=0.001; OS: 44.4% vs 62.4% vs 76.9%, P<0.001), while non-relapse mortality (NRM) was significantly higher (50.0% vs 34.9% vs 10.6%, P<0.001). Failed engraftment of platelets and BSI are independent risk factors for NRM (P<0.001). Using polymyxin and/or ceftazidime-avibactam for more than 7 days is an independent protective factor for NRM (P=0.035) . Conclusion: This study suggests that the occurrence of BSI significantly increases the NRM after HSCT in patients with hematological diseases; CRO colonization into the bloodstream has a significant impact on the DFS and OS of HSCT patients.

Triple-P Panel (Procalcitonin, Presepsin and Pentraxin3) to Confirm Sepsis

A total of 65 blood samples (25 culture positive sepsis and 40 culture negative sepsis) from patients with sepsis symptoms who resided in the ICU of Hilla city hospitals, were collected, as well as 25 samples as a control (healthy persons) during a period from January to June 2022. Data was documented at the time of admission to the ICU. Regarding PSN and PCT concentration (P value= 0.001), the control group had a significant difference from both the two patients’ groups (culture positive and negative groups of sepsis). Whereas the difference was not significant for the PTX3 concentration among patients and control (P value = 0.56). Furthermore, PSN and PCT concentrations did not significantly differ between the culture positive and culture negative groups of sepsis (P value &gt; 0.05). Moreover, there was a significant strong positive correlation between PSN and PCT (r = 0.500; P &lt;0.001).

Diagnostic Values of Blood Indices for Neonatal Sepsis

Background: Sepsis is the leading cause of death in newborns, particularly in underdeveloped countries. Early diagnosis and appropriate treatment are critical in reducing neonatal mortality. Since blood culture results are often unavailable for 48 - 72 hours, other hematologic findings may provide useful information for early diagnosis. Objectives: We examined the relationship between neonatal sepsis and blood indices in order to achieve early diagnosis. Methods: In this hospital-based retrospective multiple-event case-control study, we allocated the neonates into three groups: Culture-positive sepsis, culture-negative sepsis, and neonates without sepsis. We compared the lab data within these three groups. Results: The study included 319 neonates: 209 cases of culture-positive sepsis, 65 cases of culture-negative sepsis, and 45 cases without neonatal sepsis. Pearson's test demonstrated a significant correlation between thrombocytopenia, positive C-reactive protein (CRP), and high cell distribution width with culture-positive sepsis (P = 0.000), indicating a statistical difference between the three groups. The mean CRP and eosinophil levels were higher in the culture-positive group with fungal sepsis. Conclusions: In septic neonates with high CRP levels, particularly in conjunction with eosinophilia, fungal coverage should be considered.

Early Diagnosis of Neonatal Sepsis Using the Leukocyte Alkaline Phosphatase Score: A Cohort Study

Introduction: The clinical features of sepsis in neonates are subtle and non specific, requiring a high index of suspicion for early diagnosis. Blood culture is the gold standard for diagnosis, but it is time consuming. Therefore, there is a need for a costeffective and reliable screening tool. The Leukocyte Alkaline Phosphatase (LAP) activity of neutrophils is known to increase during bacterial infections in adults. Aim: To determine the activity of LAP in Neonatal Sepsis (NS) and compare the results with blood culture. Materials and Methods: This is a prospective cohort study conducted from January 2018 to June 2019 at Mandya Institute of Medical Sciences, Karnataka, India. Total of 200 neonates by their haematological profile were clinically suspected of having sepsis. A peripheral smear was prepared from a drop of blood and stained to assess the LAP activity. In each smear, a total of 100 consecutive segmented neutrophils were examined and were rated from 0 to 4 according to the red granular precipitate intensity within their cytoplasm. The possible range of 0-400. The blood culture report was obtained from the case sheet. The neonates were divided into two groups: Group 1 consisted of culture-proven sepsis cases, and Group 2 consisted of neonates with clinical suspicion of sepsis but negative blood culture results. Descriptive analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. Chi-square test was conducted, and a p-value &lt;0.05 was considered statistically significant. Results: Out of the 200 cases studied, 64 neonates showed a positive blood culture. The most common causative organism observed was Klebsiella pneumoniae, which was seen in 56 neonates. The age of the neonates ranged from newborn to 28 days old, with 115 being male. Furthermore, 116 neonates were term neonates, and 146 presented with early onset sepsis. The study revealed a wide range of LAP activity in both groups. In the culture-positive sepsis group, the LAP activity ranged from 36 to 350, while in the clinical sepsis group, it ranged from 10 to 354. Due to the broad range of LAP scores observed, it is concluded that LAP activity is not useful as a screening test. Conclusion: Findings of the present study indicate that LAP activity exhibited a wide range in both the culture-proven and clinical sepsis groups. However, due to this variability, LAP activity does not appear to be a reliable screening test for NS. While LAP activity assessment may still hold diagnostic value, further research is needed to refine its utility and explore its clinical relevance.

Exploring the Role of Intraoperative Positive Culture of Allograft Bone in Subsequent Postoperative Infections among Donors and Recipients in Bone Bank Processing.

Allografts have been frequently used in orthopedic procedures. The purposes of this study were to evaluate the discard rates and bacterial contamination of a bone bank, and to assess the clinical outcomes of recipients with bacterial culture-positive donor allografts. We retrospectively reviewed 1764 allografts which were harvested from living donors and stored in a bone bank from 2018 to 2022. The donors whose allografts displayed bacterial contamination at retrieval of the primary hip or knee arthroplasty were followed for microbiology and subsequent prosthetic joint infection analysis. The infected pathogens, antibiotic treatment and subsequent infection were reviewed for the intraoperative positive culture group. The discard rate was 17%, and the bacterial contamination rate of bone retrieval was 2.15%. Thirty-eight allografts at retrieval displayed confirmed bacterial growth, and 37 patients did not reveal infective signs at 6 months follow-up. A total of 1464 allografts were stored and implanted, among which 28 allografts (1.91%) were confirmed to be positive for bacterial growth and 13 cases (0.89%) were confirmed as surgical site infections. Our results validate the suggestion that our bone bank system performs good quality monitoring to eliminate the risk of dissemination of viral and bacterial diseases and to decrease surgical site infection after allograft implantation. By ensuring aseptic conditions and contamination-reducing strategies during harvesting and thawing, the allografts can be safely stored and implanted while limiting bacterial contamination. Our findings confirm that the intraoperative positive cultures of allografts did not contribute to subsequent postoperative surgical site infection in donors and recipients.

Comparative Analysis of Contact Lens-related Bacterial Keratitis According to Culture Positivity: A 25-year Retrospective Study

Purpose: This study investigated the microbiological profile and clinical characteristics of culture positive (CP) contact lens-related bacterial keratitis (CLBK) and compared them to culture negative (CN) cases.Methods: We retrospectively analyzed 142 CLBK patients hospitalized between January 1998 and December 2022. The CP and CN groups consisted of 79 eyes (100 isolates) and 63 eyes, respectively. We investigated the microbiological profile in the CP group and compared the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes between the CP and CN groups. Poor treatment outcomes were defined as a final best-corrected visual acuity (BCVA) ≤ 0.5, worsened BCVA after treatment, or the need for surgical intervention. We evaluated the risk factors for poor treatment outcomes in the entire cohort through two-proportional Z-test analysis.Results: In CP group, gram-negative bacteria accounted for 85%, and common isolates were &lt;i&gt;Pseudomonas&lt;/i&gt; (27%) and &lt;i&gt;Serratia&lt;/i&gt; (26%) species. There were significant differences in mean age (27.0 years vs. 33.8 years, &lt;i&gt;p&lt;/i&gt; = 0.009) and a history of therapeutic bandage contact lens wear (13.9% vs. 28.6%, &lt;i&gt;p&lt;/i&gt; = 0.031) between the CP and CN groups. However, there were no significant differences in symptom duration, prior use of topical antibiotics, sleeping with wearing CL, epithelial defect size, hypopyon, and poor treatment outcomes. Significant risk factors for poor treatment outcomes in the entire group included deep infiltration (Z = 2.88), epithelial healing time ≥ 7 days (Z = 2.30), initial BCVA &lt; 0.1 (Z = 2.20), over date use of contact lens (Z = 2.10), and epithelial defect size ≥ 5 mm&lt;sup&gt;2&lt;/sup&gt; (Z = 2.05).Conclusions: There were no significant differences in clinical characteristics and treatment outcomes between the CP and CN groups. Poor initial clinical findings and over date use of contact lens were associated with poor treatment outcomes in both groups.

Comparison of clinical outcomes between culture-negative and positive peritonitis in patients undergoing maintenance peritoneal dialysis: a prospective cohort study

BackgroundCulture-negative peritonitis is a serious complication in patients undergoing maintenance peritoneal dialysis (PD) and occurs in up to 40% of all peritonitis episodes. Despite its high incidence, data regarding treatment response and prognosis remain poorly defined. This study compared the clinical outcomes of patients with culture-negative and positive peritonitis.MethodThis prospective cohort study was conducted between 2021 and 2022. Patients treated with maintenance PD who developed PD-associated peritonitis were included and received standard treatment. The primary endpoint was the primary response (resolution of peritonitis 10 days after the initiation of treatment).ResultsOf the 81 patients who developed PD-associated peritonitis during the study, 35 and 46 had culture-negative and culture-positive peritonitis, respectively. Overall, 52 (64.2%) patients achieved the primary response: 24 (68.6%) in the culture-negative group and 28 (60.9%) in the culture-positive group (p = 0.630). There were no significant differences between the two groups in the incidence of complete cure (complete resolution of peritonitis without the need for Tenckhoff catheter removal or salvage antibiotic therapy or peritonitis within 120 days after treatment) (culture-negative vs. culture-positive group, 57.1% vs. 45.7%), refractory peritonitis (28.6% vs. 41.3%), relapse peritonitis (8.6% vs. 2.2%), repeat peritonitis (11.4% vs. 10.9%), salvage antibiotics (40.0% vs. 50.0%), permanent hemodialysis transfer (11.4% vs. 10.9%), Tenckhoff catheter removal (25.7% vs. 41.3%), or mortality (2.9% vs. 2.2%) (all p > 0.05).ConclusionThis study offers valuable insights into the clinical outcomes of culture-negative peritonitis versus culture-positive peritonitis. However, caution must be exercised in interpreting these findings due to the limitations of the small sample size.Clinical trial registrationThe study was retrospectively registered in the Thai Clinical Trials Registry (TCTR20221130006).

Assessing the diagnostic potential of 16SrRNA gene for neonatal sepsis: A tertiary care hospital study in South India

BackgroundThe need of the hour is to incorporate a rapid assay that could efficiently detect neonatal sepsis. We evaluated the diagnostic utility of 16SrRNA broad-range polymerase chain reaction (PCR) in neonatal sepsis. MethodsThe demographic and clinical details of 100 neonates clinically suspected to have sepsis were collected adopting pretested clinical proforma, followed by baseline laboratory investigations, including blood culture, complete blood counts, and C-reactive protein (CRP). Around, 0.2–0.3 ml of the EDTA blood was subjected to enrichment followed by DNA isolation using the modified spin column method. Based on the blood culture report, neonates were further divided into the suspected sepsis group (n = 50) and the confirmed sepsis group (n = 50). We performed 16SrRNA broad-range PCR to identify the presence of bacteria, and the results were analyzed statistically using SPSS software. ResultsNeonates in both groups were found to have clinical parameters comparable to each other except for birth weight, length, and head circumference, which was found to be lower in the culture-positive group than in culture-negative group (p < 0.05). The diagnosis of neonatal sepsis by 16SrRNA broad-range PCR compared to blood culture revealed 100% sensitivity, 64% specificity, and 73.5% positive and 100% negative predictive value. The 18 cases detected positive by PCR had clinical and other diagnostic findings consistent with sepsis. ConclusionThe 16SrRNA broad-range PCR effectively ruled out sepsis in 32 neonates within 8 h of sample collection compared to blood culture, which took 24 h. The method may not replace blood culture but can be used to complement it.

Evaluation of new generation systemic immune-inflammation markers to predict urine culture growth in urinary tract infection in children.

Systemic inflammation has been implicated in the development and progression of urinary tract infection (UTI). Accordingly, the aim of this study is to determine whether the white blood cell (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are useful markers to predict of urine culture growth in children with UTI. The second aim of this study is to evaluate the prevalence of UTI pathogens, antibiotic resistance patterns, and empirical treatment options in children diagnosed with UTI based on laboratory and clinical findings. The study population comprised 413 cases (positive urine culture) and 318 cases (negative urine culture) of pediatric patients with UTI. There was no statistically significant difference observed in the median levels of hemoglobin, hematocrit, and platelet between the negative and positive culture groups. The median levels of monocytes, WBC, NLR, SII, and CRP of the patients with a positive urine culture were shown to be statistically significantly higher than the patients with a negative urine culture. The AUC value was 0.747 (0.710-0.784) for CRP with a cutoff value of 3.2, the sensitivity value was 56.4%, and the specificity value was 98.4% in terms of UTI. The AUC value was 0.733 (0.697-0.769) for SII with a cutoff value of 600, the sensitivity value was 58.4%, and the specificity value was 83.0%. The AUC value was 0.732 (0.697-0.769) for NLR with a cutoff value of 2, the sensitivity value was 57.4%, and the specificity value was 81.1%. WBC, CRP, NLR, PLR, and SII could potentially serve as useful independent diagnostic or complementary markers for disease in children diagnosed with UTI who exhibit a positive urine culture. Escherichia coli was found to be the most common causative agent, and the commonly prescribed antibiotic was cephalosporin. However, it was observed that all identified agents of pediatric UTIs in our center exhibited high resistance to cefuroxime, trimethoprim-sulfamethoxazole, cefixime, ampicillin, and ceftriaxone.

Multiple bacterial culture positivity reflects the severity and prognosis as bronchiectasis in Mycobacterium avium complex pulmonary disease

BackgroundBacterial coinfections are observed in 19–66% of patients with Mycobacterium avium complex pulmonary disease (MAC-PD) during the entire duration of the disease. The impact of bacterial coinfection at diagnosis on the clinical course of MAC-PD has not been reported. MethodsAmong 558 patients diagnosed with MAC-PD between January 2016 and December 2020, 218 patients who underwent sputum culture tests twice or more within one year before and after diagnosis were included. We compared the patient characteristics and disease courses between the patients who had the same bacterial species detected twice or more (bacterial culture positive group: BCP group) and those who never had bacteria cultured (bacterial culture negative group: BCN group). ResultsWe included 70 patients in the BCP group and 74 in the BCN group. The radiological findings showed that BCP at diagnosis correlated with a high modified Reiff score. During the median follow-up period of 42 months, the patients in the BCP group were more likely to accomplish spontaneous sputum conversion of MAC. The treatment initiation rate for MAC-PD in the BCP group was lower than that in the BCN group (41.4% vs. 67.6%, P = 0.003). In contrast, the time to the first bronchiectasis exacerbation in the BCP group was shorter than that in the BCN group, and the frequency of bronchiectasis exacerbations was higher in the BCP group. ConclusionsPatients with BCP at diagnosis are less likely to initiate treatment for MAC-PD and more likely to develop bronchiectasis exacerbation.

Serial measurements of SIRS criteria to identify unique phenotypes of sepsis: A Microbiologic Approach

Introduction: The utility of serial scoring systems in identifying distinct sepsis phenotypes remains unknown. Methods: Eligible adults were classified into culture-positive (Cx+) and culture-negative (Cx-) groups alongside pre-defined culture subgroups. Average SIRS &amp; SEP (novel scoring system) scores were calculated at t = 0 and hours 3,6,12 &amp; 24 before and after t = 0. The primary outcome was a difference in SIRS/SEP scores amongst those that were Cx+ or Cx- at any time point. Secondary outcomes were comparing total and component SIRS/SEP scores in microbiologic subgroups over serial time points. Results: 4,701 Cx+ and 3254 Cx- patients met eligibility criteria. Statistically significant differences were seen in the average SIRS score between Cx + and Cx- groups at hours six (Cx+ 1.40+1.04 vs Cx- 1.35+1.01) &amp; 12 (Cx+ 0.95+0.95 vs Cx- 0.90+0.90) after t = 0. The hematologic, urologic, and neurologic subgroups had significant differences at numerous time points before and after T = 0. Similar findings were observed with the SEP scores. Cx+ and Cx- groups (including subgroups) consistently doubled both SIRS/SEP scores before t = 0 with an eventual return to baseline values after T = 0 but at different gradients. Conclusion: Significant differences in SIRS/SEP scores were seen in Cx+ &amp; Cx- patients at sequential time points. This microbiologic approach in homogenous culture cohorts has the potential to identify distinct phenotypes of sepsis efficiently and practically. Consistent increases in SIRS/SEP scores before t = 0 and sequential decreases after t = 0 may allow for early detection, intervention, and provision for real-time monitoring of therapeutic responses in patients with concerns for sepsis.

Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip

BackgroundSeptic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. MethodsThe clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. ResultsThirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. ConclusionsCulture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. Level of evidenceLevel II, retrospective study.

Necessity of Tissue Culture from Clinically Uninfected Wounds in Diabetic Patients

Background: The Infectious Diseases Society of America Clinical Practice Guidelines recommends not culturing specimens from patients with diabetes who do not show clinical signs or symptoms of local inflammation. However, in diabetic patients the local or systemic inflammatory response is commonly reduced, even in severely infected cases, owing to poor immune response. This study aimed to investigate the clinical significance of tissue cultures in patients with diabetic ulcers without clinical signs of infection.Methods: This study included 248 of 1,346 patients who had diabetic foot ulcers but did not exhibit any signs or symptoms of infection in our hospital. Tissue culture results were classified as either negative, positive culture in soft tissue or positive culture in bone. Wound healing outcomes were divided into two categories: healed without amputation or healed with amputation.Results: A significant difference existed between the negative culture and bone culture-positive groups. Patients who had a positive bone culture result were 2.1 times more likely to require amputation than those who had negative culture results. Moreover, the rate of amputation was higher in bone culture-positive patients than in soft tissue culture-positive patients.Conclusion: Our study showed that tissue culture may be required for patients with diabetic ulcers even if they do not exhibit any signs or symptoms of inflammation.