Polymicrobial Cultures Research Articles

A Seven-Day Course of TMP-SMX May Be as Effective as a Seven-Day Course of Ciprofloxacin for the Treatment of Pyelonephritis

BackgroundThe Infectious Diseases Society of America guidelines recommend either 14 days of trimethoprim-sulfamethoxazole (TMP-SMX) or 7 days of ciprofloxacin for the treatment of pyelonephritis. Antibiotic courses of 7 days of TMP-SMX vs 7 days of ciprofloxacin for pyelonephritis have not been previously compared. We evaluated the odds of a subsequent, symptomatic urinary tract infection (UTI) for women with Escherichia coli pyelonephritis receiving a 7-day course of TMP-SMX vs a 7-day course of ciprofloxacin. MethodsWomen ages 16 years and older with E. coli pyelonephritis presenting to 5 health care facilities in the greater Maryland area between 2010 and 2016 receiving either TMP-SMX or ciprofloxacin were included. Patients were excluded if they met any of the following criteria: (a) pregnancy, (b) dialysis dependency, (c) E. coli not susceptible to the treatment prescribed, (d) polymicrobial urine culture, or (e) >48 hours of antibiotic therapy other than TMP-SMX or ciprofloxacin. ResultsOf 272 women meeting eligibility criteria, 81 (30%) and 191 (70%) received 7 days of TMP-SMX and 7 days of ciprofloxacin, respectively. In an adjusted model, the likelihood of a recurrent UTI within 30 days for the TMP-SMX and ciprofloxacin groups was similar (adjusted odds ratio 2.30; 95% confidence interval, 0.72-7.42). ConclusionsOur findings suggest that 7 days of TMP-SMX therapy may result in similar clinical outcomes compared with 7 days of ciprofloxacin for the treatment of pyelonephritis. Considering the frequency of pyelonephritis and risks of antibiotic resistance and associated toxicities, decreasing the duration of antibiotic therapy for pyelonephritis may impact a large number of women.

Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy.

The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy effectiveness and avoid reinfection.

Evaluation of three sample preparation methods for the direct identification of bacteria in positive blood cultures by MALDI-TOF

BackgroundPatient mortality is significantly reduced by rapid identification of bacteria from sterile sites. MALDI-TOF can identify bacteria directly from positive blood cultures and multiple sample preparation methods are available. We evaluated three sample preparation methods and two MALDI-TOF score cut-off values. Positive blood culture bottles with organisms present in Gram stains were prospectively analysed by MALDI-TOF. Three lysis reagents (Saponin, SDS, and SepsiTyper lysis bufer) were applied to each positive culture followed by centrifugation, washing and protein extraction steps. Methods were compared using the McNemar test and 16S rDNA sequencing was used to assess discordant results.ResultsIn 144 monomicrobial cultures, using ≥2.000 as the cut-off value, species level identifications were obtained from 69/144 (48%) samples using Saponin, 86/144 (60%) using SDS, and 91/144 (63%) using SepsiTyper. The difference between SDS and SepsiTyper was not statistically significant (P = 0.228). Differences between Saponin and the other two reagents were significant (P < 0.01). Using ≥1.700 plus top three results matching as the cut-off value, species level identifications were obtained from 100/144 (69%) samples using Saponin, 103/144 (72%) using SDS, and 106/144 (74%) using SepsiTyper and there was no statistical difference between the methods. No true discordances between culture and direct MALDI-TOF identification were observed in monomicrobial cultures. In 32 polymicrobial cultures, MALDI-TOF identified one organism in 34–75% of samples depending on the method.ConclusionsThis study demonstrates two inexpensive in-house detergent lysis methods are non-inferior to a commercial kit for analysis of positive blood cultures by direct MALDI-TOF in a clinical diagnostic microbiology laboratory.

Improving Institutional Management of MSSA Infections in Children: A Quality Improvement Initiative

Background S. aureus is a common cause of skin/soft tissue, musculoskeletal, and bloodstream infections in children, with methicillin susceptible S. aureus (MSSA) accounting for most cases in the U.S. Antibiotic treatment of MSSA with anti-staphylococcal penicillins, or first-generation cephalosporins is associated with improved outcomes compared with treatment with broader spectrum antibiotics. The objective of our study was to analyze current treatment of MSSA infections in our institution, and to implement and assess the effect of interventions to improve appropriate prescribing.MethodsRetrospective analysis of all children with MSSA positive skin, wound, and blood cultures obtained from the Emergency Department and the inpatient setting between January 1, 2015 to June 30, 2017. Patients undergoing therapy for additional infections and poly-microbial cultures were excluded. A spaced multifaceted quality improvement intervention included medical staff education, modification of notation to MSSA culture results with therapeutic suggestions, and an institutional pathway for skin/soft-tissue infections (SSTIs). Outcomes measured included proportion of patients prescribed appropriate antibiotic therapy both with and without infectious diseases consultation.ResultsA total of 464 episodes of MSSA infection met our case criterion. Overall during the study period, 33% of patients were switched to appropriate therapy, 62% remained on clindamycin, and 5% were kept on other nonspecific therapy. Prior to intervention, appropriate therapy over the 7 pre-intervention quarters measured ranged between 18 and 43%. Post-intervention, appropriate therapy was 45–50% over the next 2 quarters. For inpatient episodes, 92% of cases with ID consultion were switched appropriately, whereas 18% of cases without ID consultion were switched appropriately.ConclusionUnder current practice habits, a majority of MSSA isolates are treated inappropriately in the absence of ID consultation. Medical staff education can be a beneficial quality improvement focus to improve antimicrobial prescribing for MSSA infections. Antimicrobial suggestions built into laboratory culture reporting and clinical pathways may also be beneficial to improve prescribing.Disclosures All authors: No reported disclosures.

Analytical Performance Characteristics of the Accelerate Pheno™ System for Pathogen Identification and Susceptibility Testing for Gram-negative Bacteremia and Candidemia

BackgroundThe Accelerate Pheno™ system is a novel fast diagnostic that significantly reduces the time to ID and AST for GNB and ID of Candida spp. bloodstream infections, with the potential to impact clinical outcomes. Prospective clinical trials are needed to evaluate the impact of this new system on clinical outcomes and antimicrobial stewardship.MethodsFrom April 14, 2016 to March 3, 2017, blood cultures from unique patients in the emergency department and medical intensive care units at Barnes-Jewish Hospital that signaled positive and were Gram-stain positive for GNB or Candida spp. were eligible. AXDX testing using pre-FDA cleared software (v1.0) was conducted in parallel with standard-of-care (SOC) diagnostic testing. SOC AST was Kirby-Bauer Disk Diffusion and/or Etest® and SOC ID was the VITEK® MS system.ResultsOf 341 screened blood culture bottles, 123 met inclusion criteria; 101 (82%) were on-panel for ID with AXDX, 88 GNB (7 species) and 13 C. glabrata or C. albicans. Non-panel organisms were other Candida spp. in 36.4% (8/22), other GNB in 54.5% (12/22), and Gram-positive bacteria in 9.1% (2/22). For on-panel organisms with MALDI-TOF as the gold standard, sensitivity for ID of GNB was 95.4%, specificity 99.9%. One each of the following was missed: E. coli, Klebsiella spp., Proteus spp., and P. aeruginosa. Of missed GNB, all except P. aeruginosa were part of polymicrobial cultures. For on-panel Candida spp., sensitivity of ID was 91.7%, specificity 99%. Overall category agreement (CA) for GNB AST between AXDX and SOC was 91.4%. CA was lowest for ampicillin-sulbactam (69.1%), piperacillin-tazobactam (85.7%), ceftazidime (86.4%), and tobramycin (87%). All other antibiotics had CA >92%. Very major errors were logged for 0.1% (n = 1 for tobramycin), major errors for 1.5% (n = 13), and minor errors for 6.3% (n = 53). There were 13 assay failures, including 10 failed AST, 2 failed ID, and 1 instrument technical failure. The most common reason for failure was too few clones of bacteria for analysis using AXDX (9/13, 69.2%).ConclusionThe Accelerate PhenoTM system is a novel fast diagnostic with high sensitivity and specificity for the ID and AST of GNB and ID of Candida spp. bloodstream infections that are on-panel.Disclosures C. A. D. Burnham, Accelerate Diagnostics: Investigator, Research support; M. Kollef, Accelerate Diagnostics: Consultant, Research support

Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific.

Propionibacterium acnes (P. acnes) has become increasingly recognized as a cause of periprosthetic joint infection (PJI). It is not currently known if the clinical presentation of P. acnes varies depending on the joint being infected. We retrospectively reviewed patients infected with P. acnes after total hip, knee, and shoulder arthroplasty from two institutions. Patients were classified as having a PJI based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, and microbiology data were analyzed. Eighteen knees, 12 hips, and 35 shoulders with a P. acnes PJI were identified. Median ESR was significantly higher in the knee (38.0mm/h, IQR 18.0-58.0) and hip (33.5mm/h, IQR 15.3-60.0) groups compared to the shoulder group (11.0mm/h, IQR 4.5-30.5). C-reactive protein levels were higher in the knee (2.0mg/dl, IQR 1.3-8.9) and hip (2.4mg/dl, IQR 0.8-4.9) groups compared to the shoulder group (0.7mg/dl, IQR 0.6-1.5). Median synovial fluid WBC was significantly higher in the knee group than shoulder group (19,950 cells/mm3, IQR 482-60,063 vs 750 cells/mm3, IQR 0-2825, respectively). Peripheral blood WBC levels were similar between groups, as was mean time of P. acnes growth in culture. Clindamycin resistance was present in all groups. The manner in which a patient with P. acnes PJI presents is joint specific. Inflammatory markers were significantly higher in the knee and hip groups compared to the hip and shoulder groups, and long hold anaerobic cultures up to 14days are necessary to accurately identify this organism.

Use of MALDI-TOF mass spectrometry after liquid enrichment (BD Bactec™) for rapid diagnosis of bone and joint infections

Advantages of MALDI-TOF MS (MS) were evaluated for diagnosis of bone and joint infections after enrichment of synovial fluid (SF) or crushed osteoarticular samples (CSs). MS was performed after enrichment of SF or crushed osteoarticular samples CS (n = 108) in both aerobic and anaerobic vials. Extraction was performed on 113 vials (SF: n = 47; CS: n = 66), using the Sepsityper® kit prior identification by MS. The performances of MS, score and reproducibility results on bacterial colonies from blood agar and on pellets after enrichment in vials, were compared. MS analysis of the vial resulted in correct identification of bacteria at a species and genus level (80.5% and 92% of cases, respectively). The reproducibility was superior for aerobic Gram-positive bacteria (Staphylococci and Gram-positive bacilli: 100% colonies), as compared to aerobic Gram-negative bacilli (89.7%), anaerobes (83.3%) and Streptococcus/Enterococcus (58.8%). MS performance was significantly better for staphylococci than for streptococci on all identification parameters. For polymicrobial cultures, identification (score>1.5) of two species by MS was acceptable in 92.8% of cases. Use of MS on enrichment pellets of bone samples is an accurate, rapid and robust method for bacterial identification of clinical isolates from osteoarticular infections, except for streptococci, whose identification to species level remains difficult.

Impact of the bacteriology of diabetic foot ulcers in limbloss.

Infections in feet of patients with diabetes mellitus is common, complex and costly. The aim of this study to investigate the isolated microorganisms in infected diabetic foot ulcers, and the impact of these infectious agents in limb loss in a tertiary medical center in Mexico City. We conducted a retrospective review in diabetic patients with infected foot ulcers from 1997 to 2014. Diabetic foot was defined according to the World Health Organization (WHO), the bacteriology of wound cultures and the impact of microorganisms in limb loss (major amputation) was studied. Patient's demographics, comorbidities, wound characteristics, and other factors associated in clinical outcomes were determined. A total of 165 subjects with soft tissue infections and/or osteomyelitis and positive cultures were included. One hundred and five (64%) were male, with a mean age of 60 year old +/- 15. One hundred fifty-nine (96%) had Type 2 diabetes mellitus, 68 (41%) history of peripheral arterial disease (PAD) and 97 (59%) patients had osteomyelitis. In 89 patients (54%), cultures were polymicrobial and one single organism was isolated in 76 cultures (46%). During the follow up, 96 (58%) patients preserved their limbs and 69 (42%) required major amputation (above or below knee). Sixty percent of patients that suffered from limb loss had polymicrobial culture (p = 0.13). Growth of Escherichia coli and Enterococcus faecium (p = 0.03) and E. coli and Morganella morgagnii (p = 0.03) was associated to limb loss. Among monomicrobial cultures, infections associated with Proteous mirabilis had higher rate of progression to limb loss (p = 0.03). PAD was associated to limb loss (p = 0.001). Management of diabetic foot requires a multimodality approach. In this study, in patients that received appropriate antibiotic therapy and optimal surgical management, we observed that history of PAD, polymicrobial and isolated P. mirabilis infections were variables associated with higher rate of limb loss.

The value of differential time to positivity of blood cultures in diagnosis of catheter-related bloodstream infection in patients with solid tumors in intensive care unit

To determine the value of differential time to positivity (DTTP) of blood culture for the diagnosis of catheter-related bloodstream infection (CRBSI) in patients with solid tumors in intensive care unit (ICU). A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and (or) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP≥2 hours (120 minutes). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with ≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve (ROC curve). The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed; the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve (AUC) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were: sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33% and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only (76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity (88.24%) and negative predictive value (86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00; χ2=0.00, P=0.98; χ2=0.00, P=0.98; χ2=0.00, P=0.98). DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

Draft Genome Sequences of Seven Bacterial Strains Isolated from a Polymicrobial Culture of Coccolith-Bearing (C-Type) Emiliania huxleyi M217.

Strains of Rhodobacteraceae, Sphingomonadales, Alteromonadales, and Bacteroidetes were isolated from a polymicrobial culture of the coccolith-forming (C-type) haptophyte Emiliania huxleyi strain M217. The genomes encode genes for the production of algal growth factors and the consumption of their hosts’ metabolic by-products, suggesting that the polymicrobial culture harbors many symbiotic interactions.

Draft Genome Sequences of Four Bacterial Strains Isolated from a Polymicrobial Culture of Naked (N-Type) Emiliania huxleyi CCMP1516

Strains of Sulfitobacter spp., Erythrobacter sp., and Marinobacter sp. were isolated from a polymicrobial culture of the naked (N-type) haptophyte Emiliania huxleyi strain CCMP1516. The genomes encode genes for the production of phytohormones, vitamins, and the consumption of their hosts’ metabolic by-products, suggesting symbiotic interactions within this polymicrobial culture.

The Synthesis of L-Alanyl and β-Alanyl Derivatives of 2-Aminoacridone and Their Application in the Detection of Clinically-Important Microorganisms.

In clinical microbiology the speed with which pathogenic microorganisms may be detected has a direct impact on patient health. One important strategy used in the laboratory is the growth of cultures in the presence of an enzymatic substrate which, once transformed by the appropriate microbial enzyme, generates a detectable colour or fluorescence output. Such substrates have previously been prepared by our group and others and are available as commercial diagnostic kits, however they all suffer from some degree of diffusion when used in a solid growth medium. This diffusion complicates the detection and differentiation of species in polymicrobial cultures and so we sought to improve on our previous work. In this work we have prepared and evaluated a series of novel fluorogenic enzyme substrates based on N-substituted-2-aminoacridones. All of the prepared substrates were found to be suitable for the detection and differentiation of certain microorganisms, however those based on the 2-amino-10-benzylacridone core in particular showed no apparent diffusion when incorporated into solid growth media. On transformation these substrates generated brightly fluorescent colonies that are clearly contrasted with the background medium due to the difference in emission wavelength (λem 445–450 nm for the substrate, λem 550 nm for the product). Here we have shown that our L-alanyl aminopeptidase substrate, 2-(N-L-alanylamino)-10-benzylacridone, is particularly suited to the detection of Gram-negative bacteria, and our β-alanyl aminopeptidase substrate, 2-(N- β-alanylamino)-10-benzylacridone, to the detection of Pseudomonas aeruginosa and Serratia marcescens when grown on solid media incorporating these substrates. The resulting fluorophore shows no apparent diffusion from the colonies of interest, and the enhanced sensitivity offered by fluorescent emission may allow for the detection of these organisms as microcolonies using automated fluorescence microscopy.

In Vitro Antimicrobial Effect of Egyptian Propolis Pastes on Microorganisms in Necrotic Primary Molars : A Comparative Study

Background: Primary teeth are very important to be restored in children, so using natural antimicrobial products is nessecary to protect children from complications of chemical drugs. Objectives: The aim of this study was to evaluate the antimicrobial effect of three intracanal propolis containg pastes against polymicrobial cultures collected from thirty five primary molars of 4-8-years old children of both sexes having necrotic root canals. Methodology: Sterile paper point were introduced in the root canal of the necrotic teeth, placed in a transport medium containing brain heart infusion (BHI), followed by identification of the isolated organisms. Agar-well diffusion technique was used to determine the antimicrobial activity of the following pastes; Metapex mixed with propolis (paste 1), zinc oxide eugenol mixed with propolis (paste 2) and ethanol extract of propolis (EEP) paste (paste 3). Results: The predominant organisms isolated were Streptococcus mutans (51.4%), Enterococcus species (34.2%), followed by Porphyromonas gingivalis (28.5%), Fusobacterium nucleatum (25.6%) and Prevotella nigrescens (8.5%). There was a statistically significant difference between inhibition zone diameters of the different paste types (P-value <0.001). Pair-wise comparison between the paste types revealed that paste 2 showed statistically significantly highest mean inhibition zone diameter values. There was no statistically significant difference between paste 1and paste 3; both showed a statistically significant lowest mean inhibition zone diameter values. Conclusion : The addition of propolis to Metapex and zinc oxide eugenol could potentiate the antimicrobial effect of each other.

General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines

ObjectivesThis study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009. MethodsWe continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine. ResultsMean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist. ConclusionsThe general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.

Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene

Fournier gangrene (FG) is a fulminant necrotizing infection of the perineal, perianal, and periurethral tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scale is used for diagnosis of necrotizing fasciitis. However, data on its relevance and usefulness in FG are lacking. The aim of this study was to evaluate the utility of the LRINEC scale in predicting the outcome of FG. This retrospective case study included 41 patents with FG treated at our institution from 2000 to 2013. The patients were divided into survivors and non-survivors. The mortality rate was 22%. The median age (75 vs. 62.5 y; p = 0.013), rate of co-existing diabetes mellitus (66.7% vs. 3.1%; p < 0.001), and median affected skin surface (4% vs. 1%; p < 0.001) were greater in the non-survivors. Seven of nine patients (77.8%) who did not survive (compared with 37.5% who survived) had a polymicrobial infection (p = 0.032). Of all the causative pathogens isolated, Proteus mirabilis was more common in non-survivors (55.6% vs. 6.3%; p = 0.001). The median calculated LRINEC score for survivors was 5 compared with 10 for the non-survivors (p < 0.001). Regression analysis showed that all the aforementioned variables, except for polymicrobial culture, were significant risk factors for predicting death. The area under the receiver operating characteristic curve for the LRINEC score was the highest, 0.976 (95% confidence interval 0.872-0.999; p < 0.0001), and the cut-off value was ≥9 with 93.7% specificity and 100% susceptibility for the prediction of a lethal outcome. The LRINEC score could be used for prediction of disease severity and outcomes. A threshold of 9 could be a high-value predictor of death during the initial evaluation of patients with FG.

Clinical Analysis of Propionibacterium acnes Infection After Total Knee Arthroplasty

BackgroundPropionibacterium acnes is a common cause of upper extremity arthroplasty infection and usually presents in an indolent subacute fashion. It is not well described how total knee arthroplasty (TKA) patients infected with P acnes present. MethodsWe retrospectively compared patients undergoing revision TKA for infection from P acnes and methicillin-sensitive Staphylococcal aureus (MSSA) in our institutional infection database. Patients were classified as having a periprosthetic joint infection based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, microbiology data, and synovial fluid white blood cell (WBC) counts were analyzed. ResultsSixteen patients with a P acnes and 30 with an MSSA TKA periprosthetic joint infection were identified. Median erythrocyte sedimentation rate was significantly higher in the MSSA group compared to the P acnes group (56.0 mm/h; interquartile range [IQR], 44.3-72.9 vs 23.0 mm/h; IQR, 18.5-52.0; respectively, P = .03) as were C-reactive protein levels (5.9 mg/dL; IQR, 3.7-26.9 vs 2.0 mg/dL; IQR, 0.5-14.0; respectively, P = .04). WBC count, synovial fluid WBC, and percentage of synovial polymorphonuclear cells were similar between groups. Mean time to culture was 8.3 ± 2.0 days in the P acnes group and 1.8 ± 0.8 days in the MSSA group. ConclusionP acnes TKA infections are associated with more acute inflammatory symptoms than typically appreciated, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism as the causative agent of TKA periprosthetic infection.

Bacterial aetiology of otitis media in children in Pakistan aged 0–59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination

Background:Otitis media (OM) is a leading cause of childhood illness. In Pakistan, the estimated incidence of OM-associated hearing impairment is >40/10,000 population and OM-associated mortality is 50–79·9/10×106 population. No OM microbiology data are available from Pakistan since 2004.Objectives:To describe the microbiology of OM in children aged 0–59 months in Pakistan.Methods:Laboratory data on ear pus specimens taken from children seen between 2004 and 2013 were retrieved from the Laboratory Information Systems of the Aga Khan University and entered into Microsoft Excel and SPSS version 16.0.Results:Bacterial culture results from 277 specimens were analysed. Staphylococcus aureus and Pseudomonas aeruginosa were the organisms most commonly isolated, followed by Streptococcus pneumoniae and Haemophilus influenzae. Polymicrobial cultures significantly increased in the post-Hib vaccination period from 19·5% to 32·7% (P = 0·038). H. influenzae also increased significantly from 16·8% to 24·5% (P = 0·038)....

Bacterial aetiology of otitis media in children in Pakistan aged 0–59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination

Background:Otitis media (OM) is a leading cause of childhood illness. In Pakistan, the estimated incidence of OM-associated hearing impairment is >40/10,000 population and OM-associated mortality is 50–79·9/10×106 population. No OM microbiology data are available from Pakistan since 2004.Objectives:To describe the microbiology of OM in children aged 0–59 months in Pakistan.Methods:Laboratory data on ear pus specimens taken from children seen between 2004 and 2013 were retrieved from the Laboratory Information Systems of the Aga Khan University and entered into Microsoft Excel and SPSS version 16.0.Results:Bacterial culture results from 277 specimens were analysed. Staphylococcus aureus and Pseudomonas aeruginosa were the organisms most commonly isolated, followed by Streptococcus pneumoniae and Haemophilus influenzae. Polymicrobial cultures significantly increased in the post-Hib vaccination period from 19·5% to 32·7% (P = 0·038). H. influenzae also increased significantly from 16·8% to 24·5% (P = 0·038).Conclusions:An increase in H. influenzae may reflect non-b capsular types (not determined in the study), or even capsular types from areas with low vaccine coverage. Increases in polymicrobial cultures and H. influenzae warrant further study.

Tunneled Hemodialysis Catheter's Infection by Leclercia Adecarboxylata: First Case Report in Colombia

Introduction: Leclercia adecarboxylata is an opportunistic gram-negative bacillus from the enterobacteria group, rarely isolated. It is generally reported as a single infection in immunosuppressed patients and less frequently in poly-microbial cultures in immune-competent patients. Clinical case: 60-years-old male with chronic kidney disease in haemodialysis since 2010, first by arteriovenous fistula and since 2014 by right jugular tunnelled catheter. During a session of haemodialysis, he presents an episode of chills and fever without apparent infectious focus; infection of catheter is suspected. Blood cultures are ordered, as well as beginning empirical therapy with vancomycin and amikacin via catheter. Blood cultures reported multisensible Leclercia adecarboxylata, presenting a good clinical response and negative blood cultures after treatment. Discussion: L. Adecarboxylata is an unusually isolated pathogen in sepsis by haemodialysis’s catheter and understudied in the literature. The importance of our case consists in being the first report in Colombia. The experience in other reports of this microorganism suggests that it has successful results with antibiotic treatment and no there’s no need to remove the catheter.

ANTIMICROBIAL ACTIVITY OF DRACAENA CINNABARI RESIN FROM SOQOTRA ISLAND ON MULTI DRUG RESISTANT HUMAN PATHOGENS

Background: Few studies showed that Dracaena cinnabari resin, collected from Soqotra Island, Yemen, has antimicrobial activity. This study&#x0D; is the first to investigate antimicrobial activity of the resin on both antibiotic multi-resistant human pathogens and on poly-microbial culture.&#x0D; Material and Methods: Antimicrobial activity of ethanolic extract of Dracaena cinnabari resin from Soqotra Island on multidrug resistant&#x0D; Gram-positive and Gram-negative human ATCC standard pathogens and Ascosphaera apis, the causal organism of chalkbrood disease of&#x0D; honeybee was studied using the agar disc diffusion method. The minimal inhibitory concentration of extracts was carried out by the broth micro&#x0D; dilution method.&#x0D; Results: Ethanolic extract of Dracaena cinnabari resin showed a considerable antimicrobial activity against all the pathogens tested. The zone&#x0D; of inhibition were between 4.9-11.5 mm. The most sensitive microbe was Staphylococcus aureus and least sensitive was Aspergillus nidulans.&#x0D; The minimal inhibitory concentration of the extract against Escherichia. coli ATCC 10402, Klebsiella pneumonia ATCC 10031, and&#x0D; Staphylococcus aureus ATCC 29212 was 1.25 μg/mL (w/v) and for the other pathogens (Candida albicans ATCC 10231, Salmonella&#x0D; typhimurum ATCC 3311 and Pseudomonos aeruginosa ATCC 2785) was 2.5 μg/mL (w/v).&#x0D; Conclusion: Ethanolic extract of Dracaena cinnabari resin has a considerable antimicrobial activity against Gram-positive and Gram-negative&#x0D; human pathogens and fungi. This extract might possess a role in the management of microbial infections in human and honeybee disease.