Identification Of Causative Organism Research Articles

Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations.

Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.

First recorded outbreak of Paramphistomum cervi in Andaman local goats (Capra aegagrus hircus) from Bay island of India: A brief communication

This communication reports an outbreak of immature paramphistomiosis in Andaman local goats (Capra aegagrus hircus) along with report of mortality and gross as well as histopathological changes. During the month of September, 2021 there was report of 38.57% mortality in goats which was investigated in depth. Outbreak occurred at South Andaman district where goats were reared under semi intensive managerial system and allowed to graze in the morning in surrounding marshy land. The affected animals showed the symptoms of immature amphistomiasis; it was further confirmed on necropsy and identification of causative organism as Paramphistomum cervi based on its typical morphological features. Histopathological examination showed damaged structure of rumen with typical degenerative changes and initiation of necrotic changes of cells with infiltration of inflammatory cells. We report the outbreak of immature amphistomiasis for the first time from Andaman and Nicobar archipelago along with the causative agent.

Evolving Patterns of Infective Endocarditis: Insights from a Tertiary Healthcare Institute in Western India

Abstract Context: Infective endocarditis (IE) is a dynamic disease with high morbidity and mortality despite advancements in diagnostics, antimicrobial therapy, and surgery. India faces a complex situation due to changing factors such as host characteristics, diagnostic techniques, antibiotics, and aggressive surgical approaches. Monitoring local epidemiology is crucial for prompt recognition and treatment. However, studies on IE trends in India are scarce and outdated. Aims: To investigate the clinical, microbiological, predisposing conditions, echocardiographic characteristics, and treatment outcomes of IE patients admitted to a Tertiary Care Academic Institute in Western India. Settings and Design: This retrospective observational study was done in a 2011-bedded tertiary care referral hospital in Western Maharashtra, between June 2019 and May 2023. The records of all adult patients (age >14 years) admitted during the study period with a definite diagnosis of IE, both native valve endocarditis and prosthetic valve endocarditis according to the modified Duke criteria, were included in the study. Baseline demographic data on age, sex, underlying heart disease, and predisposing conditions for bacteremia (infections, central venous catheters, surgeries, and invasive procedures) were collected. Subjects and Methods: The echocardiographic and microbiological findings, complications, treatment, and outcomes were noted. All blood cultures done for the diagnosis of IE were processed using standard methods to identify bacterial and fungal species and antimicrobial susceptibility profiles. For all the patients in this study, blood (5–8 mL per bottle) was collected in adult blood culture bottles using standard precautions and processed by a semiautomated blood culture system (BioMérieux, Marcyl̕ Etoile). Identification of causative organisms was performed by standard microbiological methods. Transthoracic and transesophageal echocardiography were performed to determine the location of vegetation, type of valve infected, and cardiac complications. Sample Size Calculation: Considering the Indian prevalence of IE to be 14.5% as observed by Gupta et al.,margin of error as 9%, and 95% of confidence level, the minimum required sample size calculated using WinPepi software (version: 11.65) for conducting the study was 59 patients. Statistical Analysis: Data was collected and entered into a database using Microsoft Excel. Data was represented as the frequency with percentage and Chi-square test (two-sample proportionality test) were applied for comparison of categorical variables. Quantitative data was summarized using mean and standard deviation and a two-sample t-test was applied to compare differences. P < 0.05 was considered statistically significant. Results: The mean age in the study was 44.1 ± 10.6 years with a female preponderance (male:female – 0.85:1). Rheumatic heart disease (RHD) (44.3%) was the most common underlying heart disease etiology, whereas 33% of patients did not have any cardiac disease. Blood culture was positive in 34.9% of episodes, with the most common organisms being Gram-positive Staphylococci (38%). Medical complications such as congestive heart failure (CHF) and acute kidney injury were seen in 41.2% of patients, followed by cerebrovascular accident and stroke in 20.6%. The majority of patients, 61.9%, had received antibiotics before referral to our center. Thirty-seven (58.7%) patients underwent definitive surgery for IE. The total in-hospital mortality rate was 12 (19.1%). In the univariate analysis, younger patients (<50 years) with CHF, diabetes mellitus, and Staphylococcus culture-positive IE were independent predictors of mortality. Conclusions: Over the past four decades, the landscape of IE in India has experienced noteworthy transformations. The disease profile of patients has shifted from predominantly older individuals with RHD to a rising number of younger patients with prosthetic valves or those without identified valvular conditions. Moreover, the yield of blood cultures has declined due to the increased utilization of antibiotics over the last two decades, although Staphylococcus species continue to be the most common organisms detected. Despite significant advancements in medical technology, the mortality rate remains unchanged. Our study provides compelling evidence to advocate for early surgical intervention, which holds the potential for improved outcomes.

Susceptibility Pattern of Bacteria Isolated from Patients Admitted in Medical ICU with Pneumonia

Background: Patients in ICU presenting with severe disease suffer from multidrug-resistant bacteria, resuting in reduced therapeutic options which cover ICU pathogens spectrum. Identification of causative organism and its antibiotics sensitivity pattern has become cornerstone for antibiotic selection. β-Lactams i.e. cephalosporins, carbapenems, penicillins, and monobactams constitute 60% of total antibacterials used, however; with high usage of such antibiotics the emergence of resistance. Aim: To determine prevalence of local type of bacterial isolates and their antibiotic susceptibility. Study Design: Cross sectional study Place and Duration of Study: Medical ICU, Pakistan Ordinance Factories Hospital, Wah Cantt from 1st January 2020 till 31st July 2021. Methodology: One hundred patients were enrolled. Samples were taken from blood, sputum, bronchoalveolar lavage and tracheal secretions of the patient and sent to microbiologist for culture and sensitivity reports. Results: The mean age was 57.52+13.427 years, 47 females and 53 male patients. 72 patients were shifted out and remaining 28 died. In 57 patients, sputum specimen was taken, blood specimen of 24 patients, tracheal secretion of 8 patients and 11 patients bronchoalveolar lavage was taken. 33 were positive for Klebsiella pneumoniae, 29 patients were positive for acinetobacter baumanii. Pseudomonas aeuriginosa was positive in 18 patients, 05 patients for E. coli. In gram positive category; 05 patients were positive for staph aureus, 06 patients for MRCONS, 3 to MRSA and 1 patient for coagulase negative staphylococcus species. Conclusion: The high levels of antibiotic resistance are seen among both gram negative and gram positive isolates. Presence of elevated resistance to multiple drugs is an indicator for high prevalence of multi-drug resistant gram positive as well as gram negative organisms, so proper identification of organism in order to ascertain administration of emperical drugs most effective against the isolated organism is recommended in severe cases. Keywords: Antibiogram, Bacterial isolate, Pneumonia, Sensitivity

Common Pathogens Isolated from Infected Diabetic Foot Ulcers at King Abdulaziz University Hospital, Saudi Arabia: A Retrospective Study

Objectives: To determine the common pathogens isolated from DFI to administer appropriate antibiotic treatment, followed by surgical interventions. Methods: A retrospective study was performed on 260 patients who presented with diabetic foot at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2014 to September 2020. All patients underwent swabs and tissue culture for microbiological evaluation. Patient medical records were reviewed to collect demographic and clinical data, including Glycated Hemoglobin (HgA1C), Diabetes Mellitus (DM) type, duration of diabetes, swab, tissue culture, type of surgery, and type of isolated organism. Results: Escherichia coli was the most common organism isolated from the feet of diabetic patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus agalactiae, and Pseudomonas aeruginosa. Amputations were significantly higher in patients who did not have Staphylococcus aureus or Pseudomonas aeruginosa infection, with no significant relationship between amputation and any other isolated organisms. A significant negative correlation between patient age and HgA1C level was discovered, as well as a significant positive correlation between HgA1C and the number of minor amputations. Patients with major and minor amputations had a significantly higher percentage of non-Multidrug Resistance (MDR), whereas patients with MDR had a significantly higher rate of infection with Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus. Conclusion: DM is a metabolic syndrome that affects all the body systems and impacts both morbidity and mortality. The most common organism isolated from the feet of diabetic patients was Escherichia coli, followed by Staphylococcus aureus. Ulcer specimens should be collected for culture and identification of causative organisms. Preventive measures such as good glycemic control, appropriate foot care, targeted antibiotic therapy, and patient education can reduce the incidence of amputation.

Comparative study of manual conventional blood cultures versus automated blood culture system in cases of septicemia

: Blood cultures are a proven gold standard method for the identification of causative agents of bloodstream infections. Identification of causative organism along with antibiotic susceptibility plays a pivotal role in proposing suitable antibiotic therapy. Automated blood culture systems show improved monitoring of blood cultures by reducing the time and by ensuring more accurate results when compared to the conventional blood culture system.To isolate the organism from given blood samples of a suspected case of septicemia and to compare the results of conventional and automated blood culture systems and to study the antimicrobial susceptibility pattern of the pathogens isolated.A prospective study of 6 months period was conducted among 100 subjects attending the Department of Microbiology in a tertiary care hospital. Subjects with symptoms and signs of septicemia were included. 25ml of venous blood was drawn aseptically from the venipuncture site, of which 5ml of blood was inoculated into 50ml of Brain Heart Infusion bottle in conventional blood culture system and 10ml each into aerobic and anaerobic BACTEC PLUS bottle in Automated blood culture system BACTEC FX40.Overall, 48% and 60% of the samples revealed positive growth by the conventional and automated blood culture system BACTEC FX40, respectively. Gram Positive Cocci were 52.08% and Gram Negative Bacilli were 47.91% isolated by conventional blood culture system, whereas automated blood culture system BACTEC FX40 isolated 45% and 55%, respectively. Isolates were detected within 24-48hrs and 12-24 hrs by conventional and automated blood culture systems, respectively. The anti-microbial susceptibility pattern of the pathogens isolated was also recorded by Kirby Bauer disc diffusion method of antimicrobial susceptiblity testing.Automated blood culture systems are a trustworthy substitute to conventional blood culture systems. The automated blood culture systems being more sensitive and rapid in detecting septicemia in subjects acts as an appropriate means for the initial identification and detection of blood pathogens and improved provision of antimicrobial therapeutic options for septic Patients especially in Critical Care and Intensive Care Units where positive culture reporting is crucial.

Atypical microbial keratitis

Atypical microbial keratitis refers to corneal infections caused by micro-organisms not commonly encountered in clinical practice. Unlike infections caused by common bacteria, cases of atypical microbial keratitis are often associated with worse clinical outcomes and visual prognosis. This is due to the challenges in the identification of causative organisms with standard diagnostic techniques, resulting in delays in the initiation of appropriate therapies. Furthermore, due to the comparatively lower incidence of atypical microbial keratitis, there is limited literature on effective management strategies for some of these difficult to manage corneal infections. This review highlights the current management and available evidence of atypical microbial keratitis, focusing on atypical mycobacteria keratitis, nocardia keratitis, achromobacter keratitis, and pythium keratitis. It will also describe the management of two uncommonly encountered conditions, infectious crystalline keratopathy and post-refractive infectious keratitis. This review can be used as a guide for clinicians managing patients with such challenging corneal infections.

A comparative evaluation of Typhidot and Widal tests for the detection of agglutinins against typhoid and paratyphoid bacilli in patients’ sera

Background: The term enteric fever includes typhoid fever caused by Salmonella typhi and paratyphoid fever caused by Salmonella paratyphi A, B, and C. Typhoid fever has been virtually eliminated in the developed countries during the past several decades, mainly as a result of improvement in water supply and sanitation, but it continues to be endemic in the resource-limited nations of the world. The control of paratyphoid fever has not been so successful. Bacteriological diagnosis of enteric fever consists of isolation of the bacilli from the patients and the demonstration of antibodies in their sera. Widal testing is cost-effective and gives reports quickly. The Typhidot test is based on the method of immunochromatography test. It is easy to perform, and the results can be preserved for a long time. This study aims to compare the sensitivity and specificity of the Widal test and Typhidot test for the diagnosis of enteric fever. Materials and Methods: This prospective study was carried out at the Department of Microbiology, N.C. Medical College and Hospital, Panipat, Haryana, India, over 6 months from September 2020 to February 2021. In our study, a total of 150 clinically suspected patients were included. First of all, the area for blood collection was cleaned with spirit-soaked cotton and 10 mL of blood was collected with a sterile disposable needle and syringe from a median cubital vein (antecubital vein) of each patient after obtaining informed consent from the patient (from parents in case of age below 18 years). Seven milliliters of blood was immediately transferred to a blood culture bottle by cleaning the cap of the bottle for isolation and identification of causative organisms and 3 mL was transferred to a sterile plain vial for serum separation. Then the qualitative Widal slide agglutination test and Typhidot test were performed on each sample. Results: In the present study, out of the 150 clinically suspected enteric fever cases, maximum positivity 53 (35.33%) was given by the Typhidot test, followed by 36 (24%) given by the qualitative Widal slide agglutination test and 44 (29.33%) given by blood culture for S. typhi and S. paratyphi. Conclusion: Our study highlights the use of Typhidot for early diagnosis of enteric fever and also cross-checks with Widal test and blood culture for the diagnosis of enteric fever. Typhidot tests are easy to perform and less-trained personnel can also perform the test; they have been designed to detect IgM and IgG antibodies to lipopolysaccharide or outer membrane protein antigens of S. typhi and S. paratyphi. It can be useful in the early diagnosis of infection in the initial weeks of primary infection when a single serum sample is available, with a sensitivity and specificity of 90% and 80%, respectively, considering blood culture as a gold standard.

Sensitivity and Resistance Pattern of Bacteria in Benin City, Nigeria

Background: Sensitivity and resistance pattern of bacteria provides vital information for the development and implementation of an effective antibiotic policy. Proper identification of causative organisms enables informed decision making in rational use of antibiotics. Objectives: To determine the most common site of bacterial infection, the prevalence of common bacteria based on their site of infection and to document the sensitivity of these microorganisms to two selected antibiotics. Methods: A prospective cross-sectional study conducted in seven laboratories and a private hospital in Benin City, Nigeria. A validated structured questionnaire was administered to 420 respondents. Data obtained were analyzed using Microsoft Excel and GraphPad Instat. P-values < 0.05 at 95% confidence interval were interpreted as significant. Ethical considerations were observed. Results: Response rate was 83.57%, 60% of the respondents were females while a majority were within the ages of 26-30 years (31.91%). Majority of the patients surveyed contracted Staphylococcus aureus (n=180, 51%) while Escherichia coli was the next most prevalent bacteria. Staphylococcus aureus was found to be resistant to cotrimoxazole and amoxicillin but sensitive to erythromycin and ciprofloxacin. Only 18 patients had more than one micro- organism isolated from their site of infection. Urinary tract was the most common site of infection. Isolates showed sensitivity and resistance to multiple antibiotics. Conclusion: The urinary tract was the most common site of bacterial infection while the most prevalent microorganism was Staphylococcus aureus which is sensitive to erythromycin and ciprofloxacin but not to cotrimoxazole and amoxicillin.

The risk of early complications in patients with hand infections

Background: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study population. Methods: This retrospective observational descriptive study was performed at a regional referral centre in South Africa. All primary hand infection cases treated over a period of one year were reviewed. Children under 18 years, cases with incomplete primary outcome data and post-operative infections were excluded. Clinical and demographic data was extracted from clinical records. Amputation, re-debridement and tissue loss requiring skin grafting were regarded as early complications. Bacteriological analysis comprised identification of causative organisms as well as evaluation of their resistance profiles. Risk factors that were found to be significant for development of early complications were entered into a multivariate regression analysis. Results: After inclusion and exclusion criteria were applied, 78 patients were deemed eligible for inclusion to the study. The patientassociated risk factors that were found to be associated with the development of early complications after univariate analysis were increasing age and poorly controlled diabetes mellitus. Human bites and polymicrobial infections were the only aetiological factors that were identified to be significant on a univariate level. Initial presentation to a private sector general practitioner (GP) was the only management factor to reach significance on univariate analysis. Human immunodeficiency virus (HIV) infection, CD4 count, viral load and duration of ARV treatment were not found to be significantly associated with the development of early infections. On multivariate logistic regression analysis, poorly controlled diabetes mellitus, human bites and first presentation to a private GP were the only risk factors that remained significant for the development of early complications. The culture yield was 68%. Staphylococcus aureus (S. aureus) was the most frequently isolated organism (37%), followed by polymicrobial infections (10%). S. aureus encountered in our study population remained mostly sensitive to cloxacillin; however, high levels of resistance (50%) to ampicillin were observed. Klebsiella sp. and Acinetobacter sp. were the most frequently observed Gram-negative organisms. Conclusion: After multivariate regression analysis, hand infections in poorly controlled diabetic patients, infections occurring after human bites as well as those affected by polymicrobial infections were identified as independent risk factors for development of early complications in patients with hand infections. HIV infection was not found to be a significant risk factor. Our bacteriological profile is in keeping with trends demonstrated in the literature where S. aureus infections seem to be declining in frequency while polymicrobial infections seem to be encountered more frequently. Level of evidence: Level 4

Capnocytophaga canimorsus peritonitis diagnosed by mass spectrometry in a diabetic patient undergoing peritoneal dialysis: a case report

BackgroundBacterial peritonitis is a serious complication of patients undergoing peritoneal dialysis (PD). Although the identification of causative organisms and use of appropriate antibiotics are essential for treatment, rare and fastidious bacteria are sometimes difficult to detect by conventional biochemical assays. Capnocytophaga canimorsus is a fastidious and slow-growing bacterium that forms a part of the normal oral flora of dogs and cats and is extremely rare as a peritonitis-causing organism. This report demonstrates the usefulness of a mass spectrometry-based technique in identifying such a rare organism in PD-related peritonitis and discusses the diagnosis and treatment of C. canimorsus peritonitis.Case presentationA 49-year-old woman with type 2 diabetes mellitus underwent PD for two years. Repeated exit-site infections led to subcutaneous pathway diversion two months ago. She was hospitalized with fever and abdominal pain as well as cloudy dialysis effluent. Laboratory data revealed increased serum C-reactive protein level and white blood cell (WBC) count in the effluent. Her exit site had no sign of infection, leading to the diagnosis of PD-related peritonitis. Initial therapy with intraperitoneal ceftazidime immediately ameliorated her symptoms, and the WBC count in the effluent normalized in five days. Culture test results of the dialysis effluent on admission were negative with no information regarding the infection route. However, mass spectrometry (MALDI Biotyper, Bruker Daltonics) successfully obtained the specific spectral pattern for C. canimorsus. She had four cats in her house and was advised not to allow the cats in the room where the bag exchange took place.ConclusionsC. canimorsus is a rare cause of peritonitis in PD patients and is usually susceptible to intraperitoneal third-generation cephalosporins. This mass spectrometry-based bacterial identification method could provide more opportunities to identify uncommon causes and promote appropriate antibiotics therapy in PD-related peritonitis.

Bronchoalveolar lavage for etiological diagnosis of childhood pneumonia

Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms. Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.

Antimicrobial Susceptibilty Profile of Urinary Tract Infection: A Single Centre Hospital Based Study From Nepal

Introduction: Urinary tract infection (UTI) is amongst the most common bacterial infections. Identification of causative organism and their in-vitro susceptibility test is essential for the successful treatment of a patient. The study was done to determine different bacterial species causing UTI and their antimicrobial susceptibility profile.
 Materials and methods: A total of 332 urine samples from patients attending both inpatient and outpatient departments of UCMS-TH were included in this study. Samples were subjected to culture and sensitivity test with the use of standard bacteriological techniques as described by American Society for Microbiology (ASM).
 Results Twenty three percent of the total urine samples showed significant bacterial growth. Thirteen different bacterial species were isolated. Among these, Escherichia coli (50.6%) was the most predominant one followed by Klebsiella species (15.6%), Staphylococcus aureus (7.8%) and others. Majority of bacteria isolated was found to be sensitive to imipenem (82%) followed by nitrofurantoin (78%), gentamicin (63.8%) and others.
 Conclusion: UTI is a commonly encountered case in general practice. Females are commonly affected than males. Majority of bacterial isolates were found resistant towards commonly used first line antimicrobial agents. This type of study should be continued to determine the changing pattern of microbial flora and their antibiogram.

Prevalence of altered cervical cytological pattern: Aretrospective study in females visiting tertiary care hospital

Background: Cervical cancer is one of the major causes of morbidity and mortality in India. Pap smear is a simple, non-invasive, cost-effective and sensitive tool to detect various non-neoplastic and neoplastic lesions of cervix. The objective of this study was to estimate the prevalence of cervical cytological pattern in a tertiary care centre; by using conventional Papanicolaou (Pap) smears for the screening of inflammatory, premalignant and malignant lesions of the cervix. Methods: This cross-sectional study is based on 574 patients who attended the out‑patient Department of Obstetrics and Gynecology, during the period between Jan 2015 to Feb 2017. Pap smears were prepared from patients presenting with complaints like vaginal discharge, post‑coital bleeding, inter‑menstrual bleeding, dyspareunia, and pain in lower abdomen. Conventional Papanicolaoustained smears were classified as per Bethesda 2001 nomenclature. Results: Prevalence of altered cervical cytological pattern was 75.59% amongst females visiting hospital. A total of 574 cervical pap smears were studied, out of which 66 were inadequate. Out of 508 cases, 448 cases were of NILM [including 324 (63.78%) inflammatory lesions and 124 (24.41%) normal smears] and 60 (11.81%) cases of epithelial lesions. The epithelial lesions prevalence rate was ASCUS (5.7%), LSIL (1.4%) and HSIL (1.4%), AGUS (0.78%), SCC (0.6%) and endometrial carcinoma (0.2%). Conclusions: This study shows relatively high prevalence of epithelial abnormalities with increasing age, parity, women with clinical lesions on per speculum findings. Malignancy was more common in sixth and seventh decade and intraepithelial lesions/dysplasia was seen mostly in fourth and fifth decade. Inflammatory lesions were more common in younger age group. Pap smear should be advised as a routine screening procedure; as it is a simple, cheap, safe and practical diagnostic tool for early detection of cervical cancer in high risk group population. It also helps in diagnosis of inflammatory lesions including the identification of causative organism and atrophic changes.

The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention.

Study Design:Retrospective, descriptive study.Objectives:Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective.Methods:Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis.Results:All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics.Conclusions:The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.

Bacteriological profile of diabetic foot ulcer using hicrome UTI Agar

Introduction: Foot ulcers are one of the common complications of diabetes mellitus. Diabetic foot ulcer infections are usually polymicrobial infections. For effective treatment, quick isolation and identification of causative organisms with appropriate antibiotic susceptibility testing is needed. Objective: Isolation and identification of bacteria using routine media and HiCrome UTI agar. Materials and Methods: Samples were taken from all Type II diabetes mellitus patients with foot ulcers attending hospital. Samples were collected from deeper portion of the ulcer using 2 sterile swabs and processed using conventional methods and HiCrome UTI agar. Antibiotic susceptibility testing was done on Mueller Hinton agar according to CLSI guidelines. Results: Among 100 samples tested, 138 organisms were isolated as 38% of samples yielded mixed growth. Conventional methods failed to detect 6 (4.3%) isolates form mixed cultures. HiCrome UTI agar isolated all organisms in the cultures including 4 isolates of enterococci and 2 isolates of MSSA, which were missed in conventional methods (p < 0.01). Pseudomonas (22.4%) was commonest organism isolated. Followed by Klebsiella spp. (18.8%), Proteus spp. (15.2%), MSSA (13%), Escherichia coli (11.5%), Citrobacter spp. (7.2%), MRSA (7.2%), Enterococcus spp. (4.3%). Conclusion: Gram negative organisms (75.3%) were predominantly isolated in the study. HiCrome UTI agar can be used for primary identification and quick isolation of organisms where facilities for routine culturing are not available. It is both sensitive and specific in isolating and identifying organisms as in polymicrobial infections.

Identification of causative organism in cardiac implantable electronic device infections

BackgroundThe causative organism in cardiovascular implantable electronic device (CIED) infection is usually diagnosed with the cultures from blood, removed leads, and/or infected pocket material. The cultured organism, however, is sometimes different among these samples. MethodsTwo hundred sixty patients with CIED infection, who underwent lead extraction between April 2005 and December 2014, were analyzed. More than two blood culture sets, all the extracted leads, and swab culture of the pocket were sent to the laboratory for culture. Among the patients all of whose microbiological examinations were available, we analyzed the causative organism defined as the species detected in at least two different sites. ResultsAll the culture results were available in the 208 patients, showing 69 systemic infections (including 30 cases of infectious endocarditis) and 139 local infections. Blood culture, lead culture, and swab culture were positive in 57 (27%), 169 (81%), and 152 (73%), respectively. Staphylococcus aureus [37% including methicillin-resistant S. aureus (MRSA) (12%)] and coagulase-negative staphylococci (CoNS, 36%) were the most common causative organism, followed by non-staphylococci (23%), and poly-microbial infection (4%). The detection of S. aureus from pocket or removed leads rendered higher predictive value of a causative organism than that of CoNS. The detection of Gram-negative bacteria, fungi, and mycobacteria indicated that it was most likely a causative organism. Gram-positive bacteria excluding Staphylococcus, such as Corynebacterium spp., tended to coexist as a benign organism. ConclusionsThe causative organism is mostly S. aureus and CoNS. Detection of S. aureus or Gram-negative bacteria means that it is more likely a causative organism.

Diagnostic value of neutrophil-lymphocyte ratio versus C-reactive protein in discrimination between different pathogens causing community-acquired pneumonia

Early discrimination of the causative organisms of community-acquired pneumonia (CAP) is important. The aim of the present study is to evaluate neutrophil–lymphocyte ratio (NLR) and derived NLR (dNLR) as adjunct tests to differentiate different types of CAP. NLR, dNLR, and C-reactive protein (CRP) were measured in 187 patients with CAP. Identification of causative organisms was done by direct smears, microbiological cultures, VITEK 2 compact system, and PCR of patient’s sputa together with detection of specific IgM antibodies against Chlamydia pneumoniae. There was a significant increase of NLR and CRP values in patients with bacterial pneumonia as compared to patients with TB and patients with atypical pneumonia. NLR and CRP were significantly higher in atypical than TB pneumonia. Although dNLR was significantly higher in both bacterial and atypical than TB pneumonia, it was insignificantly differ between bacterial and atypical pneumonia. For discriminating bacterial CAP from TB, the area under curve (AUC) for NLR was found to be significantly higher than that of CRP at cutoff values of 7.8 for NLR and 172.9 mg/l for CRP. Also, at cutoff values of 6.6 for NLR and 179.1 mg/l for CRP, NLR distinguished bacterial from atypical pneumonia more accurately than CRP (AUC = 0.92 versus 0.74). There was no significant difference in inflammatory marker levels between subcategories of atypical pneumonia except for CRP. There was a significant positive correlation between NLR and CRP in pneumonic patients (r = 0.71, p = 0.000). NLR is easy to be calculated from daily practice and might be used as a surrogate marker to differentiate bacterial CAP from atypical and TB pneumonia as well as atypical from TB pneumonia but could not discriminate the different pathogens causing atypical bacterial pneumonia. dNLR could discriminate TB from both bacterial and atypical pneumonia but could not differentiate bacterial from atypical pneumonia.

Organisms Recovered from Cases of Canine Pyoderma and their Antibiogram Pattern

Canine pyoderma is one of the most common causes of dermatitis with worldwide occurrence in small animal practice. The condition is diagnosed on the basis of clinical manifestations, isolation and identification of causative organisms by bacteriological cultural examination. A study on 130 clinical cases of canine pyoderma was conducted at the Teaching Veterinary Clinical Complex (TVCC), Veterinary College, Anand during July, 2016 to April, 2017. In the study undertaken, bacteriological culture examination of 116 pus swabs resulted in the recovery of 165 bacterial isolates. Exudate/pus samples were collected and subjected to bacteriological cultural isolation, identification and subsequently in vitro antibiotic sensitivity testing. On culture, staphylococci were the most predominantly isolated organisms. Amongst staphylococci, Staphylococcus pseudintermedius (49.69%, n=82), a coagulase-positive staphylococci (CPS), was the most predominantly isolated organism, followed by Staphylococcus aureus (18.18%, n=30). Moreover, coagulase-negative staphylococci (CNS), Staphylococcus epidermidis (3.03%, n=5) and S. saprophyticus (0.60%, n=1) were also recovered. The methicillin-resistant staphylococci accounted for 40.07% of the total isolates. Gram negative organisms like Pseudomonas aeruginosa (15.15%, n=25), Klebsiella pneumoniae (12.12%, n=20) and Escherichia coli (0.60%, n=1); and a lone isolate of Streptococcus spp. (0.60%) were also isolated majorly in the form of mixed infections. When subjected to in vitro antibiotic sensitivity testing the isolates showed highest sensitivity to linezolid followed by enrofloxacin, cephadroxil, clindamycin and amoxicillin-clavulanic acid whereas resistance was exhibited against erythromycin, methicillin and oxacillin.

Antibiotic Resistance Pattern among Bacteria causing Ventilator Associated Pneumonia in An Intensive Care Unit of Bangladesh

Background : Ventilator-associated pneumonia (VAP) is the most common type of nosocomial infection in critical care practice with high morbidity and mortality. Microorganisms responsible for VAP vary from place to place. So, identification of causative organism and knowledge of their resistance pattern is very important for empirical choice of antibiotic in managing VAP. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates to determine the microorganisms responsible for VAP and to study their antibiotic resistance pattern.Materials and Methods: This cross sectional study was performed over a period of six month starting from November, 2015 to April, 2016 in the Intensive Care Unit (ICU) of BIRDEM General Hospital. Patients with a clinical and radiological diagnosis of VAP were included in this study.Result: A total of 51 patients with a clinical diagnosis of VAP were included in this study. Growth was obtained in100% of the samples yielding 88 organisms. Gram-negative organisms were the mostly isolated organism (76.13%), followed by fungi (17.04%) and gram-positive cocci (6.81%). The most common pathogen was Acinetobacter sp. followed by Klebsiella sp., Candida sp. and Pseudomonas sp. respectively. Among the gram negative organisms, Acinetobacter sp., Klebsiella sp. and Pseudomonas sp. were highly resistant (&gt;80%) to third generation cephalosporins and fluoroquinolones. Resistance to aminoglycosides (&gt;68%) and imipenem (&gt;60%) was also high. Resistance of Pseudomonas sp. to piperacillin-tazobactum was lower (18.2%) in comparison to Acinetobacter sp. and Klebsiella sp. All the Gram-negative organisms were 100% sensitive to colistin except proteus. Regarding gram-positive cocci,Staphylococcus aureus is 100% sensitive to netilmycin and vancomycin with variable resistance pattern to other antibiotics.Conclusion: Emergence of drug resistance against the microorganism causing VAP is a serious concern in most of the ICUs. A knowledge of antibiotic susceptibility pattern will avoid its irrational use in order to control the spread of infection and for proper management of VAP.Bangladesh Crit Care J September 2016; 4 (2): 69-73