Positive Cultures Research Articles

Bacteriemias por anaerobios estrictos

Introduction. Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of actively searching for these microorganisms in blood culture samples. Material and methods. A retrospective descriptive study in which the medical records of patients with significant episodes of anaerobic bacteremia were reviewed over a period of 8 years (2014-2022). Results. A total of 59,898 blood cultures were processed, of which 10,451 were positive (17%). An anaerobic microorganism was identified in 209 patients. Anaerobic bacteremia accounted for 2.11% of the total number of positive blood cultures. The mean age was 63.55 years (17-96), 66% of whom were men. The origin was community in 63.64%, of nosocomial origin in 15.31% and associated with health care in 17.70%. The focus of infection was the abdominal (39.23%), followed by the respiratory (13.88%) and skin and soft tissues (13.39%). The most frequent comorbidities were: arterial hypertension (49.76%), dyslipidemia (29.67%), neoplasia (26.32%) and diabetes (26.32%). The main species isolated were the group Bacteroides spp. (44.50%) (n=93) highlighting Bacteroides group fragilis (n=65), followed by Clostridium spp. (20%) (n=42) highlighting Clostridium perfringens (n=30). The clinical evolution was good in 67.46%. The mean length of stay was 27.8 days and was associated with 20% mortality. Conclusions. Bacteremias due to anaerobes represented 2.11% of the total number of true bacteremias, so we consider the active search for these microorganisms to be appropriate.

Improving Turnaround Times for Routine Antimicrobial Sensitivity Testing Following European Committee on Antimicrobial Susceptibility Testing Methodology in Patients with Bacteraemia

Background/Objectives: Bacteraemia can be fatal without antibiotic intervention. Antibiotic Susceptibility Testing (AST) provides the necessary information for targeted antibiotic therapy; however, the traditional method using disc diffusion can take over two days from a positive blood culture. Inappropriate empiric therapy is associated with increased mortality and increased antibiotic resistance, highlighting the need for more rapid turnaround times for AST. By making changes to an established method, turnaround times can be reduced. Methods: Eighty-two patient positive blood culture samples were collected from January to April 2022, representing the range of common bacteria causing sepsis. This followed the normal methodology in the laboratory of inoculating agar from positive blood cultures in preparation for European Committee on Antimicrobial Susceptibility Testing (EUCAST) disc diffusion AST method. EUCAST methodology outlines that disc diffusion should be performed on isolates from an overnight culture of 16–24 h. This study looked at comparing disc diffusion results from cultures with 6 h of incubation to those with incubation times of 24 h, after organism identification by MALDI-ToF. Results from 6-h and 24-h cultures were compared by disc zone sizes and by interpreted susceptibility reading following EUCAST guidelines of sensitive, resistant, susceptible with increased exposure, or an area of technical uncertainty. Results: A total of 99.65% interpreted susceptibility readings matched across all organisms to all relevant antibiotics, with an average zone size difference of 1.08 mm between results from 6 h versus 24 h cultures. Conclusions: This method offers a non-automated way of using the traditional disc diffusion method, reducing turnaround times while still producing reliable and accurate results. This would mean validated ASTs can be set up in the same day as a blood culture flags positive rather than waiting for a longer culture. As this method is widely used within the laboratory already, it would mean that additional training is not required, as the process is the same, and only incubation time varies. This would positively impact patient outlook due to the shorter use of empiric therapy, and benefit antimicrobial stewardship (AMS).

Osteoarticular tuberculosis: imaging findings in pediatric patients.

Osteoarticular tuberculosis (TB) is an uncommon form of extrapulmonary TB that has the potential to damage joints and bones, generating long-term impairment. Mainly, the initial diagnosis of osteoarticular TB relies on clinical findings and imaging. When required, imaging can aim for less invasive tissue or fluid sampling for pathology, microbiology, and molecular biology analysis. Most TB diagnosis tests have variable and frequently poor sensitivities; however, bone biopsy samples have demonstrated a high percentage of culture positivity. Clinical and imaging findings of osteoarticular TB often mimic other processes, such as rheumatoid arthritis or chronic recurrent multifocal osteomyelitis. When the infection affects the growth plates, angular deformities and extremity length discrepancies can arise. Unfortunately, several osteoarticular TB cases are detected late due to the nonspecific nature of clinical symptoms and non-characteristic imaging findings. This article reviews the most common and atypical osteoarticular TB imaging presentations to increase awareness of osteoarticular TB.

Isolation and Identification of Bacterial Pathogens from Blood Cultures in a Tertiary Care Hospital and Their Clinical Correlation

Objective: This study aimed to isolate and identify bacterial pathogens from blood cultures of patients with suspected bloodstream infections (BSIs) in a tertiary care hospital, analyze their antimicrobial susceptibility patterns, and establish clinical correlations. Methods: A cross-sectional study was conducted in the Microbiology Department of a tertiary care hospital. Blood samples from 60 patients were collected aseptically, processed using BACTEC, and cultured on blood and MacConkey agar. Bacterial isolates were identified based on colonial morphology, Gram staining, and biochemical tests. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The overall culture positivity rate was 26%, with higher positivity among female patients (31.57%) and neonates or infants under six months (26%). Klebsiella pneumoniae was the most frequently isolated pathogen (53.33%), followed by Staphylococcus aureus (20.00%), Escherichia coli (13.33%), and Citrobacter species (13.33%). Klebsiella pneumoniae showed high resistance to ceftazidime and piperacillin, while remaining sensitive to cefoperazone and tobramycin. Staphylococcus aureus isolates were resistant to penicillin and erythromycin but sensitive to vancomycin and cefazolin. The prevalence of multidrug resistance among isolates underscores the need for targeted empirical therapy. Conclusion: Klebsiella pneumoniae emerged as the primary pathogen in BSIs, with significant resistance to commonly prescribed antibiotics. These findings highlight the necessity for enhanced infection control measures, especially in NICUs, and the implementation of local antibiograms to guide effective antibiotic therapy and mitigate resistance trends. Further research across multiple centers is recommended to validate these findings and inform broader clinical guidelines.

Performance evaluation of the Specific Reveal system for rapid antibiotic susceptibility testing from positive blood cultures containing Gram-negative pathogens.

Rapid antimicrobial drug administration is crucial for the efficient treatment of sepsis or septic shock, but empirical therapy is limited by the increasing prevalence of multidrug-resistant bacteria. Thus, rapid and reliable antimicrobial susceptibility testing (AST) is needed to start appropriate antimicrobial drug administration as quickly as possible. In the present study, we evaluated the performance of the Reveal rapid AST system. From February to April 2021, 102 positive blood culture bottles (BCBs) from hospitalized patients with bacteremia caused by Gram-negative bacteria were included in the study. All isolates were tested by the Reveal system directly from the positive BCBs in comparison to the DxM MicroScan WalkAway. Essential agreement (EA) and category agreement (CA) were high with 98.5% and 97.1%, respectively. We also determined the susceptibility of 10 highly resistant CDC & FDA AR strains in duplicate. Here, EA was 99.6% and CA 97.9%. The average time to result by Reveal was 5.4 h ± 1.2 h compared to an average of 16 h by DxM MicroScan WalkAway for clinical strains and 3.8 h ± 1.2 h for more resistant CDC & FDA AR strains. Susceptibility determination with the Reveal rapid AST system directly from positive BCBs is for the frequently represented bug-drug combinations a reliable and accurate approach, meeting the European ISO guideline for the performance of AST systems. Moreover, AST directly from blood cultures performed with the Reveal system saves time when compared to the conventional AST, as no subculturing is needed and time to result is very short.

Distinction of clinical features and microbiological methods between Chlamydia psittaci and Legionella pneumophila pneumonia confirmed by metagenomic next-generation sequencing

Objectives Detection and diagnosis of Chlamydia psittaci (C. psittaci) pneumonia is often overlooked due to conventional methods limitations and similarity to other atypical community acquired pneumonia (CAP). Using mNGS, we aimed to distinguish psittacosis from legionellosis for early C. psittaci pneumonia diagnosis and better prognosis. Methods Thirty-seven patients diagnosed with atypical CAP were enrolled in this retrospective study, including 14 C. psittaci pneumonia and 23 Legionella pneumophila (L. pneumophila) pneumonia. We collected and compared baseline, lab results, radiology imaging, conventional microbiological methods and more importantly, mNGS results of clinical samples, as well as the treatments and prognosis between psittacosis and legionellosis. Results Patients with C. psittaci and L. pneumophila had similar symptoms and were presented with high levels of inflammatory markers. However, patients with C. psittaci pneumonia were more likely to have exposure to birds or parrots [11 (78.6%) vs. 2 (8.7%), p < 0.001], had higher proportions of fever and chill (p = 0.015 and 0.035), higher levels of hemoglobin and albumin (p = 0.002 and 0.018) compared with those with L. pneumophila. Of 14 C. psittaci patients, only one had positive IgM antibody, with no positive cultures. Early identification of pathogens by mNGS method contributed to timely antibiotics’ adjustment and better outcomes then, yet with similar hospital mortality between two groups [7.1% (1/14) vs. 34.8% (8/23), p = 0.112]. Conclusion Early mNGS detection of atypical pathogens in multiple samples improves on traditional methods, promptly adjust empirical antimicrobial treatment to pathogen-targeted antibiotics, further improve prognosis.

Comparison of intra-assay and inter-assay reproducibility and positive detection times of two different (BacT/Alert 3D and Autobio BC) commercial blood culture systems.

In our study, we aimed to compare the performance of the BacT/Alert 3D (bioMerieux, France) system, which is currently used in our laboratory, and the Autobio BC (Autobio, China) system, which was newly introduced in our country, using standard and clinical isolates. Bacterial suspension was prepared by two technicians on the same day and three consecutive days from five different standard strains with 0.5 McFarland turbidity, then serial dilution to a final concentration was adjusted and was simultaneously inoculated in aerobic blood culture bottles. The bacterial concentration was measured by making a quantitative counting plate. The same procedure was also performed for 55 clinical isolates belonging to eleven species. After simulated bacteremia with standard and clinical isolates, the growth results were confirmed by inoculation from positive blood culture bottles onto solid medium and identification was made in the next day with MALDI-TOF MS (bioMérieux). In each study, sterile saline and blood was inoculated into the bottles as a negative control to check contamination. Intra-assay and inter-assay reproducibility of recovery rates and detection times of standard strains; recovery rates and detection times of clinical isolates were compared for both systems. Recovery rates were 100% in both systems, and when positive detection times were compared, it was found that there was no difference between the two devices in clinical isolates (p:0.262) but that Autobio BC gave significantly (p<0.001) earlier results in standard strains. In our simulated bloodstream infection study, Autobio BC was found to be comparable with BacT/Alert 3D, both recovery rates and growth detection time performance were found to be very good, and it can be used in routine microbiology laboratories.

Quiet Quitting: A Millennial Perspective on Workplace Dissatisfaction and Retention Challenges

Quiet quitting is a phenomenon where employees disengage from their work and intentionally underperform as a way of expressing their dissatisfaction with their job or employer. In Malaysia, around 46% of millennial employees are considering quitting their jobs quietly, which can have a significant impact on both the individual and the organisation, especially if key performers or those with critical knowledge and skills depart. However, little is known about the underlying psychological and organisational factors that contribute to this behaviour. Thus, the purpose of this study is to look at the causes, effects, and preventative measures of quiet quitting among Malaysian workers as well as potential solutions for this tendency. To get a better understanding of the psychological and organizational reasons leading to such phenomenon among Malaysian employees, an integrated study of self-determination theory and organisational support theory is proposed. Methods for collecting qualitative data were used in this study. Data was gathered by means of employee interviews. Convenience sampling was used to choose the respondents since participants were chosen based on their availability and desire to participate. The results demonstrate the significant role that psychological (e.g., job dissatisfaction, lack of opportunities for career development) and organizational (e.g., lack of communication, work-life balance, positive culture, lack of leadership) factors play towards quiet quitting among employees. In theory, this research provides a more thorough comprehension of the topic under investigation by putting out a more resilient and all-encompassing structure. This discovery has the potential to boost organizational performance and productivity by fostering more encouraging and fulfilling work conditions for workers.

Navigating antibiotic therapy in acute cholangitis: Best practices and new insights.

Globally, antibiotic resistance is linked to increased morbidity, mortality, and healthcare costs, which necessitates further research on optimal antibiotic usage. Acute cholangitis (AC), a common cause of community-acquired bacteremia, often requires antimicrobial therapy. Therefore, studying the appropriate use of antibiotics for AC is considered crucial for suppressing the emergence of resistant bacteria and reducing adverse antibiotic-associated events. The Tokyo Guidelines 2018 (TG18) recommend 4-7 days of antibiotics post-biliary drainage. However, this lacks strong evidence and is based primarily on various evidence and expert opinions. Recent retrospective studies advocate for a shorter 1-3-day antibiotic course for AC, thereby prompting a need to reassess the treatment duration to balance therapeutic efficacy and minimize resistance and adverse effects. Choosing the appropriate duration and antibiotics based on susceptibility to pathogens causing cholangitis is important. Awareness of local resistance patterns and understanding patients' risks of resistant pathogens are prerequisite for effective treatment. We must explore the applicability of these guidelines in specific scenarios such as severe AC, positive blood cultures, fever, or hilar biliary obstructions due to malignancy. This comprehensive review considers both the duration and type of antibiotics and aims to enhance treatment outcomes while reducing the risk of resistant bacterial infections.

Factors Influencing Children’s Hospital Nurses’ Safety Accident Management Activities for Hospitalized Children

Background: We aimed to identify the factors influencing safety accident management activities for hospitalized children in children’s hospitals. Methods: In August 2022, data were collected from 170 nurses across seven children’s hospitals in Gwangju Metropolitan City, Korea. The collected data were analyzed using independent t-tests, analysis of variance, Pearson’s correlation analysis, and multiple regression analysis. Results: Safety accident management activities for hospitalized children differ significantly based on nurses’ experience in children’s hospitals (P=0.048). Safety accident management activities were positively correlated with patient safety culture (r=0.47, P&lt;0.001), critical thinking (r=0.35, P&lt;0.001), and nursing work environment (r=0.51, P&lt;0.001). Furthermore, the most influential determinant of safety accident management activities for hospitalized children was the nursing work environment (β=0.42, P&lt;0.001), followed by nurses’ experience in children’s hospitals (β=0.20, P=0.004), and patient safety culture (β=0.17, P=0.041). These variables had an explanatory power of 34.0 % (adjusted R2=0.34, P&lt;0.001). Conclusion: A positive nursing work environment and strong patient safety culture are essential for increasing safety accident management activities among children’s hospital nurses. Additionally, children’s hospitals should provide support to the nursing staff and implement policies that encourage long-term retention of experienced nurses.

Bacterial community in fresh fruits and vegetables sold in streets and open-air markets of Dakar, Senegal.

In the context of food transition, the agrifood sector has experienced increasingly strong demand for horticultural products. Fresh fruits and vegetables are mainly vehicles of microorganisms, including pathogens that cause human infections. Food safety and compliance with health standards in the fruits and vegetable value chain are significant concerns and multiple challenges, given the prevalence of foodborne pathologies in Southern countries, particularly in Senegal. This study aimed to describe the bacterial community and assess the microbiological quality of a range of fruits and vegetables sold on street stalls and open-air markets in Dakar, the capital city of Senegal. Samples purchased in seven sites were analyzed to isolate Escherichia coli (E. coli), Salmonella spp. and Vibrio spp. Some primary samples with a positive microbiological culture were subjected to DNA extraction and subsequent metagenomic analysis. A total of 240 fresh fruit and vegetable samples were collected, including lettuce (n = 40), tomatoes (n = 40), mango slices (n = 40), onion slices (n = 40), mint leaves (n = 40), strawberries and grapes (each n = 20). Of these samples, 50.83% (122/240) and 60.41% (145/240) were contaminated with E. coli and Vibrio spp., respectively, while Salmonella was not isolated in any product. E. coli and Vibrio spp. contamination levels, 1.3 103 to 6 106 Colonies Forming Units per gram of sample (CFU/g) and 4.55 102 to 8.73 106CFU/g, respectively, were significantly above the thresholds acceptable for human consumption. The most contaminated samples were lettuce, with a prevalence of 98% (39/40) for E. coli and Vibrio spp. followed by mint leaves with 100% (40/40) and 93% (37/40) of the samples containing E. coli and Vibrio spp. respectively. Out of 46 samples sequenced, the metagenomic analysis revealed high contamination rates for E. coli, Vibrio spp. and Salmonella spp., with 100%, 67.39% and 93.47% of prevalence, respectively. On the other hand, the alpha diversity analysis shows high bacterial diversity in lettuce and mint leaf samples, while the beta diversity analysis highlighted the presence of two major clusters. Our results stress the need for a surveillance system that extends this investigation to a national scale while increasing the number of sampling sites and products analyzed.

INCIDÊNCIA E CARACTERÍSTICAS CLÍNICO-EPIDEMIOLÓGICAS DA TUBERCULOSE EM IMPERATRIZ – MA

INTRODUCTION: Tuberculosis (TB) is an infectious disease transmitted by Mycobacterium tuberculosis, which spreads through the airways when infected individuals cough, sneeze or speak, releasing aerosols containing active bacilli. OBJECTIVE: To analyze the incidence and clinical-epidemiological characteristics of tuberculosis in Imperatriz - Ma, between 2019 and 2023. MATERIALS AND METHODS: Descriptive epidemiological study, with a quantitative approach, carried out from compulsory notifications of new cases of the disease available via DATASUS. The incidence coefficients were calculated for each year of the disease. The epidemiological variables were treated using descriptive statistics. RESULTS: During the period under investigation, 447 new cases of tuberculosis were reported in the city of Imperatriz. The detection rate of new cases was higher in 2022 and lower in 2021. Regarding the epidemiological characteristics, most cases were male, brown race/color, pulmonary clinical form, first positive sputum culture, negative TB/HIV coinfection, DOT not performed, non-smoker, non-alcoholic and with evolution to cure. In addition, the age group of 20 to 29 years, incomplete 5th to 8th grade of PE and 6th month bacilloscopy not performed stood out. FINAL CONSIDERATIONS: It is essential to invest in strategies that expand access and adherence to treatment, promote a more humanized approach in patient monitoring, and develop intersectoral actions to address socioeconomic and educational barriers.

HPB SO62 - Association of positive bile cultures and the incidence of pancreatic fistulas post pancreaticoduodenectomy[PD

Abstract Background Postoperative pancreatic fistula (POPF) remains a significant complication post pancreaticoduodenectomy (PD). Recent publications show no increased incidence of POPF due to positive bile cultures. A literature search on PubMed did not show any review on the relevance of specific cultures and their exact incidence of POPF. POPF is defined as Drain Amylase greater than three times its serum level on or after postoperative day 3. A relatively benign clinical course is grade A, moderately unwell patients requiring medical/minimal intervention (grade B), and critically ill patients with sepsis, requiring invasive intervention (grade C). Grade B + C is defined as CR-POPF. Method A retrospective single-centre analysis of all patients with pancreaticoduodenectomy between 2017 and 2021 was reviewed. The clinical data that were reviewed were age, gender, length of stay[LOS], tumour staging, mortality rates, Pancreatic duct[PD], Pre-op stenting, the documented incidence of POPF/CR-POPF, Intra-Operative Bile Cultures[IOBC] and antibiotic sensitivity. The primary outcome was POPF. Secondary outcomes were 90-day mortality, LOS, return to theatre, Postoperative haemorrhage (POPH), and organ-specific relevance of POPF. All data was analysed using SPSS IBM version 29. P&amp;lt; 0.05 was taken as clinically significant. Results 100 patients were included in the study. The mean age was 68.8 (SD-9.5). The M: F ratio was 54:46. The mean postoperative length of hospital stay was 19.38 days. 48 patients (48%) were diagnosed with a POPF, among which, 22 patients (47.8%) developed a CR-POPF. 57 patients had a positive IOBC. The incidence of POPF in patients with Positive IOBC was 43/57(75.43%) and that was 5/43(11.62%) of the patients with Negative IOBC (P &amp;lt; .0001).10% of patients had postoperative haemorrhage (POPH). 9% had 90-day mortality. All 9% of patients who had a return to theatre had POPF. Conclusion Univariate analysis and logistic regression demonstrated that a positive IOBC had a higher associated incidence of POPF who underwent PD, with Klebsiella being the most common and statistically significant[P&amp;lt;.005]. The most common antibiotic found to be sensitive was Gentamicin, which is 25 per cent and, in combination with Co-amoxiclav, was found to be sensitive in 21.8% of cases. However, this is a single-centre retrospective study with variable operative techniques for different patient groups. Further studies would be warranted before correlating any results to all populations of patients developing POPF post pancreaticoduodenectomy.

Prevalence of multidrug-, extensively drug-, and pandrug-resistant bacteria in clinical isolates from King Khaled Hospital, Najran, Saudi Arabia

Abstract Background Saudi Arabia faces a growing antimicrobial resistance (AMR) problem, exacerbated by the widespread use of antibiotics in clinical and agricultural settings. Despite this, AMR surveillance has been limited, particularly in regions like Najran, making this study critical for informing local and national public health strategies. Aim This study explored the prevalence of multidrug-resistant, extensively drug-resistant, and Pandrug-resistant bacteria in Najran, Saudi Arabia. Study design This is a cross-sectional study. Methods This study included 559 diverse clinical samples (urine, wound, etc.) collected from various departments in King Khaled Hospital, Saudi Arabia. The Phoenix BD instrument was used for complete bacterial identification and antibiotic sensitivity testing. Demographic and clinical data were analyzed statistically. Results Of the 559 samples, the culture positivity rates were as follows: 51% for Escherichia coli, 22% for Staphylococcus aureus, 14% for Klebsiella pneumoniae, 6% for Acinetobacter baumannii, 6% for Pseudomonas aeruginosa, and 1% for Enterococcus faecium. Majority of the cases were from male (57%), and age 50+ (59%) recorded highest cases. Participants from outpatient department (OPD) ward recorded the highest (56%) cases, while urine sample recorded the highest (49%) cases. About 84% of the isolates were multidrug‑resistance (MDR), 10% were extensively drug‑resistance (XDR), and 6% pandrug‑resistance (PDR). Our analysis showed high sensitivity to Oxazolidonone, Tetracycline, carbapenems, Lipopeptide, Aminoglycopeptide classes of antibiotics. Conclusions The study revealed a high prevalence of drug resistance, highlighting the critical importance of continued surveillance and research to mitigate the spread of antimicrobial resistance and preserve the effectiveness of existing therapies.

The Experiences of Implementing a Near-Peer Teaching Scheme Into an Undergraduate Dental Hygiene and Dental Therapy Programme at the University of Sheffield in the United Kingdom.

To assess the learning and relationship-building potential of a near-peer teaching scheme that is low in faculty financial and time input. This longitudinal study collects data via pre- and post-programme questionnaires completed by near-peer tutors and learners following a six-week scheme schedule. Qualitative data are analysed using a descriptive analysis model to assess the perceived value of the scheme. Participants find the scheme to be highly beneficial and rewarding. In the 2023 scheme, as for all previous cohorts, no near-peer tutees reported any issues of negative cognitive congruence and most found that they had experienced a greater opportunity to ask for clarification on basic knowledge without fear of reproach. Near-peer tutors valued the opportunity to develop teaching skills in the supportive confines of their own undergraduate diploma, and reflected on their own experience of learning within a prior run of the scheme as being motivational to teach others. Near-peer teaching offers a sustainable and effective approach for dental hygiene and dental therapy programmes. It benefits both tutees and tutors, enhancing skills, fostering relationships and preparing students for future teaching roles. The scheme also promotes a positive learning culture and improves overall educational quality.

EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases.

To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath-assisted flexible cystoscopy (eFC). EndoSheaths are single-use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time-consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced. All adult patients undergoing eFC over a 26-month period at a single institution were evaluated prospectively. Post-eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2-4 = mild, 5-7 = moderate, 8-10 = severe). The diagnosis of UTI was broad and based on any one of patient self-report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi-squared testing (P < 0.05, two-tailed). Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post-eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis. This large, prospective, unselected, real-world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.

Are we doing enough to control infection risk in Australian small animal veterinary practice? Findings from a mixed methods study

BackgroundManaging risk effectively within small animal veterinary practice is integral for staff, patient and client safety. Veterinary personnel are exposed to many risks, including bites, scratches, sharps injuries and exposure to zoonotic diseases and multi-resistant organisms. Patients may also be exposed to healthcare-associated infections, including multi-resistant organisms. While veterinary owners/managers have a duty of care under legislated Workplace Health and Safety requirements, all staff have a responsibility to contribute to assessing and minimizing risk. The application of standard and transmission precautions will help with risk minimization. This study aimed to determine how small animal veterinary staff understand and perceive infection prevention and control risk and to provide recommendations to assist with risk mitigation.MethodsA mixed methods design was used. A digital questionnaire was administered to small animal veterinary staff in Australia to identify knowledge, attitudes and practices of risk related behaviors. Follow up focus groups were conducted with small animal practitioners to explore factors supporting and preventing veterinary staff from implementing recommended practices identified in the questionnaire.ResultsSmall animal veterinary staff acknowledged they participated in many high-risk activities, including recapping needles and eating and drinking in patient care areas. Injuries were common, with 77% of staff receiving a bite or scratch, and 22% receiving a sharps injury in the preceding six months. Less than one in five of these incidents was reported. Staff agreed effective infection prevention and control was the responsibility of all staff, but a designated staff member should take responsibility for managing it. The practice owner/manager was integral to supporting and promoting recommended strategies, contributing to a positive workplace culture and improving safety for staff and patients.ConclusionSmall animal veterinary staff have some understanding of how to identify, report, manage and mitigate risk but were limited by their knowledge of infection prevention and control principles.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Abstract 4138030: Eustachian Valve Endocarditis Successfully Extracted Using the Angio-Vac Aspiration System

Introduction: Eustachian valve endocarditis is a rare right-sided endocarditis that is often poorly visualized on transthoracic echocardiography (TTE). Here is a case of eustachian valve endocarditis first identified on TTE. It was refractory to intravenous antibiotic therapy and was successfully treated using the AngioVac aspiration system for percutaneous debulking. Case: A 36-year-old female with a past medical history of depression, intravenous heroin use, and substance-induced mood disorder presented with altered mental status and respiratory distress. She was found to have methicillin-sensitive staphylococcus aureus (MSSA) bacteremia, a gluteal abscess, multiple septic pulmonary emboli, and a left-sided empyema. She was started on broad-spectrum antibiotics that were narrowed to cefazolin. Her gluteal abscess was drained, and a left-sided chest tube was placed with pleural cultures growing MSSA. TTE demonstrated a mass on the eustachian valve. Subsequent transesophageal echocardiography (TEE) demonstrated two echogenic masses adherent to the eustachian valve, one measuring 17 by 9 millimeters and one measuring 15 by 8 millimeters, consistent with eustachian valve endocarditis. Despite appropriate antibiotic therapy, she continued to have intermittent fevers with persistently positive blood cultures. The patient underwent TEE-guided extraction of the eustachian valve vegetation using the AngioVac aspiration system. TEE at the end of the case demonstrated complete removal of her eustachian valve masses. Blood cultures cleared post-procedure, and she was eventually discharged to acute rehabilitation. Conclusion: In cases of eustachian valve endocarditis refractory to appropriate antibiotic therapy, the AngioVac aspiration system offers an option for percutaneous extraction of eustachian valve vegetations.

Extended-spectrum β-lactamase and carbapenemase producing Enterobacteriaceae among patients suspected with surgical site infection at Hospitals in Southern Ethiopia

BackgroundExtended-spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae are an increasing problem for patients today. Data on clinical samples for ESBL and carbapenemase-producing Enterobacteriaceae for surgical site infection patients in developing countries are limited, including Ethiopia, mainly due to resource constraints. Hence, this study aimed to determine the prevalence of extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among patients suspected to have surgical site infection at Hospital in Southern Ethiopia.Materials and methodsA hospital-based cross-sectional study was conducted on 422 suspected surgical site infections from June 1, 2022 to August 30, 2022 at Hospitals in Southern Ethiopia. Sociodemographic and clinical data were obtained by using a structured questionnaire. Clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs in sterile test tubes containing sterile normal saline (0.5 mL). Samples were cultured on blood and MacConkey agar plates. All positive cultures were characterized by colony morphology, Gram staining, and standard biochemical tests. Antimicrobial sensitivity tests were performed using Kirby Baur disk diffusion on Mueller–Hinton agar. ESBL production was confirmed using a double-disc synergy test (DDST) method. Carbapenemase production was assessed using the modified Hodge test. Logistic regression analysis was used to determine associated factors. A P-value &amp;lt; 0.05 were considered statistically significant.ResultBacteria belonging to the order Enterobacterales were cultured in 23.7% out of 422 patients with suspected surgical wound infection. Of all the isolates, Enterobacteriaceae (69 isolates) were the most frequent, with E. coli (29/69) followed by K. pneumoniae (14/69). Of 69 Enterobacteriaceae isolates, 66.6 % (46/69) were positive for ESBL production, and 21.7 (15/69) were positive for carbapenemase-producing Enterobacteriaceae. The majority of Enterobacteriaceae isolates showed sensitivity to meropenem (72.1%); however revealed 63.9% and 70.5% were resistant to gentamicin and ciprofloxacin, respectively. Similarly, a higher resistance rate to cefepime (91.8%), amoxicillin-clavulanic acid (98.4%), ceftriaxone (95.1%), and ceftazidime (91.8%). MDR rate of Enterobacteriaceae isolates was 25/61 (41%) among patients suspected for surgical site infection. The Multivariable analysis revealed that length of hospital stay in hospital [AOR = 3.81 (95% CI 2.08–6.95)] remained statistically significant factor associated with surgical site infection due to ESBL producing Enterobacteriaceae.ConclusionStudy results showed the severity of ESBL-producing Enterobacteriaceae is critical and CPE is alarming. Meropenem is the most effective antibiotic against the ESBL-producing Enterobacteriaceae. MDR rate of Enterobacteriaceae isolates was 61 (61%) among patients suspected for surgical site infection. Therefore, antibiotic selection should be based on the results of the culture and sensitivity tests.