Negative Bacteriological Cultures Research Articles

Effect of microorganisms isolated by preoperative osseous sampling on surgical site infection after autologous cranioplasty: A single-center experience

PurposeThe most frequent postoperative complication in autologous cranioplasty (AC) is infection. European recommendations include osseous sampling before cryogenic storage of a bone flap. We evaluated the clinical impact of this sampling. MethodsAll patients who underwent decompressive craniectomy (DC) and AC in our center between November 2010 and September 2021 were reviewed. The main outcome was the rate of reoperation for infection of the cranioplasty. We evaluated risk factors for bone flap infection, rate of reoperation for any reason (hematoma, skin erosion, cosmetic request, or bone resorption), and radiological evidence of bone flap resorption. ResultsA total of 195 patients with a median age of 50 (interquartile range: 38.0–57.0) years underwent DC and AC between 2010 and 2021. Of the 195 bone flaps, 54 (27.7%) had a positive culture, including 48 (88.9%) with Cutibacterium acnes. Of the 14 patients who underwent reoperation for bone flap re-removal for infection, 5 and 9 had positive and negative bacteriological cultures, respectively. Of patients who did not have bone flap infection, 49 and 132 had positive and negative bacteriological cultures, respectively. There were no significant differences between patients with and without positive bacteriological culture of bone flaps in the rates of late bone necrosis and reoperation for bone flap infection. ConclusionsA positive culture of intraoperative osseous sampling during DC is not associated with a higher risk of re-intervention after AC.

Phenotypic and Genomic Analysis of Cystic Hygroma in Pigs.

Cystic hygroma is a malformation of the lymphatic and vascular system and is recognized as a benign congenital tumor that affects humans and animals in the perinatal period. This congeni-tal disorder is rarely described in animals, and until today, cystic hygroma in pigs has not been described in the literature. In a purebred Piètrain litter with twelve live-born piglets, cystic hy-groma was noticed on the rump of two male pigs within the first week of life. In addition, a third case of a crossbred weaner (Large White × Landrace) was detected during a herd examina-tion. To rule out common differential diagnoses, e.g., abscess or hematoma, further clinical and pathological investigations were conducted. During clinical examination, a painless and soft mass, which was compressible, was detected on the rump of all affected animals. The ultra-sonographic examination revealed a fluid-filled and cavernous subcutaneous structure. In addi-tion, a puncture of the cyst was conducted, revealing a serosanguinous fluid with negative bacte-riological culture. In all cases, a necropsy was performed, showing that the animals had fluid-filled cysts lined by well-differentiated lymphatic endothelium. Based on the clinicopathological examination, cystic hygroma was diagnosed. Furthermore, SNP array genotyping and whole-genome sequencing was performed and provided no evidence for a chromosomal disorder. In the Piètrain family, several genome regions were homozygous in both affected piglets. None-theless, a dominant acting de novo germline variant could not be ruled out, and therefore differ-ent filtering strategies were used to find pathogenic variants. The herein presented lists of pri-vate variants after filtering against hundreds of control genomes provide no plausible candidate and no shared variants among the two sequenced cases. Therefore, further studies are needed to evaluate possible genetic etiology. In general, systematic surveillance is needed to identify ge-netic defects as early as possible and to avoid the occurrence of losses in the pig population.

Development of a predictive model for hospital mortality and re-admission in a cohort of infected patients that require hospitalization

RESUMENIntroducciónLos objetivos del estudio fueron: identificar variables asociadas a mortalidad intrahospitalaria y reingreso hospitalario a 3 meses; identificar el impacto de la demora en el inicio de la antibioticoterapia en la mortalidad y reportar la tasa de antibioticoterapia inapropiada.Material y métodosEstudio observacional de cohortes retrospectivo realizado en el Hospital Universitario HM Sanchinarro en Madrid. Los criterios de inclusión fueron: edad> 18 años de edad, hospitalización desde urgencias durante el periodo 1 de septiembre 2012 al 31 de marzo del 2013 con diagnóstico de infección bacteriana. Los criterios de exclusión fueron: sospecha de infección viral y cultivos bacteriológicos negativos, expectativa de vida inferior a 6 meses, falta de información clínica, asistencia exclusivamente por el servicio de urgencias traumatológicas. Se realizaron dos modelos logísticos (mortalidad y reingreso hospitalarios).ResultadosSe incluyeron 517 pacientes. Variables asociadas a mortalidad (30 fallecidos): frecuencia respiratoria (OR 1,12; IC95% 1,02; 1,22), saturación de oxígeno (OR 0,92; IC95% 0,87; 0,98), creatinina (OR 2,33; IC95% 1,62; 3,36), EPOC (OR 3,02; IC95% 1,06; 8,21), cáncer OR 3,34; IC95% 1,07; 9,98) y quimioterapia en los últimos 3 meses (OR 4,83; IC95% 1,54; 16,41). Variables asociadas a reingreso hospitalario (28 fallecidos): hepatopatía, GPT, antecedente de ictus e hipertensión arterial. Ambos modelos se destacan por su elevada especificidad y capacidad discriminativa pero baja sensibilidad. La demora en el inicio de la antibioticoterapia no influyo en la mortalidad ni reingreso. En 56 pacientes se identificó el microorganismo causal y el tratamiento antibiótico fue inapropiado en 11.ConclusionesSe registro un 5,8% de mortalidad hospitalaria y un 5,7% de reingresos. Las variables asociadas a la mortalidad intrahospitalaria difieren de las asociadas al reingreso. La demora en el inicio de la antibioticoterapia no se asoció a un efecto deletéreo. La antibioticoterapia inadecuada fue de casi el 20%.

Bloody Milk in Buffalo Cows: Diagnosis and Trials for Treatment

The present study was conducted on 80 composite milk samples collected from dairy buffaloes secreting bloody milk from all four quarters without any inflammatory signs on mammary gland, systemic reaction or decrease in milk yield at Sharkia Governorate. Somatic cell count (SCC) revealed that 46 samples (57.5%) have SCC range between 200,000 to 250,000 cell/mL, while, 34 samples (42.5%) have SCC below 200,000 cell/mL. California mastitis test (CMT) was negative for 65 out of 80 (81.3%) and positive in 15 out of 80 (18.7%). Bacteriological examination revealed that 56 out of 80 samples (70%) were bacteriologically positive and 24 (30%) were bacteriologically negative. Coagulase positive Staphylococcus aureus were identified in 14 out of 56 (25%), however, 42 samples out of 56 (75%) were contaminated with coagulase negative Staphylococci (CNS), 20 of them had SCC less than 200,000 X 103 . All Coagulase positive S. aureus were isolated from milk of SCC between 200 X 103 to 250 X 103 cell/mL. Antibiotic sensitivity test revealed that Gentamycin, Amoxycillin + Clavuylinic acid and Enrofloxacin were the most effective antibiotics on both S. aureus and CNS. Group 1, 2 and 3 (bacteriologically positive cases) were treated with Gentamycin, Amoxicillin + Clavulenic or Enrofloxacin in addition to coagulant (Amri-K) showed cure rate of 80%, 80% and 60%, respectively. Group 4 that contained animals with negative bacteriological culture were treated by coagulant (Amri-K) only, showed cure rate of 60%. However, the return rate of the disease was 0, 20, 40 and 40%, respectively. Biochemical and hematological parameters showed nonsignificant differences between bloody milk and healthy control dairy buffaloes. This study concluded that either coagulase positive or coagulase negative S. aureus is incriminated with the bloody milk syndrome in dairy buffaloes in Egypt, however, Gentamycin in addition to coagulant (Amri-k) is the best treatment.

Post-operative Fulminant Necrotizing Fasciitis Complicated by Mucormycosis in Carcinoma Endometrium: Case Report and Brief Review of Literature

Necrotizing fasciitis is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissue. The causative agents are usually aerobic and anaerobic bacteria. We report a case of necrotizing fasciitis with multidrug-resistant E. coli and complicated by mucormycosis, which is an invasive fungal infection. This rare infection occurred in a 40-year-old lady with carcinoma endometrium following elective surgery. Rapid clinical deterioration in the background of repeated negative bacteriological cultures should alert to a Mucor infection. As fungal etiology in necrotizing fasciitis is a rarity, any delay in initiating treatment can be fatal and a high degree of clinical suspicion is essential for prompt diagnosis. Management is by aggressive surgical debridement, negative pressure wound therapy and appropriate antifungals in addition to appropriate antimicrobials.

Piodermia zgorzelinowa szyi u pacjentki z zaostrzeniem choroby Leśniowskiego i Crohna

Pyoderma gangrenosum (PG) is a rare ulcerative dermatosis. Aetiology of PG remains unknown. In 50–70% cases PG occurs in association with a systemic disease, most commonly inflammatory bowel disease (Crohn's disease, ulcerative colitis). First symptoms of PG may suggest diagnosis of bacterial infection of skin such as furuncle or phlegmon, so in early phase of PG frequent method of treatment is surgical intervention. Only a complete picture of disease and negative bacteriological culture provide appropriate diagnostic evaluations. We presented the case of PG (in the neck) which affected a 29-year-old woman during aggravation of Crohn's disease.

Use of procalcitonin (PCT) to guide discontinuation of antibiotic use in an unspecified sepsis is an antimicrobial stewardship program (ASP)

Clinicians have used procalcitonin (PCT) (biomarker to differentiate bacterial from non-bacterial sepsis) to guide use of antibiotics in patients. As the data for utility of PCT to discontinue antibiotics in an antimicrobial stewardship program (ASP) are lacking, we aim to describe the outcomes of patients in whom PCT was used to discontinue antibiotics under our ASP. An antimicrobial stewardship (AS) team intervened to discontinue antibiotics in patients with persistent fever or leucocytosis, source of sepsis unknown or negative bacteriological cultures, who had completed an adequate course of antibiotic therapy and had a PCT of <0.5 μg/L. Main outcomes evaluated were 14-day re-infection, 30-day mortality and readmission. Antibiotic therapy was discontinued in 42 patients in 1 year. Unknown source of sepsis was found in 38% of the patients (including possible malignant fever) and culture-negative pneumonia was found in 21%. Two patients died of advanced cancer. One patient decided for comfort care and died one week later. One patient died due to a second episode of pneumonia 37 days after first PCT test. Six patients were readmitted within 30 days due to non-infectious causes. Three patients were readmitted due to culture-negative pneumonia. None had a 14-day re-infection. PCT used to discontinue antibiotics under our ASP did not compromise patients' outcome.

Pasteurella multocida isolation in a horse with retropharyngeal infection

Retropharyngeal infections in horses normally induce local painful swelling of the retropharyngeal area, which may lead to dyspnea, dysphagia, and systemic manifestations. Differential diagnosis of local painful swelling of the retropharyngeal area includes retropharyngeal lymph node infection, neoplasm, cellulitis, hematoma, guttural pouch empyema, parotiditis, and jugular thrombosis. Apart from Streptococcus equi ssp. equi, other bacteria are rarely reported as a cause of retropharyngeal abscesses. The reason for this might be a lack of specific sampling to identify the causative agent. This work deals with a case of retropharyngeal infection in an 11-year-old Standardbred stallion with acute depression, fever, tachycardia, asymmetric painful swelling in the throat area, ptyalism, and respiratory distress. Endoscopy, radiography, ultrasonography, blood analysis, and cytological examination of a puncture sample taken from the throat mass were consistent with a pyogenic to pyogranulomatous retropharyngeal inflammation. The clinical evolution was initially satisfactory in response to treatment with nonsteroidal anti-inflammatory drugs and antibiotics, but clinical signs relapsed twice, each time a few weeks after cessation of antibiotic therapy. The bacteriologic finding in this case was unusual and consisted of the isolation of a Pasteurella multocida strain that was obtained after the second relapse (ie, 79 days after initial admission), using a brain heart infusion (BHI) medium, and after two successive negative bacteriological cultures performed on day one of clinical signs and at the first relapse of clinical signs, respectively.

Neurosurgery (67)

Recurrent rejection of a spinal cord stimulation system. (Maastricht University Hospital, Maastricht, The Netherlands) Contact Dermatitis 2000;42:304–305.This case report involved a 52‐year old male reflex sympathetic dystrophy patient. This brief report describes a patient who responded to spinal cord stimulation positively, but who could not continue to undergo this treatment because of inflammatory‐type reactions of unknown pathophysiology. Comment by R. Ruiz‐López, MD.This is a case report communication describing a patient who responded to spinal cord stimulation (SCS) positively, but who could not continue to undergo this modality because of inflammatory‐type reactions of unknown pathophysiology. Once signs and symptoms of infection with negative bacteriological cultures had occurred for 2 consecutive times, the authors suspected contact hypersensitivity to materials of the SCS system to be the cause of rejection. Although a very rare condition, allergic reactions to cardiac pacemakers have previously been reported. In this case, a striking feature was the lack of any visible skin reaction such as rash, erythema, local swelling, or pruritus.

Lymphoplasmacellular osteomyelitis

Chronic lymphoplasmacellular osteomyelitis may occur in children, adolescents and adults, but has not been found in newborns or babies either in our series or in the literature. Symptoms suggesting an acute disease like fever are uncommon, but a primary chronic course with symptomatic and asymptomatic periods is typical. Pain and swelling are the main symptoms; painless masses are rare. In children and adolescents the clavicle and metaphyseal regions of long bones are typical sites of chronic abacterial osteomyelitis. In adults the clavicles or the first two ribs are mainly affected with synovitis of the adjacent joints, but the long bones are rarely involved. Laboratory findings are non-specific but important for the differential diagnosis. The sedimentation rate and c-reactive protein might be elevated. The X-ray examination shows osteolytic, sclerotic or mixed bony changes and, in case of a diaphyseal involvement, onionskinlike periosteal bone formation may be present, suggesting a malignant process. In late stages sclerotic bone formations may be seen as a rest. Uni- or multifocal lesions can be detected by bonescan, as can asymptomatic lesions. Magnetic resonance imaging shows gross signal intensity differences both in the bone and perifocal soft tissue and involvement of the synovium with gadolinium DPTA enhancement in T1-weighted images. In early stages of the disease granulocytes, microabscesses and new bone formations might suggest bacterial osteomyelitis that cannot be differentiated by histology. In intermediate phases lymphocytic and plasmacellular infiltrates are found, whereas in late phases sclerotic bone formations and fibrosis of the bone marrow are seen histologically. In chronic lymphoplasmacellular osteomyelitis, all clinical, radiological and histological findings, as well as negative bacteriological cultures, are mandatory and will allow a definitive diagnosis to be made. The disease may be uni- or multifocal, and new bone lesions may occur over time, as well as skin manifestations, which can be found years before or after bone involvement. The association with dermatological diseases and/or synovitis led to the acronym SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteomyelitis). For the treatment non-steroidal anti-inflammatory drugs are effective for pain relief, reduction of swelling and dysfunction. Antibiotics have been used in several series and are not effective. Major surgery is not recommended even for recurrences, and the prognosis for growth and function is excellent in the long term despite recurrences over several years.

Chronic Colitis After Aeromonas Hydrophilia Infection

Chronic Colitis After <i>Aeromonas Hydrophilia</i> Infection

Sulfonamide Therapy of Furunculosis in Brown Trout

Studies were made, both in the field and in the laboratory, to determine the effectiveness of sulfonamides in the treatment of the disease furunculosis in the brown trout (Salmo trutta). When sulfamerazine was fed at a level of 8 grams per 100 pounds of trout, the infected fish were not always rid of the bacterium which causes furunculosis. In the laboratory it was found that when virulent cultures of Bacterium salmonicida were injected into brown trout on the first day of the sulfamerazine feeding, several of the trout developed active infections after the treatment was discontinued. When virulent cultures were injected into trout on the fourth day of the sulfamerazine feeding, several “carriers” of furunculosis developed. A combination of sulfamerazine and sulfaguanidine was apparently effective in ridding experimentally infected trout of the bacterium of furunculosis. A bacteriological study was made of an outbreak of furunculosis which occurred in the brown trout fingerlings of a state hatchery. The epidemic was treated by the daily use of 8 grams of sulfamerazine per 100 pounds of trout. The sulfamerazine treatment produced a marked drop in the mortality rate of the fingerlings, but positive cultures were encountered in some treated fingerlings 8 days after the completion of the treatment. A secondary feeding of sulfamerazine at the 8-gram level was given to the hatchery trout in an effort to eliminate “holdovers” of the disease. Two positive cultures were obtained from live and apparently healthy brown trout after the secondary treatment, indicating that some of the treated hatchery trout were “carriers.” An outbreak of furunculosis, which occurred among the brood-stock brown trout of a state hatchery, was treated by the use of a combination of sulfamerazine and sulfaguanidine. The treatment produced a marked drop in the mortality rate. To date, the brown trout treated by this combination of sulfonamides have yielded negative bacteriological cultures.