Empirical Therapy Research Articles

Empiric embolization by vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report

To report the preliminary result of empiric embolization for angiographycally-negative lower gastrointestinal bleeding (LGIB) by using the pharmaco-induced vasospasm technique with or without the adjunctive use of intra-arterial multi-detector computed tomography (MDCT). 23 LGIB patients with positive MDCT findings but negative angiographic results underwent empiric pharmaco-induced vasospasm therapy. The presumed bleeding artery was semi-selectively catheterized, and a segment of bowel was temporarily spasmed with bolus injection of epinephrine and immediately followed by 4-h’ vasopressin infusion. The rebleeding, primary and overall clinical success rates were reported. MDCT showed 19 bleeders in the SMA territory and 4 bleeders in the IMA territory. Early rebleeding was found in 6 patients (26.1%): 2 local rebleeding, 3 from new-foci bleeding and 1 uncertain. Of the 10 small bowel bleeding patients, only 1 out of the 7 who underwent intra-arterial MDCT showed rebleeding, whereas 2 out of the 3 without intra-arterial MDCT rebled. No patients exhibited procedure-related major complications, including bowel ischemia and cardiopulmonary distress. The overall clinical success rate was 91.3% (21/23) with a 30-day mortality rate of 26.1% (2 of the 6 patients had early rebleeding). Empiric pharmaco-induced vasospasm therapy, when localized with/without adjunctive intra-arterial MDCT, seems to be a safe and effective method to treat angiographically-negative LGIB patients.

Using anginal symptoms to predict underlying etiology in patients with angina and no obstructive coronary disease (ANOCA)

Abstract Background Patients with angina with no obstructive coronary disease (ANOCA) can present with exertional anginal symptoms or angina at rest. Invasive coronary functional angiography (CFA) is used to diagnose endothelial-dependent and independent coronary microvascular dysfunction (CMD), microvascular spasm, and epicardial spasm. Historically, the type of anginal symptoms has been thought to be suboptimal in predicting the etiology of ANOCA. However, the sensitivity, specificity, predictive value, and correlation of angina type related to CFA abnormalities are unknown. We hypothesize that patients with predominantly exertional angina are more likely to have endothelial-independent and dependent CMD, and patients with angina at rest are more likely to have microvascular or epicardial spasm. Objective To explore sensitivity, specificity, predictive value, and correlation of angina type with underlying etiology of ANOCA as diagnosed by CFA. Methods A prospective registry-based cohort study of consecutive CFA performed in 197 ANOCA patients between 2020 and 2023 using the Doppler-tipped guidewire method. ANOCA was defined as <50% stenosis in any major epicardial artery at time of CFA. Patients were classified based on CFA diagnosis: (1) endothelial-independent CMD (coronary flow reserve [CFR] < 2.5 in response to adenosine), (2) endothelial-dependent CMD (coronary blood flow [CBF] < 50% or no change in vessel diameter in response to 54mcg intracoronary acetylcholine), (3) microvascular (<90% constriction) and epicardial spasm (>90% constriction) to 108 mcg intracoronary acetylcholine. Patients were categorized based on anginal symptoms (exertional angina or at rest angina) documented at cardiologist visit prior to CFA. McNemar’s test and Spearman correlations were performed for both types of angina and the 3 ANOCA underlying diagnoses. Results Among 197 ANOCA patients, the average age was 56.5 ± 11.9 years and 91% were female. Angina at rest had a high specificity (91.3%) but a low sensitivity (25.2%) for the diagnosis of spasm with a PPV of 90.5 (Table 1). There was a significant correlation between angina at rest and spasm (p=0.012). Angina at rest had a similarly intermediate sensitivity and specificity for endothelial independent and dependent CMD. Exertional angina had similar sensitivity, specificity, and a high PPV for endothelial independent and dependent CMD. There was a significant correlation between exertional angina and endothelial dependent CMD (p=0.025). McNemar’s test was statistically significant (p<0.001) for all analyses. Conclusion ANOCA patients with symptoms of angina at rest had a significant correlation with coronary spasms and exertional angina correlates with endothelial-dependent CMD. We demonstrate that angina at rest can be 90% specific for the diagnosis of spasm. Our findings warrant further investigation but suggest that empiric therapy based on angina type is a reasonable first step before invasive testing.

Detection of Chlamydia trachomatis and Neisseria gonorrhoeae (and Its Resistance to Ciprofloxacin): Validation of a Molecular Biology Tool for Rapid Diagnosis and Treatment

Background and Objectives: Neisseria gonorrhoeae and Chlamydia trachomatis can cause similar clinical syndromes and may coexist in infections. In emergency medicine, empirical treatment targeting both pathogens is often employed, potentially contributing to antibiotic resistance. Gonococcal resistance has emerged against first-line antimicrobials, necessitating prior testing for fluoroquinolone susceptibility. Certest Biotec developed two molecular diagnostic products for simultaneous detection: VIASURE C. trachomatis & N. gonorrhoeae Real-Time PCR Detection Kit and VIASURE Neisseria gonorrhoeae Ciprofloxacin-Resistant Real-Time PCR Detection Kit. To evaluate these products, clinical performance assessments were conducted at the Clinical Microbiology Laboratory of Miguel Servet University Hospital in Zaragoza, Spain. Results and Conclusions: Both VIASURE assays under study demonstrated high clinical sensitivity and specificity compared to reference molecular assays and Sanger sequencing. These kits offer an accurate diagnosis, facilitating appropriate treatment choices while addressing concerns about emerging antibiotic resistance. Methods: A total of 540 clinical samples from 540 patients already characterized as positive or negative for CT and NG by a molecular assay and by antibiotic susceptibility testing for ciprofloxacin using a concentration gradient diffusion method were used for the clinical evaluation. In cases where sensitivity results were unavailable, conventional PCR and Sanger sequencing were employed.

Antimicrobial resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa isolates from bloodstream infections in Australian children, 2013-2021.

Gram-negative bloodstream infections are associated with significant morbidity and mortality in children. Increasing antimicrobial resistance (AMR) is reported globally, yet efforts to track pediatric AMR at a national level over time are lacking. The Australian Group on Antimicrobial Resistance (AGAR) surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for MIC interpretation and the AMR package in R for data analysis. Over a nine-year period, there were 3,145 bloodstream infections with 3,266 gram-negative isolates reported in hospitalized children aged <18 years; 21.0% were from neonates. The median length of stay was 9 days, and 30-day all-cause mortality was 5.2%. A greater odds of death was observed in those with a multi-drug resistant organism (aOR: 2.1, 95%CI: 1.3, 3.3, p: 0.001). Escherichia coli (44.5%) and Klebsiella pneumoniae complex (12.6%) were the two most frequently reported organisms. Overall resistance in Enterobacterales to gentamicin/tobramycin was 11.6%, to ceftazidime/ceftriaxone was 12.9%, and 13.2% to ciprofloxacin. Resistance increased over time.Of 201 Pseudomonas aeruginosa isolates reported, 19.7% were resistant to piperacillin-tazobactam, 13.1% resistant to cefepime/ceftazidime and 9.8% to ciprofloxacin. Of 108 Acinetobacter spp. isolates, one was resistant to meropenem, and two were resistant to ciprofloxacin. Resistance did not increase over time. AMR in gram-negative organisms causing bloodstream infections in Australian children is increasing which should be considered when updating guidelines and empiric treatment regimens. Ongoing pediatric-specific national surveillance with pediatric reporting must remain a priority to strengthen antimicrobial stewardship and infection control programs.

Isolation and Pattern of Antimicrobial Susceptibility Testing of Acinetobacter baumannii Clinical Isolates at Taksin Hospital: A Retrospective Study from 2019 to 2021

Objective: To determine the number of isolates and drug susceptibility testing of Acinetobacter baumannii at Taksin Hospital. Materials and Methods: A 3-year retrospective descriptive study was conducted between January 2019 and December 2021. Drug susceptibility testing of isolates to 13 drugs, which included amikacin, gentamycin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, three carbapenem drugs that were imipenem, meropenem, and doripenem, ciprofloxacin, trimethoprim-sulfamethoxazole, colistin, and tigecycline, were evaluated by standard disk diffusion method and automated microdilution method. Results: One thousand six hundred sixty-five non-duplicate A. baumannii isolates from different patients were detected and included 535 in 2019, 500 in 2020, and 630 in 2021. The patients’ ages ranged from three days to 100 years. The median age of patients was 70 years with an interquartile range of 56 to 80 years. A. baumannii was mostly found in patients aged older than 50 years old at 83.6%. They were isolated from sputum in 72.3%, urine in 9%, pus in 6.3%, tissue in 6.3%, and blood in 5.2%. Overall, A. baumannii demonstrated 91.5% and 79.8% susceptibility to colistin and tigecycline, respectively, but less susceptible to other drugs tested, with a range of 0.4% to 32.6%. Drug susceptibility to carbapenem such as imipenem, meropenem, and doripenem were 19.5%, 20%, and 20.9%, respectively. The carbapenem-resistant A. baumannii (CRAB) was found at 77.6%, 80%, and 79.1% in 2019, 2020, and 2021, respectively. For total isolates tested, the mean of CRAB was 78.9±1.2%. Conclusion: The present study results suggested the importance of monitoring A. baumannii at a hospital in Bangkok. Colistin and tigecycline had the high percentages of drug susceptibility rates in vitro. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment.

Impact of Continuous Infusion Meropenem PK/PD Target Attainment on C-Reactive Protein Dynamics in Critically Ill Patients With Documented Gram-Negative Hospital-Acquired or Ventilator-Associated Pneumonia.

Population pharmacokinetic/pharmacodynamic (PK/PD) modelling of antibiotics including C-reactive protein (C-RP) dynamics could be helpful in predicting the efficacy of antimicrobials. We developed a PK/PD model for assessing the impact of continuous infusion (CI) meropenem PK/PD target attainment on C-RP dynamics in critically ill patients with documented Gram-negative hospital- (HAP) or ventilator-acquired pneumonia (VAP). Patients were grouped according to the type of antibiotic treatment received [meropenem monotherapy; meropenem plus empirical anti-MRSA (methicillin-resistant Staphylococcus aureus) therapy; meropenem in combination with another anti-Gram-negative active agent; meropenem plus a targeted anti-MRSA therapy]. A one-compartment population PK model of CI meropenem was developed by including all patients. A full C-RP production inhibition model was developed for fitting the PD data by including only patients receiving meropenem monotherapy or meropenem plus empirical anti-MRSA therapy. Monte Carlo simulations explored the relationship between the type of PK/PD target attainment of CI meropenem, defined as optimal (steady-state plasma concentration [Css] to minimum inhibitory concentration [MIC] ratio = 4-8), quasi-optimal (Css/MIC = 1-4) and sub-optimal (Css/MIC < 1) and the magnitude of C-RP production inhibition over time. A total of 64 patients providing 211 meropenem concentrations were included in the PK analysis, whereas 47 patients providing 328 C-RP data were included in the PD model. Simulations showed that optimal PK/PD target attainment was associated with the highest and most rapid C-RP production inhibition (44% and 56% at days 2 and 4, respectively). Conversely, sub-optimal PK/PD target attainment was shown to be almost ineffective (< 5% at day 4 and < 10% at day 10). Our PK/PD model predicted that attaining optimal PK/PD target with CI meropenem may grant prompt and intense C-RP decrease among critically ill patients receiving targeted monotherapy for Gram-negative HAP/VAP, thus anticipating efficacy.

A Retrospective Closed Cohort Study on Distribution of Multidrug-Resistant Bacteria in Ventilator-Associated Pneumonia and its Impact on Patient Outcome.

Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection affecting critically ill patients undergoing mechanical ventilation. This study investigated the prevalence of multidrug-resistant (MDR) organisms in VAP, the VAP rate, and the outcomes associated with MDR-VAP. This retrospective single-center study, conducted in 2022, included adult ICU cases from April 2021 to March 2022, receiving mechanical ventilation for more than 48 h. Patient data were analyzed for demographics, comorbidities, empirical antibiotic use, and outcomes. MDR organisms were identified in respiratory cultures. Among 447 patients, 133 developed VAP, with 96 cases being MDR-VAP. The mean age of the overall VAP population was 52 years, 70% of which were males. The incidence of VAP was 30.0% (95% CI: 25.7%-34.5%), while that of MDR-VAP was 21.6% (95% CI: 17.9%-25.8%). The most prevalent MDR organisms were Acinetobacter species (50%) and Klebsiella pneumoniae (46.9%). Empirical antibiotics were administered in 96% of VAP cases. The overall VAP rate was 38.03/1000 ventilator days. No single antimicrobial agent seemed to offer an empirical cover, as the susceptibility rate for most tested antimicrobials was less than 85%. Patients with MDR-VAP had a low survival rate (64.6%) and were less likely to be extubated at 13.5% compared to non-MDR-VAP (survival rate of 62.2%). COVID-19 patients had a high incidence of MDR VAP, especially with Acinetobacter. Overall, VAP mortality was 57.1%. The median ventilator days were 16 for VAP and only four for non-VAP. Gram-negative organisms, particularly Klebsiella and Acinetobacter, were the main MDR VAP culprits. MDR-VAP exhibited higher morbidity and mortality. A study focused on developing resistance by microorganisms is warranted for further understanding.

Impact of empirical treatment recommendations from 2017 European guidelines for nosocomial pneumonia

Impact of empirical treatment recommendations from 2017 European guidelines for nosocomial pneumonia

Inappropriate ceftriaxone utilization and predictor factors in Ethiopia: a systematic review and meta-analysis

Ceftriaxone stands as a cornerstone in global antibiotic therapy owing to its potent antibacterial activity, broad spectrum coverage, and low toxicity. Nevertheless, its efficacy is impeded by widespread inappropriate prescribing and utilization practices, significantly contributing to bacterial resistance. The aim of this study is to determine the overall national pooled prevalence of inappropriate ceftriaxone utilization and its predictor factors in Ethiopia. A systematic search was conducted across multiple databases including, PubMed, Science Direct, Hinari, Global Index Medicus, Scopus, Embase, and a search engine, Google Scholar, to identify relevant literatures that meet the research question, from March 20 to 30, 2024. This meta-analysis, which was conducted in Ethiopia by incorporating 17 full-text articles, unveiled a national pooled inappropriate ceftriaxone utilization of 55.24% (95% CI, 42.17%, 68.30%) with a substantial heterogeneity index (I2 = 99.24%, p value < 0.001). The review has also identified predictive factors for the inappropriate use of ceftriaxone: empiric therapy (AOR 21.43, 95% CI; 9.26–49.59); multiple medication co-prescription (AOR: 4.12, 95% CI; 1.62–8.05). Emergency ward (AOR: 4.22, 95% CI; 1.8-12.24), surgery ward (AOR: 2.6, 95% CI; 1.44–7.82) compared to medical ward, prophylactic use (AOR: 500, 95% CI; 41.7–1000), longer hospital stay-8-14 Days; (AOR: 0.167, 95% CI; 0.09–0.29), > 14 days; (AOR: 0.18, 95% CI; 0.1–0.32). The study reveals a high national pooled prevalence of inappropriate ceftriaxone utilization, standing at 55.24%, highlighting a significant hazard in the use of this antibiotic. This could be attributed to instances of overuse, misuse or prescription practices that deviates from established guidelines. This eminent challenge can lead to the development of antibiotic resistance, increased healthcare costs, adverse drug reactions, and treatment failures, necessitating multifaceted approach such as improved antibiotic stewardship, better adherence to guidelines, and enhanced clinician education on appropriate antibiotic use.

Case report: A rare secondary systemic candidiasis as a bite wound complication in a dog

An 11-year-old, 4.8 kg, intact male mixed-breed dog was evaluated for a bite wound that had occurred a day prior to consultation. On examination, the patient exhibited signs of early to-late decompensatory shock, hemothorax, pneumothorax, and rib fractures. Initial shock management and resuscitation were performed. After several days of stabilization, exploratory thoracotomy, thoracic wall reconstruction, culture sampling, and antibiotic susceptibility tests were conducted. Empirical antimicrobial treatments were performed while pending culture results. Despite aggressive antimicrobial therapy, the patient had focal seizures and wound dehiscence, presumably due to the worsening of infection and inflammation. Necrotic tissues adjacent to the dehiscence were debrided, and the wound was opened. A previous analysis of wound and blood cultures identified Candida glabrata, and itraconazole was initiated in accordance with the culture results. Successful treatment was achieved, and the wound was closed. The patient remained healthy after 2 months of monitoring. To the best of our knowledge, this was the first case report of systemic candidiasis in a dog secondary to a bite wound diagnosed via blood culture. Additionally, this case highlights successful treatment with itraconazole.

Drug resistance profiling, antimicrobial susceptibility and demographic characteristics of children with acute bacterial meningitis in a Southeastern tertiary health facility

Background: Over the years, varying patterns of bacterial susceptibility and multidrug resistance (MDR) rates have been reported in different settings. Detailed evaluation of the drug profile of the bacterial pathogens implicated in children with invasive bacterial infection helps to reduce the heightened risk of adverse events that could follow poorly managed or complicated cases in resource limited environment like ours. This study therefore, aimed to highlight the antibiotic susceptibility and MDR rate, and establish the relationship if any, between demographic characteristics and positive CSF- bacterial isolates of post neonatal children with suspected acute bacterial meningitis (ABM). The findings would guide practitioners on the empirical antimicrobials to consider in the event of clinical suspicion of ABM pending the availability of CSF isolates' antibiogram. Methods: A prospective review of 100 children with clinical suspicion of ABM from January 2016- December 2020. Descriptive statistics, chi square and regression analysis were used to establish MDR rates, Isolates' susceptibility pattern and the relationship between demographic variables and positive isolates respectively. P&lt;0.05 was accepted as significant. Results: Fluroquinolones, cephalosporins, imipenem and aminoglycosides were susceptible anti-microgram in children with ABM. Sixty-four (85.5%) of the isolates showed MDR pattern, and young children (infants and toddlers) were significantly associated with positive CSF bacterial isolates. Conclusions: ABM should be treated with combination of CNS penetrating empirical antibiotics due to rising rate of MDR pathogens. Young children with febrile illnesses should be thoroughly evaluated for possibility of CNS infection.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at &amp;lt;33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of &amp;gt;104/mL or &amp;gt;107/L and &amp;gt;105/mL or &amp;gt;108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU &amp;gt;105/mL or &amp;gt;108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

A rare complication of blood culture-negative infective endocarditis (BCNIE) on tricuspid valve: case report

Abstract Background Endocarditis is an infectious disease, with an incidence of about 15 cases per 100.000 people, affecting the tricuspid valve in 10% of cases. Infective endocarditis with negative blood cultures (BCNIE) accounts for more than 20% of cases of infective endocarditis. Perivalvular extension of the infection represents the most detrimental complications of BCNIE. Case Summary A 25-year-old South Asian male was admitted due to fever for 15 days and new onset chest pain. The blood tests showed an increase in inflammatory indices. A chest X-ray showed enlargement of the cardiac shadow. On cardiac examination, a holosystolic murmur at the left sternal edge border was heard. The transthoracic echocardiogram showed a filamentous formation on the tricuspid valve and communication between the aorta and right atrium with left-right shunt. A transesophageal echocardiogram (TEE) was performed to confirm the diagnosis of IE. Three sets of blood cultures were performed, with negative results, empirical therapy was managed and a decision for TEE-guided cardiac surgery was made. Discussion Fistula is a rare complication of IE representing the most insidious consequence of uncontrolled infection like BCNIE, a condition that has restricted the therapeutic possibilities to empirical therapy only and to early surgery. The TEE was instrumental in diagnosing right-sided infective endocarditis and allowing us to focus on the perivalvular spread of the infection in our case.

Impact of rapid blood culture identification PCR panel on optimal antibiotic use in methicillin-susceptible Staphylococcus aureus bacteremia.

In this retrospective study of 200 patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, the implementation of the BioFire® blood culture identification polymerase chain reaction (PCR) panel was associated with a decreased time to optimal MSSA antibiotic therapy and shorter durations of empiric anti-MRSA antibiotic therapy and bacteremia. The findings demonstrate the significant role of rapid PCR testing and routine stewardship review in optimizing antimicrobial therapy and management of MSSA bacteremia.

Streptococcus dysgalactiae subsp.-equisimilis as an emerging secondary pathogen in leprosy foot ulcers

Background and Objectives: Leprosy foot ulcers (LFU) tend to become chronic due to secondary bacterial infections, leading to subsequent disfigurement and disability. Treatment modality for infected plantar ulcers thus so far is majorly based on conventional approach of empirical antibacterial therapy. However, this approach tends to overlook unconventional pathogens which are likely to be present in the LFU. Materials and Methods: Twenty-six leprosy patients (17 males and 9 females) who had completed multidrug therapy (MDT) and those are suffering from foot ulcer were included. Using sterile cotton swabs, two wound swabs were collected, of these; one for bacterial culture and another for NGS (Next Generation Sequencing). Results: Out of 26 samples tested on conventional bacterial culture, Streptococcus spp. (50%) was predominant organism. On NGS, 09/26 (34.61%) showed Streptococcus-dysgalactiae-subsp.-equisimilis-GGS 12 as the most abundant single organism, along with some unknown and unclassified organisms; 03/26 (11.5%) were Arcanobacterium-haemolyticum-DSM-20595 alone and 02/26 (7.69%) were Streptococcus-pyogenes alone.Acombination of Arcanobacterium-haemolyticum-DSM-20595 and Streptococcus-dysgalactiae-subsp.-equisimilis-GGS 124 was found in nine (34.61%) specimens. Conclusion: Polymicrobial infection with conventional and unconventional pathogenic bacteria is another notable finding suggesting appropriate interventions. The study findings also reiterate the need for understanding the polymicrobial infec- tions and their role in the clinical progression of the LFU.

Budget impact analysis on the use of Sysmex PA-100 AST system as a point of care for uncomplicated urinary tract infections detection and treatment in Spanish females

Objective Efficient diagnostic methods, such as the Sysmex PA-100, provide rapid antimicrobial susceptibility test results directly from urine samples with high sensitivity and specificity, and improve treatment recommendations. Our study analyzes the economic impact of integrating the Sysmex PA-100 to assess its potential benefits and cost implications for uncomplicated urinary tract infection (uUTI) management in Spain. Methodology A budget impact model was developed using a decision tree framework to compare current UTI management practices with a new scenario incorporating the Sysmex PA-100. The clinical inputs were extracted from published literature. The model, representing adult females with uUTIs, assessed direct medical and indirect costs over three years, including diagnostic procedures, treatment costs, staff time costs, and productivity loss. The cost data was captured from two Spanish hospitals. Two scenario analyses were conducted in the model: scenario A included costs for antimicrobial resistance (AMR) emergence in patients receiving unnecessary empirical antibiotics, whereas scenario B assumed no AMR costs. Results In scenario A, 100% implementation of PA-100 within various Spanish healthcare settings over one year resulted in total cost savings of EUR 323,657,712 (EUR 119.10 per patient per year). The total overall cost savings attributable to the implementation of PA-100 over three years were EUR 970,973,137. In scenario B, the total annual savings were EUR 4,254,795 (EUR 1.57 per patient per year), and the 3-year savings were EUR 12,764,385. Conclusion The adoption of this point-of-care system results in overall cost savings, driven by reductions in direct and indirect costs related to UTI management. The model highlights potential savings over three years owing to appropriate rapid management (reduction in time to diagnosis and treatment, which leads to fewer complications and secondary infections) and reduced staff time and productivity loss costs. These findings support the potential benefits of adopting the Sysmex PA-100 to enhance UTI management and allocate healthcare resource utilization in Spain.

Artificial intelligence for predicting treatment responses in autoimmune rheumatic diseases: advancements, challenges, and future perspectives

Autoimmune rheumatic diseases (ARD) present a significant global health challenge characterized by a rising prevalence. These highly heterogeneous diseases involve complex pathophysiological mechanisms, leading to variable treatment efficacies across individuals. This variability underscores the need for personalized and precise treatment strategies. Traditionally, clinical practices have depended on empirical treatment selection, which often results in delays in effective disease management and can cause irreversible damage to multiple organs. Such delays significantly affect patient quality of life and prognosis. Artificial intelligence (AI) has recently emerged as a transformative tool in rheumatology, offering new insights and methodologies. Current research explores AI’s capabilities in diagnosing diseases, stratifying risks, assessing prognoses, and predicting treatment responses in ARD. These developments in AI offer the potential for more precise and targeted treatment strategies, fostering optimism for enhanced patient outcomes. This paper critically reviews the latest AI advancements for predicting treatment responses in ARD, highlights the current state of the art, identifies ongoing challenges, and proposes directions for future research. By capitalizing on AI’s capabilities, researchers and clinicians are poised to develop more personalized and effective interventions, improving care and outcomes for patients with ARD.

The Role of Quantitative PCR in Evaluating the Clinical Significance of Human Bocavirus Detection in Children.

Human bocavirus (HBoV) has emerged as a significant pathogen primarily associated with respiratory infections in children. This study aimed to evaluate the clinical relevance of HBoV infection by quantifying viral loads in nasopharyngeal swabs from hospitalized children with acute respiratory infections (ARIs) and investigating correlations with clinical outcomes. A total of 957 children were tested, with HBoV detected in 73 cases (7.6%), either as a sole infection or co-infection with other respiratory viruses. Quantitative polymerase chain reaction (qPCR) was employed to measure viral load, and a threshold of 104 copies/mL was used to differentiate high and low viral concentrations. Results have shown that children with lower respiratory tract infections (LRTIs) had significantly higher viral loads, most notably in cases where HBoV was the sole pathogen. Additionally, children with pre-existing health conditions were more likely to have elevated HBoV concentrations compared to those who were previously healthy. Children with higher viral loads were more likely to require oxygen supplementation and receive empirical antibiotic therapy, indicating a more severe clinical course. This study underscores the importance of considering HBoV viral load in clinical diagnostics, as higher concentrations were associated with more severe presentations, including the need for oxygen support. Future research should focus on refining diagnostic thresholds and exploring HBoV's role in co-infections to enhance patient care strategies.

Radio-Biological Confrontation in the Diagnosis of Invasive Aspergillosis: About Two Cases and Review of Literature

Invasive pulmonary aspergillosis due to Aspergillus fumigatus is an often serious mycosis, usually occurring in severely immunocompromised patients. It is accompanied by a high mortality rate due to its often difficult and late diagnosis. Diagnosis is based on early chest computed tomography and mycological examination of respiratory samples. Both patients had presented with acute respiratory distress, developing in a context of fever and deterioration of the general condition despite the initiation of broad-spectrum empirical treatment. In each of them, a chest CT scan was performed, objectifying atypical cavitary images not suggesting pulmonary aspergillosis. Cytobacteriological examination of sputum and search for Mycobacterium tuberculosis were negative. Serology for aspergillus antigens and a sample of bronchoalveolar lavage fluid for a mycological study were requested. Direct examination of bronchoalveolar lavage fluid was negative, but culture allowed the identification of Aspergillus fumigatus. Galactomannan testing was positive. Given these results, treatment with injectable voriconazole was initiated in our two cases. The evolution was marked by a clinical improvement of one patient and the death of the other patient. Invasive pulmonary aspergillosis is a major concern due to the frequency of its complications. Its diagnosis must be early to ensure adequate management for a better prognosis.

Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers-A Feasibility Study.

Objective: Patients with peripheral artery occlusive disease (PAD) are at risk of developing foot ulcers, which can subsequently lead to foot infections and an increased risk of amputation. In cases of severe ischemic foot infections (IFIs), the empirical use of antibiotics can be limb-saving. However, there is currently no evidence-based guidance on the choice of empirical antibiotic therapy for IFI. Methods and Design: This retrospective single-center cohort study included 216 hospitalized patients with severe IFI undergoing endovascular revascularization. Weighted-Incidence Syndromic Combination Antibiograms (WISCAs) were calculated to guide empirical antibiotic choice. Results: The two most common causative pathogens for IFI were S. aureus and P. aeruginosa, with frequencies of 19.8% and 6.1%, respectively. The calculation of WISCAs revealed a low empirical coverage of amoxicillin (AMX) or clindamycin (CLN) with 21.6% and 27.7%, respectively. The empirical coverage of amoxicillin/clavulanic-acid (AMC), trimethoprim/sulfmethoxazole (SXT), and ciprofloxacin (CIP) was 50.6%, 53.1%, and 55.4%, respectively. Piperacillin/tazobactam (PT) exhibited the highest empirical coverage, with 82.5% as calculated by WISCAs. The calculated WISCAs did not significantly alter when stratified by the clinical characteristics of the patients. Conclusions: The empirical antibiotic coverage of CLN and AMX was low. SXT represents a promising empirical alternative in the case of IFI, irrespective of comorbidities and the WIfI score. WISCAs can assist in the decision-making process regarding empirical antibiotic therapy choices in cases of IFI.