Higher Rate Of Positive Cultures Research Articles

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018-2023 in Southeastern US.

The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. 367 preterms born at <32 weeks gestational age (GA) between 2019-2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Implications of bacteriological study in complicated and uncomplicated acute appendicitis.

Bacteriological sample in the presence of intraabdominal free fluid is necessary to adapt the antibiotherapy and to prevent the development of resistance. The aim was to evaluate the differences between uncomplicated (UAA) and complicated acute appendicitis (CAA) in terms of bacterial culture results and antibiotic resistance, and to evaluate the factors linked with CAA. We performed a single-center, retrospective observational study of all consecutive patients who presented with appendicular peritonitis and underwent emergent surgery in a tertiary referral hospital in Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance, and postoperative outcomes of 268 patients were analyzed. UAA was considered catarrhal or phlegmonous inflammation of the appendix. CAA was considered gangrenous or perforated appendicitis. Positive microbiological cultures were significantly higher in the CAA group (68.2% vs. 53.4%). The most frequently isolated bacteria in UAA and CAA cultures were Escherichia coli (37.9% and 48.6%). Most observed resistances were against ampicillin (28.9% and 21.7%) and amoxicillin/clavulanic acid (16.4% and 10.5%) in UAA and CAA, respectively. A higher Charlson comorbidity index, an elevated white blood cell count, an open procedure, and the need for drainage were linked to CAA. Culture results, group of bacterial isolation, and most common isolated bacteria were not related to CAA. CAA presented a higher rate of positive cultures with increased identification of gram-negative bacteria. Bacterial culture from the peritoneal liquid does not reveal relevant differences in terms of antibiotic resistance.

Effect of Global Fund financial support for patients with multidrug-resistant tuberculosis.

SETTING: The Global Fund provides financial support for patients with multidrug-resistant tuberculosis (MDR-TB), patients' families and hospitals providing services for these patients in Thailand, but the impact of this support has not been evaluated.OBJECTIVE: To assess the impact of Global Fund financial support on drug adherence, out-of-pocket (OOP) payments, sputum culture conversion and the perception of the usefulness of this support.DESIGN: A retrospective cohort study was conducted in eight provincial hospitals with and without financial support in four regions of Thailand. MDR-TB patients aged ≥15 years registered in 2015-2016 who received treatment at these hospitals for at least 6 months were included.RESULTS: There was no significant difference in drug adherence rates. The OOP payments during treatment were significantly lower in patients who received financial support (P < 0.001). Although the supported group had higher positive culture rates at the beginning of treatment, sputum converted at a faster rate than for the unsupported group (P = 0.034). More than 80% of both groups perceived financial support as being useful, leading to faster diagnosis and improving follow-up compliance.CONCLUSION: Financial support for MDR-TB patients has a positive impact on treatment and should be continued.

Analysis of conjunctival flora in diabetic and non-diabetic individuals and their antibiotic sensitivity pattern

To compare the conjunctival flora of diabetic individuals and non-diabetic individuals and assess their antibiotic sensitivity pattern. A hospital based cross-sectional and descriptive study was carried out from September 2016 to August 2018 with 92 patients of age group from 40-70 years, to assess the conjunctival flora and antibiotic sensitivity pattern in diabetic and non-diabetic individuals without any pre-existing ocular diseases and adnexal disease. The rate of positive culture in Group A (Diabetics) was significantly higher as compared to Group B (Non-Diabetics) (21.7% vs. 4.3% respectively) (p&amp;#60;0.05). It was noted that there was a significantly higher incidence of the bacteria, Staphylococcus epidermidis in Group A (Diabetics) as compared to Group B (Non-Diabetics) (p&amp;#60;0.05). The antibiotic sensitivity of bacteria isolated in patients in Group A (Diabetics) showed the following observations - in Staphylococcus epidermidis, Staphlococcusaureus maximum sensitivity was seen with Gentamicin. A higher positive culture rate was seen in diabetic individuals as compared to non-diabetic individuals. It was then concluded that, as gentamicin shows maximum sensitivity to gram-posit ive and gram-negative organisms, Gentamicin is the drug of choice which takes cares of gram positive as well as gram negative bacteria and can be considered as routine pre-operative topical medication.Pre-operative cataract work up.

Routine uterine culture swab during cesarean section and its clinical correlations: A retrospective comparative study

ObjectivesCesarean sections, particularly non-elective cesareans, are an important risk factor for the development of postpartum endometritis, a leading cause of postpartum febrile morbidity. We evaluated the yield of obtaining routine intrauterine culture during elective and non-elective cesarean sections, in the prevention and management of postpartum endometritis. Study designA retrospective comparative study investigating the distribution of uterine cultures obtained immediately after fetus and placenta delivery during cesarean sections performed in a single tertiary hospital during 2017. True pathogenic bacteria were included in the study analysis and considered as positive results, while other contaminant bacteria were excluded. ResultsPositive uterine cultures were identified in 10.7 % (88/821) of cesarean sections, with no significant difference in prevalence between elective and non-elective cesareans. Escherichia coli (E.coli), isolated in 40.9 % of the positive cultures of all women, was the most common organism in non-elective cesareans vs. Group B Streptococcus (GBS) in elective cesareans. Higher rate of positive cultures was found in term vs. preterm cesareans (17.5 % vs 10.5 %, respectively, p-value = 0.04). E.coli was the most frequent pathogen reported in both women with intact membranes or premature rupture of membranes (46.3 % and 47.3 % respectively). Eight women (9.1 %) with positive cultures presented with postpartum fever; all had undergone non-elective cesarean section. In one-third of these cases the empirical antibiotic treatment was adjusted according to the uterine culture results and susceptibility testing results. ConclusionsObtaining routine intrauterine cultures during non-elective cesarean sections might be useful for detecting significant pathogens and tailoring the antibiotic treatment in postpartum endometritis.

Effect of antibiotic therapy on proton MR spectroscopy findings in human pyogenic brain abscesses.

This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess. This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P<0.0005). Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses - a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.

Factors Predicting Positive Culture in CT-Guided Bone Biopsy Performed for Suspected Osteomyelitis.

The goal of this study was to identify clinical factors and radiographic characteristics associated with positive culture results from bone biopsy in cases of suspected osteomyelitis. A total of 997 CT-guided bone biopsies were reviewed. We reviewed the images and medical records of 29 cases of suspected osteomyelitis to determine if any of the following factors affected culture results: age, sex, history of diabetes, collection of fluid aspirate at the time of biopsy, recent antibiotic therapy, elevated WBC count, and mean attenuation. Of the 29 CT-guided bone biopsies, 21% yielded positive culture results. We found no significant difference in age, sex, history of diabetes, collection of fluid aspirate at the time of biopsy, recent antibiotic therapy, or elevated WBC count between positive culture and negative culture cases. We did, however, find a significant difference in the mean CT attenuation values of the sampled bone between the two groups: 72.0 ± 41.5 HU (95% CI, 28.4-115.6 HU) among the positive culture group compared with 227.5 ± 198.8 HU (95% CI, 141.4-313.6 HU) among the negative culture group (p = 0.03). The rate of positive culture from image-guided core biopsy of suspected osteomyelitis is low. In this study, lower CT attenuation values were associated with a significantly higher rate of positive culture. An attenuation value of 150 HU may serve as a threshold above which biopsy would be expected to have lower utility for obtaining specific microbial culture data.

High Rate of Positive Cultures in Patients Referred With Antibiotic Spacers as Part of 2-Stage Exchange

BackgroundTwo-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains the gold standard treatment in North America. Occasionally, patients with knee PJI are referred for definitive management after resection and antibiotic spacer placement. Currently, little literature exists to suggest how these patients should be managed. The purpose of this study is to report the clinical outcomes of these patients. MethodsWe retrospectively identified 54 patients (54 knees) from 2000 to 2012 treated for PJI with initial TKA resection and spacer placement performed somewhere other than the definitive treatment center. The mean age at reimplantation was 64 years, with 59% being male. Redebridement and antibiotic spacer exchange was performed for all patients. Mean follow-up was 6.5 years. ResultsOf the 54 knees, 22 (41%) grew an organism from a culture taken at the time of redebridement and spacer exchange. The most common organism identified at redebridement was Staphylococcus aureus (41%). Obtaining positive cultures at redebridement was not associated with presenting erythrocyte sedimentation rate (P = .46), C-reactive protein (P = .57), or the presence of retained cement (P = .13). Forty-nine of 54 (91%) knees were ultimately reimplanted. Two-year survivorship free of infection in reimplanted knees was 98%. ConclusionPatients referred with an antibiotic knee spacer for PJI have a high rate of positive cultures at the time of redebridement. Neither the presenting serology nor the identification of retained cement was associated with obtaining positive cultures at the time of redebridement. Nevertheless, this unique cohort of patients has favorable outcomes when redebrided with spacer exchange prior to reimplantation.

A double-reprocessing high-level disinfection protocol does not eliminate positive cultures from the elevators of duodenoscopes.

Duodenoscopes have been the source of serious infection, despite correct performance of high-level disinfection (HLD). This study aimed to observe the impact of performing HLD twice on the rate of positive cultures from duodenoscope elevators. We performed double HLD (DHLD; i. e. complete manual cleaning followed by automated reprocessing, with the entire process repeated) and then randomly cultured the elevators of our duodenoscopes on about 30 % of occasions. DHLD was associated with positive elevator cultures for any microorganism in 9.4 % of cases, with a 0.8 % rate of known pathogens (627 cultures) between May 2015 and February 2016. After February 2016, and in association with changing the precleaning fluid, as well as use of a new FDA-recommended cleaning brush, the rate of positive cultures for any microorganism after DHLD was 4.8 % and 0.2 % for known pathogens (420 cultures). In a third phase, characterized by a change in personnel performing DHLD and retirement of a duodenoscope with a high rate of positive cultures, the rate of positive cultures for any microorganism was 4.9 % (783 cultures) and the rate of positive culture for known pathogens was 0.3 %. To our knowledge, no duodenoscope transmission of infection occurred during the study interval. DHLD resulted in a low rate of positive cultures for known pathogens and for organisms of low pathogenic potential, but did not eliminate these, from duodenoscope elevators. Additional improvements in HLD protocols and/or duodenoscope design are needed.

Association between positive corneal rim cultures and microbiology screening protocols in Ontario

Objective(i) To assess the rate of positive microbiological cultures of corneas prepared by the Eye Bank of Canada (Ontario Division) between January 1, 2012, and December 31, 2013; (ii) to review the microbiology protocols at the 5 major transplant centres in Ontario; and (iii) to assess the incidence of endophthalmitis during the study period. DesignRetrospective chart review. ParticipantsA total of 4186 consecutive cultured corneal tissues prepared by the Eye Bank from January 1, 2012, to December 31, 2013. MethodsRates of culture-positive cornea rims and incidence of postkeratoplasty endophthalmitis at 5 surgical centres in Ontario were determined, and the protocols used to culture rims at each site were concurrently reviewed. Culture results were analyzed via logistic regression for positive cultures. ResultsThe rate of positive cultures at each sites were as follows: centre A, 3.74%; centre B, 3.26%; centre C, 0.51%; centre D, 0.48%; and centre E, 0.04%. Centres A, B, and D were noted to have significantly higher positive rates than centre E. In comparing microbiology protocols, longer incubation period (11 days) was 12 times more likely to be associated with higher positive culture rates than shorter period (4–5 days). Six-month follow-up of all keratoplasties revealed zero reported cases of endophthalmitis. ConclusionsA literature review regarding the predictive value of routine culturing reveals conflicting data. Our findings suggest that differences in the microbiology protocols directly influence the rates of positive rim cultures. Without a standardized protocol, it is not possible to evaluate the predictive value of routine corneal rim culturing in predicting postkeratoplasty endophthalmitis.

Microbiological Characteristics and Clinical Features of Cardiac Implantable Electronic Device Infections at a Tertiary Hospital in China.

The incidence of cardiac implantable electronic device (CIED) infections is rapidly increasing worldwide. However, the microbiological characteristics and clinical features of symptomatic CIED infections are not well described. The present study included patients with CIED infections in China, and their pocket tissues were collected for clinical microbiological determination. A total of 219 patients with CIED infections were investigated; of these patients, 145 (66.2%) were positive for CIED infection in pocket tissue cultures and 24 (11.0%) were positive in both blood and pocket tissue cultures. Patients with recurrent infections and patients with systemic infections tended to have higher rates of positive cultures from pocket tissue. In addition, patients with lung diseases were more likely to have early CIED infections than late CIED infections, while patients with liver diseases were more susceptible to systemic infections than local infections. Staphylococcus species were the most common cause of CIED infections; coagulase-negative staphylococci was the predominant type (accounting for 45.2% in all cases and 68.3% in culture-positive cases). None of the Staphylococcus isolates were resistant to gentamicin, linezolid or vancomycin. Gram-negative bacilli accounted for 9.1% of all cases and 13.8% of culture-positive cases. Significant differences in the distribution of different pathogens were identified between primary infections and recurrent infections, between local infections and systemic infections, and between early infections and late infections. Our data describe the microbiological characteristics and clinical features of CIED infections, and provide evidence for advisory guidelines on the management of CIED infections in China.

A comparative study on the efficacy of first vs second blood culture set in the diagnosis of bacteraemia in Central Referral Hospital, Sikkim, India

Background: An important but controversial subject is the number of blood culture sets required for the diagnosis of blood stream infection (BSI) and also the use of appropriate antibiotics to treat bacteremia. This paper focuses on the need of two blood culture set in comparison to one blood culture in the diagnosis of bacteraemia. Methods: First and second sets were collected aseptically from two different sites at an interval of about one hour from all clinically suspect patients of bacteremia. The samples were processed in Bact/ALERT3D system and further identified in VITEK 2 compact. Results: Second blood culture set yielded higher rates of positive cultures (63%) than first set (37%). The common bacterial isolates were Coagulase negative Staphylococcus (CoNS) 29 (28%), followed by Staphylococcus aureus 20 (20%), Escherichia coli 13 (13%) and Klebsiella pneumonia 11(11%). Methicillin resistance was observed in 90% of S. aureus isolates. All Gram positive bacteria were found sensitive to vancomycin. In Gram-negative organisms, extended spectrum β-lactamases (ESBL) was observed in 40.5% isolates and resistance to carbapenems was found to be 37.8%. Discussion/Conclusion: In India, most hospitals routinely use single aerobic blood culture. The isolation of CoNS in blood is difficult to interpret hence, proper collection, processing, and relevant clinical information can significantly reduced the chances of contamination. Automated blood culture system can significantly shorten the length of time for isolation and identification compared to the manual techniques which takes about seven days. Resistance to antibiotics is a matter of concern that can result in ineffective treatment.

A Cluster of Fungal Corneal Transplant Infections, and the Surprisingly High Rate of Positive Cultures from Banked Corneal Tissue

A Cluster of Fungal Corneal Transplant Infections, and the Surprisingly High Rate of Positive Cultures from Banked Corneal Tissue

A 24-year study of the epidemiology of human brucellosis in a health-care system in Eastern Saudi Arabia

The aim of the study was to examine the epidemiology of human brucellosis in a helath-care system in Eastern Saudi Arabia. All cases of human brucellosis from 1983 to 2007 were analyzed. In the study period, there were 913 patients with brucellosis in the Saudi Aramco health-care system. There were 608 males and 305 females with a male to female ratio of (2:1). The annual incidence rate per 100,000 populations increased from 13 to 70 in 1983 and 1987, respectively, then decreased to 9 in 2006. The age of the patients ranged from 1 to 83 years with a mean age of 35.8+/-17.9 years and a median of 36 years. Of the total patients, 195 (21%) and 155 (17%) cases occurred in those between 20-30 and 31-40 years of age, respectively. Children (< or =10 years of age) constituted 5% of all the patients. The adjusted rate per 100,000 population showed that the highest rate was in those 40-49 years of age (100/100,000) and the lowest rate was in patients less than 10 years of age (2.9/100,000). The number of cases was highest in April to June (n=361; 39.5%) and the lowest reported cases were in January. Of the 219 patients whom their families had animals, 125 (57.1%) had camels, 49 (22.4%) had sheep, 24 (11%) had goats, and 21 (9.6%) had cows. Blood cultures were positive in 80.7% (201/247) of cases. There was no association between age group and the rate of positive blood culture (P value=0.244). The titer of brucella serology was 1:320 in 34.3%, 1:640 in 31%, 1:1280 in 24.7%, > or =1:2560 in 10%. The higher brucella titers were associated with higher rate of positive cultures (P value=0.0002). There was a decrease in the incidence of brucellosis over the study period. The highest incidence was in patients 40-49 years of age. Continued surveillance and efforts are needed to further decrease the cases of brucellosis.

Antibiotic Therapy for Streptococcal Pharyngitis Revisited

Infectious Diseases| August 01 2008 Antibiotic Therapy for Streptococcal Pharyngitis Revisited AAP Grand Rounds (2008) 20 (2): 15–16. https://doi.org/10.1542/gr.20-2-15 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antibiotic Therapy for Streptococcal Pharyngitis Revisited. AAP Grand Rounds August 2008; 20 (2): 15–16. https://doi.org/10.1542/gr.20-2-15 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amoxicillin, antibiotic therapy, penicillin, sore throat, streptococcal, pharyngitis Source: Lennon DR, Farrell E, Martin DR, et al. Once-daily amoxicillin versus twice-daily penicillin V in group A β-haemolytic streptococcal pharyngitis. Arch Dis Child. 2008;93(6):474–478; doi:10.1136/adc.2006.113506 Investigators from New Zealand enrolled children 5–12 years of age in a prospective, randomized (1:1), nonblinded study to determine if oral once-daily amoxicillin (1500 mg if >30 kg, 750 mg if ≤30 kg; n=177) was noninferior to oral twice-daily penicillin V (500 mg if >30 kg, 250 mg if ≤ 30 kg; n=176) for treatment of group A β-hemolytic streptococcal (GAβHS) pharyngitis. Both drugs were given for 10 days. Children were enrolled between May 1996 and November 1998 if they presented with a sore throat and signs and symptoms suggestive of acute pharyngitis at a school clinic and had a throat culture positive for GAβHS. Noninferiority was defined as the upper confidence limit (CL) of a less than 10% difference in treatment effect between the two arms. Exclusion criteria included receipt of antibiotics in the previous 72 hours; history of acute rheumatic fever (ARF), cardiac or kidney disease; a rash suggestive of scarlet fever or mononucleosis; immunocompromised state, neoplasia, terminal illness, or neutropenia; and inclusion in the study during the prior 12 weeks. Children were seen for follow-up evaluations three additional times: days 3–6, days 12-16, and days 26–36. Throat cultures were performed on all follow-up visits and all GAβHS isolates were serotyped to determine failure (same serotype as initial isolate), relapse (same serotype as previous isolate with an intervening negative culture), or new acquisition (different serotype from the initial isolate). Impact of therapy on clinical course was also evaluated at each follow-up visit. A total of 353 patients were enrolled. Half the patients were Maori and a third were Pacific Islanders. Eleven children in the amoxicillin and seven in the penicillin group did not complete their course of treatment. Both drugs were well tolerated and adherence was 97% for the amoxicillin group and 98% for the penicillin group for receiving ≥80% of their doses. Amoxicillin was not inferior to penicillin V for bacteriologic failure at any follow-up visit. On the first follow-up visit, the treatment failure rate was 5.8% in the amoxicillin group and 6.2% in the penicillin group, while at the second follow-up visit, the treatment failure or relapse rate was 12.7% for the amoxicillin group and 11.9% for the penicillin group (upper 95% CL for difference between the groups of 6.5%). At the third follow-up visit the treatment failure or relapse rate was 10.7% in the amoxicillin group and 11.3% in the penicillin group (upper 95% CL for difference between the groups of 8.5%). The higher rate of positive cultures at the second and third follow-up visits compared with the first follow-up visit was primarily due to relapse. No significant differences in resolution of symptoms were noted between treatment groups. The authors conclude that once-daily amoxicillin is noninferior to twice-daily penicillin for the treatment of GAβHS pharyngitis in this population. Drs. Rathore and Barton have disclosed... You do not currently have access to this content.

Imaging-Guided Bone Biopsy for Osteomyelitis: Are There Factors Associated with Positive or Negative Cultures?

The objective of our study was to identify the clinical and technical factors associated with positive or negative culture results in histologically positive cases of osteomyelitis obtained from imaging-guided bone biopsies. A retrospective review was performed of 800 consecutive patients undergoing imaging-guided core bone biopsies at two institutions. Seventy-five biopsies were performed for suspected osteomyelitis and 41 patients had histologically proven osteomyelitis. A chart review was performed to determine whether the following factors affected the culture result: histologic type of osteomyelitis, antibiotic therapy before biopsy, fever (temperature > or = 38.0 degrees C), elevated WBC count (> or = 10 x 10(3) microL), elevated erythrocyte sedimentation rate (ESR) (> or = 10 mm/h), elevated C-reactive protein value (CRP) (> or = 6 mg/L), the size of the biopsy needle, and the amount of purulent fluid obtained at biopsy. Of the 41 cases of osteomyelitis, 14 (34%) had positive cultures. Eighteen (44%) of 41 cases were chronic osteomyelitis. Seventeen (41%) of 41 patients received antibiotics before biopsy, seven (17%) were febrile, five (12%) had an elevated WBC count, 16 (39%) had an elevated ESR, and six (15%) had an elevated CRP value. The biopsy needle size ranged from 11- to 18-gauge. These factors did not have any significant association with positive or negative culture results. Purulent fluid was aspirated in 10 (24%) of the 41 cases. In six (15%) of the cases, > or = 2 mL of purulent fluid was aspirated and five (83%) of the six cases were associated with positive culture (p = 0.02). The rate of positive culture results in histologically proven cases of osteomyelitis obtained from imaging-guided bone biopsies is low. Aspirating > or = 2 mL of purulent fluid is associated with a significantly higher rate of positive cultures.

Microbiota aeróbia conjuntival nas conjuntivites adenovirais

Objetivos: Estudar a microbiota aeróbica conjuntival em pacientes com quadro clínico de conjuntivite viral aguda. Método: Trinta pacientes entre 18 e 40 anos portadores de conjuntivite adenoviral e 30 pacientes sem a doença foram submetidos à colheita de material da conjuntiva para cultura. Os portadores de conjuntivite adenoviral foram submetidos ao exame até 3 dias após o início dos sintomas. As culturas foram realizadas utilizando-se os meios de ágar-sangue e ágar-chocolate. Pacientes em uso de medicação tópica ou sistêmica, usuários de lentes de contato e aqueles com doença ocular prévia ou doença sistêmica foram excluídos. Resultados: Houve positividade significantemente maior das culturas de conjuntiva nos pacientes com conjuntivite adenoviral (33,3%, sendo Haemophylus influenzae em 50% e Streptococcus pneumoniae em 50%) quando comparados ao grupo controle (6,6% - Staphylococcus coagulase negativo). O grupo de pacientes com conjuntivite e que apresentaram culturas positivas, não diferiu em nenhum dos critérios clínicos analisados do grupo com culturas negativas. Conclusão: Pacientes com conjuntivite adenoviral apresentaram maior freqüência de exames de cultura de amostra de conjuntiva positivas quando comparados aos controles normais. Os pacientes com conjuntivite adenoviral com cultura positiva apresentaram evolução clínica semelhante aos pacientes com cultura negativa. Os agentes isolados na microbiota conjuntival no grupo com conjuntivite foram diferentes do observado no grupo normal. Porém o resultado das culturas não apresentou correlação com a evolução clínica.

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

55-Year-Old Man With a Lung Lesion and Hemidysesthesia

Simultaneous Bacteriologic Assessment of Bile From Gallbladder and Common Bile Duct in Control Subjects and Patients With Gallstones and Common Duct Stones

To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.