Aerobic Gram-positive Cocci Research Articles

Causative microbes and antibiotic susceptibility of acute appendicitis in adults and children

In recent years, some studies have found that acute uncomplicated appendicitis can be treated with antibiotics alone. Because of the lack of relevant research on treating acute appendicitis in Taiwan, this study investigated the microbiological characteristics of acute appendicitis to permit accurate empirical antibiotic use for uncomplicated appendicitis. In this single-center retrospective cohort study, patients listed in the Taiwan National Health Insurance Research Database with a discharge diagnosis of acute appendicitis were identified. Data for bacterial specimens and antibiotic susceptibility tests among patients treated at Tri-Service General Hospital between January 2016 and December 2021 were analyzed. Among 2805 patients diagnosed with acute appendicitis, 167 (6%) were <18 years old. The culture positivity rates among children and adults were 33% and 18%, respectively. In total, 367 aerobes and 207 anaerobes were isolated. The predominant aerobic gram-positive coccus was viridans group streptococci (8.9%), the most common aerobic gram-negative bacillus was Escherichia coli (27.9%), and the most common anaerobic microorganism was Bacteroides spp. (27.7%). The results of antibiotic susceptibility testing of the predominant microorganisms revealed that 86.3% of gram-positive aerobes were susceptible to ampicillin, 76.3% of gram-negative aerobes were susceptible to gentamicin, and all anaerobic isolates were susceptible to metronidazole. Triple first-line antibiotic combination therapy, including ampicillin, gentamicin, and metronidazole, remains highly effective against the pathogens that cause acute appendicitis.

Phenotypic virulence and antibiotic resistance features of microbial strains isolated from dental-plaque associated oral lesions

Due to the high complexity of the oral microbial community and its association with diverse oral pathologies, the investigation of microbial resistance and virulence features is essential for developing effective strategies with preventive or therapeutic value. This study focused on identifying a series of soluble virulence factors and the antibiotic resistance profiles of microbial strains isolated from the oral cavity of patients with dental plaque-associated pathologies, using culture-dependent methods. Our study demonstrates that the analyzed bacterial and fungal strains have the ability to grow competitively and induce tissue lesions, mainly mediated by esculinase and proteases (Gram‑negative bacilli), hemolysins (Actinomyces and aerobic Gram-positive cocci), amylase and DNase (anaerobic Gram‑positive cocci), lipase and DNase (yeasts) as well as exhibit resistance to antibiotics currently used in dentistry, such as beta-lactams, tetracyclines and macrolides.

Culture and sensitivity pattern of aerobic bacterial isolates in diabetic foot infections during 2018-2022 in Asian countries: a literature review study.

This research aims to determine the culture and sensitivity trend of aerobic bacterial isolates of DFI in Asian nations over a 5-year period. The article was searched using PubMed and Google Scholar with the keywords 'Diabetic Foot Infections', 'Antibiotic', 'Microbiological Profile', and their combinations. The author uses publications from 2018 to 2022 in Indonesian and English to select the appropriate journal. The author identified 11 relevant articles with microbiological profiles and sensitivity patterns in DFI. A total of 3097 isolates were found in 2498 patients with DFI. Gram-negative bacteria were the leading source of infection (n=1737; 56%). Totally, 1148 (or 37%) of all isolates were aerobic Gram-positive cocci. Staphylococcus aureus was the most commonly isolated aerobe (n=608, 20%), followed by Pseudomonas aeruginosa (n=451, 15%). Gram-positive bacteria showed good susceptibility to trimethoprim-sulfamethoxazole, chloramphenicol, doxycycline, vancomycin, and linezolid. Gram-negative bacteria displayed excellent susceptibility to aminoglycosides, piperacillin-tazobactam, and carbapenems. Gram-negative microorganisms were the most prevalent cause of DFI. This study's findings will facilitate the development of future empirical therapeutic guidelines for the treatment of DFI.

Microbiology of breast abscesses

IntroductionTreatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses. MethodsPatients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded. ResultsSixty patients were included, 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P = .013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P = .003). Aerobic gram-positive cocci were the most frequent agents in diabetics. ConclusionAnaerobes were the most frequent agents, followed by S. aureus. The etiology of breast abscesses varied with the risk factors studied.

213. Assessment of Compliance with Order Set and Bundle for Management of Staphylococcus aureus Bacteremia

Background Staphylococcus aureus (S. aureus) is an aerobic gram-positive coccus that causes a variety of infections. S. aureus bloodstream infections, also known as bacteremias, have significant morbidity and mortality and are difficult to eradicate. A single-center study showed a 9.4% recurrence rate for S. aureus bacteremia, despite adequate treatment. The Infectious Disease Society of America (IDSA) recognizes the seriousness of S. aureus infections, particularly methicillin-resistant S. aureus (MRSA), and has released guidance for treatment of these infections. Guidance for S. aureus bacteremias include identification and removal of the source and early optimization of antibiotics. Serial imaging and laboratory monitoring, including repeat blood cultures, are also necessary to establish the duration of therapy, ensure microbiologic eradication, and reduce the risk of long-term complications. Due to the complexity of S. aureus bacteremia, early involvement of infectious diseases (ID) specialists is strongly recommended. MethodsThis retrospective, single-center study was designed to evaluate the current management of S. aureus bacteremias, including compliance to the elements of the S. aureus order set and bundle. Patients 18 years and older who had a positive blood culture for S. aureus were included in this study. Recurrence of S. aureus infection was assessed at 6 months. Data was analyzed to compare patients with and without ID consults.ResultsEighty-four patients met inclusion criteria. ID consultation resulted in a higher percentage of patients achieving 100% compliance with the bundle elements compared to patients without ID consults (73% vs 25%, respectively; p=0.009). For further breakdown of compliance see Table 1. No statistical difference was detected in recurrence rates (11% vs 33%, respectively; p=0.18) or mortality (8% vs 25%, respectively; p= 0.17) possibly due to the small sample size. Table 1. Outcomes ConclusionID specialist involvement for the treatment of S. aureus bacteremia resulted in greater compliance with the S. aureus bacteremia bundle. No statistical difference in recurrence or mortality rates was detected.Disclosures All Authors: No reported disclosures

Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study.

Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated.Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP.Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.

Immunosupressive activity of opportunist pathogens of the infectious-inflammatory process in the urinary tract of men with calculous pyelonephritis

Objective - identification of pathogens of the infectious-inflammatory process of the urinary tract in men with calculous pyelonephritis, antilysozyme, anticomplementary, anti-immunoglobulin activity and inhibitory effect on the phagocytic activity of peripheral blood neutrophils.Material and methods. 34 strains of opportunistic taxa were isolated and identified by bacteriological method from 30 sick men aged 31 to 65 years (mean age 48.8 ± 4.27 years). These bacteria have antilysozyme, anti-complementary and anti-immunoglobulin activity, as well as the suppressive effect of supernatants of cultures of calculous pyelonephritis pathogens on the phagocytic activity of neutrophils in the peripheral blood of patients. The determination of the anti-complementary activity of bacteria was carried out using the principle, which includes testing the protective action of bacteria and their metabolic products against the growth of an indicator strain in the presence of a bactericidal substance (complement of blood serum). The antilysozyme activity of pathogens was investigated by a photometric method. Anti-immunoglobulin activity was studied by the method described in the work of I.S. Gaidash et al. Results. The majority of 27 (79.41%) isolated strains of Enterobacteriaceae (84%) and facultative anaerobic and aerobic gram-positive cocci (E. faecalis, S.saprophyticus) (66.67%) exhibit antilysozyme activity of varying degrees. The highest antilysozyme activity was found in the isolated strains of K. pneumoniae, 8.14% lower – in E. coli. Most (64.71%) of isolated strains of Enterobacteriaceae (68%) and gram-positive cocci (55.56%) from the urinary tract of men with calculous pyelonephritis exhibit anti-complementary activity. All isolated and identified taxa exhibit inhibitory activity against immunoglobulins of the main classes: Ig M, Ig G, and Ig A. K.pneumoniae inhibits immunoglobulins of all major classes, the concentration of Ig M decreases under the influence of this taxon by 22.36%, Ig G - by 26.88% and Ig A - by 19.61%.Conclusions. Opportunistic pathogens (E. coli, K. pneumoniae, P. mirabilis, E. cloaceae, S. marcescens, E. faecalis, S. saprophyticus) of the infectious-inflammatory process of the urinary tract in men with calculous pyelonephritis exhibit different levels of antilysozyme, anti-complementary activity; reduce the function of immunoglobulins Ig G (by 21.60%), Ig A (by 21.49%) and Ig M (by 14.30%), inhibit the phagocytic activity of neutrophilsby 15.74%, their capturing ability- by 22.59%.

Microbiología de los abscesos mamarios

IntroductionTreatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses. MethodsPatients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded. ResultsSixty patients were included: 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P=.013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P=.003). Aerobic gram-positive cocci were the most frequent agents in diabetics. ConclusionAnaerobes were the most frequent agents, followed by S.aureus. The etiology of breast abscesses varied with the risk factors studied.

RISK FACTORS AND OUTCOMES OF ENTEROCOCCUS SPECIES ISOLATED FROM CLINICAL SPECIMENS

Introduction: Enterococci are the most common aerobic and facultative anaerobic gram-positive cocci. They show intrinsic resistance to many antibiotics, acquire resistance genes and are capable of transferring resistance genes. Immunosuppression, abdominal surgery, structural abnormalities of urinary tract, long hospital/ICU stay, previous antibiotic use, mechanical ventilation, etc. are all risk factors for enterococcal infections. Objectives: A study was undertaken to nd out the risk factors and outcomes of Enterococcus species isolated from clinical specimens. Material and Methods: Single enterococcal isolates recovered from clinical specimens received for bacterial culture in this hospital during a period of one and half years were included in the study. Clinical details of the patient and risk factors were noted down in a structured proforma. Enterococci were identied and speciated by standard biochemical tests. Patient was followed up to see the outcome. Total 96 enterococci Results: were isolated during this period from hospitalized patients, out of which 86 were Enterococcus faecalis, 8 E. faecium and 2 E. solitarius. Out of these, 4.2% isolates were vancomycin resistant enterococci. Out of 96, 52.1% had a hospital stay &gt;7 days, 28.1% were on mechanical ventilation and 19.8% had central line insertion. In this study, 26% patients with enterococcal infection expired. Mortality among patients with E. faecium infection was more (62.5%) than among patients with E. faecalis infection (23.3%). Mortality in patients whose hospital stay was &gt;7 days was 42%, whereas those on mechanical ventilation was 48.1% and those with central line insertion was 52.6%. This study revealed that in Conclusion: enterococcal infections, hospital stay of &gt;7 days, mechanical ventilation and central line insertion are signicantly associated with mortality.

Surgical site infection in gynecology

Objective. The morbidity and mortality caused by sur­gi­cal site infections (SSIs) worldwide have become a major pu­blic health issue. Furthermore, the prevention of SSI re­mains a focus for healthcare systems and hospitals due to its healthcare cost reducibility. The objective of this review is to assess the guidelines recommendations re­la­ted to the prevention, diagnosis and management of SSIs. Materials and method. This paper is a review based on information found in literature. The analysis was limited to English language articles and guidelines pu­blished between January 1st, 2015 and April 30th, 2020, on PubMed, using the following keywords: surgical site in­fec­tion, wound infection in gynecology, prophylactic anti­biotics, economic impact of SSIs. In this review we dis­cuss the current trends in the management of SSIs in gy­ne­co­logy. Results. The microorganisms in gynecologic sur­ge­ry are unique as the site of infection may be from the va­gi­nal/genitourinary tract, the abdomen or the skin. The most frequent bacteria in abdominal SSI in gynecologic sur­gery are aerobic Gram-positive cocci (Staphylococcus aureus, Staphylococcus epidermidis). Also, incisions made around the perineum and the groin can become in­fected with Enterococcus species and Escherichia coli. In­ci­sio­nal cellulitis and vaginal cuff cellulitis represent the most com­mon superficial SSI. Deep tissue abscess represents the most common deep infection, whilst tubo-ovarian ab­scesses and pelvic abscesses constitute the most com­mon space and organ infections. The most serious form of SSI is necrotizing fasciitis, a life-threatening com­pli­ca­tion. Conclusions. By rigorously following the clinical re­com­men­dations and evidence, the prevention, diagnosis and treat­ment of SSI can be managed correctly. As a result, health outcomes and healthcare-re­la­ted costs will be greatly improved, thereby the quality of health­care that we deliver to patients will be furthermore increased.

Egyptian consensus for the use of antimicrobial therapy in Preoperative prophylaxis, surgical site infections and diabetic foot infections

Use of antimicrobials in surgical prophylaxis These consensuses focus on primary perioperative prophylaxis for the prevention of an initial infection, the administration of the first dose of antimicrobial beginning within 60 min before surgical incision is recommended, but administration of vancomycin and fluoroquinolones should begin within 120 min before surgical incision because of the prolonged infusion times required for these drugs. Dosing In general, it is advisable to administer prophylactic agents in a manner that will ensure adequate levels of drug in serum and tissue for the interval during which the surgical site is open, If the duration of the procedure exceeds two half-lives of the antimicrobial or there is excessive blood loss (>1500 ml), the re-dosing interval should be measured from the time of administration of the preoperative dose, not from the beginning of the procedure. The selection of certain antimicrobial in most of the surgeries is shown in Table 2, and the special dosing of antimicrobials in patients with renal impairment is shown in Table 3. Surgical site infections “SSI” SSIs or wound infections are the most common adverse events affecting hospitalized surgical patients. The most important therapy for an SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention. Before starting an empiric antibiotics course, culture should be done. The antibiotic choice is usually empiric but can be supported by Gram stain, culture of the wound contents, the site of surgery, and the hospital antimicrobial susceptibility test system ‘Hospital Biogram’. The selection of Antibiotics for treatment of incisional surgical site infections is summarized in table 4. Diabetic foot infections Diabetic Foot infections typically begin in a wound, most often a neuropathic ulceration, while all wounds are colonized with microorganisms, and the presence of infection is defined by greater than or equal to 2 classic findings of inflammation or purulence. Most DFIs are polymicrobial, with aerobic gram-positive cocci, and especially Staphylococci spp., the most common causative organisms. Clinicians should consider the possibility of infection occurring in any foot wound in a patient with diabetes. Clinicians should evaluate a diabetic patient presenting with a foot wound at three levels: the patient as a whole, the affected foot or limb, and the infected wound. The clinically noninfected wounds should not be treated with antibiotic therapy. Prescription of antibiotic therapy for all infected wounds should be done, but with caution, as it is often insufficient unless combined with appropriate wound debridement. The clinicians need to select an empiric antibiotic regimen on the basis of the severity of the infection and the likely etiologic agent(s) (shown in Table 6).

Clindamycin inhibits nociceptive response by reducing tumor necrosis factor-α and CXCL-1 production and activating opioidergic mechanisms.

Clindamycin, a bacteriostatic semisynthetic lincosamide, is useful in the management of infections caused by aerobic and anaerobic Gram-positive cocci, including bacteremic pneumonia, streptococcal toxic shock syndrome and sepsis. It has been recently demonstrated that clindamycin inhibits in vitro and in vivo inflammatory cytokine production. In the present study, we investigated the effects of clindamycin in acute and chronic models of pain and inflammation in mice and the underlying mechanisms. Intraperitoneal (i.p.) administration of clindamycin (400mg/kg) increased the animal's latency to exhibit the nociceptive behavior induced by noxious heat (hot plate model). Intrathecal injection of clindamycin (2, 10 and 50µg) also increased the animals' latency to exhibit the nociceptive behavior. Tactile hypersensitivity and paw edema induced by intraplantar (i.pl.) injection of carrageenan were attenuated by previous administration of clindamycin (200 and 400mg/kg, i.p.). Clindamycin (100, 200 and 400mg/kg, i.p.) also attenuated ongoing tactile hypersensitivity and paw edema induced by i.pl. injection of complete Freund's adjuvant (CFA). The antinociceptive activity of clindamycin (400mg/kg, i.p.) in the hot plate model was attenuated by previous administration of naltrexone (5 and 10mg/kg, i.p.), but not glibenclamide or AM251. CFA-induced production of TNF-α and CXCL-1 was reduced by clindamycin (400mg/kg, i.p.). Concluding, clindamycin exhibits activities in acute and chronic models of pain and inflammation. These effects are associated with reduced production of TNF-α and CXCL-1 and activation of opioidergic mechanisms. Altogether, these results indicate that the clindamycin's immunomodulatory effects may contribute to a pharmacological potential beyond its antibiotic property.

Commensal microflora in human conjunctiva; characteristics of microflora in the patients with chronic ocular graft-versus-host disease

PurposeTo investigate the transformation in the composition of ocular surface microflora. Evidence shows that microbial diversity correlates with autoimmune disorders. Chronic ocular graft-versus-host disease (GVHD) is the lethal complication after hematopoietic stem cell transplantation (HSCT) which influences patients’ quality of life. It has a similar pathophysiology to autoimmune disorders but the relation of the microbial status especially in the ocular surface and chronic ocular GVHD is still unknown. MethodsWe prospectively harvested conjunctival microorganism with a cotton swab from following 3 groups, 32 eyes/20 ocular GVHD patients (9 males, 11 females), 28 eyes/20 nonGVHD cases (10 males, 10 females) which defined as post hematopoietic stem cell transplantation and without ocular GVHD, and 20 eyes/11 controls (7 males, 4 females). Conventional culture-based methods were performed to examine the microbial community. ResultsOcular surface microbes in the GVHD patients was more complex in diversity compared with in the nonGVHD patients and the control. Staphylococcus species, Alpha-haemo Streptococcus, Corynebacterium species, Propionibacterium Acnes, Aerobic gram-positive cocci, Haemophilus Influenzae, and Aerobic gram-positive rod were observed in the GVHD patients, whereas only a few species detected in the other groups. ConclusionsWe found that ocular surface microbes in the GVHD patients is more diverse than that in the nonGVHD patients and the controls. These results suggest the alternation of microbes are involved in the pathogenic process of the chronic ocular GVHD. Further examination using state-of-the-art methods will be needed to gain greater insights into the diversity of microflora on the chronic GVHD-affected ocular surface.

Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study

ObjectivesParapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants. MethodsChildren <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. All bacteria detected in blood or pleural fluid (by culture/PCR) were included, with serotyping for Streptococcus pneumoniae. ResultsThe median age of all 1447 PPE/PE patients was 5 years (interquartile range 3–10). In 488 of the 1447 children with PPE/PE (34%), 541 bacteria (>40 species) were detected. Aerobic gram-positive cocci accounted for 469 of 541 bacteria detected (87%); these were most frequently Streptococcus pneumoniae (41%), Streptococcus pyogenes (19%) and Staphylococcus aureus (6%). Serotype 3 accounted for 45% of 78 serotyped S. pneumoniae strains. Annual PPE/PE incidence varied between 14 (95%CI 12–16) and 18 (95%CI 16–21) PPE/PE per million children. Incidence of S. pneumoniae PPE/PE decreased from 3.5 (95%CI 2.5–4.6) per million children in 2010/11 to 1.5 (95%CI 0.9–2.4) in 2013/14 (p 0.002), followed by a re-increase to 2.2 (95%CI 1.5–3.2) by 2016/17 (p 0.205). ConclusionsIn the era of widespread PCV immunization, cases of paediatric PPE/PE were still caused mainly by S. pneumoniae and, increasingly, by S. pyogenes. The re-increase in the incidence of PPE/PE overall and in S. pneumoniae-associated PPE/PE indicates ongoing changes in the bacterial aetiology and requires further surveillance.

Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital

PurposeDiabetic foot infections (DFIs) are major public health concerns. In the view of the ever increasing burden of multidrug-resistant (MDR) organisms, improving the use of antimicrobial agents (AMAs) is a national priority. Objective of the study was to determine antimicrobial susceptibility (AMS) pattern of aerobes in DFIs. MethodsA cross-sectional study was conducted for a period of 3 years at Department of Surgery, Kasturba hospital, Manipal, India during which, 260 diabetic foot ulcer (DFU) patients admitted in the general surgery wards were enrolled for the study. These patients’ culture specimens were observed as Gram-stained smears and cultured aerobically on blood agar and MacConkey agar plates. AMS test was performed by disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. ResultsA total of 354 microbes were isolated from the ulcer wounds of 213 diabetic foot patients, with an average of 1.7 organisms per lesion. Monomicrobial infections were less common (n=81; 31.2%) than polymicrobial infections (n=132; 50.7%). Gram-negative bacteria were the most common among the isolates (n=192; 54.2%). Aerobic Gram-positive Cocci accounted for 162 (45.8%) of all isolates. On the other hand, Staphylococcus aureus was the most frequently isolated aerobe (n=106; 29.9%) followed by Pseudomonas aeruginosa (n=91; 25.7%). ConclusionAMS data from our study recommends that doxycycline would be the appropriate choice as single drug for empirical coverage for Gram-positive organisms. The most appropriate antibiotic for Gram-negative organisms is meropenem. One of the critical observations is the presence of Acinetobacter, an MDR isolated from DFIs, which is either relatively or totally resistant to all the AMAs tested.

Microbiological Etiologies of Pneumonia Complicating Stroke: A Systematic Review.

Identifying the causal pathogens of pneumonia complicating stroke is challenging, and antibiotics used are often broad spectrum, without recourse to the microbiological cause. We aimed to review existing literature to identify organisms responsible for pneumonia complicating stroke, before developing a consensus-based approach to antibiotic treatment. A systematic literature review of multiple electronic databases using predefined search criteria was undertaken, in accordance with Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Published studies of hospitalized adults with ischemic stroke, intracerebral hemorrhage, or both, which identified microbiological etiologies for pneumonia complicating stroke up to January 1, 2017, were considered. Analysis included summary statistics and random-effects meta-analysis where appropriate. Fifteen studies (40% ischemic stroke, 60% ischemic stroke and intracerebral hemorrhage) involving 7968 patients were included. Reported occurrence of pneumonia varied considerably between studies (2%-63%) with a pooled frequency of 23% (95% confidence interval, 14%-34%; I2=99%). Where reported (60%), the majority of pneumonia occurred within 1 week of stroke (78%). Reported frequency of positive culture data (15%-88%) varied widely. When isolated, aerobic Gram-negative bacilli (38%) and Gram-positive cocci (16%) were most frequently cultured; commonly isolated organisms included Enterobacteriaceae (21.8%: Klebsiella pneumoniae, 12.8% and Escherichia coli, 9%), Staphylococcus aureus (10.1%), Pseudomonas aeruginosa (6%), Acinetobacter baumanii (4.6%), and Streptococcus pneumoniae (3.5%). Sputum was most commonly used to identify pathogens, in isolation (40%) or in conjunction with tracheal aspirate (15%) or blood culture (20%). Although the analysis was limited by small and heterogeneous study populations, limiting determination of microbiological causality, this review suggests aerobic Gram-negative bacilli and Gram-positive cocci are frequently associated with pneumonia complicating stroke. This supports the need for appropriately designed studies to determine microbial cause and a consensus-based approach in antibiotic usage and further targeted antibiotic treatment trials for enhanced antibiotic stewardship.

CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England

ObjectiveTo determine the extent of agreement and patterns of disagreement between wound swab and tissue samples in patients with an infected diabetic foot ulcer (DFU).DesignMulticentre, prospective, cross-sectional study.SettingPrimary and secondary...

Clinical study of coexistence of fungal infections in diabetic foot ulcers and its management

Background: Presently 62 million Indians are diabetics and these numbers are on the rise. Amongst chronic complications of uncontrolled diabetes, foot ulcer is one. Diabetes is the leading cause of non-traumatic lower extremity amputation in developing countries with risk being 15 to 46 times higher. Infections are predominantly polymicrobial, predominantly Aerobic Gram-Positive cocci with higher incidence of anaerobic species and fungal infections. Treatment of fungal infections in diabetic foot ulcers might reduce the disability, morbidity and mortality in diabetic patients.Methods: A total of 100 diabetic foot ulcer patients admitted or who visited to JSS Hospital over a period of 2 years, meeting the inclusion/exclusion criteria of the study, formed the study population. Detailed history, clinical evaluation &amp; necessary investigations were done. Fungal isolation from the ulcer done by 10% KOH study, Gram stain, SDA culture and slide culture methods. Positive patients were treated with antifungal agents. Outcome of the disease studied based on ulcer progression, wound healing and tissue amputations.Results: Polymicrobial flora in diabetic foot ulcers was seen (137 organisms in 100 subjects), predominantly Enterobacteriaceae and Pseudomonas. Prevalence of fungal infections in present study was 19%, of which Candida species was the commonest.Conclusions: Present study signifies the need of mycological evaluation of nonhealing diabetic ulcer, with poor progression despite antibacterial therapy &amp; foot care, introduction of antifungal treatment for proved fungal infections in diabetic foot ulcers, considering fungal infection as significant risk factor.

Conjunctival Bacteria Flora of Glaucoma Patients During Long-Term Administration of Prostaglandin Analog Drops

To investigate the effects of the long-term use of prostaglandin analogs for glaucoma treatment on the indigenous flora of the conjunctiva. Bacterial isolates were collected from the conjunctival sacs of 68 patients at Miyata Eye Hospital from February to September 2014, who had been receiving continuous monotherapy with prostaglandin analogs for glaucoma for at least 1 year. Minimum inhibitory concentrations of levofloxacin, gatifloxacin, moxifloxacin, cefmenoxime, tobramycin, chloramphenicol, and erythromycin against the isolates were measured to determine susceptibility. The positive culture rate in all cases was 90.5% (57/63 eyes), and a total of 79 bacterial strains were isolated. The isolated bacteria included aerobic gram-positive cocci (8% Staphylococcus aureus and 41% Staphylococcus epidermidis), coagulase-negative staphylococci (5%), Streptococcus spp. (1%), Corynebacterium spp. (4%), gram-negative bacteria (4%), and the facultative anaerobe Propionibacterium acnes (33%). The positive culture rates for patients using 0.005% latanoprost (Xa group) and 0.004% travoprost (Tz group) were 88.9% and 92.6%, respectively, with no statistically significant difference in the composition of isolated bacteria between groups. Methicillin-resistant S. epidermidis (MRSE) was significantly more frequently isolated in the Xa group. The antimicrobial susceptibility rates of S. epidermidis were significantly lower in the Xa group for levofloxacin, gatifloxacin, moxifloxacin, and tobramycin. The indigenous flora may be affected by the long-term use of prostaglandin analogs. The higher incidence of MRSE in the Xa group should be considered during the long-term, continuous administration of eye drops, such as in glaucoma treatment.

Seawater drowning-associated pneumonia: a 10-year descriptive cohort in intensive care unit

Background Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are scarce. The objective of the study is to describe the microorganisms isolated in early respiratory specimens obtained from seawater drowning-associated pneumonia and to provide their antibiotic susceptibility pattern.MethodsAll patients admitted for seawater drowning between 2003 and 2013 to two intensive care units, from the region in France with the highest drowning rate, were retrospectively included. Demographics, antimicrobial therapy and microbiological data from respiratory samples collected within the first 48 h after admittance were analyzed.ResultsSeventy-four drowned patients were included, of which 36 (49%) were diagnosed by the clinician as having early pneumonia. Concerning the overall population, the median simplified acute physiology score (version 2) was 45 (30–65), and the mortality was 26%. Twenty-four respiratory samples from different patients were obtained within the first 48 h. Sixteen were positive. The main microorganisms found were Enterobacteriaceae (Enterobacter spp., Klebsiella spp. and Escherichia coli) and Gram-positive aerobic cocci (Streptococcus pneumonia and Staphylococcus aureus) with a low rate of antimicrobial resistance. No MDR bacteria or fungi were identified. However, among the positive respiratory samples collected, 5/16 (31%) grew bacteria with natural resistance to amoxicillin–clavulanate, the first-line antibiotic commonly used in our cohort. Resistance was only found among Gram-negative bacteria and from respiratory samples of patients with a higher drowning grade at admission (p = 0.01).ConclusionsThis 10-year descriptive study, the largest cohort to date, provides early respiratory samples from seawater drowning patients. The microorganisms retrieved were either mostly part of the human oro-pharyngeal flora or Enterobacteriaceae and displayed low rates of antimicrobial resistance. Respiratory samples should nonetheless be collected at admittance to the ICU to avoid inappropriate treatment. Empiric use of cephalosporin could be restricted to severe patients or if Gram-negative bacilli are found after direct examination.