Initiation Of Appropriate Antibiotic Therapy Research Articles

Enhancing the accuracy and effectiveness of diagnosis of spontaneous bacterial peritonitis in cirrhotic patients: A machine learning approach utilizing clinical and laboratory data

PurposeSpontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid that develops naturally, without being triggered by any surgical conditions or procedures, and is a common complication of cirrhosis. With a potential mortality rate of 40 ​%, accurate diagnosis and prompt initiation of appropriate antibiotic therapy are crucial for optimizing patient outcomes and preventing life-threatening complications. This study aimed to expand the use of computational models to improve the diagnostic accuracy of SBP in cirrhotic patients by incorporating a broader range of data, including clinical variables and laboratory values. Patients and methodsWe employed 5 machine learning classification methods - Decision Tree, Support Vector Machine, Naive Bayes, K-Nearest Neighbor, and Random Forest, utilizing a variety of demographic, clinical, and laboratory features and biomarkers. ResultsAscitic fluid markers, including white blood cell (WBC) count, lactate dehydrogenase (LDH), total protein, and polymorphonuclear cells (PMN), significantly differentiated between SBP and non-SBP patients. The Random Forest model demonstrated the highest overall accuracy at 86 ​%, while the Naive Bayes model achieved the highest sensitivity at 72 ​%. Utilizing 10 key features instead of the full feature set improved model performance, notably enhancing specificity and accuracy. ConclusionOur analysis highlights the potential of machine learning to enhance the accuracy of SBP diagnosis in cirrhotic patients. Integrating these models into clinical workflows could substantially improve patient outcomes. To achieve this, ongoing multidisciplinary research is crucial. Ensuring model interpretability, continuous monitoring, and rigorous validation will be essential for the successful implementation of real-time clinical decision support systems.

Impact of Early Initiation of Appropriate Antibiotic Therapy on Outcome of Bloodstream Infections

Impact of Early Initiation of Appropriate Antibiotic Therapy on Outcome of Bloodstream Infections

Single-stage revision in the management of prosthetic joint infections after total knee arthroplasty – A review of current concepts

IntroductionProsthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA); and the gold standard surgical approach involves a two-staged, revision TKA (TSR). Owing to the newer, emerging evidence on this subject, there has been gradual shift towards a single-stage revision approach (SSR), with the purported benefits of mitigated patient morbidity, decreased complications and reduced costs. However, there is still substantial lacuna in the evidence regarding the safety and outcome of the two approaches in chronic PJI. This study aimed to comprehensively review of the literature on SSR; and evaluate its role within Revision TKA post PJI. MethodsThe narrative review involved a comprehensive search of the databases (Embase, Medline and Pubmed), conducted on 20th of January 2024 using specific key words. All the manuscripts discussing the use of SSR for the management of PJI after TKA were considered for the review. Among the screened manuscripts, opinion articles, letters to the editor and non-English manuscripts were excluded. ResultsThe literature search yielded a total 232 studies. Following a detailed scrutiny of these manuscripts, 26 articles were finally selected. The overall success rate following SSR is reported to range from 73 % to 100 % (and is comparable to TSR). SSR is performed in PJI patients with bacteriologically-proven infection, adequate soft tissue cover, immuno-competent host and excellent tolerance to antibiotics. The main difference between SSR and TSR is that the interval between the 2 stages is only a few minutes instead of 6 weeks. Appropriate topical, intraoperative antibiotic therapy, followed by adequate postoperative systemic antibiotic cover are necessary to ascertain good outcome. Some of the major benefits of SSR over TSR include reduced morbidity, decreased complications (such as arthrofibrosis or anesthesia-associated adverse events), meliorated extremity function, earlier return to activities, mitigated mechanical (prosthesis-associated) complications and enhanced patient satisfaction. ConclusionSSR is a reliable approach for the management of chronic PJI. Based on our comprehensive review of the literature, it may be concluded that the right selection of patients, extensive debridement, sophisticated reconstruction strategy, identification of the pathogenic organism, initiation of appropriate antibiotic therapy and ensuring adequate follow-up are the key determinants of successful outcome. To achieve this will undoubtedly require an MDT approach to be taken on a case-by-case basis.

Assessing the Interpretation of Molecular Test Results in the Diagnosis of Bloodstream Infections.

A retrospective study at the 4th Military Clinical Hospital in Wroclaw, Poland, assessed PCR testing alongside blood cultures to guide antimicrobial therapy decisions in hospitalized patients, to determine how much time the results of the molecular tests preceded conventional methods. Among 118 patients, Staphylococcus aureus (37%) and Escherichia coli (21%) were the most common bloodstream infection agents. Blood cultures utilized the BacT/ALERT 3D system, and molecular diagnostics were conducted using the FilmArray platform with the BIOFIRE BCID2 panel. Methicillin susceptibility was observed in 66% of S. aureus strains, while 26% of Gram-negative bacilli exhibited an ESBL phenotype. Therapeutic decisions based on molecular test results were often incorrect for S. aureus infections, particularly MSSA (64.5%), but generally accurate for Gram-negative bacilli. The median times from positive blood culture to BCID2 and pathogen identification/susceptibility were 10 h and 52 h, respectively. Molecular diagnostics facilitated faster initiation of appropriate antibiotic therapy, highlighting the need to educate medical staff on proper interpretation. Consulting within an antimicrobial stewardship program (ASP) could enhance the benefits of implementing molecular methods in bloodstream infection diagnostics.

Case series of calcaneal osteomyelitis in patients with melioidosis

Background: Melioidosis is an emerging infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei, which can lead to a range of clinical manifestations including acute septicaemia and chronic localized infections. Osteomyelitis is an uncommon but well-recognized complication of melioidosis, with the calcaneus being a relatively rare site of involvement. Case Description: The authors present a case series of three patients with calcaneal osteomyelitis caused by B. pseudomallei infection. All three patients presented with non-specific symptoms like fever and weight loss, followed by localized ankle/foot pain and swelling. Diagnosis was made based on imaging findings (radiographs and MRI) and isolation of Burkholderia pseudomallei from blood or pus cultures. Treatment involved a combination of initial intravenous antibiotic therapy (meropenem or ceftazidime) for 4-6 weeks, followed by oral trimethoprim-sulfamethoxazole for 6 months. One patient required surgical drainage of a plantar abscess. All patients had a favourable clinical outcome with resolution of osteomyelitis on follow-up imaging. Conclusion: Calcaneal osteomyelitis is a rare but potentially serious complication of melioidosis. Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for favourable outcomes. Clinicians should maintain a high index of suspicion for osteomyelitis in patients with melioidosis, especially in patients from endemic areas as well as in patients with risk factors like diabetes. Close follow-up and monitoring for potential relapse or reactivation are essential, particularly in immunocompromised individuals.

Association of Yersinia Infection With Kawasaki Disease: A Prospective Multicenter Cohort Study.

Yersinia infection is known to present with Kawasaki disease (KD)-like symptoms although differentiating the 2 has been a challenge. The present study aimed to describe the clinical characteristics and prevalence of Yersinia infection presenting with KD-like symptoms. The present, prospective, multicenter study enrolled patients who received a diagnosis of KD between January 2021 and January 2022 at 2 hospitals in Tokyo. Stool samples were collected within 3 days of the start of KD treatment, and cultures were performed for Yersinia . Clinical history and symptoms suggestive of Yersinia infection were also evaluated. During the study period, 141 KD patients were screened and 117 patients with evaluable stool samples were registered. Only 1 patient was positive for Yersinia pseudotuberculosis , which was detected from both stool and blood cultures. The patient was refractory to KD treatment but improved after initiation of appropriate antibiotic therapy. Routine screening for Yersinia is not appropriate for patients with KD and should be limited to certain patients in high-risk areas and those who are refractory to the standard KD treatment.

Schwere ambulant erworbene Pneumonie im Kindes- und Jugendalter

BackgroundApproximately 20% of children and adolescents with pediatric community-acquired pneumonia (pCAP) experience severe disease courses. These are characterized by hospitalization and/or occurrence of complications, such as pleural effusion, empyema and lung abscesses.ObjectiveThis article summarizes the data on clinical features, diagnostics and treatment of severe pCAP.Material and methodsThis article is based on national and international guidelines for the treatment of pCAP, especially the current guidelines of the Association of the Scientific Medical Societies in Germany (AWMF), as well as further literature from PubMed.ResultsPersistent fever (> 38.5 °C), hypoxemia, respiratory distress or lack of improvement in the child’s clinical condition after initiation of appropriate antibiotic therapy can be a reflection of a severe disease course. In cases of unequal bilateral breathing sounds, chest pain and weight loss, local complications must also be considered. In severe pCAP, the pathogens causing the disease should always be confirmed and comprehensive laboratory testing for infections can be helpful in the estimation of the severity and also assessment of the course. Important diagnostic methods include X‑ray imaging, sonography and multislice imaging procedures. The basis of treatment is usually antibiotic therapy, which is mostly chosen empirically according to the epidemiological conditions and resistance; however, in cases of a confirmed viral etiology, antibiotic treatment can be omitted. Interventional procedures, sometimes with the use of fibrinolytic treatment, are of importance in complicated courses of disease. Surgical treatment is only necessary in exceptional cases with failure of conservative treatment.PrognosisWith adequate treatment the prognosis of severe pCAP in children is good.

Early and Appropriate Use of Ceftazidime-Avibactam in the Management of Multidrug-Resistant Gram-Negative Bacterial Infections in the Indian Scenario.

The increasing prevalence of antibiotic-resistant pathogens exerts a substantial burden on the healthcare infrastructure worldwide. The World Health Organization (WHO) has declared that multidrug-resistant (MDR) Gram-negative pathogens, especially, carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii, and Pseudomonas aeruginosa as the topmost priority while developing newer antimicrobials. The increasing prevalence of infectious diseases caused by MDR Gram-negative bacteria also poses a challenge when choosing the empiric antimicrobial therapy for seriously ill hospitalized patients. The infections caused by MDR Gram-negative organisms ultimately result in increased mortality, morbidity, prolonged hospital stay, and increased cost of management. To tackle these challenges, newer antimicrobials like ceftazidime-avibactam were explored. The article also discusses the in vitro activity and therapeutic efficacy of ceftazidime-avibactam along with its pharmacokinetic properties and the role it will play in the management of MDR Gram-negative organisms in the Indian setting. Several studies have highlighted the role of early and appropriate antibiotic use in the reduction of mortality in patients with Gram-negative infections. Timely initiation of appropriate antibiotic therapy for serious infections leads to favorable clinical outcomes. Early and appropriate use of ceftazidime-avibactam while treating MDR Gram-negative infections has been associated with improved clinical outcomes. The aim of this review is to highlight the efficacy of ceftazidime-avibactam in the treatment of MDR Gram-negative infections. We have also summarized the information on outcomes achieved by early and appropriate use of ceftazidime-avibactam.

The effects of systemic corticosteroid on pediatric community-acquired pneumonia: comprehensive review

Community-acquired pneumonia (CAP) is a highly prevalent disorder in children. The treatment options available for children with CAP are inhalation therapy and initiation of appropriate antibiotic therapy. Occasionally, CAP may progress to severe pneumonia despite appropriate therapy. While there are a few studies reporting the beneficial effects of systemic corticosteroids on CAP in adult populations, their effect as adjunctive treatment on CAP in the pediatric population remains unknown. The aim of the present review is to determine the efficacy of systemic corticosteroids on CAP in children where signs, symptoms, and radiographic findings of pneumonia worsened despite appropriate treatment. In our comprehensive review, adjuvant systemic corticosteroid appeared to be effective in reducing morbidity and is associated with clinical and radiographic improvement in children with CAP.

Recent Advances in the Use of Molecular Methods for the Diagnosis of Bacterial Infections.

Infections caused by bacteria have a major impact on public health-related morbidity and mortality. Despite major advances in the prevention and treatment of bacterial infections, the latter continue to represent a significant economic and social burden worldwide. The WHO compiled a list of six highly virulent multidrug-resistant bacteria named ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) responsible for life-threatening diseases. Taken together with Clostridioides difficile, Escherichia coli, Campylobacter spp., (C. jejuni and C. coli), Legionella spp., Salmonella spp., and Neisseria gonorrhoeae, all of these microorganisms are the leading causes of nosocomial infections. The rapid and accurate detection of these pathogens is not only important for the early initiation of appropriate antibiotic therapy, but also for resolving outbreaks and minimizing subsequent antimicrobial resistance. The need for ever-improving molecular diagnostic techniques is also of fundamental importance for improving epidemiological surveillance of bacterial infections. In this review, we aim to discuss the recent advances on the use of molecular techniques based on genomic and proteomic approaches for the diagnosis of bacterial infections. The advantages and limitations of each of the techniques considered are also discussed.

Epidemiology, Risk Factors and Outcome Due to Multidrug Resistant Organisms in Paediatric Liver Transplant Patients in the Era of Antimicrobial Stewardship and Screening.

(1) Background: Multidrug-resistant organisms (MDRO) are a growing problem in liver transplant recipients (LTR), associated with high morbidity and mortality. We reviewed the impact of antimicrobial stewardship (AMS) and active screening of MDRO on the epidemiology and outcomes in paediatric LTR. (2) Methods: Single-centre retrospective review of paediatric LTR from January 2017 to December 2018. (3) Results: Ninety-six children were included; 32 (33%) patients were colonised with ≥1 MDRO and 22 (23%) patients had MDRO infections. Median (IQR) duration for start of infection was 9.5 (1.8–16.0) days. Colonisation rate with Gram-positive MDRO was 15.6%, with infection rate of 6.2%; majority due to Vancomycin-Resistant Enterococcus faecium (VRE). Colonisation with Gram-negative MDRO was 27.0%, with infection rate of 16.6%; majority due to extended-spectrum β-lactamase producing Enterobacteriaceae. Colonisation and infection rate due to Carbapenem-resistant Enterobacteriaceae was 6% and 3%, respectively, during screening and AMS, compared to historical control of 25% and 30%, respectively, without screening and AMS. There was significant reduction in VRE and CRE infection during AMS period in comparison to historical control. Pre-transplant risk factors including bacterial infections pre-transplant (p < 0.01), diagnosis of biliary atresia (p = 0.03), exposure to antibiotics (p < 0.01), EBV viraemia (p = 0.01), and auxiliary transplantation (p < 0.01) were associated with post-transplant MDRO infections. Patients with MDRO infections had longer length of hospital and paediatric intensive care unit stay days (p < 0.01) but associated with no mortality. (4) Conclusions: Our results demonstrate low incidence of colonisation and infections with MDRO, which were associated with high morbidity but no mortality in paediatric LTR. There was significant reduction in MRSA, VRE, and CRE during AMS period compared to pre-AMS era. Some risk factors are unavoidable but antibiotic overuse, early initiation of appropriate antibiotic therapy and effective infection prevention strategies can be monitored with multifaceted approach of AMS and screening of MDRO. With limited therapeutic options for MDRO and efficacy data of newer antibiotics in paediatric LTR, robust infection control practices are of paramount importance.

Achromobacter xylosoxidans Causing Late-onset Sepsis with Pneumonia in a Term Neonate

Achromobacter xylosoxidans (A. xylosoxidans), is an aerobic gram negative motile bacillus that rarely causes infection in healthy adults and is exceptionally rare in neonates. A. xylosoxidans is ubiquitous in nature, causing nosocomial infections especially in debilitated and immunocompromised patients. Few outbreaks caused by this organism were reported in Neonatal Intensive Care Units (NICU) along with sporadic cases in neonates. A 3-week-old term neonate presented with late-onset sepsis and pneumonia caused by A. xylosoxidans that was successfully treated with antibiotics and supportive care. Awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy would improve the outcome and prevent mortality.

Early post-operative morbidity and mortality predictors in peptic ulcer perforation.

Peptic ulcer perforation (PUP) is one of the cause of acute abdomen, incidence of this entity is 5% of all abdominal emergencies. Numerous prognostic factors have been reported for morbidity and mortality after PUP, this study attempts to analyze the factors affecting mortality and morbidity in patients with PUP. The medical record of patients who were operated for PUP in our clinic was retrospectively evaluated between January 2008 to January 2018. A total of 318 patients were included in this study. Patients were retrospectively analyzed in terms of age, gender, comorbidity, ASA score, biochemical, hematological parameters, complications, and mortality. The risk factors affected to morbidity and mortality were also evaluated. The study population consisted of 318 patients and the mean age of the patients was 41.30±19.37 (min-max: 16-89). In the study, 271 (85.22%) patients were male and 47 (14.78%) were female and male to female ratio was 5.76. In the analysis of the predictors of morbidity, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); pre-operative shock (p<0.001); and ASA score > III (p<0.0001) were found statistically significant. Gender was not found statistically significant (p=0.672). Mortality developed in 15 (4.71%) of 318 patients in the post-operative period. In the multivariate analysis, age ≥60 years, (p<0.001); perforation-surgery interval >24 h (p<0.001); purulent intraperitoneal contamination (p<0.001); pre-operative renal failure (p<0.001); duodenal perforation (p<0.001); and pre-operative shock (p<0.001) were found to be independent predictors of post-operative mortality. In our study, age ≥60 years, perforation-surgery interval >24 h, purulent intraperitoneal contamination, pre-oper-ative renal failure, duodenal perforation, pre-operative shock, and intensive care unit in the post-operative period were found to be independent predictors of post-operative morbidity and mortality. A comprehensive clinical evaluation, adequate fluid resuscitation, initiation of appropriate antibiotic therapy, and early access to surgery can minimize the risk of morbidity and mortality in PUP.

Clinical Features and Outcomes of Streptococcus pneumoniae Meningitis in Children: A Retrospective Analysis of 26 Cases in China.

Background Streptococcus pneumoniae is an important cause of pediatric meningitis. Objective The aim of this study was to analyze the clinical features and outcomes of children with pneumococcal meningitis at our hospital in China, so as to provide basis for improving the clinical treatment effect. Methods This retrospective analysis included patients aged <16 years treated for pneumococcal meningitis at the Department of Neurology, Children's Hospital of Shanxi (January 2014–February 2016). Clinical data were extracted from the medical records. Patients were followed up for 6 months after discharge. Results The analysis included 26 children aged 2 months to 13 years, with 17 (65.4%) aged <3 years. Presenting symptoms included fever (100%), lethargy (100%), impaired consciousness (88.5%), neck stiffness (69.2%), seizures (53.8%), and headache (50.0%). All patients had positive cerebrospinal fluid (CSF) cultures. The final treatment was vancomycin combined with a third-generation cephalosporin or other antibiotics in 25 patients. Eleven patients (42.3%) were recovered, 3 (11.5%) had neurological sequelae, and 12 (46.2%) died. Impaired consciousness ( p = 0.035), cerebral hernia ( p = 0.037), respiratory failure ( p = 0.004), heart failure ( p = 0.044), septic shock ( p = 0.037), low CSF white blood cell count ( p = 0.036), high CSF protein levels ( p = 0.028), low white blood cell count ( p = 0.036), and low blood neutrophil ratio ( p = 0.016) are associated with a poor prognosis to pneumococcal meningitis. Conclusion Pneumococcal meningitis is associated with a poor prognosis in many children. Poor prognosis might be related to early ineffective antibiotic therapy, a combination of systemic failure, neurological problems, and changed inflammatory response. It is important to rapid initiation of appropriate antibiotic therapy if meningitis is suspected.

Інтраабдомінальна інфекція у світлі останніх міжнародних рекомендацій та її роль у розвитку септичної енцефалопатії

Мета цих рекомендацій: представити міжнародну позицію, засновану на доказах, із питань застосування методів ведення внутрішньоабдомінальних інфекцій та вплив внутрішньоабдомінальних інфекцій на розвиток септичної енцефалопатії. Ускладнена інтраабдомінальна інфекція є важливою причиною захворюваності та смертності. В уявленні Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) сепсис визначається як загрозлива для життя дисфункція органа, що викликана дисрегуляторною відповіддю хазяїна на інфекцію. Дисфункція органа може бути подана як збільшення показника на більше ніж 2 бала за шкалою Sequential Organ Failure Assessment (SOFA). Раннє виявлення пацієнтів з абдомінальним сепсисом є важливим кроком для ефективного лікування з метою покращання результатів. Мікросудинна дисфункція, глобальне пошкодження тканин можуть призвести до розвитку септичної енцефалопатії, що асоціюється з поганим прогнозом. Ключовими факторами ефективної терапії внутрішньоабдомінальних інфекцій є оперативний діагноз, адекватна реанімація, ранній початок відповідної антибактеріальної терапії, ранній конт­роль джерела інфекції та постійна переоцінка клінічної відповіді на тактику ведення. Оцінка ефективності рекомендацій та якості доказів подані відповідно до Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Comparison of Conventional and Automated Blood Culture Methods for The Diagnosis of Neonatal Septicemia

Neonatal Septicemia is a serious clinical syndrome and the definitive diagnosis is based on positive blood cultures which are obtained either by conventional or automated method. Early availability of proper isolation and identification of causative bacteria facilitates the timely initiation of appropriate antibiotic therapy. Thereby the present study was conducted to identify the bacterial causes of neonatal septicemia in the fastest possible time by comparing conventional and automated blood culture methods.This cross sectional study was done during the period from January 2018 to December 2018 and included clinically suspected cases of neonatal septicemia admitted to Neonatal Intensive Care Units of Chattogram Medical College Hospital (CMCH) and Chattogram Maa-Shishu O General Hospital (CMSOGH). Out of 178 samples, automated method detected 29 (16.3%) and conventional method detected 26 (14.6%) blood culture positive samples. The yield of bacteria by automated method was 100% and by conventional method was 89.7%. Number of bacteria isolated only by automated method were 3 (10.2%). Mean time for isolation of bacteria by automated method was 26.38 hours and by conventional method was 46.34 hours. Automated method detected 47.05% of isolated bacteria in first 24 hours but none of them were detected by conventional method within first 24 hours. Among the isolated bacteria, Klebsiella spp was most common (62.0%). Most of the isolates were resistant to Ampicillin, Cefotaxime and Ceftazidime. Analyzing the findings of the study, there was no significant difference in the rate of isolation in each time interval (p=0.157) of two methods but there was significant difference in the mean time of isolation of bacteria between two methods (p=0.000004).&#x0D; Bangladesh J Med Microbiol 2021; 15 (2): 12-18

Disseminated nocardiosis coinfection with extrapulmonary tuberculosis in a patient with metastatic thymoma: A case report and literature review

Patients with metastatic thymoma postintensive chemotherapy and radiotherapy are prone to opportunistic infectious diseases. Disseminated nocardiosis is a rare disease; however, its incidence has increased in recent years due to the growing population of immunocompromised hosts. We present the first report of Nocardia beijingensis infection with extrapulmonary tuberculosis coinfection causing muscular and brain abscesses in a patient with metastatic thymoma postintensive chemotherapy and radiotherapy. This case illustrates the possibility of coinfection with two pathogens and the difficulty in establishing a rapid diagnosis. Awareness of opportunistic infections and the early initiation of appropriate antibiotic therapy are important for the treatment of immunocompromised patients with infectious diseases.

Acute Myocarditis Associated with Legionella Infection

Pneumonia is the most commonly described manifestation of Legionella pneumophila infection (legionellosis), and extrapulmonary manifestations are uncommon. There are a few descriptions of acute myocarditis associated with legionellosis. We present a case of acute myocarditis in a patient admitted for legionellosis with multisystemic involvement (lung, heart, and kidney). Left ventricular (LV) dysfunction was documented by cardiac magnetic resonance (CMR) and two-dimensional speckle-tracking echocardiography; layer-specific strain analyses were performed, which allowed to differentiate subendocardial or subepicardial contractile impairment. Layer-specific strain analyses by echocardiography demonstrated impairment of subepicardial deformation in the inferolateral wall, which mirrored CMR findings, showing late gadolinium enhancement in the subepicardium of the same LV segments. After initiation of appropriate antibiotic therapy with levofloxacin, LV systolic function rapidly improved as assessed by both CMR and strain analyses, with concomitant normalization of both clinical and biochemical abnormalities. The basic mechanisms of myocardial involvement during legionellosis are unclear; we discussed our findings according to the limited available evidence.

Meningococcal septicaemia reported in an immunocompetent adult: A Case Report

Meningococcal meningitis is caused by the Gram negative diplococcus, Neisseria meningitidis. It is characterized by nonspecific symptoms of fever and constitutional symptoms followed by septic shock and meningitis. The characteristic rash is usually not seen in the early course of the illness which may lead to delayed diagnosis, late initiation of appropriate antibiotic therapy, delayed isolation, and chemoprophylaxis of close contacts. Here, we report a case of meningococcal septicaemia in a young male who presented with fever and features of meningitis and subsequently developed the characteristic rash. The importance of early identification of the characteristic skin lesions of meningococcaemia and timely institution of appropriate antibiotic therapy to prevent complications of meningococcal septicaemia are emphasized.

Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon.

Diabetic Foot Infection (DFI) is a challenging complication of diabetes mellitus with a high burden in the Middle East where there is a marked increase in diabetes prevalence and complications. Early detection of DFI and the infectious organisms could result in the early initiation of appropriate antibiotic therapy and improved outcomes. DFI microbiological profiles differ between countries. In our region, Western guidelines are used when initiating treatment for DFI in the absence of local guidance. The purpose of our study was to determine the microbiologic profile and antimicrobial susceptibility of the DFI admissions at a large tertiary referral centre in Beirut and review other reported series in Lebanon and our region. This is a retrospective observational study of patients with DFI admitted to the American University of Beirut Medical Centre from January 2008 to June 2017. The bacteriologic isolation and antimicrobial susceptibility tests were performed according to standard microbiological methods. Between 2008 and 2017, 319 diabetic patients with DFU were admitted to AUBMC, and deep-tissue cultures were taken for 179 patients. From 179 deep tissue cultures, 314 bacterial isolates were obtained. Fifty-four percent of patients had the polymicrobial infection. Aerobic gram-negative rods (GNR) were more prevalent than gram-positive cocci (GPC) (55%, 39%, respectively). The most common isolate was Escherichia coli (15%) followed by Enterococcus (14%) and Pseudomonas aeruginosa (11%). Staphylococcus aureus isolates accounted for 9% with 50% of them being methicillin-resistant (MRSA). Among Enterobacteriaceae, 37% of isolates were fluoroquinolone-resistant, 25% were ESBL producers, and 2% were carbapenem-resistant. Antibiotic resistance was significantly associated with prior usage of antibiotics. Anaerobes were isolated in 1% and Candida species in 5% of isolates. The sensitivity, specificity, PPV, and NPV of swab culture recovery of pathogens compared with deep tissue culture were (76%, 72%, 76%, 72%) and (94%, 81%, 91%, 86%) for gram-positive and gram-negative organisms, respectively. The microbiological profile of DFI in Lebanon is comparable to other countries in the MENA region with big differences compared with the West. Therefore, it is imperative to develop local guidelines for antimicrobial treatment. The high prevalence of GNR in DFI and the high fluoroquinolone resistance should be taken into consideration when choosing empiric antibiotics. Empiric treatment for MRSA or Pseudomonas does not appear necessary except for patients with specific risk factors.