Positive Bacterial Cultures Research Articles

237. Inpatient and Discharge Antibiotic Use for Hospitalized Patients Growing Multi-Drug Resistant Bacteria in Urine Cultures

BackgroundMultidrug resistant organism (MDRO) infections are a threat to public health. Urinary tract infections (UTIs) are the most common MDRO infection and are responsible for a significant proportion of antibiotic use. Studies demonstrate both duration and type of antibiotics prescribed to patients with MDRO UTI are inappropriate, and that asymptomatic MDRO bacteriuria is inappropriately treated. In addition, antibiotics prescribed at hospital discharge are inappropriate in ~70% of patients. We sought to characterize inpatient and outpatient antibiotic durations to describe burden of antibiotic use for patients with an MDRO isolated from a urine specimen during a hospitalization.MethodsThis retrospective study was conducted at Barnes-Jewish Hospital, a 1266-bed academic medical center in St. Louis, Missouri from 11/7/12-11/7/17. Patients ≥ 18 years of age were included if they had an MDRO isolated from a urine specimen and no other positive bacterial cultures during their hospitalization. Demographics, comorbidities, cultures, and antibiotics were collected via data pulls and chart review. MDROs were defined according to European and US Center for Disease Control and Prevention guidelines. Antibiotic use was described as percentages of all antibiotics used.ResultsA total of 1052 patients had MDROs in urine cultures. Of these patients, 747 (71.0%) were discharged on oral antibiotics for a mean duration of 6.7 days, while 135 (12.8%) were discharged on IV antibiotics for a mean of 10.9 days. The five most commonly administered inpatient antibiotics after urine culture results were available (% prescribed) were IV ceftriaxone (43.0%), IV vancomycin (26.0%), PO ciprofloxacin (25.6%), IV cefepime (24.5%), and PO trimethoprim-sulfamethoxazole (17.6%). The five most commonly prescribed antibiotics at discharge were PO ciprofloxacin (22.3%), PO trimethoprim-sulfamethoxazole (17.8%), PO nitrofurantoin (8.4%), PO cephalexin (6.2%), and PO doxycycline (5.0%).ConclusionPatients with MDROs in urine cultures receive prolonged durations of inpatient and outpatient antibiotics, longer than what is recommended by current evidence and guidelines.Disclosures Dustin Stwalley, MA, AbbVie Inc (Shareholder)Bristol-Myers Squibb (Shareholder) Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)

Serum Levels of Markers of Endothelial Activation Are Not Associated with a Positive Blood Culture in Surinamese Children with Suspected Severe Infection.

Systemic serum levels of markers of endothelial activation are associated with infection. We hypothesize that levels of markers of endothelial activation are associated with the presence of a positive blood culture as a manifestation of a systemic infection in children with a suspected severe infection in Suriname. In this prospective observational cohort study, children between 1 month and 18 years of age suspected of severe infection as assessed by the threating physician, and in whom laboratory testing and blood culturing was performed before start of intravenous antibiotic treatment, were recruited at the emergency department of the Academic Hospital Paramaribo, Suriname. Serum was collected at blood culturing and after 48-72 h of admission. Serum was stored for measurement of levels of Angiopoietin (Ang)-1, Ang-2, soluble (s)P-selectin, sE-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and platelet and endothelial cell adhesion molecule-1. Fifty-one children were included of whom 10 had a positive blood culture. Baseline characteristics were similar between children with and without a positive blood culture. No significant differences in serum levels of the Angiopoietins or soluble cellular adhesion molecules between groups were observed at start of antibiotic treatment nor after 48-72 h. The data from this study indicate that in children with severe infection, serum levels of markers of endothelial cell activation are not associated with a positive blood culture. Thus, having a positive bacterial blood culture may not be the only factor driving endothelial activation in this patient population.

379. Epidemiology of Antimicrobial Use Among SARS-CoV-2 Positive and Negative Admissions in the US: A Multicenter Evaluation

BackgroundSARS-CoV-2, a novel coronavirus, emerged in Wuhan, China in December of 2019, and became a pandemic. Increases in bacterial/fungal co-infections have occurred during influenza pandemics and early data from this pandemic indicate high utilization of antimicrobial therapy. We compared the utilization of antimicrobials and health outcomes between SARS-CoV-2 positive and negative patients.MethodsPatients hospitalized at 271 US acute care facilities from 3/1/20–5/30/20 with ≥1 day length of stay (LOS) and ≥24 hours of antimicrobial therapy tested for SARS-CoV-2 were included in the study (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]). Demographics, antimicrobial utilization, duration of antimicrobial therapy, hospital LOS and ICU LOS data were analyzed by SARS-CoV-2 test results.Results142,054 patients were tested for SARS CoV-2 and 12% (n=17,075) were SARS-CoV-2 positive. SARS-CoV-2 negative and positive patients did not differ regarding presence of a positive bacterial culture. Total LOS, % ICU admission, and ICU LOS were higher among SARS-CoV-2 positive patients (Table). In total 48% of admissions were prescribed antimicrobial therapy; rates were higher in SARS-CoV-2 positive versus negative admissions (68% vs. 46%). The most common antimicrobials and classes are in Table.Antimicrobial therapy and outcomes in hospitalized SARS-CoV-2 tested patients. ConclusionAlmost half of patients tested for SARS-CoV-2 were prescribed antimicrobials, with antimicrobial use higher among those with SARS-CoV-2, despite similar rates of positive cultures. On average, antimicrobials were prescribed within 10 hours from the time to admission among patients tested. These treatment patterns may highlight the difficulties in making treatment decisions and concerns over potential bacterial superinfection in SARS-CoV-2, but also indicate potential overuse of antimicrobials. Collateral damage from antimicrobial overuse include increase selection of antimicrobial resistance, adverse effects of drugs, and unnecessary treatment costs. It will be important to continue to evaluate the utilization and appropriateness of antimicrobial use among SARS-CoV-2 patients.DisclosuresLaura A. Puzniak, PhD, Merck (Employee) Karri A. Bauer, PharmD, Merck Research Laboratories (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee) Carisa De Anda, PharmD, Merck & Co Inc, (Employee) Pamela Moise, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Latha Vankeepuram, MS, BD (Employee) Prashant Parikh, n/a, Becton, Dickinson and Company (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding)

Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management

<p><strong>Background:</strong> Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.</p><p><strong>Methods:</strong> This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).</p><p><strong>Results:</strong> The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).</p><p><strong>Conclusions:</strong> NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.</p>

Blood stream infections-prevalence in a tertiary care institute, Central India

Introduction: Septicaemia is responsible for high morbidity and mortality in developing countries like India requiring prompt antimicrobial treatment for its proper management. Aims and Objectives: Detection of etiological agent from blood culture of suspected septicaemia patients and it’s antibiogram. Material and Methods: A total of 227 blood culture samples were collected in Microbiology Laboratory during 1 July-2016 to 30 June-2017. Etiologic agents were isolated using conventional as well as automated blood culture methods and their antibiotic susceptibility was determined using standard protocol. Results: Among clinically suspected septicemic patients 39(17.18%) were culture positive. The most common organisms isolated were S. aureus(12), CONS(8), Klebsiella pneumoniae(5) and C. albicans(4) in decreasing order of their incidence. 75% of S. aureus were methicillin resistant. All Gram positive organisms were sensitive to Glycopeptide antibiotics but showed variable resistance to other antibiotics. Gram negative bacteria were multidrug resistant with high degree of resistance towards Quinolones, Cephalosporins but a high sensitivity to Carbapenems. Only one non fermenter was resistant to Carbapenems which was sensitive to Colistin. Conclusion: The use of automation can be a useful tool for isolation of rare organisms. The incidence of bacterial culture positivity is on the rise and fungal isolation is also common. In this era where over the counter drugs are easily available, drug abuse is difficult to control. But, having said that, formulation of Hospital Antibiotic Policy and its strict implementation is the need of the hour, which will eventually help us to control the menacing rise in antimicrobial resistance. Keywords: Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus.

Usefulness of prophylactic antibiotics in preventing infection after internal fixation of closed hand fractures

Prophylactic antibiotics (PA) have been shown to be ineffective in reducing the incidence of surgical site infection (SSI) in clean wounds associated with elective surgery of the hand. Routine administration of PA for internal fixation of hand fractures is a subject that has been scarcely studied. We hypothesized that PA do not reduce SSI incidence in fixation of closed hand fractures. We did a retrospective comparative study in patients who underwent open or closed reduction and internal fixation of a hand and carpus fracture. Patient demographics, past medical history, fracture characteristics and the type of internal fixation used were extracted from our electronic archives. Follow-up period lasted for 1 year, during which any form of clinically evident SSI, such as pus formation, wound dehiscence and positive bacterial culture was documented. A total of 107 patients met the inclusion criteria, 63 in the control group and 44 in the test group. The overall infection rate was 6.5%. All infections (3 in the control group and 4 in the test group) were pin-tract infections that resolved completely after pin extraction. Our study did not find significant differences between groups (P = 0.442). No specific fracture pattern was associated with increased total infection rate (p = 0.898). In this study, we found no support for routine administration of PA prior to internal fixation of closed fractures of the hand and carpus. PA should still be administered in selected patients, such as those with decreased immunity or open fractures. Further large-scale research is needed to establish proper guidelines, to reduce the adverse effects of antibiotic treatment.

Double-Volume Intraoperative Lavage Reduce Bacterial Contamination After Pancreaticoduodenectomy.

To clarify whether double-volume peritoneal lavage can decrease the risk of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy. Forty-nine patients who underwent pancreaticoduodenectomy and intraoperative peritoneal lavage using 6000mL of saline before abdominal closure were studied retrospectively. Bacterial cultures of the lavage fluid were taken twice, after irrigation using 3000mL of saline and then after an additional 3000mL of saline. Bacterial culture of the drainage fluid was taken on day 1, and the relationship between the results of bacterial cultures and clinically relevant postoperative pancreatic fistula was examined. Double amount of peritoneal lavage significantly decreased the incidence of positive bacterial cultures than single amount of peritoneal lavage (45% vs. 29%, P < .05). Multivariate analysis showed that positive bacterial culture of drainage fluid on day 1 and main pancreatic duct size (<3mm) were independent risk factors for clinically relevant postoperative pancreatic fistula. A positive bacterial culture of the final lavage fluid and preoperative biliary drainage were independent factors related to a positive bacterial culture on day 1. A positive bacterial culture on day 1 is an independent risk factor for clinically relevant postoperative pancreatic fistula during pancreaticoduodenectomy. Double-volume intraperitoneal lavage may be effective for reducing the incidence of clinically relevant postoperative pancreatic fistula.

Diapers as Promising Alternative Collection Method for Urine Specimens in Nursing Home Residents: A Noninferiority Study

ObjectiveThere is unmet need for an easy, noninvasive urine collection method to diagnose urinary tract infections (UTIs) in nursing home residents suffering from urinary incontinence or cognitive impairments. UTIs are highly prevalent in nursing home residents, and urine specimen collection can be difficult. The objective of this study was to assess if urine specimens collected from super-absorbing incontinence pads (adult diapers) are a reliable collection method for UTI diagnosis. DesignThis was a paired noninferiority laboratory study, in which pairing refers to UTI diagnostics performed directly using clinical urine specimens (reference specimen) and indirectly using urine extracted from diapers (diaper specimen). Setting and participantsIn this study, remnants of 250 clinical urine specimens were used to assess noninferiority in diagnosing UTIs, based on a 1-sided type I error of 2.5%, a power of 90%, and a noninferiority margin of 15%. MethodsUrine specimens were poured on super-absorbing disposable adult diapers and extracted after 3 hours, to use for dipstick urinalysis and bacterial culture. UTIs were defined as presence of leukocytes and a positive bacterial culture. Noninferiority was assessed by calculating a Wald-type test statistic. ResultsNoninferiority was established for diagnosing UTIs in diaper specimens, and for each of its components (dipstick leukocyte detection and bacterial culture positivity). Positive bacterial cultures were found in 72 (29.0%) diaper specimens compared with 65 (26.2%) reference specimens (difference −2.8%, 97.5% CI −7.1% to 1.5%). Leukocytes were present in 162 (64.8%) diaper specimens, compared with 175 (70.0%) reference specimens (difference −5.7%, 97.5% CI: −10.6% to −0.7%). Conclusion and implicationsOur results on diagnosing UTIs, by dipstick analysis and bacterial cultures, using super-absorbing adult diapers are promising. Before translation into clinical practice, further studies are needed to evaluate the risk of bacterial contamination by wearing adult diapers, possibly resulting in overdiagnosis of UTI.

Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative samples from hip and knee prosthesis revision

BackgroundUnexpectedly positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The aim of this study was to find out how successful this procedure is.MethodsIn a study of 508 patients, who required revision surgery of total hip (THA, n = 231) or knee arthroplasties (TKA, n = 277) because of component loosening, biopsy was carried out before their surgery. The collected tissue samples (5) from the biopsy and the revision surgery procedure itself were analyzed according the criteria of the International Consensus Meeting (ICM). Tests revealed 11 patients (7 THA, 4 TKA) with unexpectedly positive bacterial cultures from tissue samples obtained during the revision surgery due to false negative preoperative diagnostic results. These 11 patients were treated with 6 weeks antibiotic therapy and examined with a follow-up of at least 2 years (42.2 ± 16.5 months).ResultsFive patients (2 TKA, 3 THA) became reinfected, resulting in a success rate of 54.5%.ConclusionAntibiotic therapy alone of an unexpected positive intraoperative bacterial culture in prosthesis revision surgery seems to be less successful than previously assumed.

The anti-inflammatory cytokine response characterized by elevated interleukin-10 is a stronger predictor of severe disease and poor outcomes than the pro-inflammatory cytokine response in coronavirus disease 2019 (COVID-19).

Severe coronavirus disease 2019 (COVID-19) is associated with a dysregulated immune state. While research has focused on the hyperinflammation, little research has been performed on the compensatory anti-inflammatory response. The aim of this study was to evaluate the anti-inflammatory cytokine response to COVID-19, by assessing interleukin-10 (IL-10) and IL-10/lymphocyte count ratio and their association with outcomes. Adult patients presenting to the emergency department (ED) with laboratory-confirmed COVID-19 were recruited. The primary endpoint was maximum COVID-19 severity within 30days of index ED visit. A total of 52 COVID-19 patients were enrolled. IL-10 and IL-10/lymphocyte count were significantly higher in patients with severe disease (p<0.05), as well as in those who developed severe acute kidney injury (AKI) and new positive bacterial cultures (all p≤0.01). In multivariable analysis, a one-unit increase in IL-10 and IL-10/lymphocyte count were associated with 42% (p=0.031) and 32% (p=0.013) increased odds, respectively, of severe COVID-19. When standardized to a one-unit standard deviations scale, an increase in the IL-10 was a stronger predictor of maximum 30-day severity and severe AKI than increases in IL-6 or IL-8. The hyperinflammatory response to COVID-19 is accompanied by a simultaneous anti-inflammatory response, which is associated with poor outcomes and may increase the risk of new positive bacterial cultures. IL-10 and IL-10/lymphocyte count at ED presentation were independent predictors of COVID-19 severity. Moreover, elevated IL-10 was more strongly associated with outcomes than pro-inflammatory IL-6 or IL-8. The anti-inflammatory response in COVID-19 requires further investigation to enable more precise immunomodulatory therapy against SARS-CoV-2.

Outcome analysis of antibiotic-loaded poly methyl methacrylate (PMMA) beads in musculoskeletal infections

ObjectiveDespite the availability of an extensive array of antibiotics, musculoskeletal infections are not cured successfully. It is necessary to remove sequestra, infected necrotic tissue, and implants. This study was undertaken to assess the efficacy of poly methyl methacrylate (PMMA) beads and identify the variables that influence eradication and recurrence in the treatment of musculoskeletal infections. MethodsThis study was conducted on 82 patients with chronic osteomyelitis who were treated over a period of 6 years at our tertiary care hospital. We followed up with 71 patients for one year. Clinicoradiological data for the control of infection and bone healing were assessed at the final follow up visit. The correlation between antibiotic sensitivity/resistance and infection was evaluated for Gentamicin + Cefuroxime and Gentamicin + Vancomycin combinations. Chi-squared testing, using SPSS version 16.0, was used for statistical analysis, and a p-value < 0.05 was considered significant. ResultsFifty-three patients (65.4%) had an exogenous route of infection. Fifty-six patients (68.51%) presented with a discharging sinus on first presentation. In 42 patients (59%), the diagnosis was verified with a positive bacterial culture. In addition, we used antibiotic beads of Gentamicin + Cefuroxime in 74 patients (90%), while in 8 patients (10%), we used Gentamicin + Vancomycin, based on culture and sensitivity results. Recurrence was found in five cases of Gentamicin + Cefuroxime and two cases of Gentamicin + Vancomycin (p = 0.065). ConclusionAntibiotics containing PMMA beads are effective in the treatment of chronic osteomyelitis and in preventing the recurrence of infection. It is imperative to identify various factors responsible for the recurrence of infection. This may help clinicians predict the prognosis of the disease and minimise the risk of adverse outcomes.

Older age, longer procedures and tandem endoscopic-ultrasound as risk factors for post-endoscopic retrograde cholangiopancreatography bacteremia.

BACKGROUNDClinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bacteremia (PEB) occurs in up to 5% of cases, while antibiotic prophylaxis is recommended only when an ERCP is unlikely to achieve complete biliary drainage. However, the current recommendations may not cover all potential risk factors for PEB.AIMTo identify novel risk factors for PEB and evaluate appropriateness of antibiotic prophylaxis.METHODSA retrospective study of 1082 ERCP procedures performed between January 2012 - December 2013 in a single tertiary medical center. Data collection included: Demographic and clinical characteristics such as pre and post procedure antibiotic treatment and bacterial blood cultures. Exclusion criteria were: (1) Age < 18 years; (2) Positive bacterial blood culture before ERCP; (3) Scheduled antibiotic treatment prior to ERCP; (4) Hospitalization longer than 14 d before ERCP; and (5) missing critical data. Stepwise Logistic Regression analysis and Decision Tree algorithms were used for prediction modeling of PEB.RESULTSA total of 626 ERCPs performed in 434 patients were included. Mean age 66.49 ± 15.4 years and 46.5% were males. PEB prevalence was 3.7%. Antibiotic prophylaxis was administrated in 139/626 (22.2%) cases but was indicated according to the guidelines only in 44/626 (7%) cases. In all the PEB cases, prophylaxis was deemed not indicated. A stepwise logistic regression [receiver operating characteristic (ROC), 0.766], identified 3 variables as independent risk factors for PEB: Age at ERCP ≥ 75 years (OR, 3.780, 95%CI: 1.519-9.408, P = 0.004); Tandem EUS/ERCP with fine needle aspiration (FNA) (OR, 14.528, 95%CI: 3.571-59.095, P < 0.001); ERCP duration longer than 60 min (OR, 5.396, 95%CI: 1.86-15.656, P = 0.002). In a decision tree model (ROC, 0.778) the probability for PEB without any risk factors was 1% regardless of prophylaxis administration. CONCLUSIONThe prevalence of PEB in our study is similar to previous reports, despite the fact that antibiotic prophylaxis was administrated more readily than recommended. ERCP duration longer than 60 min, tandem EUS-ERCP with FNA and age above 75 years are significant risk factors for PEB. These factors should be further evaluated as indications for prophylactic antibiotic treatment before ERCP.

Utility of Procalcitonin in the Early Diagnosis of Patients with Sickle Cell Disease Presenting with Fever

Background: Patients with sickle cell disease (SCD) are at increased risk of developing bacterial infections as a result of functional asplenia. Fever, a common symptom in SCD often occurs with other sickle cell related conditions and viral infections. This poses a diagnostic challenge and early use of empiric antibiotics is recommended while awaiting cultures. The widespread administration of antibiotics to all patients with SCD with fever can result in problems such as antibiotic resistance and increased medical costs. An early and reliable biomarker is therefore needed to help distinguish between bacterial and non-bacterial causes for fever in SCD. Procalcitonin (PCT) has been shown to be elevated in bacterial but not viral infections. In SCD, few studies have looked at the role of PCT in predicting bacterial infections. Unal et al reported vaso-occlusive crisis (VOC) with or without fever did not increase PCT levels in relation to patients with no crisis and no fever. However, Rincón-López et al reported a PCT &amp;lt; 0.6ng/mL had a negative predictive value of 97.2% and potentially could be used to identify bacterial infection early. Methods: We retrospectively studied 122 patients with SCD who presented to the emergency department with fever from 2015-2019. Inclusion criteria were defined as patients with SCD, 17 years and older and PCT measurement on presentation to the emergency department. Exclusion criteria were defined as patients with SCD and fever who had received empiric antibiotics prior to labs being drawn in the emergency department. The cohort was divided into groups of patients with Confirmed Bacterial Infection (CBI, n=18), Suspected Bacterial Infection (SBI, n=6), Viral Infections (n=10) and Vaso-Occlusive Crises (VOC, n=88) only. CBI was defined as a positive bacterial culture (blood, body fluid, urine, respiratory or cerebrospinal fluid) or C.difficile toxin assay. Viral infections were defined as a negative bacterial culture in the presence of a virus found on PCR obtained with nasopharyngeal swab. Characteristics including genotype, age, gender, complete blood count, PCT, creatinine, total bilirubin, hydroxyurea use and length of stay were examined. Data was analyzed between the groups using descriptive statistics and accounting for unequal variances, with p-value set at 0.05 for significance. Results: Demographics and clinical characteristics are summarized in Table 1 (Figure). The mean age was 34.6 years with predominantly males (64.8%). Almost two-thirds were on hydroxyurea (62.3%). The most common genotype was HbSS (70.5%) followed by HbSC (26.2%) and HbSβ (3.3%). The mean PCT for patients with CBI was 8.99 ng/mL (range, 0.03-78.36) as compared to 0.31 ng/mL (range, 0.02-6.82) in the VOC group. The most common organisms detected were E.coli, C.difficile, Pseudomonas, Staphylococcus and Enterobacter. There was a significant difference between median PCT for patients with CBI and those with VOC (p=0.036) and between patients with CBI and viral infections (p= 0.045). Using a PCT of &amp;gt;0.5ng/mL resulted in 81% Sensitivity and 85% Specificity for CBI. Conclusion: In patients with SCD presenting with fever, PCT on presentation was significantly higher in those with CBI compared to VOC only or Viral Infection. Disclosures No relevant conflicts of interest to declare.

Tailored morphology, absorption and bactericidal traits of cinnamon nanocrystallites made via PLAL method: Role of altering laser fluence and solvent

The organic nanostructures with custom-made properties became increasingly demanding for sundry biological applications. In this insight, some cinnamon nanocrystallites (Cin-NCs) were produced via the pulse laser ablation in liquid (PLAL) approach in different growth solvents (ethanol, methanol and deionized water) at various laser fluences (0–3.2 J.cm−2). These as-prepared Cin-NCs were characterized to determine the synergistic properties of the solvents and laser fluences (LFs) on their structures, morphologies, optical absorption and anti-bacterial characteristics. A Q-switched Nd:YAG-1064 nm operated with pulse laser interval of 10 ns and laser frequency of 1 Hz was employed to hit the pure cinnamon target submerged in the desired solvents. The bactericidal effectiveness of the prepared Cin-NCs was tested against Gram-negative and -positive bacterial cultures. The ultraviolent visible spectra of the Cin-NCs displayed two prominent absorption bands and the FTIR spectra showed characteristic bonding vibrations due to different functional groups and bioactive components. The TEM micrograph of the best sample (ablated at the LF of 2.1 J/cm2) manifested the nucleation of Cin-NCs with diverse morphologies. The comparative evaluation of these Cin-NCs produced in different solvents at optimal LF via the PLAL technique was made. Compared to other liquid media, the Cin-NCs made in ethanol exhibited better yield, nanocrystallinity, morphology, absorbance, and bactericidal attributes. It was proven that the physical and anti-bacterial properties of these Cin-NCs can be customized by changing the LFs and types of solvents. The proposed Cin-NCs enclosing active cinnamaldehyde and polyphenols complexes revealed their potency for biomedicine.

Optimization and scale-up of laccase production by Bacillus sp. BAB-4151 isolated from the waste of the soap industry

Laccase is also known as the blue copper oxidase enzyme. Owing to its ability to oxidizes a wide variety of phenolic and non-phenolic substrates, this enzyme has many biotechnological applications. It is produced by plants, fungi, and a wide variety of bacteria. However, bacterial laccases have been studied more due to their merits over other sources. Production of bacterial laccase at the commercial level demands high yielding cultures and optimization of physicochemical parameters for more yields in a shorter period. Hence, the present research was aimed to isolate the potent laccase producing bacteria and to optimize cultural conditions for higher production of laccase. In this study, six laccase positive bacterial cultures were isolated from the waste of the soap industry in Kadi, Gujarat, India. One isolate later identified as Bacillus sp. BAB-4151 produced copious amounts of laccase. The production process of laccase was optimized at shake flask level by using one variable at a time (OVAT) method and scaled-up to 5 L capacity bioreactor. The isolate produced a higher yield of laccase under diverse physicochemical and nutritional conditions. The OVAT approach resulted in 2.9 folds improvement in the yield of laccase, which further increased by 1.4 fold during scale-up at a laboratory-scale bioreactor. The ability of the organism to produce laccase over of range of physico-chemical conditions and to retain the productivity during scale up of the process at bioreactor level suggests that the organism can be of great commercial significance.

First-Time Use of Clinical Pharmacists to Improve Appropriate Antibiotic Prescribing in a Medical ICU in Viet Nam

Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.Funding: NoneDisclosures: None

Randomized Trial of Dilute Betadine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

Category:Lesser Toes; Midfoot/Forefoot; OtherIntroduction/Purpose:There is no consensus as to which skin antiseptic technique is most effective at reducing bacterial load prior to orthopaedic foot and ankle procedures. The purpose of this study is to determine if the addition of a dilute betadine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold.Methods:In this prospective, randomized controlled trial, 242 subjects were randomized to one of two groups. The control group received only a standard skin antiseptic preparation with alcohol and chlorhexidine, while the intervention group received a three-minute dilute betadine soak and scrub followed by the standard preparation with alcohol and chlorohexidine (Figure 1). Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups.Results:Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups (p>0.05 for each). There was no difference in the bacterial growth rate between groups (26.8% growth in the intervention group versus 26.9% growth in the control group, p=0.991).Conclusion:The hallux nailfold is one of the most difficult to sterilize areas prior to orthopaedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a three-minute dilute betadine soak and scrub to a standard skin preparation with alcohol and chlorohexidine.

Channel-assisted minimally invasive interbody fusion and short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection

To explore the clinical effect of channel-assisted minimally invasive transforaminal lumbar interbody fusion combined with percutaneous short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection. The clinical data of 12 patients with non-specific lumbar intervertebral infection treated from January 2014 to January 2018 were retrospectively analyzed. There were 8 males and 4 females, aged 39 to 65(51.00±12.36) years old. Infection site located in L2, 3 of 2 cases, L3, 4 of 3 cases, L4, 5 of 6 cases, L5S1 of 1 case. There were 3 cases of hypertension, 2 cases of diabetes, and 2 cases of urinary tract infection. None of the 12 patients had a history of lumbar puncture and surgery. Debridement, autogenous bone grafting, minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system, and percutaneous short segmental vertebral fixation were performed in the patients, the diseased tissue samples were collected for bacterial culture and pathological examination. The operation time and the amount of intraoperative blood loss were recorded. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after operation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effects and the imaging data were used to assess the fusion of vertebral body. All operations were successful, with operation time of (176.00±20.76) min, and the intraoperative blood loss of (155.00±30.56) ml. The patients were followed up for 12 to 18 (14.69±4.78) months. The VAS and JOA scores at 1 week after operation and at the final follow up were significantly improved (P<0.01). The improvement rate of JOA in the final follow-up was 94%. The erythrocyte sedimentation rate and C-reactive protein were reduced to normal level in all patients, and the bone grafting got fusion. There were 7 cases of positive bacterial culture and 5 cases of negative. Debridement, autogenous bone grafting and minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system combined with percutaneous short segmental vertebral fixation is a safe, clinically reliable, minimally invasive surgical procedure for the treatment of non specific lumbar intervertebral space infections.

Antimicrobial resistance profiles of microorganisms isolated from hospitalized patients in Dominican Republic.

ABSTRACTObjective.To define the antimicrobial resistance profiles of the microorganisms most commonly isolated from hospitalized adult patients in Dominican Republic (DR).Methods.A retrospective, cross-sectional study of phenotypic antimicrobial susceptibility patterns was conducted using data from 3 802 clinical microbiology reports specifying positive bacterial cultures in samples collected from patients admitted to the clinical, surgery, and intensive care units (ICU) at three tertiary-level care hospitals in the city of Santiago de los Caballeros from 1 January 2016 – 31 December 2017. Descriptive statistics and chi-square test (P ≤ 0.05) were used to analyze the qualitative variables.Results.At the three hospitals, there were 932, 1 090, and 1 780 microbiology reports analyzed. Of the total, 1274 were from the ICU, 1 042 from the surgery unit, and 1 486 from the clinical unit. Methicillin resistance was found in 57.3% of the Staphylococcus aureus isolates and 75.3% of the coagulase-negative staphylococci. Third-generation cephalosporin resistance was detected in 54.4% of isolates identified as members of the Enterobacteriaceae family, 67.3% of the Acinetobacter spp., and 91.7% of the Pseudomonas, while carbapenem resistance was shown by 8.0%, 23.8%, and 51.0% of these, respectively. Most of the resistant Acinetobacter spp. isolates were found in just one hospital and the prevalence of Enterobacteriaceae resistant to carbapenems was highest in the ICU.Conclusion.Antimicrobial resistance levels are high among hospitalized patients in Dominican Republic and may cause enhanced risk factors that impact clinical outcomes. Urgent measures are needed to address antimicrobial resistance in DR.

Effect of tranexamic acid on the timing of drainage tube removal in total knee arthroplasty

Introduction:To investigate the effect of tranexamic acid on the removal time of drainage tube in the first unilateral total knee arthroplasty.Hypotheses:The timing of removing the drinage system can be changed when using TXA.Methods:From June 2017 to December 2018, 182 patients (42 males and 140 females) who planned to undergo primary unilateral total knee replacement were included.Age (68.1±7.1) years (60-76 years).According to the random number table method, it was divided into four groups: 45 cases of Tranexamic acid group 1 (TXA1), 46 cases of Tranexamic acid group 2 (TXA2), 46 cases of Tranexamic acid group 3 (TXA3) and None Tranexamic acid group (NTXA).TXA1-3 group intraoperative intravenous infusion combined with local application of tranexamic acid;NTXA group was locally perfused in the joint cavity with 100ml normal saline only after surgery.Differences in drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for special surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups.Results:The postoperative drainage volume of TXA1˜3 groups was 85.5±34.3ml, 189.4±72.3ml and 215.3±93.4ml, respectively, which was less than that of the non-tranexamic acid group (351.3±113.5ml). The overall difference was statistically significant (F=11.5,P=0.005). The postoperative drainage volume of tranexamic acid 1 group was less than that of tranexamic acid 2 and 3 groups.The total postoperative blood loss was 699.0±255.7ml, 710.4±296.1ml, and 715.8±248.2ml in the tranexamic acid 1-3 groups, respectively, which was less than 1130.5±354.2ml in the non-tranexamic acid group, and the overall difference was statistically significant (F=13.1,P=0.001).On the 4th day after the operation, the knee swelling degree of the tranexamic acid 1- 3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were smaller than that of the non-tranexamic acid group (1.43±0.22), and the overall difference was statistically significant (F=8.23, P=0.015).There were 2 cases of positive bacterial culture in non-tranexamic acid group and tranexamic acid group.There were 3 cases of hematoma in the non-tranexamic acid group,and 1 case of delayed wound healing.Conclusion:The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss.The removal of the drainage tube 18h after the operation can not only fully drain,relieve pain, promote the recovery of knee joint function, but also effectively reduce the risk of infection caused by the drainage tube.