Empirical Therapy Research Articles

Role of disturbance coefficient in monitoring and treatment of cerebral edema in patients with cerebral hemorrhage

BACKGROUND At present, the conventional methods for diagnosing cerebral edema in clinical practice are computed tomography (CT) and magnetic resonance imaging (MRI), which can evaluate the location and degree of peripheral cerebral edema, but cannot realize quantification. When patients have symptoms of diffuse cerebral edema or high cranial pressure, CT or MRI often suggests that cerebral edema is lagging and cannot be dynamically monitored in real time. Intracranial pressure monitoring is the gold standard, but it is an invasive operation with high cost and complications. For clinical purposes, the ideal cerebral edema monitoring should be non-invasive, real-time, bedside, and continuous dynamic monitoring. The disturbance coefficient (DC) was used in this study to dynamically monitor the occurrence, development, and evolution of cerebral edema in patients with cerebral hemorrhage in real time, and review head CT or MRI to evaluate the development of the disease and guide further treatment, so as to improve the prognosis of patients with cerebral hemorrhage. AIM To offer a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment. METHODS A total of 160 patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery, Second Affiliated Hospital of Xi’an Medical University from September 2018 to September 2019 were recruited. The patients were randomly divided into a control group (n = 80) and an experimental group (n = 80). Patients in the control group received conventional empirical treatment, while those in the experimental group were treated with mannitol dehydration under the guidance of DC. Subsequently, we compared the two groups with regards to the total dosage of mannitol, the total course of treatment, the incidence of complications, and prognosis. RESULTS The mean daily consumption of mannitol, the total course of treatment, and the mean hospitalization days were 362.7 ± 117.7 mL, 14.8 ± 5.2 days, and 29.4 ± 7.9 in the control group and 283.1 ± 93.6 mL, 11.8 ± 4.2 days, and 23.9 ± 8.3 in the experimental group (P < 0.05). In the control group, there were 20 patients with pulmonary infection (25%), 30 with electrolyte disturbance (37.5%), 20 with renal impairment (25%), and 16 with stress ulcer (20%). In the experimental group, pulmonary infection occurred in 18 patients (22.5%), electrolyte disturbance in 6 (7.5%), renal impairment in 2 (2.5%), and stress ulcers in 15 (18.8%) (P < 0.05). According to the Glasgow coma scale score 6 months after discharge, the prognosis of the control group was good in 20 patients (25%), fair in 26 (32.5%), and poor in 34 (42.5%); the prognosis of the experimental group was good in 32 (40%), fair in 36 (45%), and poor in 12 (15%) (P < 0.05). CONCLUSION Using DC for non-invasive dynamic monitoring of cerebral edema demonstrates considerable clinical potential. It reduces mannitol dosage, treatment duration, complication rates, and hospital stays, ultimately lowering hospitalization costs. Additionally, it improves overall patient prognosis, offering a promising new approach for non-invasive adjuvant therapy in cerebral edema treatment.

Surgical Infection Society Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation.

Background: Empiric anti-fungals are frequently administered in patients with non-colonic gastrointestinal (GI) perforations, but there is limited evidence of their benefit. We hypothesized that empiric anti-fungals would offer no clinical benefit compared with a standard course of antimicrobial therapy. Methods: This multi-center prospective cohort study included patients ≥18 years old undergoing operative management for non-colonic GI perforations across 15 centers between August 2021 and January 2024. The primary outcome was organ-space surgical site infection (SSI). We performed propensity score matching to adjust for confounders and a backward stepwise regression model to identify predictors of an organ-space SSI. A subgroup analysis of spontaneous upper GI perforations was performed as well. Results: A total of 192 patients were included; 138 (71.88%) received empiric anti-fungal therapy, and 17.7% developed an organ-space SSI. Before matching, empiric anti-fungal use was frequent in critically ill patients although not associated with organ-space SSI. After matching, there were no differences in organ-space SSI (17.5% vs. 17.5%, p = 0.99). In multi-variable regression, American Society of Anesthesiologists physical status classification system (ASA) category 3 increased the risk of organ-space SSI (odds ratio [OR] 2.49, p = 0.04), whereas perioperative proton-pump inhibitor (PPI) use was protective (OR 0.15, p = 0.004). In the subgroup analysis (N = 150), empiric anti-fungal therapy did not reduce infection risk. Pre-operative shock increased the risk of organ-space SSI (OR 2.83, p = 0.04), whereas PPI use remained protective (OR 0.15, p = 0.01). Conclusion: Empiric anti-fungal use was not associated with reduced organ-space SSI, even after adjusting for confounders. Given the lack of benefit, we caution against the use of routine empiric anti-fungal therapy in non-colonic GI perforations.

Child Neurology: Creatine Biosynthesis Disorder in an Adolescent With Capgras Syndrome and Reduplicative Paramnesia.

This case report and discussion pertain to a 17-year-old female patient with developmental delay and acute onset of psychosis, diagnosed with guanidinoacetate methyltransferase (GAMT) deficiency, a rare creatine biosynthesis disorder. The patient experienced auditory hallucinations, paranoia, and delusional misidentification syndromes (Capgras syndrome and reduplicative paramnesia), following a viral respiratory illness. The neurologic examination was nonfocal but included intermittent negative myoclonus, generalized stiff movements, and a mechanical gait, which initially suggested catatonia or autoimmune encephalitis. MRI of the brain was normal, as was her CSF profile, although EEG revealed diffuse slowing with frequent generalized spike waves. Sequential empiric treatments for catatonia and autoimmune encephalitis provided limited benefit. Subsequent biochemical and genetic testing confirmed GAMT deficiency, supported by a markedly decreased creatine peak on MR spectroscopy of the brain. This case highlights GAMT deficiency as a consideration in young patients with neuropsychiatric symptoms, particularly psychosis with atypical motor findings and a history of developmental delay. The rare presentation of delusional misidentification symptoms expands the spectrum of clinical findings described in patients with GAMT deficiency, a rare disorder reported in at least 130 individuals to date. Treatment with creatine and ornithine supplementation led to marked improvement, returning her incrementally toward baseline functioning. This case broadens the understanding of GAMT deficiency's phenotypic range and underscores the importance of metabolic testing in tandem with or closely following empiric but unsuccessful treatment trials, even when the initial clinical presentation suggests primary psychiatric, autoimmune, or inflammatory etiologies.

The Burden of Antimicrobial Resistant Bacteremia in Ontario: A Population-wide Analysis of Attributable Mortality from 110 Pathogen-Antibiotic Combinations.

Reliable information on the burden of antimicrobial resistance (AMR) is necessary to confront the threat of antimicrobial resistance. We sought to examine the association between AMR and mortality across cultured bacterial bloodstream pathogens in the province of Ontario, Canada. We used linked microbiology data from 114 hospital, community, and public health laboratories to develop a positive bacterial blood culture episode cohort, between January 2017 and December 2021, for the population of Ontario, Canada (population 14.6 million). Antibiotics tested in >10% of cultures of a pathogen, with resistance 1%-99%, were eligible. We used separate proportional hazards models for each pathogen, to estimate the hazard ratio of 30-day mortality for each eligible antibiotic, adjusting for patient risk factors, and summarized results using mixed-effects meta-analysis. We identified 83,962 bacteremia episodes, due to 30 pathogens, and 110 eligible pathogen-antibiotic combinations. 30-day mortality was 17.1% (14,362/83,962). Unadjusted associations between resistance and 30-day mortality were substantially larger (HR=1.47, 95%CI: 1.32-1.65) than adjusted associations accounting for age, sex, healthcare exposures, comorbidities, and co-resistance (HR=1.10, 95%CI: 1.07-1.16). Associations were larger for antibiotics commonly used for empiric treatment (HR=1.18, 95%CI: 1.10-1.26). We found that antimicrobial resistance was associated with a 10% relative increase in the risk of mortality among patients with bacteremia, and 1.2 AMR attributable deaths per 100,000 population per year in Ontario, Canada. Comprehensive risk adjustment is necessary for understanding the impact of AMR bacteremia on patient outcomes.

Eosinophilia and gastrointestinal symptoms in Immunosuppression: a classic but overlooked diagnosis.

A 77-year-old man with idiopathic hypereosinophilic syndrome on corticosteroids presented with fever, diarrhea, and anemia. Initial investigations, including screening for enteric pathogens, were negative, and empirical antibiotics were initiated, with subsequent deterioration. Endoscopy revealed Strongyloides stercoralis in the duodenal wall. Treatment with ivermectin resulted in clinical and hematologic resolution. This case highlights the need to consider strongyloidiasis in the differential diagnosis of peripheral eosinophilia.

Modeling the impact and cost of a culture-dependent molecular test for antimicrobial resistance in resource-limited settings.

Limited diagnostic access in resource-limited settings contributes to poor health outcomes among bacterial sepsis patients and the spread of antimicrobial resistance (AMR). Molecular diagnostic profiling of AMR may enable faster targeting of antibiotic therapies, improving clinical outcomes, reducing AMR development, and saving costs. We modeled the impact of a culture-dependent molecular diagnostic for pathogen identification and resistance testing among hospitalized bloodstream infection patients to guide effective and cost-efficient implementation of these tools. We evaluated patient mortality, antibiotic use, hospital-associated infections, hospital days, and costs under the standard-of-care (empiric therapy, blood culture, phenotypic susceptibility testing) compared to molecular diagnostics - varying culture and susceptibility testing coverage, culture turnaround time, and AMR prevalence. The greatest impact of the molecular diagnostic occurred with 100% diagnostic coverage of all patients, shorter culture turnaround time, and high AMR prevalence, reducing up to 6% of deaths [IQR: 0-12.1%], 5% of hospital days [IQR: 0.1-10.7%], and 21% of days on inappropriate antibiotic therapy [IQR: 18.2-24.4%]. The minimum cost per molecular diagnostic performed, offset by cost savings, ranged from $109 in India to $585 in South Africa across all modeled scenarios. In high AMR burden settings with blood culture infrastructure supporting fast turnaround times, a molecular diagnostic could improve bloodstream infection health outcomes. This impact is limited by delayed turnaround times and the effectiveness of empiric therapy. Molecular diagnostics implemented at $100 or less can generate healthcare system cost savings, supporting their adoption to improve health outcomes and reduce AMR while remaining cost neutral.

Be afraid of a long-standing skin lesion

A 91-year-old man presented to our emergency department for foul-smelling bleeding secretions and severe pain from a long-standing ulcerated skin lesion on his right frontotemporal area. This lesion had been present for over a year and originally measured about 2 cm. It had been managed at home with help from a nursing service but without any medical follow-up. Blood tests showed leukocytosis (WBC 16,800/mm3), increased C-reactive protein (174 mg/L, n.v.<5), and normochromic normocytic anemia (Hb 8.8 g/dL, MCV 94.7 fL, MCH 31 pg). The patient was admitted to the geriatrics department, and an empirical broad-spectrum antibiotic therapy with piperacillin/tazobactam (4.5 g q8h IV) and daptomycin (500 mg q48h IV due to severe CKD) was started. A CT scan of the brain revealed complete obliteration of the diploic-tecal structures across the entire frontal squama on both sides of the skull, with infiltration of the right temporal muscle. The expansive lesion extended into the intracranial site, only partially delimited by the dura mater, with coexisting right frontobasal perilesional edema extending up to the anterior convexity, which exerted significant compressive pressure on the frontal horn of the lateral ventricle with a left-right shift of the midline by approximately 3 mm. In the absence of surgical options and with persistent bleeding and severe pain, palliative sedation therapy was started. The patient died after 6 days of recovery.

BLOOD CULTURE PROVEN COMMON BACTERIAL PATHOGENS IN PATIENTS ADMITTED IN THE PEDIATRIC UNIT OF A TERTIARY CARE HOSPITAL IN PAKISTAN

Background: Bloodstream infections (BSIs) in pediatric populations represent a substantial burden of morbidity and mortality, particularly in developing countries. Rapid identification of causative bacterial pathogens and determination of their antimicrobial susceptibility profiles are essential for timely intervention and effective management of sepsis. Objective: To determine the spectrum of bacterial pathogens isolated from blood cultures and assess their antimicrobial sensitivity patterns among pediatric patients admitted with sepsis at a tertiary care hospital in Pakistan. Study Design: Descriptive cross-sectional study. Settings: Department of Pediatrics, Fauji Foundation Hospital, Rawalpindi, Pakistan. Duration of Study: 23 January 2025 to 23 April 2025. Methods: Blood samples were collected aseptically from pediatric patients meeting the clinical criteria for sepsis and processed using an automated BACTEC system. Standard microbiological techniques, identified bacterial isolates, and antimicrobial susceptibility testing were conducted by Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 25.0, with Chi-square tests applied to evaluate associations between categorical variables. Results: Among 145 enrolled patients, 117 (80.7%) demonstrated positive blood cultures. Staphylococcus aureus was the predominant pathogen (27.4%), followed by Escherichia coli (23.9%) and Klebsiella pneumoniae (22.2%). Staphylococcus aureus exhibited 100% sensitivity to vancomycin, while imipenem showed high efficacy against E. coli (95%) and K. pneumoniae (90%). Notably, substantial resistance to third-generation cephalosporins was observed. A statistically significant association was found between male gender and a higher incidence of Staphylococcus aureus infections (p=0.045). Conclusion: Staphylococcus aureus remains the leading cause of pediatric bloodstream infections, and emerging antimicrobial resistance patterns pose a serious challenge to empirical therapy. Routine surveillance of bacterial pathogens and their resistance profiles is imperative to guide effective antimicrobial stewardship and improve clinical outcomes in Pakistan's pediatric population.

Bacterial Infections and the Growing Challenge of Antimicrobial Resistance: A Study on the Role of Culture-Based Diagnosis in Treatment Decision-Making

Aim: This study aims to analyze the microbiological profiles of bacterial infections in 516 patients, focusing on the distribution of pathogens, the prevalence of single vs. mixed infections, and the impact of antimicrobial resistance (AMR) on treatment strategies. Study Design: A retrospective cohort study was conducted to evaluate the microbiological data of 516 patients diagnosed with suspected bacterial infections. Place and Duration of the Study: The study was conducted at Indira Medical College and Hospitals over 2 years. Methodology: Clinical samples (urine, pus, wound swabs, and sputum) were collected and processed using conventional microbiological techniques for pathogen identification and antimicrobial susceptibility testing. Statistical analysis was performed to determine the correlation between pathogen prevalence, infection types, and demographic factors such as age and gender. Results: Among 516 clinical samples, 174 (33.7%) were culture-positive. The most common pathogens were Escherichia coli (24.1%), Staphylococcus aureus (20.6%), and Pseudomonas aeruginosa (9.7%). Single-pathogen infections were predominant in urine samples (84.5%), while mixed infections were more frequent in pus (14.6%) and wound swabs (47%). Discussion: The findings support the dominance of E. coli as a key pathogen, particularly in urinary tract infections. The higher incidence of mixed infections in pus and wound swabs supports (usual practice) the need for broad-spectrum antibiotics in empirical therapy. Bacterial culture remains an essential diagnostic tool for identifying pathogens and determining antimicrobial susceptibility, particularly in the context of rising AMR. Conclusion: The study emphasizes the ongoing importance of bacterial culture in identifying pathogens and guiding treatment, especially in regions with high rates of AMR. It calls for enhanced antimicrobial stewardship programs and further research to refine treatment approaches for both single and mixed infections.

Prevalence and outcomes of Urinary tract infections caused by Enterobacterales resistant to third-generation cephalosporins in the Emergency Department: results from UTILY cohort, a prospective multicentre study.

In accordance with the spread of drug-resistant bacteria worldwide, an increase in the prevalence of Antimicrobial Resistance (AMR) among pathogens causing urinary tract infections (UTIs) has been described globally. The aim of this study was to describe the prevalence and outcome of UTIs caused by third-generation cephalosporin-resistant (3GC-R) Enterobacterales in a prospective cohort of patients admitted to Emergency Department (ED). We conducted an observational prospective multicentre study, involving 7 healthcare facilities, enrolling all consecutive adult patients admitted to ED with a microbiologically confirmed diagnosis of UTIs caused by Enterobacterales. The primary outcomes were the prevalence of UTIs caused by 3GC-R Enterobacterales, and 30-day mortality. During the study period, we included 288 patients with urinary tract infection: 41.7% of subjects were males, median age was 72years (IQR 56-81). The most frequently isolated pathogen was Escherichia coli (70.5%); 35.9% of all pathogens isolated were non-susceptible to 3GC. At multivariate logistic regression analysis, admission to a hospital (OR 3.31, 95% CI 1.41-7.75, p = 0.006) or a long-term care facility (OR 4.87, 95% CI 1.16-20.36, p = 0.03) in the previous three months was independently associated with isolation of a 3GC-R pathogen. Regarding the clinical outcomes, 22 out of 217 (10.1%) patients completing follow-up died at 30days. At multivariate analysis 7-day clinical response was the only variable associated with 30-day mortality (OR 0.11, 95% CI 0.04-0.36, p < 0.001). In our study, 35.9% of pathogens isolated in urine cultures of patients with community-acquired UTIs were non-susceptible to 3GC. In the ED, the knowledge of local epidemiology and of risk factors for antimicrobial resistance is of paramount importance for choosing the right empiric therapy and setting up local guidelines.

The TyphiNET data visualisation dashboard: unlocking Salmonella Typhi genomics data to support public health

BackgroundSalmonella enterica subspecies enterica serovar Typhi (abbreviated as ‘Typhi’) is the bacterial agent of typhoid fever. Effective antimicrobial therapy reduces complications and mortality; however, antimicrobial resistance (AMR) is a major problem in many endemic countries. Prevention through vaccination is possible through recently-licensed typhoid conjugate vaccines (TCVs). National immunisation programs are currently being considered or deployed in several countries where AMR prevalence is known to be high, and the Gavi vaccine alliance has provided financial support for their introduction. Pathogen whole genome sequence data are a rich source of information on Typhi variants (genotypes or lineages), AMR prevalence, and mechanisms. However, this information is currently not readily accessible to non-genomics experts, including those driving vaccine implementation or empirical therapy guidance.ResultsWe developed TyphiNET (https://www.typhi.net), an interactive online dashboard for exploring Typhi genotype and AMR distributions derived from publicly available pathogen genome sequences. TyphiNET allows users to explore country-level summaries such as the frequency of pathogen lineages, temporal trends in resistance to clinically relevant antimicrobials, and the specific variants and mechanisms underlying emergent AMR trends. User-driven plots and session reports can be downloaded for ease of sharing. Importantly, TyphiNET is populated by high-quality genome data curated by the Global Typhoid Pathogen Genomics Consortium, analysed using the Pathogenwatch platform, and identified as coming from non-targeted sampling frames that are suitable for estimating AMR prevalence amongst Typhi infections (no personal data is included in the platform). As of February 2024, data from a total of n = 11,836 genomes from 101 countries are available in TyphiNET. We outline case studies illustrating how the dashboard can be used to explore these data and gain insights of relevance to both researchers and public health policy-makers.ConclusionsThe TyphiNET dashboard provides an interactive platform for accessing genome-derived data on pathogen variant frequencies to inform typhoid control and intervention strategies. The platform is extensible in terms of both data and features, and provides a model for making complex bacterial genome-derived data accessible to a wide audience.

There is no significant difference in the treatment of aspiration pneumonia in dogs with ampicillin-sulbactam versus ampicillin-sulbactam and enrofloxacin.

Describe outcomes for dogs with aspiration pneumonia (AP) initially treated with ampicillin-sulbactam (AS) alone (monotherapy [MT]), initially with AS and enrofloxacin (initial dual therapy [iDT]), or initially with AS and later escalating with enrofloxacin (escalated dual therapy [eDT]). Retrospective review of dogs hospitalized at a teaching hospital for AP between 2010 and 2022. Inclusion criteria included consistent historical and thoracic radiographic findings and subsequent treatment with MT, iDT, or eDT. Exclusion criteria included radiographic findings suggesting other pulmonary pathologies, aspiration while hospitalized, antibiotic use in the prior month, or referral for comorbidities. Demographics, weight, vital signs, laboratory data, thoracic radiographs, lung lobes affected, antibiotic timing, and hospitalization details were recorded. Shock index, systemic inflammatory response syndrome criteria, and quick sequential organ failure assessment scores were calculated. 58 dogs met inclusion criteria. A total of 40 dogs were started on AS alone; 27 dogs were assigned to MT (46.6%). Thirteen dogs were later escalated (eDT; 22.4%). Eighteen dogs (31%) received iDT. The dogs that were escalated had significantly longer hospital stays. However, no significant differences were observed in lung lobes affected, survival to discharge, disease severity indices, and total leukocyte counts across the 3 groups. No differences were found between survivors and nonsurvivors. Ampicillin-sulbactam alone is an effective treatment for a substantial proportion of dogs with AP. Empirical treatment with MT is likely appropriate for dogs with AP lacking signs of critical illness. In dogs for which eDT was deemed clinically necessary, outcomes are not worse.

Unraveling Pediatric Group A Streptococcus Meningitis: Lessons from Two Case Reports and a Systematic Review

Streptococcus pyogenes meningitis is a rare invasive disease, accounting for less than 2% of bacterial meningitis. We presented two case reports and conducted a systematic review using PUBMED, covering the database from its inception up to 31 December 2024, of pediatric cases of Streptococcus pyogenes meningitis. Only case reports and case series were included. Differences in clinical and laboratory parameters were compared between uneventful course and complicated admissions. A total of 57 cases were included. The median age at diagnosis was 4 years. A primary infection focus outside the brain was identified in 61.39% of cases. S. pyogenes was identified from cerebrospinal fluid in 66.66% of cases and from blood in 15.79%. Septic shock occurred in 24.56% of cases, and 36.84% had brain anatomical anomalies. All patients received broad-spectrum empiric antibiotics, while protein-synthesis inhibitors were administered in 26.31% of cases. A total of 17% of patients died, and 28.07% experienced sequelae. The identification of S. pyogenes from blood and a Phoenix Sepsis Score ≥ 2 were significantly associated with a complicated clinical course. Our findings may offer useful insights for the clinical management of Streptococcus pyogenes meningitis.

C3-Glomerulonephritis in the setting of immune checkpoint inhibitor and tyrosine kinase inhibitor use: A rare unintended complication

Introduction: Kidney-related adverse events associated with Immune Checkpoint Inhibitors occur at an incidence range of 2%–5%, with an incidence of KDIGO class III acute kidney injury of 0.6%. We report a case of C3-Glomerulonephritis associated with concomitant use of Pembrolizumab and Lenvatinib that resulted in kidney failure. Case description: A 52-year-old male with a prior medical history notable for stage IV Renal Cell Carcinoma with lung metastasis, treated with Lenvatinib and Pembrolizumab, presented to the emergency room with hypertensive urgency, worsening anasarca, and was found to have nephrotic-range proteinuria and hematuria. The patient was empirically started on Prednisone and underwent kidney biopsy which was notable for Immunoglobulin positive C3 diffuse proliferative glomerulonephritis. He was found to have low complement C3, elevated sC5b-9 (SMAC) with elevated CBb, and low Factor H which are consistent with alternative pathway activation. Complement factor H antibody testing was negative, and genetic testing was unrevealing, though there were variants of undetermined significant noted. Eculizumab was planned at time of discharge, however, administration was delayed by 2 months. Clinic follow-up 1 month after initiation of Eculizumab revealed no improvement in kidney function. The patient remains dialysis dependent. Discussion: The case we describe highlights a unique diagnostic challenge associated with ICI-induced AKI with respect to concomitant VEGF use. The case adds to the repertoire of C3GN associated with these drugs that, unlike the reported cases of partial or complete recovery, instead resulted in kidney failure. We revisit the role of kidney biopsy in patients who present with AKI after treatment with these drugs, instead of empiric treatment, especially if there is suggestion of any alternate process.

A Selective Chromogenic Medium for Detecting Meropenem-Resistant Pseudomonas aeruginosa in Respiratory Samples

Background/Objectives: Meropenem is widely used to treat Pseudomonas aeruginosa infections; however, the pathogen’s increasing resistance compromises its efficacy. In this study, we aimed to develop a selective culture medium for detecting the presence of meropenem-resistant Pseudomonas aeruginosa in respiratory specimens within 24 h. Methods: The medium’s performance was challenged using a collection of 130 clinical Pseudomonas aeruginosa strains (of which 85 were meropenem-susceptible, 14 were meropenem-intermediate, and 21 were meropenem-resistant). Subsequently, clinical validation was carried out using 130 respiratory samples. Results: The selective medium demonstrated excellent sensitivity (average 98.7%) and specificity (average 90%) across bacterial concentrations ranging from 1 × 104 to 1 × 108 CFU/mL, and a high negative predictive value (average 99.2%) compared to the broth microdilution (BMD) method. Clinical validation with bronchoalveolar lavage (BAL) and tracheobronchial aspirate (TBA) clinical specimens (N = 130) revealed a strong performance, with 92,3% categorical agreement. Conclusions: This method accelerates susceptibility testing, is user-friendly, and delivers reliable results, contributing to the optimization of empirical treatment for respiratory tract infections.

Brevibacterium Species Infections in Humans—A Narrative Review

Background: Brevibacterium species are Gram-positive, non-sporulating, coryneform, aerobic rods that are catalase positive and exhibit a distinctive transition from diptheroid to coccoid morphology during culture. Infections by these species are seldom identified. Objective: This narrative review aims to present all the reported cases of Brevibacterium spp. infections in humans, focusing on data about epidemiology, antimicrobial resistance, antimicrobial treatment, and mortality. Methods: A narrative review based on a literature search of PubMed/MedLine and Scopus databases was performed. Results: In total, 41 studies providing data on 42 patients with Brevibacterium spp. infections were included in the present analysis. The median age was 48 years, while 57.5% were male. The presence of a central venous catheter and malignancy, and end-stage renal disease on peritoneal dialysis were the main predisposing factors. Bacteremia was the most common type of infection, with peritoneal dialysis-associated infections being the second most common. B. casei was the most commonly identified species. Microbial identification required the use of advanced molecular techniques, such as 16s rRNA sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry in most cases. Brevibacterium spp. was highly resistant to the combination of trimethoprim with sulfamethoxazole, clindamycin, and common beta-lactams. The most commonly used antimicrobials were vancomycin and aminoglycosides. The mortality was about 10%. Conclusion: Clinicians and laboratory personnel should consider this pathogen in the differential diagnosis in patients with malignancy or peritoneal dialysis-associated peritonitis. Vancomycin should be used for empirical treatment and while antimicrobial susceptibility testing results are pending.

Clinical Impact of Stool Polymerase Chain Reaction (PCR) Testing in Hospitalized Patients with Acute Diarrhea: A Retrospective Observational Study

Background/Objectives: Acute diarrheal illnesses are a major cause of hospital admissions, particularly in immunocompromised patients. Traditional diagnostic methods are slow and often insensitive, delaying treatment. In contrast, PCR panels provide rapid, sensitive detection of multiple pathogens. This study evaluates stool PCR testing in hospitalized adults and its impact on clinical decisions and antimicrobial stewardship. Methods: We conducted a retrospective study at Bistrița County Hospital, Romania (September 2023–September 2024), including 75 adults with acute diarrhea and negative conventional stool tests. PCR testing (VIASURE panels I and II) detected 11 bacteria, 6 viruses, and 5 parasites. Clinical and therapeutic data were analyzed, and logistic regression identified predictors of PCR positivity and adverse outcomes. Results: PCR was positive in 78% of cases, with Campylobacter spp. (57.6%) and Clostridioides difficile (20.3%) being the most common. Bloody diarrhea independently predicted PCR positivity (OR 9.78, p = 0.047). Immunosuppression and end-stage liver disease were linked to worse outcomes. PCR results led to antimicrobial therapy adjustments in 40 patients (p = 0.001), correcting inappropriate antibiotic use in 66% of those receiving empirical treatment. Targeted therapy significantly reduced antimicrobial duration from 7 to 5 days (p = 0.00001). Conclusions: Stool PCR testing enhances pathogen detection, guides targeted therapy, and reduces inappropriate antibiotic use, supporting antimicrobial stewardship and improving outcomes in selected hospitalized patients.

Clinical Types and Infective Pattern of Pyogenic Neck Abscess in Diabetic Patients

Background: Complex anatomy of neck makes the diagnosis and treatment of the neck abscess challenging. Diabetic patients especially with poorly controlled are more susceptible for such infection and faces virulent pyogenic bacteria. The course of the disease may be more rapidly progressive and serious. Some fatal complications may occur like airway obstruction, pneumonia, lung abscess, mediastinitis etc. We aimed to detect the bacteria causing different clinical types of pyogenic neck abscess and their antimicrobial sensitivity in diabetic patients. Methods: It is a prospective observational type of study carried out in the Department of Otolaryngology and Head Neck Surgery of BIRDEM General Hospital, Dhaka from 1st December, 2019 to 31st May, 2020. Total 50 cases of diabetic patients having neck abscess were selected by purposive consecutive sampling. Then history taking, clinical examinations, relevant investigations along with antibiogram were done in all cases. Afterwards data were collected in a preformed data collection sheet. Then data were analysed with Statistical Package for the Social Sciences (SPSS) V 22.0. Results: Among the 50 cases 30 were male and 20 were female. Age ranges from 32 to 83 years and mean age was 55.28 years. The commonest symptom was neck swelling 47 (94%). Other symptoms were neck pain 46 (92%), fever 42 (84%), difficulty in swallowing 15 (30%), difficulty in mouth opening 14 (28%), toothache 7 (14%), H/O tooth extraction 6 (12%), H/O neck surgery 3 (6%) and respiratory difficulty 1 (2%). On clinical examination commonly 47 (94%) patients had neck swelling which was subsequently followed by pyrexia 36(72%), trismus 16 (32%), dental caries 14 (28%) and halitosis 13 (26%). Commonest aetiology was dental origin. Most common pyogenic abscesses were involved in the anterior triangle of the neck 15 (30%) followed by Ludwig’s angina 12 (24%), submandibular abscess 10 (20%), abscess in the posterior triangle 7 (14%), parotid abscess 4 (14%), retropharyngeal abscess 1 (2%) and parapharyngeal abscess 1 (2%). Bacteria isolated from pus culture revealed Klebsiella pneumoniae 23 (46%), Staphylococcus aureus 6 (12%), Pseudomonas 5 (10%), Acinetobacter 4 (08%), E.coli 1 (2%), Proteus 2 (4%), MRSA 1 (2%), Beta haemolytic streptococcus 1 (2%). All the organisms were mostly sensitive to Meropenem, Colistin, Netilmicin, Gentamicin, Amikacin, Piperacillin+Tazobactum. But Acinetobacter was highly sensitive to only Colistin. Conclusion: Neck abscess in diabetic patients occurred commonly in male with lower middle socio-economic class. The virulence of organism is more in case of uncontrolled diabetes. Abscess in the anterior triangle was the commonest type of neck abscess and Klebsiella pneumoniae was the most frequently isolated organism. Empirical antibiotic treatment must cover gram positive, gram negative and anaerobic pathogens. Early surgical intervention can reduce the complications. Bangladesh Crit Care J March 2025; 13 (1): 23-29

Preventing Postoperative Sepsis: Multidisciplinary Implementation of Diverse Countermeasures in our first NSQIP Project.

Using data from the National Surgical Quality Improvement Project (NSQIP), we aimed to reduce the incidence of postoperative sepsis, focusing on patients receiving red blood cell (RBC) transfusions and with open wounds. We postulated that diverse countermeasures would reduce postoperative sepsis. Workgroups were created around 4 problems with root causes identified using standardized processes: excessive RBC transfusions, owing to transfusing for Hb > 7 or > 1 unit at a time; infrequent use of cell salvage due to knowledge deficit or cell salvage machine not available; incorrect antibiotics owing to penicillin-allergic patients not getting cephalosporins or patients getting empiric antibiotics to which organisms are resistant; suboptimal postoperative wound management owing to poor communication regarding care plans and care transitions. Thirteen countermeasures were implemented. With improvement in 7 of 8 process metrics, the rate of postoperative sepsis declined from 1.56% (tenth decile performance in the NSQIP database) to 0.59% (first decile), P = 0.0065.

Investigating Bacterial Bloodstream Infections in Dogs and Cats: A 4-Year Surveillance in an Italian Veterinary University Hospital

In small animal practice, blood cultures (BCs) are essential for diagnosing bacterial bloodstream infections (BSIs) and guiding targeted antimicrobial therapy, particularly in relation to the rise of multidrug-resistant (MDR) pathogens. This study analyzed 96 positive BCs from dogs and cats at the Veterinary University Hospital (VUH) of Bologna (2020–2024), assessing bacterial prevalence, antimicrobial resistance, and associated risk factors. Escherichia coli was the most common isolate (29/96), followed by Streptococcus canis (11/96). MDR percentage was 29.2% (28/96), with Gram-negatives associated with higher rates (p = 0.040). Nearly half of the cases (46.9%, 45/96) were suspected healthcare-associated infections (HAIs) significantly associated with the number of invasive devices used (p = 0.008) and with the absence of co-positive samples (p = 0.012). Empirical antibiotic therapy was administered in 94.8% (91/96) of cases, with ampicillin–sulbactam and marbofloxacin as the most used drugs. In vitro empirical therapy appropriateness was 76.9% (70/91). MDR was associated with inappropriate empirical therapy (p &lt; 0.001). Mortality within 30 days was 36.5% (35/96), significantly linked to antibiotic escalation (p = 0.006). The findings highlight the need for systematic BC surveillance in veterinary settings to optimize treatment strategies (especially in countries with restrictions on antibiotic use in animals) to mitigate MDR spread and to protect public health.