Injection Of Antibiotics Research Articles

A RARE CASE OF ISOLATED SPLENIC TUBERCULOSIS

A 30 year old female presented to emergency with chief complaint of fever upto 101 F remittent not associated with chills and rigors. On history, examination and investigations it was seen that patient had splenic abscess on ultrasound and patient was started on injectable antibiotics but was not relieved so was decided for splenectomy and then on histopathological examination it was found pt had tuberculosis. ATT was started and improved

Intraoperative Intra-articular Antibiotic Injection Reduces Infection in Shoulder Arthroplasty.

Deep infection is a debilitating complication after shoulder arthroplasty. The authors hypothesized that an intra-articular, intraoperative injection of antibiotics would result in a lower infection rate compared with intravenous antibiotics alone. Before 2007, 164 patients (group A) did not receive intra-articular antibiotics. From 2007 to 2018, 1324 patients (group B) received intra-articular antibiotics. Patients received intra-articular gentamicin at the end of surgery with the addition of 1 g of cefazolin in January 2014. Records were retrospectively reviewed for comorbidities, type of surgery, and infection. The cohort that received intra-articular antibiotics was compared with the cohort that did not to determine the effect of prophylactic intra-articular antibiotic administration in preventing infection. There was 1 deep infection in the antibiotic group compared with 5 in the non-antibiotic group (P<.001). Superficial infections developed in 2 cases of patients treated with antibiotics; there were no superficial infections in patients treated without antibiotics (P=.62). One previous study evaluated intra-articular injection of antibiotics for shoulder arthroplasty and found significantly lower rates of infection with the injection of intra-articular gentamicin. In this retrospective follow-up study, the injection of intra-articular gentamicin or gentamicin and cefazolin effectively decreased rates of postoperative infection. At mean follow-up of 399 days, intra-articular antibiotics at the time of surgery resulted in significantly fewer deep infections. Given the minimal risk of adverse events and minimal cost, this is a valid method of reducing infections in total shoulder arthroplasty. [Orthopedics. 2023;46(5):310-314.].

Efficacy of lymphotropic parenteral antibacterial therapy in patients with an acute pancreatitis

Objective.To compare clinical results of application of lymphotropic antibacterial therapy (LATH) versus standard method of parenteral administration of antibiotics in patients, suffering an acute pancreatitis.&#x0D; Materials and methods. Clinical data, the values of the leucocyte and hematological intoxication indices, and some other indices of immunity, occurring on background of lymphotropic and standard antibacterial therapy, were studied. The patients were distributed into two groups: Group I (the main) - to whom lymphotropic antibioticotherapy was conducted, and Group II (a control one) - to whom a standard antibioticotherapy was applied.&#x0D; Results. In patients of the main group the pain syndrome, belching and regurgitation have had regressed during 2 days of treatment. During 5 days of treatment the intoxication signs have been eliminated. In the patients, admitted to hospital in the first day of an acute pancreatitis manifestation, the values of the intoxication leucocytes index after 5 days of the LATH conduction were on the level of corresponding index of practically healthy people, the CD3 and CD4 quantity raised statistically significantly, and the dimensions of the inflammatory changed pancreatic gland reduced.&#x0D; Conclusion. Lymphotropic injection of antibiotics and anti-inflammatory medicines promotes inhibition of inflammatory process in pancreatic gland. On background of adverse development of inflammation, a more rapid improvement of clinical symptoms of an acute pancreatitis, as well as in the indices of the common markers of inflammatory process and cellular immune defense, are observed. The data obtained witness the advantage of LATH over a standard (parenteral) one in the treatment of an acute pancreatitis.

Incidence and Clinical Course of Acute Endophthalmitis after Idiopathic Epiretinal Membrane Surgery with Microincision Vitrectomy

Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS).Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed.Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p &lt; 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p &lt; 0.001). Six eyes (42.9%) attained legal blindness status (final VA &lt; 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0).Conclusions: Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.

Shoulder joint septic arthritis with scapular osteomyelitis a rare presentation in an infant with sickle cell disease: a challenging diagnosis; a case report from rural central India

Sickle-cell disease (SCD) a hereditary autosomal recessive disorder is the most common haemoglobinopathy worldwide. In India, it is the second most common haemoglobinopathy next to Thalassemia, prevalent in the tribal population of Central and Southern parts of India. The pathophysiology of the disease is point mutation in the beta globin chain leading to sickling of RBCs which causes obstruction in microvasculature leading to acute events like Vaso-occlusive crisis. Patients with SCD are also at an increase of orthopaedic manifestation like osteomyelitis, septic arthritis or osteonecrosis. We report a case of a 10 months old male child who presented with anaemia and fever. Child was diagnosed with SCD, later developed swelling of right shoulder joint and restrictions of movements. Diagnosis of septic arthritis of shoulder with scapular osteomyelitis was made with the help of radiological and laboratory investigations. Child was managed with injectable antibiotics and symptomatic treatment. Patients with SCD as a result of occlusion of microvasculature along with immunocompromised state are at higher risk of bacterial infections. Osteomyelitis is one of the dreaded complications. Its clinical presentation is similar to that of VOC hence there occurs a dilemma in diagnosis. A multidisciplinary approach including high degree of clinical suspicion, laboratory investigation and radiological imagining can help in early diagnosis and management.

Cases of Orbital Cellulitis Revealing Neglected Intraocular Foreign Bodies

Background: Orbital cellulitis is defined as acute inflammatory orbital swelling of infectious origin. Most often secondary to sinusitis. Intraocular foreign bodies neglected because of their small size, or sometimes radio-transparent nature, can be difficult to diagnose even with radiology and be responsible for orbital cellulitis. We demonstrate the diagnostic and therapeutic difficulties.&#x0D; Patients and Methods: This is a retrospective descriptive study of patients with unilateral orbital cellulitis revealing neglected intraocular foreign bodies, conducted in the Department of Adult Ophthalmology, Hospital August 20, 1953, involving 58 patients, from January 2015 until December 2020.&#x0D; Results: The average age of the patients was 38.5 years. The most affected age group was between 21 and 30 years with a clear male predominance. A decrease in visual acuity was found in all patients (unilateral blindness 43%) and a cellulitis complicated by a purulent melt (43%). All patients received medical treatment, including intravitreal injections of antibiotics in 71% of cases, and surgical treatment consisting of extraction of the foreign body and immediate evisceration of the eyeball in 25% of cases.&#x0D; Conclusion: Orbital cellulitis, although mostly secondary to sinusitis, can reveal various etiologies such as intra-orbital foreign bodies that can go unnoticed and be life-threatening and functionally damaging, especially when the diagnosis is made late and management is inappropriate. The presence of an intraocular foreign body must be suspected in all cases of orbital trauma associated with a palpebral wound, even if it is minimal, or in the presence of a clinical aggravation. Any delay in diagnosis and/or treatment can lead to serious complications that can affect the functional and even vital prognosis. The surgical treatment consists of the extraction of the foreign body. The recourse to evisceration in our context unfortunately continues to persist at high rates; because of the delay of consultation and thus of the management.

Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users.

Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.

Successful Management of Intraoperative Toxic Endothelial Cell Destruction During Routine Manual Small-incision Cataract Surgery

Cataract surgery is one of the most commonly performed ophthalmic surgeries worldwide. Stromal hydration is done to improve the integrity of the wound, reform the anterior chamber at the end of the surgery and obtain a water-tight wound closure to reduce the risk of endophthalmitis. At the completion of the surgery, subconjunctival injections of antibiotics and steroids are commonly given to reduce the risk of endophthalmitis. Intracameral injection of antibiotics is the delivery of drugs to prevent endophthalmitis, but if a wrong drug is injected in the anterior chamber, it can result in endothelial and anterior chamber toxicity. Here we report a rare and interesting case of a 60-year-old female who underwent manual small-incision cataract surgery (MSICS) for nuclear sclerosis grade 3. All the steps of the surgery were uneventful. At the end of the surgery, side port stromal hydration was performed, and while injecting intracameral moxifloxacin wrongly, gentamicin and dexamethasone were injected into the stroma and anterior chamber. The patient developed 3 + striate keratopathy postoperatively, which was managed with tapering doses of topical steroids, hypertonic saline, and adjuvant drugs. The endothelial cell toxicity resolved within three weeks, and the patient’s vision returned to 6/6. This case signifies that an intraoperatively wrong drug can be injected intracamerally, resulting in transient endothelial cell toxicity, which, if managed correctly, can give an excellent outcome.

Preoperative Single Dose Intraincisional vs Intravenous Ceftriaxone in Preventing Surgical Site Infection Post-Hernioplasty Conducted at a Tertiary Care Centre at Chengalpattu, Tamil Nadu, India

Introduction: Among the hospital acquired infections, Surgical Site Infection (SSI) still remains as the major problem for surgeons. Inguinal hernia surgeries are considered as clean surgeries, incidence of SSI in posthernioplasty is found to be 3.1%-4.5%. But in tertiary care centres in developing countries like India incidence is found to be high 11-14%. Aim: The aim of the present study was to compare the efficacy of preoperative single dose ceftriaxone infiltration at the incision site and preoperative Intravenous ceftriaxone only in preventing SSI in hernioplasty. Materials and Methods: A prospective interventional study was conducted at SRM Medical College and Research Institute, Chengalpattu, Tamil Nadu, from May 2021 to October 2022 for a duration of 18 months in 100 Patients, who attended the surgical outpatient block or other known cases of inguinal hernia who were referred to the surgery department from other departments. They were divided into group A or group B randomly. Hernioplasty was done on these groups, preoperative, intraoperative and postoperative wound swab was sent for these patients. Postoperatively patients were followed up on 3rd, 7th and 14th day and assessed for development of SSI. The continuous variables were presented as mean and SD. The categorical variables were expressed in percentages. The significance of continuous scale data between two groups were determined using student t-test. The Chi-square/Fischer’s-exact test was used to evaluate the significance of the categorical data analysed. Data analysis was computed using Statistical Package for Social Sciences (SPSS) version 27 and Microsoft excel office 2019. Results: Male preponderance was seen 91% in inguinal hernias. Most of the patients belonged to the age group of 41-60 (54%) years of age. Ten patients (20%) developed SSI who got i.v. antibiotic injection but only three patients (6%) developed SSI who got intraincisional antibiotic injection with a p-value of 0.037 (&lt;0.05) showing significance. One patient developed haematoma for with re-exploration was done on Postoperative Day (POD) #3. Two patients developed wound gapping for which secondary suturing was done on POD #7 and suture removal was done on POD #21. For rest of the all the patient’s suture removal was done on POD #14. Intraopertive and postoperative and organism growth was seen only in the 13 patients who developed SSI. Most common organism isolated was staph, Aureus (38.5%, 5 cases). All 13 patients who developed SSI had some co-morbidity. Out of the 13 patients who developed SSI 11 patients (84%) had surgery for more than 30 minutes. Mean hospital stay was 3-5 days (87%). Conclusion: In the present study, there was significant reduction in incidence of SSI in the group, which received preoperative single dose Intraincisional ceftriaxone than the other group which received only preoperative intravenous ceftriaxone. Preoperative intraincisional antibiotics significantly reduces the rate of SSI because of the higher concentration achieved at the incision site.

Evaluation of a Lactococcus lactis-based dried fermentation product administered through drinking water on nursery pig growth performance, fecal Escherichia coli virulence genes and pathotypes, antibiotic usage, and mortality.

A total of 34,749 pigs were used in two experiments to evaluate the effects of a postbiotic dried fermentation product (DFP) administered through drinking water on nursery pig growth performance, antibiotic injection frequency, morbidity, mortality, fecal consistency, and characterization of fecal Escherichia coli. The DFP is composed of bioactive molecules derived from Lactococcus lactis. In Exp. 1, 350 barrows (DNA Line 200 × 400; initial body weight [BW] 6.1 ± 0.01 kg) were used in a 42-d study with five pigs per pen and 35 pens per treatment. The DFP was supplied for 14 d at a target dosage of 24 mg/kg BW using a water medicator at a 1:128 dilution. On days 7 and 14, fecal samples were collected for dry matter (DM) and to determine, by a multiplex polymerase chain reaction (PCR) assay, prevalence of 11 virulence genes characteristic of E. coli pathotypes. There was no evidence (P > 0.10) for differences for growth, incidence of diarrhea, number of antibiotic injections, removals, or fecal DM. On both fecal collection days, E. coli virulence genes were present with day 7 samples positive for genes that encode for hemolysins (hlyA, exhA), intimin (eae), and enteroaggregative heat-stable enterotoxin (astA). Prevalence of enterotoxin genes (elt, estA, estB, astA) increased on day 14, but DFP had no effects on the prevalence of any of the virulence genes. A total of 32 out of 72 E. coli isolates were identified as enterotoxigenic pathotype and all except one were from day 14 fecal samples. Fourteen isolates were positive for F4 fimbria and one isolate was positive for F4 and F18 fimbriae. In Exp. 2, 34,399 nursery pigs (initially 5.6 kg) were used in 20 nursery barns with 10 barns per treatment (control or DFP). The target dosage of the DFP for the first 14 d was 35 mg/kg BW. Following the 14-d supplementation period, pigs continued to be monitored for approximately 31 d. There was no evidence (P > 0.05) for the DFP to influence the overall percentage of pigs that died or growth performance. From days 0 to 14, providing the DFP reduced (P < 0.05) the percentage of pigs that were euthanized. However, providing the DFP increased (P < 0.05) the overall percentage of pigs that were euthanized and total mortality. For the number of antibiotic injections (treatment interventions), providing the DFP reduced the number of injections for the common period (P < 0.001) and overall (P = 0.002). These results indicate that the DFP did not influence growth performance but providing the DFP in Exp. 2 led to increased total nursery pig mortality.

Autoimmune Haemolytic Anaemia, Acute Pericarditis with Cardiac Tamponade as Presenting Manifestations in Systemic Lupus Erythematosus- A Rare Case Report

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that affects mostly young women in which tissue-binding autoantibodies and immune complexes cause damage to organs and tissues. SLE is characterised by aberrant immunological responses that result in the release of higher levels and immunogenic nucleic acids, proteins, and other self-antigens. Autoimmune Haemolytic Anaemia (AIHA) is a condition in which antibodies against red blood cells are present. It is classified as a warm and cold antibody AIHA. The causes of warm antibody AIHA are autoimmune illnesses, infections, or even malignancy. The presence of Immunoglobulin G (IgG) antibodies can indicate warm autoimmune haemolytic anaemia (warm agglutinin anaemia), which is characterised by fatigue and other constitutional symptoms. Although, autoimmune haemolytic anaemia can be a component of the SLE spectrum, warm autoimmune haemolytic anaemia as the first manifestation of SLE is exceedingly rare. This case report describes a case of a 23-years-old female who presented to the hospital with complaints of breathlessness and chest pain. After evaluation she was found to have pericardial tamponade and AIHA. Pericardiocentesis was done and further investigations confirmed the diagnosis of SLE. She was treated with injectable methylprednisolone, injectable antibiotics, Tab. hydroxychloroquine, Tab. febuxostat ,Tab. colchicine, oral antidiuretic, oral levothyroxine and other supportive management. The lack of unambiguous pathognomonic characteristics or tests, coupled with the variable presentation of SLE, makes diagnosis tricky. Overall, AIHA can be an initial presentation as well as a part of other disease processes, emphasising the significance of a comprehensive work in patients with AIHA.

Practices, knowledge, and attitude toward dispensing antibiotics without a prescription in Iraqi pharmacies

Dispensing antibiotics without a prescription (DAWRx) is a potential threat to global public health and can lead to antimicrobial abuse and resistance development. Further research is required to examine the characteristics of DAWRx practice in Iraq. This study aimed to investigate the practices of DAWRx in Iraqi community pharmacies. A semi-structured, validated, pilot-tested online questionnaire was used to conduct a descriptive cross-sectional study in March 2020 among the members of the Iraqi Pharmacist Syndicate. The questionnaire contained five sections: demographics, antibiotic dispensing knowledge, and the prevalence, sources, and characteristic features of DAWRx practices. The results are presented using descriptive statistics and significant associations were reported. A total of 403 respondents completed the questionnaire and, of them, 363 were analyzed. Despite having a satisfactory knowledge of dispensing (64.7%), the practice of DAWRx was prevalent (98.3%). DAWRx was reported based on the pharmacies’ recommendation (30.58%) and patients’ request for antibiotics. Adults and pediatric patients received antibiotics from pharmacies for various conditions. Injectable antibiotics were also dispensed without a prescription (mainly ceftriaxone, n = 51/72). Moreover, the prevalence and the daily number of antibiotics dispensed were significantly associated with sex, pharmacy attitude toward DAWRx, and DAWRx upon patients’ request. A significant association was noted between the knowledge of dispensing inquiries and the prevalence of and attitude toward DAWRx (p &lt; 0.05). Impactful intervention strategies based on patterns identified in this study should be developed to improve antibiotic dispensing in community pharmacies and safeguard public health from the adverse effects of antimicrobial resistance.

Autoimmune Haemolytic Anaemia, Acute Pericarditis with Cardiac Tamponade as Presenting Manifestations in Systemic Lupus Erythematosus- A Rare Case Report

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that affects mostly young women in which tissue-binding autoantibodies and immune complexes cause damage to organs and tissues. SLE is characterised by aberrant immunological responses that result in the release of higher levels and immunogenic nucleic acids, proteins, and other self-antigens. Autoimmune Haemolytic Anaemia (AIHA) is a condition in which antibodies against red blood cells are present. It is classified as a warm and cold antibody AIHA. The causes of warm antibody AIHA are autoimmune illnesses, infections, or even malignancy. The presence of Immunoglobulin G (IgG) antibodies can indicate warm autoimmune haemolytic anaemia (warm agglutinin anaemia), which is characterised by fatigue and other constitutional symptoms. Although, autoimmune haemolytic anaemia can be a component of the SLE spectrum, warm autoimmune haemolytic anaemia as the first manifestation of SLE is exceedingly rare. This case report describes a case of a 23-years-old female who presented to the hospital with complaints of breathlessness and chest pain. After evaluation she was found to have pericardial tamponade and AIHA. Pericardiocentesis was done and further investigations confirmed the diagnosis of SLE. She was treated with injectable methylprednisolone, injectable antibiotics, Tab. hydroxychloroquine, Tab. febuxostat ,Tab. colchicine, oral antidiuretic, oral levothyroxine and other supportive management. The lack of unambiguous pathognomonic characteristics or tests, coupled with the variable presentation of SLE, makes diagnosis tricky. Overall, AIHA can be an initial presentation as well as a part of other disease processes, emphasising the significance of a comprehensive work in patients with AIHA.

Acute Mastoiditis Clinical Course and Management in Patients Presented to Khartoumar Ear, Nose and Throat Hospital during the Period from November 2017 to November 2019

Introduction: Acute mastoiditis is the most common complication of Acute Otitis Media (AOM) and it’s the cause of serious morbidity. There is no standard universally agreed-upon management approach to acute mastoiditis. This study aims to view the clinical presentation and management approaches in Khartoum Ear, Nose and Throat Hospital. Methodology: This is a prospective case series and a hospital-based study conducted at Khartoum Ear, Nose and Throat Hospital during the period from November 2017 to November 2019. A total of 61 patients were included in the study. Results: The median age at presentation is 5 years old, males are more affected than females with a ratio of 1.35:1, and the mean duration of symptoms prior to hospital admission was 9.6 days. The most common presenting symptoms were otalgia (83.3%), ear discharge (83.3%) and post-auricular swelling (83.3%), and the most common signs at admission were tenderness over the mastoid (95.1%), retroauricular swelling and protrusion of the auricle (82%), and redness over the mastoid (77%). The abnormal tympanic membrane was found in all patients with central perforation being the commonest finding (73.8%), and bulging tympanic membrane (21.3%). 34.4% of patients received oral antibiotics before admission and the mean duration of symptoms prior to admission increased significantly in those who received antibiotics 12.7 days in comparison to those who didn’t 8.3 days. Only 52.5% of patients had a past history of recurrent acute otitis media, and 8.2% had a past history of acute mastoiditis. All the patients with recurrent mastoiditis had a past history of recurrent acute otitis media. Computed Tomography (CT) scans were obtained for 50.8% and 83.9% of those scans showed coalescent mastoiditis. Further evidence of intracranial extension was found in 6.5% and Magnetic Resonance Imaging (MRI) was obtained for them. Of the study group, 67.2% presented with subperiosteal abscess, 4.9% with facial nerve palsy and 3.3% with brain abscess. Thirteen patients with no complications were managed initially with injectable and topical antibiotics and were successful in only 6 of them (46%), abscess incisions and drainages were needed in 46 patients and were successful in 34 of them (73.9%). Eighteen patients (29.5%) needed mastoidectomy and all of them were managed successfully (100%). One patient (1.6%) was referred for intracranial abscess drainage in a specialized hospital, also one patient (1.6%) initially presented with intracranial abscess died on the second day of admission and 96.8% were discharged in good condition. The mean duration of hospital stay was 7.5 days. Conclusion: Patients present to the hospital after a prolonged period with a higher rate of complications, and the delayed presentation increased significantly in patients who received oral antibiotics prior to admission. Conservative medical treatment in non-complicated acute mastoiditis was ineffective in more than half of the patients and abscess incision and drainage and/or mastoidectomy are often necessary for the management.

Clinical features and treatment of endophthalmitis after cataract surgery

The study analyzes the frequency of acute endophthalmitis occurrence after cataract surgery, the risk factors, characteristic symptoms, and the effectiveness of peri-operative prevention measures. The study retrospectively analyzed 59 670 cases of patients operated for cataract in 2017-2021. To prevent infections, patients received four instillations of third generation fluoroquinolone (quinolone antibiotic) in the course of two days prior to cataract phacoemulsification (PE), and two instillations immediately (1 hour and 30 minutes) before the surgery; three-minutes treatment of the cornea, conjunctival sac and periocular skin with 5% povidone iodine before the surgery; and as the last step of surgery, patients received subconjunctival injection of 0.05 g cefazolin with 2 mg dexamethasone. Follow-up after surgery included four injections of 0.5% levofloxacin in the course of 7-10 days, and 0.1% dexamethasone for two weeks, or fixed combination of tobramycin and dexamethasone four times per day for two weeks. The criteria for acute endophthalmitis are: loss of spatial vision, absence of red reflex, pronounced thickening of the choroid, suspended particulates in the retrovitreal space and the vitreous observed with ultrasonography in the early postoperative period (day 4-7 after surgery). There were 32 patients (0.054%) diagnosed with acute endophthalmitis. Posterior capsule rupture was the main complicative risk factor of endophthalmitis development (OR=11.75, p=0.026). Main diagnostic criteria of acute endophthalmitis were hypopyon (OR=22.5, p=0.001) and absence of red reflex (OR=19.59, p<0.001). The use of the fixed combination of tobramycin and dexamethasone was associated with 5.8-times higher risk of acute endophthalmitis than separate application of levofloxacin and dexamethasone (p=0.042). Povidone iodine and third generation fluoroquinolone as a method of acute endophthalmitis prevention after cataract surgery demonstrate comparable efficacy to intracameral antibiotic injections.

Candida Lusitaniae Endophthalmitis: A Brief Literature Review with a Focus on Treatment Options

Intraocular fungal infections are uncommon. They may originate either exogenously, as occurs with penetrating trauma and postoperative infections, or endogenously, through hematogenous spread. Patients at the highest risk of endogenous endophthalmitis are those with central venous catheters, total parenteral nutrition, and active intravenous drug use, as well as those who are immunosuppressed [1]. Candida species are the most common fungi identified from endogenous sources related to the above. Although the incidence of ocular involvement is unclear, a few studies provide a range of 2.2–16% in patients with candidemia [2,3]. Non-albicans species of candida infections are very rare. In particular, C. lusitaniae is found in only approximately 1% of patients with candida blood stream infections [4]. Treating candida ophthalmologic infections usually requires expertise of both ophthalmology and infectious diseases. Patients who have evidence of only chorioretinitis should be treated with systemic antifungal agents. Intravitreal injection in combination with systemic antifungals is recommended for patients with infections involving the macula or vitreous humor. Vitrectomy along with intravitreal injection and systemic antibiotic therapy is needed for patients with heavy vitritis [5]. The duration of treatment is decided on a case-by-case basis but typically consists of four to six weeks of systemic antifungal therapy.

A Case of Klebsiella pneumoniae Meningitis Associated with Brain Abscess and Endophthalmitis

Meningitis, brain abscess, and endophthalmitis are rare manifestations of &lt;i&gt;K. pneumoniae&lt;/i&gt; infection. We present a case of &lt;i&gt;Klebsiella&lt;/i&gt; meningitis associated with a brain abscess and endophthalmitis. A 58-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma presented with fever, pain in the right eyeball, and vision loss. Endophthalmitis and urinary tract infections were identified through ophthalmologic examination and urine analysis, respectively, and empirical antibiotic therapy was administered. Approximately seven days after treatment, the patient presented with persistent headaches. In the cerebrospinal fluid study, the white blood cell count was 210/mm&lt;sup&gt;3&lt;/sup&gt;, the protein level was 540 mg/dL, and the glucose level was 28.6 mg/ dL. Magnetic resonance imaging of the brain revealed diffuse brain abscesses in both hemispheres. &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; was isolated from the blood and urine cultures. After intravenous injection of antibiotics (vancomycin and ceftriaxone) for 2 months, the headache resolved and the results of the cerebrospinal fluid study were normal.

Autologous Serum for Fixation of Limbal Conjunctival Autograft in Primary Pterygium Surgery

Purpose: To find out the efficacy and structural stability of autologous serum for the fixation of limbal conjunctival Autograft in the management of pterygium surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Orbit and Oculoplastic department of LRBT Hospital, Karachi, from June 2020 to November 2020. Methods: This study included 100 eyes of 100 patients with primary pterygium.Eyes with nasal Pterygium of grade III were included. Patients with ocular surface disorders, infection, inflammation, pseudo pterygium, pterygium at temporal side and coagulation disorders were excluded. After pterygium excision, a free limbal conjunctival Autograft was taken from superotemporal quadrant of bulbar conjunctiva of same eye and was used to cover the bare sclera with autologous serum. Subconjunctival injection of antibiotic and steroid was given followed by 24 hour of eye pad. Postoperative outcomes of the graft were noted at theend of the six months period of follow up. Results: The mean age of the patients was 46.5 ± 8.97 years (range 20 – 60 years). Male to female ratio was 3:1 (75 males and 25 females). Graft loss was found in five patients, graft edema in one patient, graft retraction in three patients, graft overriding in two patients, recurrence of pterygium in six patients, granuloma in two patients and subconjunctival hemorrhage in 10 patients. Conclusion: Autologous serum for fixation of limbal conjunctival Autograft is a safe, efficient and cost-effective method of treatment for primary pterygium surgery.

411. Characterization of Antibiotic Prophylaxis Prior to Trans Rectal Ultrasound Guided Prostate Needle Biopsy (TRUS PNB): A 5-Year Nationwide Study among Patients in the United States Veterans Health Administration

Abstract Background Prophylactic antibiotics are used prior to TRUS PNB to reduce risk for infectious complications such as UTI, prostatitis, epididymitis, orchitis, bacteremia and sepsis. Fluoroquinolones have been commonly used for prophylaxis, however, the incidence of post TRUS PNB infections caused by fluoroquinolone resistant Escherichia coli has increased. The purpose of this study was to characterize the prophylaxis agents used nationwide in the Veterans Health Administration (VHA) prior to TRUS PNB. Methods We conducted a review of records of all patients undergoing TRUS PNB in the VHA database from January 1st, 2013 to December 31st, 2018. We collected data about outpatient oral prophylaxis antibiotics, inpatient injectable antibiotics and microbiology results from rectal swabs and urine cultures performed within 90 days prior to the procedure. Results Of 153,055 patients undergoing prostate biopsy between January 1st, 2013 and December 31st, 2018, 27.6% (n=42,319) had urine cultures and 3.9% (n=5,294) had rectal swab cultures done within the 90-day window prior to the procedure. Among these who had urine and rectal swabs culture, 3.0% (n=1,292) and 20.1% (n=1,062) were positive for E. coli, respectively; 40.2% of E. coli isolates recovered from urine and 89.6% recovered from rectal swabs were resistant to fluoroquinolones. Table 1 shows the frequencies and percentages of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure. Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Conclusion Despite the high rate of recovery of fluoroquinolone-resistant E. coli in pre-procedure urine and rectal swabs, oral fluoroquinolones remained the most frequently used prophylactic agents prior to TRUS PNB. This inadequate prophylactic coverage may increase the risk of infectious complications following prostate biopsy. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen: Advisor/Consultant.

1721. In Vitro Activity of Cefiderocol against IMP-Producing Enterobacterales Isolated in Japan

Abstract Background Beta-lactam resistance is a major worldwide concern. Metallo-β-lactamases (MBLs) are a group of enzymes that can inactivate most commonly used β-lactam antibiotics including carbapenems and are not affected by new β-lactamase inhibitors. Therefore, treating infections caused by MBL producing strains is difficult. Imipenemase (IMP) type MBL is a rare family of acquired carbapenemases detected from Enterobacterales globally, however, it has been detected and become a major therapeutic concern in clinical settings mainly in East Asia including Japan [1]. Cefiderocol (CFDC) is a novel injectable siderophore cephalosporin antibiotic with potent activity against a wide variety of carbapenem resistant strains including both serine- and metallo-type carbapenemase-producers. We evaluated in vitro activity of CFDC and comparator agents against IMP-producing Enterobacterales isolated in Japan. Methods A total of 150 IMP-producing strains consisting of 48 Escherichia coli, 34 Klebsiella pneumoniae, 29 Klebsiella oxytoca, 21 Enterobacter cloacae, 7 Citrobacter freundii, 7 Serratia marcescens, 2 Providencia rettgeri, 1 Klebsiella aerogenes, and 1 Morganella morganii were tested. The minimum inhibitory concentrations (MICs) were determined for CFDC, ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (I-R), meropenem (MEM), and amikacin (AMK) by broth microdilution according to CLSI guidelines. CFDC was tested in iron-depleted cation-adjusted Mueller-Hinton broth. Results MIC50 and MIC90 of CFDC were 0.25 and 1 µg/mL, respectively. MICs of CFDC for all tested strains ranged from ≤ 0.03 to 4 µg/mL, which showed all strains were susceptible to CFDC based on the CLSI breakpoint (≤ 4 µg/mL). On the other hand, MIC90s of CZA, C/T, I-R, MEM, and AMK were &amp;gt; 32/4, &amp;gt; 32/4, 8/4, &amp;gt; 32, and 4 µg/mL, respectively. The susceptibilities were 98.0% for AMK, 66.0% for I-R, and &amp;lt; 10% for CZA, C/T and MEM. Conclusion CFDC had potent in vitro activity against IMP-producing Enterobacterales collected from Japan, indicating CFDC has high potential for treating infections caused by these difficult-to-treat strains. Reference: 1. Logan, LK. et al., J Infect Dis. 2017 Feb 15;215(suppl 1):S28-S36. Disclosures Hidenori Yamashiro, Shionogi &amp; Co., Ltd.: Employee Ryuichiro Nakai, n/a, Shionogi TechnoAdvance Research CO., LTD.: Employee Miki Takemura, n/a, Shionogi: Employee Yoshinori Yamano, PhD, Shionogi: Employee.