Enteric Gram-negative Bacilli Research Articles

A Systematic Review of the Pulmonary Microbiome in Patients with Acute Exacerbation COPD Requiring ICU Admission.

Background: Chronic obstructive pulmonary disease (COPD) is a major health concern. Acute exacerbations (AECOPD) may require intensive care unit (ICU) admission and mechanical ventilation. Acute infections and chronic colonization of the respiratory system are known to precipitate AECOPD. Detailed knowledge of the respiratory microbiome could lead to effective treatment and prevention of exacerbations. Objective: The aim of this review is to summarize the available evidence on the respiratory microbiome of patients with a severe AECOPD requiring mechanical ventilation and intensive care admission. Methods: A systematic literature search was conducted to identify the published papers until January 2023. The collected data were then subjected to qualitative analysis. After the first analysis, a secondary focused review of the most recent publications studying the relationship between microbiome and mortality in AECOPD was performed. Results: Out of 120 screened articles six articles were included in this review. Potentially pathogenic microorganisms (PPMs) were identified in 30% to 72% of the patients with community-acquired bacteria, gram-negative enteric bacilli, Stenotrophomonas and Pseudomonas being the most frequently isolated. During hospitalization, 21% of patients experienced colonization by PPMs. Adequate antimicrobial therapy resulted in the eradication of 77% of the identified PPMs. However, 24% of the bacteria displayed multi-drug resistance leading to prolonged or failure of eradication. Conclusion: PPMs are prevalent in a significant proportion of patients experiencing an AECOPD. The most identified PPMs include community-acquired pathogens and gram-negative enteric bacilli. Notably, no differences in mortality or duration of ventilation were observed between patients with and without isolated PPMs. However, the included studies did not investigate the virome of the patients, which may influence the microbiome and the outcome of infection. Therefore, further research is essential to comprehensively investigate the complete microbial and viral composition of the lower respiratory system in COPD patients admitted to the ICU.

Microbial Load of Hand Sanitizer Dispensers—A University Hospital Study

Hospital-acquired infections are a significant concern in healthcare settings, leading to patient safety risks, increased morbidity and mortality, and financial burdens. Hand hygiene is crucial in preventing the spread of bacteria in hospitals and communities. Manual hand sanitizer dispensers can harbor presumptive pathogenic bacteria and act as fomites for bacterial transmission. This study aimed to assess the microbial contamination of manual hand sanitizer dispensers in a hospital setting and to study their antibiotic resistance profiles. Samples were collected using sterile cotton swabs and then inoculated into brain heart infusion broth. Subsequent subcultures were performed on both blood and MacConkey agar. The isolates were then identified using the Bruker MALDI Biotyper (Bruker Daltonik, Bremen, Germany) to the species level. Sampling was conducted in various wards and in the hospital and the University areas on dispenser levers and nozzle areas. The results showed that all samples yielded one or more bacterial species. Bacterial isolates identified belonged to species commonly found on the skin microflora and some Gram-negative enteric bacilli. Higher colonization was observed on the dispenser lever. Among Gram+ microorganisms, most bacterial species were shown to be sensitive to β-lactams, with the exception of Staphylococcus spp., resistant to AMP (Ampicillin) and Penicillin. However, no Methicillin resistant isolates were detected. Gram− microorganisms such as Pseudomonas luteola were shown to be sensitive to all tested antibiotics, while Pantoea agglomerans was shown to be resistant to AMC (amoxicillin–clavulanic acid). Rifampicin tested only against Bacilli showed resistance. Based on the findings, it is recommended to implement systematic cleaning and proper maintenance of manual dispenser areas or to use automated dispensers to reduce hand contact and minimize microbial contamination. Monitoring the presence of microorganisms in hand sanitizing gels and dispensers is an essential infection control strategy.

Fecal Carriage of Multi-drug Resistant Escherichia coli in Healthy Children: a Community-based Study

Introduction: Escherichia coli is enteric Gram-negative bacilli, earlier recognized as non-invasive commensal. Invasive strains of E. coli have been identified and are associated with a variety of human infections. Increasing drug resistance among E. coli has been reported. Multidrug resistance is the ability of an organism to resist at least one agent in three or more antimicrobial categories. The aim of this study was to detect fecal carriage of MDR E. coli isolates among healthy school children.
 Methods: A total of 139 stool samples were collected from Rastriya Secondary School, Purano Tudikhel, Pokhara-1. Isolation, identification, and Antibiotic susceptibility test pattern of E. coli isolates were done by standard microbiological techniques. Further Extended Spectrum Beta-Lactamase test was performed by Combined Disc Test and data analysis was done by using Microsoft Excel.
 Results: A total of 106 E. coli were isolated from the stool samples. MDR E. coli were found to be 8 (7.55%) and 7 E. coli isolates were resistant to Ceftazidime which was further tested for ESBL and 5 isolates were found to be ESBL producers. The resistance of E. coli to Ampicillin, Nitrofurantoin, Ceftriaxone, Ceftazidime, Ciprofloxacin, and Gentamicin was 27.36%, 43%, 10.38%, 6.60%, 6.60%, and 2.83% respectively. Only one isolate was resistant to all antibiotics used except Imipenem.
 Conclusion: E. coli is the main Gram-negative bacteria isolated from the stool sample and identified as the main carrier of antimicrobial resistance in species comparison of Enterobacteriaceae isolated from fecal samples. Therefore, quick surveillance is needed in order to effectively handle such MDR strains. The E. coli population susceptible to all antibiotics used was a much more diverse group than the resistant and ESBL-producing E. coli.

Evaluation of Plasmid Mediated Colistin Resistance in Colistin Resistant Gram-negative Bacilli

Background: Infections caused by carbapenem-resistant gram-negative bacteria are treated with colonistin as a last resort. However, the increased resistance in recent years is significant for treating multiple drug-resistant infections. Objectives: This study aimed to determine the resistance genes mobile colistin resistance (mcr)-1 and mcr-2 in the colistin-resistant isolates, understand the resistance mechanism, and help with treatment. Methods: Isolates were identified in the Vitek MS automated system. The antibiotic susceptibility was tested with the Vitek 2 Compact automated system. Enteric gram-negative bacilli isolates were stored at -20°C until the molecular study. DNA extraction of colistin-resistant isolates was performed by boiling method. Then, polymerase chain reaction (PCR) optimization was performed using the specific primers, and mcr-1 and mcr-2 genes were investigated by the multiplex PCR method. Results: About 170 enteric gram-negative bacilli isolate were mainly sent from internal medicine (44.7%) and neurology (13.5%) services. According to the species identification, 37.6% of the isolates were Klebsiella pneumonia, and 31.7% were Serratia marcescens. Based on PCR results, mcr-1 and mcr-2 genes were not detected in the isolates. Conclusions: Increased colistin resistance and the worrying discovery of mcr genes require urgent precautions, even though the study did not detect mcr-1 and mcr-2. New studies investigating mcr genes in new isolates are needed to understand the mechanism of resistance and identify resistant isolates.

Catheter-related bloodstream infections in children receiving parenteral nutrition: Experience of a single center with 178 patients

ObjectiveCatheter-related bloodstream infections are common in children who require parenteral nutrition and can have serious consequences, including mortality. This study aims to evaluate the frequency and nature of catheter-related bloodstream infections in children receiving parenteral nutrition. Materials and MethodsPatients between one month and 18 years of age who received parenteral nutrition within two years were evaluated for indications and complications by focusing on catheter-related bloodstream infections. ResultsTwenty-nine different catheter-related bloodstream infections were detected in 24 of 147 episodes in which parenteral nutrition was delivered via a catheter. The frequency of catheter-related bloodstream infections was 7.7 infections per 1000 catheter days. Coagulase-negative staphylococci, Gram-negative enteric bacilli, enterococci, and Candida species were the most common causative microorganisms. Five patients died. Infection frequency increased with increasing PN duration and receiving PN via a non-tunneled internal jugular catheter. Gender, age, and the number of catheter lumens were not associated with infection frequency. ConclusionCatheter-related bloodstream infection is a common complication in children receiving parenteral nutrition. Appropriate management is essential. Because parenteral nutrition duration is a risk for catheter-related bloodstream infections, the transition to enteral feeding should be considered as soon as possible.

Microbial Load, Prevalence and Antibiotic Resistance of Microflora Isolated from the Ghanaian Paper Currency Note: A Potential Health Threat

Aims: This study examined the microbial flora contamination of the Ghanaian paper currency notes and its antibiotic-resistance in Ejura Municipal, Ashanti Region, Ghana.
 Study Design: This is a descriptive cross-sectional study designed to assess the profile of microflora contamination of the Ghanaian paper currency notes and its antibiotic-resistance in the Ejura Municipality.
 Place and Duration of Study: The research was conducted in Ejura, a town in the Ejura Sekyeredumase Municipal District of the Ashanti region of Ghana, from January to May 2019
 Methodology: A total of 70 GH¢ notes, 15 each of GH ¢1, GH ¢2, and GH ¢5, 10 each of GH ¢10 and GH ¢20, and 5 of GH ¢50, were randomly sampled from people in various shops, canteens, and commercial drivers. The surfaces of each GH¢ note were gently swabbed, and tenfold serial dilution was inoculated on plate count agar (PCA), MacConkey agar, mannitol salt agar, and deoxycholate citrate agar. PCA, MCA, DCA, and MSA were the media used for the total viable count, Gram-negative rods, Gram-negative enteric bacilli, and Staphylococcus isolation in that order. For bacterial identification, the study used appropriate laboratory and biochemical tests. The data was analyzed using SPSS-IBM version 20.0.
 Results: It was found that 95.2 % of the 70 GH¢ notes tested positive for one or more bacterial isolates. On each GH¢ note, mean counts on PCA ranged from 3.0 cfu/ml ×105 to 4.8 cfu/ml ×105. Of 124 bacteria isolated. 36 (29.03 %), 32 (25.81%), 16 (12.90 %), 20 (16.13%), 13 (10.48 %), and 7 (5.66 %) were from GH¢1, GH¢2, GH¢10, GH¢5, GH¢20, and GH¢50, respectively. Bacterial isolates were Escherichia coli (25.81%), Staphylococcus aureus (18.55%), coagulase-negative Staphylococcus (15.32%), Klebsiella species (12.10%), Salmonella species (9.68%), Shigella species (8.06%), Pseudomonas aeruginosa (7.26%), and Proteus species (3.23%). Meat shops, commercial drivers, canteens, grocery stores, and vegetable shops contributed 25.81 %, 20.16 %, 19.35 %, 17.74 %, and 16.94 % of GH¢ notes respectively. There was 100% resistance of the isolates to Erythromycin (ERY), and Cotrimoxazole (COT). Amikacin (AMK) was the most effective among the antibiotics as 75% of the isolates were susceptible to it.
 Conclusion: This study has demonstrated that the GH¢ notes are heavily contaminated with potentially pathogenic bacteria that are highly resistant to the most widely used antibiotics and are a threat to public health.

Current trends in colistin susceptibility testing methods in enteric Gram-negative bacilli and other non-fermentative pathogens

Polymyxins, an age-old sort of cationic polypeptide antibiotic, are regarded as final-resort drugs in handling infections caused by multidrug-resistant Gram-negative bacteria. An exact assessment of colistin susceptibility is crucial due to increasing colistin resistance and absence of other antibiotics in curing multidrug resistance pathogens. Both Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing have investigated colistin broth microdilution and offer particular recommendations, but this method has a challenging perform in routine daily practice. It is time consuming and requires ≥48 h. In this issue, several alternative rapid tests are developed such as ResaPolymyxin Acinetobacter/Pseudomonas NP. The sensitivity and specificity of 100% for the Rapid ResaPolymyxin Acinetobacter/Pseudomonas NP test to Enterobacterales have been reported. Colistin broth disk elution test and colistin agar test are another novel potential methods that were validated by the Clinical laboratory standard institutes subcommittee for colistin screening in the Enterobacterales and Pseudomonas aeruginosa. In addition, recently, Rapid flow cytometry (FASTinov) method was introduced which requires only 2 h compared with conventional methods. This review will take a look at current trends on methods for colistin resistance measurements.

The impact of ageing on the incidence and mortality rate of bloodstream infection: A hospital-based case-cohort study in a tertiary public hospital of Brazil.

Over the past few decades, life expectancy in Brazil has increased from 48years in 1950s to 76years in 2017. The aim of this study was to investigate the impact of ageing on: (1) the frequency of hospitalisations due to bloodstream infection (BSI); (2) the incidence of hospital-acquired BSI (H-BSI); (3) the incidence of BSI caused by multidrug-resistant (MDR) agents and (4) the mortality rate of BSI in a public hospital. A hospital-based case-cohort study was conducted between 1 December 2013 and 31 December 2015. The data were analysed using multivariable logistic regression. A total of 500 BSI episodes were detected, among 11,102 hospitalizations. The incidence of hospitalisations resulting from BSI was significantly higher in older than younger patients (3.7/100 vs. 2.0/100, p<0.01). Similarly, the incidence of hospital-acquired BSI was significantly higher in older patients (2.7/100 vs. 0.9/100, p<0.01). Klebsiella pneumoniae (15.9%), Staphylococcus aureus (14.3%), Escherichia coli (13.1%) and Acinetobacter spp. (12.1%) were the most common agents isolated. MDR agents caused 37.6% of the BSI episodes; enteric Gram-negative bacilli resistant to third- or fourth-generation cephalosporins (9.7%) and carbapenem-resistant Acinetobacter spp. (9.2%) were the most common MDR agents. The following complications were independently associated with ageing: Charlson comorbidity index (OR=1.16; 95% CI=1.09-1.24); BSI secondary to urinary tract infection (OR=2.14; 95% CI=1.29-3.55); BSI secondary to pneumonia (OR=1.77; 95% CI=1.07-2.93) and 30-day mortality following BSI (OR=2.19; 95% CI=1.43-3.36). These data suggest ageing has a significant impact on hospitalisations due to BSI, H-BSI incidence and mortality from BSI in older patients attending a Brazilian public hospital. Age was not significantly associated with MDR-related BSI. These results indicate that age plays an important role in the increase in morbidities and mortality resulting from BSI in Brazil and that with the increased life expectancy observed over recent decades in Brazil, the burden of BSI will be expected to continue to increase. This dynamic needs to be better understood with additional studies.

Microbiology of Periprosthetic Hip and Knee Infections in Surgically Revised Cases from 34 Centers in Mainland China.

Background and AimPeriprosthetic joint infection (PJI) is one of the most devastating complications after total joint arthroplasty (TJA). However, the antibiotic resistance of infecting pathogens can significantly vary in different parts of the country. In the current study, we analyzed the demographic and microbiological profiles of knee and hip PJI over three years and compared the microbiological differences between them.MethodsA multicenter retrospective study of PJI patients in 34 referral medical centers in mainland China from January 2015 to November 2017 was performed.ResultsA total of 925 PJI patients were recruited, 452 were identified as knee PJIs, and 473 were hip PJIs. The most common causative pathogens were Staphylococcus aureus (26.5%) and coagulase-negative staphylococci (14.3%). Methicillin-resistant staphylococci were involved in 25.6% (237/925) of all PJI cases. Mycobacterium and fungus only accounted for 6.5% (61) of all cases. Enteric gram-negative bacilli, anaerobes, and polymicrobial pathogens were more common in hip joint prostheses than in knee PJI (P = 0.014; P = 0.006; P = 0.002, respectively).ConclusionWhile the majority of causative pathogens in PJI cases are staphylococcal species, the prevalence of atypical organisms and resistant pathogens should also be given attention and warrant the need for empiric antibiotic treatment.

No significant difference between ceftriaxone and cefotaxime in the emergence of antibiotic resistance in the gut microbiota of hospitalized patients: A pilot study

BackgroundCeftriaxone and cefotaxime share a similar antibacterial spectrum and similar indications but have different pharmacokinetic characteristics. Ceftriaxone is administered once daily and 40% of its clearance is by biliary elimination, whereas cefotaxime requires three administrations per day and shows less than 10% biliary elimination. The high biliary elimination of ceftriaxone suggests a greater impact of this antibiotic on the gut microbiota than cefotaxime. The objective of this study was to compare the impact of ceftriaxone and cefotaxime on the gut microbiota. MethodsA prospective clinical trial was performed that included 55 patients treated with intravenous ceftriaxone (1 g/24 h) or cefotaxime (1 g/8 h) for at least 3 days. Three fresh stool samples were collected from each patient (days 0, 3, and 7 or at the end of intravenous treatment) to assess the emergence of third-generation cephalosporin (3GC)-resistant Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, Pseudomonas aeruginosa, toxigenic Clostridioides difficile, and vancomycin-resistant enterococci. ResultsThe emergence of 3GC-resistant gram-negative enteric bacilli (Enterobacteriaceae) (5.9% vs 4.7%, p > 0.99), Enterococcus spp, and non-commensal microorganisms did not differ significantly between the groups. Both antibiotics reduced the counts of total gram-negative enteric bacilli and decreased the cultivable diversity of the microbiota, but the differences between the groups were not significant. ConclusionNo significant difference was observed between ceftriaxone and cefotaxime in terms of the emergence of resistance.

Investigation of Chlorhexidine Tolerance and its Association with Antibiotic Resistance in Clinical Gram-Negative Bacilli Isolates.

Chlorhexidine (CHX) is one of the most frequently used antiseptic agents in challenging multidrug-resistant (MDR) isolates. There is an increasing number of reports on reduced susceptibility (tolerance) to CHX in MDR isolates. We aimed to investigate CHX tolerance in Gram-negative bacilli (GNB) and its possible association with antibiotic resistance. A total of 84 enteric GNB (ENT) and 40 non-fermentative GNB (NFGNB) isolates were collected from different clinical specimens. Disk diffusion method was performed to differentiate between MDR and non-MDR isolates and tolerance to CHX was determined by a modified agar dilution method. In GNB isolates, CHX tolerance was defined as a minimum inhibitory concentration (MIC) ≥ 4 mg/L. We detected that 26.2% (22/84) of ENT and 50.0% (20/40) of NFGNB were MDR and the rest were non-MDR isolates. The CHX tolerance rate was detected as 50.0% (10/20) in MDR-NFGNB and 15.0% (3/20) in non-MDR-NFGNB, and this difference was statistically significant (p < 0.05). Conversely, the tolerance rate was observed as 4.5% (1/22) in MDR-ENT and 1.6% (1/62) in non-ENT, and this difference was not statistically significant (p ˃ 0.05). NFGNB isolates had a higher tendency to CHX tolerance than ENT, and antibiotic resistance facili-tates the selection of CHX tolerance in NFGNB but not in ENT isolates.

Resistencia a antibióticos β-lactámicos y eritromicina en bacterias de la cavidad oral

Introducción. La microbiota humana como fuente de bacterias y genes de resistencia constituyen un problema de salud pública. En este estudio se investigó la prevalencia de bacilos entéricos Gram negativos resistentes a β-lactámicos y de los Streptococcus del grupo viridans (EGV) con resistencia a eritromicina en la cavidad oral. Métodos. Se realizó un estudio descriptivo de corte transversal con 193 aislamientos de la cavidad oral sana de 178 adultos que asistieron a una Clínica Odontológica de la ciudad de Cali durante el 2018. La evaluación de la sensibilidad antimicrobiana se realizó en 59 bacilos entéricos y 134 EGV y se identificó por PCR los genes que confieren resistencia a β-lactámicos y eritromicina. El análisis estadístico se realizó mediante el empleo del paquete SPSS vs 23. Resultados. El 84,7% de los bacilos entéricos fueron multirresistentes y presentaron genes bla, siendo blaTEM-1 (49,2%) y blaVIM-2 (30,5%,) los más prevalentes. Los EGV fueron resistentes a eritromicina (38,8%) y clindamicina (28,4%). El 18,7% presentaron el fenotipo cMLSβ, 4,5% el iMLSβ y el 14,9% fueron M. El gen ermB se detectó en los cMLSβ, (13,4%) y el gen mef en los M (9,7%). Conclusión. En este estudio se demostró la presencia de EGV y bacilos entéricos resistentes a los antibióticos y portadores de genes de resistencia a eritromicina y genes bla en la cavidad oral sana. La presencia de estas bacterias representa un riesgo para la salud de los individuos portadores y contribuyen a la creciente epidemia de resistencia bacteriana.

An Unusual Case of Pyogenic Liver Abscess Caused by Community-acquired Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt;

Hepatic abscesses are the most common type of visceral abscesses. The annual incidence is estimated at 2.3 cases per 100,000 people and is more common in men than women. A considerable proportion of pyogenic liver abscesses are caused by hepatobiliary pathologies. However, it may also result from hematogenous seeding from the systemic circulation. Most pyogenic liver abscesses are polymicrobial in nature consisting of anaerobic and enteric gram-negative bacilli species. Less than 10% of cases are caused by Staphylococcus aureus. Of these, few are caused by Methicillin-resistant Staphylococcus aureus (MRSA) and even fewer from the community-acquired strain. The clinical manifestations of pyogenic liver abscesses usually include fever, abdominal pain and non-specific symptoms like nausea, vomiting, malaise, anorexia and weight loss. Treatment of pyogenic liver abscesses consists of source control with drainage and antibiotic therapy tailored to the isolated causative organism. We present a case of a 51-year-old Caucasian man who presented with severe right upper quadrant abdominal pain of 5 days in duration. Abdominal Computed Tomography (CT) showed a 7.7 by 6.0 centimeter multi-loculated mass in the right hepatic lobe with other scattered foci throughout the liver. The abscess was aspirated with a pigtail drain placed under CT guidance. The aspirated culture grew MRSA sensitive to Doxycycline and Trimethoprim/Sulfamethoxazole.

2342 Periodontal Flora Isolated From Pyogenic Liver Abscess in a Retired Dentist With Hepatic Metastasis of Colon Carcinoma

INTRODUCTION: The association of Streptococcus milleri group with pyogenic liver abscess is well recognized. Streptococcus gordonii, however, is a bacterium not of the milleri group and is included among the colonizers of the periodontal environment as it has a high affinity for molecules in the salivary pellicle on tooth surfaces. Here, we describe a case where Streptococcus gordonii was isolated from a pyogenic liver abscess in a retired dentist with hepatic metastasis of colon carcinoma. The clinical features, work up, management, and significance are described. CASE DESCRIPTION/METHODS: An 85-year-old male with colon carcinoma status post hemicolectomy complicated by metastasis to the liver status post chemotherapy and resection presented to the ED with intermittent abdominal discomfort for 2 weeks. Laboratory values were significant for WBC count of 16,000 with a predominance of granulocytes at 85%. CT of the abdomen and pelvis demonstrated a large, 7.6 cm by 5.3 cm, collection in the liver, likely an abscess. Infectious Diseases was consulted and recommended initiation of Meropenem and Daptomycin, in addition to drainage of the collection. The suspected abscess was drained by IR and Streptococcus gordonii sensitive to Linezolid was isolated on bacterial culture. The patient was transitioned to IV Linezolid and Metronidazole given susceptibilities. The patient's WBC count then began trending upwards. CT of the chest exhibited a 1.2 cm by 0.7 cm loculated pleural effusion on the right side. The pleural fluid collection was drained and a chest tube was placed. Studies of the drainage revealed an exudative process, although gram stain and culture were negative. Repeat CT imaging one week later revealed reduction in the size of the liver abscess. The WBC count normalized to less than 10,000 and the patient was discharged with a two-week course of oral Linezolid and Metronidazole with close outpatient follow-up with Infectious Diseases and Oncology. DISCUSSION: Pyogenic liver abscesses are generally associated with enteric gram-negative bacilli, Streptococcus milleri group, Streptococcus pyogenes, and Staphylococcus aureus. Hepatic abscesses secondary to periodontal flora have not been demonstrated in the literature without direct trauma to the GI tract involving foreign bodies contaminated with these organisms. We propose a possible hematogenous route of infection likely associated with possible risk factors related to the patient’s occupation as a dentist and history of dental manipulation.

Different microbiological profiles between hip and knee prosthetic joint infections.

The study aims to analyze the demographics and microbiological profiles of hip and knee prosthetic joint infection (PJI) and to compare the microbiological differences between hip and knee PJI. We performed a retrospective study of all PJI cases between January 2006 and December 2014 at a referral medical center in Taiwan. A total of 294 PJI cases were collected: 159 were identified as hip PJI and 135 as knee PJI. The most common causative pathogen was Staphylococcus aureus (78 cases, 27%), followed by coagulase-negative staphylococci (CoNS, 42 cases, 14%). Methicillin-resistant staphylococci (MRS) accounted for 21% of all PJI cases. Fungus and mycobacterium were only involved in 12 cases (4.1%) of all PJI cases. Polymicrobial pathogens, anaerobes, and enteric gram-negative bacilli (GNB) were more likely to occur in hip joint prostheses than in knee joint prostheses (22 vs. 6 cases, p = 0.006; 11 vs. 0 cases; p = 0.002; 20 vs. 6 cases; p = 0.014, respectively). The prevalence of polymicrobial pathogens, anaerobes, and enteric GNB was higher in the prosthetic hip infection than in the prosthetic knee infection. The high prevalence of MRS, including Methicillin-resistant (MR) S. aureus and MR-CoNS in PJI, may warrant the need for empiric antibiotic therapy with broader coverage while pending the culture result of PJI. Although fungal and mycobacterial PJI cases are rare, the incidence of these infections is relatively high in Taiwan. Fungus and mycobacterium should also be taken into consideration whenever a persistent PJI case is encountered.

Understanding of Vrikka Vidradhi w.s.r. to Renal Abscess

Acharya Sushruta and Charaka, described Vrikka Vidradhi under Abhyantara Vidradhi, Vrikka Vidradhi is also mentioned and reflect the symptom of Parshva Sankocha, and it can be correlated with Renal abscess. Renal Abscess is a collection of pus around kidney. Renal abscess is an uncommon disease caused by trauma and infection associated with kidney stone. Renal abscess is caused by infection with enteric gram-negative bacilli, Staphylococcus aureus is the etiologic agent in 90% of cortical abscess cases. Renal abscesses most commonly occur in individuals with diabetes mellitus with or without urinary tract obstruction. Common symptoms in patients with renal corticomedullary abscess include fever, chills, nausea / vomiting and flank or abdominal pain. Percutaneous drainage plus parenteral antibiotics is indicated as the initial treatment for abscesses 3-5cm in size. In cases that involve perirenal abscess or infected urinoma, also place a percutaneous perirenal drain. Hence an attempt is made to understand Vrikka Vidhradi in relation to renal abscess.

Bacterial Susceptibility to Antibiotics in Urinary Tract Infections in Children, KSAFH, Saudi Arabia, Tabuk

Objective: this study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community-acquired urinary tract infections (UTIs) at King Salman Armed Forces Hospital, Saudi Arabia, Tabuk. Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Early diagnosis and comprehensive treatment can significantly decrease late serious complications. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Methods: urinary isolates from symptomatic UTI cases attending to King Salman Armed Forces Hospital were identified by conventional methods. Positive urine cultures from 210 patients aged less than 14 years were studied. Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Results were analyzed by using the NCCLS guidelines of the 210 samples that showed growth of pathogens. Results: the most prevalent were E. coli (96.7%) followed by Klebsiella spp (3.3%). The majority (81%) of the isolates were from females, while the remaining was from males. Among these gram-negative enteric bacilli very high prevalence of resistance was observed against Ampicillin and Co-trimoxazole. For E.coli the lowest resistant rate was that for Nitrofurantoin 10.3% followed by Norfloxacin and Ceftriaxone (11.3% and 11.8% respectively). Resistance to Gentamicin and Nalidixic acid was observed in 19.2% and 47.3% respectively. For Klebsiella, all organisms were sensitive to Gentamicin and Norfloxacin and all organisms were resistant to Ampicillin. There was a high resistance rate to Ceftriaxone (42.9%).Conclusion: this study revealed that E. coli was the predominant bacterial pathogen of community-acquired UTIs at King Salman Armed Forces Hospital. Most of the organisms were resistant to Ampicillin and Co-trimoxazole; it also demonstrated an increased resistance to Nalidixic acid and Gentamicin. This study is useful for the clinician in order to improve the empiric treatment.

Bacterial Susceptibility to Antibiotics in Urinary Tract Infections in Children, KSAFH, Saudi Arabia, Tabuk

Objective: this study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community-acquired urinary tract infections (UTIs) at King Salman Armed Forces Hospital, Saudi Arabia, Tabuk. Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Early diagnosis and comprehensive treatment can significantly decrease late serious complications. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Methods: urinary isolates from symptomatic UTI cases attending to King Salman Armed Forces Hospital were identified by conventional methods. Positive urine cultures from 210 patients aged less than 14 years were studied. Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Results were analyzed by using the NCCLS guidelines of the 210 samples that showed growth of pathogens. Results: the most prevalent were E. coli (96.7%) followed by Klebsiella spp (3.3%). The majority (81%) of the isolates were from females, while the remaining was from males. Among these gram-negative enteric bacilli very high prevalence of resistance was observed against Ampicillin and Co-trimoxazole. For E.coli the lowest resistant rate was that for Nitrofurantoin 10.3% followed by Norfloxacin and Ceftriaxone (11.3% and 11.8% respectively). Resistance to Gentamicin and Nalidixic acid was observed in 19.2% and 47.3% respectively. For Klebsiella, all organisms were sensitive to Gentamicin and Norfloxacin and all organisms were resistant to Ampicillin. There was a high resistance rate to Ceftriaxone (42.9%).Conclusion: this study revealed that E. coli was the predominant bacterial pathogen of community-acquired UTIs at King Salman Armed Forces Hospital. Most of the organisms were resistant to Ampicillin and Co-trimoxazole; it also demonstrated an increased resistance to Nalidixic acid and Gentamicin. This study is useful for the clinician in order to improve the empiric treatment.

Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia

Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Incidence and Outcomes of Infections Caused by Multidrug-Resistant Enterobacteriaceae in Children, 2007-2015.

The escalating incidence of invasive disease caused by multidrug-resistant Gram-negative enteric Enterobacteriaceae (MDR-GNE) is a global concern. Scant published studies in which the epidemiology of these infections in children is described exist; previous studies focused mainly on adults, described circumscribed populations, or lacked clinical detail. The objective of this study was to examine and describe the incidence, risk factors, and outcomes associated with MDR-GNE infection in children. In this cohort study, we used data from 48 children's hospitals maintained by the Pediatric Health Information System. We documented the proportion of MDR-GNE diagnoses among children's hospital patients aged 0 to <18 years who were diagnosed with an Enterobacteriaceae-associated infection between January 1, 2007, and March 31, 2015, and we analyzed the association between MDR-GNE infection and hospital length of stay and death before discharge. During the study period, 107610 discharges included a diagnosis code for Enterobacteriaceae infection, 724 (0.7%) of which included MDR-GNE infection. The incidence of MDR-GNE, and the proportion of infections with Enterobacteriaceae organisms that were MDR-GNE increased over the study period; from 0.2% in 2007 to 1.5% by 2015 (test for trend < .001). Almost one-quarter (23%) of the infections in children hospitalized for MDR-GNE were nosocomial. Increased odds of MDR-GNE infection were associated with older age and comorbid illnesses. Lengths of stay in patients with MDR-GNE infection were increased 20% (95% confidence interval, 9.9%-30.5%; P < .001) over those without MDR-GNE infection; the increased odds for death did not reach statistical significance (1.46 [95% confidence interval, 0.98-2.18]; P = .06). Results were robust to sensitivity analyses. The incidence of pediatric MDR-GNE infection increased during 2007-2015. MDR-GNE infection was associated with increased length of stay, and we found a trend toward increased risk of death. Infections with Gram-negative enteric bacilli are becoming increasingly difficult to treat; considering the global burden of these antimicrobial-resistant organisms, interventions to curtail or even reverse this trend are needed urgently.