Microbiological Findings Research Articles

Microbiological findings in acohort of patients with coronavirus disease 2019 and venovenous extracorporeal membrane oxygenation.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is an established support option for patients with very severe respiratory failure and played an important role during the coronavirus disease 2019 (COVID-19) pandemic. Bacteria and fungi can lead to severe infectious complications in critically ill patients. The aim of this study was to describe the microbiological spectrum of bacteria and fungi detected in patients with COVID-19-associated respiratory failure supported with VV ECMO in our center. This retrospective single-center analysis included all patients with COVID-19-associated respiratory failure supported with VV ECMO in our center between March 2020 and May 2022. All findings from microbiological samples, taken as part of clinical routine assessment from initiation of VV ECMO until day30 were included. Samples were described by site and time of detection and microbiological characteristics. From March 2020 through May2022, 88patients with COVID-19-associated respiratory failure received VV ECMO support at our center. In 83/88 patients (94.3%), one or more pathogens were found in microbiological samples. Most pathogens were isolated from samples from the respiratory tract (88.6%). Earliest detection occurred in samples from the respiratory tract with amedian time of 5days to first detection. The most frequently detected pathogens were Staphylococcus spp., Candida spp., Klebsiella spp., Escherichia coli and Enterococcus spp. In this cohort of severely ill COVID-19 patients receiving VV ECMO support, pathogens were frequently detected.

P-1602. Urinalysis with Reflex Urine Culture to Screen for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Opportunities for Diagnostic and Antimicrobial Stewardship

Abstract Background Routine screening and treatment of asymptomatic bacteriuria (ASB) in kidney transplant recipients (KTRs) beyond 1 month post-transplant are no longer recommended due to potential harm. Evidence from clinical trials demonstrated that screening and treatment of ASB does not reduce the risk of pyelonephritis, acute rejection or long-term graft impairment. However, ASB screening post-transplant remains a common practice. This study characterizes our institution’s current practice with associated testing costs regarding screening and treatment for ASB for the first 3 months post-transplant. Estimated annual cost of urinalysis and urine culture in kidney transplant recipients at University of Washington Medical Center The estimated annual cost of urinalysis and urine culture was calculated based on the testing cost in 50 patients for the first three months post-transplant, assuming a total of 200 patients receive kidney transplant annually at our institution. The average cost of urinalysis and urine culture per person for the first three months after transplant was $1511.47. This estimate does not take into account urinalyses and urine cultures beyond three months. The estimated cost savings assume that urinalysis with reflex urine cultures is de-implemented and urine cultures are ordered only for symptomatic patients. This estimate does not consider the potential reduction in the number of urine cultures based on negative urinalysis in symptomatic patients. Methods We conducted a retrospective review of electronic records for 50 consecutive adult KTRs at University of Washington Medical Center between January and April 2023. Data collected included demographics, laboratory results, microbiological findings, antibiotic usage for 3 months post-transplant, and rejection within 1 year post-transplant. A chart review by 2 independent reviewers was performed to determine whether each positive urine culture (UCx) represents ASB or urinary tract infection (UTI). Results Among 50 KTRs, a total of 709 urinalyses (UA, mean 14.2 per person) and 263 UCx (mean 5.2 per person) were performed within 3 months post-transplant. Reflex from UA accounted for 95.4% of UCxs (251 out of 263), and 35.4% of UA were reflexed to UCx (251 out of 709). Of 40 positive urine cultures, 6 were considered symptomatic UTI and 34 as ASB. The mean cost of routine screening with UA with reflex UCx for the first 3 months after transplant was $1511.47. The estimated annual cost based on 200 KTRs per year exceeds $300,000 (Figure 1). All 6 UTI episodes and 5 of 34 ASB episodes (14.7%) were treated with antibiotics. Acute rejection by 1 year post-transplant occurred in 2 out of 50 patients (4%), but neither had ASB nor UTI within 3 months of transplant. Conclusion Routine UA with reflex UCx during post-transplant clinic visits accounted for the majority of cases of ASB within the first 3 months post-transplant. Decreasing the ordering of UA-guided reflexive UCx has the potential to reduce the identification of ASB and associated costs. Disclosures Ajit P. Limaye, MD, GSK: Advisor/Consultant|Memo: Advisor/Consultant|merck: Advisor/Consultant|merck: Grant/Research Support|Moderna: Advisor/Consultant|NobelPharma: DSMB member|Novartis: DSMB member|syneos: DSMB member

P-147. Exploring the Complexity of Brucellosis: Findings from a Prospective Observational Study at AIIMS, Jodhpur

Abstract Background Brucellosis, a global health concern, is often misidentified due to diagnostic complexities. In India, its prevalence is estimated at 13.5%. This study examines its microbiological and clinical spectrum for improved management. Methods AIIMS, Jodhpur, conducted a prospective observational study from April 2021 to March 2024, examining patient records for demographic data, clinical presentations, laboratory and microbiological findings, treatment approaches, outcomes, and excluding alternative causes of pyrexia of unknown origin (PUO) Results Among 1142 cases analyzed, 43 were confirmed positive for brucellosis subsequent to thorough exclusion criteria. The most common age group affected by brucellosis, intriguingly, was those under 20 years, comprising 53.49% of the cases, followed by individuals aged 21 to 50 years at 30.23%, with those over 50 years representing 16.27% of the cases. The study unveiled a spectrum of clinical presentations, including 34 cases of PUO, 3 instances of spinal involvement, 5 cases with Central Nervous System (CNS) manifestations, as well as isolated occurrences of Endocarditis and Kikuchi Disease, underscoring the diverse clinical manifestations associated with brucellosis. Noteworthy clinical indicators included a high prevalence of unpasteurized milk consumption (76.74%), fever (88.37%), and joint pain (62.79%). Predominantly, B. Melitensis accounted for 30 cases, followed by B. Abortus with 11 cases and B. Suis with 2 cases. Conclusion This study reaffirms the significant diagnostic challenge posed by brucellosis, particularly within the spectrum of PUO. Blood culture emerges as a cornerstone in the reliable diagnosis of the infection. Disclosures All Authors: No reported disclosures

P-1109. A phase 2, randomized, double-blind study of ibezapolstat compared with vancomycin for the treatment of Clostridioides difficile infection: clinical and microbiome evaluation

Abstract Background Ibezapolstat (IBZ) is Gram-positive selective spectrum antibiotic that inhibits the bacterial DNA polymerase IIIC currently in clinical trial development for the treatment of C. difficile infection (CDI) in adults. In the open-label, non-comparative, phase 2a study, 10 of 10 IBZ-treated CDI patients experienced clinical cure. The purpose of the phase 2b CDI study was to assess the safety, efficacy, and microbiome change of IBZ versus vancomycin (VAN). Methods Phase 2b (ClinicalTrials.gov, number NCT04247542) was a randomized, double-blind, active-comparator study. Participants with signs and symptoms of CDI and a positive enzyme immunoassay toxin test result were recruited from 12 centers in the USA and randomly assigned (1:1) to receive oral IBZ 450 mg every 12 h or oral VAN 125 mg every 6 h for 10 days. Stool was collected daily for microbiome evaluations. The primary endpoints were clinical cure at the end of therapy visit and safety. Secondary endpoints included microbiologic and microbiome evaluations. Results Thirty patients were recruited and were assessed in the per protocol analysis. (IBZ: n=16; VAN n=14). Fifteen of 16 (93.8%) patients given IBZ had a clinical cure versus 14 of 14 (100%) patients given VAN. IBZ and VAN were well tolerated with no serious drug-related events. C. difficile was eradicated from all stool samples after day 3 of treatment for IBZ-treated patients while three VAN-treated patients had C. difficile growth after day 3. IBZ demonstrated consistent preservation of key Bacillota species while significant decreases were observed in VAN-treated patients. CDI recurrence occurred in two patients given VAN and no patients given IBZ. Conclusion In the phase 2b study, IBZ had a clinically comparable cure rate and safety profile to oral vancomycin. Favorable microbiologic and microbiome findings were observed with IBZ-treated patients along with a lower rate of CDI recurrence. These results warrant further development in phase 3 trials. Disclosures Michael Silverman, MD, Acurx: Advisor/Consultant Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support

P-1155. Acute Osteomyelitis and Septic Arthritis in Children in Israel: Epidemiology, Microbiology, Clinics and Outcomes

Abstract Background The goal of this study was to characterize the clinical, microbiologic epidemiological characteristics and outcome associated with osteoarticular infections ( OAIs) in hospitalized children in Israel.Figure 1:Annual incidence for each disease per 100,000 hospitalizations during the years of study. SA-septic arthritis, OM-osteomyelitis Methods Patients < 18 years old admitted with a diagnosis of acute osteomyelitis (AOM) or septic arthritis ( SA), between January 2007 and December 2019 were included if they had a microbiological and/or radiological findings supporting the diagnosis. Clinical and laboratory data were retrieved from the medical records. Results 305 children with OAIs were included. The annual incidence among osteomyelitis patients increased by 10.25 cases per 100,000 hospitalizations every year (P=0.019) during the study period. Tibia and knee were the most frequently involved bones and joints. About one-half (47.5%) of the patients were febrile upon admission. Laboratory data analyses showed that 36 (26%) AOM and 74 (48%) SA patients had leukocytosis at presentation. C-reactive protein (CRP) levels ( >5 mg\dL) were elevated in 87% and 71% of patients with SA, and AOM, respectively. The most common isolated pathogens were methicillin susceptible Staphylococcus aureus followed by Kingella Kingae. About 5% of the hospitalized patients due to septic arthritis and 6% of the osteomyelitis patients had complications and underwent a surgical intervention. There were no long term sequelae. Conclusion The admission rate for acute osteomyelitis in children increased significantly during the last decade. Fever and WBC, were not sufficiently reliable to diagnose or rule out OAIs. The most common isolated pathogens are methicillin susceptible Staphylococcus aureus followed by Kingella Kingae. Through accurate diagnosis and treatment with appropriate antibiotics and surgical intervention when indicated osteoarticular infections have a favorable outcome and no long term sequelae. Disclosures All Authors: No reported disclosures

P-95. Predictors of bloodstream infection and its impact on mortality in septic arthritis: A 15-year review

Abstract Background Septic arthritis is often complicated by bloodstream infection (BSI), which can lead to metastatin infections and sepsis. In this study, we aimed to identify risk factors for septic arthritis-related BSI and assess its impact on clinical outcomes.Table 1.Comparison of clinical characteristics of septic arthritis patients with and without bloodstream infection. Methods A retrospective review spanning 15 years (January 2009 to May 2023) was conducted on patients diagnosed with septic arthritis. Data from patients with positive synovial fluid cultures were analyzed.Table 2.Laboratory and microbiologic findings of patients with septic arthritis according to bloodstream infections. Results Among 456 patients with septic arthritis, 16.8% (n=77) developed BSI. The 90-day mortality rate was significantly higher in patients with BSI compared with those without BSI (14.3% vs. 5.3%, P=0.004). Staphylococcus aureus was the most commonly identified organism in synovial fluid cultures and was associated with an increased risk of BSI (adjusted odds ratio [aOR], 2.20; 95% confidence interval [CI], 1.15-4.34; P=0.019). Independent risk factors for BSI included higher Sequential Organ Failure Assessment (SOFA) score (aOR, 1.23; 95% CI, 1.06–1.44; P=0.009), lymphopenia (aOR, 2.84; 95% CI, 1.38–6.15; P=0.006), and elevated C-reactive protein (CRP, mg/dL) levels (aOR, 1.07; 95% CI, 1.05–1.10; P< 0.001). Age ≥70 years (aOR, 3.96; 95% CI, 1.49–11.85; P=0.009) and higher SOFA score (aOR, 1.36; 95% CI, 1.12–1.67; P=0.002) were significant predictors of 90-day mortality, although BSI itself was not.Table 3.Multivariable analysis of risk factors for bloodstream infection and 90-day mortality in patients with septic arthritis.Variables with a P-value <0.05 in the univariable analysis were included in the multivariable analysis. Conclusion Mortality in patients with septic arthritis was primarily associated with systemic sepsis resulting from BSI rather than the BSI itself. Understanding the relationship between septic arthritis-related BSI and clinical outcomes can aid physicians in managing systemic infections and improving patient care.Figure 1.Distribution of causative organisms of septic arthritis. Disclosures All Authors: No reported disclosures

Cytomorphological diagnosis of sarcoidosis using EBUS-TBNA in a tuberculosis-endemic region.

Sarcoidosis, a granulomatous inflammatory disease, exhibits diverse clinical manifestations, often affecting multiple organs. Diagnostic challenges arise due to its similarities with tuberculosis, particularly in high-burden areas. Differentiating between the two relies on clinical judgment, laboratory tests, imaging, and invasive procedures. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a valuable diagnostic tool, enhancing both accuracy and patient care. This study enrolled 279 suspected sarcoidosis cases, evaluated via EBUS-TBNA between November 2022 and August 2023. The inclusion criteria comprised intrathoracic lymphadenopathy on CT, with subsequent diagnoses of either sarcoidosis or tuberculosis. Clinical, radiological, and laboratory assessments, along with EBUS-TBNA, were conducted. Cytopathological analysis focused on the presence of granulomas, histiocytic clusters, lymphocyte depletion, and necrosis, which aided in diagnosis. Statistical analysis was conducted using SPSS software to evaluate sensitivity, specificity, and predictive values. Out of 279 patients, 178 were diagnosed with sarcoidosis and 90 with tuberculosis. Adequate TBNA samples were obtained in 240 cases, predominantly from male patients. Negative tuberculin skin tests and negative culture studies were significant findings in the sarcoidosis cases (p<0.0001). Echotexture and necrosis were distinguishing features of tuberculosis, while granulomas and histiocyte patterns varied. The sensitivity and specificity for diagnosing sarcoidosis via cytomorphology were notable, particularly when combined with negative microbiological findings. Cytomorphological analysis via EBUS-TBNA significantly aids in the diagnosis of sarcoidosis, despite overlapping features with tuberculosis. The absence of necrosis and distinctive granuloma characteristics contribute to its high sensitivity and specificity. Radiological correlations and microbiological findings further enhance diagnostic accuracy. This study underscores the importance of comprehensive evaluation in intrathoracic lymphadenopathies, highlighting the pivotal role of EBUS-TBNA in tuberculosis-endemic regions.

Contributing factors to postoperative surgical site infections in pituitary neuroendocrine tumors undergoing endonasal transsphenoidal resection

Pituitary Neuroendocrine Tumors (PitNETs), often treated via endonasal transsphenoidal resection, present a risk for postoperative surgical site infections (SSIs), including intracranial infections such as meningitis. Identifying the risk factors associated with these infections is crucial for improving surgical outcomes and patient care. A retrospective study was conducted at a medical center from June 2020 to June 2023. The study included 20 patients with postoperative intracranial infections and 50 controls without infections. Inclusion criteria involved adult patients diagnosed with PitNETs who underwent standard endonasal transsphenoidal surgery and provided informed consent. Exclusion criteria included previous neurosurgical procedures, preoperative infections, concurrent severe diseases, or alternative surgical approaches. Diagnostic criteria for intracranial infections were based on clinical, hematological, cerebrospinal fluid, radiological, and microbiological findings. Statistical analyses were performed using IBM SPSS, focusing on univariate and multivariate logistic regression analyses. Univariate analysis showed no significant association of intracranial infections with factors like smoking history, previous craniotomy, operation time, hypertension, preoperative sphenoid sinusitis, BMI, and age. However, postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle were significantly associated with infections. Multivariate logistic regression further confirmed these findings, with significant odds ratios for these factors. The study reveals a significant correlation between postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle with the occurrence of SSIs following endonasal transsphenoidal resection of PitNETs. Microbial analysis revealed Escherichia coli as the most prevalent pathogen in post-surgery infections, with notable antibiotic resistance patterns observed in key bacteria, necessitating careful antibiotic selection. Tailored clinical treatment strategies addressing these risk factors are essential to reduce the incidence of postoperative SSIs and enhance patient safety.

Clinical presentation and outcome of patients with endogenous endophthalmitis.

The study aims to evaluate the clinical characteristics, risk factors, microbiological findings, and visual outcomes, as well as patient and eye survival, of patients diagnosed with endogenous endophthalmitis (EE). A retrospective study was conducted on 29 eyes from 21 patients diagnosed with EE. The mean age of presentation was 56.8 years, with a male predominance. The most common predisposing factors were diabetes mellitus and recurrent urinary tract infections. 42.9% of patients exhibited positive blood cultures, whereas positive vitreous cultures were detected in 38.1% of patients. The majority of cases were caused by bacterial infections. The median final visual acuity was 2 (0.1-2.9) LogMAR, with no significant difference between the bacterial and fungal groups. According to the Kaplan-Meier analysis, first-year survival rate was 90.5%, and the rate of eye preservation (at least one eye) was significantly lower in the presence of immunosuppresant drug usage (p = 0.004, Log Rank = 8.348). Endogenous endophthalmitis typically has a poor visual prognosis, with the loss of anatomical integrity or mortality not being uncommon. The findings of the study provide insights into the clinical and microbiological characteristics of patients with EE in Turkey. Initial visual acuity and severe intraocular inflammation at presentation have been identified as predictors of poor visual outcomes. The negative impact of immunosuppressive drug use on globe survival has been noted. In patients using immunosuppressive drugs, healthcare providers being vigilant towards infectious pathologies and prompt intervention may increase the chances of success in EE treatment.

Deep Neck Infections. Review of 111 cases.

&lt;b&gt;Introduction:&lt;/b&gt; Deep neck infections (DNI) are potentially life-threatening conditions. The infections are commonly polymicrobial, and develop as a result of oral cavity infections, tonsilitis, laryngitis, trauma, or malignancy. Timely diagnostics and management are essential to prevent severe complications such as airway obstruction, sepsis or mediastinitis. Our study highlights the clinical characteristics of DNI etiology, complications, and treatment outcomes.&lt;b&gt;Aim:&lt;/b&gt; This study aimed to provide a structured overview of a cohort of 111 patients with deep neck infection, comprising patient characteristics, etiology, clinical imaging, and complications along with the prognosis according to the used therapeutic strategy.&lt;b&gt;Methods:&lt;/b&gt; This is a retrospective analysis of 111 patients who were hospitalized with DNI. We evaluated the demographics, clinical presentation, microbiological findings, and treatment outcomes. Statistical analyses including Pearson's chi-square, Mann-Whitney U test, independent-samples Kruskal-Wallis test and binary logistic regression were used to asses our data.&lt;b&gt;Results:&lt;/b&gt; There was a predominance of male patients (62.2%) in our cohort. We found an increased DNI incidence over life in the middle-to-older age groups. The median patient age was 53 for male patients and 55 for female patients. The median hospital stay in our study was 10 days. Odontogenic infections were the leading etiology (37.8%), followed by complications of tonsillitis (23.4%) and phlegmonous laryngitis (12.6%). As many as 38.7% of patients had the following complications: airway obstruction in 25.2%, mediastinitis 10.8%, and sepsis 5.4%. The most commonly used antibiotics were ceftriaxone + metronidazole (28.8%) and amoxiclav (13.5%). The most common bacterium found in swab cultures was Streptococcus constellatus, and complications were more common in patients with a positive culture for &lt;i&gt;Acinetobacter baumannii&lt;/i&gt;. Antibacterial resistance was found in 28.8% of the specimens. There was a significant association between antibiotic resistance and complication rates (P&lt;0.05).

Development of a Reference Standard to Assign Bacterial Versus Viral Infection Etiology Using an All-inclusive Methodology for Comparison of Novel Diagnostic Tool Performance

Abstract Background Diagnostic test evaluation requires a reference standard. We describe an approach for creating a reference standard for acute infection using unrestricted adjudication and apply it to compare biomarker tools. Methods Adults and children with suspected acute infection enrolled in three prospective studies at emergency departments and urgent cares were included. Adjudicators, blinded to C-reactive protein, procalcitonin, and MeMed BV (MMBV), labeled each case (bacterial/viral/non-infectious/indeterminate). Initial adjudication involved 3 adjudicators. Reference standard cohorts were defined: Microbiologically confirmed (3/3 adjudicators concur with high confidence and a concordant microbiological finding), unanimous (3/3 adjudicators concur with high confidence), suspected (3/3 adjudicators concur with high/moderate confidence or 2/3 adjudicators concur with high confidence), and all-inclusive (remaining unlabeled cases were reviewed by up to 7 additional adjudicators until reaching a leading label). Results Among 1016 patients, 156 difficult-to-diagnose cases required over 3 adjudicators. The area under the receiver operating characteristic curve in the microbiologically confirmed (n = 427), unanimous (n = 565), suspected (n = 860), and all-inclusive (n = 1016) cohorts for MMBV were 0.98 (95% confidence interval .94–1.00), 0.98 (.95–1.00), 0.95 (.92–.98) and 0.90 (.87–.93), respectively, and for procalcitonin were 0.69 (.57–.81), 0.77 (.68–.86), 0.74 (.68–.80) and 0.70 (.65–.75), respectively. A delta in performance between MMBV and procalcitonin was maintained across the different cohorts. Conclusions Creating a reference standard that includes difficult-to-diagnose cases demands an approach to addressing diagnostic uncertainty in acute infections. Tool performance depends on the reference standard applied and decreases as the difficulty to diagnose increases, highlighting the importance of using the same reference standard when comparing tools.

Infection-Related Stillbirths: A Detailed Examination of a Nine-Year Multidisciplinary Study.

Although several conditions and specific risk factors have been associated with stillbirth (SB), in most of the cases it is difficult to identify the definitive etiopathology and cause of death. Specifically, the role of infections in SB is still debated. Our aim was to study maternal, placental, and fetal tissues in cases of SB in order to define the causative link between infections and fetal death, through a multidisciplinary clinical audit. Between 2014 and 2022, microbiological investigations on maternal, placental and fetal samples of SB cases were performed according to a standardized protocol including serology, cultures, and molecular biology. Autopsies and placental examination were mandatory in all SB cases. A total of 182 cases of SB were investigated. Bacteria were detected in 22.2% of vaginal swabs, 65% of placental biopsies, 29% of fetal blood, and 14.1% of oropharyngeal swabs. Vaginal and oropharyngeal swabs were positive for urogenital mycoplasmas in 25.2% and 8.6%, respectively. Positive results of microbiological investigations, in association with histological features suggestive of infection, were observed in six cases, indicating that fetal death was likely related to a bacterial infection. In one case, a high SARS-CoV-2 load was found in the placenta of a SB due to placental abruption. Infections were likely associated with fetal death in 3.8% of cases. Thus, in developed countries, an infection, defined when positive microbiological findings are associated with histological evidence of organ damage, is a minor contributory factor in SB.

Clinicomycological Correlation of Tinea Incognito

Background: Tinea incognito refers to the unusual clinical manifestation of dermatophytosis brought on by prior topical or systemic medication use. Given the widespread and easy diagnosis of dermatophytic infections, steroid usage has created a diagnostic conundrum, thus turning a straightforward infection that may be treated into a persistent, long-term skin disease. Objective: To examine the clinical characteristics of tinea incognito and correlate the clinical manifestations with the microbiological findings. Methods: An observational study was conducted with 100 cases in a department of microbiology, dermatology, venereology, and leprology, in India. The baseline data of the patients and clinical features of tinea incognito were recorded. To identify the causative agents, skin scrapes were collected and tested as per standard protocol. Results: In this study, 30% of the patients were between 31 and 40 years old. The male-to-female ratio was 2:1, 66% reported a history of application of the triple combination of steroids, and 34% used single steroids. Tinea corporis was seen in 30% of the patients, and the trunk/body (52%) was the most frequent site, followed by other sites (34%). Potassium hydroxide positivity was observed in 75% of the cases, cultural positivity in 77%, and both tests were positive in 75%. The most common organisms found were T. mentagrophytes (72.7 (56/77)%), T. rubrum (19.5 (15/77)%), and T. tonsurens 7.8 (6/77)%. Conclusion: Tinea incognito is a fungal skin infection that can present with various nonspecific clinical features. This steroid-modified dermatophytosis is largely under-reported because the underlying fungal infection is masked by the irrational use of topical steroids

Osteoarticular Infections in the Orthopedics-Traumatology Department at Batna University Hospital: Clinical and Biological Study Over 28 Months (2019-2021).

Introduction. Osteoarticular infections are a major public health problem. The aim of this study was to describe the clinical and biological profile of osteoarticular infections at Batna University Hospital. Materials and methods: In this retrospective study, we report on a series of 93 patients with osteoarticular infections hospitalized in the Orthopedics-Traumatology Department of Batna University Hospital, between January 1, 2019 and April 30, 2021. Results/Discussion. The mean age of patients was 32.16 years, the M/F sex ratio was 2. Our series was dominated by arthritis (29% of cases). Among the 33 bacterial strains isolated, staphylococci predominated (56%), over half of which (58.82%) were methicillin-resistant. Probabilistic treatment was not consistent with microbiological findings in most cases. Conclusion. Knowledge of the bacterial epidemiology of osteoarticular infection is an essential tool for appropriate patient management.

Unexpected Discrepancies in the Histopathological and Microbiological Diagnoses of Suspected Mucormycosis Cases at a South Indian Tertiary Care Center During the COVID-19 Pandemic.

Introduction Mucormycosis is an uncommon fungal infection caused by filamentous fungi of the Mucorales order, namely Rhizopus, Lichthemia, andMucor species. The incidence and prevalence of mucormycosis reached an all-time high during the COVID-19 pandemic due to excessive steroid use and other factors, leading to the coining of the term CAM (COVID Associated Mucormycosis). The diagnosis of mucormycosis is by a combination of histopathology and microbiological techniques, such as KOH mount and culture. Although microbiological and histopathological findings usually correlate, certain discrepancies are known to occur and are discussed in our study. The aim of our research is to study the correlation between histopathology and microbiology findings, as well as their respective merits and limitations, in suspected mucormycosis cases in COVID-19 patients at a tertiary healthcare center in South India. Methods It is a retrospective study, where data from 74 COVID-19 patients admitted in the ENT ward between June 2021 and August 2021 with a suspicion of mucormycosis was collected. Samples from these patients were sent to the pathology and microbiology departments of Rangaraya Medical College. KOH mount, culture on Saboraud's Dextrose Agar (SDA), and histopathology findings were analyzed. Results Histopathology and culture findings of Mucormycosis were correlated in 64 isolates (86.5%), including five cases (6.7%) of mixed infections, where the culture was positive for only a single type of fungus. In the remaining 10 isolates, discrepancies were observed, accounting for 13.5% of the total sample size. Pearson's correlation coefficient test did not reveal any statistically significant correlation in the case of histopathologyand microbiologyculture or KOH mount, further highlighting the presence of discrepancies. The high correlation between KOH mount and culture isolates (100%) in our study is attributable to the processing of the same sample by the microbiology department. On the other hand, the correlation between histopathology and culture in our study is 86.5%, and the expected correlation as suggested by previous studies is only 50%. These discrepancies between culture and histopathology could be due to different samples being sent to the two departments. Conclusion Although fungal cultures are considered the gold standard, they have drawbacks such as slow growth, and the potential for both false positives and false negatives. KOH mount is a rapid and cost-effective method, but it lacks specificity and sensitivity. Histopathology offers the advantage of specific species identification and assessment of tissue inflammation; however, it is an invasive procedure and poses challenges in accurately identifying the fungus. A multidisciplinary approach, with coordination between physicians, surgeons, pathologists, clinical microbiologists, and radiologists, is essential for timely diagnosis and management. For accurate identification of the causative organism, it is recommended to send the same sample for histopathological examination, KOH mount, and culture.

Chest wall-necrotizing soft tissue infection caused by Finegoldia magna and Helcococcus kunzii in an immunocompromised patient: a case report

ABSTRACT Background Necrotizing soft tissue infections are life-threatening conditions that require prompt diagnosis and intervention. This case report presents a rare case of chest wall-necrotizing soft tissue infection caused by Finegoldia magna and Helcococcus kunzii in an immunocompromised patient. Case Summary A 60-year-old female with metastatic uterine leiomyosarcoma and multiple comorbidities presented with swelling of the right breast and discharge. Surgical intervention revealed extensive necrosis, and cultures identified Finegoldia magna and Helcococcus kunzii . Despite antibiotic therapy and repeated debridement, the patient developed septic shock and coagulopathy, ultimately succumbing to infection. Conclusion This case highlights the potential of rare organisms to cause severe necrotizing soft tissue infections in immunocompromised individuals. Rare microbiological and anatomical presentations and findings are interesting incidents that require further attention. It is important to note that, although these organisms are rare, they still pose a significant risk for the development of necrotizing soft tissue infections. By reporting such cases, we will aid in raising awareness of these organisms.

MRI differentiation of CNS fungal infections: correlating imaging features with microbiological and histopathological findings.

The study aims to evaluate the magnetic resonance (MR) features of central nervous system (CNS) fungal infections and determine the associations between these findings and the type of fungus. Our main objective was to assess whether imaging can serve as a predictor for identifying the specific group of fungi responsible for the infection using microbiology and histopathology as a benchmark. A retrospective analysis was done on 50 patients with proven CNS fungal infections. Fungal type was determined and grouped according to microbial classifications into four subtypes: hyalohyphomycetes, mucorales, yeasts and dematiaceous molds. MR findings were compared with histopathology/microbiology and associations between fungal groups were sought. A total of 37 males and 13 females with a mean age of 39.3 years were included in the study. Aspergillus spp. infection (48%) was the most common. Most patients (54%) had an underlying risk factor for the infection. Pseudo-tumoral mass-like behavior was observed with Aspergillus, and the presence of meningitis was associated with yeast infections (p < 0.001). Of the 19 abscesses, 9 (47.3%) showed a dual rim sign on susceptibility-weighted imaging (SWI), and 10 (52.6%) showed intracavitary dot-like foci of dropouts on SWI. Both findings were statistically significant with dematiaceous molds (p = 0.04 and p = 0.009, respectively). Although radiological characteristics are non-specific and can overlap with each type of fungi, our study shows that certain MR features can help radiologists point towards the causative type. More specifically, dot-like foci of susceptibility point towards abscesses caused by dematiaceous molds possibly owing to melanin pigment and metal chelation properties.

Blood stream infections in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Risk factors and association with poor outcome.

Blood Stream Infections (BSI) are considered a significant cause of morbidity and mortality in patients with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). We aimed to identify risk factors for BSI upon admission, highlight clinical and microbiological findings and ascertain the frequency of mortality in patients with BSI in SJS/TEN. A retrospective cross-sectional study over 12 years (2011-2022) was performed in the department of medicine at a tertiary care hospital in Pakistan. All patients admitted with the diagnosis of SJS or TEN were included: from the health information management system. We included clinical and microbiological details, reviewed medical charts, and filled out a predesigned proforma. A total of 100 patients were admitted with SJS or TEN. The majority (55%) were of age greater than 40 years and had female preponderance (57%). Sixty five patients had a prior history of using a precipitating drug. BSI was seen in 19 patients; 68.4% had a mono-microbial infection, while 31.5% had a poly-microbial infection. In total, 10 organisms were identified, Staphylococcus aureus being the most common isolate followed by Enterococcus. Twelve patients required intensive care monitoring while 33 patients had hospital stays of equal or more than seven days. The overall mortality rate was 15% while it was 60% in those with BSI. SCORTEN score of ≥4 had a significant impact on mortality (60% deaths). Vigilant monitoring and early detection of BSI in SJS/TEN patients, especially those presenting with high SCORTEN scores can enhance clinical outcomes.

Microbiological and Clinical Features of Patients with Cellulitis in Tropical Australia; Disease Severity Assessment and Implications for Clinical Management.

Australian guidelines for the treatment of cellulitis are informed by data from temperate, metropolitan centers. It is uncertain if these guidelines are equally applicable in tropical Australia, where the population, access to healthcare, and array of potential pathogens are quite different. This retrospective study examined adults admitted to Cairns Hospital in tropical Queensland, Australia, who were treated with intravenous antibiotics for a principal diagnosis of cellulitis in 2019. The study aimed to describe the epidemiological, clinical, and microbiological findings in these cases and the resulting implications for patient management. There were 305 episodes of cellulitis; a potential pathogen was identified in 93/305 (30%), most commonly Staphylococcus aureus (45/93, 48%) or Group A Streptococcus (16/93, 17%). There was one case of Burkholderia pseudomallei. Initial treatment was most commonly with narrow spectrum β-lactam antibiotics with flucloxacillin prescribed in 170/305 (56%) and cefazolin prescribed in 74/305 (26%). Overall, 4/305 (1%) died or were admitted to the intensive care unit (ICU) within 30 days, 123/305 (40%) had an inpatient stay >48 hours, and 63/305 (21%) were readmitted to hospital within 30 days. Every patient who subsequently died or required ICU admission had an elevated early warning score (EWS ≥3) on admission. An EWS ≥3 on admission also predicted an inpatient stay of >48 hours (odds ratio [OR]: 3.2, 95% CI: 1.7-6.0; P <0.001) and 30-day readmission (OR: 2.3, 95% CI: 1.2-4.6; P = 0.01). The etiology of cellulitis in tropical Queensland, Australia, is very similar to that seen in temperate regions, enabling the use of standard management algorithms for patients with cellulitis in the region.

Primary cutaneous infections with non-tuberculous mycobacteria: a report of 6 cases

BackgroundThe incidence of non-tuberculous mycobacterium infection has shown a gradual increasing trend in recent years, among which cutaneous manifestations as an important aspect. This study aimed to describe the clinical features and microbiological findings in 6 cases of primary cutaneous nontuberculous mycobacterium infection.MethodsIn this retrospective study from June 2021 to June 2022, the clinical data and microbiological results of six cases diagnosed with primary cutaneous non-tuberculous mycobacterium infection in department of dermatology, Hangzhou Third People’s Hospital were analyzed.ResultsAll six cases were primary cutaneous non-tuberculous mycobacterium infections, four of which had a history of trauma or exposure, and two had an underlying disease that could lead to compromised immunity. All patients presented with erythema nodular skin lesions, four on the upper or lower extremities, one on the face, and one on the right hip. The histopathological findings of five patients who underwent biopsy were granulomatous inflammatory changes with mixed infiltration. Laboratory cultures using tissue or tissue fluid were all successful, including four Mycobacterium marinum, one Mycobacterium abscessus, and one Mycobacterium avium. Metagenomics next-generation sequencing detected results consistent with culture colonies in only two cases. With the exception of case 4, all patients responded well to oral medication, with a course of treatment ranging from 4 months to 1 year, and the prognosis was good.ConclusionsThe clinical features of primary cutaneous non-tuberculous mycobacterium infection are often lacking in specificity, and the identification of related strains is difficult for a variety of reasons. Although the results of metagenomics next-generation sequencing are useful for pathogen spectrum identification, its diagnostic value should be carefully reevaluated under certain circumstances. Patients with suspected triggers who do not respond well to conventional treatments should be suspected as atypical infection and potential immunosuppression. If diagnosed and treated promptly, the prognosis of primary cutaneous non-tuberculous mycobacterium infection is generally good.