Antibiotic Therapy Research Articles

Managing Perforated Diverticulitis: An Overview of Treatment Trends and Clinical Outcomes at a Single Centre in the United Kingdom.

Introduction Perforation represents the most critical manifestation of complicated diverticulitis. In 2008, it was estimated that about 2,000 cases of perforated diverticulitis (PD) were diagnosed in the United Kingdom (UK). Management of PD is evolvingwith considerable variation in approaches between hospitals and countries with an increased trend towards a conservative approach. Objective Our aim is to provide a comprehensive overview of the management strategies and treatment outcomes for PD, with a particular focus on the influence of abscess size and the presence of distant air (DA) on the successof conservative management. Methods Data from 112 patients admitted with PD to a single district hospital in the UK between 2013 and 2018 were retrospectively analysed.CT scan reports and images were examined to assess the size and number of abscesses, as well as the presence of DA. Failed initial management was defined as the need for an alternative therapeutic option after 48 hours during the index admission or readmission within 12 weeks. Follow-up data were also reviewed to evaluate the need for elective resection and stoma reversal. Result In this cohort of 112 patients with PD, a variety of treatment strategies were employed. Antibiotic therapy alone was successful in 46 patients (41%). Radiological management was successful in only six patients (5%). Surgical washout was required in 12 cases (11%), while resection was performed in 40 cases (36%). Best supportive care was provided to eight patients (7%) who were considered unfit for invasive interventions. The success rate was higher in cases with smaller abscesses and no DA (p <0.05). Specifically, 30 out of 45 patients (66.6%) with abscesses less than 4 cm and no DA were managed successfully with conservative treatment, whereas the success rate dropped to 14 out of 30 patients (47%) when DA was present (p<0.05). For abscesses larger than 4 cm, the success rate was seven out of 20 patients (35%) without DA and significantly lower at two out of 20 patients (10%) with DA (p=0.01). The data also show a shift towards increased conservative management over the six-year period, with a steady reduction in the number of surgical interventions. However, 12 patients (19%) were readmitted with complicated diverticulitis after the initial non-resectional management. Conclusion We observed a shift towards more conservative, non-operative management of acute complicated diverticulitis with perforation over the six-year period, likely influenced by advancements in diagnostic and interventional radiology, antibiotic therapy, and minimally invasive techniques. Our data also stress that cases of PD with distant extraluminal air or larger abscesses are less suited to conservative treatment, often necessitating traditional surgical interventions. Long-term follow-up showed a moderate rate of readmissions after non-resectional management, and while stoma reversal was successful in a proportion of patients, many either opted to live with the stoma or were deemed unsuitable for reversal. A larger, multicentre prospective study would likely provide more robust data on this subject.

Antibiotic Resistance and Presence of Persister Cells in the Biofilm-like Environments in Streptococcus agalactiae

Objectives: This study investigated antibiotic resistance and presence of persister cells in Streptococcus agalactiae strains belonging to capsular types Ia/ST-103, III/ST-17, and V/ST-26 in biofilm-like environments. Results: S. agalactiae strains were susceptible to penicillin, clindamycin, and erythromycin. Resistance genes were associated with tetM (80%), tetO (20%), ermB (80%), and linB (40%). Persister cells were detected in bacterial strains exposed to high concentrations of penicillin, clindamycin, and erythromycin. S. agalactiae capsular type III/ST-17 exhibited the highest percentage of persister cells in response to penicillin and clindamycin, while type Ia/ST-103 presented the lowest percentages of persister cells for all antimicrobials tested. Additionally, persister cells were also detected at lower levels for erythromycin, regardless of capsular type or sequence type. Further, all S. agalactiae isolates presented efflux pump activity in ethidium bromide-refractory cell assays. LIVE/DEAD fluorescence microscopy confirmed the presence of &gt;85% viable persister cells after antibiotic treatment. Conclusions: These findings suggest that persister cells play a key role in the persistence of S. agalactiae during antibiotic therapy, interfering with the treatment of invasive infections. Monitoring persister formation is crucial for developing strategies to combat recurrent infections caused by this pathogen.

Infection management in the extravascular implantable cardioverter defibrillator: experience from the EV ICD Pivotal study

Abstract Background The extravascular implantable cardioverter defibrillator (EV ICD) has recently emerged as an option for guideline indicated ICD patients. Results from the EV ICD Pilot and Pivotal studies demonstrated that the device can provide safe and effective therapy through chronic follow up. Lead placement outside the vasculature has the potential to reduce systemic infections. Infection occurrence and management details from the Pivotal are reported. Purpose To report on details of infection occurrence and management from the EV ICD Pivotal study. Methods The EV ICD Pivotal study was an international, prospective, single-arm, premarket clinical study. Patients with a class I or IIa indication for a single-chamber ICD per ESC or ACC/AHA/HRS guidelines were enrolled. Results In the EV ICD Pivotal study, 316 patients had an implant attempt, (74.7% male, age 53.8±13.1 years, 82% primary prevention, LVEF of 38.9%±15.4%, and NYHA Class I [23.7%] or II/III [65.5%]), of which 15 had a system or procedure-related infection (4.7%, 9 - 737 days post-implant) through an average 16.2 months follow-up. Of these infections, 8 were classified as major complications, 3 as minor, and 4 as observations. Most (n=9) infections were addressed through medication with or without wound care (2.8% of patients) while 6 (1.9% of patients) resulted in system removal. There was a single lead-related infection addressed through system explant. However, there were no reports of mediastinitis, sepsis, or endocarditis. No system removal resulted in sequelae. Conclusions Infection rates observed in the EV ICD Pivotal study were similar to those reported in the subcutaneous implantable cardioverter defibrillator. The results from this study support that EV ICD related infections are treatable with antibiotic therapy or system removal. No system or procedure-related systemic infections such as mediastinitis, sepsis, or endocarditis have been reported in the Pivotal study.

Lesion-like effect of gliosis secondary to deep brain stimulation electrode infection: illustrative case.

Deep brain stimulation (DBS) is commonly used to treat Parkinson's disease (PD) and other movement disorders when other treatments fail. Although DBS can significantly improve motor symptoms, it carries risks such as infections, which can require multiple surgeries and prolonged antibiotic therapy. Research on the long-term neurological effects of DBS-related infections is limited. A 58-year-old man with a 13-year history of PD, refractory to optimized clinical management, underwent subthalamic nucleus (STN) DBS after previous contralateral lesioning of the posterior subthalamic area. Postoperatively, the DBS lead migrated upward and was repositioned, but he developed perielectrode cerebritis 5 days later. The DBS system was completely removed, and he underwent a 28-day course of intravenous antibiotics. Initially, his motor symptoms remained unchanged, but 4 months later, he experienced a significant and sustained motor symptom improvement that continued until the last follow-up assessment (40 months). Magnetic resonance imaging performed 2 years after the explantation showed gliosis and hemosiderin deposition in the STN, suggesting that the infection-induced gliosis had a lesion-like effect, leading to the observed clinical improvement. This case suggests that infection-induced gliosis from DBS complications can unexpectedly result in long-term motor symptom improvements, potentially influencing future management strategies for similar cases. https://thejns.org/doi/10.3171/CASE24502.

Septic Thrombophlebitis of the Umbilical Vein Complicating an Intrahepatic Umbilical Venous Catheter in a Premature Newborn

Septic thrombophlebitis of the umbilical vein (SVT) is a serious pathology in neonates, characterized by inflammation of the umbilical vein due to bacterial infection, with 90% of cases linked to the use of central venous catheters (CVCs). This inflammation can lead to thrombus formation as part of the immune system's response. Premature newborn, 33 weeks gestation, delivered vaginally, with history of gestational diabetes, twin pregnancy, macrosomia and premature rupture of membranes (57 hours), initially well adapted to extrauterine life, with a birth weight of 1575 g. The infant was admitted to neonatology for respiratory distress, and an intrahepatic umbilical catheter was inserted. On the 5th day of hospitalization, the infant developed a nosocomial Klebsiella pneumoniae infection, complicated by a fulminant hemorrhagic syndrome with hematemesis and melena. The clinical course was further complicated by multivisceral failure, requiring hepatic Doppler ultrasound, which revealed umbilical vein thrombosis. The newborn was treated with curative doses of Lovenox, while targeted antibiotic therapy was maintained for three weeks after negative blood cultures, resulting in significant clinical and biological improvement. Based on this case, we conclude that it is advisable to think about umbilical vein thrombosis and to perform an abdominal ultrasound in the presence of any digestive hemorrhage in a newborn or an intrahepatic or peripheral umbilical venous catheter, or in subjects at risk (hypotrophy, polycythemia, transfusion on the catheter) in order to screen for possible umbilical or portal vein thrombosis.

Guidelines to practice in hospitals at home: penicillin infusion pumps in erysipelas treatment

Abstract Background Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favor broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIP), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings. Methods We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use, and to compare clinical outcomes between patients with and without eCIPs. Results Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and three months after it. Patient and nurse satisfaction regarding eCIPs was very high. Conclusions Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation. Key messages • Continuous infusion of benzyl penicillin via elastomeric infusors substantially decreases broad-spectrum antibiotic use among erysipelas patients treated at home. • When erysipelas patients can be treated with outpatient parenteral antibiotic therapy, the use of elastomeric benzyl penicillin infusors is safe and effective and should thus be increasingly promoted.

Epidemiology and temporal trends of infective endocarditis between 2006 and 2018 at a tertiary referral center

Abstract Introduction Despite modern diagnostics, targeted antibiotic therapy and surgical treatment the mortality rate of infective endocarditis (IE) remains high. In developed countries both the risk factors and pathogens have changed. Objective and methods In our retrospective study we analyzed the clinical and microbiological characteristics, short- and long-term all-cause mortality, and temporal trends of consecutive patients admitted with IE between 2006 and 2018. Results We included 537 cases in our study, the mean age was 55.9 ± 16.5 years (72.2% male). 325 (60.5%) cases were native left-sided IE, 14 (3%) cases were right-sided IE, 130 (24%) cases were prosthetic valve IE, 62 (11.5%) cases were intracardiac device-related IE and 6 (1%) other cases. The most common microorganisms were Staphylococci (n=175; 33%), including 104 cases of methicillin-sensitive Staphylococcus aureus (MSSA), 27 cases of methicillin-resistant Staphylococcus aureus (MRSA) and 44 cases of coagulase-negative Staphylococci. Streptococcus species were identified in 141 cases (26%), Enterococcus species in 88 cases (16%) and 72 cases (13%) were classified as blood culture-negative IE. In-hospital all-cause mortality was 14%, mortality at six months was 27%, at one-year was 31%, and at five-year was 45%. The incidence of MSSA infections increased over time (p=0.024), while coagulase-negative Staphylococci (p&amp;lt;0.001), and Streptococci (p=0.047) infections decreased. None of the observed mortality rates showed significant change over the study period. Predictors of mortality were advanced age (HR 1.37; p&amp;lt;0.001), impaired renal function (HR: 1.03; p&amp;lt;0.001), reduced ejection fraction on admission (HR 1.38; p&amp;lt;0.001), stroke (HR 1.74; p=0.001), and MRSA infection compared to Streptococci (HR 2.56; p=0.002). Conclusion During the observed 13-year period Staphylococci were the most common pathogens, with an increasing incidence of MSSA infection in our tertiary center. The mortality rate of IE remained high and showed no improvement over time.

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p &amp;lt; 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Incidence of infection in patients with acute myeloid leukemia receiving high-dose cytarabine consolidation.

Infection risk during high-dose cytarabine (HiDAC) consolidation following induction therapy for acute myeloid leukemia (AML) is not well understood complicating decisions regarding antimicrobial prophylaxis during this period. We performed a retrospective chart review of adult patients with AML undergoing HiDAC consolidation between June 2016 and November 2021 at our institution. The primary endpoint was microbiologically confirmed infection within 30 days of HiDAC administration. This study included 111 patients who received a total of 264 cycles of HiDAC therapy. 36% of patients undergoing HiDAC consolidation had at least 1 infection over the course of their consolidation therapy. Infection complicated 18% of HiDAC cycles. The majority of infections were bacterial (81%), primarily caused by gram-negative organisms. Fluoroquinolone prophylaxis was associated with a lower hazard of bacterial infection (HR 0.46, 95% CI 0.24, 0.88). However, 26% of bacterial infections broke through antibiotic therapy with multiple cases concerning for fluoroquinolone resistance. Viral and fungal infections were rare (14% and 3% of infections respectively).

Hand Osteomyelitis: A Systematic Review of the Literature and Recommendations for Diagnosis and Management.

Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty.Level of Evidence: IV.

Feasibility of mNGS in joint replacement patients exhibiting elevated ESR and CRP levels without an underlying diagnosis

ObjectiveThe aim of this study is to investigate the viability of performing initial artificial joint replacement surgery in patients presenting with unexplained elevations in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.MethodsA cohort of 22 patients, comprising 11 cases each for knee and hip joint replacements, who underwent initial artificial joint replacement surgery between November 2020 and January 2022, was recruited. All patients exhibited elevated levels of ESR and CRP prior to surgery, the etiology of which remained undetermined. Intraoperatively, joint effusion and periarticular tissues were preserved for subsequent bacterial culture and metagenomic next-generation sequencing (mNGS). Postoperatively, a combination of intravenous and local antibiotics was administered for anti-infective management. In cases where bacterial culture and/or mNGS yielded positive results, patients were diagnosed with periprosthetic joint infections (PJI) and underwent one-stage revision; conversely, negative findings led to the discontinuation of intravenous and local antibiotics therapy.ResultsAmong the cohort of 22 patients, bacterial cultures yielded negative results, while mNGS identified bacterial infection in 14 patients (63.63%), viral infection in 1 patient (4.55%), and yielded negative results in 7 patients (31.82%). All surgical incisions achieved per primam. Subsequent follow-up assessments conducted for more than 1 year postoperatively revealed absence of PJI among the patients, all of whom exhibited satisfactory progress in their rehabilitation exercises. Notably, the Knee Society Score (KSS) for knee joint patients significantly improved from a preoperative mean of 48.7 ± 3.3 points to 84.3 ± 2.2 points postoperatively, whereas the Harris Hip Score for hip joint patients increased significantly from preoperative mean of 50.6 ± 3.6 points to 87.1 ± 1.6 points (P < 0.01).ConclusionIn cases where patients present with unexplained elevations in ESR and CRP levels, primary artificial joint replacement can be undertaken following a one-stage revision approach for PJI.

Intravenous Versus Oral Omadacycline or Linezolid for Acute Bacterial Skin and Skin Infections: A post hoc Analysis of the OASIS Trials.

Appropriate oral antibiotic therapy for the treatment of acute bacterial skin and skin structure infections (ABSSSI) is a challenge, as current oral treatment guidelines do not fully cover the most common skin pathogens. Both linezolid and omadacycline are available as intravenous or bioequivalent oral formulations. This post hoc analysis of the OASIS-1 (ClinicalTrials.gov identifier NCT02378480) and OASIS-2 (ClinicalTrials.gov identifier NCT02877927) phase 3 trials assessed safety and clinical efficacy of intravenous (IV)-start versus oral (PO)-start therapy in patients treated with omadacycline or linezolid for ABSSSI. In OASIS-1, patients were randomized to IV omadacycline or linezolid, with optional switch to oral therapy, while patients in OASIS-2 received oral omadacycline or linezolid. Treatment was provided for 7-14days in both studies. The primary endpoint was an early clinical response (ECR) at 48 to 72h, defined as survival and ≥ 20% reduction in lesion size, without rescue antibacterial therapy. A total of 645 IV-start inpatients and 735 PO-start outpatients were assessed. Median age was 47years for the IV-start group and 44years for the PO-start group. Most patients had solely gram-positive infections (97% in each group; ECR [85.2% IV-start and 85.0% PO-start]), and the incidence of treatment-emergent adverse events (AEs) was similar between the groups. The most frequent AEs observed were nausea (11.2% [IV-start] versus 18.9% [PO-start]) and subcutaneous abscess (5.6% [IV-start] versus 1.9% [PO-start]). Discontinuation due to AEs was infrequent in both groups (2% [IV-start] versus 1.2% [PO-start]). Oral therapy is equally efficacious to IV therapy when omadacycline or linezolid is used to treat ABSSSIs. These data strengthen the evidence for oral omadacycline as a therapeutic option for ABSSSI, particularly for patients who have experienced treatment failure because of the limitations of other therapies. Clinicaltrials.gov, NCT02378480 and NCT02877927.

Comparative Evaluation of Antibiotic Therapies for Subclinical Staphylococcal Mastitis in Goats

Subclinical mastitis (SCM) is characterized by inflammation of the udder without visible signs of inflammation in the animal, udder and milk and hence could be diagnosed by laboratory examination only. Effective treatment of SCM in goats is crucial for maintaining quality milk production. This study was conducted at the Department of Veterinary Medicine, College of Veterinary Science and Animal Husbandry, Nanaji Deshmukh Veterinary Science University, Jabalpur (M.P.), India. A total of 236 lactating goats irrespective of age, breed, parity and stage of lactation, from both organized and unorganized sectors in and around Jabalpur, were screened over a period of six month. Based on modified California mastitis test scores, 83 goats tested positive for subclinical mastitis resulting in an overall occurrence of 35.17% (83/236). A total of 48 milk samples that tested positive for modified California mastitis test were further analyzed for bacterial isolation and identification. Among them, 34 (70.83%) samples were positive for only Staphylococcus spp., while 12 (25%) samples exhibited mixed infection with Staphylococcus spp. and Gram-positive bacilli. Then, 18 goats, positive for subclinical Staphylococcal mastitis were divided into three groups i.e. G1, G2 and G3 with six goats in each group for therapeutic study and six apparently healthy goats were taken as healthy control group (G4). G1 Goats were treated with Inj. Enrofloxacin LA @ 7.5 mg/kg b. wt. I/M single dose; G2 with Inj. Ceftizoxime @ 10 mg/kg b. wt. I/V single dose and G3 with Inj. Oxytetracycline LA @ 20 mg/kg b. wt. I/M single dose. The responses of therapeutic assessment were evaluated on the basis of somatic cell count and modified California mastitis test score. The most effective response for subclinical Staphylococcal mastitis in goats was observed with Ceftizoxime followed by Enrofloxacin LA and the least with Oxytetracycline LA.

Surgical treatment of infective endocarditis: some experiences at the Heart Institute, Ho Chi Minh City

Objective: To determine the factors associated with in-hospital mortality and the appropriate timing of operation in patients with infective endocarditis undergoing cardiac surgery. Methods: Cross-sectional study in patients admitted to the Heart Institute from 01/01/2021 to 31/12/2023 who had a diagnosis of infective endocarditis and had undergone cardiac surgery within the same hospital admission. Results: 128 patients (87 men, age: 44,8 ± 15,8 years) were enrolled. Streptococcus (37,5%) and Enterococcus (12,5%) were the most frequent pathogen agents. Aortic valve replacement and mitral valve replacement or repair were the main procedures. In-hospital mortality was 6.3%. The factors associated with in-hospital mortality included the presence of a prosthetic valve or pulmonary artery graft, abscess and/or fistula, and severe heart failure necessitating urgent operation. Preoperative duration of antibiotic therapy &gt;21 days vs ≤21 days, and &gt;14 days vs ≤14 days had no influence on in-hospital mortality. There was no infective endocarditis relapse. While waiting for cardiac surgery, the cumulative incidence of embolic events rose markedly beginning from the 3rd week after antibiotic therapy initiation. Conclusions: Factors associated with in-hospital mortality should be taken into account in the preoperative risk assessment. Patients with infective endocarditis who have indication for cardiac surgery and favorable response to antibiotic therapy should be operated after 2 weeks of antibiotic treatment.

Ovarian carcinosarcoma with lung metastasis characterized by persistent fever: A case report and literature review.

Ovarian carcinosarcoma (OCS) is a rare malignant tumor prone to distant metastasis. Primary manifestations include pelvic and/or abdominal pain, bloating, and compression. Nevertheless, it is uncommon for OCS to present primarily with persistent fever. This is the first reported case of OCS with lung metastasis characterized by persistent fever. A 61-year-old female patient complaining of abdominal pain and fever was admitted to our hospital. Computed tomography showed an irregular, slightly low-density mass on the left side of the uterus and multiple solid nodules in both lungs. She underwent cytoreductive surgery for pathologically confirmed stage IVB OCS. She was administered chemotherapy after cytoreductive surgery. Given the patient's history of persistent fever and progressively enlarged pulmonary nodules, a pulmonary abscess was considered as a possible diagnosis. Following antibiotic therapy, the patient's high body temperature did not decrease; however, following nonsteroidal anti-inflammatory drug therapy, it quickly decreased. These symptoms were eventually considered the consequence of neoplastic fever caused by lung metastases. Owing to the rapid progression of the disease, the patient ultimately died. This study suggests that, for patients with pelvic and/or abdominal pain, bloating, and pelvic masses, especially those with suspicious lesions in other organs accompanied by fever of unknown origin, a diagnosis of cancer or sarcoma with metastasis should be considered after ruling out infectious fever.

Clinical characteristics and prognosis of bloodstream infections with carbapenem-resistant Gram-negative organisms in patients with hematological malignancies: A multicenter case-control study in China

To investigate clinical characteristics of hematological malignancy (HM) patients with carbapenem-resistant gram-negative organism (CRO) bloodstream infections (BSI) in China, and to elucidate the prognostic risk factors of CRO BSI. We conducted a multicenter case-control study of 201 HM patients with CRO BSI between 2018-2020. Antimicrobial susceptibility testing and whole genome sequencing were performed for CRO isolates. Independent risk factors for 28-day crude mortality of were analyzed using Cox proportional hazards regression models. The subgroups of major species were also evaluated. The pathogens responsible for CRO BSI in HM patients dominated by ST11 CRKP, ST167 CREC and ST463 CRPA. Most isolates produced carbapenemases with KPC and NDM being the main. CRO isolates had resistance rates to conventional antimicrobials ranging from 55%-100% and poor susceptibility to novel antimicrobials related to carbapenemases and species. The 28-day crude mortality was 24.2%. Non-Hodgkin lymphoma, heart disease, blaKPC-2 positive, empirical antibiotic therapy with linezolid, Pitt bacteremia score >3.5 were risk factors for 28-day mortality and appropriate definitive antibiotic therapy, tigecycline-containing therapy and aminoglycoside-containing therapy were protective factors. blaKPC-2 positive in CRKP and ST463 in CRPA were associated with Pitt bacteremia score > 3.5. Solid tumor and other site infections before BSI were risk factors for ST463 CRPA BSI and Pulmonary infection before BSI was risk factor for KPC-KP BSI. The antimicrobial resistance of CRO isolates for BSI in HM patients is critical. HM patients with CRO BSI should be treated with appropriate definitive antibiotic therapy based on early clarification of pathology and their antimicrobial susceptibility.

Lock, stock, and Leuconostoc: an unusual presentation of a rare pathogen

Leuconostoc mesenteroides is a Gram-positive bacterium in the Lactobacillaceae family. This species is rarely encountered clinically and in the past was regarded as a contaminant when cultured. Recently it is being recognized as a pathogen responsible for opportunistic infections in immunocompromised patients. Compared to other Gram-positive cocci, Leuconostoc spp. carry intrinsic resistance to vancomycin. It is not common for clinical microbiology laboratories to isolate this organism and instead incorrectly report enterococcus and streptococcus organisms. Here, we present a case of bacteremia resulting in febrile illness and pneumonia in an 81-year-old woman with a history of rheumatoid arthritis and a notable lapse between immunomodulator therapy exposure. She was successfully treated when this organism was identified, and her antibiotic therapy was switched from vancomycin to ampicillin-sulbactam. This case highlights the importance of considering L. mesenteroides as a source of infection in patients predisposed to an immunocompromised state despite this organism’s being a rare pathogen. Keywords: Leuconostoc mesenteroides, rheumatoid arthritis, immunomodulators; vancomycin resistance

Factors associated with mortality and evaluation of clinical risk scores among cancer patients admitted with post-chemotherapy infection in Uganda: a prospective cohort study

Abstract Background Little is known about outcomes from cancer chemotherapy-associated infections in sub-Saharan Africa. Accordingly, among cancer patients admitted with post-chemotherapy infection in Mbarara, Uganda, we aimed to determine 1) the 30-day case fatality rate, 2) factors associated with mortality, and 3) clinical risk score performance. Methods We enrolled participants aged 18 years or older if they 1) received cancer chemotherapy within the past 30 days, 2) were admitted to the oncology ward, and 3) were prescribed intravenous antibiotics. We used Cox proportional hazards regression to determine predictors of 30-day mortality and calculated the area under the receiver operating characteristic curve (AUC) for each clinical risk score. Results Among 150 participants, 67 (45%) were female and the median (IQR) age was 56 (43-66) years. Esophageal cancer (18%) and pneumonia (42%) were the most common malignancy and infection, respectively. Death by 30 days occurred in 63 (42%) participants. qSOFA ≥2 (adjusted hazard ratio [aHR] 2.51, 95% confidence interval [CI] 1.42-4.44, p=0.001), and UVA score &amp;gt;4 (aHR 2.13, 95% CI 1.08-4.18, p=0.03) were independently associated with 30-day mortality. An ECOG score ≥3 was similarly independently associated with 30-day mortality in the qSOFA and UVA models. The AUCs for qSOFA and UVA were 0.70 (95% CI 0.63-0.79) and 0.72 (95% CI 0.64-0.80), respectively. Conclusions In participants with post-chemotherapy infection in Mbarara, Uganda, the case fatality rate was high. ECOG, qSOFA, and UVA scores were associated with 30-day mortality.

Is There a Role for Bronchoscopy in Aspiration Pneumonia?

Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.

Reactive Changes in Lymph Node Structure in Peritonitis and during Treatment with a New Antibiotic.

The effect of a new antibiotic peptomide A-70 on changes in the mesenterial lymph nodes caused by experimental peritonitis was studied. Differences in the morphological changes in rat lymph nodes in peritonitis and against the background of antibiotic therapy were revealed. Lymph nodes responded to peritoneal inflammation by reducing the area of cortical structures and expansion of the sinus system, which indicates a decrease in drainage-detoxification and immune function and determines unfavorable outcome of peritonitis. Antibiotic therapy reduced inflammatory manifestations and toxic pressure on the lymph system and potentiated the reactive response of the mesenteric lymph nodes: the size of lymphoid nodes and the paracortical T-dependent zone increased against the background of shrinkage of the sinus system, which attested to activation of the lymphopoietic function and immune response of lymph nodes in peritonitis. The observed changes attested to favorable prognosis of peritonitis treated with antibiotic peptomide A-70.