Negative Culture Report Research Articles

Suture Contamination During Arthroscopic Rotator Cuff Repair Is Associated With Significantly Higher Retear Rates in Magnetic Resonance Imaging: A Matched-Pair Analysis

PurposeTo evaluate the correlation between suture contamination and rotator cuff tendon retear after arthroscopic rotator cuff repair. MethodsPatients undergoing primary arthroscopic rotator cuff repair from April 1st, 2020 to September 30th, 2022 were enrolled. Those younger than 18 years, with a history of prior shoulder surgeries or shoulder infection episodes, or who declined participation, were excluded. A 5 cm section of the first-cut suture, originating from the anchor eyelet ends, in each rotator cuff repair surgery was subjected to bacteria culture and polymerase chain reaction (PCR) analysis. Patients with positive culture findings were matched 1:1 to those with negative culture reports based on age, sex, tear size as well as involved tendons, preoperative fatty infiltration grade (Goutallier grade) and preoperative muscle atrophy grade (Warner score). Postoperative rotator cuff tendon retear assessments were conducted at the 6-month mark using the Sugaya classification via magnetic resonance imaging. The Wilcoxon signed-rank test was used for matched-pair comparisons between the groups. ResultsA total of 141 patients (60 males and 81 females) with a mean age of 61.0 ± 8 years were finally enrolled. Twenty-six patients (18 males and 8 females) had a positive culture, while 115 patients (42 males and 73 females) had a negative culture. After the propensity score matching process, 24 culture-negative patients (16 males and 8 females) were selected as the culture-negative group. Age, fatty infiltration grade, and muscle atrophy grade were not significantly different between matched groups. The retear grade in the culture-positive group was found to be significantly higher than that in the culture-negative group (P = 0.020) under the matched-pair comparison. C. acnes. was the most prevalent bacterial species responsible for suture contamination. ConclusionsThe matched-pair analysis revealed that the presence of bacterial contamination on sutures was associated with a higher risk of retear in MRI following arthroscopic rotator cuff repair.

A CLINICAL STUDY DEMONSTRATING THE EFFECTIVENESS OF NEGATIVE PRESSURE WOUND THERAPY (NPWT) ON POST OPERATIVE IMMOBILIZATION OF SKIN GRAFTS

Background: Skin grafting being a commonly performed procedure comes with it's challenges regarding uptake and immobilization especially in areas requiring early mobility. The use of NPWT in such cases not only helps in reducing complications but also in reducing the hospital stay and requirement for regrafting. Methods: This is a prospective observational study conducted in Narayana medical college and hospital, Nellore. 20 cases admitted for skin grafting with negative culture report were enrolled in the study after obtaining consent. The status of graft was assessed on 4th and 6th postoperative day for complications. Results: The number of cases presenting with complications were 2 at the end of study requiring regrafting. The average length of hospital stay from application of graft to discharge was 7days. Mobility was not completely restricted in cases with NPWT in the post operative period increasing compliance of therapy by the patient. Conclusion: NPWT usage in post operative immobilization of skin grafts is shown to increase the chances of uptake and reducing complications and requirement for regrafting

Unique way of chest wall reconstruction using Integra Dermal Regeneration Template (IDRT) in a patient with post traumatic mucormycosis: A case report.

Introduction and importanceNecrotizing soft tissue infections (NSTI) are caused by toxin-producing bacteria and fungi that results in rapid progression of disease with significant local tissue destruction.Case presentationWe present a case report of a 57-year-old male patient in line with the SCARE 2020 criteria. He was admitted to the emergency department with a small abrasion on the right antero-lateral chest wall, and a diffuse necrotic patch of skin and soft tissues with purulent discharge.Clinical discussionClinical examination, routine blood investigations, CT scan chest, and chest x-ray were performed. Patient underwent debridement six times, followed by negative pressure wound therapy (NPWT). After negative culture report, Integra Meshed Dermal Regeneration Template (IMDRT), measuring 4 × 5 in. was applied and NPWT continued. The outer layer of IDRT was removed on Day 19. Split thickness skin grafting (STSG) was performed once neodermis formation was confirmed. NPWT was continued post skin grafting for a week. IDRT was successfully taken up over the raw area with exposed lung. Patient was discharged 10 days after STSG. The patient's condition improved remarkably and he was able to breathe normally. There was no puckering or tethering effect on the grafted area and not much fibrosis. He showed speedy recovery with healed donor site and 100% uptake of grafted tissue.ConclusionIDRT along with NPWT is an effective and useful technique for spontaneous regeneration of the dermis and basement membrane to promote wound healing in traumatic patients with NSTIs.Level of evidenceLevel V.Study typeTherapeutic.

Variants of Ascitic Fluid Bacterial Infection in Children with Chronic Liver Disease in a tertiary care hospital in Bangladesh

Introduction: Ascitic fluid bacterial infection is an infection of preexisting ascites in the absence of abdominal source. Ascitic fluid bacterial infection may presents in both symptomatic and asymptomatic children with chronic liver disease (CLD). Culture negative neutrocytic ascites(CNNA) is the commonest type of infection in children with CLD. Objective: To observe the variants of ascitic fluid bacterial infection in children with CLD. Methods: Thirty five consecutive children with clinical features suggestive of CLD, aged between 2-14 years of both sexes with clinically detected ascites and admitted at the Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2013 through June 2013 were enrolled in this cross sectional study. Children who had features of ascitic fluid infection like l fever, abdominal pain with tenderness were categorized as symptomatic and children who had no features of ascitic fluid infection were categorized as asymptomatic children. Demographic, clinical, haematological, biochemical and ascitic fluid study were done for both symptomatic and asymptomatic children. Variants of ascitic fluid bacterial infection was identified by ascitic fluid polymorphonuclear leucocyte count and culture report. Results: Among 35 children, majority 17 (48.6%) were between 6-10 years of age group with male predominance. About 12 (34.3%) were symptomatic and among the symptomatic children 7 (58.4%) were infected and 5 (41.6%) were non-infected, 16 (45.7%) had culture negative neutrocytic ascites (CNNA) variant of ascitic fluid bacterial infection as evident by ascitic fluid polymorphonuclear leucocyte count of  250/mm3 and negative culture report. Mean ascitic fluid polymorphonuclear neutrophil count was 515177.82/HPF among infected children and 85.4770.60/HPF among non-infected children, which is statistically significant (p-0.001). Wilson’s disease was the commonest 11(30) cause of the ...

A Prospective Study to Assess the Optimal Incubation Times for Culture and Aerobic Bacterial Profile in Prosthetic Joint Infections.

Introduction With an increase in the number of total joint arthroplasties, the count of prosthetic joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic surgeon. Microbiological diagnosis is important for administering definitive antimicrobial treatment. Negative culture reports hamper patient management and prolonged incubation periods have increased the culture yield but at the risk of culture contamination in conventional microbiology settings. Thus, we aimed to optimize the best incubation time for culture and the aerobic bacterial profile of PJIs. Material and Methods Over a year, samples from clinically suspected PJI patients were collected and processed for culture using standard techniques. The samples were incubated for up to 10 days with daily subculturing on to solid media. The bacterial isolates were identified and antibiotic susceptibility was performed. Results Out of 200 patients, 105 were included in the study and samples were collected in triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean incubation days to culture positivity was 3.6 days with 97.14% culture positivity seen by the seventh day of incubation. Twenty-four percent methicillin-resistant Staphylococcus aureus , and more than 50% extended spectrum β lactamase producing Klebsiella pneumoniae and Escherichia coli were isolated. Discussion Culture positivity in PJIs provides definitive evidence of infection and guides the treatment. Increasing the incubation times can help in maximizing the culture yield, and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it further would not provide an added advantage especially in a resource-constraint setting.

Usage-evaluation study on Vancomycin among hospitalized pediatric patients: Experience from two tertiary care centers of Eastern India

Background: Vancomycin is a highly effective bactericidal antibiotic with excellent efficacy against resistant Gram-positive microorganisms. It is losing its antimicrobial efficacy due to its rampant usage in Food and Drug Administration/Centers for Diseases Control and Prevention as well as off-label clinical uses. To stop its emerging resistance, judicious use of vancomycin following antibiotic stewardship is required. Aims: This study aims to examine the rationality of vancomycin use with respect to its adherence to Hospital Infection Control Practices Advisory Committee guidelines as well as its dosing, duration, adverse effects, and final outcome. Methodology: A retrospective cross-sectional hospital record-based study was conducted at two medical colleges of Eastern India from January 1, 2020, till June 30, 2020, incorporating all admitted newborns and children till 12 years’ age who received vancomycin for any clinical conditions. However, the patients with renal diseases or incomplete history were excluded from the study. Results: A cohort of 388 patients was included of which majority of them (41.2%) were in the age group of 2–12 years and males (56.9%). Sepsis (24.2%) and pneumonia (20.8%) were the most common indications for vancomycin prescription. Overall, appropriate usage of vancomycin was found in 57.2% of patients with maximum appropriate usage which was seen among neonates (64.5%). The areas of inappropriate usage were empirical therapy in febrile neutropenia, surgical prophylaxis, treatment of coagulase-negative Staphylococcal infection, and failure to withdraw vancomycin even after negative culture report for Gram-positive organisms. The final outcome in terms of clinical improvement was seen in 72.4% of patients irrespective of appropriate/inappropriate usage. Conclusion: Monitoring vancomycin usage should be followed in institutional practice to stop the emergence of resistance of vancomycin.

Identification of population of bacteria from culture negative surgical site infection patients using molecular tool

BackgroundManaging surgical site infections, with negative culture report in routine diagnosis is a common dilemma in microbiology accounting more than 30% worldwide. The present study attempted to identify the presence of bacterial spp. if any in wound aspirates/swabs of culture negative surgical site infections of hospitalised patients using molecular tools.MethodsNinety-seven patients with post-operative SSI whose wound swabs/aspirate were negative in the conventional aerobic culture after 72 h of incubation were analysed by 16S rRNA gene specific broad range PCR. The amplified DNA fragments were sequenced by Sanger DNA sequencing method and homology of the sequence were matched using NCBI BLAST (NCBI, USA)ResultsOf the 97 patients, 16S rRNA based broad range PCR assay could identify the presence of bacterial pathogen in 53(54.63%) cases, of which 29 isolates were supposed to be of viable but non-culturable bacteria (VBNC), 07 were of obligatory anaerobes and 13 were of unculturable bacteria, 04 were with poly bacterial infections.ConclusionsOur study highlights the usefulness of PCR assay in detecting the presence of any VBNC, anaerobes and unculturable bacteria in SSI patients regardless of how well the bacteria may or may not grow in culture. Measures should be taken to use anaerobic culture system and PCR diagnosis along with conventional culture to detect the VBNC and unculturable bacteria where Gram stain is positive for better patient care.

Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach.

Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach.

Microbiological Etiology of Chronic Cough Associated with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Study from Karachi, Pakistan

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) worsens the respiratory symptoms that are usually triggered by infection with bacteria or viruses or by environmental pollutants. Therefore, the aim of this study was to determine the bacterial etiology from sputum culture in patients suffering from acute exacerbation of COPD, admitted in hospital. Methods: The study was cross sectional observational, where sputum bacterial cultures were analyzed from the patients with Acute exacerbation COPD treated in the ICU of a tertiary care hospital for pulmonary disease from January 2019 to December 2019. Two sputum samples were collected from each patient for bacterial examination. The results of sputum bacterial culture findings were expressed as frequency and percentage by using SPSS. Results: In the present study, there were 1296 patients, both males 749 (57.8%) and females 547 (42.2%). The mean age of patients was 57.39±19.74years. 470 (36.3%) showed negative culture reports. 440 (34.0%) patients had Moraxella infection, which was most common organism in all patients, and 149 (11.5%) patients had Pseudomonas infection, 157(12.1%) patients had Yeast Albicans and in only 1 (0.1%) patient Enterobacter infection were found. Other pathogens in low frequency identified were Haemophilus parainfluenzae, Streptococcus pneumoniae, Escherichia coli and Haemophilus influenzae. It was observed that the frequency of infections was linked with increasing age. Conclusion: With increasing age, people are prone to acquire pulmonary infections specifically COPD. It is therefore very important to perform sputum culture to identify the causative agents and treat the patients with appropriate antibiotic to reduce the episodes of AECOPD. Keywords: Bacteria; Sputum Culture; COPD; Antibiotic; Cough.

Daptomycin versus teicoplanin for bloodstream infection due to methicillin-resistant Staphylococcus aureus with a high teicoplanin minimal inhibitory concentration ≥1.5 mg/L: a propensity score-based analysis.

BackgroundRecent reports have described decreased effectiveness of teicoplanin in the treatment of bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) with teicoplanin minimal inhibitory concentration (MIC) ≥1.5 mg/L. Consensus guidelines recommend considering use of alternative agents for MRSA infections involving a higher teicoplanin MIC, despite of limited data to support this recommendation.Patients and methodsTo compare the clinical outcome among patients with bacteremia due to MRSA with teicoplanin MIC ≥1.5 mg/L, we included patients who received high-dose daptomycin (≥8 mg/kg/day) and those who received standard-dose (6 mg/kg/day) or high-dose (6 mg/kg/12 hours) maintenance teicoplanin. The primary endpoint was a favorable outcome, defined as the resolution of clinical signs and symptoms and a negative culture report at the end of therapy. Adjusted analyses were performed by multivariate analysis and propensity score-based matching.ResultsOf 142 patients eligible for inclusion, 28 (19.7%) were treated with high-dose daptomycin, 27 (19.0%) with high-dose teicoplanin, and 87 (61.3%) with standard-dose teicoplanin. In multivariate regression analysis, Pittsburgh bacteremia score ≥4 (OR, 5.3; 95%CI, 1.9–14.5) was independently associated with an unfavorable outcome. After propensity-score matching with age and Pittsburgh bacteremia score ≥4, patients on high-dose daptomycin were more likely to have favorable outcomes than those on standard-dose teicoplanin (74.1% vs 42.6%; P=0.02). However, there was no significant difference in terms of favorable outcomes (P=0.12) between patients receiving high-dose daptomycin and those receiving high-dose teicoplanin after the same propensity-score matching.ConclusionTreatment with high-dose daptomycin resulted in significantly better outcomes than with standard-dose teicoplanin in the treatment of MRSA bacteremia with teicoplanin MIC ≥1.5 mg/L. However, the clinical outcome of the patients receiving high-dose teicoplanin was similar to that of the patients receiving high-dose daptomycin.

A Randomized Controlled Study to Compare Conventional and Evidence Based Treatment Protocols in Fresh Compound Fractures.

A recent concept review in Journal of Bone and Joint Surgery (JBJS) outlines evidence to control peri-operative infections in compound fractures. However, evidence for impact of adopting a protocol combining measures that have some evidence is lacking in literature. The present method of treatment at King George's Medical University (KGMU) is representative of the conventional practice of managing compound fractures in India and is an appropriate control for trial against the Experimental Evidence Based Protocol (EBP). To study the additional impact of adopting Evidence Based Protocol on parameters defining infection rate and bone union. This randomized controlled study was conducted at the orthopaedics department of KGMU. Two hundred and twenty six patients of compound fractures of both bone leg, age > 12y were randomized to two groups. One group received standard treatment and the experimental group received treatment as per JBJS review. Random allocation was tested by comparing baseline characteristics of the two groups. The two groups were compared for all the outcome variables in terms of time to a negative wound culture, time to wound healing, time to union at fracture site and time to achieve complete range of motion at knee joint. Random allocation was successful. EBP group reported significantly lesser time to a negative culture report from wound (mean in conventional=4.619, experimental=1.9146, p=0.0006), lesser time to bony union (mean in conventional=23.8427 weeks, experimental=22.8125 weeks, p=0.0027), lesser time to wound healing (mean in conventional=14.4425 weeks experimental=10.4513 weeks, p=0.0032), and a lesser duration of hospital stay (mean in conventional=6.5982 days, experimental=4.5000 days, p=0.0343). EBP based on the guidelines suggested by Fletcher et al., significantly shorten the time taken for achieving a negative culture and hasten wound and fracture healing. Therefore EBP is recommended for use in settings like the KGMU trauma center.

Anesthesia Literature Review

Anesthesia Literature Review

Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures*

Preliminary data suggest that antibiotic discontinuation in patients with negative quantitative bronchoscopy and symptom resolution will not increase mortality. Because our hospital algorithm for antibiotic discontinuation rules out ventilator-associated pneumonia in the setting of negative quantitative bronchoscopy cultures, we compared antibiotic utilization and mortality in empirically treated, culture-negative ventilator-associated pneumonia patients whose antibiotic discontinuation was early versus late. Retrospective, observational cohort study. Eight hundred sixty-seven bed, tertiary care, teaching hospital in Hartford, CT. Eighty-nine patients with clinically suspected ventilator-associated pneumonia and a negative (<10 colony forming units/mL) quantitative bronchoscopy culture between January 2009 and March 2012. Early discontinuation patients (n = 40) were defined as those who had all antibiotic therapy stopped within one day of final negative culture report, whereas late discontinuation patients (n = 49) had antibiotics stopped later than one day. Univariate analyses assessed mortality, antibiotic duration, and frequency of superinfections. Multivariate logistic regression was performed to assess the effect of early discontinuation on hospital mortality. Patients had a mean ± SD Acute Physiology and Chronic Health Evaluation II score of 26.0 ± 6.0. Mortality was not different between early discontinuation (25.0%) and late discontinuation (30.6%) patients (p = 0.642). Antibiotic duration (days) was also not different for patients who died vs. those who survived (Median [interquartile range]: 3 [1-7.5] vs. 3 [1.75-6.25], respectively, p = 0.87), and when controlling for baseline characteristics and symptom resolution, only Acute Physiology and Chronic Health Evaluation II score was associated with hospital mortality on multivariate analyses. There were fewer superinfections (22.5% vs. 42.9%, p = 0.008), respiratory superinfections (10.0% vs. 28.6%, p = 0.036), and multidrug resistant superinfections (7.5% vs. 35.7%, p = 0.003), in early discontinuation compared with late discontinuation patients. In this severely ill population with clinically suspected ventilator-associated pneumonia and negative quantitative bronchoalveolar lavage cultures, early discontinuation of antibiotics did not affect mortality and was associated with a lower frequency of MDR superinfections.

Microbiological and clinical characteristics of diabetic foot infections in northern India

India has the largest diabetic population of 50.8 million that could reach an epidemic proportion by 2030. Diabetic foot infection is one of the dreaded complications of diabetes. Only a few studies that focus on patterns of diabetic foot infection in our region, where diabetic foot care is inadequate, are available. This study evaluated microbial and clinical characteristics of diabetic foot infections that will be helpful in taking appropriate measures for their management. In this prospective study conducted during 2008-2009, sixty-two diabetic foot patients underwent detailed history, clinical examination, and laboratory investigations including parameters of systemic infections. Microbial culture and sensitivity were performed at the time of presentation. Among 62 cases, 43.5% had mono-microbial infection, 35.5% had poly-microbial infections, and 21% had sterile culture. Among 82 bacteria isolated, 68% were Gram negative and 32% were Gram positive. Leukocyte counts were higher (16928±9642 versus 14593±6687 cells/mm(3)) and haemoglobin (7.9±2.4 versus 9.2±2.2 mg/dl) lower in poly-microbial compared to mono-microbial infections. Haemoglobin counts were lower and leukocyte counts higher in Gram-negative compared to Gram-positive infections. Patients with sterile cultures also had clinical evidence of persistent infection. Escherichia coli were the most common isolate and piperacillin/tazobactam showed highest sensitivity. Gram-negative bacteria were most prevalent in diabetic foot infection. It is not uncommon to have culture reports negative despite clinical evidence of infection. This study suggests that piperacillin/tazobactam should be the treatment of choice on an empirical basis prior to a definitive bacteriological study and in cases with negative culture reports.

Systematic Assessment of Culture Review as a Tool to Assess Errors in the Clinical Microbiology Laboratory

Daily supervisory review is a common practice in microbiology laboratories; however, there are no publications describing errors corrected by this practice. To determine (1) the correction rates for routinely reviewed positive cultures, (2) the correction rates for negative cultures, and (3) the types of corrections that are found, including the number with potential clinical significance. We prospectively assessed errors identified during culture report review for all positive (10-month period) and negative (1-month period) cultures at a single, university-based clinical microbiology laboratory in the United States. Errors were classified using predefined categories, and total and per category error rates were determined. A chi(2) test was used to assess significant differences between error rates. A total of 112,108 culture reports were examined; 914 reports required a total of 1043 corrections. Of 101,703 positive culture reports, 786 (0.8%) required 900 corrections, 302 (0.3%) of which were potentially clinically significant. Of 10,405 negative culture reports, 128 (1.2%) required 143 corrections, 5 (0.05%) of which were potentially clinically significant. The rate of potentially clinically significant errors was significantly higher among positive versus negative culture reports (P < .001). Errors from positive culture reports most commonly involved susceptibility (374 [42%]), reporting (275 [31%]), and identification workup (217 [24%]). Most potentially significant errors from positive culture reports involved susceptibility testing (n = 253) and specimens from wound or lower respiratory tract (P < .001). Review of culture reports from positive cultures from nonsterile sites with special attention to antimicrobial susceptibility testing and reporting would be most likely to detect potentially significant errors within the clinical microbiology laboratory.

BLOOD CULTURES IN PAEDIATRIC PATIENTS: A STUDY OF CLINICAL IMPACT

Purpose: Blood cultures form a critical part of evaluation of patients with suspected sepsis. The present study was undertaken to study the risk factors, duration of incubation for obtaining positive cultures, and the clinical impact of the culture report. Methods: A total of 220 samples from 107 pediatric patients presenting with suspected bacteraemia were processed aerobically. Results: Cultures were positive in 18.7% of the samples. Most of the positive cultures were obtained after 24 hours of incubation of the broth and no isolates were obtained beyond day 4 of incubation. Therapy was modified in 54.23% of the patients after receipt of culture report. Conclusions: Incubation beyond four days (unless with specific indication like enteric fever) may be unnecessary for issuing a negative culture report. Repeated isolation of doubtful pathogens confirms true bacteraemia. Early culture report increases therapeutic compliance.

Blood cultures in paediatric patients: A study of clinical impact

Blood cultures form a critical part of evaluation of patients with suspected sepsis. The present study was undertaken to study the risk factors, duration of incubation for obtaining positive cultures and the clinical impact of the culture report. A total of 220 samples from 107 pediatric patients presenting with suspected bacteraemia were processed aerobically. Cultures were positive in 18.7% of the samples. Most of the positive cultures were obtained after 24 hours of incubation of the broth and no isolates were obtained beyond day 4 of incubation. Therapy was modified in 54.23% of the patients after receipt of culture report. Incubation beyond four days (unless with specific indication like enteric fever) may be unnecessary for issuing a negative culture report. Repeated isolation of doubtful pathogens confirms true bacteraemia. Early culture report increases therapeutic compliance.

OBSERVATIONS ON THE DIPHTHERIA CARRIER AS AN AGENT IN THE SPREAD OF DIPHTHERIA

It is the practice of the Detroit Department of Health, whenever a case of diphtheria is reported, to ask the police department immediately to post a quarantine sign on the home in which the case is reported. A nurse is detailed to the home as soon as practicable in order to adjust quarantine signs, give instructions relative to the observance of quarantine, and take cultures from all contacts. She also notes and reports to the department the names and ages of contacts, and whether or not they have received immunizing doses of diphtheria antitoxin. Persons who receive an immunizing dose of diphtheria antitoxin are released from quarantine as soon as a report from the laboratory indicates that there are no diphtheria organisms in their throats. Persons who do not receive an immunizing dose of antitoxin are required to obtain two negative culture reports from the laboratory before they are released