Microbiology Reports Research Articles

Implementation of a computerized decision support system to improve the appropriateness of antibiotic therapy using local microbiologic data.

A prospective quasi-experimental study was undertaken in 218 patients with suspicion of nosocomial infection hospitalized in a polyvalent ICU where a new electronic device (GERB) has been designed for antibiotic prescriptions. Two GERB-based applications were developed to provide local resistance maps (LRMs) and preliminary microbiological reports with therapeutic recommendation (PMRTRs). Both applications used the data in the Laboratory Information System of the Microbiology Department to report on the optimal empiric therapeutic option, based on the most likely susceptibility profile of the microorganisms potentially responsible for infection in patients and taking into account the local epidemiology of the hospital department/unit. LRMs were used for antibiotic prescription in 20.2% of the patients and PMRTRs in 78.2%, and active antibiotics against the finally identified bacteria were prescribed in 80.0% of the former group and 82.4% of the latter. When neither LMRs nor PMRTRs were considered for empiric treatment prescription, only around 40% of the antibiotics prescribed were active. Hence, the percentage appropriateness of the empiric antibiotic treatments was significantly higher when LRM or PMRTR guidelines were followed rather than other criteria. LRMs and PMRTRs applications are dynamic, highly accessible, and readily interpreted instruments that contribute to the appropriateness of empiric antibiotic treatments.

The strength of coughing may forecast the likelihood of spread of multi-drug resistant microorganisms from the respiratory tract of colonized patients

Current recommendations indicate that patients who are coughing and have multidrug resistant microorganisms (MDROs) in their sputum are considered to be shedders and should be cared for in single room isolation at least until symptoms resolve. Airborne spread and subsequent contamination of surfaces adjacent to patients may contribute to transmission. Hence, isolation measures for patients colonized or infected with MDRO at their respiratory tract are intended to interrupt such transmission. However, the potential for microbial shedding in patients with MDRO-positive microbiological reports from their respiratory tract and factors justifying the need for single room isolation are viewed controversially. Cough aerosol produced by patients colonized with MDROs was measured for viable counts. Descriptive analysis together with logistic regression analysis was performed to assess the impact of strength of cough on growth of MDRO on culture plates. In 18% (23/128) MDRO were transmitted. Multivariate analysis revealed that strength of cough significantly predicts the yield of MDRO on culture plates (P = 0.012). Based on these results it can be concluded that risk stratification for decision of single room isolation of patients colonized or infected with MDROs at their respiratory tract may also take the severity of cough into consideration. However, more work is required in order to assess the severity of cough objectively.

Antimicrobial stewardship: the role of the clinical microbiology service

Antimicrobial stewardship (AMS) aims to optimise antimicrobial prescribing to maximise effectiveness and minimise potential adverse effects such as toxicity and the emergence of resistant organisms. Effective AMS programs have been shown to reduce inappropriate antimicrobial use, reduce institutional bacterial resistance rates, improve patient outcomes and reduce healthcare costs. AMS is mandatory for Australian public and private hospital accreditation under The National Safety and Quality Health Service Standard 3.14. The clinical microbiology service (CMS) is an integral part of effective AMS programs. Key CMS activities include: • the provision of best practice diagnostic tests for a range of pathogens to deliver accurate and timely results, enabling clinicians to de-escalate or cease unnecessary antimicrobials • cascade reporting of antimicrobial susceptibility reports • providing comments in microbiology reports to help guide appropriate antimicrobial therapy • clinical liaison for critical results and high risk patient groups such as intensive care • education to prescribers about appropriate antimicrobial use • the development and review of appropriate clinical guidelines • the production of an annual cumulative antibiogram to guide empiric antimicrobial therapy and inform local clinical guidelines • the provision of surveillance data on resistant organisms for infection control purposes.

Linkage, Evaluation and Analysis of National Electronic Healthcare Data: Application to Providing Enhanced Blood-Stream Infection Surveillance in Paediatric Intensive Care

BackgroundLinkage of risk-factor data for blood-stream infection (BSI) in paediatric intensive care (PICU) with bacteraemia surveillance data to monitor risk-adjusted infection rates in PICU is complicated by a lack of unique identifiers and under-ascertainment in the national surveillance system. We linked, evaluated and performed preliminary analyses on these data to provide a practical guide on the steps required to handle linkage of such complex data sources. MethodsData on PICU admissions in England and Wales for 2003-2010 were extracted from the Paediatric Intensive Care Audit Network. Records of all positive isolates from blood cultures taken for children <16 years and captured by the national voluntary laboratory surveillance system for 2003-2010 were extracted from the Public Health England database, LabBase2. “Gold-standard” datasets with unique identifiers were obtained directly from three laboratories, containing microbiology reports that were eligible for submission to LabBase2 (defined as “clinically significant” by laboratory microbiologists). Reports in the gold-standard datasets were compared to those in LabBase2 to estimate ascertainment in LabBase2. Linkage evaluated by comparing results from two classification methods (highest-weight classification of match weights and prior-informed imputation using match probabilities) with linked records in the gold-standard data. BSI rate was estimated as the proportion of admissions associated with at least one BSI. ResultsReporting gaps were identified in 548/2596 lab-months of LabBase2. Ascertainment of clinically significant BSI in the remaining months was approximately 80-95%. Prior-informed imputation provided the least biased estimate of BSI rate (5.8% of admissions). Adjusting for ascertainment, the estimated BSI rate was 6.1-7.3%.ConclusionLinkage of PICU admission data with national BSI surveillance provides the opportunity for enhanced surveillance but analyses based on these data need to take account of biases due to ascertainment and linkage error. This study provides a generalisable guide for linkage, evaluation and analysis of complex electronic healthcare data.

Time to Positivity of Blood Cultures Supports Antibiotic De-escalation at 48 Hours

Appropriate de-escalation of empirical antimicrobial therapy is a fundamental component of antimicrobial stewardship. Concern for the late detection of bloodstream pathogens may undermine early streamlining efforts and subject patients to protracted courses of nonessential therapy. To quantify the prevalence of bacterial bloodstream infection (BSI) detection after more than 48 hours of culture incubation. We also assessed the impact of antimicrobial therapy delivered prior to blood sample collection. We retrospectively evaluated time to blood culture positivity (TTP) in adult patients at an academic tertiary care hospital. Microbiology reports were reviewed to identify the TTP for the first positive blood culture bottle for each episode of BSI occurring from February 1, 2011, to July 31, 2011. Isolates were classified as true pathogens or contaminants. Blood culture results after 48 hours of incubation were compared with results after 120 hours of incubation. The median TTP of 416 monomicrobial BSIs and 210 contamination episodes was 13.7 and 24.4 hours, respectively (P < .001). The median TTPs in those who received and did not receive prior antibiotics were 17.0 and 12.8 hours, respectively (P < .001). By 48 hours, 98% of aerobic Gram-positive and Gram-negative BSIs were detected. Culture results at 48 hours were 97% sensitive and had a negative predictive value of 99.8%. Few true BSIs are detected after more than 48 hours of culture incubation. Clinicians may adjust empirical antibiotic coverage at this time with little risk for subsequent bacterial pathogen detection.

Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units

Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs). A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors. The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05). While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.

A large retrospective single-centre study to define the best image acquisition protocols and interpretation criteria for white blood cell scintigraphy with 99mTc-HMPAO-labelled leucocytes in musculoskeletal infections

The diagnosis of infection is often based on clinical, pathological and microbiological results. However, these investigations lack specificity. White blood cell (WBC) scintigraphy is considered the gold standard nuclear imaging technique for diagnosing infections in bone and soft tissues (except spondylodiscitis). However, image acquisition and interpretation criteria differ amongst centres throughout the world, leading to differences in reported results. The aim of this study was to identify the most accurate WBC scintigraphy acquisition and interpretation protocols for diagnosis of bone and soft tissue infections. Included in this retrospective study were 297 patients with suspected bone or soft tissue infection who underwent WBC scintigraphy with (99m)Tc-HMPAO-labelled leucocytes between 2009 and 2012. Sensitivity, specificity, accuracy, and positive and negative predictive values of WBC scintigraphy were determined for two different dual time point acquisition protocols (fixed-time acquisition and time decay-corrected acquisition) and five image interpretation methods (visual and semiquantitative with four different reference regions of interest). Final diagnosis was based on pathological and microbiological reports, and when these were not available, on clinical follow-up of at least 6 months. The best acquisition protocol was 4 h and 20 - 24 h dual time-point acquisition with time decay-corrected acquisition. When using this acquisition protocol, visual qualitative interpretation led to a sensitivity of 85.1 %, a specificity of 97.1 %, a diagnostic accuracy of 94.5 %, a positive predictive value of 88.8 % and a negative predictive value of 95.9 %. For semiquantitative analysis, the best results were found when lesion-to-reference ratios were calculated with the contralateral side as the reference tissue, except for osteomyelitis and infected osteosynthesis, for which the contralateral bone marrow was found to be the best reference tissue. Results of the semiquantitative analyses per se were not better than for visual analysis. In the optimal analysis protocol, scans are first visually evaluated, and if this gives equivocal results, semiquantitative analysis is performed. This strategy resulted in an improved sensitivity of 97.9 %, a specificity of 91.8 % and a diagnostic accuracy of 93.1 %. WBC scintigraphy for bone and soft-tissue infection is best performed using a dual acquisition protocol at 4 h and at 20-24 h after injection, in which the acquisition time of the scans is corrected for decay. In most patients, visual analysis is sufficient and leads to high diagnostic accuracy. When interpretation by visual analysis is inconclusive, semiquantitative analysis adds accuracy. Based on our results, we propose a flow chart for analysing WBC scintigraphy in musculoskeletal infections.

P096: Antibiotic stewardship in intensive care units: a cross sectional study of 355 ICUs in Germany

Results The questionnaire was completed by 355 German ICUs (61% response rate). The most common measures used (>80% of the ICUs) were personal restrictions for antibiotic prescriptions, routine access to unit-based bacterial resistance data and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14%) employed ABS consultants or infectious diseases specialists for the prescription of antimicrobial medication. Hospitals with their own integrated microbiological laboratory report twice as much to take part in surveillance networks of antimicrobial use (34%) and bacterial resistance (32%) compared with hospitals with external laboratories (15% and 14%, respectively, p 23% vs. 11%, p<0.05). Conclusion While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these strategies vary markedly. Organizational-leveled control strategies to improve antibiotic control are already quite common in Germany. In contrast, other strategies widely considered effective such as the continuous surveillance of antimicrobial use and bacterial resistance or the employment of infectious disease consultants are still scarce. More effort is required with regard to incentives for infectious diseases consultants and to the participation in surveillance networks. This study provides a benchmark for future antibiotic stewardship programs.

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

Spinal epidural abscess (SEA), once considered a rare occurrence, has showed a rapid increase in incidence over the past 20-30 years. Recent reports have advocated for conservative, nonoperative management of this devastating disorder with appropriate risk stratification. Crucial to a successful management strategy are decisive diagnosis, prompt intervention, and consistent follow-up care. The authors present a review of their institutional experience with operative and nonoperative management of SEA to assess morbidity and mortality and the accuracy of microbiological diagnosis. A retrospective analysis of patient charts, microbiology reports, operative records, and radiology reports was performed on all cases involving patients admitted with the diagnosis of SEA between July 1998 and May 2009. Seventy-seven cases were reviewed (median patient age 51.4 years, range 17-78 years). Axial pain was the most common presenting symptom (67.5% of cases). Presenting signs included focal weakness (55.8%), radiculopathy (28.6%), and myelopathy (5.2%). Abscesses were localized to the lumbar, thoracic, and cervical spine, respectively, in 39 (50.6%), 20 (26.0%), and 18 (23.4%) of the patients. Peripheral blood cultures were negative in 32 (45.1%) of 71 patients. Surgical site or interventional biopsy cultures were diagnostic in 52 cases (78.8%), with concordant blood culture results in 36 (60.0%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequent isolate in 24 cases (31.2%). The mean time from admission to surgery was 5.5 days (range 0-42 days; within 72 hours in 66.7% of cases). Outcome data were available in 72 cases. At discharge, patient condition had improved or resolved in 57 cases (79.2%), improved minimally in 6 (8.3%), and showed no improvement or worsening in 9 (12.5%). Patient age and premorbid weakness were the only factors found to be significantly associated with outcome (p = 0.04 and 0.012, respectively). These results strongly support immediate surgical decompression combined with appropriately tailored antibiotic therapy for the treatment of symptomatic SEA presenting with focal neurological deficit. The nonsuperiority discovered in other patient subsets may be due to allocation biases between surgically treated and nonsurgically treated cohorts. The present data demonstrate the accuracy of peripheral blood culture for the prediction of causative organisms and confirm patient age as a predictor of outcomes.

Acute PostoperativeStaphylococcus SchleiferiEndophthalmitis following Uncomplicated Cataract Surgery: First Report in the Literature

We report a rare case of acute postoperative Staphylococcus schleiferi endophthalmitis following an uneventful cataract extraction. An 83-year-old woman underwent uneventful phacoemulsification without receiving the usual intracameral cefuroxime solution due to cephalosporin intolerance. Two days postoperatively, she presented with acute ocular pain and blurred vision in the operated eye. Ophthalmic examination revealed signs of acute keratitis and endophthalmitis. Corneal scrapes and vitreous taps were sent for cultivation and analysis. The patient received intravitreal antibiotics at the same time. Cultivation grew S schleiferi, a pathogen commonly found in dogs. Following microbiological report, the patient received a repeated intravitreal injection of 1 mg/0.1 mL vancomycin combined with fortified topical vancomycin drops. One week later, the inflammation subsided completely while the corneal ulcer healed and visual acuity improved dramatically. Further examination revealed the existence of the same pathogen in a specimen obtained from the dog owned by the patient's family. This description of S schleiferi endophthalmitis highlights the need to provide alternative intracameral antibiotic solution in the operating room and avoid direct contact with dogs during the first postoperative period after intraocular surgery.

Routine Microbiologic Culture of Kidney Transport Fluid: A Single-Center Retrospective Study

BackgroundMicrobiologic culture of renal transplant fluid (RTF) has been performed since the 1950s and remained routine in some transplant centers. Although not evidence based, this conventional practice is relatively time consuming and costly. This single-center study sought to determine the prevalence and clinical significance of positive microbiologic cultures of RTF. MethodsData on RTF were collected retrospectively from renal transplant cases who had samples taken from RTF for microbiology from 2000 to 2006. Review of patient notes and microbiology reports identified positive results, time and type of antibiotic, posttransplantation development of sepsis, and any significant infection. ResultsOver the 6-year period we performed 370 renal transplantations from cadaveric or non–heart-beating donors. The living related or unrelated cases (n = 67) were excluded because we did not obtain RTF samples. Among the 303 remaining recipients, 237 (78%) had microscopy, culture, and sensitivity reports available. Positive cultures were identified in 66 patients, of whom 2% (n = 6) developed postoperative complications, including those related to organisms identified in the RTF in 3 patients. ConclusionsEarly identification of microorganisms, particularly in transplant patients, affects patient outcomes and quality of life. Routine screening of RTF for contamination allows for RTF-informed treatment of symptomatic patients after transplantation.

Prevalence and Genetic Analysis of Phenotypically Vi- Negative Salmonella Typhi Isolates in Children from Kathmandu, Nepal

The Vi capsular polysaccharide (ViPS) protects Salmonella enterica subspecies enterica serotype Typhi (S.Typhi) in vivo by multiple mechanisms. Recent microbiological reports from typhoid endemic countries suggest that acapsulate S.Typhi may occur in nature and contribute to clinical typhoid fever that is indistinguishable from disease caused by capsulate strains. The prevalence and genetic basis of ViPS-negative S.Typhi isolates in children from Kathmandu, Nepal, were tested in 68 isolates. Although 5.9% of isolates tested negative for capsular expression by slide agglutination tests, a novel multiplex PCR assay and individual PCR analyses demonstrated the presence of all 14 genes responsible for the synthesis, transportation and regulation of the ViPS. These data suggest that phenotypically acapsulate S.Typhi may not have a genetic basis for the same.

Epidemiology of vaccine-preventable invasive diseases in Catalonia in the era of conjugate vaccines

We investigated the incidence and distribution of cases of invasive pneumococcal disease (IPD), invasive meningococcal disease (IMD) and invasive Hemophilus influenzae disease (IHiD) notified by hospital laboratories to the Microbiological Reporting System of Catalonia between 2005 and 2009. Incidence rates were compared using the rate ratio (RR) and 95% CI were calculated. A value of p < 0.05 was considered statistically significant. Of the 6,661 cases, 6,012 were IPD, 436 IMD and 213 IHiD. The global annual incidence per 105 inhabitants was 16.62 (95% CI 16.20–17.04) for IPD, 1.21 (95% CI 1.09–1.32) for IMD and 0.59 (95% CI 0.51–0.67) for IHiD. IPD increased in 2009 compared with 2005 (RR:1.55, 95%CI: 1.43–1.70) and IMD and IHiD remained stable. Pneumonia was the most-frequent clinical manifestation of IPD (75.6%) and IHiD (44.1%) and meningoencephalitis with or without sepsis for IMD (70.6%). The male:female ratio was 1.37 for IPD, 1.0 for IMD and 1.15 for IHiD. The age groups with the highest incidence were the ≤ 2 y and 2–4 y groups for IPD (66.40 and 50.66/100,000 persons-year) and IMD (14.88 and 7.26/100,000 persons-year) and the ≤ 2 y and ≥ 65 y groups for IHiD (1.88 and 1.89/100,000 persons-year). The most-frequent serotypes were serotype 1 (19.0%) in IPD and untypeable serotypes (60.8%) in IHiD. Serogroup B (78.3%) was the most frequent in IMD. S. pneumoniae is the most-frequent agent causing invasive disease in Catalonia. The main clinical manifestations were pneumonia in IPD and IHiD and meningitis in IMD. The main causative agent of meningitis was N. meningitidis in people aged < 20 y and S. pneumoniae in people aged ≥ 20 y. Vaccination with conjugate vaccines may reduce the risk of infectious disease in our setting.

Results of the rubella elimination program in Catalonia (Spain), 2002–2011

Rubella is usually a mild disease with nonspecific symptoms, but can cause congenital rubella syndrome (CRS) when infection occurs during pregnancy. The objective of this study was to evaluate the sensitivity and positive predictive value of different data sources used for surveillance purposes in the Rubella Elimination Program of Catalonia between 2002 and 2011. The Urgent Notification to the Statutory Disease Reporting System, the Individualized Disease Reporting System, screening for other viruses included in the Measles Elimination Program, the Microbiological Reporting System and the Minimum Hospital Discharge Data were evaluated. 100 suspected cases of postnatal rubella and 6 suspected cases of CRS were detected. For postnatal rubella, Urgent Notification had the highest sensitivity (32.5%; 95%CI 18.6–49.1), followed by the Virus screening in Measles Elimination Program (25%; 95%CI 12.7-41.2). Virus screening in the Measles Elimination Program had the highest PPV (76.9%; 95%CI 46.1–94.9), followed by the Individualized Disease Reporting System (57.1%; 95%CI 28.9–82.3). For CRS cases, the Individualized Disease Reporting System had the highest sensitivity (100%, 95%CI 29.2–100) and the highest PPV (60%; 95%CI 14.7–100). Most confirmed postnatal cases (25 cases, 48.1%) were in the 25–44 y age group followed by the 15–24 y age group (11 cases, 21.2%). The highest values of sensitivity and PPV for the detection of confirmed cases corresponded to activities that were specifically introduced in the measles and rubella elimination programs.

OHP-045 Impact of a Multidisciplinary Staff Meeting on Antibiotic Treatment Quality For Osteoarticular Infections in an Orthopaedic Surgery Care Unit

BackgroundTreating osteoarticular infections is difficult.Purpose To evaluate professional practise, we studied the effect of a multidisciplinary staff meeting on the quality of antibiotic treatment in an orthopaedic surgery care unit.Materials...

Development and validation of a risk model for identification of non-neutropenic, critically ill adult patients at high risk of invasive Candida infection: the Fungal Infection Risk Evaluation (FIRE) Study

There is increasing evidence that invasive fungal disease (IFD) is more likely to occur in non-neutropenic patients in critical care units. A number of randomised controlled trials (RCTs) have evaluated antifungal prophylaxis in non-neutropenic, critically ill patients, demonstrating a reduction in the risk of proven IFD and suggesting a reduction in mortality. It is necessary to establish a method to identify and target antifungal prophylaxis at those patients at highest risk of IFD, who stand to benefit most from any antifungal prophylaxis strategy. To develop and validate risk models to identify non-neutropenic, critically ill adult patients at high risk of invasive Candida infection, who would benefit from antifungal prophylaxis, and to assess the cost-effectiveness of targeting antifungal prophylaxis to high-risk patients based on these models. Systematic review, prospective data collection, statistical modelling, economic decision modelling and value of information analysis. Ninety-six UK adult general critical care units. Consecutive admissions to participating critical care units. None. Invasive fungal disease, defined as a blood culture or sample from a normally sterile site showing yeast/mould cells in a microbiological or histopathological report. For statistical and economic modelling, the primary outcome was invasive Candida infection, defined as IFD-positive for Candida species. Systematic review: Thirteen articles exploring risk factors, risk models or clinical decision rules for IFD in critically ill adult patients were identified. Risk factors reported to be significantly associated with IFD were included in the final data set for the prospective data collection. Data were collected on 60,778 admissions between July 2009 and March 2011. Overall, 383 patients (0.6%) were admitted with or developed IFD. The majority of IFD patients (94%) were positive for Candida species. The most common site of infection was blood (55%). The incidence of IFD identified in unit was 4.7 cases per 1000 admissions, and for unit-acquired IFD was 3.2 cases per 1000 admissions. Statistical modelling: Risk models were developed at admission to the critical care unit, 24 hours and the end of calendar day 3. The risk model at admission had fair discrimination (c-index 0.705). Discrimination improved at 24 hours (c-index 0.823) and this was maintained at the end of calendar day 3 (c-index 0.835). There was a drop in model performance in the validation sample. Economic decision model: Irrespective of risk threshold, incremental quality-adjusted life-years of prophylaxis strategies compared with current practice were positive but small compared with the incremental costs. Incremental net benefits of each prophylaxis strategy compared with current practice were all negative. Cost-effectiveness acceptability curves showed that current practice was the strategy most likely to be cost-effective. Across all parameters in the decision model, results indicated that the value of further research for the whole population of interest might be high relative to the research costs. The results of the Fungal Infection Risk Evaluation (FIRE) Study, derived from a highly representative sample of adult general critical care units across the UK, indicated a low incidence of IFD among non-neutropenic, critically ill adult patients. IFD was associated with substantially higher mortality, more intensive organ support and longer length of stay. Risk modelling produced simple risk models that provided acceptable discrimination for identifying patients at 'high risk' of invasive Candida infection. Results of the economic model suggested that the current most cost-effective treatment strategy for prophylactic use of systemic antifungal agents among non-neutropenic, critically ill adult patients admitted to NHS adult general critical care units is a strategy of no risk assessment and no antifungal prophylaxis. Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.

Microbiological pattern of ear swabs in chronically discharging ears in a Tertiary Care hospital in India

Aims: The aim of this study was to identify the microorganisms associated with the chronic discharging ears and their antimicrobial susceptibility pattern. To find the pattern in bacteriological flora and their susceptibility patterns in patients from the different parts of India. Settings and Design : Observational, retrospective study. Subjects and Methods : A total of 106 patients with unilateral or bilateral active chronic discharging ears attending the outpatient clinic or in-patients were included in the study. All patients' chart details were reviewed and history, clinical findings and microbiology reports were noted. Results : The microbiology of 106 samples (106 patients) was studied (in bilateral ear disease, information about the side from where the swab was taken, was not available). Among them, 72 (67.92%) grew a single isolate while 34 (32.07%) grew two or more organisms. Major micro-organism isolated was Pseudomonas aeruginosa 48 (30.96%), followed by Staphylococcus aureus 46 (29.676%), non-fermenting gram negative bacilli (NFGNB) 17 (10.96), Coliforms 22 (14.20%). Drug susceptibility pattern of P. aeruginosa showed that Piperacillin was active against the majority of the isolates 94%, followed by Ceftazidime 83.3%, Amikacin 81.2%, Netilmicin, Tobramycin 60% and Ciprofloxacin, Gentamicin, Aztreonam 62.5%. Most of the S. aureus isolates were susceptible to Oxacillin in 80% and Erythromycin in 43%. Conclusions : Commonest organisms isolated from chronically discharging ears were P. aeruginosa and S. aureus, with P. aeruginosa marginally more than S. aureus. When patients from north and south were segregated, majority of isolates were P. aeruginosa in south (P. aeruginosa 28, S. aureus 23), whereas S. aureus was more in north (23 S. aureus, 20 P. aeruginosa). Coliforms were isolated more in south (13 south, 9 in north), similarly, NFGNB were also more in south (11 south, 6 north). Majority of isolates of P. aeruginosa were susceptible to Piperacillin and S. aureus was susceptible to Oxacillin.

A Study of Hospital Acquired Infections in ICU of a Tertiary Care Hospital in Bangalore

Introduction: Infections acquired in health care settings during the course of treatment are among one of the major causes of death and increased morbidity among hospitalized patients. Hospital acquired infections have significant bearing on economic costs owing to the increased length of stay. Objectives: 1.To find out common organisms causing hospital acquired infection and their antibiotic susceptibility 2. To find the relation between invasive procedures and hospital acquired infections Methodology: Retrospective analysis of inpatients records of medical intensive care units using a predesigned and structured questionnaire. Hospital acquired infections were identified as per operational definition which was based on microbiological reports. Results: The rate of Hospital acquired infection was 1.2% among patients admitted to Medical ICU. It is observed that duration of hospital stay is considerably long among these patients. Organisms isolated from the specimens are Pseudomonas, Methicillin resistant staphylococcus, These organisms were sensitive to Amikacin in addition to other drugs such as Cephaperazone, Vancomycin, Linezolid, and Netilmycin. Logistic regression analysis (using statistical package for social sciences) revealed statistically significant association between Hospital Acquired Infections and Patients on Ventilators [Odds ratio =16.66 (P = 0.04]. Conclusion: The rate of Hospital acquired infections are more in intensive care units. Invasive procedures contribute to the development of Hospital acquired infection. Therefore strict infection control programmes and antibiotic policy should be formulated.

The mass spectrometry technology MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time- Of-Flight) for a more rapid and economic workflow in the clinical microbiology laboratory

Introduction: In order to improve the outcome of patients, reduce length of stay, costs and resources engaged in diagnostics, more rapid reports are requested to the clinical microbiologists.The purpose of this study is to assess the impact on workflow of MALDI-TOF technology, recently made available for use in routine diagnostics. Methods:The work list by the management information system is sent to the instrument MALDI-TOF, where are held at least three successive analytic sessions: the first includes bacteria isolated from CSF, blood cultures, and cases already reported as serious/urgent, the second includes all other germs isolated, the third, microorganisms that require extraction with trifluoroacetic acid (TFA) or formic acid (FA) for identification.The results of each session direct to the execution of different types of susceptibility testing. Results:The times of microbial identifications are reduced by 24 or 48 hours and made available to the clinician for the rational empirical therapy.The reagent costs are reduced by 40%.The subcultures were reduced by 80%, and microscopic examinations by 50%.The antibiotic susceptibility tests were immediately performed with the most appropriate method, based on the knowledge of local epidemiology and microbial species. Conclusion:The bacteriology is the less automated discipline among the clinical laboratory activities and results of diagnostic tests are poorly well-timed. The new interpretative algorithms of MALDI-TOF spectra, now available, allow the correct identification of bacteria in near real time, completely eliminating the wait is necessary for biochemical identification and guiding the operator in selecting the most appropriate antibiotic susceptibility tests. This technology makes work more rapid, economic and efficient, eliminating errors and, together with effective computerization of data, transforms the information content of the microbiological report, making it much more effective for the therapy and the patient care.

Microbial Biotechnology: evolution of your premier journal

Dear Readers, Microbial Biotechnology (MBT) is undergoing a number of interesting changes that we would like to report. The first is its transition to an author-pays open access model from 2013. We believe open access will offer the journal a number of advantages, including the flexibility to grow without the constraints of a page budget, and substantial increases in exposure, with all articles being made freely available via Wiley Online Library and PubMed Central. MBT's transition to open access will significantly benefit both authors and readers, and hence the field of biotechnology as a whole. The Journal will continue to be editorially independent and its editorial team will continue to apply ever increasing standards of peer review, thus ensuring that the journal continues to be the high quality publication we know and value. Another is that MBT was assigned its first Impact Factor at the end of June and, since that time, has experienced a significant increase in submissions. As has been the case with its sister journals, Environmental Microbiology and Environmental Microbiology Reports, this rise in submissions will translate into an Editor-implemented rise in quality–originality threshold for acceptance, which in turn will positively influence subsequent IFs. Given the steady increase in exciting science we receive, we are confident that MBT will experience healthy increases in IF over the coming years. An important characteristic of MBT is the strength of its Editorial team – its Editors, Editorial Board and army of ad hoc reviewers, composed of leaders in the different sectors of microbial biotechnology, leaders both in the sense of representing the field and in pioneering the way forward. It is these dedicated scientists who set the benchmark for the field and for the papers that are published in MBT. They do this by providing constructive, critical reviews on submissions and by submitting their own work, and thereby ensure that MBT publishes some of the best research from high profile groups. The Editors are deeply indebted to the dedicated selfless support of its Editorial Board and ad hoc reviewers: thank you all for your tremendous support! The declared goal of MBT is to promote the field of applied microbiology, inter alia by stimulating young researchers to carry out original research on novel topics at the interfaces of the various disciplines that impact on biotechnology. It does so not only by showcasing important developments by leading groups, but also by profiling topics and new developments the Editors consider will lead to ground-breaking discoveries. One means it employs to do this is to publish Special and Themed Issues on such topics, edited by top researchers in the field. Exciting recent ones have been on Microbial Vaccines and Immunomodulators (http://onlinelibrary.wiley.com/doi/10.1111/mbt.2012.5.issue-2/issuetoc) edited by Carlos Guzman, Ennio de Gregorio, Jan ter Meulen and Martin Friede, and Microbial Resource Mangement (http://onlinelibrary.wiley.com/doi/10.1111/mbt.2012.5.issue-3/issuetoc), edited by Nico Boon and Willy Verstraete. Another means is the Web Alert of Larry Wackett which assembles the best websites for relevant diverse aspects of applied microbiology. A third is the biannual original, sometimes provocative, Crystal Ball series, in which international experts speculate on the key new developments/theories/paradigms that will drive discoveries in the field over the following years. This feature, which appears in the first issue of the year, always creates considerable interest and, in some cases, amusement. Take a look at the 2013 CB in this issue. And finally: check out below the most downloaded and most cited papers in MBT (see the MBT website for latest updates) to see who is publishing what in hot interest-generating biotechnology. Top downloaded articles Marine genomics: at the interface of marine microbial ecology and biodiscovery Karla B. Heidelberg, Jack A. Gilbert, Ian Joint Bacterial persistence increases as environmental fitness decreases Seok Hoon Hong, Xiaoxue Wang, Hazel F. O'Connor, Michael J. Benedik, Thomas K. Wood Strategies for discovery and improvement of enzyme function: state of the art and opportunities Praveen Kaul, Yasuhisa Asano Natural products for cancer chemotherapy Arnold L. Demain and Preeti Vaishnav Anaerobic benzene degradation by bacteria Carsten Vogt, Sabine Kleinsteuber, Hans-Hermann Richnow Top cited articles Metabolic engineering to enhance bacterial hydrogen production Maeda, T; Sanchez-Torres, V; Wood, TK Identification of furfural as a key toxin in lignocellulosic hydrolysates and evolution of a tolerant yeast strain Heer, D; Sauer, U Microbial degradation of lignin: how a bulky recalcitrant polymer is efficiently recycled in nature and how we can take advantage of this Ruiz-Duenas, FJ; Martinez, AT Microbial reporters of metal bioavailability Magrisso, S; Erel, Y; Belkin, S Indole and 7-hydroxyindole diminish Pseudomonas aeruginosa virulence Lee, J; Attila, C; Cirillo, SLG; Cirillo, JD; Wood, TK So, submit your best work to MBT, participate in its upward march to become the flagship of microbial biotechnology research, and your paper may be in one of these lists in future!